Alessandro Bracci

1. For decades, bruxism was primarily considered the act of grinding teeth during sleep, both within the research and clinical communities. Over the past fifteen years, however, a rapid expansion i...

Background: Despite the aetiology of awake bruxism (AB) being prevalently linked to psychological factors, several studies suggested that the use of certain substances, such as tobacco smoking, can contribute to the increase in masticatory muscle activities (MMA) during wakefulness.Objective: The aim of this study is to assess whether there is a correlation between the frequency of awake bruxism behaviours and smoking habits.Methods: Participants were recruited, without gender or ethnic restriction, at the University of Siena, Siena, Italy, by advertising. Participants completed a questionnaire containing the four‐item patient health questionnaire for anxiety and depression (PHQ‐4) and some items from the Global Adult Tobacco Smoking (GATS) questionnaire. Moreover, they performed one week of awake bruxism behaviours monitoring via the ecological momentary assessment (EMA).Results: A total of 100 participants (university employees, dentists, undergraduate and post‐graduate students) were included in the study (34 males and 66 females, mean age 24.5 years). Of them, 39% were smokers and 61% were non‐smokers. The multiple variable linear regression analysis results showed a statistically significant correlation between the frequency of awake bruxism behaviours and the PHQ‐4 scores. Specifically, for every 1% increase in PHQ‐4 score, the mean frequency of the AB behaviours increases 5‐fold. Awake bruxism behaviours did not show any statistically significant correlation with the number of smoked cigarettes (p > 0.05). Mandible bracing significantly correlated with the number of years of smoking (B = 1.58, p = 0.002).Conclusions: According to the present study's findings, the frequency of awake bruxism behaviours correlated with symptoms of anxiety and depression but not with smoking status.

Objective: The aim of the present study is to get deeper into the complex interplay that might exist between awake bruxism (AB), tobacco smoking, and anxiety and/or depression symptoms in a group of healthy young adults.Materials and Methods: The study participants were recruited by advertising the investigation at the University of Siena, Siena, Italy. The inclusion criteria were being in good general health, without systemic diseases or oral diseases. People with ongoing medical or dental treatment and those with a history of systemic disease or temporomandibular disorders were excluded. The participants who were included in the study received a questionnaire containing three sections for the assessment of AB behaviors, anxiety and depression symptoms, and the number of cigarettes smoked.Results: A total of 141 healthy young adults met the inclusion criteria. Different awake masticatory muscle activities showed different strengths of association with anxiety and depression symptoms. However, no relationship was found between the number of smoked cigarettes and the frequency of the various masticatory muscle activities considered.Conclusions: The result of the present study shows no clear‐cut association between the frequency of self‐reported AB behaviors and smoking in healthy individuals.

Objectives In recent years, a smartphone-based ecological momentary assessment (EMA) approach for assessing awake bruxism (AB) has attracted growing interest, both in clinical and research settings. The present study was designed to investigate subjects’ experience using an EMA-based smartphone application to detect factors that could hamper or facilitate its use for clinical and research purposes. Materials and methods Thirty-two patients with temporomandibular disorders (TMDs) pain (14 males, 18 females; mean age 28.3 ± 12.1 years) were recruited at the Orofacial Pain Unit of the University of Siena, Siena, Italy. They were monitored for one week to collect data on their AB behaviors. Time investment, feelings, encountered difficulties, and reasons for not using the app were assessed in a diary with 5-point Likert scales. Descriptive analysis of quantitative data was assessed, and content analysis of textual data was performed. Results Quantitative data showed a good experience with the app (median of 4). The main motivation to use the EMA-based smartphone application was to gain insight into their own AB behaviours. The most negative experience was the short time window available to answer to the alert. Conclusion The EMA-based smartphone application was well accepted for multiple day evaluation. Clinical relevance These results open up important clinical scenarios for AB evaluation as well as the possibility to carry out large-scale studies on general population samples and/or on selected subpopulations.

Objective: The aim of this investigation was to compare the self‐reported frequency of awake bruxism (AB) behaviours by means of a validated single‐observation point questionnaire (i.e., Oral Behaviour Checklist [OBC]) with the frequency reported in real‐time with an Ecological Momentary Assessment (EMA) over 1 week.Materials and Methods: One hundred healthy young adults took part in the study. The frequency of some activities belonging to the spectrum of AB behaviours (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using the EMA approach with smartphone technology support over 1 week. The OBC questionnaire was used to evaluate the self‐reported frequency of the same AB behaviours. Spearman's rank correlation coefficient was adopted to test the correlation between the average score of each OBC question considered (i.e., teeth contact, mandible bracing, teeth clenching, teeth grinding) and the average frequency of the corresponding EMA item.Results: Statistical analysis showed a weak‐to‐moderate level of correlation between the two different AB assessment methods. Mandible bracing showed the highest level of correlation, while teeth grinding had the lowest one.Conclusions: While the OBC represents a valid and easy‐to‐administer screening tool for evaluating bruxism behaviours, the EMA approach provides a more detailed real‐time report on AB behaviours.

To present a list of key points for good Temporomandibular Disorders (TMDs) clinical practice on behalf of the International Network for Orofacial Pain and Related Disorders Methodology (INfORM) group of the International Association for Dental, Oral and Craniofacial Research (IADR). An open working group discussion was held at the IADR General Session in New Orleans (March 2024), where members of the INfORM group finalized the proposal of a list of 10 key points. The key points covered knowledge on the etiology, diagnosis, and treatment. They represent a summary of the current standard of care for management of TMD patients. They are in line with the current need to assist general dental practitioners advance their understanding and prevent inappropriate treatment. The key points can be viewed as a guiding template for other national and international associations to prepare guidelines and recommendations on management of TMDs adapted to the different cultural, social, educational, and healthcare requirements.

To assess the frequency of awake bruxism (AB) behaviors in a group of undergraduate dentistry students and correlate it with the status of anxiety and depression. The frequency of five oral behaviors (i.e., relaxed jaw muscle, teeth contact, mandible bracing, teeth clenching, teeth grinding) was evaluated using a smartphone-based ecological momentary assessment (EMA) approach. The anxiety and depression status was investigated with the four-item patient health questionnaire for anxiety and depression (PHQ-4). ANOVA with Tukey post-hoc test was used to assess the difference in frequency of AB behaviors among the four PHQ-4 groups. Among the four groups, there was a statistically significant difference in the frequency of relaxed jaw muscle, teeth contact, mandible bracing, and teeth clenching, but not for teeth grinding. Based on this cross-sectional study's findings, psyche seems to have a determinant impact on AB behaviors, which is significantly higher in individuals with anxiety and depression traits.

Background: Recently, the Standardized Tool for the Assessment of Bruxism (STAB) and the bruxism screener (BruxScreen) have been developed for use in research and clinical settings.Objective: As to ascertain high‐quality use of both instruments worldwide, it was our aim to develop a guideline for the translation and cultural adaptation of the STAB and the BruxScreen.Methods and Results: This paper describes a 12‐step guideline for the translation and cultural adaptation of the STAB and the BruxScreen. A format of a translation log is provided as well. Besides, a website has been created for the guidance of translation teams.Conclusion: Following the 12 steps, new language versions of the STAB and the BruxScreen will be ready for further testing (reliability, validity, responsiveness and interpretability) and, ultimately, application in research and clinics around the world.

Background: Together with psychosocial and hereditary factors, bruxism is a possible risk factor for orofacial pain. Bruxism is defined as a masticatory muscle activity characterized by repetitive or sustained tooth contact, or by bracing or thrusting of the mandible. A smartphone application to report awake bruxism (AB) has been developed and translated into more than 25 languages.Objective(s): To translate the application into Swedish, adapt it to Swedish culture and conduct a study to evaluate the usability of the application for studies on family history and associated risk factors.Methods: Translation and cultural adaption of the Swedish version of the application (BruxApp) was carried out in a four‐step sequential process. Ten young adults (22–30 years) were recruited together with ten parents (42–67 years) and reported their AB with the application over two seven‐day periods. Pain, stress and parafunctional behaviours were assessed by questionnaires.Results: The back translation check showed minimal discrepancies between the translation and the English version. Participants did not report any problems with the application. Response rates for both groups were 65%. A difference in frequency of AB was shown between young adults and parents (22.0% vs. 12.5%, p < .001). A positive moderate correlation was found between AB and stress (r = 0.54, p = .017).Conclusion: The use of application strategies enables data collection on AB which can be used in both clinical and research settings. The results suggest that the Swedish version is ready for implementation and for studies on the relationships between AB, family history and psychosocial factors.