Nikola Stanisic

Background: Tooth wear is a prevalent and multifactorial condition with consequences ranging from minor aesthetic concerns to substantial functional impairment. Objectives: The study aimed to evaluate the relationships between occlusal tactile acuity (OTA), maximum voluntary bite force and tooth wear in a clinical patient cohort. Methods: Tooth wear, OTA and maximum bite force were assessed in 51 patients (29 women and 22 men; mean age 63 years, SD 17). Tooth wear in the anterior, canine and posterior regions was assessed with the Tooth Wear Evaluation System 2.0 in natural teeth and the Modified California Dental Association protocol in prosthetically restored teeth. Associations between OTA, bite force and tooth wear were assessed using Pearson's correlation and Spearman's rank correlation coefficients. Significant variables were entered into multivariable linear regression models and adjusted for age and sex. Results: There was a moderate positive correlation between bite force and overall tooth wear ( r = 0.38, p = 0.006) and a small negative correlation between OTA and posterior tooth wear ( r = −0.28, p = 0.044). In the multivariable models, bite force showed a strong significant association with overall tooth wear also after adjustment for age ( R ² = 0.458, p < 0.001). Conclusions: Bite force may be a clinically relevant factor associated with accumulated tooth wear, whereas OTA was not independently associated with tooth wear. Longitudinal studies are needed to determine whether bite force can predict tooth wear progression and whether more comprehensive assessments of occlusal loading can improve risk assessment in rehabilitated dentitions.

Pain and parafunctional behaviour may influence how the jaw motor system functions and adapts. The jaw system provides a relevant model for studying these interactions because of its high sensorimotor demands and its susceptibility to temporomandibular disorders (TMD) and bruxism. This thesis investigated how pain and parafunction influence training-induced neuroplasticity and sensorimotor performance in the jaw system, with a focus on corticomotor excitability assessed via transcranial magnetic stimulation. Three studies were conducted. Study I was a systematic review of 17 studies examining the effects of acute and chronic pain on training-induced corticomotor plasticity and functional outcomes. Study II was a cross-sectional observational study of 70 adults with and without TMD pain, combining ecological momentary assessment of awake bruxism with simultaneous masseter surface electromyography (sEMG) to assess jaw muscle overload in daily life. Study III was a case-control intervention study with 29 participants examining the effects of a seven-day jaw exercise programme on jaw sensorimotor performance and masseter corticomotor excitability. Study I showed that both acute and chronic pain may perturb training-induced corticomotor neuroplasticity, with more consistent effects in acute pain. Study II showed that self-reported awake bruxism correlated with sEMG-assessed muscle overload, and that individuals with TMD pain exhibited more awake bruxism, higher stress levels, and longer periods of low-intensity muscle overload. Study III showed that short-term jaw training improved sensorimotor performance in both the pain-free and TMD pain groups, although the pattern differed between groups. Higher bruxism scores were associated with higher active motor threshold and smaller training-related increases in motor evoked potential amplitude. Taken together the results suggest that pain and parafunctional behaviour can influence the loading, capacity, and adaptive potential of the jaw motor system. These findings support a model in which TMD pain and bruxism interact to shape corticomotor neuroplasticity and jaw sensorimotor adaptation.

While muscle overload is commonly implicated in musculoskeletal pain conditions, real-time assessment of associated behavioural and physiological features is challenging. This study aims to investigate the relationship between self-reported awake bruxism using Ecological Momentary Assessment (EMA) and jaw muscle activity registered by surface electromyography (sEMG), and differences between individuals with and without temporomandibular disorder (TMD) pain. Seventy participants (38 women, 32 men), of which 31% reported pain, completed 3-day EMA using a smartphone application combined with a sEMG device only for day 1. Overload, defined as muscle activity exceeding 20% of maximum voluntary contraction (MVC), was evaluated for duration and area under curve (AUC). A strong correlation was observed between EMA-reported bruxism and sEMG overload duration (ρ = 0.62, p < 0.001). AUC showed a correlation with EMA only in the TMD group. Participants with TMD pain exhibited shorter high-intensity bursts (60–79% MVC, p ≤ 0.005) but prolonged low-intensity muscle activity (20–39% MVC, p < 0.001). Bruxism behaviour and stress levels were higher in women and in individuals with pain. The results suggest that combining EMA and sEMG provides valid assessment of musculoskeletal overload, capturing both perceptual and physiological dimensions. Incorporating EMA in pain management can identify pain-related risk behaviours, thus supporting tailored patient-centred interventions.

Background: The multifactorial nature of chronic pain should be reflected in pain assessment. The aim of this observational study comparing samples from three generations assessed at different times was to present differences in pain, stress and mental well‐being. Methods: Pain sites, widespread pain, stress (Perceived Stress Scale‐4) and mental well‐being (30‐item General Health Questionnaire) were described across generations from the Malmö neck and shoulder study (parents, Generation 1, n = 12,607), Malmö offspring study, and Malmö Offspring pain study (children and grandchildren, Generation 2, n = 1572; Generation 3, n = 936). Results: Pain prevalence remained comparable across generations. In all generations, women reported more pain sites compared to men, mean difference 1.0 (95% CI 0.9–1.1) in Generation 1, mean difference 1.3 (95% CI 1.0–1.6) in Generation 2, and mean difference 0.9 (95% CI 0.5–1.3) in Generation 3. The frequency of widespread pain for women and men was 28% and 16% in Generation 1, 27% and 12% in Generation 2, and 22% and 15% in Generation 3, respectively. Perceived stress levels were consistently higher in Generation 2 and 3 compared to Generation 1 for both women and men. Among women, mental well‐being remained stable between Generation 1 and 2 but declined significantly in Generation 3 (mean difference 3.2, 95% CI 2.4–4.3). Conclusions: The results suggest significant gender disparities, with women consistently reporting more pain sites, higher stress levels, and reduced mental well‐being compared to men. Furthermore, the findings suggest that generational differences in coping—or other factors—may mitigate the impact of psychosocial distress on pain prevalence, warranting further research. Significance: This study highlights the comparability of pain prevalence across generations despite increasing stress and declining mental well‐being, particularly in women. These findings emphasise the importance of integrating mental health support and gender‐specific coping strategies into pain management, offering insights into biopsychosocial mechanisms underlying the interactions between pain and perceived stress.

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.

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.

Background: The recent introduction of ecological momentary assessment (EMA) smartphone-based strategies has allowed achieving some interesting data on the frequency of different awake bruxism (AB) behaviors reported by an individual in the natural environment. Objective: The present paper aims to review the literature on the reported frequency of AB based on data gathered via smartphone EMA technology. Methods: On September 2022, a systematic search in the Pubmed, Scopus and Google Scholar databases was performed to identify all peer-reviewed English-language studies assessing awake bruxism behaviors using a smartphone-based Ecological Momentary Assessment. The selected articles were assessed independently by two authors according to a structured reading of the articles’ format (PICO). Results: A literature search, for which the search terms “Awake Bruxism” and “Ecological Momentary Assessment” were used, identified 15 articles. Of them, eight fulfilled the inclusion criteria. The results of seven studies using the same smartphone-based app reported a frequency of AB behaviors in the range between 28.3 and 40% over one week, while another investigation adopted a different smartphone-based EMA approach via WhatsApp using a web-based survey program and reported an AB frequency of 58.6%. Most included studies were based on convenience samples with limited age range, highlighting the need for more studies on other population samples. Conclusions: Despite the methodological limits, the results of the reviewed studies provide a standpoint for comparison for future studies on the epidemiology of awake bruxism behaviors.