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.

The prevalence of awake bruxism (AB) has been reported as being 30%, with sleep bruxism (SB) at 9–15%. Most studies have focused on SB, emphasizing the importance of AB research. For epidemiological evaluations of AB, a smartphone application based on ecological momentary assessment (EMA) was introduced. The aims of this multi-center study were: (1) to investigate how well lay subjects comprehend the AB terminology used in the smartphone application, and (2) to find out whether professional instruction improved their comprehension. The study population consisted of lay subjects from Italy, Portugal, and Finland comprising 307 individuals (156 men, 151 women; 18–86 years). Subjects first completed a five-item questionnaire about the meanings of the five AB terms used in the smartphone application. Each question offered four answer options, with one being correct. Immediately afterwards, the meanings of the terms were instructed. Lastly, the subjects were re-tested with the same questionnaire. In Finland and Italy, the re-tested correct answer scores for the single terms were at 89–97% per term. Improved comprehension was seen across sex, education, and age groups. In the Portuguese data, no improvement was found. Significant differences were found between countries in the improved scores for all terms that were correct following the instruction (Finland, 16.3% to 72.1%; Italy, 32.3% to 83.8%; Portugal, 23.1% to 33.7%) (p < 0.001). In conclusion, standardized instruction on AB terminology prior to EMA is recommended to improve the reliability of collected data.

Background: The brief Diagnostic Criteria for Temporomandibular Disorders (bDC/TMD) was recently published to simplify the full Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol.Objective: To measure the inter‐examiner reliability, sensitivity and specificity of bDC/TMD Axis I diagnoses against DC/TMD Axis I diagnoses in primary and tertiary clinic TMD patient populations.Methods: A multi‐center (Finland, Israel) retrospective study on 334 patients' records was conducted. A full DC/TMD clinical examination data was reduced to bDC/TMD items. Five Level 3 calibrated examiners independently determined a bDC/TMD diagnosis. Inter‐examiner reliability, sensitivity and specificity were calculated for individual diagnoses, using DC/TMD diagnosis as the reference standard.Results: Inter‐examiner reliability showed excellent to good reliability in all diagnoses except headache attributed to TMD, in which it was fair. Apart from headache attributed to TMD, the sensitivity of individual pain diagnoses was high. The sensitivity was lower in joint diagnoses. The specificity was high in all diagnoses.Conclusion: The bDC/TMD is a reliable instrument for general practitioner use.

Background: Bruxism is defined as a repetitive jaw‐muscle activity characterised by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible. Bruxism can occur during sleep (sleep bruxism, SB) or during wakefulness (awake bruxism, AB). To date, the effect of AB on the purported negative consequences of bruxism has remained unclear.Objectives: The assessment of AB, its relation to temporomandibular disorders (TMD) treatment modalities, and their possible outcomes were investigated among TMD patients resistant to treatment in primary care and referred to a tertiary care clinic.Methods: The records of 115 patients were studied. Patients were referred to the Head and Neck Centre, Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, for TMD treatment between 2017 and 2020. The data derived from the eligible patients' records included the following: background data (age and sex), referral data (reason and previous treatment), medical background (somatic and psychiatric), clinical and possible radiological diagnoses at a tertiary care clinic, treatment modalities for masticatory muscle myalgia, bruxism assessment, its possible treatment modalities and their outcomes, and overall management outcome. We analysed the outcomes of single treatment modalities and combined groups of modalities. For the demographic data, the Chi‐squared test and Fischer's Exact test were used to determine the associations between the categorical variables. A Sankey‐diagram was used to describe the flow of treatment.Results: Temporomandibular joint‐pain‐dysfunction syndrome (K07.60) was the most frequent single reason to refer a patient to tertiary care (17.4%). At referral, men had myalgia (M79.1) significantly more often (p = .034) than women. Similarly, men had depression (p = .002) more often and other psychiatric diagnoses (p = .034). At tertiary care, the presence of AB was assessed in 53.9%, and self‐reported AB was recorded in 48.7%. In patients with possible AB, those who were prescribed neuropathic pain medication showed significantly less improvement in symptoms (p = .021) than those who underwent splint therapy (p = .009). Overall, half of the patients showed overall improvement in their TMD symptoms from the treatment combinations.Conclusion: Despite several treatment modalities, only half of the patients showed improvement in their symptoms in the present study. A standardised assessment method encompassing all factors contributing to bruxism behaviours and their consequences is suggested.

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: The brief Diagnostic Criteria for Temporomandibular Disorders (bDC/TMD) was developed to simplify the original DC/TMD for wider clinical use. While its diagnostic accuracy for most painful TMDs is acceptable, the sensitivity for headache attributed to TMD (HaTMD) was reported to be poor. Objectives: To improve the diagnostic sensitivity of HaTMD within the bDC/TMD framework by reintroducing selected examination items from the original DC/TMD protocol. Methods: This retrospective multicentre study used data from Finland and Israel. The cohort included 114 individuals previously diagnosed with HaTMD according to the DC/TMD and with myalgia and/or arthralgia diagnoses in both DC/TMD and bDC/TMD. Four examination items excluded from the bDC/TMD—E1b (headache location in temple), E4c (familiar headache on assisted opening), E5a/b (lateral movements) and E5c (protrusive movements)—were reintroduced individually. Four calibrated examiners reassessed each modified dataset. Inter‐examiner reliability (Cohen's kappa) and diagnostic sensitivity were calculated using DC/TMD as the gold standard. Results: Inter‐examiner reliability for HaTMD diagnosis was almost perfect (κ = 0.81–1.00) across all items. Sensitivity improved markedly from the previously reported 0.16–0.38 to 0.82 (E1b)–0.90 (E5c). Item E1b (temple headache confirmation) was present in 95% of Finnish and 86% of Israeli cases, identifying it as the most representative finding. Conclusion: Reintroducing item E1b into the bDC/TMD examination substantially increases the diagnostic sensitivity for HaTMD while maintaining brevity. Refinement of the painful TMD diagnostic decision tree and prospective validation of the modified bDC/TMD are recommended to ensure reliability and clinical applicability.