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A Clinical Study
Open Access Peer-reviewed

Bruxism in Mosul City Part 2

Basser Ali Abdullah , Gassan Yassin Hamed
International Journal of Dental Sciences and Research. 2020, 8(3), 83-86. DOI: 10.12691/ijdsr-8-3-6
Received March 23, 2020; Revised April 28, 2020; Accepted May 08, 2020

Abstract

Bruxism is defined as the grinding or clenching of the teeth. Pathological bruxism can cause damage to dental surfaces, joint pain and many other dentally related tissues. it is assumed that 8-20% of the population suffer from bruxism. This study aimed to determine the prevalence of sleep bruxism and awake bruxism and their relation with age, gender, previous trauma, unilateral chewing, headache and ear problems. This research included 450 patients, two hundred seventy one females and one hundred seventy nine males, the age ranged between 13-65 years old, signs and symptoms of TMDs were recorded according to Helkimo index, grinding, clenching, history of previous trauma, unilateral chewing, and headache reported by the patients were recorded in a case sheet, ear problems complaints including (pain, ringing sound, buzzing sound and subjective hearing loss) were investigated and recorded. Statistical analysis was done by using Chi square and one way ANOVA tests. The result of this study reveal that the prevalence of grinding was 28.8% whereas the prevalence of clenching was 24.8%, female to male ratio was 1.5:1, the group of age between 21-30 years represent the most prevalent cluster age, they represent 60.4% from the study sample. A highly significant relationships p ≤ 0.001 among sleep, awake bruxsim and pervious trauma, unilateral chewing and headache were found in this study. There were highly significant relations between grinding, clenching and ear problems p ≤ 0.001.

1. Introduction

In humans, bruxism is defined as the grinding or clenching of the teeth. Pathological bruxism can cause damage to dental surfaces, joint pain and many other dentally related tissues. 1. Bruxism is a naturally occurring behavior in humans, it can be pathological in certain individuals. It is assumed that 8-20% of the population displays pathological bruxism 2. Bruxism has been associated with many problems such as abrasions of teeth, chips occur on the tooth, trouble of sleeping, pain in the temporal area, muscles spasm and tenderness of the joints. Although bruxism can lead to many problems, it remains understudied and its mechanisms are not fully understood 3. Lobbezoo et. al. (2013) settled on the meaning of bruxism is: Bruxism is a continuous contraction of jaw-muscle categorized by grinding or clenching of the teeth and/or by forcing of the mandible. Bruxism clinically appear in two form: it may happen at sleep (named as sleep bruxism) or may happen at wakefulness (named as awake bruxism). Human bruxism has been described as non-functional in nature 4. Recent research suggests that bruxism is largely controlled by the central nervous system 5. Many studies suggest that the nigrostriatal dopaminergic pathway of the basal ganglia regulates bruxism 3. Evidence of the nigrostriatal pathway is supported by observations in case reports, a clinical trial on sleep bruxism, and evidence of bruxism being exacerbated by long term dopaminergic drug use (such as amphetamines) 6. It is consequent that conflicts in systemic neurotransmitter center may be the cause of the bruxism 7, 8. The disturbance of the five subcortical nuclei which are responsible for movements coordination is observed in bruxiser 9. Headache which is happening more than 15 days each month for at least 3 months is defined as chronic headache 10. The more prevalent types of primary headaches are the Migraine and tension-type headache, while the head injury is the most public secondary headaches 11. An intimate association between sleep and headache have been recorded 12. So headache is the end result of Sleep disturbances and stress 13. Recently bruxism considered as a sleep disorder 14, then once headache and sleep disorder coexist, they lead to exacerbate the pain in patients complain from chronic headache 15. Some study have emphasized a relationship among ear problems and TMD 16, 17, 18. The most repeatedly described symptoms in the studies are ringing sound, ear pain, a fullness sensation, defeat of hearing and vertigo 16, 17, 18, 19. The association of these symptoms can be explained by the anatomic, neurologic and emotional relationships of these structures 20. According to these finding we conclude that hyper action of the muscles of mastication may lead to contraction of tensor tympani muscle and tympanic membrane, which will lead to disturbances in acoustic tube function leading to ear fullness, balance dysfunction and hearing defect 21.

2. Material and Method

This research conducted on 450 patients attending oral diagnosis clinic at Mosul university for two years duration, this sample includes 271 females & 179 males. Their age fluctuated from 13 to 65 years. The patients identified to have tempromandibular disorders since there is no other disease entities, which explain their symptoms. To decrease bias and ensure standardization, the examination of patients were done in oral diagnosis clinic at Mosul university by the same author. Patients with history of head injury were excluded. Also patients how taken antidepressant drugs were excluded. The severity of the signs & symptoms of tempromandibular disorders were assessed numerically by using Helkimo index 1974 which is essential to assess the treatment need and to simplify comparison with other researches. previous trauma and unilateral chewing were recorded. Headache was reported as symptom which occurs once weekly or more, and it is classified as unilateral and bilateral. Aural symptoms were reported as otalgia, ringing sound, buzzing sounds and subjective hearing loss. Statistical analysis with 11.5 window SPSS (statistical package of social science) was used with one way ANOVA and a chi square tests with p≤0.001 considered significant value.

3. Result

Table 1 demonstrates distribution of the patients according to age and gender, the age group (21-30) years was the most prevalent age cluster, it was constituted 59.3% from the total sample, Females represented more than males constituting 60.4% of whole sample.

Participants who complained of sleep bruxism were account 28.8% (130 patients) from the whole sample and the group of age (21-30) years was the most prevalent age group, women were complained from grinding more often than men, they represent 70% in competition with men whom represent 30 % as revealed in Table 2.

Table 3 shows the number of participants who complained of awake bruxism, it shows that 112 patients suffered from awake bruxsim, the age group (21-30) years was the most represented age group and female to male ratio was 2:1.

Table 4 illustrate the relationships of grinding with, previous trauma, headache and unilateral chewing, a high significant relationships (P ≤ 0.001) were found.

A highly significant relationship were found among a wake bruxism, previous trauma, headache and unilateral chewing as shown in Table 5.

A significant relationships among grinding, otalgia, tinnitus, buzzing sound and subjective hearing loss were found in this study as revealed by Figure 1.

Figure 2 demonstrate a highly significant relationships between awake bruxism, otalgia, tinnitus, buzzing sounds and subjective hearing loss.

4. Discussion

The result of this study reveals that prevalence of grinding was 28.8% whereas the prevalence of clenching was 24.8% and this outcome disagree with other researches 22, 23 and consistent with other study done on italian students 24. The high percentage of bruxsim may be related to many factors including psychological and socioeconomic as the people in this country are exposed to many stressful factors like war, sanction and insecurity. According to this study the prevalence of bruxsim was more in female than male at a ratio 1.5/1 and this is consistent with other study, 25 and the age group between (21-30) years was the most represented age and this agrees with other study 26. The high prevalence of bruxsim in female in this study is attributed to that men showed higher levels of the desirability for stress control than women 22. Regarding the age, this study agree with hypothesis that there is common trend that the prevalence of bruxsim is reduces with age 25. Researchers proposed that estrogen receptors control metabolic functions with regard to the relaxation of ligaments, which may donate to the progression of temporomandibular disorder 27. They conclude that, both age and sex have a significant role in temporomandibular disorder and and both aural symptoms and sleep bruxism when studied at the same time. Thus, it is essential to regard the temporomandibular disorder-sleep bruxism-aural symptoms triad in experimental and epidemiological analytic study systems so that patients can be properly managed 28. A highly significant relations between sleep, awake bruxsim and unilateral chewing were found in this study and this agrees with Yeler et al 2017 who conclude that unilateral chewing seems to be a common factors which may lead to bruxsim and temporomandibular disorder 29. This study shows positive relationships between sleep, awake bruxsim and headache and this result is consistent with other study 25, the relation between SB and the pain is difficult to evaluate however central pathophysiological mechanism are play a part in initiation of bruxim and many psychological factors like anxiety and stress seem to aggravate sleep bruxsim leading to complex pattern of combined conditions 10. The result of current study reveals significant relationships of sleep and awake bruxsim with ear problems as shown in Figure 1 and Figure 2. The study of the model also showed a real link concerning ear pain symptoms and temporomandibular disorder, This is coincide with certain studies 30, 31. Earlier researchers established that signs of temporomandibular disorder are forecasters of the progress of some aural symptoms, like ringing sound. The association between temporomandibular disorder and aural symptoms is not completely explained. This association explained by embryological, functional and anatomic associations within the area that includes the temporomandibular joint, muscles supplied by the fifth cranial nerve and middle ear, it has been proposed that spasms of the lateral pterygoid muscle, lead to hypertonia in the tensor tympani muscle, so producing alterations in the acoustic tube and a consequential decrease in the air circulation of the middle ear 26. Therefore, the unusual action of the tensor tympani muscle is connected with aural complains, like ear fullness, ringing sound, vertigo and sound loudness 21. A research performed by Felício et al (2008). proposed that the unusual changes occurred in the masticatory muscles due to bruxism not solitary source of distress, on the other hand may be due to changes in the TMJ 26. The environmental and biological factors play a significant role in the temporomandibular disorder and bruxism 31, 32, 33.

5. Conclusion

Sleep and awake bruxim are significantly prevailing disorder in Mosul affecting females in the ratio of 1.5:1 with males. Headache, ear problems, previous trauma and unilateral chewing are the most predisposing factors for bruxim.

References

[1]  Wall JD, Welch D, Khon L, Essener R. The effects of acute L-dopa on brux-like and masticatory motor patternes, EMG phase analysis in rats. 2017: MSC thesis. Southern Illinois University Edwardsville.
In article      
 
[2]  Guaita, M., &Högl, B. Current Treatments of Bruxism. Current Treatment Options in Neurology, 2016: 18(2), 10.
In article      View Article  PubMed
 
[3]  Behr M, Hahnel S, Faltermeier A, Bürgers R, Kolbeck C, Handel G, Proff P.. The two main theories on dental bruxism. Annals of Anatomy. 2012: 194(2).
In article      View Article  PubMed
 
[4]  Lobbezoo F, Ahlberg J, Glaros A G, Kato T, Koyano K, Lavigne G J, Winocur E. Bruxism defined and graded: an international consensus.Journal of Oral Rehabilitation, 2013: 40(1),
In article      View Article  PubMed
 
[5]  Shetty S, Pitti V, SatishBabu C L, Surendra Kumar G P, Deepthi B C. Bruxism: a literature review. Journal of Indian Prosthodontic Society 2012
In article      
 
[6]  Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. Journal of Oral Rehabilitation,2001: 28(12), 1085–1091.
In article      View Article  PubMed
 
[7]  Lobbezoo F, Lavigne G J, Tanguay R, Montplaisir J Y. The effect of catecholamine precursor L-dopa on sleep bruxism: a controlled clinical trial. Movement Disorders: Official Journal of the Movement Disorder Society, 1997a: 12(1).
In article      View Article  PubMed
 
[8]  Lobbezoo F, Soucy J P, Montplaisir J Y, Lavigne G J. Striatal D2 Receptor Binding in Sleep Bruxism: A Controlled Study with Iodine-123-Iodobenzamide and Single-photon-emission Computed Tomography. Journal of Dental Research, 1996:75(10), 1804-1810.
In article      View Article  PubMed
 
[9]  Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. Journal of Oral Rehabilitation, 2001: 28(12), 1085-1091.
In article      View Article  PubMed
 
[10]  Martynowicz H, Smardz J, Michalek-Zrabkowska1 M, Gac P, Poreba R, Wojakowska A, Mazur G, Wieckiewicz M.Evaluation of Relationship Between Sleep Bruxism and Headache Impact Test-6 (HIT-6) Scores: A Polysomnographic Study. Front. Neurol. 2019: 10: 487.
In article      View Article  PubMed
 
[11]  Headache Classification Committee of the International Headache Society(IHS). The International Classification of Headache Disorders, 3rd edition (betaversion). Cephalalgia. (2013) 33: 629-808.
In article      View Article  PubMed
 
[12]  Stark CD, Stark RJ. Sleep and chronic daily headache. Curr Pain Headache Rep. 2015: 19:468.
In article      View Article  PubMed
 
[13]  Wang J, Huang Q, Li N, Tan G, Chen L, Zhou J. Triggers of migraine and tension-type headache in China: a clinic-based survey. Eur J Neurol. 2013:20: 689-96.
In article      View Article  PubMed
 
[14]  Demjaha1 G, Kapusevska B, Pejkovska-Shahpaska B.Bruxism Unconscious Oral Habit in Everyday Life.Maced J Med Sci. 2019 Mar 15; 7(5):876-881.
In article      View Article  PubMed
 
[15]  Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012: 153: 2432-40.
In article      View Article  PubMed
 
[16]  . Morais A, Gil D.Tinnitus in individuals without hearing loss and its relationship with temporomandibulardysfunctionBraz J Otorhinolaryngol. 2012:78. 59-65.
In article      View Article  PubMed
 
[17]  Hilgenberg P, Saldanha A, Cunha C, Rubo J, Conti P. Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients. J Oral Rehabil, 2012: 39, 239-244.
In article      View Article  PubMed
 
[18]  Calderon P, Hilgenberg P, Rossetti L, LaurentiJ,.ContiP.Influence of tinnitus on pain severity and quality of life in patients with temporomandibular disorders J Appl Oral Sci, 2012: 20, 170-173.
In article      View Article  PubMed
 
[19]  Fernandes G,. Franco A,. Siqueira J, Gonçalves D, Camparis C, Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms. J Oral Rehabil, 2012: 39, 538-544.
In article      View Article  PubMed
 
[20]  Camparis C, Formigoni G, Teixeira M, de SiqueiraJ.Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics. J Oral Rehabil, 2005: 32. 808-814.
In article      View Article  PubMed
 
[21]  Ramírez L, Ballesteros L, Sandoval G. Otological symptoms among patients with temporomandibular joint disorders. Rev Med Chil, 2007: 135, 1582-1590.
In article      
 
[22]  Winocur E, Uziel N, Lisha T, Goldsmith C, Eli I. Self‐reported bruxism associations with perceived stress, motivation for control, dental anxiety and gagging. J Oral Rehabil. 2011; 38: 3‐11.
In article      View Article  PubMed
 
[23]  Wetselaar P, Vermaire E,Lobbezzo F and Schuller A. The prevalence of awake bruxsim and sleep bruxsim in the Dutch adult population.J Oral Rehabil 2019,1-7.
In article      View Article  PubMed
 
[24]  Negra J., lobbezoo F, Faria P, Lombardo L, Sicliani G, Stellini E and Manfredini D. Relationship of self-reported sleep bruxsim and awake bruxsim with chronotype profiles in Italian dental students. CRANIO, 2018; January 1-6.
In article      
 
[25]  Manfredini D, Winocur E, Guarda-NardiniL, Paesani D and Lobbezoo F. Epidemiology of bruxsm in adults: A systemic review of literature.J OROFAC PAIN; 2013;27.99-110.
In article      View Article
 
[26]  Felício C, Melchior M, Ferreira C, Da Silva D. Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy Cranio, 2008; 26. 118-125.
In article      View Article  PubMed
 
[27]  Tuz H, Onder E, Kisnisci R. Prevalence of otologic complaints in patients with temporomandibular disorder Am J Orthod Dentofac Orthop, 2003; 123. 620-623.
In article      View Article
 
[28]  Melchior M, Mazzetto M, Felício C. Temporomandibular disorders and parafunctional oral habits: an anamnestic study Dental Press J Orthod, 2012; 17. 83-89.
In article      View Article
 
[29]  Yeler D, Yılmaz N, Koraltan M and Aydın‏ E. A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students CRANIO.35 (5), 308-314, 2017.
In article      View Article  PubMed
 
[30]  Blanco-Hungría A, Rodríguez-Torronteras A, Blanco-Aguilera A, Biedma-Velázquez L, Serrano-Del-Rosal R, Segura-Saint-Gerons R. Influence of sociodemographic factors upon pain intensity in patients with temporomandibular joint disorders seen in the primary care setting Med Oral Patol Oral Cir Bucal, 2012; 17. e1034-e1041.
In article      View Article  PubMed
 
[31]  Khoury S, Carra MC, Huynh N, Montplaisir J, Lavigne GJ. Sleep bruxism‐tooth grinding prevalence, characteristics and familial aggregation: a large cross‐sectional survey and polysomnographic validation. Sleep. 2016;39:2049‐2056.
In article      View Article  PubMed
 
[32]  Manfredini D, Piccotti F, Ferronato G, Guarda-NardiniL. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent, 2010; 38. 392-399.
In article      View Article  PubMed
 
[33]  Bruno P,Arnaldo G and Júniorc F. Temporomandibular disorder: otologic implications and its relationship to sleep bruxism. Brazilian Journal of Oto rhinolaryngology: 2018,84(5) 614-619.
In article      View Article  PubMed
 

Published with license by Science and Education Publishing, Copyright © 2020 Basser Ali Abdullah and Gassan Yassin Hamed

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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Normal Style
Basser Ali Abdullah, Gassan Yassin Hamed. Bruxism in Mosul City Part 2. International Journal of Dental Sciences and Research. Vol. 8, No. 3, 2020, pp 83-86. http://pubs.sciepub.com/ijdsr/8/3/6
MLA Style
Abdullah, Basser Ali, and Gassan Yassin Hamed. "Bruxism in Mosul City Part 2." International Journal of Dental Sciences and Research 8.3 (2020): 83-86.
APA Style
Abdullah, B. A. , & Hamed, G. Y. (2020). Bruxism in Mosul City Part 2. International Journal of Dental Sciences and Research, 8(3), 83-86.
Chicago Style
Abdullah, Basser Ali, and Gassan Yassin Hamed. "Bruxism in Mosul City Part 2." International Journal of Dental Sciences and Research 8, no. 3 (2020): 83-86.
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[1]  Wall JD, Welch D, Khon L, Essener R. The effects of acute L-dopa on brux-like and masticatory motor patternes, EMG phase analysis in rats. 2017: MSC thesis. Southern Illinois University Edwardsville.
In article      
 
[2]  Guaita, M., &Högl, B. Current Treatments of Bruxism. Current Treatment Options in Neurology, 2016: 18(2), 10.
In article      View Article  PubMed
 
[3]  Behr M, Hahnel S, Faltermeier A, Bürgers R, Kolbeck C, Handel G, Proff P.. The two main theories on dental bruxism. Annals of Anatomy. 2012: 194(2).
In article      View Article  PubMed
 
[4]  Lobbezoo F, Ahlberg J, Glaros A G, Kato T, Koyano K, Lavigne G J, Winocur E. Bruxism defined and graded: an international consensus.Journal of Oral Rehabilitation, 2013: 40(1),
In article      View Article  PubMed
 
[5]  Shetty S, Pitti V, SatishBabu C L, Surendra Kumar G P, Deepthi B C. Bruxism: a literature review. Journal of Indian Prosthodontic Society 2012
In article      
 
[6]  Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. Journal of Oral Rehabilitation,2001: 28(12), 1085–1091.
In article      View Article  PubMed
 
[7]  Lobbezoo F, Lavigne G J, Tanguay R, Montplaisir J Y. The effect of catecholamine precursor L-dopa on sleep bruxism: a controlled clinical trial. Movement Disorders: Official Journal of the Movement Disorder Society, 1997a: 12(1).
In article      View Article  PubMed
 
[8]  Lobbezoo F, Soucy J P, Montplaisir J Y, Lavigne G J. Striatal D2 Receptor Binding in Sleep Bruxism: A Controlled Study with Iodine-123-Iodobenzamide and Single-photon-emission Computed Tomography. Journal of Dental Research, 1996:75(10), 1804-1810.
In article      View Article  PubMed
 
[9]  Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. Journal of Oral Rehabilitation, 2001: 28(12), 1085-1091.
In article      View Article  PubMed
 
[10]  Martynowicz H, Smardz J, Michalek-Zrabkowska1 M, Gac P, Poreba R, Wojakowska A, Mazur G, Wieckiewicz M.Evaluation of Relationship Between Sleep Bruxism and Headache Impact Test-6 (HIT-6) Scores: A Polysomnographic Study. Front. Neurol. 2019: 10: 487.
In article      View Article  PubMed
 
[11]  Headache Classification Committee of the International Headache Society(IHS). The International Classification of Headache Disorders, 3rd edition (betaversion). Cephalalgia. (2013) 33: 629-808.
In article      View Article  PubMed
 
[12]  Stark CD, Stark RJ. Sleep and chronic daily headache. Curr Pain Headache Rep. 2015: 19:468.
In article      View Article  PubMed
 
[13]  Wang J, Huang Q, Li N, Tan G, Chen L, Zhou J. Triggers of migraine and tension-type headache in China: a clinic-based survey. Eur J Neurol. 2013:20: 689-96.
In article      View Article  PubMed
 
[14]  Demjaha1 G, Kapusevska B, Pejkovska-Shahpaska B.Bruxism Unconscious Oral Habit in Everyday Life.Maced J Med Sci. 2019 Mar 15; 7(5):876-881.
In article      View Article  PubMed
 
[15]  Houle TT, Butschek RA, Turner DP, Smitherman TA, Rains JC, Penzien DB. Stress and sleep duration predict headache severity in chronic headache sufferers. Pain. 2012: 153: 2432-40.
In article      View Article  PubMed
 
[16]  . Morais A, Gil D.Tinnitus in individuals without hearing loss and its relationship with temporomandibulardysfunctionBraz J Otorhinolaryngol. 2012:78. 59-65.
In article      View Article  PubMed
 
[17]  Hilgenberg P, Saldanha A, Cunha C, Rubo J, Conti P. Temporomandibular disorders, otologic symptoms and depression levels in tinnitus patients. J Oral Rehabil, 2012: 39, 239-244.
In article      View Article  PubMed
 
[18]  Calderon P, Hilgenberg P, Rossetti L, LaurentiJ,.ContiP.Influence of tinnitus on pain severity and quality of life in patients with temporomandibular disorders J Appl Oral Sci, 2012: 20, 170-173.
In article      View Article  PubMed
 
[19]  Fernandes G,. Franco A,. Siqueira J, Gonçalves D, Camparis C, Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms. J Oral Rehabil, 2012: 39, 538-544.
In article      View Article  PubMed
 
[20]  Camparis C, Formigoni G, Teixeira M, de SiqueiraJ.Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics. J Oral Rehabil, 2005: 32. 808-814.
In article      View Article  PubMed
 
[21]  Ramírez L, Ballesteros L, Sandoval G. Otological symptoms among patients with temporomandibular joint disorders. Rev Med Chil, 2007: 135, 1582-1590.
In article      
 
[22]  Winocur E, Uziel N, Lisha T, Goldsmith C, Eli I. Self‐reported bruxism associations with perceived stress, motivation for control, dental anxiety and gagging. J Oral Rehabil. 2011; 38: 3‐11.
In article      View Article  PubMed
 
[23]  Wetselaar P, Vermaire E,Lobbezzo F and Schuller A. The prevalence of awake bruxsim and sleep bruxsim in the Dutch adult population.J Oral Rehabil 2019,1-7.
In article      View Article  PubMed
 
[24]  Negra J., lobbezoo F, Faria P, Lombardo L, Sicliani G, Stellini E and Manfredini D. Relationship of self-reported sleep bruxsim and awake bruxsim with chronotype profiles in Italian dental students. CRANIO, 2018; January 1-6.
In article      
 
[25]  Manfredini D, Winocur E, Guarda-NardiniL, Paesani D and Lobbezoo F. Epidemiology of bruxsm in adults: A systemic review of literature.J OROFAC PAIN; 2013;27.99-110.
In article      View Article
 
[26]  Felício C, Melchior M, Ferreira C, Da Silva D. Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy Cranio, 2008; 26. 118-125.
In article      View Article  PubMed
 
[27]  Tuz H, Onder E, Kisnisci R. Prevalence of otologic complaints in patients with temporomandibular disorder Am J Orthod Dentofac Orthop, 2003; 123. 620-623.
In article      View Article
 
[28]  Melchior M, Mazzetto M, Felício C. Temporomandibular disorders and parafunctional oral habits: an anamnestic study Dental Press J Orthod, 2012; 17. 83-89.
In article      View Article
 
[29]  Yeler D, Yılmaz N, Koraltan M and Aydın‏ E. A survey on the potential relationships between TMD, possible sleep bruxism, unilateral chewing, and occlusal factors in Turkish university students CRANIO.35 (5), 308-314, 2017.
In article      View Article  PubMed
 
[30]  Blanco-Hungría A, Rodríguez-Torronteras A, Blanco-Aguilera A, Biedma-Velázquez L, Serrano-Del-Rosal R, Segura-Saint-Gerons R. Influence of sociodemographic factors upon pain intensity in patients with temporomandibular joint disorders seen in the primary care setting Med Oral Patol Oral Cir Bucal, 2012; 17. e1034-e1041.
In article      View Article  PubMed
 
[31]  Khoury S, Carra MC, Huynh N, Montplaisir J, Lavigne GJ. Sleep bruxism‐tooth grinding prevalence, characteristics and familial aggregation: a large cross‐sectional survey and polysomnographic validation. Sleep. 2016;39:2049‐2056.
In article      View Article  PubMed
 
[32]  Manfredini D, Piccotti F, Ferronato G, Guarda-NardiniL. Age peaks of different RDC/TMD diagnoses in a patient population. J Dent, 2010; 38. 392-399.
In article      View Article  PubMed
 
[33]  Bruno P,Arnaldo G and Júniorc F. Temporomandibular disorder: otologic implications and its relationship to sleep bruxism. Brazilian Journal of Oto rhinolaryngology: 2018,84(5) 614-619.
In article      View Article  PubMed