A New Analyzing Method for Quantification of Abrasion on the Bruxcore Device for Sleep Bruxism Diagnosis

Aims: To evaluate a newly developed semi-automatic computer-based method to analyze the objectivity of the Bruxcore Bruxism-Monitoring Device (BBMD) by assessing the interrater reliability. The capability of the BBMD to differentiate between sleep bruxers (SB) and healthy controls was also verified by estimating the sensi-tivity, specificity, and predictive values. Methods: Forty-eight SB and 21 controls took part in this investigation. After a detailed clinical dental examination, each participant received a BBMD to be worn for 5 consecutive nights. The BBMDs were then scanned and rated by 2 independent examiners using the new method, which counted the abraded area in pixels. Interrater reliability was assessed by intraclass correlation coefficient (ICC) analyses. Results: The analyses showed a very high interrater reliability of ICC = 0.99, and comparison of the mean pixel scores revealed val-ues that were approximately 8 times higher for the SB than for the controls. With a selected pixel score cutoff point of 2900, a sensi-tivity of 79.2% and a specificity of 95.2% were found. The clini-cal diagnosis was correctly predicted in 97.4% of the SB and 66.7% of the controls. Conclusion: The results support the assumption that the newly developed analyzing method for the assessment of the BBMD is a clinically suitable, objective, and applicable method that seems to be able to differentiate between SB and a healthy control sample. These data, however, need to be confirmed in further investigations using polysomnographic recordings.

abrasion; clinical assessment; reliability; sleep bruxism

1. American Sleep Disorders Association. The International Classification of Sleep Disorders, Revised: Diagnostic and Coding Manual. Rochester, MN: American Sleep Disorders Association, 1997.

2. Ramfjord SP. Bruxism, a clinical and electromyographic study. J Am Dent Assoc 1961;62:21–44.

3. Macaluso GM, Guerra P, Di Giovanni G, Boselli M, Parrino L, Terzano MG. Sleep bruxism is a disorder related to periodic arousals during sleep. J Dent Res 1998;77:565–573.

4. Kato T, Rompré P, Montplaisir JY, Sessle BJ, Lavigne GJ. Sleep bruxism: An oromotor activity secondary to microarousal. J Dent Res 2001;80:1940–1944.

5. Kato T, Montplasir JY, Guitard F, Sessle BJ, Lund JP, Lavigne GJ. Evidence that experimentally induced sleep bruxism is a consequence of transient arousal. J Dent Res 2003;82:284–288.

6. Lobbezoo F, Soucy JP, Hartman NG, Montplaisir JY, Lavigne GJ. Effects of the D2 receptor agonist bromocriptine on sleep bruxism: Report of two single-patient clinical trials. J Dent Res 1997;76:1610–1614.

7. Lobbezoo F, Lavigne GJ, Tanguay T, Montplaisir JY. The effect of catecholamine precursor L-dopa on sleep bruxism: A controlled clinical trial. Mov Disord 1997;12:73–78.

8. Hicks RA, Chancellor C. Nocturnal bruxism and type A-B behavior in college students. Psychol Rep 1987;60:1211–1214.

9. Pingitore G, Chrobak V, Petrie J. The social and psycho-logic factors of bruxism. J Prosthet Dent 1991;65:443–446.

10. Kampe T, Edman G, Bader G, Tagdae T, Karlsson S. Personality traits in a group of subjects with long-standing bruxing behaviour. J Oral Rehabil 1997;24:588–593.

11. Rugh JD, Harlan J. Nocturnal bruxism and temporo-mandibular disorders. Adv Neurol 1988;49:329–341.

12. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest 2001;119:53–61.

13. Ahlberg J, Rantala M, Savolainen A, et al. Reported bruxism and stress experience. Community Dent Oral Epidemiol 2002;30:405–408.

14. Mealiea WL Jr, McGlynn FD. Temporomandibular disorders and bruxism. In: Hatch JP, Fisher JG, Rugh JD (eds). Biofeedback: Studies in Clinical Efficacy. New York: Plenum, 1987:123–151.

15. Bader G, Lavigne G. Sleep bruxism; an overview of an oromandibular sleep movement disorder. Sleep Med Rev 2000;4:27–43.

16. Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. J Oral Rehabil 2001;28: 1085–1091.

17. Lavigne GJ, Rompré PH, Montplaisir JY. Sleep bruxism: Validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 1996;75:546–552.

18. Rugh JD, Solberg WK. Electromyographic studies of bruxist behavior before and during treatment. J Calif Dent Assoc 1975;3(9):56–59.

19. Clark GT, Rugh JD, Handelman SL. Nocturnal masseter muscle activity and urinary catecholamine levels in bruxers. J Dent Res 1980;59:1571–1576.

20. Ikeda T, Nishigawa K, Kondo K, Takeuchi H, Clark GT. Criteria for the detection of sleep-associated bruxism in humans. J Orofac Pain 1996;10:270–282.

21. Baba K, Clark GT, Watanabe T, Ohyama T. Bruxism force detection by a piezoelectric film-based recording device in sleeping humans. J Orofac Pain 2003;17:58–64.

22. Vanderas AP, Menenakou M, Kouimtzis T, Papagiannoulis L. Urinary catecholamine levels and bruxism in children. J Oral Rehabil 1999;26:103–110.

23. Carlson GE, Egermark I, Magnusson T. Predictors of bruxism, other oral parafunctions, and tooth wear over a 20- year follow-up period. J Orofac Pain 2003;17:50–57.

24. Marbach JJ, Raphael KG, Janal MN, Hirschkorn-Roth R. Reliability of clinician judgements of bruxism. J Oral Rehabil 2003;30:113–118.

25. Forgione AG. A simple but effective method of quantifying bruxing behavior [abstract 292]. J Dent Res 1974;53:127.

26. Heller RF, Forgione AG. An evaluation of bruxism control: Massed negative practice and automated relaxation training. J Dent Res 1975;54:1120–1123.

27. Pierce CJ, Gale EN. Methodological considerations concerning the use of Bruxcore Plates to evaluate nocturnal bruxism. J Dent Res 1989;68:1110–1114.

28. Isacsson G, Bodin L, Seldén A, Barregård L. Variability in the quantification of abrasion on the Bruxcore device. J Orofac Pain 1996;10:362–368.

29. Zweig MH, Campbell G. Receiver operating characteristic (ROC) plots: A fundamental evaluation tool in clinical medicine. Clin Chem 1993;39:561–577.

30. Velden M. Die Signalentdeckungthorie in der Psychologie. Stuttgart: Kohlhammer, 1982.

31. Guggenmoos-Holzmann I, Wernecke KD. Medizinische Statistik. Berlin: Blackwell-Wiss-Verl, 1996.

32. Bowley JF, Stockstill JW, Pierce CJ. Reliability and validity of instrumentation used to record nocturnal clenching and/or grinding. J Orofac Pain 1993;7:378–385.

33. Haketa T, Baba K, Akishige S, Fueki K, Kino K, Ohyama T. Utility and validity of a new EMG-based bruxism detection system. Int J Prosthodont 2003;16:422–428.

34. Lavigne GJ, Goulet JP, Zuconni M, Morisson F, Lobbezoo F. Sleep disorders and the dental patient: An overview. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:257–272.

35. Holmgren K, Sheikholeslam A, Riise C. Effect of a fullarch maxillary occlusal splint on parafunctional activity during sleep in patients with nocturnal bruxism and signs and symptoms of craniomandibular disorders. J Prosthet Dent 1993;69:293–297.

36. Yap AUJ. Effects of stabilization appliances on nocturnal parafunctional activities in patients with and without signs of temporomandibular disorders. J Oral Rehabil 1998;25:64–68.

37. Raphael KG, Marbach JJ, Klausner JJ, Teaford MF. Is bruxism severity a predictor of oral splint efficacy in patients with myofascial pain? J Oral Rehabil 2003;30:17–29.

38. Okkerse W, Brebels A, De Deyn PP, et al. Influence of a biteplane according to Jeanmonod, on bruxism activity during sleep. J Oral Rehabil 2002;29:980–985.

39. Dubé C, Rompré PH, Manzini C, Guitard F, De Grandmont P, Lavigne GJ. Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. J Dent Res 2004;83:398–403.

40. Okeson JP. The effects of hard and soft occlusal splints on nocturnal bruxism. J Am Dent Assoc 1987;114:788–791.