Research routes on awake bruxism metrics: Implications of the updated bruxism definition and evaluation strategies

Alessandro Bracci, University of Padova, Padova, Italy
Frank Lobbezoo, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Anna Colonna, University of Siena, Siena, Italy
Steven Bender, Texas A&M School of Dentistry, Dallas, TX
Paulo C. Conti, University of Sao Paulo, São Paulo, Brazil
Alona Emodi-Perlman, Tel Aviv University, Telaviv, Israel
Birgitta Häggman-Henrikson, Malmö University, Malmö, Sweden
Gary D. Klasser, LSU Health Sciences Center - New Orleans
Ambra Michelotti, University of Naples Federico II, Naples, Italy
Gilles J. Lavigne, Hôpital du Sacré-Coeur de Montréal, and Universite de Montreal, Montreal, Quebec, Canada
Peter Svensson, Aarhus University, Aarhus, Denmark
Jari Ahlberg, University of Helsinki, Helsinki, Finland
Daniele Manfredini, University of Siena, Siena, Italy


BACKGROUND: With time, due to the poor knowledge on it epidemiology, the need to focus on awake bruxism as a complement of sleep studies emerged. OBJECTIVE: In line with a similar recent proposal for sleep bruxism (SB), defining clinically oriented research routes to implement knowledge on awake bruxism (AB) metrics is important for an enhanced comprehension of the full bruxism spectrum, that is better assessment and more efficient management. METHODS: We summarised current strategies for AB assessment and proposed a research route for improving its metrics. RESULTS: Most of the literature focuses on bruxism in general or SB in particular, whilst knowledge on AB is generally fragmental. Assessment can be based on non-instrumental or instrumental approaches. The former include self-report (questionnaires, oral history) and clinical examination, whilst the latter include electromyography (EMG) of jaw muscles during wakefulness as well as the technology-enhanced ecological momentary assesment (EMA). Phenotyping of different AB activities should be the target of a research task force. In the absence of available data on the frequency and intensity of wake-time bruxism-type masticatory muscle activity, any speculation about the identification of thresholds and criteria to identify bruxers is premature. Research routes in the field must focus on the improvement of data reliability and validity. CONCLUSIONS: Probing deeper into the study of AB metrics is a fundamental step to assist clinicians in preventing and managing the putative consequences at the individual level. The present manuscript proposes some possible research routes to advance current knowledge. At different levels, instrumentally based and subject-based information must be gathered in a universally accepted standardised approach.