Bruxism is a continuously distributed behaviour, but disorder decisions are dichotomous (Response to letter by Manfredini, De Laat, Winocur, & Ahlberg (2016)).
Bruxism is a continuously distributed behaviour, but disorder decisions are dichotomous (Response to letter by Manfredini, De Laat, Winocur, & Ahlberg (2016)).
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磨牙症是一种连续分布的行为，但紊乱决策是二分的（对 Manfredini、De Laat、Winocur 的信件的回应，
DOI：
10.1111/joor.12425
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发表时间：
2016
影响因子：
2.9
通讯作者：
Lobbezoo,F
中科院分区：
文献类型：
--
作者：
Raphael,KG;Santiago,V;Lobbezoo,F
我们非常高兴地看到Manfredini、De Laat、Winocur和Ahlberg（1）撰写的这封信，他们是关于磨牙症定义和分级的原始共识声明（2）的许多共同作者。作者指出，他们同意我们最近作为对原始共识文件的批评而撰写的评论（3）中提出的“几乎所有论点”。我们感谢他们的支持和同意，但也欢迎有机会对他们提出的几点作出回应，因为这些点表明了我们需要进一步澄清的领域。我们从未打算暗示磨牙症行为是二分法的，我们也没有评论病因学和临床后果之间的关系。他们信中提出的主要问题可能来自语义上的误解。声明（睡眠）磨牙症是一种“行为”，并不排除它不仅仅是一种行为的可能性（在某些指定和验证的临界点），无论是风险因素还是障碍。“活动”和“行为”在英语中实际上是同义词。举一个例子，强迫性洗手肯定是一种行为，但它也可能是精神病学中强迫症的一部分，一种有害的功能障碍。当然，行为不是“黑/白”;事实上，我们特别提到“连续的睡眠磨牙症行为”（p. pending）。然而，通常使用某种二分临界点来做出某种疾病的决定，因为超过临界点有助于决定是否需要临床行动或干预。这是一个临床效率问题，并不能固有地反映潜在行为的自然分布。选定的临界点可以表明进一步评估或治疗的益处超过成本和治疗风险的点。
We were extremely pleased to see the letter composed by Manfredini, De Laat, Winocur and Ahlberg (1), many of the co-authors of the original consensus statement (2) on the defining and grading of bruxism. The authors state that they agree ‘on almost all the arguments’ raised in our recent commentary (3) written as a critique of the original consensus paper. We appreciate their support and agreement, but also welcome the opportunity to respond to several points that they raise, as these points indicate areas in which we need to provide further clarification. We never intended to imply that bruxism behaviour was dichotomous, and we did not comment on the relationship between aetiology and clinical consequences.The primary issue raised in their letter may derive from a semantic misunderstanding. Stating that (sleep) bruxism is a ‘behaviour’in no way precludes the possibility (at some tobe-specified and validated cut point) of it being more than a behaviour, either a risk factor or disorder.‘Activity’and ‘behaviour’are virtually synonymous in English. To provide an example of an activity than can be both a behaviour and/or indicative of a disorder, compulsive washing of the hands is certainly a behaviour but it can also be part of an obsessive-compulsive disorder in psychiatry, a harmful dysfunction. Certainly, behaviour is not ‘black/white’; in fact, we specifically refer to ‘the continuum of sleep bruxism behaviour’(p. pending). However, the decision that something is a disorder is typically made using some kind of dichotomous cut point, because exceeding the cut point facilitates the decision about need for a clinical action or intervention. This is a matter of clinical efficiency, not inherently reflecting the natural distribution of the underlying behaviour. The chosen cut point may indicate the point at which benefits of further assessment or treatment exceed costs and treatment risks.