Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism.
Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism.
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DOI：
10.1111/joor.12413
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发表时间：
2016-10
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
受关于磨牙症定义和分级的国际共识的启发（Lobbezoo F、Ahlberg J、Glaros AG、Kato T、Koyano K、Lavigne GJ 等 J Oral Rehabil. 2013；40:2），本评论探讨了其对定义睡眠磨牙症 (SB) 的贡献和基本假设。共识将磨牙症简单地重新定义为一种行为，这是一种进步，但我们探讨了一个隐含的问题：磨牙可能不仅仅是行为吗？行为本身并不需要临床治疗，这使得共识提出的“诊断分级系统”不合适。然而，如果 SB 被认为是一种疾病，那么诊断分级可能会有用。因此，为了充分认识共识声明的贡献，我们首先考虑确定 SB 是否是一种以有害功能障碍为特征的疾病或增加疾病可能性的危险因素的标准和证据。其次，审查了共识声明中提出的“诊断分级系统”的优点和缺点。迄今为止最有力的证据并不支持“诊断”所暗示的 SB 是一种疾病。仅凭行为无法诊断；疾病是。即使作为行为分级系统，所提出的系统也会因直接多导睡眠图（PSG）分类的 SB 的自我报告敏感性较差以及 SB 和便携式 PSG 的临床判断之间的关联性较差而被削弱；对二分式报告的依赖；未能通过有效的行为观察将 SB 行为视为一个连续体、可测量和定义的。迄今为止，缺乏将 SB 行为置于连续体中的自我报告或临床医生报告的有效性证据，这引起了人们对其在任何磨牙症行为分级系统中潜在效用的担忧，并阻碍了未来研究 SB 是否可能是一个有用的风险因素，或其本身是一种需要治疗的疾病。
Inspired by the international consensus on defining and grading of bruxism (Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ et al. J Oral Rehabil. 2013;40:2), this commentary examines its contribution and underlying assumptions for defining sleep bruxism (SB). The consensus’ parsimonious redefinition of bruxism as a behaviour is an advance, but we explore an implied question: might SB be more than behaviour? Behaviours do not inherently require clinical treatment, making the consensus-proposed ‘diagnostic grading system’ inappropriate. However, diagnostic grading might be useful, if SB were considered a disorder. Therefore, to fully appreciate the contribution of the consensus statement, we first consider standards and evidence for determining whether SB is a disorder characterised by harmful dysfunction or a risk factor increasing probability of a disorder. Second, the strengths and weaknesses of the consensus statement’s proposed ‘diagnostic grading system’ are examined. The strongest evidence-to-date does not support SB as disorder as implied by ‘diagnosis’. Behaviour alone is not diagnosed; disorders are. Considered even as a grading system of behaviour, the proposed system is weakened by poor sensitivity of self-report for direct polysomnographic (PSG)-classified SB and poor associations between clinical judgments of SB and portable PSG; reliance on dichotomised reports; and failure to consider SB behaviour on a continuum, measurable and definable through valid behavioural observation. To date, evidence for validity of self-report or clinician report in placing SB behaviour on a continuum is lacking, raising concerns about their potential utility in any bruxism behavioural grading system, and handicapping future study of whether SB may be a useful risk factor for, or itself a disorder requiring treatment.
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影响因子：
4.4
作者：
Lavigne, GJ;Guitard, F;Montplaisir, JY
通讯作者：
Montplaisir, JY
影响因子：
3.6
作者：
Manfredini, Daniele;Poggio, Carlo E.;Lobbezoo, Frank
通讯作者：
Lobbezoo, Frank
影响因子：
2.9
作者：
Castroflorio, T.;Bargellini, A.;Manfredini, D.
通讯作者：
Manfredini, D.
影响因子：
3
作者：
Camparis, Cinara Maria;Formigoni, Gilberto;de Siqueira, Jose Tadeu Tesseroli
通讯作者：
de Siqueira, Jose Tadeu Tesseroli
影响因子：
2.1
作者：
Murray, CG;Sanson, GD
通讯作者：
Sanson, GD