Epidemiological and clinical research by a miniature bruxism detection device - Verify the prevalence, proportionate contribution for TMD and efficacy of oral appliance therapy -

目的：通过自评问卷和/或牙齿磨耗程度来评估睡眠磨牙症(SB)。然而，这些可靠性被认为不足以检测正在进行的SB事件。一种解决方案可以是一个微型的自给自足的肌电检测器-分析仪(BiteStrig0！R，S.L.P.以色列)，可以直接应用于咬肌。我们之前的研究表明，以多导睡眠图为金标准，该设备具有足够的可靠性来检测磨牙症事件(灵敏度：0.92，特异度：0.91)；然而，当应用于亚洲受试者时，该设备偶尔会显示错误信息。这可能是由于亚洲人和高加索人之间的皮肤抵抗力差异造成的。对此，最近开发了升级模型来解决这一问题。这项研究验证了该装置的改进。SB也被认为是TMD体征和症状的诱发/持续因素。然而，SB水平…之间的直接关系由于很难从流行病学上衡量SB的严重程度，TMD的体征和症状的更多和流行程度仍不清楚。方法：6名健康志愿者(1女5男，平均年龄24.5±0.55岁)，通过便携式肌电评估和伴随视频记录被诊断为磨牙症，并参与了连续10晚的Bitestrin记录。每个受试者在连续5个晚上分别在他们的双侧颊面部皮肤表面涂抹传统的和升级的Bitestria。比较两组患者错误信息的发生率。本调查以某高中一年级学生为调查对象，共195人(男/女：86/109，平均年龄15.4±0.5岁)。他们接受了临床检查，并被解释了Bitestrain的用法。磨牙症发作在其30%MVC阈值时被检测到，SB发作总数被分类为0-3(分别为40、41-74、75-124和≦125)。结果：传统系统和升级系统的错误信息发生率分别为14/30(46.7%)和1/30(3.3%)，升级系统的错误信息发生率显著低于传统系统(P&lt；0.01，卡方检验)。在195名应答者中，29名受试者没有返回Bitestrain，40名Biteband显示错误或没有迹象。重度搅拌者(≧评分3分)的TMJ点击发生率是对照组的3.5 8倍(95%CI：1.2 1~10.39，P=0.0 2)，而其他体征和症状与TMJ点击无关。该设备似乎在临床上也适用于亚洲人群。这些结果支持TMJ点击可能与严重磨牙症有关。然而，本研究在一夜之间测量了SB，多个SB记录应包括在进一步的研究中。较少

Objective : Sleep bruxism (SB) has been assessed by a self-estimated questionnaire and/or degree of tooth attrition. However these reliabilities were recognized insufficient to detect on-going SB events. One solution can be a miniature self-contained EMG detector-analyzer (BiteStrip○!R, S.L.P. Israel) that can be applied directly to the masseter muscle. Our previous study demonstrated this device has sufficient reliability to detect bruxism events with polysomnography as a golden standard (sensitivity : 0.92, specificity : 0.91); however, this device occasionally showed error message when applied in Asian subjects. This would be potentially due to skin resistance difference between Asian and Caucasians. In response, the version-up model has been developed recently to solve this problem. This study verified the improvement of this device. SB also has been hypothesized as a precipitating/perpetuating factor in TMD signs and symptoms. However, the direct relationship between the SB level … More and prevalence of the TMD signs and symptoms were still unclear, because of the difficulty in measuring the SB severity epidemiologically. Therefore, the aim of this study was to investigate the relationship in an adolescent population by using a miniature SB detection device (BiteStrip○!R, S.L.P. Israel).Methods : Six healthy volunteers (1 female and 5 males, mean age 24.5+/-0.55) who had been diagnosed as bruxisers by means of portable electromyography assessment and concomitant video recording and participated continuous 10-nights BiteStrip recordings. Each subject was applied both conventional and version-up BiteStrip on their bilateral buccal skin surface individually during continuous 5-nights. The incidence rates of error message were compared. The 1st degree students of a high school were exhaustively recruited, and 195 students (male/female : 86/109, mean age 15.4±0.5 yr) among them participated in this survey. They received clinical examination and were explained the usage of BiteStrip. Bruxism episodes were detected at their 30% MVC threshold, and total number of SB episodes was classified into 0-3 (<40, 41-74, 75-124 and ≦ 125, respectively). Relationship between their SB levels and presence/absence of the TMD signs and symptoms (clicking, limitation of mouth opening (LMO), headache, shoulder stiffness) were calculated, and odd-ratio and confidence interval (CI) were estimated by a simple regression analysis.Results : The incidence (rates) of error message in the conventional and version-up systems were 14/30 (46.7%) and 1/30 (3.3%) and the incidence in the version-up system was significantly lower than that in the conventional systems (p<0.01, Chi-square test). Of which 195 responders, 29 subjects didn't return BiteStrip and 40 BiteStrip showed error or no indication. Severe bruxier (≧score 3) had 3.58 times higher prevalence of TMJ clicking (95% CI : 1.21-10.39, P=0.02), whereas other signs and symptoms showed no significant relation.Conclusion : This modification made in the version-up BiteStrip was able to reduce the incidence of the error message in this system. The device appears to be clinically applicable even for Asian population. These results supported TMJ clicking can be associated with severe bruxism. However this study measured SB in one night, multiple SB recordings should be included in a further research. Less