Dental Tribune Asia Pacific No. 6, 2016

16 Dental Tribune Asia Pacific Edition | 6/2016 TRENDS & APPLICATIONS Conclusions drawn from the clinical tests are that intra-oral electrostimulation is safe and ef- fective and performs in a satis- factory manner to enhance saliva production and improve dryness symptoms. 3. Peri-oral diagnostic device: Screening device for bruxism Bruxism is the most well- known form of oral parafunction. Parafunctions are movements of the masticatory system that are considered outside or beyond normal function. The prevalence of bruxism in the adult popula- tion is estimated at 8 per cent; however, as many individuals may be unaware of this condition, the occurrence is most likely higher. Bruxism is prevalent during the night, but some people with bruxism unconsciously clench their teeth during the day, often when they feel anxious or tense. In some cases, bruxism is mild and may not even require treatment. However, it may be frequent and intense, and can lead to tem- poromandibular disorder (TMD), headaches, damaged teeth and periodontium, and other prob- lems. Unfortunately, people with sleep bruxism usually are not aware that they brux, so they are not diagnosed until complications occur. That is why it is important to diagnose sleep bruxism as early as possible and to seek appropriate treatment. Bruxism is usually diag- nosed based on clinical examina- tion of the teeth, complaints of jaw and masticatory pain, and reports by the bed partner of grinding noises. Patients suspected of brux- ism are not routinely referred to the sleep laboratory due to its high cost. Thus, clinical and experimen- tal data are scarce and there is no widely accepted gold standard for a definitive, objective diagnosis. BiteStrip (SLP)11 is a diagnostic tool that can assist the clinician in detecting bruxism and assessing over time the effectiveness of the therapy delivered to treat the dis- order. It is a miniature single-use electronic device designed as a screener for bruxism (Fig. 7). It con- sists of three electromyography (EMG) electrodes and an amplifier to acquire masticatory muscle sig- nals, a central processing unit with real-time software that detects and analyses EMG Patterns, and a dis- play that exhibits the measure- ments in the morning. All ele- ments are integrated on a single flexible substrate. At bedtime, patients are in- structed to attach the device over the mandible to the cheek, to ac- tivate it and to perform a series of maximal strength clenching and grinding activities in order to es- tablish an individual threshold for the night-time monitoring (Fig. 8). The device must be worn for at least 3 hours of sleep. In the morning, patients deactivate the device and wait for approximate- ly 20 minutes for the bruxism index (number of bruxing events per hour of recording) to be dis- played.12 The BiteStrip device was used in a before-and-after experimental clinical study with the objective of evaluating the effect of a MAD on sleep bruxism and sleep scores.12 After a habituation period of one week, sleep bruxism scores were taken at baseline and after use of the MAD for 30 days. Scores were compared using BiteStrip, which registered the number of contrac- tions of the unilateral masseter muscle after a 5 hours period, giv- ing a severity score of 0 to 3 after the registrations. In order to assess sleep, the Sleep Assessment Ques- tionnaire, a screening tool with scores ranging from 0 to 68, was administered before and after use of the MAD. Twenty-eight subjects (13 wo- men and 15 men; mean age of 42.9 ± 12.0) with a clinical history of sleep bruxism and no spontaneous TMD pain were selected. The clini- cal diagnosis of either moderate or severe sleep bruxism was further confirmed through use of BiteStrip (score of 2 or 3) at baseline. A 30-day follow-up period was used for evaluation. Both methods were validated against polysomnogra- phy. In addition, common signs and symptoms of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders were evaluated before and after use to assess the side-effects of the MAD. The results showed a statis- tically significant improvement in both sleep bruxism and sleep scores based on BiteStrip and the Sleep Assessment Questionnaire (Wilcoxon signed-rank and Stu- dent’s paired t-test, p < 0.05). Con- cerning the signs and symptoms of TMD, there was a significant reduc- tion in temporomandibular joint sounds, as well as in masseter and temporalis tenderness to palpa- tion. In summary, the improve- ment measured by BiteStrip was the same as the improvement as- sessed by other methods. Conclusion In conclusion, implementation of electronically based intra- and peri-oral therapeutic and diagnos- tic devices creates new possibilities for all kinds of novel applications for which the power of electronics and related technologies (software, wireless communications) is har- nessed to provide better and per- sonal medical services at lower costs. Editorial note: A list of references is available from the publisher. Conflict of interest declaration: The author is President of Saliwell. Dr Andy Wolff specialised in the field of oral medicine at Tel Aviv University and hasbeenalead- ing researcher in the field of salivary glands for over three decades. In 2003, he co-found- ed Saliwell, a company that offers innovative solutions for people suf- fering from chronic dry mouth. AD Fig. 7: BiteStrip device.—Fig. 8: BiteStrip usage. 7 8 “The power of electronics and related technologies is harnessed to provide better and personal medical services at lower costs.” 78

Dental Tribune Asia Pacific No. 6, 2016

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