Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Oct;43(10):791-8.
doi: 10.1111/joor.12413. Epub 2016 Jun 10.

Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism

K G Raphael  1 , V Santiago  2 , F Lobbezoo  2   3
Affiliations

Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism

K G Raphael et al. J Oral Rehabil. 2016 Oct.

Abstract

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.

Keywords: bruxism; diagnosis; grinding; risk factor; sleep bruxism; temporomandibular disorders; validity.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest

Dr. Lobbezoo reports other from Sunstar Suisse, grants from Sunstar Suisse, grants from Somnomed, during the conduct of the study. The other authors have stated explicitly that there are no conflict of interests in connection with this article.

References

    1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil. 2013;40:2–4. - PubMed
    1. Wakefield JC. The concept of mental disorder. On the boundary between biological facts and social values. Am Psychol. 1992;47:373–388. - PubMed
    1. Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: a systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:e26–e50. - PubMed
    1. Manfredini D, Poggio CE, Lobbezoo F. Is bruxism a risk factor for dental implants? A systematic review of the literature. Clin Implant Dent Relat Res. 2014;16:460–469. - PubMed
    1. Manfredini D, Ahlberg J, Mura R, Lobbezoo F. Bruxism is unlikely to cause damage to the periodontium: findings from a systematic literature assessment. J Periodontol. 2015;86:546–555. - PubMed