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Background: Bruxism, a common oral parafunctional behavior characterized by the grinding or clenching of teeth, is a multifactorial condition with potentially detrimental effects on oral health and overall well-being. In recent years, there has been growing interest in understanding the relationship between bruxism and alcohol abuse, as both are prevalent issues that may share underlying factors and exacerbate each other. This systematic review, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, aims to evaluate the frequency of bruxism among individuals with alcohol abuse., Methods: A comprehensive search of electronic databases, including PubMed, Lilacs, Scopus and Web of Science, will be conducted to identify relevant studies published up to the knowledge cutoff date in January 2023. The search strategy will include keywords related to bruxism, alcohol abuse, and their synonyms. Inclusion criteria will encompass original research studies, such as observational, cross-sectional, cohort, and case-control studies, as well as clinical trials, that examine the relationship between bruxism and alcohol abuse. Two independent reviewers will perform the study selection, data extraction, and quality assessment, with discrepancies resolved by consensus., Results: The systematic review will present a summary of the identified studies, including the study design, characteristics of the study populations, and key findings related to the association between bruxism and alcohol abuse. The potential mechanisms underlying this relationship will also be explored. Subgroup analyses and the quality of evidence will be assessed. Finally, the implications of this association for clinical practice and further research will be discussed., Conclusions: This systematic review will contribute to a better understanding of the interplay between bruxism and alcohol abuse, shedding light on potential risk factors, mechanisms, and clinical implications. The findings may have significant implications for the prevention, management, and treatment of bruxism, particularly in individuals with a history of alcohol abuse., (© 2024. The Author(s).)

This paper summarises the background reasoning and work that led to the selection of the items included in the Standardised Tool for the Assessment of Bruxism (STAB), also introducing the list of items. The instrument is currently being tested for face validity and on-field comprehension. The underlying premise is that the different motor activities included in the bruxism spectrum (e.g. clenching vs. grinding, with or without teeth contact) potentially need to be discriminated from each other, based on their purportedly different aetiology, comorbidities and potential consequences. Focus should be on a valid impression of the activities' frequency, intensity and duration. The methods that can be used for the above purposes can be grouped into strategies that collect information from the patient's history (subject-based), from the clinical assessment performed by an examiner (clinically based) or from the use of instruments to measure certain outcomes (instrumentally based). The three strategies can apply to all aspects of bruxism (i.e. status, comorbid conditions, aetiology and consequences). The STAB will help gathering information on many aspects, factors and conditions that are currently poorly investigated in the field of bruxism. To this purpose, it is divided into two axes. Axis A includes the self-reported information on bruxism status and potential consequences (subject-based report) together with the clinical (examiner report) and instrumental assessment (technology report). Axis B includes the self-reported information (subject-based report) on factors and conditions that may have an etiological or comorbid role for bruxism. This comprehensive multidimensional assessment system will allow building predictive model for clinical and research purposes., (© 2022 John Wiley & Sons Ltd.)

Objective: To evaluate the self-reported SB prevalence and explore associated risk factors in puerperal women who had given birth in Rio Grande, Southern Brazil., Methods: A single, standardized questionnaire was given within the 48 h postpartum period. Self-reported SB was the main outcome investigated. Chi-square test was used to compare proportions, and Poisson regression with robust variance adjustment was used in the multivariate analysis., Results: A total of 2225 women were included. Only 79 (3.6%) of these reported clenching or grinding their teeth during sleep. Adjusted analysis showed that the higher education level of the mothers (PR = 3.07; 95% CI 1.49-6.28; P = 0.006); living with three or more persons in the household (PR = 0.54; 95% CI 0.34-0.84; P = 0.007); medication intake during pregnancy (PR = 1.68; 95% CI 1.09-2.58; P = 0.017); smoking (PR = 1.93; 1.16-3.23; P = 0.024), or ever smoked (PR = 1.82; 95% CI 0.85-3.90; P = 0.024); severe anxiety (PR = 1.36; 95% CI 0.61-3.02; P = 0.005); and headache upon waking (PR = 4.19; 95% CI 1.95-9.00; P < 0.001) were significantly associated with self-reported SB., Conclusion for Practice: Our data pointed towards new factors in a specific group of women that may be relevant for preventing sleep-related behaviors in the pregnancy-puerperal cycle. The higher levels of education, medication intake, smoking or even smoked, severe anxiety, the higher the probability of puerperal woman to self-report SB. The nighttime tooth clenching strongly increased headache upon waking., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Bruxism may lead to changes or damage to the oral and perioral tissues. Bruxism may occur during sleep or when awake. Many patients will not require active management; however, for some, intervention is required. Control of bruxism may be difficult, if not impossible, but the need exists for preservation of the dentition and quality of life. A prediction of risk to the tissues for the planning of interventions is difficult and relies upon evidence of past damage and assessment of future risks. Treatment options may need to be imaginative and rescuable. This series of papers will review the aetiology of bruxism, its impacts and treatment strategies for persistent bruxers who are at risk of, or suffering, tissue damage., (© 2022. The Author(s).)

(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction. It can occur together with sleep disturbances and may be associated with abnormal body movements, breathing difficulties, increased muscle activity, and heart rate disturbances. This disorder is becoming an important dental concern in children. (2) Methods: A literature review was carried out based on a search in PubMed and Google Scholar databases for articles on bruxism in children, published between 2014 and 2021. The etiology, diagnosis, and treatment of bruxism in children were of particular interest in the study. (3) Results: A total of 40 articles were included in the review. The analyzed studies indicated that the prevalence rates of bruxism in children vary widely from 13% to 49%. The etiology of bruxism is complex and incomprehensible, and the main diagnostic criteria for this condition in children are subjective observation, clinical history, and clinical examination. The recommended therapy for sleep bruxism in children is physiotherapy and psychotherapy. (4) Conclusions: Dentists and primary care physicians should correctly diagnose bruxism in children, educate parents, prevent potential consequences for oral health, and identify possible comorbidities. Appropriate clinical guidelines for the treatment and prophylaxis of bruxism in children should also be developed.

Bruxism has become more and more debatable and pressing issue all over the world last years. the etiology of bruxism has been changing diverse definitions, over the years, however recently it is defined as a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and by bracing or thrusting of the mandible. This literature review discusses the possible risk factors of bruxism in children and adolescence, among which behavioral abnormalities and sleep disturbances predominates. Moreover, it reviews pathological impact of bruxism on general health and quality of life. The literature review has been carried out using the "ScienceDirect", "Scopus" and "PubMed" databases in order to define relevant scientific works - published in English, during the last 5 years. 31 most relevant articles were chosen. Bruxism is a psychophysiological disorder that can take place during the day and/ or night, in a form of clenching and grinding. It can cause health problems such as tooth sensitivities, headaches, facial myalgia, ear ache, tightness/stiffness of the shoulders, limitation of mouth opening, sleep disruption, sleep disruption of bed partner due to noise, excess tooth mobility, inflamed & receding gums, Temporomandibular Joint Disorder, tooth wear and breakage and tongue's deformation. Considering the potential negative consequences of bruxism on dental and oral health, various clinical methods have been devised to assess it over the years. As the etiology is multifactorial, there is no exact treatment to prevent bruxism. Counselling and behavioral strategies, splint therapy, medications, and contingent electrical stimulation can be used as different ways reducing the effects of bruxism.

Objective: Sleep bruxism, a major sleep disorder that causes serious harm to oral health, is considered a multifactorial disease. Sleep bruxism can be induced by smoking, which also adversely affects sleep quality. The objective of present study was to clarify the associations between sleep bruxism, sleep quality, and exposure to secondhand smoke (SHS)., Methods: To assess the prevalence of sleep bruxism, sleep quality, and SHS exposure, we conducted oral examinations and self-report questionnaires on university students in Japan. Sleep bruxism and quality were screened using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the third edition of the International Classification of Sleep Disorders (ICSD-3). The inclusion criteria were adults aged between 18 and 19 years, non-smokers and non-alcohol drinkers. The exclusion criteria was failing to complete the questionnaire in full., Results: We analyzed a total of 1781 Japanese young adults. Young adult females who had been exposed to SHS had worse sleep quality (p = 0.019) than those who had not. Young adult female with worse sleep quality showed a higher prevalence of sleep bruxism (p = 0.034) than those with better sleep quality. Using structural equation modeling, direct associations were identified between SHS exposure and poor sleep quality (standardized coefficients, 0.153; p = 0.008) and between sleep bruxism and poor sleep quality (standardized coefficients, 0.187; p = 0.022) in young adult females. However, no association was found among young adult males., Conclusion: SHS exposure is indirectly associated with sleep bruxism through poor sleep quality in Japanese young adult females., (Copyright © 2019 Elsevier B.V. All rights reserved.)

The aim of this study was to verify the oral habits, symptoms, and characteristics of some children aged 8 to 10 years that could be associated with possible sleep bruxism. A cross-sectional study was performed. Questionnaires were sent to parents to obtain information on sex, age, school shift, sleep quality, parents' perception of children's behavior, and children's oral habits (nail biting, object biting, and lip biting), and symptoms such as headache or earache. In addition, parents reported the frequency of sleep bruxism (no day to 7 days a week). Descriptive analysis and multinomial logistic regression were performed and the level of significance was set at 5%. A total of 1,554 parents of children aged 8 to 10 years participated in this study. Possible sleep bruxism was reported as mild for 65.7%, moderate for 25.3%, and severe for 9% of the children. In the adjusted multinomial logistic regression, boys were 79% more likely to have sleep bruxism (OR: 1.79; 95%CI 1.23-2.60) and were 2.06 more times at risk of being in the habit of lip biting (OR: 2.06; 95%CI 1.26-3.37). Children with possible severe sleep bruxism were 61% more likely to develop object biting (OR: 1.61; 95%CI 1.09-2.39), 52% more likely to have headaches (OR: 1.52; 95%CI 1.01-2.28), and 3.29 more times at risk of poor sleep quality (OR: 3.29; 95%CI 2.25-4.82). Based on the report, boys with lip and object biting habits, headaches, and poor sleep quality presented a higher chance of possible severe sleep bruxism.

Sleep bruxism (SB) is a common phenomenon defined as a masticatory muscle activity during sleep. Untreated severe SB can have significant dental and orofacial consequences. SB has often been linked with stress and maladaptive coping strategies. Therefore, in this study, a potential correlation between SB, perceived stress and coping strategies was evaluated. A total of 60 adults were enrolled into this study. Participants underwent a detailed intra- and extraoral exam focused on detecting bruxism symptoms. Additionally, the overnight Bruxism Index was recorded using the Bruxoff device. A total of 35 participants with symptoms of bruxism were assigned to the study group, whereas 25 asymptomatic participants were assigned to the control group. The Perceived Stress Scale (PSS-10) was used for stress assessment and Brief-COPE for coping strategies. Results showed that the higher the PSS-10 score, the higher the Bruxism Index was in the study group. Positive coping strategies were chosen most frequently in the control group, while maladaptive ones were chosen in the study group. It can be concluded that there is a relationship between perceived stress and sleep bruxism. Moreover, the type of coping strategies used by participants may have an impact on sleep bruxism, but the relationship should be further investigated.

Objective: To evaluate the prevalence of sleep bruxism, as well as its principal signs and symptoms, in the city of Rio Grande. Evaluate the association of sleep bruxism with gender, age, education and psychological stress., Method: The study was cross-sectional type. A representative sample of the population (1280 people residing in the urban area of the city aged greater than or equal to 18 years old) were interviewed. The evaluation of sleep bruxism was by mean of questionnaire based on diagnostic criteria of the International Classification of Sleep Disorders., Results: The prevalence of sleep bruxism found in the population was 8,1% (confidence interval of 95% - 95%CI - 6,6 - 9,5). Among the signs and symptoms of dysfunction used for the diagnosis of sleep bruxism, tooth wear (70,3%) and pain in masticatory muscles (44,5%) were the most frequently reported by people who report teeth grinding during sleep. There was no significant difference in the prevalence of sleep bruxism between sexes. People older than 40 had a higher prevalence of sleep bruxism. The dysfunction was associated with a higher level of education (prevalence ratio - PR = 1.92; 95%CI 1,35 - 2,72) and psychological stress (PR 1,76; 95%CI 1,11 - 2,81)., Conclusion: There was a significant prevalence of sleep bruxism in the general population, causing various damages to the Stomatognathic system. The psychological stress is a risk factor for this dysfunction.

Prader-Willi syndrome (PWS) is a complex disorder that affects multiple systems and may cause craniofacial and dentofacial abnormalities. However, there is still a lack of evidence in the literature regarding the progress of orthodontic treatment in patients with PWS. This case report describes the successful orthodontic treatment of a patient with PWS. A girl, 9 years 0 months of age, who had been diagnosed with PWS had protruding maxillary incisors and a convex profile. Her malocclusion was due to the posteriorly positioned mandible. Screening tests for sleep apnea syndrome showed that she had sleep-disordered breathing, including obstructive sleep apnea and bruxism. We also observed an excessive overjet of 10.0 mm, a deep overbite of 6.8 mm, and the congenital absence of the mandibular second premolars. The patient was diagnosed with an Angle Class II malocclusion and a skeletal Class II jaw-base relationship with a deep overbite. Functional appliance therapy with mandibular advancement, which can enlarge the upper airway and increase the upper airspace, was performed to prevent further deterioration of the patient's obstructive sleep apnea. An acceptable occlusion with a proper facial profile and functional excursion were achieved without interference after comprehensive 2-stage treatment that incorporated orthodontic therapy for the patient's excessive overjet and deep overbite. The resulting occlusion was stable, and the occlusal force and the contact area gradually increased over a 2-year retention period. These results suggest that orthodontic treatment offers the opportunity to greatly improve the health and quality of life of people with PWS., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Bruxism is characterised by clenching or grinding of the teeth due to contraction of the masseter, temporalis and other jaw muscles. Bruxism may lead to masticatory muscle hypertrophy, tooth surface loss, fracture of restorations or teeth, hypersensitive or painful teeth and loss of periodontal support. Sleep bruxism has previously been viewed as a dysfunctional movement or pathological condition, whereas it is now accepted as a centrally controlled condition with various systemic risk factors. It has been postulated that sleep bruxism may have a protective role during sleep, for example in relation to airway maintenance or in stimulating saliva flow. A diagnosis of sleep bruxism may be made via patient report and clinical interview, clinical examination, intraoral appliances or recording of muscle activity. Bruxism in itself does not require treatment: management is only indicated where problems arise as a result of bruxism. Oral appliances primarily aim to protect the dentition from damage caused by clenching/grinding, although they may reduce muscle activity. Irreversible occlusal adjustments have no basis in evidence in the management of bruxism. Behavioural strategies include biofeedback, relaxation and improvement of sleep hygiene. Administration of botulinum toxin (Botox) to the masticatory muscles appears to reduce the frequency of bruxism, but concerns have been raised regarding possible adverse effects. Dentists should be aware of the potential aetiology, pathophysiology and management strategies of sleep bruxism.

The aim of the present study was to evaluate factors associated with sleep bruxism in five-year-old preschool children. A preschool-based cross-sectional study was conducted with 761 pairs of children and their parents/caregivers. Sleep bruxism was diagnosed using a questionnaire administered to the parents/caregivers, who also answered questionnaires addressing sociodemographic data and parent's/caregiver's sense of coherence. Clinical oral evaluations of the children to determine dental caries, traumatic dental injuries, malocclusion and tooth wear were performed by two researchers who had undergone a training exercise (interexaminer Kappa: 0.70 to 0.91; intraexaminer Kappa: 0.81 to 1.00). Descriptive analysis and logistic regression for complex samples were carried out (α = 5%). The prevalence of sleep bruxism among the preschool children was 26.9%. The multivariate analysis revealed that bruxism was associated with poor sleep quality (OR = 2.93; 95 CI: 1.52-5.65) and tooth wear (OR = 2.34; 95%CI: 1.39-3.96). In the present study, sleep bruxism among preschool children was associated with tooth wear and poor sleep quality of the child. In contrast, psychosocial aspects (sense of coherence) were not associated with sleep bruxism.

Sleep bruxism (SB) and psychological stress are commonly considered as contributing factors in the aetiology of temporomandibular disorder (TMD) pain. However, the lack of longitudinal studies and fluctuating nature of SB, psychological stress and TMD pain have led to contradictory results regarding the association between the possible aetiological factors and TMD pain. In the present study we investigated the contribution of SB and psychological stress to TMD pain in a longitudinal study of 2 clinical TMD pain cases during a 6-week study protocol. Two female volunteers with clinically diagnosed myalgia based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) participated in the study. Questionnaires were used to record jaw-muscle pain and psychological stress experience, and an ambulatory polysomnography technique was used to record SB intensity. Visual analysis of the data revealed that the intensity of TMD pain was not hardwired, neither with psychological stress experience nor with increased SB activity. Within the limitations of single-patient clinical cases design, our study suggested that the presence of TMD pain cannot be explained by a simple linear model which takes psychological stress or SB into account. It also seems that psychological stress was a more important predictor factor for TMD pain than SB., (© 2017 John Wiley & Sons Ltd.)

Objective: This systematic review was performed to determine the risk factors related to bruxism in children., Design: This systematic review was conducted with reporting in agreement to the PRISMA statement and according to guidelines from the Cochrane Handbook for Systematic Reviews of Interventions. We conducted a systematic search of seven online databases, with the last search updated on 1st October 2016. The seven databases were Pubmed, Embase, Cochrane Library database, Web of Science, CNKI, CBM, and WF. The included trial type were RCT, cohort studies, and case-control studies, and bruxism symptoms were assessed by questionnaires and examinations. Eighteen out of the 5637 initially identified studies met the inclusion and exclusion criteria., Results: gender, age, gene, mixed position, anxiety, the nervous, secondhand smoke, high psychological reactions, responsibility, move a lot during sleep, sleeps with mouth open, snores loudly, restless sleep, sleep hours, sleep with light on, noise in room, headache, biting, cheeks tonus, perioral musculature participation, conduct problems, peer problems, emotional symptoms, mental health problems, birth weight, occupation of family head, maternal marital status, hyperactivity, family income seemed to have statistical significance from the present systematic review and meta-analysis., Conclusions: The risk factors related to bruxism were as follows: Male, gene, mixed position, moves a lot, anxiety, the nervous, psychological reactions, responsibility, secondhand smoke, snore loudly, restless sleep, sleep with light on, noise in room, "sleep hours, ≤8h", headache, objects biting, conduct problems, peer problems, emotional symptoms and mental health problems., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: Sleep bruxism (SB) is a sleep disorder with high incidence in toddlers and may perpetuate to adulthood. The multifactorial etiology of bruxism includes pathophysiologic and psychological factors., Aim: To investigate the relationship between depression, stressful events, and the presence of symptoms of anxiety and depression with SB in children of adolescent mothers., Design: This cross-sectional study nested in a cohort evaluated a sample of 536 mothers and their children aged 24-36 months. Interviews were conducted with mothers. Maternal report of SB was collected. Mother's major depressive disorder was assessed using the Mini International Neuropsychiatric Interview (MINI Plus); Life Events Scale assessed the stressful events; Beck Depression Inventory and Beck Anxiety Inventory investigated the symptoms of depression and anxiety. Poisson regression analysis was applied to assess the association of maternal psychological disorders and stressful events with SB on children., Results: Prevalence of SB was 25.93% (95% CI 22.2-29.7). After adjustments, maternal major depression disorder [PR 1.43 (95% CI 1.06-1.92)] and the presence of stressful events mainly environmental changes [PR 1.47 (95% CI 1.08-2.00)] showed significant association with bruxism in children., Conclusion: This study showed a positive association between mother's psychological traits and SB development in their toddlers., (© 2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: The aim of this article was to systematically review the literature to assess the relationship between risk factors and sleep bruxism (SB) in adults (age ≥18 years)., Design: A systematic search of the following databases was carried out: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs and SciELO. Nine out of the 4583 initially identified articles were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines., Results: Among the nine analyzed articles, associations between SB and gastro-esophageal reflux disease (GERD) (OR=6.6, CI=1.4-30.9) was found in one randomized clinical trial (RCT). Four cross-sectional studies suggested history of SB during childhood (OR=8.1 CI=5.4-12-2), age (OR=3.1, CI=2.3-4.1) and chronic migraine (OR=3.8, C.I=1.8-7.8) as determinant factors for the development of SB. In one case-control study, patients with genetic polymorphisms were more likely to present SB (OR=4.3, CI=1.6-11.3). Smoking (OR=2.8, CI=2.2-3.5) and alcohol intake (OR=1.9, CI=1.2-2.8) showed moderate association in two case-control studies., Conclusions: History of SB during childhood, gastro-esophageal reflux disease and genetic polymorphisms seem to be important risk factors associated to SB in adults. Dry mouth on awakening seems to be a protective factor. Association does not infer with causality. Even if the evidence emerged from the considered studies was clinically relevant, further studies are requested to better understand the biological mechanisms behind the described associations., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The prevalence of both bruxism and attention deficit hyperactivity (ADHD) has increased in recent years., Aim: This study evaluated the direct and indirect effects of signs of ADHD, reported by parents/caregivers and teachers, with sleep bruxism. In addition, this study explores the effects of socio-economic status (SES) on sleep bruxism., Design: This cross-sectional study was performed in Diamantina, Brazil, with 851 randomly selected schoolchildren aged 6-12 years. The schoolchildren were underwent an oral examination for the evaluation of bruxism. Moreover, parents/caregivers fill out a form for the assessment of sleep bruxism and sociodemographic factors. Parents/caregivers and teachers responded to the Swanson, Nolan and Pelham scale - version IV (SNAP-IV) for the assessment of ADHD signs. The structural equation modelling approach was used, and standardized coefficients to direct, indirect and total effects were calculated., Results: ADHD signs had a significant moderate (SC = -0.19, P < 0.01) effect on sleep bruxism. SES had a significant indirect effect on bruxism via sucking habits. Moreover, SES had a significant direct (SC = -0.16, P = 0.01) and total effect on tooth wear (SC = -0.17, P < 0.01)., Conclusion: This study concluded that signs of ADHD and SES have a complex direct and indirect effects on sleep bruxism among schoolchildren., (© 2017 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Bruxism is an abnormal repetitive movement disorder characterized by jaw clenching and tooth gnashing or grinding. It is classified into two overlapping types: awake bruxism (AB) and sleep bruxism (SB). Theories on factors causing bruxism are a matter of controversy, but a line of evidence suggests that it may to some extent be linked to basal ganglia dysfunction although so far, this topic has received little attention. The purpose of this article was to review cases of bruxism reported in various movement disorders. The biomedical literature was searched for publications reporting the association of bruxism with various types of movement disorders. As a whole, very few series were found, and most papers corresponded to clinical reports. In Parkinsonian syndromes, AB was rarely reported, but seems to be exacerbated by medical treatment, whereas SB is mainly observed during non-REM sleep, as in restless leg syndrome. AB is occasionally reported in Huntington's disease, primary dystonia, and secondary dystonia; however, its highest incidence and severity is reported in syndromes combining stereotypies and cognitive impairment, such as Rett's syndrome (97%), Down syndrome (42%), and autistic spectrum disorders (32%). Taken as a whole, AB seems to be more frequent in hyperkinetic movement disorders, notably those with stereotypies, and is influenced by anxiety, suggesting an involvement of the limbic part of the basal ganglia in its pathophysiology., (© 2016 by the American College of Prosthodontists.)

Although well studied since the 50's, bruxism remains a largely unknown pathology. Its origin is complex, mixing psychological as well as neurological, odontological and hypnic aspects. However, the few analyzes performed on this topic have allowed to set convincing etiopathological hypotheses, including central dysregulation of the dopaminergic system as well as of the neuro-masticatory system. To avoid harmful consequences as headaches, temporomandibular disorders and premature dental scuffs / fractures, it is mandatory to diagnose bruxism as early as possible. For this purpose, and in addition to anamnestic and clinical data, the practitioner can confirm diagnosis with polysomnography, including electromyographic study of masticatory muscles and audiovisual recording. Some orthodontic, pharmacological and psychological solutions have already proved efficient. Nevertheless, a better knowledge of causative neurobiological mechanisms would allow to foresee etiology-based treatments.

Bruxism is defined as repetitive activity of the masticatory muscles, characterized by clenching the teeth or teeth grinding and/or by tapping and swaying. This study investigated sleep bruxism. The etiology is multifactorial: mainly central (neuropathic disorder, anxiety) but also genetic and local (posture, mouth breathing). The diagnosis is based primarily on the anamnesis and examination of dental wear and progression over time (photos and dental castings). A diagnostic guide is proposed in this article. Frequently found in children, bruxism is not always considered pathological. The severity criteria relate intensity (number of dental attrition facets) as well as the context found in children: anxiety, ventilation disorders, and fragile dental structures. Management is multidisciplinary and depends on the etiologic diagnosis., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Since the publication of a special issue on bruxism of the NTvT in July 2000, consensus has been reached on bruxism's definition as a repetitive masticatory muscle activity that is characterised by clenching and/or grinding while awake (awake bruxism) or during sleep (sleep bruxism). As yet, however, no consensus exists about the diagnosis of bruxism: sufficient evidence to establish the reliability and validity of the commonly used techniques (self-report, clinical examination, imaging, electromyography, polysomnography) has not yet been produced. Morphological factors are no longer considered important aetiological factors, while increasing evidence suggests aetiological roles for psychosocial, physiological, biological, and exogenous factors. This review paper is the first part of a diptych and is concerned with the definition, diagnostics, epidemiology and possible causes of this disorder. In the second part, that will be published in the next issue, associations of bruxism with other conditions will be discussed, along with its (purported) consequences and its management.

Study Objectives: Sleep bruxism (SB) is characterized by tooth grinding and jaw clenching during sleep. Familial factors may contribute to the occurrence of SB. This study aims are: (1) revisit the prevalence and characteristics of SB in a large cross-sectional survey and assess familial aggregation of SB, (2) assess comorbidity such as insomnia and pain, (3) compare survey data in a subset of subjects diagnosed using polysomnography research criteria., Methods: A sample of 6,357 individuals from the general population in Quebec, Canada, undertook an online survey to assess the prevalence of SB, comorbidities, and familial aggregation. Data on familial aggregation were compared to 111 SB subjects diagnosed using polysomnography., Results: Regularly occurring SB was reported by 8.6% of the general population, decreases with age, without any gender difference. SB awareness is concomitant with complaints of difficulties maintaining sleep in 47.6% of the cases. A third of SB positive probands reported pain. A 2.5 risk ratio of having a first-degree family member with SB was found in SB positive probands. The risk of reporting SB in first-degree family ranges from 1.4 to 2.9 with increasing severity of reported SB. Polysomnographic data shows that 37% of SB subjects had at least one first-degree relative with reported SB with a relative risk ratio of 4.625., Conclusions: Our results support the heritability of SB-tooth grinding and that sleep quality and pain are concomitant in a significant number of SB subjects., (© 2016 Associated Professional Sleep Societies, LLC.)

Bruxism is defined as a repetitive jaw muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. There are two distinct circadian phenotypes for bruxism: sleep bruxism (SB) and awake bruxism, which are considered separate entities due to the putative difference in their etiology and phenotypic variance. The detailed etiology of bruxism so far remains unknown. Recent theories suggest the central regulation of certain pathophysiological or psychological pathways. Current proposed causes of bruxism appear to be a combination of genetic and environmental (G×E) factors, with epigenetics providing a robust framework for investigating G×E interactions, and their involvement in bruxism makes it a suitable candidate for epigenetic research. Both types of bruxism are associated with certain epigenetically determined disorders, such as Rett syndrome (RTT), Prader-Willi syndrome (PWS), and Angelman syndrome (AS), and these associations suggest a mechanistic link between epigenetic deregulation and bruxism. The present article reviews the possible role of epigenetic mechanisms in the etiology of both types of bruxism based on the epigenetic pathways involved in the pathophysiology of RTT, PWS, and AS, and on other epigenetic disruptions associated with risk factors for bruxism, including sleep disorders, altered stress response, and psychopathology.

Objective: The aim of this article was to systematically review the literature to identify papers dealing with risk factors associated with sleep bruxism (SB) in children., Design: A systematic search was carried out based on the following databases: PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, SciELO. Studies investigating risk factors related to SB after multiple regression analysis and bruxism symptoms assessed with clinical diagnosis or specific questionnaires were searched. Six out of the 4546 initially identified studies were selected. This review was conducted according to the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions, with reporting in agreement to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines., Results: Among the six analyzed articles, one randomized clinical trial (RCT) suggested the increase of SB in heavily exposed patients to second hand smoke (SHS) (OR=4.5, CI=2.2-9.4), two cross-sectional studies suggested neuroticism as determinant factor for the development of sleep bruxism (OR=1.9, CI=1.3-2.6), among children and three case-control studies suggested that children with sleep disturbances were more likely to have SB (OR=3.3, CI=1.6-6.6). Parafunctional behaviours (OR=2.3, CI=1.2-4.3) had a moderate association., Conclusions: SHS and sleep disturbances presented the strongest association with SB. The most recurrent source of bias was the lack of blinding procedures. Furthermore, the use of reliable SB diagnostic procedures should be recommended to increase the quality of future studies. The evidence emerged from the considered studies was clinically relevant., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Sleep bruxism refers to a nocturnal parafunctional activity including the clenching, grinding or gnashing of teeth. While most of the nocturnal bruxism cases seen in the general population are apparently idiopathic, it has been reported to be associated with a range of neurological diseases such as Huntington's disease, cranio-cervical dystonia and post-anoxic brain damage, but not multiple sclerosis (MS). We describe three cases of MS patients who have had moderate to severe complaints of bruxism in the two weeks following their relevant MS attacks. None of the three patients had a diagnosis of bruxism prior to her attack. The diagnosis was confirmed in one out of three by a polysomnography. One patient did not have any complaints related to bruxism previous to her attack, whereas two had mild and infrequent complaints. The symptoms of the relevant attacks were left hemihypesthesia in all and hemiparesis in two. None of the patients had spasticity that could result in severe teeth clenching. All three patients presented with morning headaches and jaw pain or tightness and were treated successfully with botulinum toxin (Btx) injections applied to their masseter and temporalis muscles. The cause of bruxism is controversial but lesions of the cortico-basalganglia-thalamo-cotrical loops are thought to be most likely. However, acute or chronic lesions in those pathways were not demonstrated in the 3 patients. It is feasible that they had normal appearing white matter interruptions in their cortico-basalganglia-thalamocortical loops along with their relevant attack., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objectives: This study aims to analyze the subjective and objective characteristics of tinnitus in sleep bruxism patients., Patients and Methods: The study included 57 patients (12 males; 45 females; mean age 33.89±12.50 years; range 19 to 55 years) with sleep bruxism and tinnitus (sleep bruxism group) and 24 patients (6 males, 18 females; mean age 43.75±16.19 years; range 21 to 58 years) only with tinnitus (control group). Sleep bruxism was diagnosed by the diagnostic criteria of American Academy of Sleep Medicine. Patients were performed pure tone audiometry to detect hearing thresholds at standard and high frequencies. Tinnitus frequency and loudness were assessed. Subjective aspects of tinnitus were identified by tinnitus handicap inventory., Results: The statistical analysis revealed that the sleep bruxism group had significantly lower hearing thresholds except 1000 Hz and 2000 Hz. Tinnitus frequency was between 3000 Hz and 18000 Hz in sleep bruxism group while it was between 6000 and 16000 Hz in control group with no statistically significant difference (p=0.362). Sleep bruxism group had significantly lower tinnitus loudness and tinnitus handicap inventory scores in comparison to control group (p=0.024 and p=0.000, respectively)., Conclusion: Tinnitus caused by sleep bruxism and temporomandibular joint issues has higher frequency and lower loudness compared to patients with only tinnitus.

This study evaluated the association of level of anxiety in children with and without sleep bruxism (SB). The study was performed with 84 six- to eigth-years-old children, divided into two groups: with bruxism (BG) and without bruxism (CG). Following the criteria purposed by American Academy of Sleep Medicine (AASM) to determine SB, the presence of tooth wear has been verified through clinical examinations, and the parents have answered a questionnaire about their children's behavior and habits. Additionally, the State-Trait Anxiety Inventory for Children (STAIC) was applied to parents of the selected patients. Data analysis revealed a statistical significant difference between the groups (Student's t-test, p = 0.0136). Based on the results, anxiety assessment revealed that children with bruxism have reached higher levels in the STAIC scale than the non-bruxism group. Therefore, it indicates a direct relationship between the presence of anxiety disorder and the onset of bruxism in children.

Various definitions, classifications and theories been ascribed to bruxism. Knowledge gained through expanding research initiatives have transformed some of the concepts that were once held as truths. Sleep bruxism is no longer considered a parasomnia nor is its etiology believed to be based on purely mechanical factors or psychological Issues. It is now considered to be primarily a sleep-related movement disorder with a yet to be determined multifactorial etiology involving complex multisystem physiological processes. Dental practitioners should recognize the transformation occurring in the study of sleep bruxism, understand the evolution in both definitions and classification of this phenomenon and embrace and consider new concepts related to its etiology. This paradigm shift will certainly affect the daily practice of dentistry.

Objective: The purpose of our study was to evaluate the association between environmental factors, sleep duration, and sleep bruxism (SB) in schoolchildren., Methods: A case-control study was performed. Individuals participating in the study were randomly chosen from public and private schools in Belo Horizonte, Brazil. A total of 120 children with bruxism and 240 without bruxism (mean age, 8 years) participated in our study. A questionnaire for parents was used to collect data based on criteria taken from the American Academy of Sleep Medicine. Conditional binary logistic regression statistical tests and χ2 tests were used for analysis., Results: The final logistical model found that children with a median sleep time < or = 8 h per night (odds ratio [OR], 2.561 [95% confidence interval {CI}, 1.480-4.433]), who did not enjoy a good night's sleep (OR, 3.253 [95% CI, 1.600-6.615]), who slept with noise in the room (OR, 2.699 [95% CI, 1.645-4.429]), and who had the light on (OR, 2.370 [95% CI, 1.446-3.884]), were more likely to have SB., Conclusion: Children who sleep for less than 8h a night are more likely to have SB. Light and noise in the room were two predisposing factors for the occurrence of SB., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Purpose: Sleep bruxism is common among the various oromotor alterations found in individuals with cerebral palsy (CP). Few studies have investigated the use of the mastication device denominated "hyperbola" (HB) and none was found describing the use of such a device for the treatment of bruxism in children with CP. The aim of the present study was to evaluate the effect of the HB on electromyographic (EMG) activity in the jaw-closing muscles and the reduction in sleep bruxism in a child with CP using surface EMG analysis before and after nine months of treatment., Methods: A seven-year-old boy with severe spastic CP and sleep bruxism was enrolled in this study. The HB was chosen as the treatment option for sleep bruxism in this case because the child did not accept an occlusal splint. The HB has a hyperbolic shape and is made of soft, non-toxic, odorless, tasteless silicone. There are five different sizes of HB manufactured based on the diversity of tooth sizes. This device produces proprioceptive excitation in the dentoalveolar nerve, spindles and Golgi tendon organs. HB has been employed for the treatment of temporomandibular disorder, abnormal oro-dental development, abnormal occlusion, xerostomy, halitosis and bruxism. HB therapy was performed for 5 min six times a day over a nine-week period. Surface EMG of the mandible at rest and during maximum contraction was performed on the masseter and temporalis muscles bilaterally to evaluate electromyographic activity before and after nine months of HB usage., Results: HB usage led to a visible tendency toward the reorganization of mastication dynamics, achieving a marked balance in electromyographic activity of the jaw-closing muscles and improving the child's quality of life., Conclusion: Based on the findings of the present study, this noninvasive therapy may be useful for individuals with cerebral palsy due to its positive effects and low cost, which allows its use in the public health realm. Further clinical studies with a larger sample size are needed to validate these results and allow the development of a new treatment protocol for patients with spastic cerebral palsy., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Bruxism is involuntary grinding of the teeth and can occur as a complication of brain injury. If untreated, bruxism can lead to severe occlusal trauma. Herein, we present a patient with traumatic brain injury and nocturnal bruxism that was treated with botulinum toxin injection. A 21 yr old male patient with traumatic brain injury from a car accident was admitted to our inpatient rehabilitation unit. He had a history of coma for 2 wk in the intensive care unit. The initial cranial computed tomography scan indicated a superior thalamic hemorrhage. On admission to our department 3 mo postinjury, his mental status was good and he was able to walk without assistance, but he had mild ataxia. He complained about severe teeth grinding at night, which began 2 mo postinjury. Botulinum toxin-A was injected into the masseter muscles (20 U in each muscle) and temporalis muscles (15 U in each muscle) bilaterally. A decrease in bruxism was reported within 3 d. Clinical improvement persisted at assessment 4 mo posttreatment. Botulinum toxin injection can be used as an effective treatment for bruxism associated with brain injury.

Objective: The aim of the present work was to systematically review the literature and identify all peer-reviewed papers dealing with etiological and risk factors associated with bruxism., Data Sources: Data extraction was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for randomized clinical trials (RCT), controlled clinical trials (CCT) or cohort studies: Cochrane Library, Medline, and Embase from 1980 to 2011. Unpublished literature was searched electronically using ClinicalTrials.gov., Data Selection: The primary outcome was bruxism etiology. Studies should have a standardized method to assess bruxism., Data Extraction: Screening of eligible studies, assessment of the methodological quality and data extraction were conducted independently and in duplicate. Two reviewers inspected the references using the same search strategy and then applied the same inclusion criteria to the selected studies. They used criteria for methodological quality that was previously described in the Cochrane Handbook. Among the 1247 related articles that were critically assessed, one randomized clinical trial, one controlled clinical trial and seven longitudinal studies were included in the critical appraisal. Of these studies, five were selected, but reported different outcomes., Data Synthesis: There is convincing evidence that (sleep-related) bruxism can be induced by esophageal acidification and also that it has an important relationship with smoking in a dose-dependent manner. Disturbances in the central dopaminergic system are also implicated in the etiology of bruxism.

Aims: To identify potential predictors of self-reported sleep bruxism (SB) within children's family and school environments., Methods: A total of 65 primary school children (55.4% males, mean age 9.3 ± 1.9 years) were administered a 10-item questionnaire investigating the prevalence of self-reported SB as well as nine family and school-related potential bruxism predictors. Regression analyses were performed to assess the correlation between the potential predictors and SB., Results: A positive answer to the self-reported SB item was endorsed by 18.8% of subjects, with no sex differences. Multiple variable regression analysis identified a final model showing that having divorced parents and not falling asleep easily were the only two weak predictors of self-reported SB. The percentage of explained variance for SB by the final multiple regression model was 13.3% (Nagelkerke's R² = 0.133). While having a high specificity and a good negative predictive value, the model showed unacceptable sensitivity and positive predictive values. The resulting accuracy to predict the presence of self-reported SB was 73.8%., Conclusion: The present investigation suggested that, among family and school-related matters, having divorced parents and not falling asleep easily were two predictors, even if weak, of a child's self-report of SB.

Background: Many dentists believe that sleep bruxism (SB) is a pathogenic factor in myofascial temporomandibular disorder (TMD), but almost all supportive data rely on patients' self-reports rather than on direct observation., Methods: The authors administered a structured self-report interview to determine whether a large and well-characterized sample of patients with myofascial TMD (124 women) experienced SB more often than did matched control participants (46 women). The authors then used data from a two-night laboratory-based polysomnographic (PSG) study to determine whether the case participants exhibited more SB than the control participants., Results: The results of independent sample t tests and χ(2) analyses showed that, although self-reported rates of SB were significantly higher in case participants (55.3 percent) than in control participants (15.2 percent), PSG-based measures showed much lower and statistically similar rates of SB in the two groups (9.7 percent and 10.9 percent, respectively). Grinding noises were common in both case participants (59.7 percent) and control participants (78.3 percent)., Conclusions: Most case participants did not exhibit SB, and the common belief that SB is a sufficient explanation for myofascial TMD should be abandoned., Clinical Implications: Although other reasons to consider treating SB may exist, misplaced concern about SB's sustaining or exacerbating a chronic myofascial TMD condition should not be used to justify SB treatment.

Background: Exposure to secondhand smoke (SHS) is a serious public health threat and represents a preventable cause of morbidity among children. Sleep bruxism is characterised by teeth grinding or clenching movements during sleep and may begin in adulthood as well as in childhood., Objectives: To investigate the association between SHS exposure and sleep bruxism in children., Methods: Sleep bruxism was investigated in 498 children (mean age: 9.2±1.9). Family members were interviewed and asked whether they smoked in the presence of their children. Children were classified according to their exposure to SHS into heavily, moderately, lightly and occasionally exposed. Children with sleep bruxism and exposed to SHS were randomly divided into two groups: children in group 1 were not exposed to SHS for 6 months, whereas children in group 2 were., Results: Thirty-one per cent of the children under investigation suffered from bruxism. Among them, 116 children (76%) were exposed to SHS. Exposed children showed a higher risk of sleep bruxism (p<0.05). After 6 months, sleep bruxism was found in 38% and in 90% of children, in the first and in the second group, respectively, this difference was statistically significant (p<0.05). In group 1, changes were statistically significant in those who were heavily and moderately exposed (p<0.05) but not in those lightly and occasionally exposed (p>0.05). In group 2, changes were not statistically significant (p>0.05)., Conclusion: The findings showed that high and moderate exposure to SHS is associated with sleep bruxism in children.

Objectives: Previous studies have found an association between bruxism and emotional and behavioral problems in children, but reported data are inconsistent. The objective of this study was to estimate the prevalence of bruxism, and of its components clenching and grinding, and its associations with mental problems and depression., Methods: Data from two Brazilian birth cohorts were analyzed: one from 869 children in Ribeirão Preto - RP (São Paulo), a more developed city, and the other from 805 children in São Luís - SL (Maranhão). Current bruxism - evaluated by means of a questionnaire applied to the parents/persons responsible for the children - was defined when the habit of tooth clenching during daytime and/or tooth grinding at night still persisted until the time of the assessment. Additionally, the lifetime prevalence of clenching during daytime only and grinding at night only was also evaluated. Mental health problems were investigated using the Strength and Difficulties Questionnaire (SDQ) and depression using the Children's Depression Inventory (CDI). Analyses were carried out for each city: with the SDQ subscales (emotional symptoms, conduct problems, peer problems, attention/hyperactivity disorder), with the total score (sum of the subscales), and with the CDI. These analyses were performed considering different response variables: bruxism, clenching only, and grinding only. The risks were estimated using a Poisson regression model. Statistical inferences were based on 95% confidence intervals (95% CI)., Results: There was a high prevalence of current bruxism: 28.7% in RP and 30.0% in SL. The prevalence of clenching was 20.3% in RP and 18.8% in SL, and grinding was found in 35.7% of the children in RP and 39.1% in SL. Multivariable analysis showed a significant association of bruxism with emotional symptoms and total SDQ score in both cities. When analyzed separately, teeth clenching was associated with emotional symptoms, peer problems, and total SDQ score; grinding was significantly associated with emotional symptoms and total SDQ score in RP and SL. Female sex appeared as a protective factor for bruxism, and for clenching and grinding in RP. Furthermore, maternal employment outside the home and white skin color of children were associated with increased prevalence of teeth clenching in SL., Conclusions: Mental health problems were associated with bruxism, with teeth clenching only and grinding at night only. No association was detected between depression and bruxism, neither clenching nor grinding. But it is necessary to be cautious regarding the inferences from some of our results., (© 2011 John Wiley & Sons A/S.)

Sleep bruxism (SB) is a common sleep-related motor disorder characterized by tooth grinding and clenching. SB diagnosis is made on history of tooth grinding and confirmed by polysomnographic recording of electromyographic (EMG) episodes in the masseter and temporalis muscles. The typical EMG activity pattern in patients with SB is known as rhythmic masticatory muscle activity (RMMA). The authors observed that most RMMA episodes occur in association with sleep arousal and are preceded by physiologic activation of the central nervous and sympathetic cardiac systems. This article provides a comprehensive review of the cause, pathophysiology, assessment, and management of SB., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Conditions that affect sleep can impact overall health. More than 70 million Americans suffer from problems with sleep. The purpose of this article is to provide the basic science of sleep physiology and how it relates to disorders that are pertinent to dentistry. Concepts are presented that explain airway dynamics and how the jaw and tongue influence airway obstruction. Additionally, explanation is given on an association between temporomandibularj aw dysfunction and bruxism during sleep.

Studies have found a higher prevalence of sleep bruxism (SB) in individuals with cognitive impairment. The aim of this study was to identify the prevalence and factors associated with the clinical manifestation of SB in children with and without cognitive impairment. The sample was made up of 180 individuals: Group 1 - without cognitive impairment; Group 2 - with Down syndrome; Group 3 - with cerebral palsy. Malocclusions were assessed based on the Dental Aesthetic Index (DAI); lip competence was assessed based on Ballard's description. The bio-psychosocial characteristics were assessed via a questionnaire and clinical exam. Statistical analysis involved the chi-square test (p < 0.05) and multivariate logistic regression. The prevalence of bruxism was 23%. There were no significant differences between the groups (p = 0.970). Individuals with sucking habits (OR [95% CI] = 4.44 [1.5 to 13.0]), posterior crossbite (OR [95% CI] = 3.04 [1.2 to 7.5]) and tooth wear facets (OR [95% CI] = 3.32 [1.2 to 8.7]) had a greater chance of exhibiting SB. Sucking habits, posterior crossbite and tooth wear facets were identified as being directly associated with the clinical manifestations of bruxism.

Duloxetine is a serotonin-norepinephrine reuptake inhibitor which is generally safe and well tolerated. Antidepressants especially selective serotonin reuptake inhibitors (SSRIs) were associated with inducing bruxism; however, duloxetine-induced bruxism has not been reported yet. Here, we report a case of duloxetine-induced bruxism in a patient with generalized anxiety disorder.

Unlabelled: The aim of this cross-over, randomized, single-blinded trial was to examine whether intra-esophageal acidification induces sleep bruxism (SB). Polysomnography with electromyogram (EMG) of masseter muscle, audio-video recording, and esophageal pH monitoring were performed in a sleep laboratory. Twelve healthy adult males without SB participated. Intra-esophageal infusions of 5-mL acidic solution (0.1 N HCl) or saline were administered. The frequencies of EMG bursts, rhythmic masticatory muscle activity (RMMA) episodes, grinding noise, and the RMMA/microarousal ratio were significantly higher in the 20-minute period after acidic infusion than after saline infusion. RMMA episodes including SB were induced by esophageal acidification. This trial is registered with the UMIN Clinical Trials Registry, UMIN000002923., Abbreviations: ASDA, American Sleep Disorders Association; EMG, electromyogram; GER, gastroesophageal reflux; LES, lower esophageal sphincter; NREM, non-rapid eye movement; REM, rapid eye movement; RMMA, rhythmic masticatory muscle activity; SB, sleep bruxism; SD, standard deviation; UES, upper esophageal sphincter.

Sleep bruxism (SB) is a parafunctional oromotor habit that can sometimes pose a threat to the integrity of the structures of the masticatory system if the magnitude and direction of the forces exerted exceed the system 's adaptive capacity. Over the years science has tried to provide a consistent explanation of the etiopathogenesis and physiopathology of SB, although the pathophysiological mechanisms are even now not yet fully understood. There is at present no specific, effective treatment to eliminate the habit of bruxism permanently. There are only palliative therapeutic alternatives steered at preventing the pathological effects of SB on the stomatognathic system and alleviating the negative clinical consequences of the habit. The objective of this article is to review and update the fundamental scientific concepts of SB and to furnish an approach to the main types of therapy used, based on the scientific literature.