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The pulsed phase locked loop (PPLL) device used to measure changes in intracranial pressure.and corresponding changes in intra-cranial diameter.
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In this study, the authors investigated the link between jaw clenching/bruxism and temporal bone movement associated with multiple sclerosis (MS). Twenty-one subjects participated in this study (10 patients with MS and 11 controls). To quantify the change in intracranial dimension between the endocranial surfaces of the temporal bones during jaw cl...
Context in source publication
Context 1
... E. Williams, D.D.S.; John E. Lynch, Ph.D.; Vidhi Doshi, B.S.; G. Dave Singh, D.D.Sc., Ph.D., B.D.S.; Alan R. Hargens, Ph.D. in overall cranial health. Moreover, modern radiographic techniques have allowed critical evaluations of compli- ance in the cranial sutures, suggesting that cranial mobil- ity is detectable. With external manipulation of the cranial vault, temporal bone movement (the mean angle of change at the squamosal suture) is about 1.75°. For example, the mastoid process moves by 1.66°, the malar line moves by 1.25° and the sphenoid bone moves by 2.4°. Other measurements indicate that this amount of movement is common in most sutures. 5 It is thought that changes in intra-cranial pressure (ICP) lead to corresponding changes in intra-cranial diameter. 6-7 These changes can be measured using a pulsed phase locked loop (PPLL) device 8 (Figure 1). The PPLL device originally was used to measure pulsatile changes in ICP. [9][10] The PPLL device transmits a 500 kHz ultrasonic tone burst through the cranium via a transducer placed on the subject's head. The tone burst passes through the cutaneous tissues, reflects off the ipsilateral intracranial temporal bone (Echo 1), passes through the intracranial contents; reflects off the endocranial surface of the temporal bone on the opposite (contralateral) side of the skull, and is received back (as Echo 2) by the originating transducer (Figure 2). Any change in cranial diameter produces a phase shift in the ultrasound sig- nal. [9][10] The PPLL processing software is designed to track changes in the phase of the ultrasonic signal as it strikes the intracranial surfaces of the temporal bones and converts those changes into an estimated target delay (∆L, change in acoustic wavelength). 8 The resulting target delay estimates are then converted into a distance measuring the intracranial distance using the equation: d =1/2v*t where t is the target delay estimate and v is the speed of sound. Thus, the time of the phase shift is converted into millimeters of movement (d) of the temporal bones (change in acoustic wavelength, ...
Citations
... Williams et al. [20] 4 Ferreira et al. [21] 4 Choi et al. [22] 6 Verhoeff et al. [23] 7 Handa et al. [24] 5 Alvater Ramos [25] 3 ...
... The general quality of the included studies ranged from low [19][20][21][22]24,25,27,28] to moderate [27,29]. It should be considered that the low quality of the selected evidence is likely related to the great heterogeneity among studies for the methodologies, diagnostic tools and rehabilitation treatment administered. ...
... The latter tends to increase when occlusion is impaired, also contributing to head and neck pain. In this context, some studies hypothesized that the augmented mobility of cranial bones due to reduced bone mass density, especially in the temporal ones, expands and contracts during bruxism, increasing intracranial pressure, which can favor brain damage [20]. Another mechanism that can be involved in the pathogenesis of TMD or SD in MS patients is cerebellar dysfunction. ...
Patients affected by neurological disorders can develop stomatognathic diseases (SD) related to decreased bite force and quality of mastication, bruxism, severe clicking and other temporomandibular disorders (TMD), which deeply affect patients’ swallowing, masticatory and phonation functions and, therefore, their quality of life. The diagnosis is commonly based on medical history and physical examination, paying attention to the temporomandibular joint (TMJ) range of movements, jaw sounds and mandibular lateral deviation. Diagnostic tools such as computed tomography and magnetic resonance imaging are used instead in case of equivocal findings in the anamnesis and physical evaluation. However, stomatognathic and temporomandibular functional training has not been commonly adopted in hospital settings as part of formal neurorehabilitation. This review is aimed at describing the most frequent pathophysiological patterns of SD and TMD in patients affected by neurological disorders and their rehabilitative approach, giving some clinical suggestions about their conservative treatment. We have searched and reviewed evidence published in PubMed, Google Scholar, Scopus and Cochrane Library between 2010 and 2023. After a thorough screening, we have selected ten studies referring to pathophysiological patterns of SD/TMD and the conservative rehabilitative approach in neurological disorders. Given this, the current literature is still poor and unclear about the administration of these kinds of complementary and rehabilitative approaches in neurological patients suffering from SD and/or TMD.
... Previous studies linked jaw clenching/bruxism and temporal bone movement in patients with MS. The displacement of cranial bones can cause fluid pressure changes in the ventricles and damage brain tissue around them [27]. As a result of this mechanical stress, osteoclast-mediated bone resorption can be accelerated [28], creating conditions for caries to install. ...
Background:
Multiple sclerosis is an autoimmune disease of the central nervous system with neurological and motor symptoms that affect the orofacial region. The aim of this work is to present a patient that lacks the three classic orofacial manifestations but has other less common clinical alterations.
Case presentation:
A 49-year-old female patient diagnosed with long-term relapsing-remitting multiple sclerosis visited the dentist complaining of mild but persistent orofacial pain including the temporomandibular joint and pain not specific to any tooth. She presented mucosal irritation, xerostomia, halitosis, and localized gingivitis. There was excessive wear of the upper and lower incisal edges and the occlusal faces of the upper canines and loss of six teeth due to caries. After a clinical oral examination, the diagnosis was temporomandibular joint disorder, gingivitis, dental hypersensitivity, bruxism, hyposalivation, xerostomia, and halitosis.
Conclusions:
Patients with multiple sclerosis present classic orofacial manifestations. Although these were not observed in this patient, she had others, such as gingivitis, tooth hypersensitivity, and bruxism. In addition, despite few studies associating a higher prevalence of caries with these patients, the number of carious and missing teeth in this patient highlight the evidence that multiple sclerosis has had a significant impact on the patient's dental status over the years.
... Indeed, it has been suggested that proprioceptive alterations and cerebellar ataxia (deficits in the voluntary coordination of mus- cle movements),23as well as bruxism and para-functional habits47may contribute to an increased susceptibility of TMDs in people with multiple sclerosis. For instance, one study reported a higher prevalence of bruxism and para-functional habits in people with multiple sclerosis,22contributing to further motor impairments of the oro-facial system. ...
Objectives:
Despite more than 25 years of research focused on this topic, it remains unclear whether people with multiple sclerosis are more likely to present with oral health problems. The aim of this study was to provide the first systematic review of this literature.
Methods:
A literature search for studies focused on oral health and multiple sclerosis was conducted using PRISMA guidelines. Electronic databases (PubMed, Scopus, Web of Science, MEDLINE and CINAHL) were searched up until February 2019. Two independent coders extracted data, and study quality graded using the Newcastle-Ottawa Scale (NOS).
Results:
From 1281 articles identified, 17 met all the eligibility criteria. Of the seventeen studies, more than half included a nonclinical control group, and the majority were observational studies. The included studies were of poor to moderate quality. Taken together, the results provided only very limited evidence that people with multiple sclerosis are more likely to present with dental caries and gingival disease. There was suggestive evidence that people with multiple sclerosis may be at higher risk of periodontal disease and present with poorer oral hygiene, and moderate evidence for an association between multiple sclerosis and temporomandibular disorders.
Conclusions:
This systematic review provides evidence of an association between multiple sclerosis and at least some oral health problems. When temporomandibular disorders and periodontal status specifically have been assessed, most studies provide evidence of an association with multiple sclerosis. However, this review also clearly highlights the need for further, high-quality studies in this area.
... According to a recent systematic review on its epidemiology, the prevalence of the bruxism ranges from about 8 to 31.4% with no gender differences [3]. Although the pathogenesis of bruxism is not completely understood, current evidence suggests it may be related to central events, which are manifested peripherally [4,5], thus involving both the peripheral (morphological), and central (pathophysiological and psychosocial) factors [6]. While previous epidemiological studies show that bruxism is associated with restless sleep, sleeping with the lights on, loud snoring, heavy alcohol use, caffeine intake, smoking, anxiety, and stress [7][8][9], seasonal variation in bruxism symptoms has not been tested and reflects a major niche in our understanding and the epidemiology of bruxism. ...
Objective
Seasonality of bruxism and its symptoms has not been tested and reflects a major niche in our understanding and the epidemiology of bruxism. Our aim is to use the Google Trends data to examine whether there was a seasonal pattern in the Google search volumes of bruxism and its symptoms on a population basis.
Methods
In the observational, ecological research, we interrogated Google Trends for the following query terms: [bruxism] and [teeth grinding + teeth clenching] to obtain the internet search query volume. These queries were searched within the USA, the UK, Canada, and Australia from January 2004 to December 2017.
Results
The cosinor analysis showed statistically significant seasonal patterns in [bruxism] in the USA (amplitude {A} = 1.91, p = 0.003), Canada (A = 1.91, p < 0.001), and Australia (A = 2.25, p < 0.001), and a trend towards a seasonal variation in the UK (A = 1.11, p = 0.032), with a peak in the winter months and trough in the summer months. Similarly, a statistically significant seasonal variation was found in [teeth grinding + teeth clenching] in the USA (A = 5.54, p < 0.001), the UK (A = 4.36, p < 0.001), and Australia (A = 3.11, p < 0.001), and a trend towards a seasonal variation in Canada (A = 1.53, p = 0.034). The peaks in winter and troughs in summer were reversed by 6 months in countries of northern hemisphere compared to Australia. Time series plots emphasized the consistency of seasonal trend that was ascertained in the cosinor analysis, by repeating in nearly all years.
Conclusion
The preliminary evidence showed a seasonal variation in bruxism and its symptoms, with a peak in the winter months. This novel finding in bruxism epidemiology requires to be verified with clinical studies, and further researches are necessary to elucidate the potential mechanism behind seasonal variation in bruxism.
... Based on the literature, the number of studies investigating the coexistence of MS and bruxism is limited. In a recent study including a small sample population, researchers reported that temporal bone displacement was observed to be greater in MS patients than those in the control group, and the authors asserted that episodic attacks of bruxism were associated with the increases seen in intracranial pressure triggering demyelination in MS patients 17 . ...
Objective:
To determine the prevalence of bruxism and related factors in patients with multiple sclerosis (MS).
Methods:
Diagnosed with relapsing-remitting MS under the 2010-revised McDonald diagnostic criteria, 182 patients without MS exacerbations during the previous three months were included in the patient group, and 145 healthy individuals made up the control group in the study. Demographic data of the participants in both groups were determined. In the patient and control groups, the diagnosis of definite bruxism was made using the International Classification of Sleep Disorders (Diagnosis and Coding Manual, Second Edition).
Results:
Bruxism was found in 29.7% (n = 54) of the patients and in 12.4% (n = 18) of the controls, and the difference was statistically significant (p < 0.001). Of all patients, the onset of bruxism was found in 70.4% (n = 38) after the diagnosis and in 29.6% (n = 169) prior to the diagnosis of MS. Compared with those without bruxism, the mean age (p = 0.031) and the score of the Expanded Disability Status Scale (p = 0.001) were also significantly higher among MS patients with bruxism. Between MS patients with and without bruxism, no significant differences were found in terms of sex, marital status, educational status, employment, cigarette smoking, total number of exacerbations, number of exacerbations within the previous year, and drugs used.
Conclusions:
The frequency of bruxism was found to be higher in the patients with MS than in the controls. Bruxism is associated with age and the Expanded Disability Status Scale score in MS patients.
... although there is some evidence that hyper-mobility of the skull is possible, 3 the fixed volume of the intracranial space and the high velocity and pressure of the arterial input is the main driving force for capillary perfusion. The venous response and cerebrospinal fluid oscillations provide a buffer for this driving force, which facilitates readiness for new input without reflux or stasis in intracranial blood flow. ...
Non-invasive intracranial vascular imaging is essential for studying neurovascular diseases such as stroke, dementia, Parkinson's disease, headache, idiopathic intracranial hypertension, Menière's disease, and vascular malformations. In this article, we aimed for the reader to gain an understanding of dural sinus and cortical vein anatomy and explore venous imaging using a new interleaved MR angiographic sequence as well as susceptibility weighted imaging and quantitative susceptibility mapping.
... There have been reports of temporomandibular joint (TMJ) problems in the maxillofacial area and pain in the face area of MS patients (29,53,54). It was shown that jaw clenching and bruxism seen in MS patients may affect temporal bones, causing enlargement of cranial cavity (55). A study using 50 MS patients showed that MS may play an etiological role in TMJ disorders (29). ...
Multiple sclerosis (MS) is an inflammatory, demyelinating condition affecting the central nervous system. MS exhibits characteristics of an auto-immune disease. Etiology of this condition remains unknown but environmental and genetic factors are often thought to be responsible. A possible relationship between dentistry and MS has often been mentioned in the literature. Special attention and interdisciplinary cooperation are required in the diagnosis of MS and the application of dental treatments in order to optimize general and dental health status of patients with MS. In this review, MS-dental related studies and recommendations for dental treatment approaches for individuals with MS are discussed.
Link (Eng):
http://www.journalagent.com/tjn/pdfs/TJN_21_1_1_6%5BA%5D.pdf
Link (Tur):
http://www.journalagent.com/tjn/pdfs/TJN_21_1_1_6.pdf
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.
