CLINICAL

RESEARCH
Impact of Sleep Bruxism on Oral
Health–Related Quality of Life
Koong Jiunn Tay, MDS
Dental Branch, Singapore Armed Forces Medical Corps;
National University Centre for Oral Health, Singapore.

Yap Adrian Ujin, MSc, PhD, Grad Dip Psychotherapy

Department of Dentistry, Ng Teng Fong General Hospital, National University Health System;
National University of Singapore; National Dental Centre Singapore, Singapore.

Patrick Finbarr Allen, BDS, MSc, PhD

Faculty of Dentistry, National University of Singapore; National University Centre for
Oral Health, Singapore.

Purpose: To determine the prevalence of possible tooth grinding (TG) and possible sleep bruxism (SB) and
to examine their impacts on oral health–related quality of life (OHRQoL) among Asian adults. Materials and
Methods: A total of 3,072 subjects (18 to 65 years of age) from 12 dental centers were invited to complete
a self-administered questionnaire on TG/SB and OHRQoL, and 2,417 were included in the study. Participants
were subsequently categorized into three groups (no TG/SB, possible TG, and possible SB) based on the
International Classification of Sleep Disorders. The 14-item Oral Health Impact Profile (OHIP-14) severity,
extent, and prevalence scores were subsequently computed and compared. Data were examined using
Kruskal-Wallis and Mann-Whitney U tests, Spearman correlation, and univariate regression analysis (P < .05).
Results: Of the 2,417 subjects (mean age 24.79 ± 7.49 years), 42.82% reported either possible TG (n = 921;
38.11%) or possible SB (n = 114; 4.72%). Significant differences in global and domain OHIP-14 scores were
found between the groups, except for the extent scores in functional limitation and physical disability. Mean
global severity scores of the possible SB group (9.36 ± 9.45) were 1.5- and 2.2-fold larger than the possible
TG (6.39 ± 7.61) and no TG/SB (4.22 ± 6.15) groups, respectively. A significant but weak correlation (r = 0.14
to 0.19) was found between the number of positive responses for TG/SB and OHIP-14 severity scores.
Conclusions: A high prevalence of possible TG and SB was found among the Asian cohort studied. Possible
TG and SB were significantly associated with poorer OHRQoL. The physical pain, psychologic discomfort,
and psychologic disability domains were most influenced by TG/SB. More epidemiologic studies on the
functional, physical, and psychosocial influences of SB are required. Int J Prosthodont 2020;33:285–291.
doi: 10.11607/ijp.6782

B
ruxism is a repetitive masticatory muscle activity characterized by clenching or
grinding of the teeth and/or bracing or thrusting of the mandible. Experts have
recently proposed distinct definitions for sleep and awake bruxism depending
on the circadian phenotype.1 Sleep bruxism (SB) is defined as a masticatory muscle
activity during sleep that is rhythmic (phasic) or nonrhythmic (tonic) and is not a move- Correspondence to:
ment or sleep disorder in otherwise healthy individuals. Conversely, awake bruxism is Dr Koong Jiunn Tay
27 Medical Drive
defined as a masticatory muscle activity during wakefulness that is characterized by
#08-01 Singapore 117510
repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible Email: koongjiunn@gmail.com
and is not a movement disorder in otherwise healthy individuals.2 A modified grading
Submitted October 23, 2019;
system for SB has been proposed that categorizes SB as possible, probable, or defi-
accepted January 10, 2020.
nite based on a combination of self-report and clinical assessment.2 SB is a complex ©2020 by Quintessence
phenomenon associated with multiple etiologic factors.3 It is believed to be centrally Publishing Co Inc.

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 Clinical Research
regulated with biologic and psychosocial contributing
factors.4,5 Although several recent studies6–9 have pro-
posed psychosocial factors to be the major cause, more
epidemiologic studies are needed to confirm this.
The prevalence of SB ranges from 9.3% to 15.3%
based on self-report questionnaires.10,11 Epidemiologic
studies using polysomnography or electromyography
are rare.10,11 A study on 1,042 adults in Brazil using both
questionnaires and polysomnography reported a 5.5%
prevalence of SB.12 Prevalence of self-reported brux-
ism was found to be higher among Asian when com-
pared to Caucasian and Hispanic subjects.13 Although
the prevalence of SB in Asian countries may differ from
North America and Europe,14 studies on SB in Asian
populations are largely limited.10
SB can be determined by instrumental and nonin-
strumental approaches.2 Instrumental methods include
assessment of masticatory muscle activity, heart rate
variability, and respiratory parameters.2 Noninstru-
mental methods encompass self-reported question-
naires and interviews of patients or sleep partners.14,15
Self-reported assessments remain the most utilized
instrument for SB, as they are more convenient and
economical for both clinical and research settings.2
Moreover, self-reported bruxism has strong positive
correlations with clinical diagnostic instruments.16–18
These instruments are also critical for understanding
the pathophysiology of bruxism and its interaction with
psychologic factors.2,16,19
SB has many detrimental effects on the stomato-
gnathic system and is associated with physical pain, dys-
function, and temporomandibular disorders (TMD).19–21
It is related to systemic health and linked to rapid eye
movement behavior disorders and obstructive sleep ap-
nea.2,10,11,22 Furthermore, SB may affect quality of life,
especially the functional and psychologic domains.23,24
However, large population studies on the impact of SB
on quality of life are lacking. The 14-item Oral Health Im-
pact Profile (OHIP-14) is the most widely used measure
for sleep- and bruxism-related research.23–27 It is a vali-
dated instrument measuring the biologic, psychologic,
social, and cultural aspects of health.28 Assessment of
OHRQoL is key to understanding the impact of diseases
at the patient level. This enables health care providers to
focus on specific aspects of well-being in the presence
of disease while caring for patients.25,26 The common
approach to analyzing OHRQoL data using mean global
(total) and domain scores is believed to be incomplete
and ineffective, as they do not provide insight into the
impact on oral health.29,30 The OHIP-14 and its indi-
vidual domains could be more meaningfully analyzed in
terms of severity, extent, and prevalence scores.31
There is a paucity of epidemiologic studies on SB in
Asian populations. Studies on SB and OHRQoL tend to
focus more on children and TMD patients.23 Studies on
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military cohorts are also scarce, with prior work indicat-
ing a bruxism prevalence of 69% and 20% in air crew
and navy personnel, respectively.32,33 A high preva-
lence of TMD (36%), which is associated with SB, was
also observed among Asian military populations.34 SB
is deemed be a stress coping strategy among military
personnel and is believed to be related to psychologic
well-being and OHRQoL.34,35
The aims of this study were to determine the preva-
lence of possible tooth grinding (TG) and possible SB
and their impacts on OHRQoL among military person-
nel. The association between TG/SB and OHRQoL was
also examined. The null hypotheses were as follows: the
prevalence of possible TG and possible SB would be low
among Asian military personnel; TG and SB would not
impact OHRQoL; and there would be no association be-
tween the number of positive responses for TG/SB and
OHIP-14 severity scores.
MATERIALS AND METHODS
Study Design
This cross-sectional observational study was conduct-
ed across 12 dental centers of the Singapore Armed
Forces. Approval for the study was attained from the
Institutional Review Board, and informed consent was
obtained from all participants. Personnel who visited
the dental centers for regular check-ups and dental
treatment were invited to complete a questionnaire. The
self-administered questionnaires included demographic
information, symptoms of TG and SB, and the OHIP-14.
Exclusion criteria included personnel with serious medi-
cal and psychologic conditions deemed medically unfit
for any form of military service according to the military
physical employment standards.
Assessment of Sleep Bruxism
Self-reported SB was evaluated using the Diagnostic
Criteria of the International Classification of Sleep Dis-
orders (ICSD-3).22 Participants were asked three ques-
tions about the presence or absence of TG or bruxism
during sleep, presence of muscular discomfort, and
presence of loud grinding noises. Participants were cat-
egorized into one of three separate groups: no TG/SB
(when they answered “no” to all questions), possible
TG (when they answered “yes” to any of the questions),
and possible SB (when they answered “yes” to all three
questions) based on the recent international consensus
on bruxism.1,2
Assessment of OHRQoL
OHRQoL was determined using the OHIP-14 ques-
tionnaire.28 The 14-item questionnaire assesses seven
distinct domains (functional limitation, physical pain,
psychologic discomfort, psychologic disability, physical

disability, social disability, and handicap). Each domain
was appraised by two questions that were scored us-
ing a 5-point Likert scale (0 = never; 4 = very often),
based on their experience in the past month. OHRQoL
was evaluated by OHIP-14 severity, extent, and preva-
lence scores.31 OHIP-14 global (total response for all
14 questions) and domain scores were computed as
proposed by Slade et al.31 Severity is the summation of
the responses based on the Likert scale. The total score
can range from 0 to 56, with higher scores indicat-
ing poorer OHRQoL. Extent is the number of responses
answered with fairly often or very often (FOVO), while
prevalence is the percentage of participants reporting
FOVO.
Statistical Analyses
Data from the finished questionnaires were entered
using Microsoft Excel and anonymized by removing
all unique identifiers. Incomplete questionnaires with
one or more missing entries were discarded. Data were
exported and analyzed using SPSS 25.0 statistical soft-
ware (IBM) with probability of Type I error set at .05.
Normality of data was examined using the Kolmogorov-
Smirnov test. As data were not normally distributed,
nonparametric statistical analyses were employed.
Kruskal Wallis test, post hoc Mann-Whitney U test, and
chi-square test were performed to determine significant
differences in OHRQoL outcomes (ie, OHIP-14 severity,
extent, and prevalence scores) among the three groups
(ie, no TG/SB, possible TG, and possible SB). The signifi-
cance level was adjusted to .017 with Bonferroni cor-
rection to account for multiple variable comparisons.
Associations between the number of positive responses
for TG/SB and OHIP-14 severity scores were examined
using Spearman correlation test (P < .05). Univariate
regression analysis provided quantification of the rela-
tionship between the number of positive responses for
TG/SB and OHIP-14 severity scores.
RESULTS
A total of 3,072 subjects were invited to participate in
the study, and 2,739 completed the survey (response
rate of 89.16%). After discarding incomplete question-
naires, data from 2,417 participants were utilized for
this study, including 2,360 men (mean age 24.54 ±
7.16 years of age) and 57 women (mean age 35.89 ±
11.85 years of age) (Table 1). The prevalence rates of
no TG/SB (n = 1,382), possible TG (n = 921), and pos-
sible SB (n = 114) were 57.18%, 38.10%, and 4.72%,
respectively.
Significant differences in OHIP-14 global and domain
severity scores (P < .001) were observed among the
three groups (Table 2). Subjects with possible SB had sig-
nificantly higher global severity scores (ie, poorer quality
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Tay et al
Table 1   Distribution of Subjects
No. No Possible Possible
(%) TG/SB TG SB
Men 2,360 (97.64) 1,347 (55.73) 903 (37.36) 110 (4.55)
Women 57 (2.36) 35 (1.45) 18 (0.74) 4 (0.17)
Total 2,417 (100) 1,382 (57.18) 921 (38.10) 114 (4.72)
TG = tooth grinding; SB = sleep bruxism.
of life) compared to those with possible TG (P < .001)
and no TG/SB (P < .001). Mean global severity scores of
the possible SB group (mean 9.36 ± 9.45) were 1.5- and
2.2-fold larger than the possible TG (mean 6.39 ± 7.61)
and no TG/SB (mean 4.22 ± 6.15) groups, respectively.
Post hoc Mann-Whitney U test showed that subjects
with possible SB had significantly greater global OHIP-
14 scores than those with possible TG (P < .001). The
latter group in turn had a significantly greater score
than those with no TG/SB (P < .001). For the SB group,
the highest mean severity scores were observed for the
physical pain, psychologic discomfort, and psychologic
disability domains.
For OHIP-14 extent (FOVO) scores, significant differ-
ences were observed for global OHIP (P < .001) and
all domains (P < .001) apart from functional limita-
tion (P = .055) and physical disability (P = .596) (Table
3). Subjects with possible SB had significantly greater
mean global extent scores than those with possible TG
(P < .001) and no TG/SB (P < .001). The highest mean
extent scores were again observed in the physical pain,
psychologic discomfort, and psychologic disability do-
mains for the possible SB group.
Significant differences were also observed for OHIP-
14 prevalence (FOVO) scores (P < .001) among the
three groups (Table 4). Subjects with possible SB had
significantly greater global prevalence scores than the
TG (P < .001) and no TG/SB (P < .001) groups. Among
the various domains, the highest prevalence (FOVO)
scores were again noted for the psychologic discomfort
(11.40%), psychologic disability (9.65%), and physical
pain (7.89%) domains in the possible SB group.
The number of positive responses for possible TG/SB
was significantly correlated with OHIP-14 severity scores
(P < .05), though the correlation was weak (r < 0.19)
(Table 5). Correlation coefficients for the various do-
mains ranged from 0.14 to 0.17, with the physical pain
domain being the highest. Regression analysis also
showed significant positive relationships between re-
sults for global OHIP (P < .001) and all domains with
positive responses for TG/SB (P < .001). The most af-
fected domain was physical pain (β = 0.26), followed
by psychologic discomfort (β = 0.25), psychologic dis-
ability (β = 0.22), functional limitation (β = 0.18), handi-
cap (β = 0.18), social disability (β = 0.17), and physical
disability (β = 0.16).
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 Clinical Research

Table 2   Mean and Median OHIP-14 Severity Scores for the Three Groups
No TG/SB Possible TG Possible SB
Mean ± SD Median (IQR) Mean ± SD Median (IQR) Mean ± SD Median (IQR) P
Global OHIP 4.22 ± 6.15 1.00 (6.00) 6.39 ± 7.61 3.00 (11.00) 9.36 ± 9.45 6.00 (13.25) < .001
Functional limitation 0.58 ± 1.01 0.00 (1.00) 0.93 ± 1.26 0.00 (2.00) 1.07 ± 1.30 0.00 (2.00) < .001
Physical pain 0.92 ± 1.35 0.00 (2.00) 1.30 ± 1.49 1.00 (2.00) 1.89 ± 1.63 2.00 (3.00) < .001
Psychologic discomfort 0.95 ± 1.41 0.00 (2.00) 1.35 ± 1.63 1.00 (2.00) 1.78 ± 1.83 2.00 (2.00) < .001
Physical disability 0.47 ± 1.04 0.00 (0.00) 0.73 ± 1.23 0.00 (2.00) 1.04 ± 1.40 0.00 (2.00) < .001
Psychologic disability 0.57 ± 1.07 0.00 (1.00) 0.85 ± 1.32 0.00 (2.00) 1.40 ± 1.65 1.00 (2.00) < .001
Social disability 0.37 ± 0.91 0.00 (0.00) 0.62 ± 1.13 0.00 (1.00) 1.09 ± 1.70 0.00 (2.00) < .001
Handicap 0.37 ± 0.86 0.00 (0.00) 0.60 ± 1.09 0.00 (1.00) 1.08 ± 1.69 0.00 (2.00) < .001
SD = standard deviation; IQR = interquartile range.
All P values were significant (Kruskal Wallis test; P < .017 after Bonferroni correction).

Table 3   Mean and Median OHIP-14 Extent (FOVO) Scores for the Three Groups
No TG/SB Possible TG Possible SB
Mean ± SD Median (IQR) Mean ± SD Median (IQR) Mean ± SD Median (IQR) P
Global OHIP 0.19 ± 0.81 0.00 (0.00) 0.32 ± 1.13 0.00 (0.00) 0.58 ± 1.65 0.00 (0.00) < .001a
Functional limitation 0.02 ± 0.14 0.00 (0.00) 0.03 ± 0.19 0.00 (0.00) 0.02 ± 0.13 0.00 (0.00) .055
Physical pain 0.04 ± 0.23 0.00 (0.00) 0.06 ± 0.27 0.00 (0.00) 0.09 ± 0.31 0.00 (0.00) .001a
Psychologic discomfort 0.07 ± 0.28 0.00 (0.00) 0.11 ± 0.37 0.00 (1.00) 0.15 ± 0.45 0.00 (0.00) .004a
Physical disability 0.02 ± 0.17 0.00 (0.00) 0.02 ± 0.17 0.00 (0.00) 0.04 ± 0.26 0.00 (0.00) .596
Psychologic disability 0.03 ± 0.17 0.00 (0.00) 0.05 ± 0.25 0.00 (0.00) 0.12 ± 0.40 0.00 (0.00) .001a
Social disability 0.01 ± 0.13 0.00 (0.00) 0.02 ± 0.18 0.00 (0.00) 0.07 ± 0.34 0.00 (0.00) .003a
Handicap 0.02 ± 0.12 0.00 (0.00) 0.03 ± 0.18 0.00 (0.00) 0.01 ± 0.38 0.00 (0.00) < .001a
Extent scores were considered the number of fairly often or very often (FOVO) responses.
aSignificant (Kruskal-Wallis test; P < .017 after Bonferroni correction).

DISCUSSION Italy and reported prevalence rates of 8.2% and 4.4%

Prevalence of Possible TG/SB
The prevalence of possible TG/SB was high (42.82%)
in the Asian military cohort studied. The presence of
possible TG/SB was found to negatively affect OHRQoL,
especially the physical pain, psychologic discomfort,
and psychologic disability domains. Subjects with pos-
sible SB had the highest global and domain OHIP-14
scores. Although the number of positive responses for
TG/SB was significantly correlated with the OHIP-14 se-
verity scores, the relationship was weak. In view of the
aforementioned, the three null hypotheses were duly
rejected.
The present study used the diagnostic grading system
for SB proposed by Lobbezoo et al.1,2 A substantially
higher prevalence of possible TG (38.11%) and simi-
lar occurrence of possible SB in the present study was
noted (4.72%) when compared to the study by Ohay-
on et al,15 who conducted a telephone survey involv-
ing subjects from the United Kingdom, Germany, and
for possible TG and possible SB, respectively.15 System-
atic reviews of epidemiologic studies have reported a
slightly higher SB prevalence of 9.3% to 15.3%.10,11 The
variance could be attributed to disparities in assessment
methodology, diagnostic criteria, and study population,
as well as the differentiation between TG and SB. The
higher prevalence of TG/SB observed in the present
study may be contributed in part by military environ-
ment stress, which increases risk of bruxism.32,35
OHIP-14 Severity Scores
Significant differences in OHIP-14 global severity scores
were observed between the no TG/SB, possible TG,
and SB groups (P < .001). Subjects with possible SB had
the highest mean global OHIP-14 scores, indicating the
poorest quality of life. The findings concurred with two
other studies conducted in Brazil and China conveying
the negative impact of SB on OHRQoL, with bruxers
having worse quality of life compared to nonbrux-
ers.23,24 SB has many negative health consequences,

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 Tay et al

and several studies have labelled it Table 4   OHIP-14 Prevalence (FOVO) for the Three Groups
as a potential disorder or temporo- Prevalence, % (n)
mandibular disorders (TMD) risk
No TG/SB Possible TG Possible SB P
factor.2 Understanding the influ-
Global OHIP 9.48 (131) 13.79 (127) 19.30 (22)) < .001
ence of SB on OHRQoL has major
clinical implications and is essential Functional limitation 1.74 (24) 3.26 (30) 1.75 (2) < .001
for patient-centered care.26 Despite Physical pain 2.75 (38) 5.10 (47) 7.89 (9) < .001
this, the impact of SB on the various Psychological discomfort 5.86 (81) 9.01 (83) 11.40 (13) < .001
domains of quality of life in the gen- Physical disability 1.16 (16) 1.63 (15) 1.75 (2) < .001
eral adult population has not been
Psychological disability 2.32 (32) 3.80 (35) 9.65 (11) < .001
commonly explored.
Social disability 0.94 (13) 2.17 (20) 4.39 (5) < .001
Significant differences in all func-
tional, physical, and psychosocial Handicap 1.52 (21) 2.50 (23) 7.02 (8) < .001
domains were observed between The percentage of participants answering fairly often or very often (FOVO).
All P values were significant (Kruskal Wallis test; P < .017 after Bonferroni correction).
subjects with and without possible
TG/SB in the present study (Table 2).
A related study, however, reported
significant differences only in the Table 5   Correlation and Univariate Regression Analyses of Possible
functional limitation, physical disabil- TG/SB and OHIP-14
ity, and handicap domains.24 Unlike No. of positive responses for TG/SB
the current study, which comprised Spearman correlation Regression analysis
a large sample of 2,417 healthy mili-
Severity scores r values β
tary personnel, the earlier study was
conducted in 515 TMD patients. Global OHIP 0.19 1.43
Functional limitations and pain are Functional limitation 0.15 0.18
interlinked with psychologic status Physical pain 0.17 0.26
among subjects with TG/SB and Psychologic discomfort 0.15 0.25
may be associated with TMD.5 It has Physical disability 0.14 0.16
been postulated that psychoemo-
Psychologic disability 0.16 0.22
tional factors (ie, anxiety, stress,
depression) could influence the de- Social disability 0.14 0.17
velopment of SB.4,6,7 Although the Handicap 0.15 0.18
association between SB and psycho- All values were statistically significant (P < .05).
Univariate regression analysis: independent variable = number of positive responses for TG/SB;
social factors has been established, dependent variable = global OHIP and individual domain severity scores.
the studies were limited to chil-
dren and adolescents.36This study,
which heeded the international call
for more epidemiologic studies,5,9 each domain, the number of responses reporting FOVO (ie, extent score), as
showed that SB impacted the func- well as the percentage of participants reporting FOVO (ie, prevalence), were
tional, physical, and psychosocial tabulated (Tables 3 and 4).
domains of OHRQoL in Asian adults. Significant differences in OHIP-14 extent and prevalence scores were gen-
erally observed between subjects with no TG/SB, possible TG, and possible
OHIP-14 Extent and Prevalence SB. Differences in extent scores for the functional limitation and physical
Scores disability domains were, however, not significant among the three groups.
Interpretation of data in earlier This incongruity with OHIP severity scores can be attributed to the distribu-
OHRQoL studies may be incom- tion of FOVO responses for these domains. The highest global OHIP preva-
plete, as the reporting of significant lence scores were observed for the possible SB group. Approximately one
differences based on means or me- in five subjects (19.30%) with possible SB reported that their quality of life
dians alone is not meaningful.29,30 was often affected. This contrasted with 13.73% and 9.48% among the
There is a need to determine what is possible TG and no TG/SB subjects. The poorer OHRQoL may be attributed
clinically important instead of focus- to the biologic, physical, esthetic, and other consequences of SB, includ-
ing on hypothesis testing.26,30 This ing TMD-related pain/dysfunction and tooth wear, as well as compromised
study followed Slade’s recommen- dental and facial appearance.21 Such effects of SB also explain in part the
dations to analyze specific variables higher prevalence (FOVO) for the psychologic and physical pain domains in
of OHIP-14 and its domains.31 For the possible SB group.

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 Clinical Research
Relationship Between SB and OHRQoL
A relatively higher proportion of possible SB subjects
complained of psychologic discomfort (self-conscious
and tense), psychologic disability (difficult to relax and
embarrassed), and physical pain (pain and discomfort)
domains compared to the other groups. This suggests
that possible SB subjects had a greater tendency of psy-
chosocial, emotional, and pain impairments. Psycholog-
ic factors have been implicated in the etiology of SB.5,8
Recent cross-sectional and longitudinal studies have
confirmed the connection between polysomnography-
determined SB and psychopathologic status.37,38 The
association was, however, nonlinear and complex.37,38
Centrally regulated SB motor activity could be triggered
by chronic stress and negative emotions.4,7 Further-
more, bruxers with high anxiety and stress are prone to
developing TMD.5,7,8,39 Long-term prospective studies
are necessary to confirm the cause and/or effect rela-
tionships between SB and psychologic factors.9,39 Such
studies are, however, technically challenging and expen-
sive to conduct, especially if instrumental assessment of
SB, such as sleep polysomnography, is involved.2
Correlations between the number of positive re-
sponses for possible TG or SB and OHIP-14 severity
scores were significant. The strength of association was,
however, weak for global OHIP and all domains. The
highest correlations were observed for physical pain
and psychologic disability. Findings from the regression
analysis were consistent with the physical pain, psycho-
logic discomfort, and psychologic disability domains,
accounting most for the probability of possible SB.
Nonetheless, a recent systematic review concluded that
the association between SB and anxiety in adults is still
controversial, although some specific symptoms of the
anxiety disorders spectrum could be linked to probable
SB.40 Other factors consistently related to SB, including
the use of alcohol, caffeine, tobacco, and some psy-
chotropic medications, as well as gastro-oesophageal
reflux and TMD, might also influence OHRQoL and war-
rant further investigation.40
Limitations of Study
This cross-sectional study focused on a military popula-
tion with possible gender bias in view of the greater
number of men in the military. The presence of other
oral conditions like periodontal disease, dental caries,
and tooth loss might influence OHRQoL and should ide-
ally be assessed. The military cohort, however, consisted
of healthy adults who were deemed dentally fit with few
significant oral health issues upon active deployment.
Possible TG or SB might still be the major contributing
factor among those affected. Given the cross-sectional
design of the study, a causal relationship between TG/
SB and poorer OHRQoL cannot be established without
further research. Although the study provided valuable
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knowledge on the influence of possible TG or SB on
OHRQoL, the study needs to be expanded to incorpo-
rate the civilian population before results can be gener-
alized. As the study utilized only self-report assessments,
the term “possible” TG or SB was duly adopted.2 Future
studies could incorporate clinical examinations for signs
and symptoms of SB, including tooth wear, to attain a
diagnostic grade of probable SB.2 The gold standard for
diagnosing SB, which gives the grade of definite SB, is
sleep polysomnography.2 International consensus has,
however, supported the use of a noninstrumental ap-
proach for assessing SB due to feasibility reasons.2 The
noninstrumental and self-reported approach has shown
high validity and positive correlations with clinical in-
struments in several studies.16–18,41
This study addressed some of the inadequacies of
other related studies, including poor reporting of inclu-
sion/exclusion criteria, questionable diagnostic criteria,
and lack of standardized SB classification.10 The cur-
rent study is the only large-scale study on the impact of
SB on OHRQoL among Asian adults. Furthermore, the
determinants of OHRQoL were comprehensively ana-
lyzed based on OHIP-14 severity, extent, and prevalence
scores.
CONCLUSIONS
The present study examined the prevalence of possible
TG/SB and their impact on OHRQoL. Within the limita-
tions of this study, a high prevalence of possible TG and
SB was found in the Asian cohort. Subjects with pos-
sible TG and SB had poorer OHRQoL. Physical pain, psy-
chologic discomfort, and psychologic disability domains
were most influenced by TG or SB. More epidemiologic
studies on the functional, physical, and psychosocial
impacts of SB on OHRQoL are still required and should
incorporate both qualitative and quantitative OHRQoL
assessments.
ACKNOWLEDGMENTS
The authors declared no conflicts of interest and received no specific
funding for this work. This research was approved by the Institution-
al Review Board (S32B/407-3DEN). Informed consent was obtained
from all participants included in the study.
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Literature Abstract

Occlusal Migration of Teeth Adjacent to Implant Prostheses in Adults: A Long-Term Study

The purpose of this study was to evaluate the effect of continuous tooth eruption on the outcomes of single-implant–supported
restorations in the anterior maxillae of adults. A total of 76 patients aged 21 to 78 years treated with single-implant–supported restorations
in the esthetic zone were included. Radiographs obtained at crown placement and follow-up examinations from 1 to 15 years postloading
were analyzed with regard to vertical incisal plane changes of the implant-supported crown relative to adjacent teeth. Infraocclusion
increased over time by 0.08 ± 0.02 mm/year. Infraocclusion was more pronounced (P = .04) for delayed (0.09 mm/year) vs immediate
(0.06 mm/year) implant placement and for younger vs older adults (0.0013 mm/year per additional year of age; P = .014). No statistically
significant association between infraocclusion and sex, ethnicity, implant site, timing of implant temporization, surgical protocol, or type of
restoration was found. Infraocclusion of single-implant–supported maxillary anterior restorations may result in esthetic concerns over time.
Greater infraocclusion occurs in delayed implant placement and in younger individuals.
Polymeri A, Li Q, Laine ML, Loos BG, Wang HL. Int J Oral Maxillofac Implants 2020;35:342–349. References: 32. Reprints: Hom-Lay Wang,
homlay@umich.edu —Steven Sadowsky, USA

Volume 33, Number 3, 2020 291

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