10.59987/ads/2014.2.52-60
Aim. Assess oral health, treatment needs and the correlation between tooth wear and medication in patients with psychiatric disease. Methodology. 92 patients (40 male and 52 female) admitted in the Department of Neurology and Psychiatry of the Umberto I Hospital of Rome underwent an oral and dental clinical examination in accordance according to World Health Organization Basic Methods Criteria. One dentist performed all clinical examinations, training and calibration was carried out by an experienced clinical examiner. To measure the degree of inter-examiner agreement Kappa statistics was calculated. Level of tooth wear was assessed using the tooth wear classification of Johansson et al. Exact psychiatric pathology and medications of each patient were registrated. The Statistical Package for the Social Sciences (SPSS Inc., Chicago, Ill.) was used to analyze the data. A value of P &lt; 0.05 was considered statistically significant. Results. 34.78% of the sample regarding tooth wear demonstrated score 2. Men demonstrated 30% score 2, and 20% score 3 and 4 whereas female patients 38.46% score 2, 7.69% score 3 and none score 4. Conclusions. Chronic exposure to neuroleptic drugs can cause phenomena of bruxism. There is a direct correlation between tooth wear, psychiatric disorders and administration of certain drugs. Poor oral hygiene and extensive unmet needs for dental treatment were widespread among psychiatric patients.
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Annali di stomatologia
bruxism
Tooth wear among patients suffering from mental disorders
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Original Article
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2022-08-16
2014-06-01
2023-12-04
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Ann Stomatol (Roma)
G. Pompa
2014
10.59987/ads/2014.2.52-60
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1971-1441
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bruxism
en
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Tooth wear among patients suffering from mental disorders
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                                                                                                 Original article



    Tooth wear among patients suffering
    from mental disorders




                                                                                                                    li
                                                                   na
    Luca Piccoli, DDS, PhD                                needs for dental treatment were widespread
    Laith Konstantinos Besharat, DDS, PhD                 among psychiatric patients.




                                                                 io
    Michele Cassetta, MD, DDS, PhD
    Guido Migliau, MD, DDS, PhD                           Key words: tooth wear, psychiatric disorders,
    Stefano Di Carlo, MD, DDS, PhD                        bruxism.
    Giorgio Pompa, MD, DDS, PhD




                                                              az
                                                          Introduction
    Department of Oral and Maxillo-facial Sciences,
    Sapienza University of Rome, Italy                    Wear is described as the progressive loss of material




                                                           rn
                                                          from the contracting surfaces of a body, caused by
                                                          relative motion at the surface (1, 2). Tooth wear is a
    Corresponding author:                                 complex, multifactorial phenomenon with the interplay
    Lait Konstantinos Besharat                            of biological, mechanical, chemical and tribological




                                                        te
    Department of Oral and Maxillo-facial Sciences        factors (2). Over the last fifty years we have wit-
    Sapienza University of Rome                           nessed a general improvement of the oral hygiene,
    Viale Regina Elena, 287/A                             surely due to awareness campaigns, prevention and
    00161 Rome, Italy
    E-mail: besharatlk84@yahoo.it
                                                     In   large scale access to dental services. In spite of all
                                                          these measures that certainly improved the oral and
                                                          dental health status; teeth because of their function
                                                          undergo a slow but gradual wear due to normal aging
    Summary                                               (3-5), so it may be considered a physiological
                                      ni
                                                          process with an expected annual rate of wear of ap-
    Aim. Assess oral health, treatment needs and the      proximately 11µm (6); in some cases, this wear is ac-
    correlation between tooth wear and medications        centuated by diseases, disorders and administration
    in patients with psychiatric disease.                 of certain drugs through their side affects (dry mouth,
                          o

    Methodology. 92 patients (40 male and 52 female)      salivary gland hypofunction, muscle rigidity) could
    admitted in the Department of Neurology and Psy-      lead to a significant friction between the occlusal sur-
                      izi


    chiatry of the Umberto I Hospital of Rome under-      faces of teeth resulting in increased wear. Therefore
    went an oral and dental clinical examination in ac-   amount of tooth wear depends on factors such as
    cordance according to World Health Organization       muscular forces, lubricants, patient diet habits and
    Basic Methods Criteria. One dentist performed all     the type of the restorative material used (7). Specifi-
          Ed




    clinical examinations, training and calibration was   cally erosion-related wear is increasing in the general
    carried out by an experienced clinical examiner.      population (8, 9). The presence of teeth worn has be-
    To measure the degree of inter-examiner agree-        come a common phenomenon in modern dentistry
    ment Kappa statistics was calculated. Level of        especially in aging population (2, 10). This could be
    tooth wear was assessed using the tooth wear          the result of the increased interested in retaining
    classification of Johansson et al. Exact psychi-      teeth as opposed to having them extracted (11).
    C




    atric pathology and medications of each patient       However tooth wear is a clinical finding in all age
    were registrated. The Statistical Package for the     groups (12-14). The terms attrition, abrasion, erosion
CI




    Social Sciences (SPSS Inc., Chicago, Ill.) was        and abfraction all have been used to describe the
    used to analyze the data. A value of P < 0.05 was     loss of tooth structure (2), but they only describe clini-
    considered statistically significant.                 cal manifestations of a number of events without in-
    Results. 34.78% of the sample regarding tooth         cluding the causative factor (15). Attrition which is de-
    wear demonstrated score 2. Men demonstrated           fined as a gradual loss of hard tooth substance from
    30% score 2, and 20% score 3 and 4 whereas fe-        occlusal contacts with an opposing dentition or
©




    male patients 38.46% score 2, 7.69% score 3 and       restoration, is related to aging but may be accelerat-
    none score 4.                                         ed by extrinsic factors such as parafunctional habits
    Conclusions. Chronic exposure to neuroleptic          of bruxism, traumatic occlusion in the partially eden-
    drugs can cause phenomena of bruxism. There is        tulous dentition and malocclusion (16, 17). Clinically
    a direct correlation between tooth wear, psychi-      occlusal wear attributable to attrition will produce
    atric disorders and administration of certain         equal and matching wear facets on opposing teeth
    drugs. Poor oral hygiene and extensive unmet          (18, 19).

    52                                                                        Annali di Stomatologia 2014; V (2): 52-60
    Tooth wear among patients suffering from mental disorders


    Abrasion is the loss of tooth substance through me-         bating sleep bruxism (51-53); about 69% related
    chanical means, independent of occlusal contact (20).       their sleep bruxism or its aggravation to stress or
    The most common cause of dental abrasion is tooth           anxiety (54).
    brushing (16, 21). Abfraction describes loss of tissue
    in the cervical region as a result of crack formation




                                                                                                                       li
    during tooth flexure (10, 19). Mastication and maloc-       Materials and methods
    clusion play a major role in abfraction lesions (22).




                                                                    na
    Dental erosion is defined as loss of tooth structure by     A sample of: 92 patients (40 male and 52 female)
    a non bacterial chemical process (18, 20). The              with average age of 40 years were submitted to our
    source of acid can be endogenous, such as from              investigation. All subjects gave their consent to par-
    gastric reflux, or exogenous from acidic foods and          ticipate in this study. The patient selection was made




                                                                  io
    drinks (23); the distribution and wear pattern of ero-      randomly among the patients at the Day Hospital of
    sion is specifically associated with origin of the acid     the Department of Psychiatry at the Sapienza Univer-
    and the posture of the head when the acid is present        sity of Rome. All patients were medically balanced;




                                                               az
    (24, 25). Patients with bulimia or gastric reflux pre-      none was under a psychotic attack and were all capa-
    sent the lingual surfaces of their maxillary anterior       ble of understanding the supplied information. The
    teeth severely affected while their mandibular teeth        fact that the screening was completely free of charge
    are protected from the erosive effect by the tongue         guaranteed a heterogeneous sample in terms of so-




                                                            rn
    and saliva (24). To determine if tooth wear is a result     cio-economic status and oral health. Indeed, the ex-
    of abfraction, erosion, abrasion or erosion is really       aminations, not necessarily conducted in the pres-
    difficult since these factors could act together with       ence of pain, involved both dentally healthy subjects
    other ones masking in this way the true nature of           and subjects affected by different dental diseases.




                                                         te
    tooth wear (18).                                            Clinical examination was conducted by the same cali-
    According to literature, tooth wear is more likely to be    brated operator registrating:
    associated with bruxism than with temporomandibular         i) oral hygiene status, utilizing the Green and Ver-
    joint disorders (TMJD). Although an association be-              millon Semplified Oral Hygyen Index (OHI-S) (55)
    tween tooth wear and TMJD has been reported (26,
                                                      In        ii) degree of tooth wear using a method derived from
    27), most studies indicate that TMJD is not a risk fac-          the criteria set by Johansson et al. (56)
    tor for tooth wear (28-34). Bruxism on the other hand       iii) the type of psychiatric diagnosis and drug thera-
    has been consistently implicated in tooth wear etiolo-           pies in place.
    gy (28, 35-37).                                             For each individual were made four three intra-oral
                                                ni

    Bruxism is defined as the oral activity characterized       photographs and a facial profile. The purpose and
    by grinding or clenching of teeth without the pres-         procedures of the study were explained to the partici-
    ence of food (38). The symptoms that confirm the            pants and informed consent was obtained. Informa-
                              o

    presence of this disease are: grinding noise, pain in       tion on diagnosis and treatments was collected from
    jaw muscles, pain in the temporomandibular joint            the patient’s medical charts and files. Moreover dur-
                          izi


    (TMJ), headaches and neck pain. Clinically patients         ing the phases of the anamnesis a series of ques-
    who suffer from bruxism present: tooth wear, sucking        tions have been carried out based on a table formu-
    the cheeks, tongue jagged, tooth fracture, ankylosis,       lated by the working group. Interviews typically began
    failure of dental prosthesis or dental restoration due      with a standard questionnaire. It consisted of so-
           Ed




    to wear temporomandibular joint disorders and diffi-        ciodemographic information, sleep/wake schedule,
    culty in prosthetic rehabilitation. However, it is appro-   physical health queries, and questions related to
    priate to differentiate two types of bruxism: awake         sleep and mental disease symptoms. All questions
    bruxism and sleep bruxism. Bruxism is a very com-           required were made for entire diagnostic descriptions
    mon condition, most people it is estimated around           according to the International Classification of Sleep
    80-90% at least once in their lifetime had symptoms         Disorders (ICSD) (57) and the Diagnostic and Statisti-
    C




    of grinding (39), the prevalence of the phenomenon          cal Manual of Mental Disorders, fourth edition (DSM-
    is estimated between 5-8% in general population ac-         IV) classifications (58). The duration of interviews
CI




    cording to the majority of the authors (40-46). Sleep       ranged from 20 to 60 min and were all completed in
    bruxism is an oral habit characterized by a rhythmic        one session. The ICSD (57) suggests the following as
    activity of the temporomandibular muscles that caus-        minimal criteria for sleep bruxism: (I) the presence of
    es a forced contact between dental surfaces during          teeth grinding during sleep; and (II) at least one of the
    sleep. It is accompanied by tooth clenching or grind-       following associated features: abnormal tooth wear,
    ing that can be loud enough to be heard by the bed          muscular discomfort, or sound associated with the
©




    partner. A Canadian study reported an 8% preva-             tooth grinding.
    lence of tooth grinding during sleep (47). A Finnish
    twin cohort study, reported tooth grinding at least
    once a week in 3.7% of the women and 3.8% of the            Classification of tooth wear
    men (48). Another 2 international studies found a
    rate of 10% of sleep tooth grinding (49, 50). Anxiety       Various systems for classifying and evaluating the
    disorders and stress are known factors for exacer-          wear of the teeth exist. Tooth wear indices are the

    Annali di Stomatologia 2014; V (2): 52-60                                                                         53
    L. Piccoli et al.


    most popular method of quantifying wear over a long         Data reliability
    period of time as they are readily available and do not
    require special equipment (59). Many of these use a         In order to check intra-examiner and inter-examiner
    five-point scale based on severity of dental wear. In-      levels of data consistency:
    tra-examiner reliability are of key importance for the      - Both examiners received a 6 month training in as-




                                                                                                                         li
    usefulness of these methods, and reliability of these           sessing these measures and indices.
    approaches has been confirmed in many studies, but          - Kappa statistics were calculated regarding tooth




                                                                    na
    no method is universally accepted (60). Measure-                wear, oral and hygiene status; inter-examiner val-
    ments can also be recorded by the use of laser pro-             ue for the first examiner respectively was 0.86,
    filometry (61) or stereomicroscopy images and com-              0.84, and 0.88, 0.86, for the second one.
    puterized image fitting (62). 3D laser scanning can be      - Each examiner was calibrated separately against




                                                                  io
    used to scan the surface of a replica to construct a            the experienced supervisor.
    3D image for quantifying the wear more accurately           - Recalibration sessions were conducted periodically
    (63). In addition to traditional rating systems there           through data collection; every 15 patients a random




                                                               az
    have been recently introduced sophisticated and                 sample of three patients were re-examined sepa-
    complex wear simulators, but a clear correlation be-            rately by both investigators in order to ensure data
    tween in vitro and clinical data has not been estab-            reliability. During the cross-checking sessions each
    lished (26). Moreover clinical performance of dental            examiner was blinded to previous data collected and
    biomaterials cannot be precisely predicted and oral




                                                            rn
                                                                    to information regarding the patient’s anamnesis.
    environment cannot be simulated simply because              - Upon reexamination no significant differences in
    standard oral conditions doesn’t exist (64). However,           scores were noticed.
    the usefulness of all these innovative diagnostic tools     - Data were entered in two different personal com-




                                                         te
    in a clinical setting is questionable despite improved          puters by the two examiners, the two data files
    accuracy and reliability they have a high cost and re-          were compared in order to detect entry errors.
    quire specialized hardware and software restricting             The two files resulted identical.
    their use in everyday dental practice (65).
                                                      In
    The degree of tooth wear for each tooth was classified
    according to a method that is derived from the criteria     Results
    set out by Johansson et al. (48). The dental wear
    evaluation procedure was performed with the patient         The sample was composed of 92 patients; 56.52%
    sitting upright in a dental chair, wiping the surfaces of
                                                                were women and 44.48% were men (Fig. 1):
                                         ni
    teeth with a jet of air and cotton wool. Degree of wear
                                                                - 5% of male patients and 8% of female patients
    was estimated by direct vision or by using a mirror ac-
                                                                     showed values between 0.3 and 0.6, as evidence
    cording to five criteria:
                                                                     of a satisfactory state of oral hygiene (Fig. 2).
    • Score 0: no visible facet in the enamel. Morpholo-
                            o

                                                                - 13% of male patients and 13% of female ones
         gy of the occlusal/incisal intact.
                                                                     showed values between 0.7 and 1.8 as evidence
    • Score 1: marked wear facets in enamel. Morphol-
                        izi


                                                                     of a medium degree of oral hygiene (Fig. 2).
         ogy of the occlusal/incisal altered.
                                                                - 83% of male patients and 79% of female ones re-
    • Score 2: wear into the dentin. The dentin is ex-
                                                                     ported values between 1.9 and 3.0 corresponding
         posed occlusal/engraved or on an adjacent tooth
                                                                     to a poor oral hygiene (Fig. 2).
         surface. The morphology of the occlusal/incisal
            Ed




                                                                The mental disorders registrated during the examina-
         has changed in shape with a reduction in height
                                                                tion of the sample are:
         of the crown.
                                                                  1) paranoid schizophrenia
    • Score 3: extensive wear into dentin. Dentine area
                                                                  2) disorders of language
         larger (> 2 mm square) exposed to occlusal/in-
         cisal. The morphology of the occlusal/incisal total-     3) dysthymia
         ly lost locally or generally. Substantial loss of        4) schizophrenia
    C




         height of the crown.                                     5) residual psychosis
    • Score 4: wear in the secondary dentin.                      6) mental retardation
CI




                                                                  7) schizophrenia undifferentiated
                                                                  8) psychoneurosis
    Statistical analysis                                          9) personality disorders
                                                                10) depressive disorders
    Statistical analysis was performed using SPSS Inc,          11) psychosis
                                                                12) adjustment disorders
©




    ver. 13.0, Chicago, IL, USA. Chi-squared test was
    used for statistical evaluation of proportions. Students    13) disorders of power
    T-test for 2 independent means was applied. In cases        14) moderate depression
    with more than 2 independent means we used the              15) anxious depressive syndrome
    ANOVA test. Moreover wherever necessary a linear            16) affective syndrome dipolar
    regression analysis was performed. A p-value of less        17) affective disorders of the personalities
    than 0.05 was considered significant. A 95% CI was          18) bipolar disorder grade II
    used in all analysis.                                       19) alcoholism.

    54                                                                             Annali di Stomatologia 2014; V (2): 52-60
    Tooth wear among patients suffering from mental disorders


    Side effects of the various medications received from              grade 0 19.57%, grade 3 13.04% and grade 4 8.70%
    the patients are reported in Table 1.                              (Fig. 3).
    Grade 2 tooth wear was registrated in 34.78% of the                By comparing the degree of tooth wear in the two sex-
    patients whereas grade 1 in 23.19% of the patients,                es separately we observed a greater degree of wear fe-




                                                                                                                                 li
                                                                                Figure 1. Percentages of male and female pa-




                                                                         na
                                                                                tients of the sample.




                                                                       io
                                                                    az
                                                                 rn
                                                              te
                                                                                        Figure 2. Oral hygiene of sample.
                                                           In
                              o                 ni
                          izi



    Table 1. Side effects of medications adminestered to the sample.
           Ed




    Drug                   SIDE EFFECTS
    SEROQUEL:              drowsiness, dyspepsia, constipation, dry mouth, asthenia, rhinitis, tachycardia.
    TRANQUIRIT:            drowsiness, dyspepsia, constipation, dry mouth, asthenia, rhinitis, tachycardia.
    DEPAKIN CHRON: gastric irritation, nausea, hyperammonemia, weight gain, transient loss of hair, aggression,
                   hyperactivity, behavioral problems, ataxia, tremors, lethargy, drowsiness, hallucinations, anemia,
    C




                   skin rash.
    LEPONEX:               constipation, hypersalivation, dry mouth, nausea, vomiting, anorexia, tachycardia, hypertension,
CI




                           tremors, rigidity, seizures, sweating, arrhythmias, myocarditis, delirium, respiratory depression,
                           hyperlipidemia, skin reactions.
    AKINETON:              constipation, dry mouth, nausea, vomiting , tachycardia, dizziness, confusion, euphoria, hallucinations,
                           memory impairment, anxiety.
    TAVOR:                 drowsiness confusion, ataxia, amnesia, dependence, aggression, muscle weakness, dry mouth,
©




                           gastrointestinal and visual disturbances.
    CYMBALTA:              dry mouth, gastrointestinal disturbances, constipation, eye dryness, difficulty of urination, headache,
                           arrhythmias.
    RIVOTRIL:              drowsiness, fatigue, dizziness, muscle hypotonia, coordination disturbances, restlessness,
                           confusion, amnesia, dependence, hypersalivation, pruritic, visual disturbances.
    FELISON:               drowsiness, confusion, ataxia, dependence.


    Annali di Stomatologia 2014; V (2): 52-60                                                                                    55
    L. Piccoli et al.


    males; about 38% of females showed the grade 2 com-      Regarding medications was found that about half of
    pared with 30% of males (Figs. 4, 5). Similarly 38% of   female patients taking the Depakine chon compared
    the females showed grade 1 tooth wear while the per-     to 20% of male patients (Fig. 6). Moreover 20% of
    centage for males ranged around 20% (Figs. 4, 5).        males receive Seroquel while 23% of female patients
    It is important however to note that while the degree    receive Tranquirit (Fig. 6). Figure 6 lists all drug ther-




                                                                                                                       li
    of wear 4 reaches 20% in males, females have not         apies lists of the sample comparing the various rates
    presented a single case (Figs. 4, 5).                    between the sexe




                                                                  na
                                                                      Figure 3. Tooth wear of patients.




                                                                io
                                                             az
                                                          rn
                                                       te
                                                    In
                                                                      Figure 4. Degree of tooth wear on male patients.
                            o          ni
                        izi
            Ed




                                                                      Figure 5. Degree of tooth wear on female pa-
                                                                      tients.
    C
CI
©




    56                                                                           Annali di Stomatologia 2014; V (2): 52-60
    Tooth wear among patients suffering from mental disorders


                                                                           Figure 6. Medications administered to the entire
                                                                           sample.




                                                                                                                         li
                                                                      na
                                                                    io
                                                                 az
                                                              rn
                                                           te
                                                        In
                              o                 ni

    Discussion                                                    suffering from xerostomia leading to gingivitis, peri-
                          izi


                                                                  odontitis, stomatitis and increased risk of caries;
    Psychiatric patients are turning to the dentist much          therefore oral hygiene is of great importance for
    more rarely than the general population (66). Taking          these patients (66, 75, 76). In some subjects we not-
    into account that the 2 main reasons that the general         ed the presence of old incongruous dental prosthesis
           Ed




    population avoids going to the dentist are dental care        associated with a very poor hygiene. Males in our
    anxiety and the cost of care it is natural that those fac-    study in concordance with international literature (66)
    tors generally are accentuated in the population of pa-       showed a lower index of oral hygiene than females
    tients suffering from mental disorders. Another reason        and that value resulted statistically significant at the
    that influences the low affluence of psychiatric patients     χ2 test. The majority of the patients are not self-suffi-
    to the dentist is pain insensitivity that mental disorders    cient with regard to oral hygiene and in terms of ac-
    C




    patients demonstrate and could be a result of the             cess to dental care.
    pathology itself or a side effect of the medications that     In our study we registrated a high prevalence of tooth
CI




    they receive. Insensitive to pain associated with illness     wear in our sample (80%) whereas in international lit-
    and injury, has been reported frequently in this popula-      erature in studies that involve general population of
    tion (67-73). It is important to underline that even if se-   all ages this percentage doesn’t exceed 20% (30,77).
    vere tooth wear has an impact on oral pain levels (74),       Wear at the majority of the patients involved sites of
    in the population studied none of the patients exam-          occlusal contact only a small part (7%)of the female
    ined referred oral or tooth pain. Pain insensitivity could    population examined showed tooth surface loss with
©




    lead to a delay in diagnosis and treatment.                   characteristics of erosion in noncontact areas and
    On examination it was found a general and wide-               around contact areas typical of acid regurgitation re-
    spread neglect of oral hygiene. During the clinical ex-       sulting from gastroesophageal reflux disease
    aminations we registrated cases of gingival hyperpla-         (GERD). Interviewing this part of the sample didn’t
    sia and in some cases dental abscesses that persist-          occur that they consume highly acidic carbonated
    ed for a long time. Patients suffering from long term         beverages or fruit juices. Habitual sucking of lemons
    psychiatric illness are on medication for long periods        other fruits or tomatoes weren’t referred.

    Annali di Stomatologia 2014; V (2): 52-60                                                                           57
    L. Piccoli et al.


    On the basis of the presence of both clinical and            vary flow. Special precautions must be taken when
    anamnestical indicators authors retain that the major-       performing surgery and when prescribing or adminis-
    ity (93%) of the registrated wear at the sites of oc-        tering analgesics, antibiotics or sedative agents that
    clusal contact derives from either awake bruxism             are likely to have an adverse interaction with psychi-
    (60%) or sleep bruxism (40%).                                atric medications. Preventive dental education use of




                                                                                                                                   li
    Authors retain that there is an association between          saliva substitutes and anticaries agents are indicate.
    bruxism psychiatric disorders and their medications          An improved understanding of the factors associated




                                                                     na
    that can cause phenomena such as: dry mouth, mus-            of tooth wear may lead to more effective interven-
    cle stiffness, hypofunction of salivary glands. Given the    tions. Tooth wear is a public health problem and the
    nature of our study we cannot claim that surely med-         multitude of indices and flaws in existing indices
    ications and not the pathologies themself cause brux-        make published data difficult to elaborate, analyze




                                                                   io
    ism but international literature support the correlation     and interpret.
    between medications and bruxism. It is worthnoting
    that a psychological stress component may play a role,
    but not all tooth grinders have emotional problems




                                                                az
                                                                 References
    (78). Another international study highlighted the use of
    the Naranjo Adverse Drug Reactions Probability Scale,         1. Ramalho A, Miranda J. The relationship between wear and
    which indicated a highly probable relationship between           dissipated energy in sliding systems. Wear. 2006;260:361-
    the bruxism and long-term exposure of neuroleptic                367.




                                                             rn
    therapy (79). Moreover various cases of antidopamin-          2. Mair L, Stolarski T, Vowles R, Lloyd C. Wear: mechanisms,
    ergic related bruxism have been reported (80). Fur-              manifestations and measurement. Report of a workshop. J
    thermore suggested involvement of adrenergic, sero-              Dent. 1996;24:141-148.
                                                                  3. Pergamalian A, Rudy TE, Zaki HS, Greco CM. The associ-




                                                          te
    tonergic, and dopaminergic systems in the pathogene-
                                                                     ation between wear facets, bruxism, and severity of facial pain
    sis of bruxism, as the side effects were relieved after
                                                                     in patients with temporomandibular disorders. J Pros Dent.
    propranolol was added to ongoing antipsychotic treat-            2003;90:194-200.
    ment (81). It has been postulated that disturbances in        4. Tsiggos N, Tortopidis D, Hatzikyriakos A, Menexes G. As-
                                                       In
    the central dopaminergic system, especially within the
    mesocortical tract, are linked to bruxism (82, 83) and
                                                                     sociation between self-reported bruxism activity and occur-
                                                                     rence of dental attrition, abfraction, and occlusal pits on nat-
    selective serotonin reuptake inhibitors (SSRIs) induced          ural teeth. J Prosthet Dent. 2008;100:41-6.
    bruxism (84, 85). SSRI-induced bruxism is considered          5. Pigno MA, Hatch JP, Rodrigues-Garcia RC, Sakai S, Rugh
    to be a consequence of serotonergically mediated inhi-           JD. Severity, distribution, and correlates of occlusal tooth wear
                                          ni
    bition of the dopaminergic system.                               in a sample of Mexican-American and European-American
    Absence of tooth wear of grade 4 in our study in the             adults. Int J Prosthodont. 2001;14:65-70.
                                                                  6. Goho C, Jones HL. Association between primary dentition
    female population and a 20% prevalence in the male
                                                                     wear and clinical temporomandibular dys-function signs. Pe-
    one is probably reflecting the higher bite force of
                            o

                                                                     diatr Dent. 1991;13:263-6.
    males compared to females (36).                               7. Hugoson A, Bergendal T, Ekfeldt A, Helkimo M. Prevalence
    It is worth noting underline the fact that authors faced         and severity of incisal and occlusal tooth wear in an adult
                        izi


    an unexpected collaboration and will from the majori-            Swedish population. Acta Odontol Scand. 1988;46:255-65.
    ty of the psychiatric patients to undergo a clinical ex-      8. Barlett DW. Retrospective long term monitoring of tooth wear
    amination, phenomenon that other authors in other                using study models. Br Dent J. 2003;194:211-3.
    studies have noted too (86).                                  9. Kononen M, Klemetti E, Waltimo A, Ahlberg J, Evalahti M,
            Ed




                                                                     Kleemola-Kuhala E, et al. Tooth wear in maxillary anterior
                                                                     teeth from 14 to 23 years of age. Acta Odontol Scand.
    Conclusions                                                      2006;64:55-8.
                                                                 10. Pintado MR, Anderson GC, DeLong R, Douglas WH. Vari-
                                                                     ation in tooth wear in young adults over a two-year period.
    Our study in accordance with the international litera-
                                                                     J Prosthet Dent. 1997;77:313-20.
    ture showed a high frequency of psychiatric patients
    C




                                                                 11. Mahalick J, Knap F, Weiter E. Occlusal wear in prostho-
    who suffered from tooth wear. Many drugs adminis-                dontics. J Am Dent Assoc. 1971;82:154-159.
    tered during psychiatric therapy often act as an en-         12. Bartlett DW. The role of erosion in tooth wear: aetiology, pre-
CI




    docrine disruptor with a marked decrease in saliva, in           vention and management. Int Dent J. 2005;55:277-284.
    other cases with stiffness muscle factors that will          13. Arnadottir IB, Holbrook WP, Eggertsson H, Gudmundsdot-
    surely accentuate the level of wear of the teeth no              tir H, Jonsson SH, Gudlaugsson JO, et al. Prevalence of den-
    longer lubricated by saliva. From the results shown              tal erosion in children: a national survey. Comm Dent Oral
    by us and by a careful review of the literature we can           Epidemiol. 2010;38:521-526.
    say that certainly there is a correlation between tooth      14. Zhou Z, Zheng J. Tribology of dental materials: a review. J
©




                                                                     Phys D: Appl Phys. 2008;41:113001.
    wear and administration of certain psychiatric drugs.
                                                                 15. Jagger D, Harrison A. An in vitro investigation into the wear
    Therefore it is more than necessary to introduce the
                                                                     effects of unglazed, glazed, and polished porcelain on hu-
    figure of the dentist in psychiatric institutions in order       man enamel. J Prosthet Dent. 1994;72:320-323.
    to monitor the oral health of these patients. Preva-         16. Smith B, Robb N. The prevalence of toothwear in 1007 den-
    lence of dental disease in this population usually is            tal patients. J Oral Rehabil. 1996;23:232-239.
    extensive because of disinterest in performing appro-        17. Bartlett DW, Coward PY, Nikkah C, Wilson RF. The preva-
    priate oral hygiene techniques and diminished sali-              lence of tooth wear in a cluster sample of adolescent school-


    58                                                                                   Annali di Stomatologia 2014; V (2): 52-60
    Tooth wear among patients suffering from mental disorders


          children and its relationship with potential explanatory fac-           rison K. Pain assessments in self-injurious patients with bor-
          tors. Br Dent J. 1998;184:125-129.                                      derline personality disorder using signal detection theory. Psy-
    18.   Dugmore CR, Rock WP. The prevalence of tooth erosion in                 chiatry Res. 1997;70:175-83.
          12-year-old children. Br Dent J. 2004;196:279-282.                41.   Russ M, Clark WC, Cross LW, Kemperman I, Kakuma T, Har-
    19.   Johansson A, Johansson A, Omar R, Carlsson G. Rehabil-                  rison K. Pain and self-injury in borderline patients: sensory




                                                                                                                                               li
          itation of the worn dentition. J Oral Rehabil. 2008;35:548-566.         decision theory, coping strategies, and locus of control. Psy-
    20.   Hattab F, Yassin O. Etiology and diagnosis of tooth wear:               chiatry Res. 1996;63:57-65.




                                                                               na
          a literature review and presentation of selected cases. Int J     42.   Al-Omiri MK, Lamey PJ, Clifford T. Impact of tooth wear on
          Prosthodont. 2000;13:101-107.                                           daily living. Int J Prosthodont. 2006;19:601-5.
    21.   Grippo JO, Simring M, Schreinder S. Attrition, abrasion, cor-     43.   K. Persson, B. Axtelius, B . Söderfeldt, M. Östman Monitoring
          rosion and abfraction revisited: a new perspective on tooth             oral health and dental attendance in an outpatient psychi-
          surface lesions. J Am Dent Assoc. 2004;135:1109-1118.                   atric population Journal of Psychiatric and Mental Health Nurs-




                                                                             io
    22.   Litonjua L, Andreana S, Bush P, Cohen R. Tooth wear:at-                 ing. 2009;16:263-271.
          trition, erosion, and abrasion. Quintessence Int. 2003;34:435-    44.   Shlomo Paul Zusman, Alexander Michael Ponizovsky, Dan
          446.                                                                    Dekel, Abd-el-Samia Masarwa,Tirza Ramon, Lena Natapov,
    23.   Kelleher M, Bishop K. Tooth surface loss: an overview. Br               Alexander Grinshpoon. An assessment of the dental health




                                                                          az
          Dent J. 1999;186:61-66.                                                 of chronic institutionalized patients with psychiatric disease
    24.   Mair L. Wear in dentistry-current terminology. J                        in Israel. Spec Care Dentist. 2010;30(1).
          Dent.1992;20:140-144.                                             45.   Van’t Spijker A, Rodrigues JM, Kreulen CM. Prevalence of
    25.   Bishop K, Kelleher M, Briggs P, Joshi R. Wear now? An up-               tooth wear in adults. Int J Prosthodont. 2009;22:35-42.




                                                                       rn
          date on the etiology of tooth wear. Quintessence                  46.   Hartmann E, Metha N. Bruxism: personality traits and oth-
          Int.1997;28:305-313.                                                    er characteristics. Sleep Res. 1987;16:350.
    26.   Lewis R, Dwyer-Joyce R. Wear of human teeth: a tribolog-          47.   Johansson A, Haraldson T, Omar R, Kiliaridis S, Carlsson
          ical perspective. J Engineering Tribology. 2005;219:2-19.               GE. A system for assessing the severity and progression of
    27.   Bader G, Lavigne G. Sleep bruxism; an overview of an oro-               occlusal tooth wear. J Oral Rehabil. 1993;20:125-31.




                                                                    te
          mandibular sleep. Sleep Med Rev. 2000 Feb; 4(1): 27-43.           48.   American Sleep Disorders Association, Diagnostic Clas-
    28.   Halász P, Ujszaszi J, Gadoros J. Are microarousals preceded             sification Steering Committee. International classification
          by electroencephalographic slow wave synchronization                    of sleep disorders: diagnostic and coding manual (ICSD).
          precursors of confusional awakenings? Sleep 1985;8:231-                 Rochester, MN: American Sleep Disorders Association.
          238.
                                                                 In               1990.
    29.   Hublin C, Kaprio J, Partinen M, Koskenvuo M. Sleep brux-          49.   American Psychiatric Association. Diagnostic and statistical
          ism based on self-report in a nationwide twin cohort. J Sleep           manual of mental disorders. 4th ed. Washington, DC:
          Res. 1998;7:61-67.                                                      American Psychiatric Association. 1994.
    30.   ICSD—International Classification of Sleep Disorders: Di-         50.   Al-Omiri MK, Harb R, Abu Hammad OA, Lamey P-J, Lynch
                                                 ni
          agnostic and Coding manual. Diagnostic Classification                   E, Clifford TJ. Quantification of tooth wear: conventional vs
          Steering Committee, Thorpy, MJ, Chairman, Rochester, Min-               new method using toolmakers microscope and a three-di-
          nesota: American Sleep Disorders Association, 1990.                     mensional measuring technique. J Dent. 2010;38:560-568.
    31.   Kato T, Montplaisir J, Blanchet P, Lund JP, Lavigne GJ. Id-       51.   Peters MCRB, Delong R, Pintado MR, Pallesen U, Qvist
                                 o

          iopathic myoclonus in the oromandibular region during                   V,Douglas WH. Comparison of two measurement techniques
          sleep: a possible source of confusion in sleep bruxism di-              for clinical wear. J Dent. 1999;27:479-485.
                             izi


          agnosis. Mov Disord. 1999;14:865-871.                             52.   Sajewicz E, Kulesza Z. A new tribometer for friction and wear
    32.   Kato T, Thie N, Montplaisir J, Lavigne GJ. Bruxism and oro-             studies of dental materials and hard tooth tissues. Tribol Int.
          facial movements during sleep. Dent Clin North Am.                      2007;40:885-895.
          2001;45:657-684.                                                  53.   Azzopardi A, Bartlett DW, Watson TF, Smith BG. A litera-
    33.   Lavigne GJ, Manzini C. Sleep bruxism and concomitant mo-                ture review of the techniques to measure tooth wear and ero-
             Ed




          tor activity. In: Principles and practice of sleep medicine.            sion. Eur J Prosthodont Restor Dent. 2000;8:93-97.
          Kryger, Roth, Dement, editors. Philadelphia: W.B. Saunders.       54.   Reet Sjoè Gren, Gun Nordstroè M.Oral health status of psy-
          2000;773-785.                                                           chiatric patients. Journal of Clinical Nursing 2000; 9:
    34.   Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep            632±638.
          bruxism: prevalence and association among Canadians.              55.   Naranjo CA, Busto U, Sellers EM, et al. A method for esti-
          Sleep 1994;17:739-743.                                                  mating the probability of adverse drug reaction. Clin Phar-
    C




    35.   Hublin C, Kaprio J, Partinen M, et al. Sleep bruxism based              macol Ther. 1981;30:239-245.
          on self-report in a nationwide twin cohort. J Sleep Res.          56.   Ingrid Kempermana, Mark J. Russ, W. Crawford Clark, Tat-
          1998;7:61-67.                                                           suyuki, Kakuma, Elizabeth Zanine, Katherine Harrisona. Pain
CI




    36.   Glass EG, McGlynn FD, Glaros AG, et al. Prevalence of tem-              assessment in self-injurious patients with borderline per-
          poromandibular disorder symptoms in a major metropolitan                sonality disorder using signal detection theory Psychiatry Re-
          area. Cranio. 1993;11:217-220.                                          search, 70 _1997. 175]183.
    37.   Magnusson T, Carlsson GE, Egermark I. Changes in sub-             57.   Glentworth P, Harrison A, Moores GE. Measurement of
          jective symptoms of craniomandibular disorders in children              changes in surface profile due to wear using a 147Pm [beta]
          and adolescents during a 10-year period. J Orofac Pain.                 particle backscatter technique II: Application to the simulated
©




          1993;7:76-82.                                                           wear of dental composite resin and amalgam restora-
    38.   Micheli F, Fernandez M, Gatto M, et al. Bruxism secondary               tions.Wear. 1984;93:53-62.
          to chronic antidopaminergic drug exposure. Clin Neu-              58.   Lambrechts P, Braem M, Vuylsteke-Wauters M, Vanherle G.
          ropharmacol. 1993;16:315-323.                                           Quantitative in vivo wear of human enamel. J Dent
    39.   Guieu R, Samuelian JC, Coulouvrat H. Objective evaluation               Res.1989;68:1752-1754.
          of pain perception in patients with schizophrenia. Br J Psy-      59.   Robert H. Dworkln Pain Insensitivity in Schizophrenia: A Ne-
          chiatry. 1994;164:253-5.                                                glected Phenomenon and Some Implications. Schizophre-
    40.   Kemperman I, Russ M, Clark WC, Kakuma T, Zanine E, Har-                 nia Bulletin. 1994;20(2):235-248.


    Annali di Stomatologia 2014; V (2): 52-60                                                                                                 59
    L. Piccoli et al.


    60. Adler G, Gattaz WF. Pain perception threshold in major de-            cisal tooth wear and self-reported TMD pain in children and
        pression. Biol Psychiatry 1993;34:687-9.                              adolescents. Int J Prosthodont. 2004;17:205-10.
    61. Bostwick JM, Jaffee MS. Buspirone as an antidote to             74.   Ekfeldt A, Hugoson A, Bergendal T, Helkimo M. An individ-
        SSRI-induced bruxism in 4 cases. J Clin Psychiatry 1999;              ual tooth wear index and an analysis of factors correlated to
        60:857-860.                                                           incisal and occlusal wear in an adult Swedish population. Acta




                                                                                                                                             li
    62. Winocur E, Gavish A, Voikovitch M, et al. Drugs and brux-             Odontol Scand.1990;48:343-9.
        ism: a critical review. J Orofac Pain. 2003;17:99-111.          75.   Dahl BL, Carlsson GE, Ekfeldt A. Occlusal wear of teeth and




                                                                            na
    63. Kiyoshi Mochizuki, Keiichiro Tsujino, Yumi Ohtawa, Masashi            restorative materials. A review of classification, etiology, mech-
        Yakushiji, Kou Nomura, Tatsuya Ichinohe, Yuzuru Kaneko.               anisms of wear, and some aspects of restorative proce-
        Dental care for physically or mentally challenged at public           dures.Acta Odontol Scand. 1993;51:299-311.
        dental clinics. Bull Tokyo Dent Coll. 2007;48(3):135-142.       76.   Spear F. A patient with severe wear on the posterior teeth
    64. Amir I, Hermesh H, Gavish A: Bruxism secondary to an-                 and minimal wear on the anterior teeth. J Am Dent Assoc.




                                                                          io
        tipsychotic drug exposure: a positive response to propanolol.         2009;140:99-104.
        Clin Neuropharmacol. 1997;20:86-89.                             77.   Laberge L, Tremblay RE, Vitaro F, Montplaisir J. Develop-
    65. Maurice M. Ohayon, Kasey K. Li, Christian Guilleminault. Risk         ment of parasomnias from childhood to early adolescence.
        Factors for Sleep Bruxism in the General Population.                  Pediatrics. 2000;106:67-74.




                                                                       az
        Chest. 2001;119;53-61.                                          78.   Bartlett D, Dugmore C. Pathological or physiological erosion
    66. Lee W, Eakle W. Possible role of tensile stress in the etiol-         – is there a relationship to age? Clin Oral Investig.
        ogy of cervical erosive lesions of teeth. J Prosthet Dent.            2008;12:27-31.
        1984;52:374-380.                                                79.   Satoh T, Harada Y. Tooth-grinding during sleep as an arousal




                                                                    rn
    67. Carlsoon GE, Egemark I, Magnusson T. Predictors of                    reaction. Experientia. 1971;15:785-786.
        signs and symptoms of temporomandibular disorders: a 20-        80.   Rugh JD, Solberg WK. Electromyographic studies of brux-
        year follow-up study from childhood to adulthood. Acta Odon-          ist behavior before and during treatment. Calif Dent Assoc
        tol Scand. 2002;60:180-5.                                             J. 1975;3:56-59.
    68. Magnusson T, Carlsoon GE, Egemark I. Changes in clini-          81.   Funch DP, Gales EN. Factors associated with nocturnal brux-




                                                                 te
        cal signs of craniomandibular disorders from the age of 15            ism and its treatment. J Behav Med. 1980;3:385-397.
        to 25 years. J Orofac Pain. 1994;8:207-15.                      82.   Pompa G, Giovannetti A, Gentile T, et al. Control factors in
    69. Bernhardt O, Gesch D, Splieth C, Schwahn C, Mack F,                   removable complete dentures: from the articulation quintet
        Kocher T, et al. Risk factors for high occlusal wear                  to kinetic contact. Ann Stomatol (Roma). 2010 Apr;1(2):14-
                                                              In
        scores in a population-based sample: results of the Study
        of Health in Pomerania (SHIP) Int J Prosthodont. 2004;17:       83.
                                                                              9. Epub 2010 Dec 8.
                                                                              Green JC, Vermillon JR. The semplified oral hygiene index.
        333-9.                                                                JADA 1964;68:25-31.
    70. Schierz O, John MT, Schroeder E, Lobbezoo F. Association        84.   Mazza D, Pompa V, Pompa G, et al. Qualitative comparison
        between anterior tooth wear and temporomandibular disor-              of MR TSE T2 and HASTE in temporomandibular disorders.
        der pain in a German population. J Prosthet Dent.                     Clinical observations. Minerva Stomatol. 2005 Apr;54(4):219-
                                               ni

        2007;97:305-9.                                                        26. English, Italian.
    71. Smith BG, Robb ND. The prevalence of toothwear in 1007          85.   Kampe T, Edman G, Tagdae T, et al. Reported symptoms
        dental patients. J Oral Rehabil.1996;23:232–9.                        and clinical finding in a group of subjects with longstanding
                               o

    72. John MT, Frank H, Lobbezoo F, Drangsholt M, Dette KE. No              bruxism behavior. J Oral Rehabil. 1997;24:581-587.
        association between incisal tooth wear and temporo-             86.   Spear F. A patient with severe wear on the anterior teeth and
        mandibular disorders. J Prosthet Dent. 2002;87:197-203.               minimal wear on the posterior teeth. J Am Dent Assoc.
                           izi


    73. Hirsch C, John MT, Lobbezoo F, Setz JM, Schaller HG. In-              2008;139:1399-1403.
            Ed
    C
CI
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