Bruxism is a continuously distributed behaviour, but disorder decisions are dichotomous (Response to letter by Manfredini, De Laat, Winocur, & Ahlberg (2016))

International consensus on the assessment of bruxism: Report of a work in progress

“…Amongst the series of exchanges over whether bruxism should be considered a disorder, 4–6 Raphael et al 4 pointed out that if higher levels of masticatory muscle activity increase the risk of negative oral health consequences (eg, severe masticatory muscle pain or temporomandibular joint pain, extreme mechanical tooth wear, prosthodontic complications), 12–14 bruxism should be considered a risk factor rather than a disorder in otherwise healthy individuals. Whilst a risk factor is an attribute that increases the probability of a disorder but does not “guarantee” it, a disorder is a condition that is a harmful dysfunction per se, that is inherently causing harm to the person and representing a dysfunction in normal biopsychosocial processes.…”

“…Unlike the rapid acceptance of the new definition for bruxism, the grading system ignited a series of exchanges focused on the practical utility of the system, on the status of bruxism as disorder, behaviour, or risk factor and on the consequences thereof in terms of diagnosis and management. 4–6 …”

“…Unlike the rapid acceptance of the new definition for bruxism, the grading system ignited a series of exchanges focused on the practical utility of the system, on the status of bruxism as disorder, behaviour, or risk factor and on the consequences thereof in terms of diagnosis and management. [4][5][6] In March 2017, an international consensus meeting, Assessment of Bruxism Status, with bruxism experts from around the globe (see should be considered a disorder or merely a behaviour that can be a risk factor for certain clinical conditions (ie, bruxism status); (iii) to re-examine the 2013 grading system based on data for reliability, sensitivity and specificity of each source of information/ approach (ie, bruxism assessment) and (iv) to develop a research agenda for necessary studies on various bruxism topics (ie, research agenda).…”

Bruxism: An umbrella review of systematic reviews

“…Regarding accuracy of diagnostic methods investigating AB in particular, current synthesis literature was considered non‐existent, as no SR on the topic were found. Some SR investigated methods to assess SB, proposing that portable diagnostic devices presented overall high values of specificity and sensitivity compared to the reference standard PSG, but it must be pointed out that a clear definition regarding bruxism as a behaviour or a disorder is not yet well established . Depending on future consensus updates, there may be a reappraisal of PSG criteria, which are currently used as reference for SB diagnosis …”

“…12 Nonetheless, in daily practice, clinicians are required to make decisions on the most suitable approach to manage bruxism, which includes recognising whether or not a treatment is needed. 13,14 Therefore, although there is no definitive agreed upon treatment, some therapies might be useful in the management of this condition, including approaches like occlusal appliances, pharmacological treatments, behavioural therapies and other approaches. 15 It must be pointed out that evidence regarding some of these therapeutic methods is often weak and therefore caution in their use is needed.…”