title: Bruxism is unlikely to cause damage to the periodontium: findings from a systematic literature assessment.
abstract: BACKGROUND
  This paper systematically reviews the MEDLINE and SCOPUS literature to answer the following question: Is there any evidence that bruxism may cause periodontal damage per se?
  
  
  METHODS
  Clinical studies on humans, assessing the potential relationship between bruxism and periodontal lesions (i.e., decreased attachment level, bone loss, tooth mobility/migration, altered periodontal perception) were eligible. Methodologic shortcomings were identified by the adoption of the Critical Appraisal Skills Program quality assessment, mainly concerning the internal validity of findings according to an unspecific bruxism diagnosis.
  
  
  RESULTS
  The six included articles covered a high variability of topics, without multiple papers on the same argument. Findings showed that the only effect of bruxism on periodontal structures was an increase in periodontal sensation, whereas a relationship with periodontal lesions was absent. Based on the analysis of Hill criteria, the validity of causation conclusions was limited, mainly owing to the absence of a longitudinal evaluation of the temporal relationship and dose-response effects between bruxism and periodontal lesions.
  
  
  CONCLUSIONS
  Despite the scarce quantity and quality of the literature that prevents sound conclusions on the causal link between bruxism and the periodontal problems assessed in this review, it seems reasonable to suggest that bruxism cannot cause periodontal damage per se. It is also important to emphasize, however, that because of methodologic problems, particularly regarding sleep bruxism assessment, more high-quality studies (e.g., randomized controlled trials) are needed to further clarify this issue.
authors.affiliation: Temporomandibular Disorders Clinic, Department of Maxillofacial Surgery, University of Padova, Padova, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Manfredini
authors.forename: Jari
authors.initials: J
authors.lastname: Ahlberg
authors.forename: Rossano
authors.initials: R
authors.lastname: Mura
authors.forename: Frank
authors.initials: F
authors.lastname: Lobbezoo
mesh_terms: D016301:Alveolar Bone Loss / Q000209:etiology; D002012:Bruxism / Q000150:complications*; D006801:Humans; D017622:Periodontal Attachment Loss / Q000209:etiology; D010510:Periodontal Diseases / Q000209:etiology*; D014085:Tooth Migration / Q000209:etiology; D014086:Tooth Mobility / Q000209:etiology
keywords: Bruxism; periodontium; review