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Pillai, R. S., Kothari, S. F., Svensson, P. & Castrillon, E. (2024). Comparison of force profiles from two musculoskeletal palpation methods: A methodological study. Journal of Oral Rehabilitation, 51(5), 879-885
Open this publication in new window or tab >>Comparison of force profiles from two musculoskeletal palpation methods: A methodological study
2024 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, Vol. 51, no 5, p. 879-885Article in journal (Refereed) Published
Abstract [en]

Background: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol recommends a 5 s and 1 kg force dynamic palpation around the lateral condylar pole of the temporomandibular joint. However, the accuracy and precision of the generated force are not known.Objective: To assess and compare the force profiles generated from dynamic palpation manually and using a palpometer, based on the forces and time recommendations suggested by the DC/TMD protocol.Methods: Nineteen healthy adults applied forces of 0.5 kg, 1.0 kg and 2.0 kg on a calibrated force sensor in a circular motion within target times of 2 s and 5 s. Participants used their right index finger for manual palpation and a calibrated palpometer for device-assisted palpation. Ten repetitions of each target force at both target times were applied. Time taken to complete each application was recorded. Repeated measures analysis of variance was used for analysis of accuracy measured as the relative difference between targeted force and actual force values and precision measured as the coefficient of variation (CV) within the 10 repeated measurements.Results: Accuracy was significantly lower (better) and precision higher (lower CV) with the palpometer than with manual palpation (p < .001). There were significant differences in accuracy and precision between the different forces but not palpation times. Most participants could not achieve the target times and tended to be faster, irrespective of the palpation method (p > .063).Conclusion: A palpometer is a more accurate and precise palpation method for dynamic force assessment compared to manual palpation; however, it remains difficult to standardize the palpation duration.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
arthralgia, DC/TMD, dynamic force, palpation, temporomandibular joint
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-65486 (URN)10.1111/joor.13651 (DOI)001145541700001 ()38240374 (PubMedID)2-s2.0-85182623587 (Scopus ID)
Available from: 2024-01-29 Created: 2024-01-29 Last updated: 2024-05-21Bibliographically approved
Ishii, Y., Iida, T., Honda-Sakaki, M., Svensson, P., Yoshida, K. & Komiyama, O. (2024). Comparison of masticatory muscle activity between young adults and elderly participants using a novel standardized bite device.. Journal of Dentistry, 143, Article ID 104887.
Open this publication in new window or tab >>Comparison of masticatory muscle activity between young adults and elderly participants using a novel standardized bite device.
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2024 (English)In: Journal of Dentistry, ISSN 0300-5712, E-ISSN 1879-176X, Vol. 143, article id 104887Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Standardized bite training is required to prevent oral hypofunction in elderly individuals. We aimed to compare masticatory muscle activity between 24 young adults and 16 pre-elderly individuals during a biting task using a novel standardized bite device (BD).

METHODS: The BD was made of silicone rubber and included a high-force or low-force plate spring or no plate spring (dummy). The compressive stiffness of the material in each BD was measured using a texture analyzer. All participants performed a biting task 50-times at a rate of 1/s each using the three types of BDs on the right first molar. Electromyographic (EMG) activity was recorded bilaterally from the masseter and temporalis muscles. The variability of each biting training session was calculated as the coefficient of variance (CV) from the EMG activity during each biting task for each muscle. Masticatory muscle fatigue was assessed using a numerical rating scale (NRS).

RESULTS: Compressive stiffness was significantly different between each BD (P < 0.001). The CV and NRS scores were not significantly different between the groups. The EMG activities during each bite task in all muscles were not significantly different for any measurement item between the age groups. The EMG activities of high- and low-force BDs in the right temporalis (ipsilateral) muscle were significantly higher than those of the dummy BD (P < 0.001).

CONCLUSIONS: Compressive stiffness of the BD affected EMG activity only in the ipsilateral temporalis muscle, but not in the masseter or contralateral temporalis muscles, without any age effect.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Age-effects, Bite device, Compressive stiffness, Masticatory muscle activity, Oral rehabilitation
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66277 (URN)10.1016/j.jdent.2024.104887 (DOI)001203008200001 ()38360395 (PubMedID)2-s2.0-85185933895 (Scopus ID)
Available from: 2024-03-08 Created: 2024-03-08 Last updated: 2024-04-25Bibliographically approved
Durham, J., Ohrbach, R., Baad‐Hansen, L., Davies, S., De Laat, A., Goncalves, D. G., . . . Alstergren, P. (2024). Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing. Journal of Oral Rehabilitation, 51(5), 785-794
Open this publication in new window or tab >>Constructing the brief diagnostic criteria for temporomandibular disorders (bDC/TMD) for field testing
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2024 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 5, p. 785-794Article in journal (Refereed) Published
Abstract [en]

Background: Despite advances in temporomandibular disorders' (TMDs) diagnosis, the diagnostic process continues to be problematic in non-specialist settings.

Objective: To complete a Delphi process to shorten the Diagnostic Criteria for TMD (DC/TMD) to a brief DC/TMD (bDC/TMD) for expedient clinical diagnosis and initial management.

Methods: An international Delphi panel was created with 23 clinicians representing major specialities, general dentistry and related fields. The process comprised a full day workshop, seven virtual meetings, six rounds of electronic discussion and finally an open consultation at a virtual international symposium.

Results: Within the physical axis (Axis 1), the self-report Symptom Questionnaire of the DC/TMD did not require shortening from 14 items for the bDC/TMD. The compulsory use of the TMD pain screener was removed reducing the total number of Axis 1 items by 18%. The DC/TMD Axis 1 10-section examination protocol (25 movements, up to 12 sets of bilateral palpations) was reduced to four sections in the bDC/TMD protocol involving three movements and three sets of palpations. Axis I then resulted in two groups of diagnoses: painful TMD (inclusive of secondary headache), and common joint-related TMD with functional implications. The psychosocial axis (Axis 2) was shortened to an ultra-brief 11 item assessment.

Conclusion: The bDC/TMD represents a substantially reduced and likely expedited method to establish (grouping) diagnoses in TMDs. This may provide greater utility for settings requiring less granular diagnoses for the implementation of initial treatment, for example non-specialist general dental practice.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
facial pain, temporomandibular disorders, temporomandibular joint, temporomandibular joint disorders, temporomandibular joint dysfunction syndrome
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-64863 (URN)10.1111/joor.13652 (DOI)001136362000001 ()38151896 (PubMedID)2-s2.0-85180920007 (Scopus ID)
Available from: 2024-01-08 Created: 2024-01-08 Last updated: 2024-05-21Bibliographically approved
Svensson, P. (2024). Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal.. Acta Odontologica Scandinavica, 83, 144-150
Open this publication in new window or tab >>Could painful temporomandibular disorders be nociplastic in nature? A critical review and new proposal.
2024 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 83, p. 144-150Article, review/survey (Refereed) Published
Abstract [en]

Classification of temporomandibular disorders (TMD) and, indeed, all types of orofacial pains has significantly progressed in the last decade based on international consensus work and operationalized clustering of signs and symptoms. A challenging gap nevertheless continues to exist in terms of understanding the underlying pain mechanisms and link to management. Recently, a novel mechanistic descriptor 'nociplastic pain' was introduced, and diagnostic algorithms and characteristic features were proposed. This narrative and critical review aim to discuss to what extent could painful TMD conditions fit into this category. Moreover, a number of less common types of orofacial pain could possibly also reflect nociplastic pain mechanisms. A model to differentiate TMD pain mechanisms is proposed, and the implications for management are discussed. The purpose of this review is to stimulate original and novel research into mechanisms of orofacial pain and hopefully thereby improve management of the individual patient.

Place, publisher, year, edition, pages
Medical Journals Sweden, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66968 (URN)10.2340/aos.v83.40586 (DOI)38623025 (PubMedID)2-s2.0-85190801126 (Scopus ID)
Available from: 2024-04-26 Created: 2024-04-26 Last updated: 2024-05-21Bibliographically approved
Iwata, Y., Nishimori, H., Iida, T., Masuda, M., Yoshida, K., Ishii, Y., . . . Komiyama, O. (2024). Effect of clinical experience and training with visual feedback on standardized palpation outcomes: Potential implications for assessment of jaw muscle sensitivity. Journal of Oral Rehabilitation, 51(3), 601-610
Open this publication in new window or tab >>Effect of clinical experience and training with visual feedback on standardized palpation outcomes: Potential implications for assessment of jaw muscle sensitivity
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2024 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 3, p. 601-610Article in journal (Refereed) Published
Abstract [en]

Background: The evaluation of muscle pain and sensitivity by manual palpation is an important part of the clinical examination in patients with myalgia. However, the effects of clinical experience and visual feedback on palpation of the masticatory muscles with or without a palpometer are not known.

Objective: To estimate the effects of clinical experience and visual feedback on the accuracy of palpation in standardized settings.

Methods: Thirty-two dentists (age 35 ± 11 years) classified as either specialists (n = 16) or generalists (n = 16) participated in this experiment. All dentists were instructed to target force levels of 500- or 1000-gf, as determined on an electronic scale using either standardized palpometers or manual palpation (MP). All dentists participated in four different tests: MP, MP with visual feedback (MPVF), palpometer (PAL) and PAL with visual feedback (PALVF). Actual force values for each type of palpation from 0 to 2, 2 to 5 and 0 to 5 s were analysed by calculating target force level.

Results: The relative differences during 2-5 and 0-5 s with 1000 gf were significantly lower for generalists than for specialists (p < .05). In generalists and specialists, the coefficients of variation and the relative differences during 2-5 s were significantly lower for PAL and PALVF than for MP (p < .05).

Conclusions: These findings suggest that the use of a palpometer, but not clinical experience with palpation of masticatory muscles, increases the accuracy of palpation, and ≥2 s of palpation with a palpometer is optimal for masticatory muscles.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
clinical experience, masticatory muscles, myalgia, palpation, standardized palpometer, visual feedback
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-64144 (URN)10.1111/joor.13629 (DOI)001108369400001 ()37994202 (PubMedID)2-s2.0-85177567972 (Scopus ID)
Available from: 2023-12-06 Created: 2023-12-06 Last updated: 2024-04-11Bibliographically approved
Manfredini, D., Ahlberg, J., Lavigne, G. J., Svensson, P. & Lobbezoo, F. (2024). Five years after the 2018 consensus definitions of sleep and awake bruxism: An explanatory note. Journal of Oral Rehabilitation, 51(3), 623-624
Open this publication in new window or tab >>Five years after the 2018 consensus definitions of sleep and awake bruxism: An explanatory note
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2024 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 3, p. 623-624Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2024
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-64103 (URN)10.1111/joor.13626 (DOI)001108376600001 ()37994212 (PubMedID)2-s2.0-85177553059 (Scopus ID)
Available from: 2023-12-06 Created: 2023-12-06 Last updated: 2024-04-11Bibliographically approved
Madhan, S., Nascimento, G. G., Ingerslev, J., Cornelis, M., Pinholt, E. M., Cattaneo, P. M. & Svensson, P. (2024). Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity. Journal of Oral Rehabilitation, 51(4), 684-694
Open this publication in new window or tab >>Health-related quality of life, jaw function and sleep-disordered breathing among patients with dentofacial deformity
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2024 (English)In: Journal of Oral Rehabilitation, ISSN 0305-182X, Vol. 51, no 4, p. 684-694Article in journal (Refereed) Published
Abstract [en]

Background and ObjectivesPatients with dentofacial deformity (DFD) requiring orthognathic treatment have poor aesthetics, jaw function and psychological well-being, which potentially affect the quality of life. This study aimed to investigate the health-related general, oral and orthognathic quality of life, jaw function and sleep-disordered breathing at different stages of orthognathic surgical treatment.MethodsA total of 120 consecutive patients with DFD were recruited and grouped as pre-orthodontic treatment (group 1), pre-surgery (group 2), 4 months post-surgery (group 3), 24 months post-surgery (group 4) and in addition 30 controls without DFD (group 0). Outcomes were assessed using general health Short Form Survey (SF-36), Oral Health Impact (OHIP-14), Orthognathic Quality of Life Questionnaire (OQLQ), STOP-Bang and Jaw Function Limitation Scale (JFLS) questionnaires. In addition, presence or absence of pain was recorded. Data were tested with analysis of variance, Kruskal-Wallis test, Tukey post hoc test and structural equation modelling (SEM).ResultsResults revealed SF-36 (p = .814) and STOP-Bang (p = .143) total scores did not differ between control and treatment groups. In contrast, OHIP-14, OQLQ and JFLS total scores differed between groups (p = .001). Higher scores were observed in groups 1 (p = .001), 2 (p = .001) and 3 (p = .041) compared to group 0, indicating poor oral health in patients with DFD. Importantly, in group 4, oral health-related quality of life was better, and OHIP-14 (p = .936) and JFLS (p = .572) scores did not differ from controls. OQLQ scores of group 4 were significantly lower than group 1 (p = .001) but higher than group 0 (p = .013). SEM results revealed a significant negative associations of pain with JFLS and OQLQ; OHIP-14 with OQLQ; OHIP-14 with SF-36; and finally STOP-Bang with SF-36. Positive associations were observed between JFLS and OHIP-14; OHIP-14 and OQLQ.ConclusionOral health-related quality of life and jaw function appears to be improved 24 months after orthognathic surgery. Pain and limitation in jaw function had a negative association with health-related quality of life. Through structural modelling equation, we identified negative association of pain and limitation in jaw function with oral health, which further has negative effects on general health in patients with detofacial deformity. Our finding revealed significant decrease in OHIP-14, OQLQ and JFLS scores at 24 months follow-up indicate an improvement in oral health and limitation in jaw function after bimaxillary orthognathic surgery.image

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
dentofacial deformities, oral health, orthognathic surgery, pain, quality of life, sleep apnea
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-65485 (URN)10.1111/joor.13619 (DOI)001144480600001 ()38239176 (PubMedID)2-s2.0-85182449978 (Scopus ID)
Available from: 2024-01-29 Created: 2024-01-29 Last updated: 2024-03-28Bibliographically approved
Caetano, J. P., Goettems, M. L., Nascimento, G. G., Jansen, K., da Silva, R. A., Svensson, P. & Boscato, N. (2024). Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children. Clinical Oral Investigations, 28(2), Article ID 142.
Open this publication in new window or tab >>Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children
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2024 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, no 2, article id 142Article in journal (Refereed) Published
Abstract [en]

Objectives This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children. Methods Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors. Results From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC - 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC - 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism. Conclusion Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints. Clinical significance The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.

Place, publisher, year, edition, pages
Springer, 2024
Keywords
Malocclusion, Screen time, Temporomandibular joint disorders, Bruxism, Child, Cross-sectional studies
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-66092 (URN)10.1007/s00784-024-05545-1 (DOI)001160884300001 ()38347236 (PubMedID)2-s2.0-85185145370 (Scopus ID)
Available from: 2024-02-26 Created: 2024-02-26 Last updated: 2024-03-08Bibliographically approved
Salbego, R. S., Conti, P. C., Soares, F. F., Ferreira, D. M., Herreira-Ferreira, M., de Lima-Netto, B. A., . . . Bonjardim, L. R. (2024). Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders. Clinical Oral Investigations, 28(6), Article ID 302.
Open this publication in new window or tab >>Influence of psychometric and sleep quality features on painful mechanical sensitivity and pain modulation in patients with temporomandibular disorders
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2024 (English)In: Clinical Oral Investigations, ISSN 1432-6981, E-ISSN 1436-3771, Vol. 28, no 6, article id 302Article in journal (Refereed) Published
Abstract [en]

Investigating the collective impact of psychometric properties and sleep quality on pain sensitivity in temporomandibular disorder (TMD) patients could improve clinical management strategies. Objective Assessing whether combined psychometric properties and sleep quality impact painful mechanical sensitivity and pain modulation in TMD patients. Materials and methods A cross-sectional study using secondary data analysis of 77 TMD patients and 101 controls. All participants completed questionnaires characterizing their psychometric profile (anxiety, depression, stress and catastrophizing) and sleep quality, alongside psychophysical tests for painful mechanical sensory (mechanical pain threshold (MPT), pressure pain threshold (PPT), and wind-up ratio (WUR)) and conditioned pain modulation (CPM). Participants were grouped into "High distress" or "Low distress" categories based on psychometric properties and sleep quality using hierarchical cluster and k-means analyses. Multiple linear regression evaluated the influence of TMD, age, and the distress cluster on MPT, WUR, PPT, and CPM in masseter and thenar muscles. Differences were statistically significant when p < 0.05. Results The presence of TMD was the strongest predictor of mechanical painful sensitivity in the trigeminal region (MPT[F(3,174) = 51.902;p < .001;R-2 = .463]; TMD presence (beta = -.682) / PPT[F(3,174) = 15.573;p < .001;R-2 = .198] TMD presence (beta = -.452), and extra-trigeminal (MPT[F(3,174) = 35.897;p < .001;R-2 = .382] TMD (beta = -.647) / CPM [F(3,174) = 4.106;p < .05;R2 = .050] TMD presence (beta = .197). Furthermore, neither the high distress group nor the low distress group were able to significantly influence the variation of the values of any of the psychophysical variables evaluated (p > .05). Conclusions There is not a significant influence of impairment clusters based on psychological variables and sleep quality on painful mechanical sensitivity and pain modulation, regardless of the presence of TMD. Clinical relevance This outcome suggests that psychosocial factors and sleep quality may not play a decisive role in the sensory-discriminative aspect of pain, particularly concerning painful TMD.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Temporomandibular disorder, Psychosocial, Painful sensitivity, Cluster analysis
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-67318 (URN)10.1007/s00784-024-05699-y (DOI)001215615100001 ()38714576 (PubMedID)
Available from: 2024-05-20 Created: 2024-05-20 Last updated: 2024-05-20Bibliographically approved
Kothari, S. F., Devendran, A., Sørensen, A. B., Nielsen, J. F., Svensson, P. & Kothari, M. (2024). Occurrence, presence and severity of bruxism and its association with altered state of consciousness in individuals with severe acquired brain injury. Journal of Oral Rehabilitation, 51(1), 143-149
Open this publication in new window or tab >>Occurrence, presence and severity of bruxism and its association with altered state of consciousness in individuals with severe acquired brain injury
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2024 (English)In: Journal of Oral Rehabilitation, E-ISSN 1365-2842, Vol. 51, no 1, p. 143-149Article in journal (Refereed) Published
Abstract [en]

Background: Excessive jaw muscle activity is a frequent complication after acquired brain injury (ABI).

Objective: The study aimed to identify the occurrence and severity of jaw muscle activity and its association with altered state of consciousness in patients with ABI.

Methods: A total of 14 severe ABI patients with varied altered state of consciousness were recruited. A single-channel electromyographic (EMG) device was used to assess the jaw muscle activity for three consecutive nights during Week 1 and Week 4 following admission. Differences in number of EMG episodes/h between Week 1 and 4 were analysed using non-parametric tests and association between the EMG activity and altered state of consciousness were analysed using Spearman's correlation test.

Results: Nine of fourteen (64%) patients showed indications of bruxism (cutoff: >15 EMG episodes/h). The average EMG episodes/h at admission were 44.5 ± 13.6 with no significant changes after Week 4 of admission (43 ± 12.9; p = .917). The EMG episodes/h ranged from 2 to 184 during Week 1 and 4-154 during Week 4. There were no significant correlations between the number of EMG episodes/h during the three nights and the individuals altered state of consciousness during Week 1 and Week 4.

Conclusion: Patients with ABI had a conspicuously high but variable level of jaw muscle activity at admission and it tend to remain high after 4 week of hospitalisation which could potentially lead to adverse effects such as excessive tooth wear, headaches and pain in jaw muscles. The lack of associations between individuals altered level of consciousness and EMG activity could be due to low sample size and further studies are clearly warranted in this patient group with special needs. Single-channel EMG devices can record jaw muscle activity early in the hospitalisation period and might be a helpful tools for early detection of bruxism in ABI patients.

Place, publisher, year, edition, pages
John Wiley & Sons, 2024
Keywords
brain injury, bruxism, consciousness, GrindCare, jaw muscle activity, stroke and traumatic brain injury
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-61913 (URN)10.1111/joor.13540 (DOI)001020084800001 ()37325820 (PubMedID)2-s2.0-85164159381 (Scopus ID)
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2024-06-18Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0001-5809-8037

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