The Effect of Bruxism on Balance

Primary outcomes

1. Short Form 36 (SF-36)

   Time frame: Single assessment during study visit (1 day)

   Quality of Life Scale/Short Form-36 (SF-36): SF-36 was developed by the Rand Corporation to obtain information about the health status of the individual. It was translated into Turkish by Koçyiğit and his colleagues, who conducted a validity and reliability study. It consists of eight sub-dimensions and 36 items. The sub-dimensions consist of physical function, social function, physical role difficulty, emotional state difficulty, mental health, energy/vitality, pain, and general perception of health. A score of "0" represents the worst health status, while "100" represents the best health status. Each sub-dimension is evaluated individually without calculating the total score.

2. Pittsburgh Sleep Quality Index

   Time frame: Single assessment during study visit (1 day)

   Pittsburgh Sleep Quality Index (PSQI): It is a 24-question scale developed by Buysse et al. in 1989 that evaluates sleep quality in the last month. A Turkish validity and reliability study was performed in 1996. The sum of the scores of seven components, subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, sleep medication use, and daytime dysfunction, gives the total score index. The total PSQI score ranges from 0 to 21; a score above 5 points indicates poor sleep quality; a score of 5 points or less indicates good sleep quality. The PSQI is one of the most commonly used scales for evaluating sleep quality. The validity of the use of this index in sleep disorders has been tested before, and it has been frequently used in studies on bruxism.

3. Beck Anxiety Inventory (BAI)

   Time frame: Single assessment during study visit (1 day)

   This scale's 21 items describe the most typical symptoms of anxiety disorders. It was developed to measure the intensity of anxiety symptoms in clinical populations. It asks respondents to indicate how much they have been affected by each symptom during the last week, on a scale from 0 (Not at all) to 3 (Severely - I could barely stand it). Total scores are the sum of all item scores, and range from 0 to 63; higher scores indicate higher anxiety. When this instrument was developed, the goal was to more easily discriminate between anxiety disorders and depressive disorders, whose symptoms frequently overlap on other assessment tools.

4. Fonseca Anamnestic Index

   Time frame: Single assessment during study visit (1 day)

   Fonseca Anamnestic Index (FAI): It was developed in 1994 by Fonseca et al. and consists of 10 questions investigating pain in the head and TMJ. Turkish validity and reliability of the test was performed by Kaynak et al. The questionnaire includes various questions about joint, head, and neck pain; joint movements; parafunctional habits; impaired occlusion; and emotional stress. Participants were asked to answer "Yes" , "Sometimes" , or "No" to each question, and TMD was classified as none, mild, moderate, or severe according to the total score.

5. Pain level-Visual Analog Scale (VAS)

   Time frame: Single assessment during study visit (1 day)

   Pain level-Visual Analog Scale: A visual analog scale (VAS) was used to assess the severity of pain related to bruxism. A VAS line was drawn on a 10 cm long horizontal line (0 = no pain and 10 = most intense pain), and the patient was asked to mark the pain intensity they perceived at rest, active use, and at night on this VAS line.

6. Trigger Point Evaluation

   Time frame: Single assessment during study visit (1 day)

   Trigger points in trapezius, masseter and temporalis muscles will be evaluated by algometre.

   Sudden reaction or vocal response of the patient with light pressure applied to this point and the presence of reflected pain in a region distant from this region indicated the presence of a trigger point (the minimum and maximum pressure sensitivity range varies from person to person, as it differs in sensitivity).

7. Perceived Stress Scale

   Time frame: Single assessment during study visit (1 day)

   Perceived Stress Scale: It was developed by Cohen, Kamarck, and Mermelstein in 1983 and consists of 14 items. Its Turkish validity and reliability was performed by Eskin et al., and this scale has been used in many studies on bruxism. The scale consists of two subdimensions: stress/discomfort perception and self-efficacy perception. Participants rate the stress they perceive on the scale as "0" never, "1" almost never, "2" sometimes, "3" often, and "4" very often. The stress level perceived by individuals is determined by summing the scores obtained from the items. A score between 0-56 points is obtained from the scale, and the higher the score, the higher the perceived stress level.

8. Measurement of dynamic balance

   Time frame: Single assessment during study visit (1 day)

   Balance assessments will be performed using Computerized Posturography (ProKin 252, Tecnobody, Dalmine, Italy), this device provides objectively measurable data for balance measurements.

   TecnoBody Prokin 252 will be used to measure and evaluate the patient's dinamik balance and proprioception levels in detail.

9. Evaluation of the Masseter's muscle stiffness

   Time frame: Single assessment during study visit (1 day)

   Masseter's muscle stiffness will be assessed with MyotonPRO. MyotonPRO (Muomeetria Ltd., Tallinn, Estonia) is a hand-held device used to quantify muscle stiffness. This device operates by generating a mechanical impulse on the skin overlying the muscle being assessed, followed by MyotonPRO measurements of the mechanical oscillations of muscles produced by the mechanical impulse. This method can determine the resistance of the muscle to deforming forces or muscle stiffness.