Evaluation by app in smartphones of awake &nbsp;bruxism at the return of presential classes in two university centers

Byron Velasquez Ron; Veronica Mosquera Cisneros; Pamela Pazmiño Troncoso; Maria Rodriguez Tates; Eddy Alvares Lalvay; Luis Chauca  Bajaña; Andrea Ordoñez Balladares

doi:10.12688/f1000research.133946.2

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Research Article

Revised

Evaluation by app in smartphones of awake bruxism at the return of presential classes in two university centers

[version 2; peer review: 1 approved, 1 approved with reservations, 3 not approved]

Byron Velasquez Ron ^1,2, Veronica Mosquera Cisneros², Pamela Pazmiño Troncoso², [...] Maria Rodriguez Tates², Eddy Alvares Lalvay², Luis Chauca Bajaña³, Andrea Ordoñez Balladares³

Byron Velasquez Ron ^1,2, Veronica Mosquera Cisneros², [...] Pamela Pazmiño Troncoso², Maria Rodriguez Tates², Eddy Alvares Lalvay², Luis Chauca Bajaña³, Andrea Ordoñez Balladares³

PUBLISHED 05 Aug 2024

Author details Author details

¹ State University of New York University Center for Academic and Workforce Development, Manhathan, New York, USA
² UDLA, Universidad de Las Americas, Quito, Via Nayon, 170523, Ecuador
³ Universidad de Guayaquil, Guayaquil, Guayas, Ecuador

Byron Velasquez Ron
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Veronica Mosquera Cisneros
Roles: Investigation, Methodology, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Pamela Pazmiño Troncoso
Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Maria Rodriguez Tates
Roles: Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Eddy Alvares Lalvay
Roles: Conceptualization, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Luis Chauca Bajaña
Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Andrea Ordoñez Balladares
Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background. The return to normality post-pandemic brought some inconveniences to the population, especially students. To evaluate the frequency of awake bruxism behaviors through the use of an app on smartphones in dental students returning to presential classes. Awake bruxism was evaluated with the creation of an app that according to the authors evaluates: relaxed jaw muscles, dental contact, jaw effort, clenching teeth and teeth grinding, 5 frequent oral conditions in the population. The frequency of awake/daytime bruxism (AB) in healthy individuals when comparing other populations with possible risk factors for additive bruxism (psychological factors, depression, suicide delusions, etc.), evaluating consequent clinical signs (fatigue, muscle pain, attritions and dental openings).

Methods: The sample of three hundred (n=300) young adults legally enrolled in two Ecuadorian universities, the sample was selected among fifth, sixth, seventh, eighth and ninth semester students legally enrolled and who are attending Faculty of Dentistry classes in 2 different cities (Quito and Guayaquil). The app was configured to provide 20 alerts during the day x seven days a week, in real time.

Results. The study obtained 95% reliability and 5% error in research, was used. The relaxation condition was present in all users, but 40% of the alerts were associated with jaw and tooth discomfort, 39% corresponded to the discomfort of mandibular clenching, and 24% corresponded to tooth contact. A direct significant association was found between the state of relaxation and nonrelaxation, with a high probability of reports related to nonrelaxation (p ≤ 0.05).

Conclusions: Awake bruxism with the app was evaluated, identifying 5 behaviors such as: relaxed mandibular muscles, dental contact, mandibular effort, clenching and grinding teeth, frequent conditions in the population; reporting a state of mandibular relaxation, there is a high probability that a condition of nonrelaxation would be reported (p≤0.05).

Keywords

bruxism, ecological momentary assessment, smartphone, prevalence, COVID-19 pandemic.

Corresponding author: Byron Velasquez Ron

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Velasquez Ron B et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions.

How to cite: Velasquez Ron B, Mosquera Cisneros V, Pazmiño Troncoso P et al. Evaluation by app in smartphones of awake bruxism at the return of presential classes in two university centers [version 2; peer review: 1 approved, 1 approved with reservations, 3 not approved]. F1000Research 2024, 12:766 (https://doi.org/10.12688/f1000research.133946.2) First published: 30 Jun 2023, 12:766 (https://doi.org/10.12688/f1000research.133946.1) Latest published: 05 Aug 2024, 12:766 (https://doi.org/10.12688/f1000research.133946.2)

Revised Amendments from Version 1

Responding to the reviewers, indicating that the verb evaluation was abstract around the research topic, they recommended using the verb monitor. The objective was corrected by clarifying the goal of the research in a better way, expanding the section of materials and methods with better explanation on the recommendation of the reviewers, the conclusion as it should respond to the objective was also revised. In the introduction, the wording is improved by including references suggested by the reviewers that justify the topic to be investigated. In the materials and methods, contact is made with the creators of the app via email, confirming the authorship of the same, making the application free. Table 1 with the suggested indications is changed. In the discussion it is completely reorganized, the language and references are reviewed, the suggestions to discuss clearly about the use of the app and the follow-up it provides on Awake bruxism are respected, the result of the state of relaxation that the patients had is also discussed, contrasting with other studies that applied EMA fundamental basis of the application. The conclusion is reviewed when the objective is found that the first 4 days of monitoring in the bruxism app showed symptoms such as discomfort in the jaw and teeth, from day 4 the students answered in the record of the alerts in the app that they felt relaxed, according to authors it was due to the brain action that they generate unconsciously to self-control, let's remember that Awake Bruxism is an activity that the patient does not know he has but that is generated in summer hours, for this reason scientists justify that the human brain reconditions its reactions so that it becomes preventive or is on alert of a diagnosed condition.

See the authors' detailed response to the review by Maria Beatriz Duarte Gaviao
See the authors' detailed response to the review by Swapna B V and kavishma Sulaya

Background

Bruxism is a debated topic, especially when considering dental clinical manifestations and their relationships with other medical specialties,¹ causing controversy in confronting effects and consequences. A panel of experts, including dentists, psychologists, and specialists in pain and facial pain, defined bruxism using strategies such as polysomnography (PSG) and electromyography (EMG)² to determine whether it is triggered by specific clinical signs such as involuntary movements³ in the chewing muscles.⁴ There are many studies on this topic; unfortunately, scientific evidence on awake bruxism is limited. The concept of awake bruxism is currently considered muscular activity during wakefulness that is characterized by repetitive or sustained dental contact, accompanied by pushes or mandibular reinforcements (movements) during a person’s conscious activities, which is not necessarily pathological but has clinical consequences.⁵^,⁶ When comparing populations, awake bruxism has risk factors such as mental disorders, depression, and suicidal delusions, among others, with clinical signs such as fatigue, muscle pain, dental attrition, and temporomandibular joint pain, suggesting the need for the evaluation of intercultural comparisons, social strata and lifestyle habits.⁷ Evaluation can be performed with noninstrumental approaches such as self-reports (anamnestic questionnaires), clinical observation, instrumental evaluation using electromyography (EMG), and ecological momentary assessment (EMA) strategies.²^,⁸^,⁹

EMA allows us to collect data in real time over a given period of time by recording multiple coincident points in the environment.¹⁰^–¹² This instrumentation goes beyond retrospective questionnaires, making EMA very useful in the evaluation of oral activity. The limitation of EMA is that the data are fragmented, as only specific behaviors are selected.¹³^–¹⁵ To control this bias, in Italy, the research group under Professor Alessandro Bracci at the University of Pavoda created a smartphone app, which incorporates EMA to collect data on dental contact, jaw clenching, tooth compression and teeth grinding.¹⁶^,¹⁷

The application provides data on the frequency of awake bruxism behaviors (clinical signs entered into the application) over a period of one week, with evaluation 4 times per day. These data are stored in the memory of the phone. After the evaluation time, we obtained data on the percentage and frequency of clinical signs.¹⁸

The objective of this study was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app.

Materials and Methods

Approval was obtained from the Bioethics Committee of the University of the Americas (CEBE-2022-0601). Three hundred (n = 300) young adults who were legally enrolled in two different Ecuadorian universities (*UDLA/UESG) in Quito and Guayaquil were randomly selected after signing the informed consent form and agreeing to participate in the study. They underwent a one-week registration period with a smartphone app (BruxApp Research^®, Pontedera, Italy) developed by Dr. Alessandro Bracci et al., with the aim of reporting and monitoring the frequency of AB behaviors in their natural environment; this free application can be accessed via Google Pay and the App store. The students were made aware of the responsibility of participating in the research, making their country and their university known to the world.

The sample included fifth-, sixth-, seventh-, eighth- and ninth-semester students who were legally enrolled and who were attending face-to-face classes conducted by the Faculty of Dentistry at two different Ecuadorian universities (Quito and Guayaquil). The inclusion criteria included having recent generation smartphones, good general health and the absence of temporomandibular joint disorder (TMD)/orofacial pain and/or any documented degenerative, neurological or systemic disease (e.g., rheumatological disease, hormonal disease). An informative meeting was held during which the students maintained contact with the principal investigators (BV, VM, PP, MRT, EAL, LCH, and AO).

During that session, the objective of the study was explained, and training was provided on how to use the app (Figure 1).

Figure 1. Flow diagram research.

The Bruxism APP collects a person’s data in a self-informed way in their daily life with an EMA approach (ecological approach), sending random messages during the day that alert the person of the conditions of their teeth and jaw muscles; individuals must respond within 5 minutes by touching the cone of the screen of their cell phone and indicating the current condition of their jaw muscles: jaw muscle relaxation, teeth contact, jaw clenching, teeth clenching and teeth grinding.

The objective of the study was explained while providing training for the correct use of the application (Figure 1).

The students were instructed to download the BruxApp and asked to start their first data collection session the next morning, which included 20 alerts per day at random intervals. The participants were instructed to comply with at least 60% of the requests per day (answering within the first 5 minutes; otherwise, the screen sent an error message) Students who responded to <60% of the alerts were excluded from the study automatically. Data were recorded during a period of 7 days, the records were calibrated from 8.00 to 12.30 and from 14.30 to 22.00, and the participants were instructed to ignore alerts during meals and particular activities (smoking, singing). The application records were recorded all day. After seven valid days of recordings, the software generated an anonymous .csv file, which the students sent to the researchers via prearranged emails. The data were collected by the lead author (B. V.) in collaboration with two resident dentists of the Specialty of Oral Rehabilitation (V. M., P. P., MRT, and EAL) of dentistry and two professors (LCH and A. of the Faculty of Dentistry of the University of Guayaquil).

To maximize the recording window, lunchtime was excluded because the participants were instructed to ignore alerts during meals and activities (smoking, singing). If the minimum number of valid responses per day was not obtained, the software automatically added another recording day to ensure completion of the 7-day protocol.

For the study of awake bruxism, the chi-square test (Table 1) was used to determine the association between muscle relaxation and nonrelaxation. In the alerts from the app, in the first stage, the muscles were not in occlusal contact (maximum intercuspation); in the second stage, there was occlusal contact (maximum intercuspation) and clenching of the jaw and teeth accompanied by grinding. The existing correlation was direct despite being in different contexts, demonstrating that the conditions were present during the conscious activity of the person (awake). When reporting mandibular relaxation, there was a high probability that muscle relaxation was reported in the application (p≤0.05).

Table 1. Significance test.

Chi-square tests
	Valor	gl	Asymptotic significance (bilateral)
Pearson's Chi-square	1200.000^†	16	<.001
Likelihood ratio	902.565	16	<.001
Linear-by-linear association	299.000	1	<.001
N. of valid cases	300

† 9 boxes (36.0%) had an expected count of less than 5. The minimum expected count was 0.56.

Results

Assuming 95% reliability and 5% error in the research, a sample size of 300 young adults from the two universities involved in the study was included in simple random sampling model. The research was characterized by analyzing variables such as sex and age (Table 2).

Table 2. Distribution of the sample by sex.

Sex^†	n	%n
Female	253	84.33
Male	47	15.67
Total^‡	300	100

† Sex.

‡ Total Sex.

The proportion of females among the selected sample was 84.33%, compared with that of 15.67% for males. Thus, the proportion of females in this study was significantly greater than that of males. A total of 79% of the participants were aged 21 to 22 years, which was expected since this sample set consisted of young adults studying at a university (Table 3).

Table 3. Distribution of the sample by age.

Age (years)^§	n	%n
19	30	10
21	134	44.7
22	104	34.7
23	10	3.33
24	1	0.33
25	12	4
26	6	2
27	1	0.33
32	2	0.67
Total^¶	300	100

§ Age.

¶ Total Ages.

Relaxation was evident in all users, but 40% of the alerts were associated with jaw and tooth discomfort, 39% corresponded to mandibular clenching, and 24% corresponded to tooth contact (Table 4).

Table 4. Distribution of alerts according to user conditions.

Conditions	Alerts	%
Relaxed	3652	68.9
Jaw clenching^§	917	15.28
Tooth contact	573	9.55
Tooth clenching	487	8.12
Pain when opening/closing the mouth	142	2.37
Daytime pressure	142	2.37
Teeth grinding	70	1.17
Difficulty opening the mouth when waking up	10	0.17
Sore teeth	7	0.12
Total	6000	100

§ Jaw clenching was most relevant

Thus, among the aforementioned symptoms, 63% of the alerts sent by BruxApp were related to specific symptoms. The study was conducted in one week: on the first day, 33% of the participants reported discomfort; on the second day, 61% reported maxillary discomfort; on the third day, 64% reported decreased discomfort; on the fourth day, 21% reported a decrease in discomfort; on the fifth day, the discomfort percentage was maintained; on the sixth day, 41% of the participants reported being relaxed; and on the seventh day, the percentage of participants who reported being relaxed increased by 51% (Table 5).

Table 5. Distribution of alerts according to condition among sex and age groups.

		Sex/Age (Groups)
		Females years				Males years
Condition		18/21 years	22/25 years	26/32 years	Total	18/21 years	22/25 years	Total	Grand Total
Relaxed	Alerts	1644	1308	115	3067	295	290	585	3652
Relaxed	%Alerts	45.2	35.82	3.19	83.98	8.08	7.94	16.02	100
Tooth clenching	Alerts	242	164	11	417	42	28	70	487
Tooth clenching	%Alerts	49.69	33.48	2.26	85.63	8.62	5.7	14.37	100
Jaw clenching	Alerts	442	307	25	774	83	60	143	917
Jaw clenching	%Alerts	48.20	33.48	2.73	84.41	9.05	6.54	15.59	100
Sore teeth	Alerts	1	1	5	7	0	0	0	7
Sore teeth	%Alerts	14.29	14.29	71.43	100	0	0	0	100
Tooth contact	Alerts	277	194	15	486	50	37	87	73
Tooth contact	%Alerts	48.34	33.86	2.62	84.82	8.73	6.46	15.18	100
Difficulty opening the mouth upon waking	Alerts	5	5	0	10	0	0	0	10
Difficulty opening the mouth upon waking	%Alerts	50	50	0	100	0	0	0	100
Pain when opening/closing the mouth	Alerts	67	48	5	120	12	10	22	142
Pain when opening/closing the mouth	%Alerts	47.18	33.8	3.52	84.51	8.45	7.04	15.5	100
Daytime pressure	Alerts	68	48	4	120	12	10	22	142
Daytime pressure	%Alerts	47.89	33.8	2.82	84.51	8.45	7.04	15.5	100
Teeth grinding	Alerts	34	25	0	59	6	5	11	70
Teeth grinding	%Alerts	48.57	35.71	0	84.29	8.57	7.14	15.71	100
Total	Alerts	2780	2100	180	5060	500	440	940	6000
Total	%Alerts	46.33	35	3	84.33	8.33	7.33	15.7	100

Discussion

The collection of heterogeneous information, the calibration of personal self-reports and group reports on phones, and training in the use of the smartphone app facilitated the data collection. The included population of dental students may have had a positive influence on the results, as having knowledge of what the app is measuring limited the bias in the study.

The app used in the study to monitor the frequency of AB behavior revealed that the symptomatology found was more significant in 84% of women aged 21 to 22 years, and the daily use of technology by young people was helpful in their fulfillment of responses to the alerts of the app. This information coincides with what was proposed by Dias et al. in 2021, which indicates that the use of the EMA approach in smartphone programs for monitoring AB behaviors was useful in the long term, making individuals aware of the recognition of the different pathologies considered by the application.¹⁹^,²⁰

The BruxApp provides various frequencies and percentages depending on sex and age groups; 32.13% of women and 5.91% of men reported experiencing maxillary discomfort, justifying its diagnostic importance. The report indicated that 68.9% of alerts received responses regarding a state of relaxation (without jaw discomfort).²¹^,²² When excluding the state of relaxation, mandibular clenching had the greatest significance at 39%. Monitoring the nonrelaxation state with five specific conditions included in the app, such as jaw muscle relaxation, tooth contact, jaw force, teeth clenching, and teeth grinding, resulted in the collection of data for >6000 alerts (20 alerts × 300 participants × 7 days).

During the 7-day observation period, data on 42000 alerts were collected. Zani et al. (2021) used the BruxApp in 2 Italian universities for monitoring AB behaviors by assessing the state of relaxation and nonrelaxation, coinciding with 5 conditions: relaxation of the mandibular musculature, 76.4%; contact with teeth, 13.6%; mandibular bracing, 7.0%; teeth clenching, 2.5%; and teeth grinding, 0.5%.21,22 Data collected using the EMA approach in observational studies indicate a reference in the frequency of AB behaviors, indicating that predisposing factors may vary in women under normal conditions, stress factors, and hormonal factors.²³^,²⁴

Jaw clenching was the most frequently reported, at 15.28%, and dental pain was the least frequently reported, at 0.17%, and the combined frequency of AB in a state of nonrelaxation was 23.6%²⁵; the consideration of psychological factors within the etiology of AB, which relates to sex, provides a statistical variable indicating that men control their emotions better²⁶ than women do. Studies conducted by Bracci et al. (2018) showed similarities with our study, revealing a slight difference in sex when monitoring AB behaviors with EMAs, which was not a determinant of the outcome.¹⁰^,²⁷

No statistically significant differences were found between the population participating in the research (UDLA; USG), the self-reported strategies for AB, which helped in the data collection, and the alerts generated by the app during the 7-day monitoring period, which controlled the bias of the study due to the alarm that was activated according to the program.²⁸^,²⁹

The alerts generated in the evaluation by using the application provided diverse results: 33% of participants reported experiencing jaw discomfort the first day, 61% reported it on the second day, 64% reported it on the third day, 21% reported it on the fourth day, the result did not change on the fifth day, 41% reported experiencing relaxation on the sixth day, and 51% reported experiencing relaxation on the seventh day.

The natural fluctuation in the recognition consisting of the symptomatology reported regarding the specific AB behaviors recorded in the app demonstrates considerable variability.³⁰^,³¹ These findings indicate that relaxed muscles are recognized in a high percentage of the investigated population, taking the baseline results as a starting point when evaluating the combined frequencies of all the symptoms of AB indicated in the app.³²^,³³

The EMA strategy used in the smartphone application indicated a medium frequency value that provided reliability in monitoring AB behaviors, reducing the influence of natural fluctuations directly related to the specific symptomatology.³⁴^,³⁵ Unfortunately, e-mail registration limited daytime contact with the patients with TMD,³⁶^,³⁷ and it is recommended that future research evaluate the increase or decrease in the frequency of AB symptoms, relating them to eating habits, smoking habits, medication use, and psychological problems.³⁸^,³⁹

Compared with the findings of other similar studies that have contributed to updating the concept of bruxism by providing strategic evaluation options,⁴⁰^,⁴¹ population comparisons will be made better by translating the BruxApp⁴²^,⁴³ into several languages, which opens the possibility of conducting multicenter epidemiological research on bruxism.

Conclusion

During 7 days of monitoring the frequency of AB behaviors through a smartphone app, the student population experienced discomfort in the jaw and teeth in the first 4 days, reaching a state of relaxation on the seventh day.

Data availability

Zenodo. Evaluation by app in smartphones of awake bruxism at the return of presential classes in two university centers, https://doi.org/10.5281/zenodo.7979723.⁴³

This project contains the following underlying data:

• Table 1: Significance test
• Table 2.docx (Data of distribution of the sample by gender)
• Table 3.docx (Data of distributions of sample by age)
• Table 4.docx (Data of distribution of alerts according to user conditions)
• Table 5.docx (Data of distribution of alerts according to condition among sex and age groups)

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgments

The authors would like to express their special thanks to Universidad de Las Américas.

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34. Sabbagh H, Sabbagh A, Heppner A, et al.: Patients’ perceptions on temporomandibular disorder treatment with hydrostatic oral splints - a pilot study. BDJ Open. 2022 Feb 5; 8(1): 4. PubMed Abstract | Publisher Full Text | Free Full Text
35. Duanmu Z, Liu L, Ren Y, et al.: Development of a biomechanical model for dynamic occlusal stress analysis. Int. J. Oral Sci. 2021; 13: 29. PubMed Abstract | Publisher Full Text | Free Full Text
36. Goldstein G, DeSantis L, Goodcacre C: Bruxism: Best Evidence Consensus Statement. J. Prosthodont. 2021 Apr; 30(S1): 91–101. Publisher Full Text
37. Manfredini D, Colonna A, Bracci A, et al.: Bruxism: a summary of current knowledge on aetiology, assessment and management. Oral Surg. 2020; 13(4): 358–370. Publisher Full Text
38. Youny S, Salinas T, Wiens J: The effect of patient specific factors on oclussal forces generated: best evidence consensus statement. J. Prosthodont. 2021; 30(S1): 52–60. Publisher Full Text
39. Malvin N, Lobbezzo F, Karen S, et al.: Stress-evoked muscle activity in women with and without chronic myofascial face pain. J. Oral Rehabil. 2021; 48: 1089–1098.
40. Pereira NC, Oltramari PVP, Conti PCR, et al.: Frequency of awake bruxism behaviour in orthodontic patients: Randomised clinical trial: Awake bruxism behaviour in orthodontic patients. J. Oral Rehabil. 2021 Apr; 48(4): 422–429. PubMed Abstract | Publisher Full Text
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43. Velasquez Ron B, Rodriguez Tates M: Evaluation by app in smartphones of awake bruxism at the return of presential classes in two university centers. Zenodo.F1000Res.2023; 1(23): 215.Publisher Full Text

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Version 2

VERSION 2 PUBLISHED 30 Jun 2023

Author details Author details

Veronica Mosquera Cisneros
Roles: Investigation, Methodology, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Pamela Pazmiño Troncoso
Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Maria Rodriguez Tates
Roles: Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Eddy Alvares Lalvay
Roles: Conceptualization, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Luis Chauca Bajaña
Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Andrea Ordoñez Balladares
Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 05 Aug 2024, 12:766

https://doi.org/10.12688/f1000research.133946.2

version 1

Published: 30 Jun 2023, 12:766

https://doi.org/10.12688/f1000research.133946.1

© 2024 Velasquez Ron B et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) is/are employees of the US Government and therefore domestic copyright protection in USA does not apply to this work. The work may be protected under the copyright laws of other jurisdictions when used in those jurisdictions.

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Velasquez Ron B, Mosquera Cisneros V, Pazmiño Troncoso P et al. Evaluation by app in smartphones of awake bruxism at the return of presential classes in two university centers [version 2; peer review: 1 approved, 1 approved with reservations, 3 not approved]. F1000Research 2024, 12:766 (https://doi.org/10.12688/f1000research.133946.2)

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Open Peer Review

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Key to Reviewer Statuses VIEW HIDE

ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions

Version 2

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PUBLISHED 05 Aug 2024

Revised

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Reviewer Report 16 Oct 2024

Gabriela de Araujo, Universidade Federal de Santa Maria, Santa Maria, Brazil

Not Approved

https://doi.org/10.5256/f1000research.168484.r328134

Dear authors, investigating the frequency of behaviors related to awake bruxism, especially in a sample of university students, is important given the increased incidence of this outcome. The topic and idea of the study is relevant, since the use of apps can help change behavior and help identify important signs. However, the study has significant errors in the writing, limiting readers' comprehension on several points. In addition, the shows insufficiency of important information, especially in the study's methodology, could lead to future studies being reproduced. After reading, some aspects could be clarified to improve the article, so please leave your comments below.

#Abstract: -The methodology section shows insufficient important information for an initial understanding of the study. How does the app assess the frequency of bruxism? It's not clear how the app identifies the behaviors of tooth contact, muscle relaxation, teeth grinding and the apartment.
-Describe the statistical analysis used.

#Introduction: - Bruxism has different types of classification depending on how the diagnosis is made. In this case, as the bruxism was self-reported by the student through the app, the most correct term to describe it is “possible bruxism”. Please take care to use the correct term throughout the study.
- Please reference the following sentence: “When comparing populations, awake bruxism has risk factors such as mental disorders, depression, and suicidal delusions, among others”
- Please describe in the introduction a study from the last five years that has assessed possible awake bruxism in students, and what the associated factors are. The introduction also shows insufficiency data on the prevalence of this condition, especially in relation to the study sample (young students).
- Are there any studies that have evaluated bruxism-related apps? If so, please describe.

#Methods: - Please include that “possible awake bruxism” was assessed through the participants' self-report;
-Important information on data collection is missing. How were participants contacted to take part in the study and download the app? When was the study carried out? Was it after the COVID-19 pandemic?
- Why were only university students from recent semesters included? Were only dental students considered? It is not clear here.
- Why was there no sample calculation? Especially in descriptive studies, this is unpredictable. I suggest calculating the power of the study.
- The statistical analysis part is not very clear. Be careful when relating the chi-square test to the expression “association”. The statistical analysis was carried out to check the distribution of the sample (frequencies) and not associations.

#Results: - There are many tables that don't need to exist. I suggest adding the distribution tables for the sex and age variables. I also suggest classifying the age variable categorically (adolescents, young adults and adults) according to the World Health Organization classification.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: dentistry; pediatric dentistry; social and preventive dentistry; epidemiology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Reviewer Report 11 Oct 2024

Dyanne Medina, University of São Paulo, São Paulo, Brazil

Not Approved

https://doi.org/10.5256/f1000research.168484.r328132

In the abstract, I can identify some deficiencies in the study. The second sentence begins with "To" but is incomplete and shows insufficient clarity. Additionally, the description of awake bruxism behaviors is confusing. In the background section, these behaviors are defined in one way, but in the results, they are labeled differently, and in the conclusion, yet another set of names is used. This inconsistency makes it unclear which behavior is being discussed.
I have never encountered the term "jaw effort" in the context of awake bruxism. In physiology, "jaw effort" is distinctly defined as "jaw bracing" or "jaw clenching." Jaw effort refers to the amount of force or muscular activity required to perform a specific task, such as chewing, which involves dynamic jaw movements during repetitive actions. In contrast, jaw bracing refers to the often subconscious contraction of the jaw muscles, typically involving sustained tension. The way this was described raises concerns that participants may have been given instructions that led them to misreport their behaviors.
In the introduction, the study by Souza does not specifically state that individuals with awake bruxism are at risk for suicidal delusions. In fact, Souza's study is unique in the field and lacks further evidence to support such claims, so this cannot be presented as a fact, nor can the other risk factors. Additionally, the phrase "when comparing populations" is vague—what populations are being compared?
Furthermore, in the introduction, the authors mention instrumental approaches such as PDG and EMG, but these concepts are discussed separately. They should be consolidated since they pertain to the same topic. I also noticed that there is no mention in the introduction of the significance of returning to classes or why this is an important moment to assess students’ frequency of awake bruxism.
The rationale for assessing relaxation versus non-relaxation is not well explained. I strongly recommend reviewing other articles on EMA and awake bruxism, where the behaviors are more clearly described, as the explanation in the methods section is quite confusing.
The methods section needs to be better detailed to align with the results being presented. In the results section, a condition called "daytime pressure" is suddenly introduced, though it was not mentioned previously in the methods, along with other new conditions.
The manuscript requires substantial revision, particularly regarding its design, objectives, results, and interpretation. Additionally, the discussion and conclusion need to be more clearly articulated, they are many inconsistencies to allow publishing this article. That said, the authors have done commendable work with a substantial and representative sample.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

No
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My research area are: Temporomandibular disorders, bruxism, ecological momentary assessment, fatigue, chewing performance and quantitative sensory testing.

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Reviewer Report 07 Oct 2024

Swapna B V, Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, India

kavishma Sulaya, Department of Prosthodontics and Crown& Bridge, Manipal Academy of Higher Education, Manipal, Karnataka, India; Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, Karnataka, India

Approved with Reservations

https://doi.org/10.5256/f1000research.168484.r310982

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VERSION 1

PUBLISHED 30 Jun 2023

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Reviewer Report 22 May 2024

Swapna B V, Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, India

Not Approved

https://doi.org/10.5256/f1000research.146965.r274092

This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate.

The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.

The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.

The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Prosthodontics

We confirm that we have read this submission and believe that we have an appropriate level of expertise to state that we do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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Author Response 05 Aug 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

05 Aug 2024

Author Response
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from ... Continue reading
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Competing Interests: We have no conflicts of interest to disclose. Close
Report a concern
Author Response 26 Jun 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

26 Jun 2024

Author Response
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from ... Continue reading
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Response to comments from reviewers:

Reviewer 2 .
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Response to comments from reviewers:

Reviewer 2 .
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Competing Interests: We have no conflicts of interest to disclose. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 05 Aug 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

05 Aug 2024

Author Response
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from ... Continue reading
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Competing Interests: We have no conflicts of interest to disclose. Close
Report a concern
Author Response 26 Jun 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

26 Jun 2024

Author Response
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from ... Continue reading
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Response to comments from reviewers:

Reviewer 2 .
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Response to comments from reviewers:

Reviewer 2 .
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Competing Interests: We have no conflicts of interest to disclose. Close
Report a concern

Views

Reviewer Report 14 May 2024

Dobromira Antonova Shopova, Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria

Approved

https://doi.org/10.5256/f1000research.146965.r224191

The work is clearly and accurately presented and it cites the current literature properly.
The study design is appropriate and the work is with technically and scientifically sound.
The sufficient details of methods and analysis provide to allow replication by other researchers.
The statistical analysis and its interpretation are appropriate.
All the source data underlying the results are available to ensure full reproducibility.
The conclusions are adequately drawn and supported by the results.
1. The introduction is short, with only 17 cited authors. In general, the number of references is not large - 50, which tends to the minimum for a review article. I ask the authors to add more articles, especially those published in the last 5 years. Authors can add and more similar articles to enrich their article. 50 cited articles are too small number.
2. Long tables make the results quite difficult. Try to systematize the cited authors more tightly.
3. The discussion is voluminous enough and a sufficient number of authors are compared.
4. The conclusion consists of one short sentence. Authors can submit their opinion on the most suitable app according to them.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: I am a prosthodontics.I am interested in digital technologies in dentistry - additive manufacturing and milling CAD/CAM. I also started working in the field of implantology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

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Views

Reviewer Report 14 May 2024

Maria Beatriz Duarte Gaviao, University of Campinas (UNICAMP), Piracicaba, Brazil

Not Approved

https://doi.org/10.5256/f1000research.146965.r224184

This manuscript aimed to evaluate the awake bruxism in university students using a smartphone application.
This is an important and interesting issue, the sample is adequate and the authors have looked for a good methodology. Nevertheless, the manuscript needs reworking to be more comprehensible.
In general, the English language needs to be revised. Furthermore, cited references must be checked for the names of the authors and their respective numbers throughout the text, synchronized with the list of references.
Abstract: The “Background” does not make sense. Please, rewrite and defined the aim precisely. Also define the app used, BruxApp app, so as not to confuse the reader. The phrase “Awake bruxism was evaluated with the creation of an app that according to the authors evaluates…” it seems that the authors of this manuscript created the app. It is not possible to understand what additive bruxism is.
The conclusion repeats the results and is vague.

Text
Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and nonrelaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

No
Are the conclusions drawn adequately supported by the results?

No

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Oral Physiology, Temporomandibular disorders, Brruxism, Quality of life.

CITE

Report a concern

Author Response 05 Aug 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

05 Aug 2024

Author Response
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from ... Continue reading
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Competing Interests: We have no conflicts of interest to disclose. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 05 Aug 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

05 Aug 2024

Author Response
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from ... Continue reading
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed

Cites references reviewed

Introduction totally changed

Aim changed

The Bracci Team created the app (Siena University)

References 16 corrected.

Statistical analysis changed the order

Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.

Discussion totally changed

Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed

Aim changed

Conclusion totally changed

SB corrected

Abbreviation reviewed

The manuscript is corrected

English language reviewed

References 16 corrected.

For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.

The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.

BA changed for AB (awake bruxism)

References 24,25 reviewed

Conclusion totally changed
Competing Interests: We have no conflicts of interest to disclose. Close
Report a concern

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 30 Jun 2023

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1	2	3	4	5
Version 2 (revision) 05 Aug 24			read	read	read
Version 1 30 Jun 23	read	read	read

Maria Beatriz Duarte Gaviao, University of Campinas (UNICAMP), Piracicaba, Brazil
Dobromira Antonova Shopova, Medical University of Plovdiv, Plovdiv, Bulgaria
Swapna B V, Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, India

kavishma Sulaya, Manipal Academy of Higher Education, Manipal, India; Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, India
Dyanne Medina, University of São Paulo, São Paulo, Brazil
Gabriela de Araujo, Universidade Federal de Santa Maria, Santa Maria, Brazil

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Reviewer Report

1 Views

16 Oct 2024 | for Version 2

Gabriela de Araujo, Universidade Federal de Santa Maria, Santa Maria, Brazil

1 Views Cite this report Responses(0)

Not Approved

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

dentistry; pediatric dentistry; social and preventive dentistry; epidemiology.

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Reviewer Report

2 Views

11 Oct 2024 | for Version 2

Dyanne Medina, University of São Paulo, São Paulo, Brazil

2 Views Cite this report Responses(0)

Not Approved

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

No
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My research area are: Temporomandibular disorders, bruxism, ecological momentary assessment, fatigue, chewing performance and quantitative sensory testing.

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Reviewer Report

7 Views

07 Oct 2024 | for Version 2

Swapna B V, Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, India

7 Views Cite this report Responses(0)

Approved With Reservations

I would like to appreciate the efforts made by the authors in considering all the suggestions from the reviewers for improving the manuscript.
I have few suggestions

1. Abstract – background of the study still remains unclear, could be re written in better way to improve the readership.
2. Introduction - terminologies like pushes or mandibular reinforcement, additive bruxism, jaw effort is still mentioned, are these terminologies appropriate.
3. Recheck reference number 16, it is not by Dr Alessandro Bracci.
4. The conclusion needs to be elaborated as it is too short.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Prosthodontics

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

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Reviewer Report

24 Views

22 May 2024 | for Version 1

Swapna B V, Manipal Academy of Higher Education (Ringgold ID: 76793), Manipal, India

24 Views Cite this report Responses(2)

Not Approved

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Prosthodontics

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Author Response

05 Aug 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Reviewed 1 : Maria Beatriz Duarte Gaviao

Please, revised the English language in the Introduction, as commented above. Almost paragraphs need to be rewritten, specially the last one, in which the first sentence does not make sense considering the study design, since the AB was not evaluated before or during the pandemic. Moreover, the aim needs to be better described and conclusion must be in agreement.
Please, check if the BruxApp was developed by Dr Alessandro Bracci et al. The reference 16 does not match with this information, as well as the authors of reference 16 did not developed the app, I think.
Statistical analysis must be inserted in the end of Methods. Please, explain why the condition of relaxation and non relaxation was associated. Why is this association important?
Many paragraphs of the Discussion are results, not characterizing discussion.
The Conclusion is not reliable, since stress with parafunctions were not evaluated.
Finally, the manuscript needs intense reformulation regarding the design, aim, results and their interpretation, and a more precise discussion and conclusion. Despite this, the authors have performed a good job using an expressive sample.

Response to comments from reviewers:

English language reviewed
Cites references reviewed
Introduction totally changed
Aim changed
The Bracci Team created the app (Siena University)
References 16 corrected.
Statistical analysis changed the order
Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.
Discussion totally changed
Conclusion totally changed

Reviewer 2 : Swapna B V
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed
Aim changed
Conclusion totally changed
SB corrected
Abbreviation reviewed
The manuscript is corrected
English language reviewed
References 16 corrected.
For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.
The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.
BA changed for AB (awake bruxism)
References 24,25 reviewed
Conclusion totally changed

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Competing Interests

We have no conflicts of interest to disclose.

Author Response

26 Jun 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

Dear Mr. Editor, after the corrections recommended by the reviewers and yours, we present an Original Research article entitle Monitoring the frequency of awake bruxism behaviors in dental students from two university centers by using a smartphone app, for consideration by F1000reserach . We confirm that this work is original and has not been published elsewhere, nor is it currently under consideration for publication elsewhere. In this paper was to monitor the frequency of awake bruxism behaviors in dental students by using a smartphone app. We attach the comments of the reviewers and the new manuscript with all the changes made. We believe that this manuscript is appropriate for publication by F1000reserach.

Response to comments from reviewers:

Reviewer 2 .
This manuscript aims to evaluate the use of smartphone applications in university students with awake bruxism.

Abstract- The background is not clear and needs to be rewritten more meaningfully. Please re-write the aim of the study and the conclusion.

In introduction, the abbreviation SB is for sleep bruxism, but it is wrongly mentioned. There are other abbreviations that have not been expanded, eg. EMA, GA. Please check whether the use of terminologies like pushes or mandibular reinforcement, additive bruxism is appropriate. The methodology of this study is interesting as the tool used for evaluation is gaining popularity, however the manuscript needs to be improvised and more comprehending to improve the readership. The English language requires lot of corrections and improvement as most of the sentences do not convey the intended meaning to the reader.
The reference number 16 cited is not by Dr Alessandro Bracci, about development of the app, It is wrongly cited. Is the app available as free version for download? How did the researcher persuade the respondents to download it?

What is the full form of BA, mentioned in discussion? The reference number 24, 25 does not match with information about gender differences.
The conclusion should be rewritten as this sentence “Bruxism awake with the app was evaluated, identifying 5 behaviors such as’’ makes no sense.
Response to comments from reviewers:

Abstract totally changed
Aim changed
Conclusion totally changed
SB corrected
Abbreviation reviewed
The manuscript is corrected
English language reviewed
References 16 corrected.
For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.
The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.
BA changed for AB (awake bruxism)
References 24,25 reviewed
Conclusion totally changed

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Competing Interests

We have no conflicts of interest to disclose.

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Reviewer Report

10 Views

14 May 2024 | for Version 1

Dobromira Antonova Shopova, Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria

10 Views Cite this report Responses(0)

Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

I am a prosthodontics.I am interested in digital technologies in dentistry - additive manufacturing and milling CAD/CAM. I also started working in the field of implantology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

17 Views

14 May 2024 | for Version 1

Maria Beatriz Duarte Gaviao, University of Campinas (UNICAMP), Piracicaba, Brazil

17 Views Cite this report Responses(1)

Not Approved

Is the work clearly and accurately presented and does it cite the current literature?

No
Is the study design appropriate and is the work technically sound?

No
Are sufficient details of methods and analysis provided to allow replication by others?

No
If applicable, is the statistical analysis and its interpretation appropriate?

No
Are all the source data underlying the results available to ensure full reproducibility?

No
Are the conclusions drawn adequately supported by the results?

No

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Oral Physiology, Temporomandibular disorders, Brruxism, Quality of life.

Respond to this report

Responses (1)

Author Response

05 Aug 2024

Byron Velasquez Ron, UDLA, Universidad de Las Americas, Quito, 170523, Ecuador

English language reviewed
Cites references reviewed
Introduction totally changed
Aim changed
The Bracci Team created the app (Siena University)
References 16 corrected.
Statistical analysis changed the order
Relaxation and non-relaxation were associated, the app allows in its monitoring to decipher if the patient is relaxed, in some cases the patient does not accept that he is not relaxed, the monitoring clarifies that on some occasions he may be asymptomatic and therefore does not know the condition.
Discussion totally changed
Conclusion totally changed

Abstract totally changed
Aim changed
Conclusion totally changed
SB corrected
Abbreviation reviewed
The manuscript is corrected
English language reviewed
References 16 corrected.
For academic purposes the app is free, a letter from the institution must be sent that proves the study to be carried out.
The participants were socialized about their ailments, as they did not know the subject and explained to them, the study aroused a lot of interest.
BA changed for AB (awake bruxism)
References 24,25 reviewed
Conclusion totally changed

View more View less

Competing Interests

We have no conflicts of interest to disclose.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Evaluation by app in smartphones of awake bruxism at the return of presential classes in two university centers

Abstract

Keywords

Revised Amendments from Version 1

Background

Materials and Methods

Figure 1. Flow diagram research.

Table 1. Significance test.

Results

Table 2. Distribution of the sample by sex.

Table 3. Distribution of the sample by age.

Table 4. Distribution of alerts according to user conditions.

Table 5. Distribution of alerts according to condition among sex and age groups.

Discussion

Conclusion

Data availability

Acknowledgments

References

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