Ontology and Bruxism: Do We Have Enough Information?

ABSTRACT

The idea of classifying and defining bruxism according to ontological principles may be interesting, but currently we just do not have enough information to label in a black or white manner the many facets of bruxism. In an era in which general knowledge on bruxism by the dental communities is surely in need of improvement, efforts to clarify the road map tracked by the current panelists who drafted the definition should be appraised carefully. The recent introduction of a standardized multidimensional evaluation system (i.e., Standardized Tool for the Assessment of Bruxism [STAB]) and a screening instrument for bruxism (i.e., BruxScreen) should be viewed as the starting points to enter a new era in the discipline of bruxism, in which non‐hierarchical and non‐preconceived approaches are used to collect data. Artificial intelligence strategies to mine data gathered with the above instruments might help building predictive models along the etiology‐status‐consequences trajectory, as recently suggested in a model for awake bruxism metrics. Until then, proposals to adopt ontological principles to classify bruxism will be merely based on speculations rather than on facts.

Dear Editor,

We read with interest the recent commentary by Skarmeta [1]. The author is not novel to pen this kind of personal comments, which are a potentially interesting strategy to enhance discussion [2], but often carry the risk of derailing the attention of readers from the joint efforts of most experts who have tried to advance the bruxism field over the past decades [3].

In his recent paper, the author proposes an ontological approach to the definition of bruxism, with the aim to ‘clarify communication within the medical community and advance research by enabling a comprehensive ontology‐based classification of bruxism’. The intentions are potentially laudable, but we admit the arguments to back up the proposal are insufficient. Ontology essentially is a more complex variation in taxonomy, and it might surely be viewed as one of the many approaches to classify disease. It has also been discussed as a potential strategy to implement and/or integrate currently available orofacial pain classification schemes [4]. Conceptually, it represents a form of categorisation that incorporates many different arbitrary complex relationships to categorise the concepts while providing a sophisticated model where everything is interconnected. The typical example to illustrate this approach refers to the difference between viewing a tree with all its branches (taxonomy) and viewing it as a web with everything being interconnected (ontology).

The ultimate ontological proposal of the author is to use the term bruxism as an apex condition that branches into two different supertypes: ‘sleep bruxism’ and ‘awake bruxism’. These branches further subdivide into ‘normo’ and ‘patho’ subtypes. Then, the author speculates about some finer details and makes two examples: ‘occurrent bracing associated with low perceived stress may be a subset of awake normo‐bruxism’, whilst ‘concurrent clenching associated with perceived stress leading to restoration failure may be included inthe awake patho‐bruxism’, indicating the relation of a frequent specific masticatory motor activity with known risk factors such as perceived stress and outlining a detrimental consequence.

The idea may be interesting, but we feel the author missed a very simple point: currently, we just do not have enough information to label in a black or white manner the many facets of bruxism [5]. In an era in which general knowledge on bruxism by the dental communities is surely in need of improvement [6], efforts to clarify the road map tracked by the current panellists who drafted the definition should be appraised carefully [7, 8]. The recent introduction of a standardised multidimensional evaluation system (i.e., standardised tool for the assessment of bruxism [STAB]) [9] and a screening instrument for bruxism (i.e., BruxScreen) [10] should be viewed as the starting points to enter a new era in the discipline of bruxism, in which non‐hierarchical and non‐preconceived approaches are used to collect data [11].

The collection of data with standardised approaches has just began, and a considerable amount of time will be needed to move on from speculations to evidence as far as the complex interactions between etiological/risk factors, the spectrum of masticatory muscle activities and the purported consequences are concerned. For instance, if one gets back to the suggestions of the author, how can we state that bracing associated with low perceived stress is ‘normal’? What defines normal? What discriminates between bracing due to low or high perceived stress? And how can we state that clenching leads to restoration failure? What about grinding? What about other concurrent causes of restoration failure? On one hand, we are just scratching the surface of the complex phenomenon of bracing [12, 13], whilst on the other hand, we simply do not have enough information on the relationship between different approaches to evaluate bruxism [14] or its impact on everyday dentistry [15]. And, more in general, what about the possibility that a single type of jaw‐muscle activity may have multiple consequences to the point that it can be either Normo‐ and/or Patho‐bruxism [16]?

Artificial intelligence strategies to mine data gathered with the above instruments might help building predictive models along the aetiology‐status consequences trajectory, as recently suggested by Bracci et al. [17] in a model for awake bruxism metrics. Until then, all in all, Skarmeta's proposal will be merely based on speculations rather than on facts. Thus, the author is kindly encouraged to appraise the need to adopt homogeneous efforts with the scientific community instead of voicing individual suggestions. The definition and assessment strategies that are currently viewed as references are actually the results of multiauthored, year‐long fruitful in‐person debates, which still remain the best possible approach to share knowledge and provide expert suggestions. Bruxism, as recently pointed out, is the dental gateway to medicine [18]. We should all feel responsible for the quality of information provided in such a complex and intriguing field.

Peer Review

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/joor.13890.