Conceptualizing an international classification of oral behaviors (ICOB): A road map and future developments

Bruxism is now understood as a multidimensional masticatory muscle behavior occurring during sleep and/or wakefulness, but no formal classification system exists to organize related oral behaviors and phenotypes.

A closed international expert workshop was held at the 2025 IADR General Assembly in Barcelona. Three regional groups prepared reports on the need, desirable features, and possible structure of an International Classification of Oral Behaviors (ICOB). Presentations and discussions were synthesized into shared principles.

Consensus supported a classification aligned with the current bruxism definition, organized by circadian manifestation and muscle activity phenotype, with optional descriptors such as tooth contact and chronicity. Neurological movement disorders should be excluded, while other oral behaviors beyond bruxism should be included.

The workshop established core ICOB principles and research priorities. Future steps include drafting a classification proposal, Delphi rounds, and psychometric evaluation to improve diagnostic clarity, research standardization, and clinical decision-making.