Background & Aims

Awake bruxism (AB) has garnered attention for its association with temporomandibular disorders (TMD) and has been linked with psychosocial factors such as anxiety and stress.1,2 However, there is still a lack of studies analyzing the frequency of AB behaviors in patients with TMDs evaluating psychosocial factors employing an instrumental approach, as the ecological momentary assessment. This study aims to assess AB frequency, anxiety, and stress in TMD patients and compare it with an asymptomatic control group. Additionally, aims to analyze the AB frequency in two subgroups, TMD patients with high anxiety and TMD patients with low anxiety symptoms.

Methods

A total of 153 participants (n=116 asymptomatic group, n=37 TMD patients) underwent AB frequency assessment via EMA using a smartphone application that sent alerts at random intervals every day for one week. Participants reported in real time which of the AB behaviors best represented their current condition: relaxed jaw muscles, tooth contact, tooth clenching, tooth grinding, or jaw bracing. Questionaries of anxiety disorder (Generalized Anxiety Disorder Scale [GAD7]) (State Trait Anxiety Inventory (STAI-S; STAI-T), and stress (Perceived Stress Scale [PSS]) were collected. Data from the control group reporting over 85% relax jaw muscles were used to transform GAD7 results into T-scores.3,4 Data were initially transformed into z score, after that the formula T score = 10(z score) + 50 was applied. A T-score above 60 was higher than the healthy reference group. Subsequently, TMD patients were divided into patients with high anxiety (T-score ? 60) and low anxiety symptoms (T-score ? 60)

Results

During the seven days, the AB frequency was 74.8% ± 19.1% for TMD patients and 45.7% ± 25.8% for pain-free subjects (p < .000). Mandible bracing and teeth clenching had a higher frequency in the TMD group (p < .000), while tooth contact and grinding did not differ between the groups. Relaxed jaw muscles were more frequent in asymptomatic patients (p<.000). Painful TMD group presented significantly higher scores than the asymptomatic group on the GAD7(P < .006), PSS(P<.000) and STAI T (P < .031) questionaries. The analysis showed that AB behaviors: Teeth Clenching(p < .003), Total AB frequency(p < .004), and the psychosocial variable: PSS(p < .000), differed significantly between the TMD subgroups: high and low anxiety symptoms, demonstrating that the TMD with high anxiety group had statistically significant higher frequencies of AB behaviors and higher scores for the psychosocial variables.

Conclusions

Painful TMD patients have a higher AB frequency and are characterized by jaw bracing and teeth clenching. Among TMD patients, the teeth clenching behavior appears to be influenced by anxiety levels, particularly in TMD patients with higher anxiety levels. AB frequency in painful TMD patients could be influenced by psychosocial factors, such as anxiety and stress.

References

1.Ahlberg J, Lobbezoo F, Ahlberg K, et al. Self-reported Bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal.2013;18:e7?e11.

2.ManfrediniD, LobbezooF. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain. 2009;23:153–166.

3.Baad-Hansen L, Svensson P. Psychosocial profiles of temporomandibular disorder pain patients: Proposal of a new approach to present complex data. J Oral Facial Pain Headache 2017; 31:199–209.

4.Medina Flores D, Barragán Nuñez MI, Müller de Quevedo H et al. Real time evaluation of awake bruxism behaviors in young asymptomatic students and its impact on the masticatory muscles. J Prosthet Dent. 2023 Apr 15:S0022-3913(23)00174-9.

Presenting Author

Dyanne Medina Flores

Poster Authors

Dyanne Medina Flores

Bauru School of Dentistry, University of São Paulo

Lead Author

E-mail

Juliana Stuginski-Barbosa

Bauru Orofacial Pain Group

Lead Author

E-mail

Maria Emilia Servin Berden

Bauru School of Dentistry, University of São Paulo

Lead Author

E-mail

Samilla Braga

Universidade de São Paulo

Lead Author

E-mail

Carolina Cunha

Sacred Heart University Center

Lead Author

E-mail

Daniela Müller de Quevedo

Feevale University

Lead Author

E-mail

Paulo Conti

University of São Paulo

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Orofacial Pain