A Pragmatic Approach to the Management of Severe Awake Bruxism in an Adolescent with Cerebral Palsy and Global Developmental Delay

Cerebral palsy is a neurological and motor condition characterised by muscle balance and posture impairments. Bruxism and malocclusion were frequently observed in patients with cerebral palsy, in contrast to other oral anomalies. The report outlines how severe awake bruxism is managed in a 16-year-old Korean boy who has nonverbal spastic cerebral palsy and global developmental delay. The treatment protocol involved the fabrication of soft occlusal splints of three and four millimetres in thickness, followed by the placement of stainless-steel crowns on all first permanent molars whilst video recording and a bruxism diary was kept. Fixed restorations demonstrate increased endurance in withstanding bruxism force in persons who are dependent on their caretaker.

The Epidemiology of Bruxism in Relation to Psychological Factors

The aim of the present study was to establish the prevalence of sleep/awake bruxism among young students in Transylvania and to correlate the presence of this muscle activity with behavioral variations. This analytical, observational, cohort, cross-sectional, and prospective study involved 308 volunteers aged between 19 and 30 years of different nationalities, all students of the “Iuliu Hațieganu” University of Medicine and Pharmacy in Cluj-Napoca, Romania. Subjects were asked to complete an anonymous questionnaire which was structured in five sections. The results obtained from the questionnaires were analyzed separately for sleep bruxism and for awake bruxism. We did not find any statistically significant correlation between awake bruxism or sleep bruxism and age (p = 0.30 and p = 0.37, respectively), sex (p = 0.44 and p = 0.48, respectively), or nationality (p = 0.55 and p = 0.67, respectively). Only a high degree of stress and frustration (p = 0.035 and p = 0.020) was observed in European subjects except for the Romanians and the French, likely related to the difficulties of adapting to the language and lifestyle in Romania. Female sex was statistically significantly associated with an increased level of stress (p = 0.004), duty-related depression (p = 0.006), and duty-related anxiety (p = 0.003). Stress and anxiety can be favorable factors in the appearance of both types of bruxism; however, depression is associated only with awake bruxism.

The Association between Emotional Stress, Sleep, and Awake Bruxism among Dental Students: A Sex Comparison

Psychosocial factors may play an important role in the etiology of sleep and awake bruxism. The purpose of this study was to assess the relationship between emotional stress and bruxism in male and female dental students at various stages of their education. Dental education in Israel is based on a six-year curriculum, divided into three stages: pre-medical studies (yr. 1–2), manual skills (yr. 3–4), and clinical experience (yr. 5–6). Each stage requires different capabilities and skills. Questionnaires regarding psychological state (SCL-90) measuring depression, anxiety, and somatization as well as stress evaluation questioners (Perceived Stress Scale questionnaire 14) were completed by 387 dental students in the 1st to 6th years. Sleep and awake bruxism were evaluated based on the respondent’s awareness. During the manual stage of studies, a significant increase was identified, albeit with weak correlations, between stress scales, depression, anxiety, somatization, and the prevalence of awake bruxism, particularly among males. Only in females was sleep bruxism correlated with emotional parameters, whereas no significant difference in sleep bruxism was observed in males throughout the stages of the study. The manual years of dental education were found to be linked to higher levels of emotional distress and awake bruxism, particularly in men. Sleep bruxism, on the other hand, was not directly linked to emotional factors, implying a distinct etiology.

Polymorphic variants in genes related to stress coping are associated with the awake bruxism

Background Chronic stress is one of the leading predisposing factors in bruxism aetiology, but the influence of genetic factors is also suggested. We aimed to study whether sequence variants in genes involved in stress regulation pathways: NTRK2 and BDNF, may be associated with awake bruxism susceptibility, clinical presentation, and patients’ perceived stress level. Methods The study group included 104 patients with probable awake bruxism and 191 population controls. Patients underwent dental examination concerning the symptoms of bruxism and psychological testing. Genotyping was performed using HRMA and sequencing. Statistical analyses were conducted, and P values below 0.05 were considered statistically significant. Results We observed a positive correlation of measured stress level and pathological teeth attrition in the anterior segment (r = 0.45, P < 0.001), enamel attritions (r = 0.44, P < 0.001), tongue impressions (r = 0.50, P < 0.001) and posterior teeth attrition (r = 0.27, P = 0.005). Moreover, the c.196A variant (p.66Met) of the BDNF gene and c.1397-31392G allele of the NTRK2 gene were present with elevated frequency, comparing to controls. Conclusions This study hence the thesis that perceived stress level is a substantial contributing factor to awake bruxism occurrence and its clinical manifestations. Moreover, sequence variants in genes related to stress coping may be correlated with awake bruxism’s susceptibility via elevated perceived stress level.

Psychosocial and Behavioral Factors in Awake Bruxism—Self-Report versus Ecological Momentary Assessment

The issue of psychosocial factors and concurrent conditions associated with AB is a relatively new approach in the study of Awake Bruxism (AB). In the present study a population of 84 dental students were assessed for probable AB with two modes of AB assessment: Single point self-report (SR) and ecological momentary assessment through a designated smartphone application (BA). The two assessment modes were compared with regard to their ability to phenotype subjects as far as the following psychosocial and behavioral variables are concerned: Gender; depression; somatization; oral behaviors; chronic pain and associated pain symptoms in the head, neck and scapula. Two-way ANOVA showed main effect of SR for the following variables: Chronic Pain Intensity score (F(1,49) = 6.441, p < 0.02), migraine/headache (F(1,81) = 7.396, p < 0.01), pain in neck (F(1,81) = 6.726, p < 0.05), pain in scapula (F(1,81) = 8.546, p < 0.005) and the oral behaviors of pushing the tongue forcefully against the teeth (F(1,81) = 5.222, p < 0.05) and inserting the tongue between the upper and lower teeth (F(1,81) = 5.344, p < 0.03). The effect of SR on the habit of chewing gum was borderline (F(1,81) = 3.369, p = 0.07). Main effect of BA was found for depression (F(1,81) = 6.049, p < 0.05), while the effect of BA on somatization was borderline (F(1,81) = 3.657, p = 0.059). An interaction between SR and BA groups could be observed for the behavior of biting, chewing or playing with the tongue, cheeks or lips (F(1,81) = 4.117, p < 0.05). The results suggest that a combination of a single-point self-report referring to the past 30 days, and an ecological momentary assessment supplying information about the actual timing of the report, can help us to better assess AB, as well as increase our ability to define the phenotype of subjects with AB as far as psychosocial and behavioral factors are concerned.

Association between self-reported bruxism and academic performance in university students.

Objective: To evaluate the association between self-reported bruxism and academic performance in students at a university in Lima, Peru. Material and Methods: A total of 203 students were evaluated in this study, between the ages of 19 and 35 years. Self-reported bruxism was measured using the Bruxism Assessment Questionnaire. Academic performance was evaluated using the Approval Index Scale. In addition, other variables were included such as employment status, socioeconomic level, stress, anxiety, among others. The association of variables were factored in using the chi-square test and the logistic regression presented the unadjusted and adjusted analisis. Results: The frequency of self-reported awake bruxism and sleep bruxism was 53.20% and 36.45%, respectively. Evidence revealed there was a statistically significant association between awake bruxism with stress and anxiety, and sleep bruxism with anxiety. Students with high academic performance (OR=2.36; IC del 95%:1.06-5.23) and low academic performance (OR=5.72; IC del 95%:1.28-25.57) were found to be more likely to have awake bruxism than those with medium academic performance. Conclusion: This study revealed a statistically significant association between self-reported awake bruxism and academic performance. However, in the future it is suggested to carry out a study with focus only on students with bruxism and with a larger sample of participants with low academic performance to confirm the association found between these variables.

Association between sleep and awake bruxism in patients with migraine

IntroductionWhen migraine undergoes transformation from episodic to chronic form it becomes more disabling due to the refractoriness in treatment and the emergence of comorbidities, with the establishment of a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and awake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with the process of chronification.Methods210 patients were allocated to the study, 97 with episodic migraine and 113 with chronic migraine, who underwent face-to-face interviews with the completion of the scales: specific questionnaire for the diagnosis of sleep and awake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (daytime sleepiness), MIDAS (migraine incapacity) and HIT-6 (impact of headache). ResultsThe prevalence of sleep and awake bruxism was similar in patients with episodic versus chronic migraine (p = 0.300 and p = 0.238). The correlation of patients with concomitant awake and sleep bruxism and with high scores on the migraine incapacity (MIDAS) and headache impact (HIT-6) scales was higher among patients with chronic migraine than in patients with episodic migraine. (p <0.001 and p <0.001). ConclusionSleep and awake bruxism alone are not more prevalent in chronic migraine when compared to episodic migraine, although bruxism causes greater impact and disability on individuals with chronic migraine.