Cirujano Dentista

Journal of

Oral Rehabilitation

Journal of Oral Rehabilitation 2011 38; 3–11

Self-reported Bruxism - associations with perceived stress, motivation for control, dental anxiety and gagging*
E. WINOCUR, N. UZIEL, T. LISHA, C. GOLDSMITH & I. ELI
Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel Department of Oral Rehabilitation, theSUMMARY To examine possible associations between self-reported bruxism, stress, desirability of control, dental anxiety and gagging. Five questionnaires were distributed among a general adult population (402 respondents): the Perceived Stress Scale (PSS), Desirability of Control Scale (DC), Dental Anxiety Scale (DAS), Gagging Assessment Scale (GAS), and Bruxism Assessment Questionnaire. A high positivecorrelation between DAS and GAS (R = 0Æ604, P < 0Æ001) was found. PSS was negatively correlated with DC (R = )0Æ292, P < 0Æ001), and was positively correlated with GAS (R = 0Æ217, P < 0Æ001) and DAS (R = 0Æ214, P < 0Æ001). Respondents who reported bruxing while awake or asleep showed higher levels of GAS, DAS and PSS than those who did not. There were no differences between the bruxers and thenon-bruxers (sleep and aware) with regard to the DC scores. The best predictors of awake bruxism were sleep bruxism (OR = 4Æ98, CI 95% 2Æ54–9Æ74) and GAS (OR = 1Æ10, CI 95% 1Æ04–1Æ17). The best predictors of sleep bruxism were awake bruxism (OR = 5Æ0, CI 95% 2Æ56–9Æ78) and GAS (OR = 1Æ19; CI 95% 1Æ11– 1Æ27). Self-reported sleep bruxism significantly increases the odds for awake bruxism and viceversa. Tendency for gagging during dental care slightly increases the odds of both types of self-reported bruxism, but desirability of control is not associated with these phenomena. KEYWORDS: bruxism, dental anxiety, gagging, motivation for control, perceived stress Accepted for publication 6 May 2010

Introduction
Bruxism is defined as the actions of clenching the teeth, bracing the jaws withoutactual tooth contact, gnashing and grinding the teeth while awake or while asleep (1). Once categorised as a parasomnia, sleep bruxism was redefined in 2005 by the American Academy of Sleep Medicine as a movement disorder taking place during sleep (2). The aetiology of sleep bruxism has not been completely determined to date. In the past, the general opinion was that bruxism occurs because ofperipheral causes, such as occlusal interferences and problematic anatomy, whereas current research points to causes in the central nervous system (3). Risk factors for the development of bruxism include disturbances in neu*This study was undertaken in partial fulfilment of a DMD thesis (T.L.), School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel. ª 2010 Blackwell Publishing Ltdrotransmitters, drug use, smoking, alcohol, disease processes, trauma and psychological processes, such as stress (4). ‘‘Awake bruxism’’ is defined as the clenching of teeth and jaws while awake, of which the individual is aware (5). It is not usually expressed as tooth grinding but rather as clenching of the teeth and jaws in the absence of neuroleptic medications and certain medical conditions. Itspathophysiology remains unknown, but stress and anxiety are considered to be risk factors, even in the absence of scientific proof (5). Other conditions which are closely associated with stress related to oral activities are dental fear, anxiety and phobia. These emotional states interfere with dental treatment, are deleterious to oral health and can cause a great deal of needless suffering (6).Epidemiological research studies have shown that 5%–19% of the worldwide adult population suffers to some extent from
doi: 10.1111/j.1365-2842.2010.02118.x

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E . W I N O C U R et al.
dental anxiety (7–9). and express this anxiety during dental treatment verbally and through body language (10). It has been suggested that excessive gagging during dental care in some subjects, possibly those with...