Prevalence and associated factors to sleep bruxism in adolescents from Teresina, Piauí

Sousa, Heloísa Clara Santos; Lima, Marina de Deus Moura de; Dantas Neta, Neusa Barros; Tobias, Raissa Quaresma; Moura, Marcoeli Silva de; Moura, Lúcia de Fátima Almeida de Deus

doi:10.1590/1980-549720180002

ABSTRACT:

Introduction:

Sleep bruxism (SB) is defined as a repetitive jaw muscle activity whose epidemiology in adolescents has been little studied. This cross-sectional study aimed to determine the prevalence of sleep bruxism and associated factors in adolescents.

Methodology:

The sample consisted of 594 students aged 11 to 14 years old from Teresina, Piauí, Brazil. Self-administered questionnaire was answered by parents/caregivers and dental clinical examination was performed. Pearson’s chi-squared test was used to assess the association between SB and independent variables. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio (PR).

Results:

The prevalence of SB in adolescents was 22.2%. Multivariate analysis showed a higher prevalence of SB in male gender adolescents (PR = 1.41; 95%CI 1.04 - 1.89), presenting snoring (PR = 1.39; 95%CI 1.02 - 1.89) and difficulty falling asleep (PR = 1.92; 95%CI 1.38 - 2.66).

Conclusion:

SB is a frequent condition in adolescents, and the factors associated with its prevalence were: male sex, snoring and difficulty falling asleep.

Keywords:
Sleep bruxism; Epidemiology; Prevalence; Risk factors; Adolescent

INTRODUCTION

Sleep bruxism (SB) is a repetitive activity of the mandibular musculature, characterized by supporting or pushing the jaw, tightening or grinding the teeth during sleep¹1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
https://doi.org/10.1111/joor.12011... . The condition has been associated with injuries to orofacial structures and negative impact on the quality of life of schoolchildren²2. Hoz-Aizpurua JL, Díaz-Alonso E, Touche-Arbizu R, Mesa-Jiménez J. Sleep bruxism. Conceptual review and update. Med Oral Patol Oral Cir Bucal 2011; 16(2): e231-8. DOI: 10.4317/medoral.16.e231
https://doi.org/10.4317/medoral.16.e231... ^,³3. Aguilera AB, Lopez LG, Aguilera EB, Aizpurua JL, Torronteras AR, Saint-Gerons RS, et al. Relationship between self-reported sleep bruxism and pain in patients with temporomandibular disorders. J Oral Rehabil 2014; 41(8): 564-72. DOI: 10.1111/joor.12172
https://doi.org/10.1111/joor.12172... ^,⁴4. Carvalho AM, Lima MD, Silva JM, Neta NB, Moura LF. Bruxism and quality of life in schoolchildren aged 11 to 14. Cien Saude Colet 2015; 20(11): 3385-93. DOI: 10.1590/1413-812320152011.20772014
https://doi.org/10.1590/1413-81232015201... . The prevalence of SB presents variable percentages in the different age groups⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... and there is little information about their epidemiology in adolescents⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... .

Most epidemiological studies on SB are performed with schoolchildren⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... ^,⁷7. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
https://doi.org/10.1111/j.1365-263X.2009... ^,⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... ^,⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... ^,¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50., and the diagnosis is based on reports from family members describing characteristic sounds generated by grinding teeth during sleep⁷7. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
https://doi.org/10.1111/j.1365-263X.2009... ^,⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... ^,⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... . Polysomnographic examinations are considered gold standard for diagnosis, but their use in population studies is still not feasible due to the high cost and the need for qualified professionals to perform the procedures¹1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
https://doi.org/10.1111/joor.12011... ^,¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.^,¹³13. Raphael KG, Janal MN, Sirois DA, Dubrovsky B, Klausner JJ, Krieger AC, et al. Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls. J Oral Reahabil 2015; 42(10): 751-8. DOI: 10.1111/joor.12310
https://doi.org/10.1111/joor.12310... .

The search for factors associated with SB has been guiding the knowledge of possible predictors of the condition in different age groups¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... ^,¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.^,¹⁴14. Alajbeg IZ, Zuvela A, Tarle Z. Risk factors for bruxism among Croatian navy employees. J Oral Rehabil 2012; 39(9): 668-76. DOI: 10.1111/j.1365-2842.2012.02313.x
https://doi.org/10.1111/j.1365-2842.2012... ^,¹⁵15. Castroflorio T, Bargellini A, Rossini G, Cugliari G, Rainoldi A, Deregibus A. Risk factors related to sleep bruxism in children: a systematic literature review. Arch Oral Biol 2015; 60(11): 1618-24. DOI: 10.1016/j.archoralbio.2015.08.014
https://doi.org/10.1016/j.archoralbio.20... . Pathophysiological and genetic agents were suggested as possible factors associated with SB. However, psychosocial agents have received increasing attention¹⁶16. Lobbezoo F, Ahlberg J, Manfredini D, Winocur E. Are bruxism and the bite causally related? J Oral Rehabil 2012; 39(7): 489-501. DOI: 10.1111/j.1365-2842.2012.02298.x
https://doi.org/10.1111/j.1365-2842.2012... ^,¹⁷17. Murali RV, Rangarajan P, Mounissamy A. Bruxism: conceptual discussion and rewiew. J Pharm Bioallied Sci 2015; 7(1): S265-70. DOI: 10.4103/0975-7406.155948
https://doi.org/10.4103/0975-7406.155948... ^,¹⁸18. Manfredini D, Ahlberg J, Winocur E, Lobbezoo F. Management of sleep bruxism in adults: a qualitative systematic literature review. J Oral Rehabil 2015; 42(11): 862-74. DOI: 10.1111/joor.12322
https://doi.org/10.1111/joor.12322... . Few factors associated with SB in adolescents are known; among them: temporomandibular joint sounds and stress⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... .

The objective of this study was to determine the prevalence of SB and associated factors in adolescents from Teresina, Piauí.

METHODOLOGY

ETHICAL ASPECTS

This is a cross-sectional observational study carried out after approval by the Research Ethics Committee, Protocol no. 508.040/CAAE 03362112.1.0000.5214, from Universidade Federal do Piauí (UFPI), Teresina, Piauí, Brazil, conducted in accordance to Resolution 466/12 of the National Health Council.

SAMPLE

The study population was composed of adolescents aged between 11 and 14 years, enrolled in public and private schools in the city - which, according to data from the Municipal Education Department of Teresina, in 2011, accounted for 54,056 students.

The type of sampling adopted was complex conglomerates, with proportional allocation at each stage. The first stage consisted of areas of the city (20.8% north, 21.0% south, 17.0% southeast, 21.6% east and 19.6% downtown). The second stage, by the school models (25.9% private, 27.0% of the state public network and 47.1% of the municipal public network). The first sampling unit was defined by the schools; the second, by classes; and the third, by the students.

To calculate the sample size, a prevalence of 35.3% (~ 36.0%)⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... , with a 95% confidence interval (95%CI) and a 4% error margin, was considered. Because this is a multi-stage sample, the effect of the design was corrected by a factor of 1.5 (deff). For the sample calculation, the Epi Info^TM (version 3.5.2; Centers for Disease Control and Prevention, Atlanta, GA, USA) was used. The calculation was obtained by the following Equation 1:

n=deff∂2pqNɛ2N+ ∂2pq(1)

In which

n is the sample that was calculated,

∂ is the confidence level,

pq is the variance of the occurring phenomenon,

N is the population,

ε is the sample error.

From this formula, a sample size of 524 adolescents was obtained and 20% was added to compensate eventual losses, totaling 629 individuals asked to participate in the study.

A random sorting of the schools, classes and schoolchildren was carried out according to the city zones and the type of institution, as described in Table 1. The individuals that were present on the day of data collection were included in the study and, together with the parents/guardians, authorized the participation.

Thumbnail

Table 1:
Number of adolescents to be analyzed, distribution by school networks and location zone.

CALIBRATION

For the standardization of the diagnosis of tooth wear, clinical examiner training was carried out by teachers at the UFPI Children’s Dental Clinic, who were experienced in epidemiological studies. Twenty adolescents who did not participate in the study were examined for intra-examiner agreement, obtaining a kappa value of 0.9. To this end, the subjects were examined twice, with an interval of two weeks.

PILOT STUDY

Before data collection, a pilot study was conducted with 52 adolescents from schools that did not participate in the sample, in order to evaluate the methods. There was no need to make changes to the methodology initially proposed.

DATA COLLECTION

Data collection was carried out from September to November 2013. Prior authorization was requested from the directors of the school units selected for the research. The principals sent a letter to the adolescents’ parents informing them that their children had been selected to participate in the study. The terms of consent and the parents’ questionnaire were attached to the letters.

As there was no questionnaire validated on the subject studied, the questionnaire addressed to parents was prepared based on the literature¹1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
https://doi.org/10.1111/joor.12011... ^,⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... ^,⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... ^,⁷7. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
https://doi.org/10.1111/j.1365-263X.2009... ^,⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... ^,⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... ^,¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.^,¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... ^,¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... ^,²⁰20. Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011; 25(5): 439-45. DOI: 10.1590/S1806-83242011000500011
https://doi.org/10.1590/S1806-8324201100... ^,²¹21. Sutin AR, Terracciano A, Ferrucci L, Costa-Junior PT. Teeth grinding: is emotional stability related to bruxism? J Res Pers 2010; 44(3): 402-5. DOI: 10.1016/j.jrp.2010.03.006
https://doi.org/10.1016/j.jrp.2010.03.00... ^,²²22. Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
https://doi.org/10.4317/medoral.18232... . The questions addressed socioeconomic conditions, demographic data and possible factors associated with the presence of SB. The socioeconomic and demographic questions investigated included gender⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... , age⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... , age, type of school (public or private), family income (categorized based on the Brazilian monthly minimum wage at the time of the interview, equivalent to BRL 678.00)⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... , maternal schooling (years of formal study) and marital status of the parents⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... ^,¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... .

The diagnosis of bruxism was based on the affirmative report of the parents about the grinding of teeth during sleep¹1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
https://doi.org/10.1111/joor.12011... ^,⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... ^,⁷7. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
https://doi.org/10.1111/j.1365-263X.2009... ^,⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... ^,⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... ^,¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... . Information on the presence of snoring⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^-¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... ^,¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... , headaches upon awakening¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... , deleterious oral habits (onicophagy, digital sucking, biting objects or other habits)¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.^,²⁰20. Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011; 25(5): 439-45. DOI: 10.1590/S1806-83242011000500011
https://doi.org/10.1590/S1806-8324201100... , general health problems (gastrointestinal, neurological/psychological, cardiac, respiratory, parasitic or other)⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... ^,⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... ^,²¹21. Sutin AR, Terracciano A, Ferrucci L, Costa-Junior PT. Teeth grinding: is emotional stability related to bruxism? J Res Pers 2010; 44(3): 402-5. DOI: 10.1016/j.jrp.2010.03.006
https://doi.org/10.1016/j.jrp.2010.03.00... , difficulty sleeping⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^-¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... and parents’ perception of the presence of anxious behavior or not⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... ^,²¹21. Sutin AR, Terracciano A, Ferrucci L, Costa-Junior PT. Teeth grinding: is emotional stability related to bruxism? J Res Pers 2010; 44(3): 402-5. DOI: 10.1016/j.jrp.2010.03.006
https://doi.org/10.1016/j.jrp.2010.03.00... ^-²²22. Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
https://doi.org/10.4317/medoral.18232... .

The adolescents were examined in the school under artificial light (Pelican Startec model table lamp, 127 V) by a single examiner, who used sterilized cotton rollers, flat mouth mirror (Golgran^®, São Paulo, Brazil) and exploratory probe (Golgran^®, São Paulo, Brazil) recommended by the World Health Organization (WHO)²³23. World Health Organization (WHO). Oral health surveys: basics methods. . Geneva: WHO; 1997.. The teenagers sat in a school chair, their heads positioned on the examiner’s lap. In the clinical examination, dental abrasions were evaluated²⁴24. American Academy of Sleep Medicine (AASM). International Classification of sleep disorders. 2nd edition. Westchester: American Academy of Sleep Medicine; 2005., in which the presence of bright and polished facets on permanent incisors and/or molars (palatal surface, incisal edges and functional cusps) was verified²⁰20. Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011; 25(5): 439-45. DOI: 10.1590/S1806-83242011000500011
https://doi.org/10.1590/S1806-8324201100... ^,²⁴24. American Academy of Sleep Medicine (AASM). International Classification of sleep disorders. 2nd edition. Westchester: American Academy of Sleep Medicine; 2005.. The data were annotated in an individual form.

DATA ANALYSIS

The data were scanned and analyzed in the Statistical Package for the Social Sciences^® (SPSS) software version 18.0 for Windows. Pearson’s chi-squared test was applied to verify the association between the presence of SB and the independent variables. Poisson regression analysis with robust variance associated socioeconomic and clinical variables with a higher prevalence of SB. P-values ≤ 0.05, with 95%CI were considered statistically significant. In the multivariate analysis, a Backward Stepwise process was used. Variables with p ≤ 0.20 in the bivariate analysis were included in the model. The results were expressed in prevalence ratio (PR), measure of effect for prevalence studies.

RESULTS

A total of 594 (94.4%) of the 629 adolescents selected were included in the final sample. The prevalence of SB was 22.2%. The majority of the adolescents were females (63.1%), public school students (74.1%), with a family income below the current minimum wage (55.2%). Wear was observed in 579 teeth (76.6% in incisors and 9% in molars) of 80.64% of the adolescents examined.

The distribution of independent variables associated with SB is described in Table 2. Positive association was observed in the bivariate analysis between SB and gender, age, anxious behavior, morning headache, snoring and sleep quality (p < 0.05).

Thumbnail

Table 2:
Distribution of independent variables associated with sleep bruxism (n = 594).

The PRs obtained in the multivariate analysis of the variables associated to SB are presented in Table 3. Males (PR = 1.41; 95%CI 1.04 - 1.89), snoring (PR = 1.39; 95%CI 1.02 - 1.89) and sleep difficulties (PR = 1.92; 95%CI 1.38 - 2.66) were associated with a higher prevalence of SB in the final model.

Thumbnail

Table 3:
Crude and adjusted prevalence ratio of variables associated with sleep bruxism (n = 594).

DISCUSSION

The present study contributes to the current state of knowledge by pointing out prevalence and factors associated with SB in an age group in which evidence is limited.

SB is a frequent condition in adolescents in Teresina, and the prevalence of SB found was higher than that reported for youngsters from another age group⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... and for adults²⁵25. Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain 2013; 27(2): 99-110. DOI: 10.11607/jop.921
https://doi.org/10.11607/jop.921... , still lower than that reported for Brazilian children⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... , although the prevalence reported in children is variable⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... ^,²⁶26. Manfredini D, Restrepo C, Diaz-Serrano K, Winocur E, Lobbezoo F. Prevalence of sleep bruxism in children: a systematic review of the literature. J Oral Rehab 2013; 40(8): 631-42. DOI: 10.1111/joor.12069
https://doi.org/10.1111/joor.12069... . Studies have mentioned that the prevalence of SB decreases with age⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,²⁵25. Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain 2013; 27(2): 99-110. DOI: 10.11607/jop.921
https://doi.org/10.11607/jop.921... ^,²⁶26. Manfredini D, Restrepo C, Diaz-Serrano K, Winocur E, Lobbezoo F. Prevalence of sleep bruxism in children: a systematic review of the literature. J Oral Rehab 2013; 40(8): 631-42. DOI: 10.1111/joor.12069
https://doi.org/10.1111/joor.12069... .

In population-based studies, it is possible that the prevalence is underestimated, because the diagnosis is made through the reports of parents, who do not always sleep in the same space as the individuals investigated¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.. This is a limitation to be considered when interpreting the results. The comparison between prevalence studies is also hampered by the use of different ages within the age groups, diagnostic methods and non-specification of the form of bruxism - sleep or daytime¹1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
https://doi.org/10.1111/joor.12011... ^,¹¹11. Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50..

The present study observed that boys present a higher prevalence of SB than girls, a result that corroborates those presented by Renner et al.¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... , Lam et al.⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... and Kato et al.²⁷27. Kato T, Velly AM, Nakane T, Matsuda Y, Maki S. Age is associated with self-reported sleep bruxism, independently of tooth loss. Sleep Breath 2012; 16(4): 1159-65. DOI: 10.1007/s11325-011-0625-7
https://doi.org/10.1007/s11325-011-0625-... . However, it disagrees with the observation of Serra Negra et al.⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... , who conducted a study with a different age group. The prevalence of SB in males may represent a characteristic of SB distribution in this age group, and may be related to the fact that boys are more agitated and, in general, motivated to contain their emotions, which would favor the occurrence of involuntary movements¹²12. Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
https://doi.org/10.1111/j.1600-0528.2011... .

In the current study, SB was associated with the adolescent’s age, as in another study²⁷27. Kato T, Velly AM, Nakane T, Matsuda Y, Maki S. Age is associated with self-reported sleep bruxism, independently of tooth loss. Sleep Breath 2012; 16(4): 1159-65. DOI: 10.1007/s11325-011-0625-7
https://doi.org/10.1007/s11325-011-0625-... . Investigations are still needed to explain the mechanism involved²⁷27. Kato T, Velly AM, Nakane T, Matsuda Y, Maki S. Age is associated with self-reported sleep bruxism, independently of tooth loss. Sleep Breath 2012; 16(4): 1159-65. DOI: 10.1007/s11325-011-0625-7
https://doi.org/10.1007/s11325-011-0625-... . Carra et al.¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... verified a lower SB frequency in individuals older than 12 years, which was not verified in the present study. However, they mentioned that the observation may be related to the fact that the parents visit their children in their room less frequently after reaching that age, influencing the reports¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... .

Frequent psychosocial factors in adolescence, such as stress, anxiety, depression, neuroticism, hyperactivity, mental and emotional health problems have been associated with the presence of SB⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... ^,⁶6. Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
https://doi.org/10.1111/joor.12391... ^,⁸8. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
https://doi.org/10.1007/BF03262743... ^,⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... . In this and other studies, anxiety was associated⁵5. Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
https://doi.org/10.1590/2176-9451.19.6.0... ^,²¹21. Sutin AR, Terracciano A, Ferrucci L, Costa-Junior PT. Teeth grinding: is emotional stability related to bruxism? J Res Pers 2010; 44(3): 402-5. DOI: 10.1016/j.jrp.2010.03.006
https://doi.org/10.1016/j.jrp.2010.03.00... ^,²²22. Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
https://doi.org/10.4317/medoral.18232... and, as a clinical implication, this suggests that psychological treatment could be a positive factor for the control of the condition⁷7. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
https://doi.org/10.1111/j.1365-263X.2009... .

Patients with SB generally have morning headaches¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... ^,²⁰20. Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011; 25(5): 439-45. DOI: 10.1590/S1806-83242011000500011
https://doi.org/10.1590/S1806-8324201100... ^,²⁸28. Palinkas M, Canto GL, Rodrigues LA, Bataglion C, Siéssere S, Semprini M, et al. Comparative capabilities of clinical assessment, diagnostic criteria, and polysomnography in detecting sleep bruxism. J Clin Sleep Med 2015; 11(11): 1319-25. DOI: 10.5664/jcsm.5196
https://doi.org/10.5664/jcsm.5196... , an association confirmed in the present study. Such a finding suggests that the presence of this symptom may contribute to the diagnostic hypothesis of SB. Carra et al.¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... have mentioned that repetitive muscle contractions may be associated with tension headache or both conditions may share common risk factors with no causal relationship. Nevertheless, we recommend that studies with designs that allow the investigation of this hypothesis are conducted.

The presence of snoring was one of the factors associated with the higher prevalence of SB, corroborating the results presented by other authors⁹9. Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
https://doi.org/10.1016/j.sleep.2010.11.... ^,¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... and suggesting this respiratory disorder related to sleep as a predictor of the condition. It is possible that, in the event of an obstruction, SB favors the reestablishment of normal breathing¹⁰10. Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
https://doi.org/10.11607/jop.1057... ^,¹⁹19. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
https://doi.org/10.1111/j.1600-0722.2011... . However, such an association needs to be better elucidated.

Problems related to sleep quality are common symptomatic consequences reported in individuals with bruxism²²22. Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
https://doi.org/10.4317/medoral.18232... , a finding that was also confirmed in our results. Higher prevalence of SB was found in individuals with difficulty sleeping. One possible justification is that SB has been described as a complex nervous system excitation response, which can be accompanied by body movements, increased heart rate, and respiratory changes²²22. Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
https://doi.org/10.4317/medoral.18232... .

CONCLUSION

Sleep bruxism is a frequent condition in adolescents, and the factors associated with their higher prevalence were: male sex, snoring and difficulty sleeping.

References

¹
Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
» https://doi.org/10.1111/joor.12011
²
Hoz-Aizpurua JL, Díaz-Alonso E, Touche-Arbizu R, Mesa-Jiménez J. Sleep bruxism. Conceptual review and update. Med Oral Patol Oral Cir Bucal 2011; 16(2): e231-8. DOI: 10.4317/medoral.16.e231
» https://doi.org/10.4317/medoral.16.e231
³
Aguilera AB, Lopez LG, Aguilera EB, Aizpurua JL, Torronteras AR, Saint-Gerons RS, et al. Relationship between self-reported sleep bruxism and pain in patients with temporomandibular disorders. J Oral Rehabil 2014; 41(8): 564-72. DOI: 10.1111/joor.12172
» https://doi.org/10.1111/joor.12172
⁴
Carvalho AM, Lima MD, Silva JM, Neta NB, Moura LF. Bruxism and quality of life in schoolchildren aged 11 to 14. Cien Saude Colet 2015; 20(11): 3385-93. DOI: 10.1590/1413-812320152011.20772014
» https://doi.org/10.1590/1413-812320152011.20772014
⁵
Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
» https://doi.org/10.1590/2176-9451.19.6.054-061.oar
⁶
Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
» https://doi.org/10.1111/joor.12391
⁷
Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
» https://doi.org/10.1111/j.1365-263X.2009.00973.x
⁸
Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
» https://doi.org/10.1007/BF03262743
⁹
Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
» https://doi.org/10.1016/j.sleep.2010.11.013
¹⁰
Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
» https://doi.org/10.11607/jop.1057
¹¹
Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.
¹²
Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
» https://doi.org/10.1111/j.1600-0528.2011.00644.x
¹³
Raphael KG, Janal MN, Sirois DA, Dubrovsky B, Klausner JJ, Krieger AC, et al. Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls. J Oral Reahabil 2015; 42(10): 751-8. DOI: 10.1111/joor.12310
» https://doi.org/10.1111/joor.12310
¹⁴
Alajbeg IZ, Zuvela A, Tarle Z. Risk factors for bruxism among Croatian navy employees. J Oral Rehabil 2012; 39(9): 668-76. DOI: 10.1111/j.1365-2842.2012.02313.x
» https://doi.org/10.1111/j.1365-2842.2012.02313.x
¹⁵
Castroflorio T, Bargellini A, Rossini G, Cugliari G, Rainoldi A, Deregibus A. Risk factors related to sleep bruxism in children: a systematic literature review. Arch Oral Biol 2015; 60(11): 1618-24. DOI: 10.1016/j.archoralbio.2015.08.014
» https://doi.org/10.1016/j.archoralbio.2015.08.014
¹⁶
Lobbezoo F, Ahlberg J, Manfredini D, Winocur E. Are bruxism and the bite causally related? J Oral Rehabil 2012; 39(7): 489-501. DOI: 10.1111/j.1365-2842.2012.02298.x
» https://doi.org/10.1111/j.1365-2842.2012.02298.x
¹⁷
Murali RV, Rangarajan P, Mounissamy A. Bruxism: conceptual discussion and rewiew. J Pharm Bioallied Sci 2015; 7(1): S265-70. DOI: 10.4103/0975-7406.155948
» https://doi.org/10.4103/0975-7406.155948
¹⁸
Manfredini D, Ahlberg J, Winocur E, Lobbezoo F. Management of sleep bruxism in adults: a qualitative systematic literature review. J Oral Rehabil 2015; 42(11): 862-74. DOI: 10.1111/joor.12322
» https://doi.org/10.1111/joor.12322
¹⁹
Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
» https://doi.org/10.1111/j.1600-0722.2011.00846.x
²⁰
Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011; 25(5): 439-45. DOI: 10.1590/S1806-83242011000500011
» https://doi.org/10.1590/S1806-83242011000500011
²¹
Sutin AR, Terracciano A, Ferrucci L, Costa-Junior PT. Teeth grinding: is emotional stability related to bruxism? J Res Pers 2010; 44(3): 402-5. DOI: 10.1016/j.jrp.2010.03.006
» https://doi.org/10.1016/j.jrp.2010.03.006
²²
Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
» https://doi.org/10.4317/medoral.18232
²³
World Health Organization (WHO). Oral health surveys: basics methods. . Geneva: WHO; 1997.
²⁴
American Academy of Sleep Medicine (AASM). International Classification of sleep disorders. 2nd edition. Westchester: American Academy of Sleep Medicine; 2005.
²⁵
Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain 2013; 27(2): 99-110. DOI: 10.11607/jop.921
» https://doi.org/10.11607/jop.921
²⁶
Manfredini D, Restrepo C, Diaz-Serrano K, Winocur E, Lobbezoo F. Prevalence of sleep bruxism in children: a systematic review of the literature. J Oral Rehab 2013; 40(8): 631-42. DOI: 10.1111/joor.12069
» https://doi.org/10.1111/joor.12069
²⁷
Kato T, Velly AM, Nakane T, Matsuda Y, Maki S. Age is associated with self-reported sleep bruxism, independently of tooth loss. Sleep Breath 2012; 16(4): 1159-65. DOI: 10.1007/s11325-011-0625-7
» https://doi.org/10.1007/s11325-011-0625-7
²⁸
Palinkas M, Canto GL, Rodrigues LA, Bataglion C, Siéssere S, Semprini M, et al. Comparative capabilities of clinical assessment, diagnostic criteria, and polysomnography in detecting sleep bruxism. J Clin Sleep Med 2015; 11(11): 1319-25. DOI: 10.5664/jcsm.5196
» https://doi.org/10.5664/jcsm.5196

Financial support: none

Publication Dates

Publication in this collection
28 May 2018

History

Received
27 Oct 2016
Accepted
22 Dec 2016

Este é um artigo publicado em acesso aberto sob uma licença Creative Commons

[1] ¹
Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavigne GJ, et al. Bruxism defined and graded: an international consensus. J Oral Rehabil 2013; 40(1): 2-4. DOI: 10.1111/joor.12011
» https://doi.org/10.1111/joor.12011

[2] ²
Hoz-Aizpurua JL, Díaz-Alonso E, Touche-Arbizu R, Mesa-Jiménez J. Sleep bruxism. Conceptual review and update. Med Oral Patol Oral Cir Bucal 2011; 16(2): e231-8. DOI: 10.4317/medoral.16.e231
» https://doi.org/10.4317/medoral.16.e231

[3] ³
Aguilera AB, Lopez LG, Aguilera EB, Aizpurua JL, Torronteras AR, Saint-Gerons RS, et al. Relationship between self-reported sleep bruxism and pain in patients with temporomandibular disorders. J Oral Rehabil 2014; 41(8): 564-72. DOI: 10.1111/joor.12172
» https://doi.org/10.1111/joor.12172

[4] ⁴
Carvalho AM, Lima MD, Silva JM, Neta NB, Moura LF. Bruxism and quality of life in schoolchildren aged 11 to 14. Cien Saude Colet 2015; 20(11): 3385-93. DOI: 10.1590/1413-812320152011.20772014
» https://doi.org/10.1590/1413-812320152011.20772014

[5] ⁵
Machado E, Dal-Fabbro C, Cunali PA, Kaizer OB. Prevalence of sleep bruxism in children: a systematic review. Dental Press J Orthod 2014; 19(6): 54-61. DOI: 10.1590/2176-9451.19.6.054-061.oar
» https://doi.org/10.1590/2176-9451.19.6.054-061.oar

[6] ⁶
Emodi Perlman A, Lobbezoo F, Zar A, Rubin PF, Van Selms MK, Winocur E. Self-Reported bruxism and associated factors in israeli adolescents. J Oral Rehabil 2016; 43(6): 443-50. DOI: 10.1111/joor.12391
» https://doi.org/10.1111/joor.12391

[7] ⁷
Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009; 19(5): 309-17. DOI: 10.1111/j.1365-263X.2009.00973.x
» https://doi.org/10.1111/j.1365-263X.2009.00973.x

[8] ⁸
Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4): 192-5. DOI: 10.1007/BF03262743
» https://doi.org/10.1007/BF03262743

[9] ⁹
Lam MH, Zhang J, Li AM, Wing YK. A community study of sleep bruxism in Hong Kong children: association with comorbid sleep disorders and neurobehavioral consequences. Sleep Med 2011; 12(7): 641-5. DOI: 10.1016/j.sleep.2010.11.013
» https://doi.org/10.1016/j.sleep.2010.11.013

[10] ¹⁰
Rossi D, Manfredini D. Family and school environmental predictors of sleep bruxism in children. J Orofac Pain 2013; 27(2): 135-41. DOI: 10.11607/jop.1057
» https://doi.org/10.11607/jop.1057

[11] ¹¹
Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Corrêa-Faria P, Gonzaga GC, Marques LS, et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1): 46-50.

[12] ¹²
Renner AC, Silva AA, Rodriguez JD, Simões VM, Barbieri MA, Bettiol H, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40(3): 277-87. DOI: 10.1111/j.1600-0528.2011.00644.x
» https://doi.org/10.1111/j.1600-0528.2011.00644.x

[13] ¹³
Raphael KG, Janal MN, Sirois DA, Dubrovsky B, Klausner JJ, Krieger AC, et al. Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls. J Oral Reahabil 2015; 42(10): 751-8. DOI: 10.1111/joor.12310
» https://doi.org/10.1111/joor.12310

[14] ¹⁴
Alajbeg IZ, Zuvela A, Tarle Z. Risk factors for bruxism among Croatian navy employees. J Oral Rehabil 2012; 39(9): 668-76. DOI: 10.1111/j.1365-2842.2012.02313.x
» https://doi.org/10.1111/j.1365-2842.2012.02313.x

[15] ¹⁵
Castroflorio T, Bargellini A, Rossini G, Cugliari G, Rainoldi A, Deregibus A. Risk factors related to sleep bruxism in children: a systematic literature review. Arch Oral Biol 2015; 60(11): 1618-24. DOI: 10.1016/j.archoralbio.2015.08.014
» https://doi.org/10.1016/j.archoralbio.2015.08.014

[16] ¹⁶
Lobbezoo F, Ahlberg J, Manfredini D, Winocur E. Are bruxism and the bite causally related? J Oral Rehabil 2012; 39(7): 489-501. DOI: 10.1111/j.1365-2842.2012.02298.x
» https://doi.org/10.1111/j.1365-2842.2012.02298.x

[17] ¹⁷
Murali RV, Rangarajan P, Mounissamy A. Bruxism: conceptual discussion and rewiew. J Pharm Bioallied Sci 2015; 7(1): S265-70. DOI: 10.4103/0975-7406.155948
» https://doi.org/10.4103/0975-7406.155948

[18] ¹⁸
Manfredini D, Ahlberg J, Winocur E, Lobbezoo F. Management of sleep bruxism in adults: a qualitative systematic literature review. J Oral Rehabil 2015; 42(11): 862-74. DOI: 10.1111/joor.12322
» https://doi.org/10.1111/joor.12322

[19] ¹⁹
Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011; 119(5): 386-94. DOI: 10.1111/j.1600-0722.2011.00846.x
» https://doi.org/10.1111/j.1600-0722.2011.00846.x

[20] ²⁰
Miamoto CB, Pereira LJ, Ramos-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011; 25(5): 439-45. DOI: 10.1590/S1806-83242011000500011
» https://doi.org/10.1590/S1806-83242011000500011

[21] ²¹
Sutin AR, Terracciano A, Ferrucci L, Costa-Junior PT. Teeth grinding: is emotional stability related to bruxism? J Res Pers 2010; 44(3): 402-5. DOI: 10.1016/j.jrp.2010.03.006
» https://doi.org/10.1016/j.jrp.2010.03.006

[22] ²²
Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013; 18(1): e7-11. DOI: 10.4317/medoral.18232
» https://doi.org/10.4317/medoral.18232

[23] ²³
World Health Organization (WHO). Oral health surveys: basics methods. . Geneva: WHO; 1997.

[24] ²⁴
American Academy of Sleep Medicine (AASM). International Classification of sleep disorders. 2nd edition. Westchester: American Academy of Sleep Medicine; 2005.

[25] ²⁵
Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. J Orofac Pain 2013; 27(2): 99-110. DOI: 10.11607/jop.921
» https://doi.org/10.11607/jop.921

[26] ²⁶
Manfredini D, Restrepo C, Diaz-Serrano K, Winocur E, Lobbezoo F. Prevalence of sleep bruxism in children: a systematic review of the literature. J Oral Rehab 2013; 40(8): 631-42. DOI: 10.1111/joor.12069
» https://doi.org/10.1111/joor.12069

[27] ²⁷
Kato T, Velly AM, Nakane T, Matsuda Y, Maki S. Age is associated with self-reported sleep bruxism, independently of tooth loss. Sleep Breath 2012; 16(4): 1159-65. DOI: 10.1007/s11325-011-0625-7
» https://doi.org/10.1007/s11325-011-0625-7

[28] ²⁸
Palinkas M, Canto GL, Rodrigues LA, Bataglion C, Siéssere S, Semprini M, et al. Comparative capabilities of clinical assessment, diagnostic criteria, and polysomnography in detecting sleep bruxism. J Clin Sleep Med 2015; 11(11): 1319-25. DOI: 10.5664/jcsm.5196
» https://doi.org/10.5664/jcsm.5196

School network	Number of adolescents
State
Downtown	23
East	24
North	43
Southeast	40
South	40
Total	170
Municipal
Downtown	28
East	83
North	64
Southeast	51
South	70
Total	296
Private
Downtown	72
East	29
North	24
Southeast	16
South	22
Total	163
Total	629

	With SB (n = 132)	Without SB (n = 462)	p-value*
	n (%)	n (%)	p-value*
Tooth wear
Yes	107 (22.3)	372 (77.7)	0.890
No	25 (21.7)	90 (78.3)	0.890
Gender
Male	61 (27.9)	158 (72.1)	0.012
Female	71 (18.9)	304 (81.1)	0.012
Age (years)
11	37 (24.0)	117 (76.0)	0.031
12	41 (25.5)	120 (74.5)
13	18 (13.0)	120 (87.0)
14	36 (25.5)	105 (74.5)
Type of school
Public	106 (24.1)	334 (75.9)	0.064
Private	26 (16.9)	128 (83.1)	0.064
Maternal schooling (years)
Up to 7	55 (23.9)	175 (76.1)	0.728
Between 8 and 11	58 (21.0)	218 (79.0)
Over 12	19 (21.6)	69 (78.4)
Marital status of the parents
Separated	59 (25.2)	175 (74.8)	0.157
Live together	73 (20.3)	287 (79.7)	0.157
Family income (MW)
≤ 1	82 (25.0)	246 (75.0)	0.071
> 1	50 (18.8)	216 (81.2)	0.071
Anxious behavior
Yes	62 (30.1)	144 (69.9)	0.001
No	70 (18.0)	318 (82.0)	0.001
General health condition
Health problems	63 (25.1)	188 (74.9)	0.149
No health problems	69 (20.1)	274 (79.9)	0.149
Habits
Yes	71 (23.1)	237 (76.9)	0.614
No	61 (21.3)	225 (78.7)	0.614
Headache upon waking up
Yes	74 (27.8)	192 (72.2)	0.003
No	54 (17.6)	253 (82.4)	0.003
Nocturnal snoring
Yes	58 (31.0)	129 (69.0)	0.001
No	69 (18.2)	310 (81.8)	0.001
Sleep quality
Difficulty sleeping	46 (39.0)	72 (61.0)	< 0.001
Sleeps well	86 (18.1)	390 (81.9)	< 0.001

	PR_crude (95%CI)	PR_adjusted (95%CI)
Gender
Male	1.48 (1.08 - 2.01)	1.41 (1.04 - 1.89)
Female	1	1
Age (years)
11	0.92 (0.60 - 1.41)	1.00 (0.67 - 1.49)
12	1.05 (0.70 - 1.56)	1.05 (0.72 - 1.54)
13	0.55 (0.33 - 0.93)	0.61 (0.37 - 1.01)
14	1	1
Type of school
Private	1.37 (0.92 - 2.04)	-
Public	1
Marital status of the parents
Live together	1.28 (0.94 - 1.75)	-
Separated	1
Family income (MW)
≤ 1	1.37 (0.98 - 1.89)	-
> 1	1
Anxious behavior
Yes	1.76 (1.29 - 2.39)	1.33 (0.96 - 1.84)
No	1	1
Headache upon waking up
Yes	1.56 (1.13 - 2.13)	1.31 (0.94 - 1.79)
No	1	1
Snoring
Yes	1.70 (1.25 - 2.30)	1.39 (1.02 - 1.89)
No	1	1
Sleep quality
Difficulty sleeping	2.36 (1.75 - 3.19)	1.92 (1.38 - 2.66)
Sleeps well	1	1

Saúde Pública

Saúde Pública

Prevalence and associated factors to sleep bruxism in adolescents from Teresina, Piauí

ABSTRACT:

Introduction:

Methodology:

Results:

Conclusion:

INTRODUCTION

METHODOLOGY

ETHICAL ASPECTS

SAMPLE

CALIBRATION

PILOT STUDY

DATA COLLECTION

DATA ANALYSIS

RESULTS

DISCUSSION

CONCLUSION

References

Publication Dates

History