Self-reported bruxism in patients with post-traumatic stress disorder.

OBJECTIVE: The present study aimed to investigate the association between self-reported awake/sleep bruxism, and orofacial pain with post-traumatic stress disorder (PTSD). METHODS: A case-control study with a convenience sample was designed. Participants were recruited from a university-based Trauma Ambulatory. The diagnosis of PTSD was established through a clinical interview and the Structured Clinical Interview (SCID-I/P). Thirty-eight PTSD patients and 38 controls completed the Research Diagnostic Criteria for Temporomandibular Disorders Axis-II to categorize awake/sleep bruxism and orofacial pain. Following this, we performed a short clinical examination of the temporomandibular joint and extraoral muscles. RESULTS: Adjusted logistic regression analysis showed that awake bruxism was associated with PTSD (OR = 3.38, 95% CI = 1.01-11.27, p = 0.047). Sleep bruxism was not associated with any covariate included in the model. In a Poisson regression model, PTSD (IRR = 3.01, 95% CI = 1.38-6.55, p = 0.005) and the muscle pain/discomfort (IRR = 5.12, 95% CI = 2.80-9.36, p < 0.001) were significant predictors for current orofacial pain. CONCLUSIONS: PTSD was associated with self-reported awake bruxism and low-intensity orofacial pain. These conditions were frequent outcomes in patients previously exposed to traumatic events. CLINICAL RELEVANCE: We suggest including a two-question screening for bruxism in psychiatry/psychology interviews to improve under-identification and to prevent harmful consequences at the orofacial level.

Evaluation of periodontitis in hospital outpatients with major depressive disorder. A focus on gingival and circulating cytokines.

An imbalance in stimulated cytokine production is associated with the etiopathogenesis of numerous diseases such as major depressive disorder (MDD) and periodontal disease. Increased cytokine levels have been reported in the gingival crevicular fluid (GCF) of patients with MDD. Thirty-six outpatients with MDD participated in this study. Each outpatient was age-matched (± 3 years) with a healthy control (n=36). The patients were controlled for race and smoking habits. Unstimulated and stimulated interleukin 6 (IL-6), interleukin 1ß (IL-1ß), and interferon-γ (INF-γ) production in whole blood culture (WBC) and IL-6 and IL-1ß levels in the GCF were evaluated. Circulating levels of IL-6 and IL-1ß (unstimulated) as well as GCF IL-1ß were modestly lower in MDD patients, compared to the levels in age-matched controls (Mann-Whitney, p=0.002, 0.0075, ANCOVA, p=0.025, respectively). In the unstimulated group, there was no correlation between the levels of circulating IL-6 and GCF IL-6 (r=0.07, p=0.67), and between the levels of circulating IL-1ß and the IL-1ß level in the CGF (r=-0.08, p=0.63). In the LPS stimulation group, there was no correlation between the levels of circulating levels of IL-6 and GCF IL-6 (r=0. 02, p=0.91) or between the circulating IL-1ß and GCF IL-1ß (r=0.13, p=0.42). We observed modest immunosuppression in MDD patients (evaluated by no stimulation whole blood culture [WBC]), especially in patients with melancholic depression, chronic depression, and severe depression.

Impact of post-traumatic stress disorder on oral health.

BACKGROUND: The stress experienced as an intense and traumatic event can increase the odds of orofacial pain, affect the biomechanics of masticatory system and compromise the periodontal health. This study was conducted to investigate the impact of post-traumatic stress disorder (PTSD) on oral health. METHODS: A case-control study with a convenience sample was designed. Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing, and plaque were recorded at 6 sites per tooth. A visual analog scale (VAS) was used to evaluate the pain after probing. The Research Diagnostic Criteria for Temporomandibular Disorders Axis II (RDC/TMD Axis II) and Structured Clinical Interview (DSM-IV) were also applied. The final sample comprised 38 PTSD patients and 38 controls. RESULTS: Patients with PTSD had a higher degree of chronic pain, more depression and nonspecific physical symptoms (including and excluding pain) compared with the control group (Fisher exact test p < 0.001, and Chi-squared test, p < 0.001, < 0.001, < 0.001, respectively). Patients with PTSD also had more pain after periodontal probing compared with controls (Mann-Whitney, p = 0.037). The prevalence of sites with CAL or PPD ≥ 4, ≥ 5, ≥ 6 were not different between the groups. Age was associated with moderate periodontitis (multivariable logistic regression model, OR = 3.33, 95% CI = 1.03-10.75, p = 0.04). LIMITATION: The severity of PTSD precluded an ample sample size. CONCLUSIONS: Patients with PTSD presented a worse RDC/TMD Axis II profile, more pain after periodontal probing, and no difference related to periodontal clinical parameters. More studies are needed to confirm these findings.

Influência do estresse sobre as doenças periodontais / Influence of stress on periodontal diseases

Alguns autores têm encontrado um relacionamento importante entre a doença periodontal e fatores estressores. A maioria das pesquisas correlaciona parâmetros clínicos periodontais com instrumentos psicométricos (escalas de auto-avaliaçäo) que medem a existência ou freqüência desses fatores. Esses instrumentos säo questionários e näo säo adequados ao diagnóstico psiquiátrico, mostrando apenas a presença ou ausência de sintomas psíquicos. Apesar da falta de um diagnóstico operacional, os resultados dessas pesquisas podem ser explicados pela associaçäo existente entre estresse e diminuiçäo da funçäo imunológica. Também foi observada uma maior incidência de GUNA (Gengivite Ulcerativa Necrosante Aguda) em grupos influenciados por fatores psicossociais

Estresse, depressao, alteracoes imunologicas e doenca periodontal / Stress, depression, immune system abnormalities and periodontal disease

Fatores estressores psicossociais e depressao tem sido associados com diminuicao da funcao imunologica e aumento da susceptibilidade a infeccoes e neoplasias. Alguns autores tem encontrado uma relacao importante entrea doenca periodontal e os fatores estressores que pode ser explicada pelas alteracoes em ...