RESUMEN
BACKGROUND: Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes. AIM: To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents. DESIGN: A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis. RESULTS: PSB and PAB are related to each other, with moderate and positive correlation (ß = .390). Poor sleep quality and higher household income had a direct effect on both PSB (ß = -.138; ß = .123, respectively) and PAB (ß = -.155; ß = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (ß = -.102). Adolescents that drool on the pillow (ß = .184) and/or have agitated sleep (ß = .104) tend to have PSB. CONCLUSION: Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.
Asunto(s)
Bruxismo , Bruxismo del Sueño , Humanos , Adolescente , Femenino , Bruxismo del Sueño/complicaciones , Masculino , Niño , Bruxismo/complicaciones , Encuestas y Cuestionarios , Adulto Joven , Calidad del Sueño , Ritmo Circadiano/fisiologíaRESUMEN
O Bruxismo é um comportamento, com atividade muscular mastigatória, que pode apresentar-se como bruxismo do sono (BS) e bruxismo em vigília (BV). Possui etiologia multifatorial, sendo pouco explorado entre adolescente. Essa tese é composta por dois artigos que avaliam a prevalência, fatores associados e análise de caminhos. O objetivo do artigo 1 (n=403) foi reconhecer os caminhos que influenciam a ocorrência de provável bruxismo do sono (PBS) e provável bruxismo em vigília (PBV) em adolescentes. O artigo 2 (n=342) objetivou avaliar a associação entre PBV e hábitos de morder, satisfação de vida, caracteristicas do sono e perfil cronotipo em adolescentes, por meio de um estudo caso-controle. Com aprovação do comitê de ética institucional, participaram do estudo adolescentes de 12 a 19 anos de idade, regularmente matriculados em escolas públicas e privadas de Belo Horizonte. Os pais/cuidadores responderam a um questionário sobre características do sono de seus filhos. Os adolescentes responderam aos seguintes instrumentos: questionário sobre hábitos de morder, características do sono e relato de bruxismo; a escala "The Circadian Energy Scale" (CIRENS), para mensurar o perfil cronotipo; e o dominio self da versão brasileira da Escala Multidimensional de Satisfação de Vida para Adolescentes (EMSVA). O PBS e PBV foram mensurados considerando o auto relato positivo, somado à presença de desgaste dentário por atrição aferido em exame clinico feito pela pesquisadora previamente calibrada. A análise descritiva foi incluida nos artigos 1 e 2. O artigo 1 usou a análise de caminhos, tecnica que descreve as dependências direcionadas entre um conjunto de variáveis. No artigo 2 foi feita regressão logistica condicional (OR) (p<0,05). Como resultados no artigo 1, verificou-se que 22,3% dos adolescentes apresentaram PBS e 51,1% PBV. As duas manifestações de bruxismo apresentaram associação entre si, com uma correlação moderada e positiva (ß= 0,390). Qualidade do sono e renda familiar tiveram um efeito direto sobre PBS (ß= - 0,138; ß=0,123; respectivamente) e em PBV (ß= - 0,155; ß=0,116; respectivamente), de modo que aqueles com maior renda e com má qualidade do sono tenderam a apresentar provável bruxismo tanto BS, quanto BV. Cronotipo teve efeito direto sobre o PBS, de modo que adolescentes com cronotipo matutino tenderam a ter o comportamento (ß= -0,102). Adolescentes que relataram babar no travesseiro enquanto dormiam (ß= 0,184) e/ou que tinham sono agitado (ß= 0,104) tenderam a apresentar PBS. Já no artgido 2 verificou-se que má qualidade do sono (OR=1,731, IC95% 1,054-2,842, p=0,030), hábito de morder objetos muitas vezes (OR=3,303, IC95% 1,631-6,690, p=0,001), hábito de morder ou apertar os lábios algumas vezes (OR=2,134, IC95% 1,230-3,702, p=0,007) e hábito de morder ou apertar os lábios muitas vezes nas duas semanas anteriores à avaliação (OR=2,355, IC95% 1,203- 4,608, p=0,012) foram associados à ocorrencia de PBV. Concluiu-se com o artigo 1 que o perfil cronotipo, renda familiar e caracteristicas do sono influenciaram no caminho percorrido pelo PBS, enquanto renda e qualidade do sono influenciam o PBV. Enquato atraves do artigo 2, concluiu- se que adolescentes com má qualidade do sono e que apresentam habitos de morder tiveram mais chance de apresentar PBV.
Bruxism is a behavior, with masticatory muscle activity, which can present itself as sleep bruxism (SB) and awake bruxism (AB). It has a multifactorial etiology, and is little explored among adolescents. This thesis is composed of two articles assessing prevalence, associated factors, and path analysis. The objective of article 1 (n=403) was to recognize the pathways influencing the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents. Paper 2 (n=342) aimed to evaluate the association between PSB and biting habits, life satisfaction, sleep characteristics and chronotype profile in adolescents by means of a case-control study. After approval by the institutional ethics committee, adolescents aged 12 to 19 years, regularly enrolled in public and private schools in Belo Horizonte, Brazil, participated in the study. Parents/caregivers answered a questionnaire about their children's sleep characteristics. The adolescents answered the following instruments: a questionnaire about biting habits, sleep characteristics and bruxism report; the Circadian Energy Scale (CIRENS), to measure the chronotype profile; and the self domain of the Brazilian version of the Multidimensional Life Satisfaction Scale for Adolescents (MLSSA). The PSB and PAB were measured considering the positive self-report, added to the presence of attrition dental wear measured in a clinical examination performed by a previously calibrated researcher. Descriptive analysis was included in articles 1 and 2. Article 1 used path analysis, a technique that describes the directed dependencies among a set of variables. In article 2, conditional logistic regression (OR) was performed (p<0.05). As results in article 1, it was found that 22.3% of the adolescents presented PSB and 51.1% PAB. The two manifestations of bruxism showed an association with each other, with a moderate and positive correlation (ß= 0.390). Sleep quality and family income had a direct effect on PSB (ß= - 0.138; ß=0.123; respectively) and on PAB (ß= -0.155; ß=0.116; respectively), so that those with higher income and poor sleep quality tended to show likely bruxism in both SB and AB. Chronotype had a direct effect on PSB, such that adolescents with morning chronotype tended to have the behavior (ß= -0.102). Adolescents who reported drooling on the pillow while sleeping (ß= 0.184) and/or who had restless sleep (ß= 0.104) tended to present PSB. In artgid 2, on the other hand, it was found that poor sleep quality (OR=1.731, 95%CI 1.054-2.842, p=0.030), habit of biting objects often (OR=3.303, 95%CI 1.631-6.690, p=0.001), habit of biting or tightening lips sometimes (OR=2, 134, 95%CI 1.230-3.702, p=0.007) and biting or lip-squeezing often in the two weeks prior to evaluation (OR=2.355, 95%CI 1.203- 4.608, p=0.012) were associated with the occurrence of PAB. It was concluded with article 1 that the chronotype profile, family income and sleep characteristics influence the path taken by PSB, while income and quality of sleep influence PAB. In article 2, it was concluded that adolescents with poor sleep quality and those with biting habits were more likely to present PAB.
Asunto(s)
Bruxismo , Ritmo Circadiano , Bruxismo del Sueño , Salud del Adolescente , Calidad del SueñoRESUMEN
Objective: To assess the association between self-reported awake bruxism (AB) and the chronotype profile among Brazilian, Portuguese, and Italian dental students.Methods: A cross-sectional study involving 205 dental students was developed. Self-reported AB as well as information on sleep characteristics were collected from a questionnaire. The Morningness-Eveningness Questionnaire (MEQ) was used to measure the chronotype profile. Descriptive statistical analysis, the chi-square test, and univariate analysis were used to evaluate the factors associated with AB.Results: The prevalence of AB in all groups was 33.7%. The intermediate chronotype profile was the most prevalent (60.4%), and only 16.7% of the participants had the morning profile. The univariate analysis showed that older dental students (OR = 2.640, 95% CI 1.388-5.021) and those with the eveningness chronotype profile (OR = 3.370, 95% CI 1.302-8.725) are associated with AB.Discussion: Students over the age of 22 and those with the eveningness chronotype profile were prone to AB.
Asunto(s)
Bruxismo , Vigilia , Brasil/epidemiología , Bruxismo/epidemiología , Ritmo Circadiano , Estudios Transversales , Humanos , Italia/epidemiología , Portugal/epidemiología , Autoinforme , Estudiantes de Odontología , Encuestas y CuestionariosRESUMEN
OBJECTIVES: The assessment of bruxism and its clinical characteristics is acknowledged in literature. This study aimed to evaluate the association of adolescents' facial patterns with bruxism and its related clinical features in the form of signs and symptoms. MATERIALS AND METHODS: Four hundred and three adolescents answered a questionnaire evaluating sleep bruxism (SB) and awake bruxism (AB). Parents/caregivers answered a questionnaire evaluating the adolescents' sleep features (drooling on the pillow, snoring). Adolescents' facial (dolichofacial/brachyfacial/mesofacial) and clinical features (pain in masseter/temporal muscle, indentations marks on the tongue, linea alba, tooth attrition, mouth's maximum opening and masseter electrical activity) were evaluated. Multinomial regression was performed. Odds ratio (OR) and confidence intervals (CI) were provided. RESULTS: Brachyfacial adolescents were less likely to present possible AB compared to mesofacials (OR=0.46, CI=0.21-0.98). Brachyfacial adolescents were more likely to present pain in the temporal muscle (OR=6.59, CI=2.18-19.87) and a higher number of posterior teeth with attrition (OR=1.25, CI=1.02-1.57) compared to mesofacials. Dolichofacial adolescents were more likely of not presenting pain in the masseter muscle (OR=2.23, CI=1.03-4.83), had a higher mouth's maximum opening (OR=1.43, CI=1.04-1.97), had a higher number of posterior teeth with attrition (OR=1.17, CI=1.00-1.37) and were more likely to drool on the pillow (OR=2.05, CI=1.15-3.67) compared to mesofacials. Dolichofacial adolescents were more likely of not presenting pain in the temporal muscle (OR=6.36, CI=2.30-17.54), to present themselves without marks on the tongue (OR=2.26, CI=1.09-4.69) and present a higher mouth's maximum opening (OR=2.09, CI=1.40-3.13) compared to brachyfacials. CONCLUSION: Bruxism and its clinical features differ among dolichofacial, brachyfacial and mesofacial adolescents.
Asunto(s)
Bruxismo , Cara/anatomía & histología , Cara/fisiología , Adolescente , Bruxismo/epidemiología , Niño , Estudios Transversales , Huesos Faciales , Músculos Faciales , Dolor Facial , Femenino , Humanos , Masculino , Músculo Masetero , Músculos Masticadores , Oportunidad Relativa , Proyectos Piloto , Bruxismo del Sueño , Encuestas y Cuestionarios , Músculo Temporal , Adulto JovenRESUMEN
Objective: To assess sleep bruxism prevalence and its association with circadian preference and sleep-related characteristics among dental students. Methods: Dental students of the Federal University of Minas Gerais participated in this cross-sectional study. Participants answered a scale assessing individuals' circadian preference, and a questionnaire regarding sleep-related characteristics and behaviors, history of muscle ache in the temporomandibular area, and history of bruxism. Results: One hundred fifty-two students participated in the study. Sleep bruxism was reported by 11.3%. Most students (63.2%) were classified as intermediary, 34.9% as morningness, and 1.3% as eveningness. Individuals who reported muscle ache in the temporomandibular area in the morning (PR = 3.5; 95% CI = 1.1-11.5) were more likely to be in the group with sleep bruxism. Conclusion: Muscle ache in the temporomandibular area is an important associated factor with sleep bruxism among dental students. Special attention should be paid to dental students' circadian preference.
Asunto(s)
Bruxismo , Bruxismo del Sueño , Estudios Transversales , Humanos , Prevalencia , Sueño , Estudiantes de Odontología , Encuestas y CuestionariosRESUMEN
O bruxismo do sono é o comportamento dos músculos mastigatórios de ranger e/ou apertar os dentes com forte influência de fatores emocionais e do ciclo circadiano. O desacordo entre a preferência individual pelo dia ou noite (cronotipo) e as atividades diárias podem favorecer a ocorrência de bruxismo. O objetivo deste estudo transversal foi avaliar a associação entre provável bruxismo do sono (BS), e perfil cronotipo entre adolescentes de Belo Horizonte. Um total de 403 adolescentes, de 12 a 19 anos, sem síndromes e/ou alterações neurológicas, regularmente matriculados em escolas públicas e privadas, e seus pais/responsáveis participaram do estudo, que foi aprovado pelo Comitê de Ética em Pesquisa Institucional (CAAE: 91561018.5.0000.5149. Os pais/responsáveis responderam a um questionário sobre hábitos e características do sono de seus filhos. Os adolescentes responderam a dois questionários. O primeiro continha perguntas sobre hábitos, características do sono e relato de ocorrência do bruxismo do sono, elaborado segundo proposto pelo Consenso Internacional de Bruxismo. O segundo instrumento utilizado foi a escala "The Circadian Energy Scale" (CIRENS), que contém três questões sobre o nível de energia usual no período da manhã, da tarde e à noite, e permite classificar o perfil cronotipo. Posteriormente, exames clínicos extra e intra orais foram realizados, por um examinador previamente calibrado, para identificar sinais clínicos potencialmente associados ao provável BS. O provável BS foi mensurado através de uma escala que considerou o número de sinais e sintomas clínicos e a frequência do relato de BS. Maiores escores na escala sugeriram maior gravidade de provável BS. Adotou-se análises descritivas e de regressão de Poisson (p<0,05) para análise estatística. A prevalência de provável bruxismo do sono foi de 21,1%. O perfil cronotipo intermediário foi o mais prevalente (83,1%), seguido pelo perfil matutino (9,7%) e pelo perfil vespertino (7,2%). A ocorrência de provável BS não foi estatisticamente associada aos diferentes perfis cronotipo. O modelo de regressão de Poisson ajustado revelou que adolescentes que relatam ter pesadelo pelo menos uma vez na semana (RP =4,725, IC=1,517-14,717), ou uma vez por mês (RP= 3,595, IC=1,149-11,247), que babam muitas vezes no travesseiro durante o sono (RP=1,841, IC=1,017-3,334) e possuem menor nível de energia durante o dia (RP= 0,876, IC=0,774-0,992) apresentam maior gravidade de provável BS quando comparados aos adolescentes que não tem pesadelo, que não babam no travesseiro durante o sono e que possuem mais energia diária, respectivamente. Conclui-se que o provável BS foi mais prevalente entre adolescentes que relataram ter pesadelo, que babavam no travesseiro durante o sono e que possuíam baixo nível de energia diário. Nessa amostra, o provável BS não foi associado aos diferentes perfis cronotipo.
Sleep bruxism (SB) is characterized by the behavior of clenching and/or grinding of the teeth, with emotional factors and the circadian cycle having a strong influence on the condition. The disagreement between individual preference for day or night (chronotype) and daily activities may favor the occurrence of bruxism. The objective of this cross-sectional study was to evaluate the association between probable SB and chronotype profile among adolescent from Belo Horizonte, Minas Gerais. A total of 435 adolescents, aged 12 to 19 years old, without syndromes and/or neurological disorders, who were regularly enrolled in public and private schools, and their parents/caregivers participated in the study that was approved by the institutional Ethics Committee on Human Research (CAAE: 91561018.5.0000.5149). Parents/caregivers responded a questionnaire designed to gather information about their child's sleeping habits. The adolescents answered two questionnaires. The first contained questions about sleeping habits, characteristics of sleep, and self-report of bruxism and was elaborated according to the proposed by the Consensus of Bruxism. The second questionnaire was The Circadian Energy Scale (CIRENS) for classification of the chronotype profile. Subsequently, extraoral and intraoral clinical examinations were performed in the schools' rooms, by a previously calibrated examiner, to identify clinical signs and symptoms potentially associated with probable SB. The probable SB was measured according to a scale that considers the presence and severity of clinical signs and symptoms and the frequency of BS. In the scale, higher scores meant a greater severity of probable BS. Data analysis included descriptive statistics and Poisson regression (p<0.05). The prevalence of probable SB was 21.1%. The intermediate chronotype was the most prevalent (83.1%), followed by the morningness profile (9.7%) and the eveningness profile (7.2%). The occurrence of probable SB was not statistically associated with chronotype profiles. The adjusted Poisson regression model revealed that participants who reported having nightmares at least once per week (PR: 4.725, 95% CI: 1.51714.717) or once per month (PR: 3.595, 95% CI: 1.14911.247), drooling on the pillow during sleep several times per night (PR: 1.841, 95% CI: 1.0173.334), and having a lower energy level during the day (PR: 0.876, 95% CI: 0.7740.992) had a higher severity of probable BS. This study concluded that probable SB was more prevalent among adolescents who reported having nightmares, who drool on the pillow during sleep, and who have lower daily energy levels. In this sample, the probable SB was not associated with the chronotype profiles.
Asunto(s)
Adolescente , Sueño , Estudiantes , Relojes Biológicos , Adolescente , Ritmo Circadiano , Bruxismo del Sueño , Higiene del Sueño , Estudio ObservacionalRESUMEN
Objective: To evaluate the prevalence of self-reported awake and sleep bruxism and its association to sleep characteristics among dental students. Methods: A cross-sectional study was conducted with 153 students of a Brazilian Dental School. Students who accepted to participate answered a questionnaire evaluating their sex, age, place of living, paid work, nocturnal paid work, hours of sleep per night, time to fall asleep, sleep quality, if participant had a bedroom partner, if participant is quiet on bed while sleeping and intake of sleep medication. Information on intake of energy drink, if participant wake up overnight, if participant wake up tired and it has been difficult to concentrate on daily activities was also collected. Awake and sleep bruxism was based on self-report. Descriptive analysis and chi-square test were carried out. Results: Most students were female (73%) and mean age was 21 years old (±3.25). The prevalence of self-reported awake and sleep bruxism was 36.5% and 11.3%, respectively. Most participants rated their sleep quality as good (57.2%) and reported that they woke up feeling tired (52.6%). Intake of sleep medication in the last 30 days (P=0.002), waking up overnight and taking over an hour to sleep again in the last 30 days (P=0.005) and waking up feeling tired (p=0.012) were associated factors to self-reported awake bruxism. Conclusion: The prevalence of self-reported awake bruxism was higher than the prevalence of sleep bruxism among dental students. Intake of sleep medication, waking up overnight and taking over an hour to sleep again and waking up tired were can be indicators of the presence of awake bruxism in dental students.
Objetivo: Avaliar a prevalência de bruxismo em vigília e do sono e sua associação com características do sono em estudantes de odontologia. Métodos: Ao todo 153 estudantes de uma Faculdade de Odontologia brasileira foram convidados a participar desse estudo transversal, respondendo a um questionário avaliando sexo, idade, endereço, realização de trabalho remunerado e/ou trabalho noturno remunerado, horas de sono por noite, tempo para adormecer, qualidade do sono, sono agitado e a presença de um colega de quarto. A ingestão de bebida energética e pílulas para dormir, o histórico de acordar durante a noite, acordar sentindo-se cansado e dificuldades de concentração nas atividades diárias também foram avaliadas. O diagnóstico de bruxismo baseou-se no auto-relato. Foi realizada a análise descritiva e teste qui-quadrado. Resultados: A média de idade dos participantes foi de 21 anos (±3,25) e 73% eram do sexo feminino. A prevalência do bruxismo em vigília foi de 36,8% e bruxismo do sono foi de 11,3%. A maioria dos participantes, 57,2%, classificou a qualidade do sono como boa, porém 52,6% relataram que acordavam cansados. O uso de medicamento para dormir nos últimos 30 dias (P=0.002), acordar durante a noite e demorar mais de uma hora para dormir novamente nos últimos 30 dias (P=0.005) e acordar sentindo-se cansado (P=0.012) foram fatores associados ao bruxismo em vigília auto-relatado. Conclusão: A prevalência de bruxismo em vigília foi maior que a prevalência do bruxismo do sono em estudantes de odontologia. O uso de medicamento para dormir, acordar durante a noite e demorar mais de uma hora para dormir e acordar sentindo-se cansado podem ser fatores indicadores da presença de bruxismo em vigília em estudantes de odontologia.