Prevalence of painful temporomandibular disorders, awake bruxism and sleep bruxism among patients with severe post-traumatic stress disorder.

BACKGROUND: Post-traumatic stress disorder (PTSD) is associated with painful temporomandibular disorder (TMD) and may be part of the aetiology of awake bruxism (AB) and sleep bruxism (SB). Investigating the associations between PTSD symptoms on the one hand, and painful TMD, AB and SB on the other, can help tailoring treatment to the needs of this patient group. OBJECTIVES: The aim of this study was to investigate the associations between PTSD symptoms and painful TMD, AB and SB among patients with PTSD, focusing on prevalence, symptom severity and the influence of trauma history on the presence of painful TMD, AB and SB. METHODS: Individuals (N = 673) attending a specialised PTSD clinic were assessed (pre-treatment) for painful TMD (TMD pain screener), AB and SB (Oral Behaviours Checklist), PTSD symptoms (Clinician-Administered PTSD Scale) and type of traumatic events (Life Events Checklist). RESULTS: Painful TMD, AB and SB were more prevalent among patients with PTSD (28.4%, 48.3% and 40.1%, respectively) than in the general population (8.0%, 31.0% and 15.3%, respectively; all p's < .001). PTSD symptom severity was found to be significantly, but poorly, associated with the severity of painful TMD (rs  = .126, p = .001), AB (rs  = .155, p < .001) and SB (rs  = .084, p = .029). Patients who had been exposed to sexual assault were more likely to report AB than patients who had not. Similarly, exposure to physical violence was associated with increased odds for SB. CONCLUSION: Patients with severe PTSD are more likely to experience painful TMD, AB or SB, whereas type of traumatic event can be of influence. These findings can contribute to selecting appropriate treatment modalities when treating patients with painful TMD, AB and SB.

The Association Between Self-Reported Awake Oral Behaviors and Orofacial Pain Depends on the Belief of Patients That These Behaviors Are Harmful to the Jaw.

AIMS: To examine if the existence of an association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw and to investigate if an additional variable (ie, somatic symptoms, depression, and/or anxiety) indirectly affects the association between the causal attribution belief and the report of awake oral behaviors. METHODS: Prior to the first clinical visit, patients referred to a specialized clinic for complaints of orofacial pain and dysfunction completed a digital questionnaire. Data of 329 patients diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (82.4% women; mean ± SD age = 41.9 ± 14.7 years) were analyzed. RESULTS: Causal attribution belief moderated the association between awake oral behaviors and orofacial pain intensity. In addition, the relationship between causal attribution belief and self-reported oral behaviors was partially mediated by the presence of somatic symptoms (8%), depression (9%), and anxiety (16%). CONCLUSION: Awake oral behaviors were positively associated with orofacial pain, but only under the condition of a strong belief of the patients in causal attribution of these behaviors to the jaw pain complaint. No such association was present in case of a low causal attribution belief. It appeared that, within this patient cohort, the relationship between causal attribution belief and self-reported oral behaviors was (in part) the result of shared psychologic risk factors.