Awake bruxism prevalence, associated factors, and behavioral therapies

Author(s)

Mariana Barbosa Câmara Souza

• Document type: Doctoral Thesis
• Press: Piracicaba, SP.
• Institution: Universidade Estadual de Campinas (UNICAMP). Faculdade de Odontologia de Piracicaba
• Defense date: 2021-04-09

Examining board members

Renata Cunha Matheus Rodrigues Garcia; Erika Oliveira de Almeida; Giancarlo Canales De La Torre; Larissa Soares Reis Vilanova; Raissa Micaella Marcello Machado

• Advisor: Renata Cunha Matheus Rodrigues Garcia

Abstract

This thesis is formed by researches that aimed (1) to evaluate awake bruxism (AB) frequency in pre-university students; (2) to evaluate AB frequency in patients with temporomandibular disorders (TMD); (3) to verify the effect of behavioral therapies, such as Biofeedback (BFB) and Ecological Momentary Intervention (EMI) on AB, orofacial pain and biopsychosocial factors; and (4) to verify AB and TMD prevalence, its association with psychosocial factors and quality of life (QoL), as well as academic perspectives of dental students considering the COVID-19 pandemic. To answer the first objective, 69 pre-university students used the Bruxapp® application for 7 days to measure AB frequency. Questionnaires about anxiety and depression (Hospital Anxiety and Depression Scale – HADS), stress (Perceived Stress Scale – PSS), oral health-related QoL (OHIP-14), and oral behaviors (Oral Behaviors Checklist – OBC) were used. For the second objective, 60 volunteers were selected, 30 with and 30 without TMD. AB was evaluated by the Bruxapp® application. For objective 3, 90 patients with orofacial pain and AB were divided into three groups: BFB, EMI, and Control (without intervention). AB was measured by electromyography during standardized tasks, and the pain was self-reported and by pressure pain threshold test. Besides, HADS, PSS and WHOQOL-bref were used, being the last used to assess QoL. Assessments were performed before, 30, and 90 days after therapies. Moreover, for objective 4, 268 final-year dental students completed online questionnaires about AB, TMD, HADS, PSS, and WHOQOL-bref, and also answered structured questions about academic perspectives. For all objectives, adequate statistical tests were used, considering ? = 0.05. The average AB frequency in pre-university students (objective 1) was 38.4%, and AB was significantly correlated with OBC, anxiety, depression, stress, and OHIP-14 (all P<0.001). The average AB frequency in patients with TMD (objective 2) was 51.7%, differing from participants without TMD (P=0.040). Considering the therapies’ effect on AB (objective 3), BFB and EMI reduced the number of AB episodes, with EMI showing greater reductions after 90 days. Psychological factors and QoL had a significant time effect (P<0.05), without statistical difference among the three groups. The BFB and EMI groups had lower scores for self-reported pain (P<0.05), and the pressure pain threshold increased after 30 days of interventions. Moreover, considering the COVID-19 pandemic (objective 4), AB and TMD were reported by 54.8% and 64.2% of participants, respectively, being associated with worse QoL. Still, COVID-19 fear had a significant association with anxiety and stress, and with some aspects related to academic perspectives. Thus, considering all results achieved, it was possible to conclude that pre-university students had moderate AB frequency, which is correlated with psychosocial factors, and that this frequency is significantly higher in patients with TMD. BFB and EMI therapied reduced AB, positively influencing the participants’ QoL. Furthermore, the COVID-19 pandemic affected the academic perspectives of final-year dental students, and this population had a high prevalence of AB and TMD, and high levels of anxiety, depression, and stress. (AU)

• FAPESP's process: 17/23429-3 - Influence of behavioral therapies on awake bruxism, biopsychosocial factors and orofacial pain: randomized controlled clinical trial
• Grantee: Mariana Barbosa Câmara de Souza
• Support Opportunities: Scholarships in Brazil - Doctorate