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leep bruxism, which is defined as nonfunctional tooth contact
during sleep, continues to have an unknown etiology.''^
Investigators have suggested that local dental, systemic, and/or
psychologic factors may play a role m the expression of the disor-
der, but the relative importance of these variables remains unclear.
While the importance of occlusai and anatomic factors in explain-
ing the etiology and maintenance of the temporomandibular disor-
ders, in general, and bruxism, in particular, has been cballenged,^'
there is diverse evidence that suggests that bruxing behavior during
sleep IS a centrally mediated problem.''""
To what degree psychologic variables impact tbe central expres-
sion of sleep bruxing, and just how they may do that, has yet to be
determined. Some research has provided evidence that psychologic
variables such as anxiety, hostility, and intrapunitive reactions to
frustrating situations are significantly correlated with bruxing
behavior,""" Conversely, other research suggests that bruxers are
normal individuals without higher levels of anxiety, hostility, or
frustration.''"" Emotional stress is one common factor that has
often been linked to increased bruxing behavior.'*"''
Funch and Gale''' studied one patient's self-reported stress levels
over 69 days and found a significant relationship between high antici-
patory stress (ie, for the day following sleep bruxing measurement)
and tbe subject's bruxing activity measured by electromyograph
(EMG). Their results indicated that high anticipatory stress was the
best predictor of bruxing activitj' and that high stress 1. Trait anxiety (Taylor Manifest Anxiety Scale"
preceding bruxing measures was not predictive of and Profile of Mood State'']
EMG-mcasured bruxing activity." Another study of 2. Depression (Pilowsky Depression Scale" and
58 .sleep bruxers provided evidence of a negative Profile of Mood State")
relationship between FMG-mcasured sleep brtixing 3. Denial and irritability (Illness Behavior
and subjectively perceived same-day stress estimates."^ Questionnaire")
It remains unclear as to how and to what degree 4. Health locus of control (Multidimensional
psychologic variables such as stress impact upon Health Locus of Control Scales")
the central expression of bruxing behavior. At a
most basic level, two items are unclear. Is stress a During the initial interview, each subject also indi-
factor perceived by all or only some sieep bruxers? cated whether he/she believed bruxing behavior
How does perceived stress relate to sleep bruxing was or was not stress related. AI! interviewing was
behavior? The aim of this study was to examine completed by the same clinician.
the relationship between sleep bruxism, self- During the second visit, each sub|ect was trained
reported stress, and a number of personality vari- in the use of a portable EMC monitor, which mea-
ables. A specific goal of the study was to examine sures bruxism-related EMC activity above a 20 pV
the correlation between perceived daily stress level threshold in the home environment.'' A detailed
and EMG-measured sleep hruxism. description of the procedure for these subjects'
EMC recordings is described elsewhere." The
EMG provided bedside rape recordings of the
number of bruxing episodes per hour slept (fre-
Materials and Methods quency) and of bruxing activity in terms of sec-
onds per hour slept (duration). Subjects were
instructed to obtain 15 consecutive nights of EMG
Subjects recordings for baseline evaluation. Regular
appointments were scheduled to monitor the use
Participants were 100 residents of the greater of the portable EMG. There are a number of issues
Buffalo, New York, metropolitan area who were that are related to the advantages and disadvan-
subjects in a bruxism treatment outcome study.'" tages of surface EMC that could affect outcome.
Subjects were selected from 350 hruxers who were These issues are addressed by rhe study design''
either referred by their dentists or were respon- but are not discussed here because they have been
dents to a newspaper announcement. Selection cri- adequately reviewed previously."" The reliability
teria included: and validity of the portable EMG used for this
1. A self-reported history of bruxism study has been previously documented.'*"
2. Current bruxing activity verified either by Immediately before commencing each night's
someone else hearing them brux or by the EMC sleep evaluation, the subjects recorded their
presence of wear facets consistent with the levels of stress for the prior 24-hour period. Stress
bruxism disorder was measured on a Likert scale of 1 to 5 accord-
3. Measurable EMG activity indicating bruxism ing to the method used by Eunch and Gale,^' with
during sleep 1 indicating no stress present and 5 representing
the highest level of stress possihie. Subjects
Only one subject was omitted from the study
returned their baseline tape recordings and stress
because the minimum baseline criterion of 1.0
ratings after the 15th night of recording. They
mean bruxing episode per hour was not met.
were then randomly assigned to receive various
Subjects' ages ranged from 18 to 72 years with a
treatments, the results of which were published
mean age of 38. Sixty-five women and 35 men
previously.'"'^-^
completed the study.
related to subseqtjent self-report of daily stress and the understanding, diagnosis, and treatment of
because only a few individuals had a demonstrable psychophysiologic disorders such as bruxism,
stress-bruxism relationship, it appears unlikely more research addressing the relative importance
that self-perceived daily stress is a major factor in of psychologic variables in the expression of these
sleep-bruxing behavior. This is not to say that disorders is needed. To date, the data suggest that
bruxing activity is not related to stress, but it the relationship between psychologic variables and
might indicate that (1) bruxets are not very aware the expression of bruxism is more complex than a
of the stressful nature of daily events, and/or simple cattse-and-effect relationship motivated by
(2) they minimize tbe personal impact of life perceived life stress-
events.
Although the present sttidy did not demonstrate
a statistically significant group correlation between Ackn owl edg ment
EMG-measured bruxing activity and psychologic
variables, our data suggest that some individuals This rcscarirh was supported in part hy USPHS research grants
veridically associated increasing stress with DF.-05344 and DE-04358 from the National institute cf Dental
increasing bruxing behavior. It is also apparent Research, National Institute of Health, Berhesda, Maryland,
that there wete far more individual bruxers who
did not reliably make that stress-bruxing associa-
tion. This failure to make a reliable stress-bruxing References
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Resumen Zusammenfassung
Estrés, estrés anticipsdor, y medidas psicológicas rela- Stress, Stressbereitschaft, und psychologiscbe
cionadas al bruxismo durante el sueño Messungen verbunden mit nächtlichem Bruxismus,
Este estudió examinó: (V las relaciones entre el bruxismo noc- Diese Studie prüfte (!) die Be7iehungen zwischen elektromyo-
turno medido por medio de electromiografia, el estrés auto- graphisch gemessenem nacbtlichem Bruxismus und einigen
reportado, y diversas variables de la personalidad, y (2) la Persönlich keitsvariabien und f2.f die Beziebung zwisciien dem
relación enlre la creencia de una relación bruxism o-est res y el Glauben an einen Zusammenbang zwischen Stress und
estrés auto-reporta do Cien adultos que bru>;aban, completaron Bruxismus und dem subjektiven Stress. 100 erwachsene Brjxer
una serie cuestionarios de personalidad, e indicaron si ellos füllten eine Reibe von Persöniichkeitsfragebogen aus, gaben an,
creian en la relación entre ei bruKismo y el estrés. Estas per- ob sie an einen Zusammenbang zwischen Stress und Bruxismus
sonas también recibieron un examen dentai y se Íes tomó glaubten und wurden iahnär^tlicb untersucht. In der Folge wur-
impresiones dentales. Subsecuentemente, se registraron rnedi- den elektromyographische Messungen der Brjxismusfrequenz
das e i ectro mío gráficas de la frecuencia y duración del bruxismo, und -dauer wäbrend 15 aufeinanderfolgenden Nacbten
por quince noches consecutivas. Cada noche antes de realizar vorgenommen. Vor jeder Nacbt gaben die Personen den Grad
las medidas electrorniográficas, las personas indicaron los nive- ihres Stresses in den vorangebenden 24 Stunden an. Es wurde
les de estrés correspondientes a las 24 horas anteriores. No se kein gesamthafter Zusammenhang zwischen den eiektromyo-
estableció una relación general entre las medidas eieotro- graphischen Werten und den persöniicben Vanabien und auch
miográficas y las variables de personalidad, ni tampoco entre nicht zwischen den olektromyographischen Werten und dem
las medidas electromiográficas y el estreés auto-reporlado subjektiven Stress gefunden. Eine Korreiation zwisciien den
fureon significativas, en el caso de ocho individuos. Ademas, las elektromyographischen Werten und dem subjektiven Stress war
personas con niveles de estrés aitos presentaron mas signifikant bei acht Personen. Weiter berichteten Personen mit
ansiedad, irritabiiidad y depresión, y menor recbazo. Las per- viel Stress über mehr Angstiicbkeit. Irritierbarkeit,
sonas que creian en la relación entre el bruxismo y el estrés se Depressionen, und weniger Verneinung. Personen, welche an
quejaron de mayor estrés. einen Zusammenhang zwischen Stress und Bruxismus glaubten
berichteten uhBrnrnsaomn RtreB.«