Impact of long-term stress on awake bruxism: An observational longitudinal within-subject study of stress-related changes

BACKGROUND: Awake bruxism (AB), characterized by repetitive jaw muscle activity during wakefulness, is often associated with stress, anxiety and depression. OBJECTIVES: The aim of the study was to examine the long-term relationships between psychological distress, resilience and AB behaviors during stressful periods. To this end, a longitudinal, within-subject design of the study was used. MATERIAL AND METHODS: A repeated-measures design was employed to evaluate 136 individuals. The participants underwent 2 assessments: the baseline evaluation conducted at the onset of an armed conflict (phase 1); and the follow-up evaluation, performed 1 year later, when the conflict remained ongoing (phase 2). Each subject served as their own control. At each phase of the study, the participants completed a self-report questionnaire, the Oral Behavior Checklist (OBC), which addressed selfawareness of performance of teeth grinding, teeth clenching, tooth contact, and/or mandible bracing while awake. A score of 2 and above on any of the questions indicated positive awareness of the presence of AB behaviors. The additional questionnaires referred to subjects' ability to cope with stress adaptively, their ability to recover from stress, perceived stress, screening for depressive and anxiety symptoms, and screening for adjustment disorder and post-traumatic stress disorder (PTSD). RESULTS: A significant increase in teeth clenching was apparent during phase 2. The subjects' ability to cope with stress in an adaptive manner, as well as their perceived stress levels, increased the likelihood of AB behaviors during both phases (odds ratios ranging from 11% to 27%). CONCLUSIONS: Awake bruxism behaviors in general, and teeth clenching in particular, should be considered as possible stress-relieving behaviors.