Bruxismo como consequência do estresse pandêmico: revisão integrativa / Bruxism as a consequence of pandemic stress: integrative review

O período pandêmico com todas as suas implicações possibilitou um aumento dos níveis de estresse em parte da população, que teve como consequência a obtenção ou o agravamento do bruxismo. Objetivo: O objetivo deste artigo foi realizar uma revisão integrativa sobre como o estresse causado pela pandemia de COVID-19 influenciou no desenvolvimento do bruxismo, considerando o perfil dos indivíduos acometidos. Realizou-se uma revisão integrativa da literatura a partir da seleção de artigos publicados nas bases de dados BVS, PubMed e EBSCOhost. Para isto, a seguinte questão de pesquisa foi formulada: "Existe relação entre o bruxismo e a pandemia de COVID-19?". A busca objetivou encontrar artigos publicados em português, espanhol e inglês, durante os anos de 2019 a 2023, utilizando os descritores "bruxismo", "COVID-19" e "estresse psicológico" e as suas respectivas versões em inglês, juntamente com a estratégia de busca AND. Revisão de literatura: Vinte estudos foram incluídos, ficando evidente uma prevalência do bruxismo como consequência do estresse pandêmico em pessoas jovens, do sexo feminino, além de estudantes/profissionais da área da saúde. Considerações finais: Acredita-se que a pandemia de COVID-19 vivenciada entre os anos de 2019 e 2023 tenha causado e/ou exacerbado estresse, sendo este um importante fator causador do bruxismo.(AU)

The pandemic period with all its implications allowed an increase in stress levels in part of the population, which resulted in the obstruction or worsening of bruxism. Objective: The aim of this article was to carry out an integrative review on how the stress caused by the COVID-19 pandemic influenced the development of bruxism, considering the profile of affected individuals. Method: An integrative literature review was carried out based on the selection of articles published in the VHL, PubMed and EBSCOhost databases. For this, the following research question was formulated: "Is there a relationship between bruxism and the COVID-19 pandemic?". The search aimed to find articles published in Portuguese, Spanish and English, during the years 2019 to 2023, using the descriptors "bruxism", "COVID-19" and "psychological stress" and their respective versions in English, together with the strategy of search AND. Integratve review: Twenty studies were included, revealing a prevalence of bruxism as a consequence of pandemic stress in young, females, in addition to students/health professionals. Final considerations: It is believed that the COVID-19 pandemic experienced between 2019 and 2023 caused and/or exacerbated stress, which is an important factor causing bruxism.(AU)

Una clínica adecuada para el bruxismo / An appropriate clinic for bruxism

Este trabajo plantea una clínica para el bruxismo, luego de dar cuenta de las causas que lo constituyen desde su fisiología. El bruxismo es producido por el impedimento de descarga ­por diversos motivos singulares de cada padeciente­ de la energía agresiva que el cuerpo tiene para defenderse u atacar. Esta energía no es exclusivamente fisiológica, sino también emocional, por lo cual hacer gimnasia o deportes no resuelve la problemática; de todos modos, la clínica a emprender debe contemplar un trabajo en ambos aspectos. Se diferencia la agresividad ­energía vital necesaria para el vivir cotidiano­ de la violencia, tomando desarrollos de Winnicott, Perls y Lorenz. Si bien las causas que impiden su descarga son diversas, la sintomatología es común. Por eso no sirve un grupo de autoayuda que no contemple la clínica singular, siendo adecuado el recurso grupal como modalidad de trabajo. Se considera que la clínica adecuada para la cura del bruxismo debe incluir: la toma de conciencia y el cambio de modalidades conductuales habituales respecto a la agresividad ­a la vez que su posibilidad de historizarlos­, unidos a un trabajo que posibilite la descarga efectiva corporal y afectiva de las energías agresivas, realizado en una modalidad de trabajo grupal (AU)

This work proposes a clinic for bruxism, after accounting for the causes that constitute it from its physiology. Bruxism is produced by the impediment of discharge - for various reasons unique to each patient - of the aggressive energy that the body has either to defend itself or to attack. As this energy is not exclusively physiological but also emotional, doing gymnastics or sports does not solve the problem, at the same time that the clinic to undertake must contemplate working in both aspects. Aggressiveness -vital energy necessary for daily living- is differtent from violence, taking in account developments from Winnicott, Perls and Lorenz. Although the causes that prevent its discharge are diverse, they share the same symptomatology. That is why a self-help group that does not contemplate the singular clinic is not useful, being the group resource a suitable modality of work. The appropriate clinic for the cure of bruxism should take into account: the awareness and the change of habitual behavioral modalities in regard to aggression -as well as the possibility of historicizing them-, together with a work that enables the effective corporal and affective discharge of aggressive energies, carried out in a modality of group work (AU)

The prevalence of bruxism and related factors in patients with multiple sclerosis: a comparative study / A prevalência do bruxismo e fatores relacionados em pacientes com esclerose múltipla: um estudo comparativo

ABSTRACT Objective: To determine the prevalence of bruxism and related factors in patients with multiple sclerosis (MS). Methods: Diagnosed with relapsing-remitting MS under the 2010-revised McDonald diagnostic criteria, 182 patients without MS exacerbations during the previous three months were included in the patient group, and 145 healthy individuals made up the control group in the study. Demographic data of the participants in both groups were determined. In the patient and control groups, the diagnosis of definite bruxism was made using the International Classification of Sleep Disorders (Diagnosis and Coding Manual, Second Edition). Results: Bruxism was found in 29.7% (n = 54) of the patients and in 12.4% (n = 18) of the controls, and the difference was statistically significant (p < 0.001). Of all patients, the onset of bruxism was found in 70.4% (n = 38) after the diagnosis and in 29.6% (n = 169) prior to the diagnosis of MS. Compared with those without bruxism, the mean age (p = 0.031) and the score of the Expanded Disability Status Scale (p = 0.001) were also significantly higher among MS patients with bruxism. Between MS patients with and without bruxism, no significant differences were found in terms of sex, marital status, educational status, employment, cigarette smoking, total number of exacerbations, number of exacerbations within the previous year, and drugs used. Conclusions: The frequency of bruxism was found to be higher in the patients with MS than in the controls. Bruxism is associated with age and the Expanded Disability Status Scale score in MS patients.

RESUMO Objetivo: Neste estudo, pretendeu-se determinar a prevalência de bruxismo e fatores relacionados em pacientes com esclerose múltipla (EM). Métodos: Diagnosticados com EM remitente recidivante sob os critérios de McDonald Diagnostic revisados em 2010, 182 pacientes sem ataques de EM durante os últimos três meses foram incluídos no grupo de pacientes, e 145 indivíduos saudáveis constituíram o grupo de controle no estudo. Os dados demográficos dos participantes dos dois grupos foram determinados. Nos grupos de pacientes e controle, o diagnóstico de bruxismo definitivo foi feito usando a Classificação Internacional de Distúrbios do Sono (1) (Manual de Diagnóstico e Codificação Segunda Edição). Resultados: O bruxismo foi detectado em 29,7% (n = 54) dos pacientes e observado dentro de 12,4% (n = 18) dos controles, e a diferença foi estatisticamente significante (p <0,001). De todos os pacientes, o tempo inicial de bruxismo foi encontrado em 70,4% (n = 38) após o diagnóstico e em 29,6% (n = 169) antes do diagnóstico. Em comparação com aqueles sem bruxismo, os níveis de idade média (p = 0,031) e o escore da Escala de Status de Incapacidade Expandida (p = 0,001) também foram significativamente maiores entre os pacientes com esclerose múltipla com bruxismo. Entre os pacientes com esclerose múltipla com e sem bruxismo, não foi encontrada diferença significativa em termos de sexo, estado civil, status educacional, emprego, tabagismo, número total de ataques, número de ataques no último ano e medicamentos utilizados. Conclusões: A freqüência de bruxismo foi maior em pacientes com esclerose múltipla do que nos controles. O bruxismo está associado à idade e ao escore da Escala de Status de Incapacidade Expandida (EDSS) em pacientes com EM.

Pobreza y salud bucal en comunidades afrodescendientes vulnerables / Poverty and oral health in vulnerable Afro-descendants communities

Objetivo: Determinar la relación entre pobreza y salud bucal en comunidades afrodescendientes vulnerables. Métodos: Estudio realizado en 240 adultos residentes en Tierra Baja, Manzanillo y Boquilla de Cartagena, Colombia. La selección fue a conveniencia en visita domiciliaria. El estudio conto con una etapa descriptiva y una analítica. En la primera etapa descriptiva se indagó por variables sociodemográficas, presencia de pobreza, condiciones de salud bucal, hábitos de higiene oral y otros nocivos. En la segunda, analítica de corte transversal, se clasificó la pobreza en objetiva, subjetiva y general, como variables independientes en tanto que la condición de salud bucal y hábitos bucales las dependientes. La valoración clínica de la población estuvo a cargo de examinadores entrenados. Los datos se analizaron a partir de frecuencias y proporciones y odds ratio por regresión logística bivariada. Resultados: De los participantes 76,7 por ciento se percibieron pobres y 89,2 por ciento contaban con sus necesidades básicas insatisfechas (pobreza objetiva); el 65,8 por ciento se clasificaron con pobreza general. Se encontraron asociaciones entre la pobreza objetiva y subjetiva y la condición de salud bucal inadecuada (odd ratio: 2,17 y 1,8 respectivamente) y entre hogares con pobreza general y frecuencia del cepillado (odd ratio: 2,18), recambio del cepillo de dientes (odd ratio: 2,3) y hábito del bruxismo (odd ratio: 2,4). Conclusiones: La pobreza ejerce influencia desfavorable en la salud bucal en comunidades afrodescendientes vulnerables. Se demuestra la necesidad de una intervención efectiva en el entorno social(AU)

Objective: To determine the relationship between oral health and the presence of poverty in african descent of Tierra Baja, Manzanillo and Boquilla, Cartagena, Colombia. Methods: Study conducted in 240 adults selected convenience in the home visit. The first descriptive stage asses sociodemographic variables, presence of poverty, oral health condition, oral health habits and other nocuous. In the second analytical stage of cross-section, the poverty classified as objective, subjective and general were the independent variables while the oral health condition and oral habits were the dependent variables. There was calibration of examiners, for clinical assessment. The data were analyzed from frequencies and proportions and odds ratio by bivariate logistic regression. Results: 76,7 percent of participants perceived poor and 89,2 percent had their Dissatisfied Basic Needs (objective poverty); 65,8 percent were classified as general poor people. There were associations between objective and subjective poverty and inadequate oral health condition (OR: 2.17 and 1.8 respectively) and among households with general poverty and frequency of brushing (OR: 2.18), toothbrush replacement (OR: 2,3) and habit of bruxism (OR: 2,4). Conclusions: Poverty has an adverse influence in oral health in vulnerable Afro-descendants communities. It is demonstrated the necessity of effective interventions in the social environment(AU)

Avaliação da influência do tratamento ortodôntico em sinais e sintomas de disfunção temporomandibular, no relato de bruxismo, na hipervigilância à dor e nos sintomas de ansiedade e depressão / Evaluation of orthodontic treatment on signs and symptoms of temporomandibular dysfunction, bruxism, pain hypervigilance, anxiety and depression

Novos estudos são necessários para elucidar com maior clareza o impacto da ortodontia na saúde dos músculos mastigatórios e das articulações temporomandibulares. A associação do estudo de sinais e sintomas de DTM com a investigação dos fatores psicossociais apresentam perspectivas promissoras, assim como o conhecimento da presença de hábitos parafuncionais. Entender como os fatores psicossociais interferem nos resultados dos tratamentos clínicos pode trazer contribuições enriquecedoras para a odontologia. Um modelo que tem sido aceito no entendimento da etiologia das DTM é o modelo biopsicossocial, que envolve uma combinação de fatores biológicos, psicológicos e sociais. Segundo essa perspectiva, entende-se que um problema biológico pode ter antecedentes psicológicos, assim como consequências comportamentais. O objetivo deste trabalho é avaliar a influência da ortodontia no desenvolvimento de sinais e sintomas de disfunção temporomandibular, no relato de bruxismo, na hipervigilância à dor e nos sintomas de depressão e ansiedade. 111 pacientes iniciando tratamento ortodôntico foram examinados em 3 sessões: t1 (no momento da instalação do aparelho), t2 (dois meses após a instalação), e t3 (seis meses após o início do tratamento). Nas 3 sessões os pacientes foram examinados clinicamente para avaliação oclusal, limiares de dor à pressão e aplicações de questionários de bruxismo, hipervigilância, depressão e ansiedade. Foram feitas comparações a respeito de cada variável quantitativa considerando os três tempos de avaliação através de Análise de variância (ANOVA) a um critério. O teste t foi utilizado para avaliar diferenças entre as médias das variáveis quantitativas no tempo inicial (t1) e tempo final (t3) de avaliação. Para avaliar o efeito da ortodontia sobre variáveis qualitativas oclusais foi utilizado o teste exato de Fisher. Foram considerados estatisticamente significantes aqueles resultados que apresentaram nível de significância igual ou menor que 0,05. O presente estudo demonstrou que a ortodontia não interfere no surgimento de sinais e sintomas de disfunção temporomandibular, sendo que não houve diferenças na presença de ruído articular e no LDP em nenhum dos sítios durante os períodos avaliados. Os resultados apontaram que nos grupos que não possuíam bruxismo do sono (controle), houve um aumento no relato de bruxismo em vigília após o início da ortodontia. Considerando o grupo de pacientes com maiores sintomas de ansiedade, encontrou-se maior presença de relato de bruxismo em vigília. Por último, os resultados demonstraram que a ortodontia não alterou os escores do questionário de hipervigilância à dor e os sintomas de ansiedade e depressão.(AU)

Further studies are needed to elucidate more clearly the impact of orthodontics on the health of the masticatory muscles and temporomandibular joints. The study of the association of signs and symptoms of TMD with psychosocial factors have promising prospects, as well as the presence of parafunctional habits. Understanding how psychosocial factors affect the results of clinical treatments can bring great contributions to dentistry. A model that has been accepted in the understanding of the etiology of TMD is the biopsychosocial model, which involves a combination of biological, psychological and social factors. From this perspective, it is understood that a biological problem may have psychological backgrounds, as well as behavioral consequences. The objective of this study is to evaluate the influence of orthodontics in the development of signs and symptoms of temporomandibular disorders, the report of bruxism, hypervigilance to pain, and symptoms of depression and anxiety. 111 patients initiating orthodontic treatment were examined in 3 sessions: t1 (at the time of orthodontic appliance installation), t2 (two months after installation), and t3 (six months after the start of the treatment). In the three sessions, patients were examined clinically for occlusal evaluation, pain pressure thresholds were measured, and bruxism, hypervigilance, depression and anxiety questionnaires were applied. Comparisons were made with respect to each quantitative variable considering the three phases of evaluation through a multi-way analysis of variance (ANOVA). The t test was used to assess differences between means of quantitative variables at the initial time (t1) and end time (t3) evaluation. To evaluate the effect of orthodontics on occlusal qualitative variables we used Fisher's exact test. This study showed that orthodontics does not interfere with the appearance of signs and symptoms of temporomandibular dysfunction, and there were no differences in the presence of articular noise and LDP on any of the sites during the evaluation period. The results showed that the group that did not reported sleep bruxism (control), showed an increase in the reporting of awake bruxism after the start of orthodontics. Considering the group of patients with higher anxiety symptoms, we found a greater presence of daytime bruxism report. Finally, the results showed that orthodontics did not alter the scores of pain hypervigilance questionnaire and symptoms of anxiety and depression.(AU)

Factors associated with bruxism in children with developmental disabilities

The aim of the present study was to investigate factors associated with bruxism in children aged from 1 to 13 years with developmental disabilities. A total of 389 dental records were examined. The bruxism analyzed was determined based on parental reports. The following variables were also analyzed: gender, age, International Code of Diseases (ICD), mouth breathing, history of gastroesophageal reflux, use of psychotropic drugs, gingival status, reports of xerostomia, hyperkinesis, pacifier use, thumb sucking and involuntary movements. For the purposes of analysis, the individuals were categorized as being with and without bruxism. Variables with a p-value < 0.25 in the bivariate analysis were incorporated into the logistic regression models. Females had a 0.44-fold (95%CI: 0.25 to 0.78) greater chance of exhibiting bruxism than males. Individuals with gastroesophageal reflux had a 2.28-fold (95%CI: 1.03 to 5.02) greater chance of exhibiting bruxism. Individuals with reported involuntary movements had a 2.24-fold (95%CI: 1.19 to 4.24) greater chance of exhibiting bruxism than those without such movements. Exhibiting involuntary movements, the male gender and gastroesophageal reflux are factors associated with bruxism in children with developmental disabilities.

La disfunción temporomandibular y su relación con algunos factores de riesgo en niños de 7 a 11 años: Los Arabos, Matanzas / Temporomandibular dysfunction and its relationship with several risk factors in children aged 7 to 11 years: Los Arabos, Matanzas

La articulación temporomandibular constituye una de las estructuras faciales más complejas y ha sido reconocida como una causa de dolor y disfunción desde principios del siglo pasado. Su complicado funcionamiento determina que las mínimas alteraciones produzcan en ellas una gran diversidad de problemas funcionales, a los que se les conoce como trastornos temporomandibulares, que pueden originarse muy temprano con relación a las etapas de crecimiento y desarrollo craneofacial. El objetivo de este trabajo fue determinar la prevalencia de disfunción de la articulación temporomandibular e identificar los factores de riesgo asociados a estos trastornos en el grupo estudiado. Esta investigación fue de tipo descriptiva y transversal, cuyo universo de trabajo estuvo conformado por 320 niños, con edades comprendidas entre 7 y 11 años, pertenecientes a la Escuela primaria urbana Sofiel Riverón. El diagnóstico de disfunción fue realizado mediante la aplicación del Test de Krogh Paulsen. Los resultados mostraron que 6 de cada 100 niños encuestados presentaba disfunción temporomandibular y los factores de riesgo identificados con mayor frecuencia fueron: interferencias oclusales (45 por ciento), hábitos parafuncionales (35 por ciento), bruxismo (15 por ciento), estrés (5 por ciento). Fue apreciado un incremento de estos factores conjuntamente con las edades, aunque no de manera uniforme. Se hace necesario enfatizar en el examen funcional de la articulación temporomandibular en niños, ante la manifestación precoz de desórdenes temporomandibulares y mediante actividades de promoción, prevención e intervención clínicas oportunas, actuar sobre estos factores de riesgo y contribuir a disminuir las cifras de afectados.

The temporomandibular joint is one of the most complex facial structures and has been recognized as a pain and dysfunction source since the beginning of the last century. Its complicated functioning determines that the minimal alterations produce a great diversity of functional problems, known as temporomandibular disorders that may be originated very early with relation to the cranio-facial growing and development stages. The aim of this work was determining the prevalence of the temporomandibular joint dysfunction and identifying the risk factors associated to these disorders in the studied group. This was a cross- sectional descriptive research; the working universe was formed by 320 children aged 7-11 years, assisting the urban primary school Sofiel Riverón. The dysfunction diagnosis was made applying the Krogh Paulsen test. The results showed that 6 of every 100 inquired children had temporomandibular dysfunctions and the risk factors more frequently identified were: oclusal interferences (45 percent), parafunctional habits (35 percent), bruxism (15 percent), and stress (5 percent). It was appreciated these factors increment with the age, although not in an even way. It is necessary to emphasize in the functional examination of the children temporomandibular joint in the presence of precocious temporomandibular disorders and, through opportune activities of promotion, prevention and clinical intervention, influence on these risk factors and contribute to diminishing the number of affected children.

Association between respiratory problems and dental caries in children with bruxism.

Context: Bruxism is the habit of clenching or grinding one's teeth in non-functional activities and affects both children and adults alike. Respiratory problems, such as asthma and upper airway infections, are reported to be the etiological factors of bruxism. Aims: The aim of the present study was to determine whether there is an association between respiratory problems and dental caries in children who exhibit the habit of bruxism. Setting and Design: An observational cross-sectional study was carried out. Materials and Methods: Patient histories were taken and clinical exams were performed on 90 children for selection and allocation to one of two groups. For the determination of bruxism, a questionnaire was administered to parents/guardians and an oral clinical exam was performed based on the criteria of the American Academy of Sleep Medicine. Thirty-three male and female children between 4 and 7 years of age participated in the study - 14 children with bruxism and 19 children without bruxism. Statistical Analysis: The data were statistically analyzed using the chi-square test, with level of significance set at 5% (P < 0.05). Results: Mean age of the participants was 5.73 years. The male gender accounted for 45.5% (n = 15) of the sample and the female gender accounted for 54.5% (n = 18). A statistically significant association was found between respiratory problems and dental caries among the children with bruxism. Seventy-seven percent of the children with bruxism had caries and 62.5% the children with respiratory problems exhibited the habit of bruxism. Conclusions: There seems to be an association between bruxism, respiratory problems, and dental caries in children.

Planejamento em reabilitação oral: restabelecimentoda relação intermaxilar por meio de prótese provisóriaoverlay / Oral rehabilitation planning: restoring the jaw relationship by using an interim overlay denture

Este trabalho descreve o planejamento e confecçãode prótese overlay para restabelecer arelação intermaxilar em paciente parcialmentedentado com bruxismo. Paciente do sexo masculino,com 51 anos de idade, compareceu parareabilitação oral queixando-se da dificuldade demastigação e estética. O paciente apresentavaalto grau de desgaste oclusal nos dentes remanescentesda arcada superior. O planejamentofoi a confecção de prótese overlay provisóriasuperior para restabelecimento da relação intermaxilar.Após a instalação da prótese overlaycom projeções metálicas e recobrimento oclusalem todos os dentes, as alterações na função eestética apresentaram-se clinicamente satisfatóriaspara o paciente. Pode-se verificar com ouso da prótese melhora na posição fisiológicanormal para posterior reabilitação oral definitivapor meio de próteses fixas sobre implante.

The present article describes the treatmentplanning and fabrication of overlay denture torestore the jaw relationship in a partial edentulouspatient with bruxism. A male patient,51 years old, was referred to the oral rehabilitationclinic complaining about the chewingand aesthetic. The occlusal surface of the superiorteeth presented severe wear. The fabricationof an interim overlay denture to restorethe jaw relationship was planned. The overlayhad metallic projections and covered the occlusalsurface of superior teeth. After overlayinsertion both function and aesthetic of thepatient were recovered. It was concluded thatthe use of overlay improved the physiologicalnormal position of the jaw and could providea favorable prognosis for a definitive oralrehabilitation with implant-supported fixeddenture.

Allergic rhinitis and bruxism in children – association andoccurrence

Purpose: The study assessed the occurrence ofallergic rhinitis and bruxism, and the associationbetween these variables from a sample of childrenranging from 1 to 12 years of age in thecity of Santa Maria, RS, Brazil. Study design:This was a retrospective study and data wereanalyzed from 465 records belonging to the PediatricDentistry Clinic at the Federal Universityof Santa Maria from January 1997 to December2008. In a questionnaire applied to the children’sparents, questions about bruxism and allergicrhinitis occurrence were included. The chi-squaretest was used to assess data. Girls made up 51%of the sample and boys 49%. Results: The resultsshowed a 53.1% allergic rhinitis occurrenceand a 23.9% bruxism occurrence. Of the childrenshowing bruxism, 63% also showed allergicrhinitis. Conclusion: Therefore, the associationbetween bruxism and allergic rhinitis was significant.It was concluded that bruxism-bearing childrenare likely to develop allergic rhinitis.

Behavioral problems and emotional stress in children with bruxism

Bruxism has a multifactorial etiology, and psychosocial factors have been considered to increase the risk of occurrence of this parafunction. The aim of this study was to evaluate the behavior profile of a group of children diagnosed with bruxism. Eighty 7-11-year-old children of both genders (mean age 8.8 years) first recruited as eligible participants. Twenty-nine children (18 males and 11 females) whose parents/guardians reported to present frequent episodes of tooth grinding/clenching while awake or during sleep (at least 3 nights a week) in the previous 3 months were enrolled in the study. The diagnosis of bruxism was established based on the parents/guardians' report about the children's behavior, habits and possible discomforts in the components of the stomatognathic system allied to the presence of signs and symptoms such as pain on the masticatory muscles, masseter muscle hypertrophy, wear facets, fractures of restorations, dental impressions on the cheek mucosa and tongue. As part of the psychological evaluation, the Rutter's Child Behavior Scale-A2 was applied to the parents/caregivers (one for each child) and the Child Stress Scale was applied to the children. Data were analyzed descriptively based on the frequency of each studied variable. Twenty-four (82.76%) children needed psychological or psychiatric intervention; 17 of them presented neurotic disorders and 7 children presented antisocial disorders. Six (20.70%) children presented significant physical and psychological manifestations of stress. The findings of the present study suggest that behavioral problems and potential emotional problems can be risk factors to bruxism in children.

A etiologia do bruxismo é multifatorial, e fatores psicossociais têm sido apontados como notáveis potencializadores do risco para a ocorrência dessa parafunção. O presente estudo teve como objetivo avaliar o perfil comportamental de um grupo de crianças com bruxismo. Oitenta crianças de ambos os sexos, com idade entre 7 e 11 anos (idade media de 8,8 anos) foram recrutadas como possíveis participantes. Vinte e nove crianças, 18 do sexo masculino e 11 do feminino, cujos pais ou responsáveis relataram que as mesmas apresentavam rangimento dental freqüente (3 noites por semana) ou apertamento/rangimento dental em vigília, nos últimos 3 meses, foram selecionadas para o estudo. O diagnóstico de bruxismo foi estabelecido com base no relato dos pais ou responsáveis sobre os hábitos cotidianos das crianças e possíveis desordens do sistema estomatognático aliados à presença de sinais e sintomas tais como dor à palpação da musculatura mastigatória, hipertrofia do músculo masseter, facetas de desgaste, fratura de restaurações, impressões dentais na bochecha e lingual. Como parte da avaliação psicológica, a Escala Comportamental Infantil A2 de Rutter foi aplicada aos pais ou responsáveis (um por criança) e a Escala de Stress Infantil foi aplicada às crianças. Os dados foram tabelados e analisados descritivamente com base na freqüência de cada variável estudada. Vinte e quatro (82,76%) crianças necessitavam de intervenção psicológica ou psiquiátrica, sendo que 17 crianças apresentavam desordens neuróticas e 7 apresentavam desordens anti-sociais. Seis (20,70%) crianças apresentaram manifestações físicas e psicológicas de stress. Os resultados do presente trabalho sugerem que problemas comportamentais e potencialidades para o desenvolvimento de desequilíbrios emocionais podem ser fatores de risco para o bruxismo em crianças.

Fatores associados ao bruxismo em crianças de 4 a 6 anos / Factors associated to bruxism in children from 4 - 6 years

TEMA: o bruxismo tem trazido prejuízos para a qualidade de vida das pessoas. Suas implicações para a motricidade orofacial e fala em crianças ainda não estão bem estabelecidas. OBJETIVO: investigar a ocorrência do bruxismo e fatores associados relativos aos hábitos orais, motricidade orofacial e funções de mastigação, respiração e deglutição em crianças de 4 a 6 anos. MÉTODO: participaram 141 crianças da referida faixa etária que frequentam três centros de educação infantil paulistas. Os pais preencheram protocolo de investigação sobre bruxismo e as crianças passaram por avaliação da motricidade orofacial. O grupo pesquisa foi composto pelas crianças cujos pais indicaram qualquer frequência de ranger ou apertamento de dentes, durante o sono ou não. Para análise estatística utilizou-se Análise de Variância, Teste de Igualdade de Duas Proporções e cálculo da Odds Ratio, nível de significância de 5 por cento. RESULTADOS: observou-se elevada ocorrência de bruxismo entre as crianças (55,3 por cento). Foram fatores associados a esta ocorrência: sialorreia durante o sono, uso de chupeta, hábito de morder lábios e roer unhas, tônus de bochechas e tipo de mordida alterados, além da participação da musculatura perioral durante deglutição de líquidos. Houve alta ocorrência de crianças dos dois grupos com queixa de dor de cabeça frequente (76 por cento) e que dormem menos do que o recomendado para a idade (35 por cento). CONCLUSÃO: os achados comprovaram relação entre bruxismo, hábitos orais e aspectos alterados da motricidade orofacial das crianças da faixa etária estudada reforçando a necessidade de ações fonoaudiológicas junto às instituições e famílias.

BACKGROUND: bruxism has brought losses for the life quality of people. Its implications in the orofacial motricity and speech of children are still not well known. AIM: to investigate bruxism occurrence and associated factors concerning oral habits, orofacial motricity and functions of chewing, breathing and swallowing in children from 4 to 6 years. METHOD: 141 children from the referred age group who attend three education centers in São Paulo took part in the study. Parents filled in an investigation protocol on bruxism and the children were submitted to an orofacial motricity assessment. The research group was composed by children whose parents indicated habits of teeth clenching or grinding, during sleep or not. For the statistical analysis the Analysis of Variance, the Two-Proportion Equality Test and the Odds Ratio calculation were used, with a significance level of 5 percent. RESULTS: a high occurrence of bruxism among the children (55.3 percent) was observed. The identified associated factors were: sialorrhea during sleep, pacifier use, habit of lip and fingernails biting, altered cheek tonus and bite, besides the participation of the perioral muscles during liquid swallowing. There was a high occurrence of children from both groups complaining about frequent headaches (76 percent) and who slept less hours than what is recommended for their age (35 percent). CONCLUSION: the findings corroborated the relationship among bruxism, oral habits and altered aspects of orofacial motricity in children from the studied age group, reinforcing the necessity of speech therapy actions next to the institutions and families.

Considerações fisiopatológias sobre bruxismo / Hysiopathologic considerations about bruxism

O bruxismo é uma parafunção oral que pode ser incluída nas patologias de causa e/ou efeito multifatorial, relacionada à hiperatividade muscular, extremamente destrutiva pelo atrito dos dentes em movimento parafuncional, adquirida de forma inconsciente, que pode ocorrer durante o dia, todavia, mais frequente durante o sono. Essa patologia, pode provocar desgastes dentais, lesões nas estruturas de suporte, desordens da articulação temporomandibular e cefaléias. Sua natureza é multifatorial e não suficientemente esclarecida, assim estão envolvidos desde fatores psicológicos até alterações físicas. Atualmente, sugere-se uma resposta controlada por neurotransmissores do sistema dopaminérgico, pois além do desgaste dentário o paciente pode apresentar fraturas dentárias, mobilidade, migração patológica, dores musculares e articulares, principalmente, ao acordar. Por sua característica multifatorial o tratamento, muitas vezes, requer atuação de vários profissionais. Sendo assim, é indispensável o amplo conhecimento do cirurgião-dentista sobre os mecanismos fisiológicos envolvidos no desenvolvimento do bruxismo, e sobre as características clínicas, para determinação de tratamentos adequados que resultem em um prognóstico favorável e duradouro. Por conseguinte, a partir desta revisão literária objetiva-se relatar sobre a etiopatogenia, características clínicas e tratamento de bruxômanos.

Bruxism is an oral parafunction that can be included in the pathologies of cause and / or effect of multifactorial, related to muscle hyperactivity, it is extremely injurious by the teeth grinding in parafunctional movement, destructive by the friction of the teeth moving parafunctional, acquired unconsciously, that may occur during the day, however, more frequent during sleep. This disease can generate dental wear; affect dental support structures, temporomandibular joint dysfunction and headaches. The etiology of bruxism is multifactorial and yet unknown. Psychological and even physical alterations factors are linked to it, although, nowadays a controlled answer by neurotransmitters from dopamine receptors system is suggested. Other than abnormal wear patterns of occlusal surface the patient may present jaw and temporomandibular joints pain, especially in the morning. Since its multifactorial characteristics, the treatment requires multidisciplinary professional attention. The surgeon-dentist wide knowledge about the physiology mechanism and clinical characteristics involved in the bruxism development is essential to determine a successful treatment and to obtain a good prognostic. The aim of this study is to discuss the etiology, clinical characteristics and treatment for the bruxers.

Bruxismo na infância: um sinal de alerta para odontopediatras e pediatras / Childhood bruxism: a warning sign to pediatric dentists and pediatricians

OBJETIVO: Apresentar uma revisão de literatura sobre o bruxismo na infância, abordando os fatores etiológicos, as características clínicas, os sinais e sintomas, a importância do diagnóstico por parte dos pediatras e odontopediatras e o tratamento multidisciplinar desta condição parafuncional. FONTES DE DADOS: Foram selecionados os artigos mais relevantes sobre o tema publicados desde 1907 até 2007, com pesquisa realizada no Medline, na Bibliografia Brasileira de Odontologia (BBO) e em livros de Odontologia. SÍNTESE DOS DADOS: O bruxismo é definido como um hábito não funcional do sistema mastigatório, caracterizado pelo ato de ranger ou apertar os dentes, podendo ocorrer durante o dia e durante o sono. A etiologia é multifatorial e a literatura sugere vários fatores associados: dentário, fisiológico, psicológico e neurológico. As forças exercidas pelo bruxismo podem provocar distúrbios em diferentes graus nos dentes e nos tecidos de suporte, na musculatura e na articulação têmporo-mandibular. O sinal mais comum é o desgaste nas faces incisais dos dentes anteriores e oclusais nos posteriores, além de mobilidade e hipersensibilidade dentárias, fratura de cúspides e restaurações e hipertonicidade dos músculos mastigatórios. CONCLUSÃO: O conhecimento dos fatores etiológicos e das características clínicas do bruxismo na infância é fundamental para que o diagnóstico seja precoce, permitindo que pediatras, odontopediatras e psicólogos possam estabelecer um tratamento multidisciplinar e favoreçam o desenvolvimento integral da criança para a promoção de saúde e bem-estar individual.

OBJECTIVE: To present a review of literature on childhood bruxism, including etiological factors, clinical characteristics, signs and symptoms, the importance of the diagnosis by pediatric dentists and pediatricians and the multidisciplinary management of this parafunctional condition. DATA SOURCE: The most relevant articles published on the subject from 1907 to 2007 were selected, from Medline and Brazilian Bibliography on Odontology databases as well as dentistry books. DATA SYNTHESIS: Bruxism is defined as a non-functional habit of the stomatognatic system, characterized by the act of grinding or squeezing the teeth, with occurrences during the day or sleep. The etiology is multifactorial with contribution of several factors (dental, physiological, psychological and neurological variables). The forces produced by bruxism can harm the teeth, their supporting tissues, muscles and temporomandibular articulation. Common clinical signs are: attrition on the incisal faces of the anterior teeth and occlusal faces in the posterior teeth, as well as dental hypermobility and hypersensibility, cusp and restoration fracture and muscle hypertonicity. CONCLUSIONS: The knowledge on the etiological factors and the clinical characteristics of childhood bruxism is important to establish early diagnosis and treatment, with a multidisciplinary approach that should include pediatricians, pediatric dentists and psychologists in order to provide adequate infant development focused on health promotion and individual well-being.

Un enfoque holístico en el diagnóstico y tratamiento del bruxismo / A holistic approach in bruxism diagnosis and treatment

El bruxismo es una actividad parafuncional caracterizada por rechinar, apretar, trabar y masticar con los dientes, cuya etiología se considera debida a una combinación de problemas relacionados con la presencia de algún tipo de desarmonía oclusal y factores psíquicos o de origen psicosomático. Existe una compleja interacción de mecanismos centrales, psicomáticos, hábitos de movimiento y estructuras morfológicas esqueletales implicadas y concatenadas en la fisiopatología del bruxsimo. Las estructuras y sistemas formales de interacción de esta problemática multifactorial deben ser conocidos y manejados por el profesional experto en el tema para encarar una terapéutica coherente que conduzca a resultados satisfactorios. Los diagnósticos y tratamientos holísticos, los cuales contemplan el bienestar global del individuo desde el punto de vista físico, mental y emocional, son indispensables para encarar el bruxismo con un enfoque alópata y también naturista, contextual, multi y transdisciplinario y donde psicólogos, naturistas, periodoncistas, protesistas, ortodoncistas y otros especialistas médicos actúen con el único fin de sanar de forma integral al enfermo.

Bruxismo: acercamiento a un fenómeno creciente: [revisión] / Bruxism: approach to an increasing phenomenon: [review]

Se realizó una revisión bibliográfica actualizada sobre el bruxismo, fundamentalmente la problemática de las causas, compromisos morfofisiológicos, la frecuencia de aparición de este fenómeno de acuerdo con la edad, el género, la ocupación y el apareamiento. La misma pretende ampliar la actividad profesional del estomatólogo, teniendo en cuenta la preocupación que suscita el conocimiento y el deseo de aprender desde la teoría; y más allá de verla solo como información, sino como la necesidad de penetrar en tendencias actuales sobre la base conceptual convencional. Los elementos aquí desarrollados propician el interés por la oclusión y nutre el proceder clínico, sin descartar la idea de lo estimulante que resulta para el equipo de salud ampliar sus horizontes.

An up-dated bibliographical review about bruxism was performed, fundamentally the problem of the causes, morphophysiological commitments, the frequency of apparition of this phenomenon according to age, gender, occupation and mating. The same one pretends to enlarge the professional activity of the stomatologist, taking into account the preoccupancy that promotes the knowledge and the desire of learning from the theory; and beyond seeing it just as information, but as the necessity of penetrating in current tendencies on the conceptual conventional base. The elements here developed propitiate the interest for the occlusion and it support the clinical procedure, without discarding the idea of how stimulating for the health team it is to enlarge their horizons.

Prevalence of bruxism and emotional stress and the association between them in Brazilian police officers

This study aimed to assess the prevalence of bruxism and emotional stress in Brazilian police officers, due to exposure to stressful situations, and to assess the relationship between the type of work done by a police officer and the presence of bruxism and emotional stress. A cross-sectional study was conducted at the Military Police of the State of São Paulo, Campinas, SP, Brazil. The final sample included 394 male police officers (mean age = 35.5 years). Bruxism was diagnosed by the presence of aligned dental wear facets associated with the presence of one of the following signs or symptoms: self-report of tooth-grinding, painful sensitivity of the masseter and temporal muscles, discomfort in the jaw musculature upon waking. The Stress Symptoms Inventory (SSI) was applied to evaluate emotional stress. The type of work done by the police was classified as organizational or operational, the latter being assumed as the more stressful since it exposes the police officer to life risk. The results showed a prevalence of bruxism of 50.2 percent and a prevalence of emotional stress of 45.7 percent. The Chi-square test indicated an association between stress and bruxism (P < .05). No significant association was found between emotional stress and type of work (P = .382) or between bruxism and work activity (P = .611). It could be concluded that emotional stress was associated with bruxism, independently of the type of work done by police officers.

Study of the relationship of psychosocial disorders to bruxism in adolescents.

BACKGROUND AND AIM: Bruxism has been defined as a diurnal or nocturnal parafunctional habit. Etiology of bruxism has remained controversial and some investigators believe that psychological factors may play a major role in promoting and perpetuating this habit. The aim of this case-control study was to assess the existence of an association between bruxism and psychosocial disorders in adolescents., Participants were chosen among 114, 12-14 year old students (girls). They were divided into two groups, bruxers and nonbruxers, on the basis of both validated clinical criteria and interview with each patient. A few participants were excluded on the basis of presence of systemic disorders, TMJ disorders, other oral habits, primary teeth, defective restorations and premature contacts. Following matching of two groups in regard to parent's age and education, mother's marital status, child support status, mother's employment status, and socio-economical status, 25 cases and 25 controls were enlisted. A self report validated questionnaire (YSR, 11-18 yr) was then filled out by both groups for the evaluation of 12 psychosocial symptoms. RESULTS: Remarkable differences in certain psychosocial aspects were found between the two groups. Prevalence of psychosocial disorders including Thought Disorders (P < 0.005), Conduct Disorders (P < 0.05), Antisocial Disorders (P < 0.06) as identified by YSR was significantly higher in bruxers. Significant differences between the two groups also emerged in total YSR scores (P < 0.005). The results of Odds Ratio revealed that a bruxer adolescent has 16 times greater probability for psychosocial disorders than a non-bruxer one. Fischer exact test and T-test were used and Odds Ratio and Confidence Interval was estimated. CONCLUSION: Support to the existence of an association between bruxism and psychosocial disorders has been provided.