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Manifestation of Stress and Anxiety in the Stomatognathic System of Undergraduate Dentistry Students

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Manifestation of Stress and Anxiety in the Stomatognathic System of Undergraduate Dentistry Students Manifestation of stress and anxiety in the stomatognathic system of undergraduate dentistry students Author Owczarek, Joanna Elzbieta, Lion, Katarzyna Malgorzata, Radwan-Oczko, Malgorzata Published 2020 Journal Title Journal of International Medical Research Version Version of Record (VoR) DOI https://doi.org/10.1177/0300060519889487 Copyright Statement © The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). Downloaded from http://hdl.handle.net/10072/391532 Griffith Research Online https://research-repository.griffith.edu.au Retrospective Clinical Research Report Journal of International Medical Research 48(2) 1–12 Manifestation of stress and ! The Author(s) 2020 Article reuse guidelines: anxiety in the stomatognathic sagepub.com/journals-permissions DOI: 10.1177/0300060519889487 system of undergraduate journals.sagepub.com/home/imr dentistry students Joanna Elzbieta_ Owczarek1 , Katarzyna Małgorzata Lion2 and Małgorzata Radwan-Oczko1 Abstract Objective: To assess the relationship between psychoemotional state and signs of oral cavity occlusal and nonocclusal parafunctions, together with masseter muscle tone, in undergraduate dentistry students. Methods: The study population comprised first and fifth grade dentistry students who were investigated using psychological and health questionnaires, and stomatological examination with electromyography of the masseter muscles. Differences in variables between first and fifth grade students were analysed using Student’s t-test or v2-test and Pearson’s correlation coefficient was used to analyse associations between variables. Results: A total of 113 students (52 first-grade, mean age 20 years; and 61 fifth-grade, mean age 23.6 years) were included. Older age was associated with lower level of perceived stress and anxiety. Moreover, a significant positive relationship was observed between level of perceived stress and anxiety and tone of both masseter muscles. Conclusions: Increased psychoemotional burden and increased rates of experienced anxiety were associated with growth of masseter muscle tone in this study population. Keywords Stress, anxiety, temporomandibular disorder (TMD), electromyography, masseter muscle, dental students Date received: 10 June 2019; accepted: 24 October 2019 1Department of Oral Pathology, Wroclaw Medical Corresponding author: University, Wroclaw, Poland Joanna Elzbieta_ Owczarek, Department of Oral Pathology, 2Department of Psychiatry, Division of Consultation Wroclaw Medical University, ul. Krakowska 26, 50-425 Psychiatry and Neuroscience, Wroclaw Medical Wroclaw, Poland. University, Wroclaw, Poland Email: [email protected] Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 Journal of International Medical Research Introduction with the most common stressors including: coping with exams and grading, limited According to Lazarus and Folkman, the definition of stress is ‘a particular relation- free time, long teaching hours, high work- ship between the person and the environ- load and high competitivity. Numerous ment that is appraised by the person as research studies have shown that levels of taxing or exceeding his or her resources stress among dental students are and endangering his or her well-being’.1 significantly higher than in students from 6,11–18 Whereas Spielberger described anxiety as a different disciplines, not only medical. transient condition, caused by a particular The aim of the present study was to situation of a given individual, character- assess the relationship between the ized by feeling of concern and tension, psychoemotional state of dental students interacting with the activation of the auto- and manifestations of occlusal and nomic nervous system.2 nonocclusal parafunctions in the oral Among the medical professions, dentistry cavity tissues, together with the tone of is suggested to be the most stressful.3 the masseter muscles. The study was Psychoemotional factors have been well performed using specific stages of investiga- proven to play a significant, causative role tion: assessment of the psychoemotional in the development of many so called civili- state of the subjects; clinical evaluation zation diseases, such as high blood pressure, of the presence of parafunctional symptoms heart disease, diabetes mellitus and temporo- in the oral cavity; examination of the mandibular disorder (TMD).4–9 According to masseter muscle tone; and assessment the World Health Organization, temporo- of relationships between the examined mandibular disorders are the third most parameters. common reason, after caries and paradont- opathy, for referral to a dental office.10 Temporomandibular disorder is on the Subjects and methods rise among the populations of industrialized countries,8,11 and numerous factors play a Study population causative role in the aetiology of TMD. The This observational study comprised a effects of ‘civilizational stress’ (the stressful population of first grade and fifth grade conditions of life), are understood to man- ifest in the development of certain oral par- (last year of study in the Polish education afunctions, such as teeth grinding, bruxism program) dentistry student volunteers from or cheek biting.4 Eventually, all of those the Department of Dentistry, Wroclaw parafunctional activities may cause Medical University, Poland, and was increased masticatory muscle tone and pro- conducted during October and November mote its intensification, which induces an 2017. Students with a beard were escalation in TMD symptoms, including excluded from study entry. The study was face muscular pain, headaches, and tempo- approved by Wroclaw Medical University romandibular joint movement disorder or Bioethical Commission, and verbal crackling. Furthermore, increased tone of informed consent to take part in the study the masseter muscle itself is one of the was provided by all of the participants. symptoms of TMD.4,9 Data were obtained via questionnaires and Student populations are being placed clinical examination, and were statistically under a greater level of stressful situations analysed for between-group differences and than the average representative of society, correlations. Owczarek et al. 3 Psychoemotional assessment groups: normal, 0–7 points; borderline abnormal, 8–10 points; and abnormal, The psychoemotional state of each student 11–21 points.20,23 In the present study, stu- was assessed using a questionnaire com- dents were evaluated using the HADS-A posed of two parts. The first part of the subscale only. survey comprised two psychological instru- In the second part of the survey, students ments: The Perceived Stress Scale (PSS)-10 were questioned about demographic data by Cohen, Kamarch and Mermelstein19 and and subjective complaints concerning their the Hospital Anxiety and Depression Scale stomatognathic system, namely, perceived (HADS) by Zigmond and Snaith.20 temporomandibular joint pain, bruxism The PSS-10 is a self-reported question- and teeth grinding, and increased tension naire to measure the level of psychological of the masticatory muscles. stress, and is widely used to evaluate the subjective stressfulness of situations and Clinical evaluation the effectiveness of stress-reducing actions. The Polish 10-item version of the shortened Each participant underwent an intraoral 10-item PSS-10 questionnaire was used in investigation to evaluate the presence (or the present study.21 The scale comprises lack) of occlusal and nonocclusal parafunc- 10 questions scored from 0 (never) to 4 tion symptoms observed in hard and soft (very often), with a maximum number of oral cavity tissues, such as tooth wear, gin- 40 points and a minimum of 0. Points are gival recessions, tongue crenations and assigned to three groups: low, 0–13 points; linea alba or signs of cheek biting (uni- or medium, 14–19 points; and high, 20–40 bilateral). points, with higher scores representing Tooth wear is described in the literature higher stress levels. The PSS-10 has been as clearly demarcated, shiny surfaces on the shown to predict objective biological occlusal surfaces of the tooth, that are worn markers of stress and an increased risk for out.24,25 In the current study, tooth wear disease among people with higher perceived was assessed according to the Tooth Wear stress levels.19,21 According to published Index (TWI) criteria, introduced by Smith meta-analyses of studies of stress among and Knight in 1984.26 A lack of tooth wear dental students, the PSS was used to was considered only when the subject assess psychological aspects of stress in obtained a TWI score of 0. Student partic- about 20.5% of all the studies.13–15 ipants with TWI scores between 1 and 4 The HADS is commonly used by clini- were classified as having diagnosed cians to determine levels of anxiety and tooth
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