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Risk Factors for Bruxism 118 RESEARCH AND SCIENCE Monika Kuhn Jens Christoph Türp Risk factors for bruxism Department of Oral Health & Medicine, University Center for Dental Medicine Basel, Switzer- land A review of the literature from 2007 to 2016 CORRESPONDENCE Prof. Dr. Jens C. Türp, MSc, M.A. Abteilung Myoarthropathien/ Orofazialer Schmerz Klinik für Oral Health & KEYWORDS Medicine Epidemiology UZB-Universitätszahnkliniken Risk Hebelstrasse 3 Odds ratio CH-4056 Basel Jaw clenching Tel. +41 61 267 26 32 Tooth grinding Fax +41 61 267 26 60 E-mail: [email protected] SWISS DENTAL JOURNAL SSO 128: 118–124 (2018) Accepted for publication: SUMMARY 7 June 2017 The aim of the present study was to summarize adolescents, apart from distress, behavioral the risk factors for bruxism that were identified abnormalities and sleep disturbances predomi- by a systematic search of the literature published nated. between 2007 and 2016. Depending on the size Knowledge of the identified risk factors may be of the odds ratios (ORs) and the lower limit of useful when taking the medical history of bruxing the 95% confidence intervals indicated by the patients. Although many of the described vari- reports, four risk categories were differentiated. ables cannot be influenced by prophylactic or Among others, emotional stress, consumption therapeutic means, we recommend the following of tobacco, alcohol, or coffee, sleep apnea syn- patient-centered approach (“SMS therapy”): drome, and anxiety disorders were recognized as self-observation, muscle relaxation, stabilization important factors among adults. In children and (Michigan) splint. Introduction (grade B: OR > 2; 1 < CILL ≤ 2), probable (grade C: 1 < OR ≤ 2; Conceivably the phenomenon of bruxism has always accompa- CILL > 1), or possible (grade D: 1 < OR ≤ 2; CILL ≤ 1). nied the history of humankind (Kaidonis et al. 1993; Lange The OR is a measure orf risk assessment. It indicates how 2013). To the present date jaw clenching and tooth grinding are much greater the chance is to encounter the interesting phe- prevalent in all age groups, social classes, and cultures (Manfre- nomenon (e.g., a disease) in a group with a risk factor as dini et al. 2013; Cavallo et al. 2014; Machado et al. 2014; Vieira- compared to a group without this factor. In general, an OR Andrade et al. 2014; Progiante et al. 2015; Cavallo et al. 2016). is considered clinically relevant if it is either greater than 2 Ten years ago, our research group published in this journal the ( interpreted as “harmful”) or smaller than 0.5 (“protective”) results of a systematic review summarizing those risk factors (Gesch 2004). It should be noted that the values of 2 and 0.5 known by the middle of June 2007, whose existence in adults, constitute rather a tacit agreement than rationally substantiat- compared to their absence, was associated with a higher risk for ed boundary limits. However, such a convention is not un- the occurrence of bruxism (Kuliš & Türp 2008). In that article we common. The situation is similar in the case of statistical tests distinguished four grades of severity (A to D) depending on the in which the level of significance is commonly set at 5% and odds ratio (OR) as well as the lower limit of the 95% confidence confidence intervals (confidence probability) at 95% (Straus interval (CILL) indicated in the publications. Using this distinc- et al. 2005). tion, we classified the chance for the presence of a bruxism- As regards content the present work continues the publica- related risk factor as very high (grade A: OR > 2; CILL > 2), high tion of the year 2008 insofar as we expand the insights gained SWISS DENTAL JOURNAL SSO VOL 128 2 P 2018 118-124_T1-1_kuhn_E.indd 118 06.02.18 09:05 RESEARCH AND SCIENCE 119 at that time by the literature published until December 31, The searches were aimed at identifying reported findings from 2016. In this follow-up study, we are particularly interested epidemiologic studies which had been published between Janu- in the question whether additional, then still unknown risk ary 1, 2007, and December 31, 2016, in the form of scientific factors have appeared. It was our objective to find as many as articles. The search in the database “Japan Medical Abstracts possible (ideally all) different – already known as well as new – Society” was restricted to the time period from 2007 to 2013. variables described in the professional literature during the The search strategies applied in the selected databases are listed predefined period of time. In contrast to the work published in Table I. in the year 2008, the present search included children and A decisive inclusion criterion were details concerning ORs adolescents. and 95% confidence intervals; articles without information In this article, the word “risk factor” is used as neutral broad- on ORs and confidence intervals were not taken into account. er term for the two constructs “risk indicator” and “causal risk The obtained hits were verified regarding their relevance. Based factor”. While a risk indicator points to an elevated disease risk on the criteria mentioned above, findings were classified into without having itself a causal influence on the development of grades A to D and tabulated. the disease, a causal risk factor etiologically contributes to an increased disease risk (Faller & Lang 2015). Results The search yielded a total of 202 hits (Tab. I), of which the arti- Materials and Methods cles listed in Tables II and III remained following a close review. Electronic literature searches were carried out in the following A part of the risk factors in adults known already before 2008 databases (last update on February 17, 2017): was confirmed by further studies or expanded by details (Tab. II). 1. PubMed (www.pubmed.gov) This concerns the following seven variables: emotional stress; 2. Virtual Health Library (bvsalud.org) the consumption of stimulants, such as tobacco, alcohol, and 3. LIVIVO (www.livivo.de) coffee; the diseases sleep apnea syndrome and anxiety disorder; 4. Google Scholar (scholar.google.de) age. Newly identified factors associated with bruxism predomi- 5. Japan Medical Abstracts Society nantly concern diseases, such as reflux esophagitis, depression, (www.jamas.or.jp/ index.html) respiratory diseases, or nocturnal frontal lobe epilepsy. Tension, Tab. I Selected search strategies and outcomes Database Search terms Hits Relevant Cumulative hits relevant hits PubMed (risk*[Title/Abstract] OR risk*[MeSH:noexp] OR risk 478 135 135 Filter: *[MeSH:noexp] OR cohort studies[MeSH Terms] OR – Publication dates: group[Text Word] OR groups[Text Word] OR grouped [Text Word]) 2007/01/01 to 2017/02/17 AND bruxism – Species: “Humans” PubMed ‒ MeSH 1 (bruxism[MeSH] OR bruxism) AND (Risk[MeSH] OR "Risk 126 47 5 Assessment"[MeSH]) AND (("2007/01/01"[PDat] : "2017/02/17"[PDat]) AND Humans[Mesh]) PubMed ‒ MeSH 1 (((("Bruxism"[Mesh] ) OR bruxism) ) ) AND (("Odds Ratio"[Mesh] 59 25 4 OR odds ratio*) AND ( "2007/01/01"[PDat] : "2017/02/17"[PDat] ) AND Humans[Mesh]) Virtual Health Library tw:(bruxism*) AND type_of_study:("case_reports" OR 119 37 6 "case_control" OR "cohort") AND clinical_aspect:("etiology" OR "prediction") AND limit:("humans") AND year_cluster:("2012" OR "2007" OR "2008" OR "2010" OR "2009" OR "2011" OR "2013" OR "2014" OR "2015" OR "2016" OR "2017" ) LIVIVO (bruxism* AND risk*) AND PY=2007:2017 216 66 8 (bruxism* AND etiolog*) AND PY=2007:2017 367 86 25 Google Scholar (Bruxism AND (risk OR risk factors)) [tiab] 124 3 2 Time period: 2007-2017 Japan Medical Abstracts ブラキシズム 130 21 17 Society (医中誌Web) リスクファクター (2007–2013) リスク 病因 or 病因論 Sum: 202 1 Medical Subject Headings SWISS DENTAL JOURNAL SSO VOL 128 2 P 2018 118-124_T1-1_kuhn_E.indd 119 05.02.18 20:19 120 RESEARCH AND SCIENCE emotional instability, and attenuated psychotic personality professional literature has been well documented and consis- traits are also linked to a higher chance of bruxism. For the tently discussed (Mienna et al. 2014; Wieckiewicz et al. 2014; first time, a genetic variable was identified. Karakoulaki et al. 2015; Cavallo et al. 2016), many additional The risk factors in children and adolescents, among other factors can be associated with jaw clenching and tooth grind- things, are related to behavioral abnormalities and sleep dis- ing. Significantly, no occlusal factor has been identified. By orders (Tab. III). contrast, indications regarding the role of genetic and heredi- tary influences on bruxism are increasing in the professional Discussion literature (Lobbezoo et al. 2014), as is similarly the case with The findings of our study demonstrate that apart from the cor- regard to temporomandibular disorders (Smith et al. 2013; Luo relation between emotional stress and bruxism, which in the et al. 2015; Meloto et al. 2015; Visscher & Lobbezoo 2015). Tab. II Risk factors for bruxism in adults determined between 2007 and 2016, sorted according to the size of the odds ratios (ORs) Grade of Variable Type of study OR CI1 Source severity A Social phobia (social anxiety disorder) Case-control study 23.7* 2.9–191.0 (Hermesh et al. 2015) Marital status: married Cross-sectional study 6.9 3.9–12.2 (Alajbeg et al. 2012) Emotional stress Cross-sectional study 5.9* 2.6–13.3 (Quadri et al. 2015) Awake bruxism Cross-sectional study 5.0** 2.6–9.8 (Winocur et al. 2011) Sleep bruxism Cross-sectional study 5.0* 2.5–9.7 (Winocur et al. 2011) Regular smoking Cross-sectional study 2.9** 2.3–3.6 (Rintakoski & Kaprio 2013) B Reflux esophagitis Cross-sectional study 6.6** 1.4–31.0 (Mengatto et al. 2013) Nocturnal frontal lobe epilepsy Case-control study 5.4** 1.3–21.7 (Bisulli et al. 2010) Single nucleotide polymorphism Case-control study 4.3** 1.6–11.3 (Abe et al.
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