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Anger Held Inward, Aggressive Dream Content in Craniomandibular

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Anger Held Inward, Aggressive Dream Content in Craniomandibular doi: 10.4181/RNC.2015.23.04.1088.08p Anger held inward, aggressive dream content in original craniomandibular disorders and bruxers Raiva para dentro, conteúdo agressivo em sonhos em bruxômanos com distúrbios craniomandibulares Omar Franklin Molina1, Zeila Coelho Santos2, Maria Aparecida Sobreiro3, Mary Louise Cano4 RESUMO ABSTRACT Objetivo. Avaliar raiva para dentro e conteúdo agressivo em pesadelos Objective. To evaluate means in anger-in and aggressive dream con- naqueles com transtornos temporomandibulares/bruxismo. Método. tent in craniomandibular disorder/bruxers. Method. Two question- Dois instrumentos para raiva para dentro e outro para conteúdo agres- naires to evaluate anger-in and aggressive content in nightmares, sivo em pesadelos, critérios clínicos para transtornos temporomandi- clinical examination, and criteria for craniomandibular disorders/ bulares e bruxismo foram usados em 70 indivíduos com transtornos bruxism were used in 70 subjects with craniomandibular disorders/ temporomandibulares e bruxismo (66 do sexo feminino, idade media bruxism (66 females, mean age 31.3); in 28 bruxers without cranio- 31,3 anos); 28 indivíduos com bruxismo e sem transtornos tempo- mandibular disorders (19 females, mean age 32.3); and in 39 controls romandibulares (19 do sexo feminino, idade media 32,3 anos); e 39 without such disorders (26 females, mean age 30.6). Results. Anger- controles sem esses transtornos (26 do sexo feminino, idade media inward was not different between craniomandibular disorder/brux- 30,6 anos). Resultados. Os valores em raiva para dentro não foram ism (130.7) and non craniomandibular disorder/bruxism (105.6); diferentes para os grupos transtornos temporomandibulares/bruxismo but it was different when compared with control group (70.1): cra- (130,7) e sem transtornos temporomandibulares/bruxismo (105,6), niomandibular disorder/bruxism versus control group (p<0.001); mas foram diferentes em relação ao grupo controle (70,1): transtornos non craniomandibular disorder/bruxism and control group (p<0.01). temporomandibulares/bruxismo versus grupo controle (p<0001); sem Frequencies of aggressive dream content in nightmares were about: transtornos temporomandibulares/bruxismo versus grupo controle craniomandibular disorder/bruxism: 71.4%; non craniomandibular (p<0,01). As frequências de conteúdo agressivo em pesadelos foram: disorder/bruxism: 67.9% and control group: 46.2% (p=0.02). Means transtornos temporomandibules/bruxismo=71,4%, sem transtornos/ in aggressive dream events were not different among the groups. bruxismo 67,9%; grupo controle=46.2% (p=0,02). As médias em Conclusions. Anger-in was higher in those with craniomandibular conteúdo agressivo não foram diferentes entre os grupos. Conclusão. disorders/bruxism. Aggressive events in bad dreams and nightmares Os valores em raiva para dentro foram maiores naqueles com trans- decreased from the more psychologically disturbed subgroup to the tornos temporomandibulares/bruxismo. Os eventos agressivos dimi- less psychological disturbed one. nuíram do grupo com mais distúrbios psicológicos para aquele com menos distúrbios.. Unitermos. Bruxismo, Transtornos Craniomandibulares, Ira, So- Keywords. Bruxism, Craniomandibular Disorders, Anger, Dreams, nhos, Agressão Aggression Citação. Molina OF, Santos ZC, Sobreiro MA, Cano ML. Anger Citation. Molina OF, Santos ZC, Sobreiro MA, Cano ML. Raiva held inward, aggressive dream content in craniomandibular disorders para dentro, conteúdo agressivo em sonhos em bruxômanos com dis- and bruxers. túrbios craniomandibulares. This study was carried out at UNIRG Schools of Dentistry and Psychology, Correspondence: Gurupi-TO, Brazil. Omar Franklin Molina Av. Pará 1544 CEP 77400-020, Gurupi-TO Tel: 00 55 63 92444575 email: [email protected] 1.DDS, MDS, Orofacial Pain Unit, UNIRG, School of Dentistry, Gurupi- -TO, Brazil. Original 2.DDS, MDS, Dean, School of Dentistry, UNIRG, Gurupi-TO, Brazil. Recieved in: 23/06/15 3.DDs, MDS, Ph.D, Anatomy Department, UNIRG, School of Dentistry, Acept in: 03/11/15 Gurupi-TO, Brazil. 4.BBS, MDS, Saint Thomas University and Miami University (USA). Conflict of Interest: no 522 Rev NeurociencRev Neurocienc 2015;23(4):522-529 2013;21(v):p-p INTRODUCTION nance of self-cohesiveness, the restoration of a fragmen- 8 Craniomandibular disorders (CMDs) is a collec- ting self, and the development of new psychic structures . tive term used to describe a number of related disorders Dream characters are projected parts of the original affecting the temporomandibular joints (TMJs), masti- dreamer’s self which have been denied expression in the catory muscles, and adjacent musculoskeletal structures waking personality. Some DID individuals present with presenting with common symptoms including pain and an alternative personality who is bad in terms of the need limited mouth opening1. CMDs may be part of an inter- to manifest aggression in dreams9. When individuals are disciplinary group of somatoform syndromes defined as subjected to severe psychological trauma, they develop functional somatic syndromes, characterized by similar alter personalities, including one related with aggressive mechanisms, etiologies and psychosocial impairement2. behavior; a powerful affect that may have previously been The term “La Bruxomanie” was first introduced in the directed toward others10. Such a behavior may in certain dental and psychological literature by Marie and Pie- circumstances appear in bad dreams and nightmares. tkiewicz in 1907 and was later adapted to describe the The literature about psychological factors in CMDs and act of gnashing and grinding the teeth at daytime/ni- BB individuals is scarce and there is a paucity of studies ghttime without a functional purpose. Jaw movements about anger inward and aggression, violence and hostility during teeth grinding are produced by rhythmic and/or in dreams, thus the goal of this study is twofold: 1.Eva- sustained tonic contractions of jaw closing muscles and luate scores in anger held inward in BB subjects with usually occur without patient´s awarenes3. Sleep bruxism CMDs, using a novel instrument; 2.Test the hypothesis (SB) is defined as a parafunctional and orofacial motor that aggressive events in bad dreams and nightmares oc- activity encompassing clenching, bracing, gnashing, and cur more frequently in those presenting CMDs and BB grinding of the teeth during sleep4. Many CMDs and as compared to two sets of control individuals. bruxing behavior (BB) individuals, present somatoform and dissociative disorders (DID) that in some way are related to sleep disorders including nightmares and bad METHOD dreams5. Sample The oral cavity possesses intense emotional sig- CMDs+BB patients (n=70), non CMDs+BB nificance and in certain conditions, stress and emotional patients (N=28) and Non CMDs Non BB controls tension may be channeled to the teeth and strong mas- (n=39) in this investigation were those referred consecu- ticatory muscles. In a review of the literature examining tively for diagnosis and treatment to the Department of psychological factors6, it was reported that BB, may be Orofacial Pain UNIRG University, School of Dentistry a mechanism to release overt aggression, frustration and in the period 2013-2015. Patients referred consecuti- rage when an individual´s basic drives are blocked and vely were included in the CMDS and BB group if they her or she is frustrated. BB is more likely to appear when demonstrated three or more signs and symptoms cha- the individual is facing periods of stress, life dilemmas, racteristics of CMDs: A complaint of facial/TMJ pain, anxiety, tension, rage and strangulated aggression which actively seeking treatment for CMDs, presence of joint need to be channeled outward in some way6. Previous noises, difficulties to perform normal jaw movements, studies have indicated that many CMDs subgroups pre- tenderness to palpation and headache of musculoskele- sent with symptoms of psychopathology, including an- tal origin. It is widely accepted in the current literature11 xiety, depression, somatization and dissociation5,7. Some on CMDs, that a combination of signs and symptoms subgroups also present sleep disorders including sleep better defines CMDs patients. The presence of BB was fragmentation, increased body movements, nightmares evaluated using a combination of patients´ self-report and bad dreams associated with their psychopathology. and clinical evaluation. BB was accepted as present follo- Dreaming serves three primary functions: the mainte- wing the observation of wear facets on the anterior teeth, Rev NeurociencNeurocienc 2013 2015;23(4):522-529;21(v):p-p 523 cheek/tongue biting (scalloping laterally on the tongue), sent giving permission to use their material for research hypertrophy of the alveolar bone and masseter muscle, purposes long before initiating the study, this investiga- original patient´s report of catching himself or herself clenching tion was approved by the Ethics Committee of the Den- or grinding during the day and/or at night, patient´s re- tal School 0010-2015. port of awakening with pain, information from a bed partner that the patient clenches or grinds the teeth at Procedure night, awakening with tension and/or fatigue in the mas- All patients at UNIRG Orofacial pain unit are seter muscles, awakening with pain in the face, TMJs and evaluated comprehensively, establishing and obtaining head and other signs and symptoms. a full description of the chief complaint (usually pain), Only those patients
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