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Vol 3, No 1 (2015) ISSN 2167-8677 (online) DOI 10.5195/d3000.2015.34

Familial aggregation of anxiety associated with bruxism David Gorski1

1 University of Pittsburgh School of Dental Medicine, Pittsburgh PA, USA

Abstract Citaon: Gorski D. (2015) Familial aggregaon of Background: This paper reports the co-occurrence of heritable anxiety-related disorders anxiety associated with bruxism. Denstry 3000. and awake bruxism in a family and discusses the heritability of anxiety and implicaons of 1:a001 doi:10.5195/d3000.2015.34 awake bruxism as comorbidity to anxiety disorders. Received: June 2, 2015 Accepted: June 26, 2015 Subjects: Ten out of 14 members of an extended family reported having a professionally di- Published: July 20, 2015 agnosed anxiety-related disorder. All individuals with anxiety disorders also showed in- Copyright: ©2015 Gorski D. This is an open ac- traoral signs of wear from bruxism and reported being aware of grinding their teeth while cess arcle licensed under a Creave Commons awake. Addionally, three out of the four family members without an anxiety-related dis- Aribuon Work 4.0 United States License. order did not report grinding their teeth and showed no occlusal wear from bruxism. All of Email: deg32@pi.edu the individuals that were examined were educated about the short-term and long-term complicaons associated with bruxism, but all of them elected to not have treatment per- formed. Praccal Implicaons: Anxiety disorders are highly related to suicidal behaviors, parcular- ly in children and adolescents. Addionally, awake bruxism can oen serve as an indicator of anxiety or . By recognizing bruxism as a possible manifestaon of psychological dis- tress, the dental praconer may be able to direct paents to life-saving services like psy- chologists and crisis hotlines when appropriate.

Introduction been measured at 32%, indicating that had been worsening in the past significant heritability for this anxi- two years. The patient had a rela- Bruxism is defined as “a repetitive ety-based condition [5]. tively unremarkable medical histo- jaw-muscle activity characterized ry. Other than minor seasonal aller- by clenching or grinding of the teeth Awake bruxism and anxiety are of- gies for which he was taking no and/or by bracing or thrusting of ten only considered in their respec- medications, his only notable condi- the ” that can occur while tive fields of and psychol- tions were Generalized Anxiety Dis- asleep ( bruxism) or while ogy. This report describes the co- order and Major Depressive Disor- awake (awake bruxism) [1]. Awake occurrence of anxiety disorders and der. For these conditions, he was bruxism is reported in 20% of the their manifestation as adult population in the US [2], but awake bruxism in family, researchers have only recently and it discusses the clin- linked its occurrence to anxiety dis- ical implications of these orders [3]. findings.

The heritability estimates for anxie- Subjects ty disorders range from 20% to 65% [4]. From family and twin A 28 year-old male was studies, the heritability of General- complaining of “jaw ized (GAD) has pain” and “headaches”

New articles in this journal are licensed under a Creative Commons Attribution 4.0 United States License. This journal is published by the University Library System, University of Pittsburgh as part of its D-Scribe Digital Publishing Program and is cosponored by the University of Pittsburgh Press. http://dentistry3000.pitt.edu Familial aggregaon of anxiety associated with bruxism

Vol 3, No 1 (2015) DOI 10.5195/d3000.2015.34

had provided some to have it remade. All members of relief from the head- the family, regardless of whether aches and jaw pain. they presented with signs of brux- ism, were educated on bruxism and Figures 3 and 4 the short-term and long-term com- show the phenotypi- plications associated with the con- cal distribution in dition. the family after oral examinations and Discussion medical history in- terviewing of the Recent studies on twins have found proband’s family. a significant degree of heritability taking Pristiq, a selective serotonin Out of 13 individuals examined, ten for anxiety disorders. But, these and norepinephrine reuptake inhib- had professional diagnoses of anxie- studies have been unable to pin- itor, and Carbonate, a ty-related conditions and also point any single genes that are re- pharmaceutical typically used to showed intraoral signs of bruxism sponsible for the occurrence of anx- (Figures 5, 6, and iety [6]. Instead, it has been sug- 7). Additionally, gested that anxiety has a highly out of the four multifactorial pattern of inher- family members itance, with the environment play- who did not have ing a role and a large number of an anxiety-related genes contributing a small individ- condition, only in- ual effect [7]. That being said, based dividual II.1 on the pedigrees for anxiety (Figure showed any in- 3) and associated bruxism (Figure traoral signs of 4), it would appear that at least bruxism or admit- some of the genes that contribute to ted to “grinding or anxiety in the proband’s family are clenching their inherited in an autosomal dominant treat . A thorough teeth” (Figure 8). fashion, with all three noted genera head and neck exam with inspection tions affected by the condition. of hard and soft tissues showed bi- None of the family members that lateral sensitivity of the masseter were inspected wished to have and medial pterygoid muscles, with treatment performed. well-defined wear facets on the in- Individuals III.1 and cisal and lingual surfaces of his II.4 already had occlu- maxillary canines (Figure 1). Addi- sal splints that they tionally, trauma from occlusal wear wore at night. They was noted on his single mandibular both rated their (Figure 2). When ques- symptom relief from tioned, the patient stated that he their occlusal splints was aware that he had been grind- as “moderate.” Indi- ing his teeth during the day. He re- vidual II.4 said that called that his sister had recently his occlusal splint was been having similar symptoms and “uncomfortable and had received a “night guard” that awkward” to wear but did not wish

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Vol 3, No 1 (2015) DOI 10.5195/d3000.2015.34

Awake bruxism has been noted to viduals (I.1, have a number of varied associa- III.4, and III.6) tions—smoking, intake, and who did not consumption [8]. However, have an anxie- in a study of 86 children by Monaco ty disorder also did not brux. Only one family member festations of anxiety and stress in (individual II.1) showed signs of their patients, they may be able to from bruxism, counsel these patients and ultimate- but was not diagnosed with ly direct them to life-saving services anxiety. This family member such as therapists and crisis cen- attributed the wear patterns to et al, 72% percent of children that ters. “occasional grinding” due to stress bruxed showed significant anxiety in the workplace. scores, while only 12% of non- bruxers had similar psychological This report highlights the im- findings [9]. This would indicate portance for dental health profes- that the act of bruxing is highly cor- sionals to understand the signifi- related with anxiety disorders. The cance of dental manifestations due results from this study agree with to other conditions. Many dental professionals are aware of the evidence linking perio- dontal disease to heart dis- ease [10] and diabetes [11]. As a result, many dentists are able to act as “early warning indicators” and counsel their patients about possible systemic comor- bidities. Simi- larly, the dental field should become aware the findings from the family report- of bruxism as a possible ed here. Indeed, in this family, brux- predictor of heritable ism and multifactorially inherited anxiety-related disor- anxiety disorders appear to be in- ders. Anxiety disorders tertwined. Each person with a diag- are highly related to nosed anxiety-related disorder also suicidal behaviors, par- had signs of occlusal wear associat- ticularly in children and ed with bruxism and were aware adolescents [12]. If that they bruxed while awake. Simi- dentists are able to rec- larly, three out of four of the indi- ognize the oral mani-

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Vol 3, No 1 (2015) DOI 10.5195/d3000.2015.34

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