Bruxism is a recurring condition among people suffering from post-traumatic stress disorder

Julia Moióli | FAPESP Agency – According to a study published in the magazine Clinical Oral Investigations, people who suffer from post-traumatic stress disorder (PTSD) often report that they constantly clench or grind their teeth during the day – a habit known as waking bruxism. The work, which included the clinical examination of approximately 80 patients, including cases and controls, draws attention to the importance of dentists and psychiatrists working together in the most accurate diagnosis of the two health problems.

A concept coined in the United States, based on the behavior exhibited by war veterans, post-traumatic stress disorder began to include, over time, also victims of urban violence. It is estimated that this condition affects around 4% of people exposed to violent or accidental events, such as combat, torture, death threats, stray bullets, natural disasters, serious injuries, physical or sexual violence and sudden kidnappings.

“Considering that, in the Metropolitan Region of São Paulo, more than 50% of the inhabitants have already been exposed to some type of urban trauma, a number comparable to areas of civil conflict, it is of great importance to understand the possible psychological and physical manifestations of PTSD, which can last for years after the trauma”, says Yuan-Pang Wangresearcher at the Institute of Psychiatry at the Faculty of Medicine of the University of São Paulo (IPq-FM-USP) and co-author of the study.

These symptoms include distressing, involuntary and recurrent memories of the event, negative emotional state, self-destructive behavior, changes in sleep pattern and dissociative reaction (changes in consciousness, memory, identity, emotion, perception of the environment and behavioral control), among others. Few studies, however, have studied the relationship between post-traumatic stress and orofacial pain and bruxism, which is defined as the repetitive activity of the chewing muscle. Its prevalence in the general population varies between 8% and 30%.

In this study supported by FAPESP patients diagnosed with PTSD at the Trauma Outpatient Clinic of the Institute of Psychiatry at FM-USP were referred to a clinical examination that aimed to analyze their oral health.

According to the researchers, in addition to self-reported bruxism, patients also showed a decrease in pain threshold after clinical examination.

“It was found that oral hygiene was not related to the problem”, says Ana Cristina de Oliveira Solis, first author of the study. “The periodontal assessment, which also included measuring the level of bacterial plaque and gingival bleeding, showed that patients with post-stress stress -traumatic patients had a similar level of oral hygiene to controls. However, patients had more pain after probing.”

Multidisciplinary treatment

According to researchers, bruxism is currently no longer considered an isolated symptom, but evidence of a larger problem. “Our work shows that there may be a manifestation of post-traumatic stress disorder at the oral level, evidenced by bruxism and a higher level of pain after a clinical dental examination. This requires joint action between psychiatrists, psychologists and dentists, which can contribute to the screening [rastreamento] and the treatment of both health conditions”, says Solis.

To this end, the researcher recommends that, during the clinical examination, the dentist pays attention to the patients’ reports of pain and considers the possibility of being faced with a person with psychiatric problems that have not yet been diagnosed.

“Patients who have experienced a traumatic event may feel embarrassed to talk about the subject and seek specialized help; The habit of seeking dental care is much more common and frequent”, says Solis. “For this reason, it would be interesting for the dentist to incorporate dental instruments into his routine care. screening for mental disorders and applied them to these patients. It is also important to know how to advise the patient to seek specialized help.”

Psychiatrists, in turn, can question patients with PTSD about oral symptoms, such as bruxism, muscle pain and temporomandibular joint (TMJ) pain. If so, they should refer you to the dentist so that multidisciplinary treatment can be carried out and your quality of life can improve.

The article Self-reported bruxism in patients with post-traumatic stress disorder can be read at: https://link.springer.com/article/10.1007/s00784-024-05534-4.