Interaction Between Awake and Sleep Bruxism Is Associated with Increased Presence of Painful Temporomandibular Disorder

Aims: To explore whether awake and sleep bruxism interact in their associations with painful temporomandibular disorders (TMD) and whether the interaction is multiplicative or additive. Methods: In this case-control study, all participants (n = 705) were part of the multicenter Validation Project and were recruited as a convenience sample of community cases and controls and clinic cases. Logistic regression analyses were applied to test for the association between self-reported bruxism (sleep and/or awake) and the presence of painful TMD, and odds ratios (ORs) with 95% confidence intervals (95% CIs) were computed. Regression models included an interaction term to test for multiplicative interaction, and additive interaction was calculated as the relative excess risk due to interaction (RERI). Results: Based on logistic regression analyses adjusted for age and gender, the main effects for both awake (OR = 6.7; 95% CI: 3.4 to 12.9) and sleep (OR = 5.1; 95% CI: 3.1 to 8.3) bruxism were significant. While the multiplicative interaction (OR = 0.57; 95% CI: 0.24 to 1.4) was not significant, the results indicated a significant positive additive interaction (RERI = 8.6; 95% CI: 1.0 to 19.7) on the OR scale. Conclusion: This study has demonstrated that awake and sleep bruxism are associated with an increased presence of painful TMD, and that both types of bruxism are not independently associated, but interact additively. As such, the presence of each factor amplifies the effect of the other.

awake bruxism; interaction effect; pain; sleep bruxism; temporomandibular disorders

1. LeResche L. Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors. Crit Rev Oral Biol Med 1997;8:291–305.

2. Reissmann DR, John MT, Schierz O, Wassell RW. Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent 2007;35:643–650.

3. Sierwald I, John MT, Schierz O, et al. Association of temporomandibular disorder pain with awake and sleep bruxism in adults. J Orofac Orthop 2015;76:305–317.

4. Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: A systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e26–e50.

5. Svensson P, Jadidi F, Arima T, Baad-Hansen L, Sessle BJ. Relationships between craniofacial pain and bruxism. J Oral Rehabil 2008;35:524–547.

6. Fernandes G, Franco AL, Siqueira JT, Gonçalves DA, Camparis

CM. Sleep bruxism increases the risk for painful temporomandibular disorder, depression and non-specific physical symptoms. J Oral Rehabil 2012;39:538–544.

7. Marklund S, Wänman A. Risk factors associated with incidence and persistence of signs and symptoms of temporomandibular disorders. Acta Odontol Scand 2010;68:289–299.

8. Michelotti A, Cioffi I, Festa P, Scala G, Farella M. Oral parafunctions as risk factors for diagnostic TMD subgroups. J Oral Rehabil 2010;37:157–162.

9. Feu D, Catharino F, Quintão CC, Almeida MA. A systematic review of etiological and risk factors associated with bruxism. J Orthod 2013;40:163–171.

10. Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain 2009;23:153–166.

11. American Academy of Sleep Medicine. International Classification of Sleep Disorders, ed 3. Darien, IL: American Academy of Sleep Medicine, 2014.

12. Lobbezoo F, Naeije M. Bruxism is mainly regulated centrally, not peripherally. J Oral Rehabil 2001;28:1085–1091.

13. Lavigne GJ, Kato T, Kolta A, Sessle BJ. Neurobiological mechanisms involved in sleep bruxism. Crit Rev Oral Biol Med 2003; 14:30–46.

14. Lobbezoo F, Ahlberg J, Glaros AG, et al. Bruxism defined and graded: An international consensus. J Oral Rehabil 2013; 40:2–4.

15. VanderWeele TJ, Robins JM. Four types of effect modification: A classification based on directed acyclic graphs. Epidemiology 2007;18:561–568.

16. Edwards RR, Smith MT, Kudel I, Haythornthwaite J. Painrelated catastrophizing as a risk factor for suicidal ideation in chronic pain. Pain 2006;126:272–279.

17. Bergman S, Herrström P, Jacobsson LT, Petersson IF. Chronic widespread pain: A three year followup of pain distribution and risk factors. J Rheumatol 2002;29:818–825.

18. Johnston V, Jimmieson NL, Souvlis T, Jull G. Interaction of psychosocial risk factors explain increased neck problems among female office workers. Pain 2007;129:311–320.

19. Siemiatycki J, Thomas DC. Biological models and statistical interactions: An example from multistage carcinogenesis. Int J Epidemiol 1981;10:383–387.

20. Schiffman EL, Truelove EL, Ohrbach R, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. I: Overviewand methodology for assessment of validity. J Orofac Pain 2010;24:7–24.

21. Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 2014;28:6–27.

22. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992;6: 301–355.

23. Derogatis LR. SCL-90-R: Administration, Scoring and Procedures Manual-II for the Revised Version and Other Instruments of the Psychopathy Rating Scale Series. Towson, MD: Clinical Psychometric Research, 1992.

24. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain 1992;50:133–149.

25. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–396.

26. Markiewicz MR, Ohrbach R, McCall WD Jr. Oral behaviors checklist: Reliability of performance in targeted waking-state behaviors. J Orofac Pain 2006;20:306–316.

27. Jackson H, McGorry P, Edwards J, et al. Cognitively-oriented psychotherapy for early psychosis (COPE). Preliminary results. Br J Psychiatry Suppl 1998;172:93–100.

28. Kleinman A. Patients and Healers in the Context of Culture: An Exploration of the Borderline Between Anthropology, Medicine, and Psychiatry. Berkeley: University of California, 1980.

29. Rothman KJ. Epidemiology: An Introduction. New York: Oxford University, 2002.

30. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology, ed 3. Philadelphia: Lippincott Williams & Wilkins, 2012.

31. Huang GJ, LeResche L, Critchlow CW, Martin MD, Drangsholt MT. Risk factors for diagnostic subgroups of painful temporomandibular disorders (TMD). J Dent Res 2002;81:284–288.

32. Marklund S, Wänman A. Incidence and prevalence of temporomandibular joint pain and dysfunction. A one-year prospective study of university students. Acta Odontol Scand 2007; 65:119–127.

33. Ahmad M, Hollender L, Anderson Q, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): Development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:844–860.

34. Lavigne GJ, Rompré PH, Montplaisir JY. Sleep bruxism: Validity of clinical research diagnostic criteria in a controlled polysomnographic study. J Dent Res 1996;75:546–552.

35. Raphael KG, Sirois DA, Janal MN, et al. Sleep bruxism and myofascial temporomandibular disorders: A laboratory-based polysomnographic investigation. J Am Dent Assoc 2012;143: 1223–1231.

36. Raphael KG, Janal MN, Sirois DA, et al. Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls. J Oral Rehabil 2015;42:751–758.

37. Rompré PH, Daigle-Landry D, Guitard F, Montplaisir JY, Lavigne GJ. Identification of a sleep bruxism subgroup with a higher risk of pain. J DentRes 2007;86:837–842.