The Association Between Self-Reported Awake Oral Behaviors and Orofacial Pain Depends on the Belief of Patients That These Behaviors Are Harmful to the Jaw

Aims: To examine if the existence of an association between self-reported awake oral behaviors and orofacial pain depends on the belief of patients that these behaviors are harmful to the jaw and to investigate if an additional variable (ie, somatic symptoms, depression, and/or anxiety) indirectly affects the association between the causal attribution belief and the report of awake oral behaviors. Methods: Prior to the first clinical visit, patients referred to a specialized clinic for complaints of orofacial pain and dysfunction completed a digital questionnaire. Data of 329 patients diagnosed with myalgia according to the Diagnostic Criteria for Temporomandibular Disorders (82.4% women; mean ± SD age = 41.9 ± 14.7 years) were analyzed. Results: Causal attribution belief moderated the association between awake oral behaviors and orofacial pain intensity. In addition, the relationship between causal attribution belief and self-reported oral behaviors was partially mediated by the presence of somatic symptoms (8%), depression (9%), and anxiety (16%). Conclusion: Awake oral behaviors were positively associated with orofacial pain, but only under the condition of a strong belief of the patients in causal attribution of these behaviors to the jaw pain complaint. No such association was present in case of a low causal attribution belief. It appeared that, within this patient cohort, the relationship between causal attribution belief and self-reported oral behaviors was (in part) the result of shared psychologic risk factors.

associations; awake oral behaviours; causal attribution belief; pain-related temporomandibular disorders; psychological factors

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

2. Baad-Hansen L, Thymi M, Lobbezoo F, Svensson P. To what extent is bruxism associated with musculoskeletal signs and symptoms? A systematic review. J Oral Rehabil 2019;46: 845–861.

3. 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.

4. Lobbezoo F, Lavigne GJ. Do bruxism and temporomandibular disorders have a cause-and-effect relationship? J Orofac Pain 1997;11:15–23.

5. Svensson P, Graven-Nielsen T. Craniofacial muscle pain: Review of mechanisms and clinical manifestations. J Orofac Pain 2001;15:117–145.

6. Blanco Aguilera A, Gonzalez Lopez L, Blanco Aguilera E, et al. Relationship between self-reported sleep bruxism and pain in patients with temporomandibular disorders. J Oral Rehabil 2014;41:564–572.

7. Fernandes G, Franco-Micheloni AL, Siqueira JT, Gonçalves DA, Camparis CM. Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents. Braz Oral Res 2016;30:S1806–83242016000100214.

8. Lobbezoo F, van Wijk AJ, Klingler MC, Ruiz Vicente E, van Dijk CJ, Eijkman MA. Predictors for the development of temporomandibular disorders in scuba divers. J Oral Rehabil 2014;41:573–580.

9. Jang JY, Kwon JS, Lee DH, Bae JH, Kim ST. Clinical signs and subjective symptoms of temporomandibular disorders in instrumentalists. Yonsei Med J 2016;57:1500–1507.

10. Today MN. What is bruxism, or teeth grinding? Brighton, UK: Healthline Media UK Ltd, 2020. https://www.medicalnewsto-day.com/articles/190180.

11. 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.

12. Raphael K. Recall bias: A proposal for assessment and control. Int J Epidemiol 1987;16:167–170.

13. Jones EE, Davis KE. From acts to dispositions: The attribution process in person perception. In: Berkowitz L (ed). Advances in Experimental Social Psychology. New York: Academic Press, 1965:219–266.

14. Kelley HH. Attribution theory in social psychology. Nebraska Symposium on Motivation 1967;15:192–238.

15. Weiner B. An attributional theory of achievement motivation and emotion. Psychol Rev 1985;92:548–573.

16. Kelley HH, Michela JL. Attribution theory and research. Annu Rev Psychol 1980;31:457–501.

17. Gómez-de-Regil L. Causal attribution and illness perception: A cross-sectional study in Mexican patients with psychosis. ScientificWorldJournal 2014;2014:969867.

18. Petrie KJ, Weinman J. Why illness perceptions matter. Clin Med (Lond) 2006;6:536–539.

19. Roesch SC, Weiner B. A meta-analytic review of coping with illness: Do causal attributions matter? J Psychosom Res 2001;50:205–219.

20. Nykvist K, Kjellberg A, Bildt C. Causal explanations for common somatic symptoms among women and men. Int J Behav Med 2002;9:286–300.

21. Buitenhuis J, de Jong PJ. Fear avoidance and illness beliefs in post-traumatic neck pain. Spine (Phila Pa 1976) 2011;36 (suppl 25):s238–s243.

22. White KS, Lehman DR, Hemphill KJ, Mandel DR, Lehman AM. Causal attributions, perceived control, and psychological adjustment: A study of chronic fatigue syndrome. J Appl Soc Psychol 2006;36:75–99.

23. van der Meulen MJ, Ohrbach R, Aartman IH, Naeije M, Lobbezoo F. Temporomandibular disorder patients’ illness beliefs and self-efficacy related to bruxism. J Orofac Pain 2010;24:367–372.

24. Lobbezoo F, Ahlberg J, Raphael KG, et al. International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil 2018;45:837–844.

25. Fishman EJ. Toward a theory of the perceived control of the attribution process. Educational Research Review 2014; 13:1–16.

26. Muzalev K, van Selms MK, Lobbezoo F. No dose-response association between self-reported bruxism and pain-related temporomandibular disorders: A retrospective study. J Oral Facial Pain Headache 2018;32:375–380.

27. 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.

28. van der Meulen MJ, Lobbezoo F, Aartman IH, Naeije M. Validity of the Oral Behaviours Checklist: Correlations between OBC scores and intensity of facial pain. J Oral Rehabil 2014;41:115–121.

29. Ohrbach R, Markiewicz MR, McCall WD Jr. Waking-state oral parafunctional behaviors: Specificity and validity as assessed by electromyography. Eur J Oral Sci 2008;116:438–444.

30. Vilanova LS, Garcia RC, List T, Alstergren P. Diagnostic criteria for temporomandibular disorders: Self-instruction or formal training and calibration? J Headache Pain 2015;16:505.

31. Kroenke K, Spitzer RL, Williams JB. The PHQ-15: Validity of a new measure for evaluating the severity of somatic symptoms. Psychosom Med 2002;64:258–266.

32. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001; 16:606–613.

33. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006;166:1092–1097.

34. MacKinnon DP, Luecken LJ. How and for whom? Mediation and moderation in health psychology. Health Psychol 2008;27(suppl):s99–s100.

35. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol 1986;51:1173–1182.

36. Aiken LS, West SG. Multiple Regression: Testing and Interpreting Interactions. Newbury Park, CA: Sage, 1991.

37. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008;40:879–891.

38. Sobel ME. Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology 1982;13:290–312.

39. Preacher KJ, Leonardelli GJ. Calculation for the Sobel test: An interactive calculation tool for mediation tests [computer soft-ware]. 2001.

40. Preacher KJ, Kelley K. Effect size measures for mediation models: Quantitative strategies for communicating indirect effects. Psychol Methods 2011;16:93–115.

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

42. Manfredini D, Ahlberg J, Wetselaar P, Svensson P, Lobbezoo F. The bruxism construct: From cut-off points to a continuum spectrum. J Oral Rehabil 2019;46:991–997.

43. Shieh G. Clarifying the role of mean centring in multicollinearity of interaction effects. Br J Math Stat Psychol 2011;64:462–477.

44. Joubert CE. Relationship of self-esteem, manifest anxiety, and obsessive-compulsiveness to personal habits. Psychol Rep 1993;73:579–583.

45. Chow JC, Cioffi I. Effects of trait anxiety, somatosensory amplification, and facial pain on self-reported oral behaviors. Clin Oral Investig 2019;23:1653–1661.

46. White KS, Craft JM, Gervino EV. Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders. Behav Res Ther 2010;48:394–401.

47. Mackinnon DP, Warsi G, Dwyer JH. A simulation study of mediated effect measures. Multivariate Behav Res 1995;30:41.

48. Nwankwo CH, Igweze AH. Comparison of tests of indirect effect in single mediation analysis. Amer J Theor Appl Stat 2016;5:64–69.