Evaluation of Anxiety Levels in Children and Their Mothers and Appearance of Sleep Bruxism in Turkish Children and Associated Risk Factors: A Cross-Sectional Study

Aims: To evaluate the anxiety of children and their mothers in relation to sleep bruxism (SB) and associated risk factors. Methods: A total of 96 children (48 with and 48 without bruxism) and their mothers participated in this study. A form with comprehensive history and oral and parafunctional habits associated with SB was used. Screen for Child Anxiety and Related Disorders (SCARED) was used to measure anxiety in children. The anxiety levels of the mothers were evaluated with the State-Trait Anxiety Inventory (STAI). SPSS version 21.0 was used for the analyses. Chi-square test was used to compare categorical data. Student t test or Mann-Whitney U test was used for the comparison of continuous data, and multiple logistic regression model was applied to detect the real factors associated with SB. Results: The comparisons of SCARED total (P = .005), factor 3 (separation anxiety; P = .015), factor 4 (social anxiety; P = .011) and factor 5 (school fear; P = .005) showed significant differences between groups. State anxiety scores of the mothers were significantly higher in the bruxism group (P < .001). Statistically significant differences were seen for learning/behavioral/anger problems, mouth breathing, snoring, bad breath, parasitic infections, sleep difficulty, chewing a pen or pencil, and sleeping in their own room (P < .05). The real risk factors associated with SB were learning/behavioral/anger problems, an experience causing stress, snoring, and increased anxiety levels of mothers and children. Conclusion: Elevated anxiety levels of mother or children, learning/behavioral/anger problems, experience causing stress, and snoring increased the risk of having SB in children.

anxiety; bruxism; child; maternal

1. 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.

2. Sateia MJ. International classification of sleep disorders-third edition highlights and modifications. Chest 2014;146:1387–1394.

3. Alencar NA, Fernandes AB, Souza MM, Luiz RR, Fonseca-Gonçalves A, Maia LC. Lifestyle and oral facial disorders associated with sleep bruxism in children. Cranio 2016;35:168–174.

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

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

6. Castroflorio T, Bargellini A, Rossini G, Cugliari G, Deregibus A. Sleep bruxism and related risk factors in adults: A systematic literature review. Arch Oral Biol 2017;83:25–32.

7. Castroflorio T, Bargellini A, Rossini G, Cugliari G, Rainoldi A, Deregibus A. Risk factors related to sleep bruxism in children: A systematic literature review. Arch Oral Biol 2015;60:1618–1624.

8. Kuhn M, Türp JC. Risk factors for bruxism. Swiss Dent J 2018;128:118–124.

9. Drumond CL, Ramos-Jorge J, Vieira-Andrade RG, Paiva SM, Serra-Negra JMC, Ramos-Jorge ML. Prevalence of probable sleep bruxism and associated factors in Brazilian schoolchildren. Int J Paediatr Dent 2019;29:221–227.

10. Guo H, Wang T, Niu X, et al. The risk factors related to bruxism in children: A systematic review and meta-analysis. Arch Oral Biol 2018;86:18–34.

11. Rodrigues JA, Azevedo CB, Chami VO, Solano MP, Lenzi TL. Sleep bruxism and oral health-related quality of life in children: A systematic review. Int J Paediatr Dent 2020;30:136–143.

12. Guo H, Wang T, Li X, Ma Q, Niu X, Qiu J. What sleep behaviors are associated with bruxism in children? A systematic review and meta-analysis. Sleep Breath 2017;21:1013–1023.

13. Bader G, Lavigne G. Sleep bruxism; an overview of an oromandibular sleep movement disorder. Sleep Med 2000;4:27–43.

14. Rintakoski K, Hublin C, Lobbezoo F, Rose RJ, Kaprio J. Genetic factors account for half of the phenotypic variance in liability to sleep-related bruxism in young adults: A nationwide Finnish twin cohort study. Twin Res Hum Genet 2012;15:714–719.

15. Serra-Negra JM, Paiva SM, Abreu MH, Flores-Mendoza CE, Pordeus IA. Relationship between tasks performed, personality traits, and sleep bruxism in Brazilian school children–a population-based cross-sectional study. PLoS One 2013;8:e80075.

16. Ahlberg J, Piirtola M, Lobbezoo F, et al. Correlates and genetics of self-reported sleep and awake bruxism in a nationwide twin cohort. J Oral Rehabil 2020;47:1110–1119.

17. Karibe H, Shimazu K, Okamoto A, Kawakami T, Kato Y, Warita-Naoi S. Prevalence and association of self-reported anxiety, pain, and oral parafunctional habits with temporomandibular disorders in Japanese children and adolescents: A cross-sectional survey. BMC Oral Health 2015;15:8.

18. Winocur E, Uziel N, Lisha T, Goldsmith C, Eli I. Self-reported bruxism associations with perceived stress, motivation for control, dental anxiety and gagging. J Oral Rehabil 2011;38:3–11.

19. Takemura T, Takahashi T, Fukuda M, et al. A psychological study on patients with masticatory muscle disorder and sleep bruxism. Cranio 2006;24:191–196.

20. Restrepo CC, Vásquez LM, Alvarez M, Valencia I. Personality traits and temporomandibular disorders in a group of children with bruxing behaviour. J Oral Rehabil 2008;35:585–593.

21. Türkog˘ lu S, Akça ÖF, Türkog˘ lu G, Akça M. Psychiatric disorders and symptoms in children and adolescents with sleep bruxism. Sleep Breath 2014;18:649–654.

22. Carra MC, Huynh N, Morton P, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17- yr-old population. Eur J Oral Sci 2011;119:386–394.

23. Mota-Veloso I, Celeste RK, Fonseca CP, et al. Effects of attention deficit hyperactivity disorder signs and socio-economic status on sleep bruxism and tooth wear among schoolchildren: Structural equation modelling approach. Int J Paediatr Dent 2017;27:523–531.

24. Garmroudinezhad Rostami E, Touchette É, Huynh N, et al. High separation anxiety trajectory in early childhood is a risk factor for sleep bruxism at age 7. Sleep 2020;43:zsz317.

25. Oliveira MT, Bittencourt ST, Marcon K, Destro S, Pereira JR. Sleep bruxism and anxiety level in children. Braz Oral Res 2015;29:S1806-83242015000100221.

26. Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M. Psychometric properties of the screen for Child Anxiety Related Emotional Disorders (SCARED): A replication study. J Am Acad Child Adolesc Psychiatry 1999;38:1230–1236.

27. Karaceylan Çakmakçı F. Çocuklarda Anksiyete Bozukluklarını Tarama Ölçeg˘ i Geçerlik ve Güvenirlik Çalıs¸ması. Thesis. Kocaeli University, 2004:28.

28. Metzger RL. A reliability and validity study of the State-Trait Anxiety Inventory. J Clin Psychol 1976;32:276–278.29.

29. Öner N, LeCompte A. Durumluk-Sürekli Kaygı Envanteri El Kitabı. Istanbul: Bog˘ aziiçi Üniversitesi Yayını, 1983:30.

30. Souza VA, Abreu MH, Resende VL, Castilho LS. Factors associated with bruxism in children with developmental disabilities. Braz Oral Res 2015;29:1–5.

31. Ahlberg K, Jahkola A, Savolainen A, et al. Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work. Head Face Med 2008;4:4.

32. Ribeiro MB, Manfredini D, Tavares-Silva C, et al. Association of possible sleep bruxism in children with different chronotype profiles and sleep characteristics. Chronobiol Int 2018;35:633–642.

33. Segù M, Pollis M, Santagostini A, Meola F, Manfredini D. Correlation between parental-reported tooth grinding and sleep disorders: Investigation in a cohort of 741 consecutive children. Pain Res Manag 2020;2020:3408928.

34. Restrepo C, Manfredini D, Lobbezoo F. Sleep behaviors in children with different frequencies of parental-reported sleep bruxism. J Dent 2017;66:83–90.

35. Serra-Negra JM, Lobbezoo F, Martins CC, Stellini E, Manfredini D. Prevalence of sleep bruxism and awake bruxism in different chronotype profiles: Hypothesis of an association. Med Hypotheses 2017;101:55–58.

36. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009;19:309–317.

37. Renner AC, da Silva AA, Rodriguez JD, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012;40:277–287.

38. Katayoun E, Sima F, Naser V, Anahita D. Study of the relationship of psychosocial disorders to bruxism in adolescents. J Indian Soc Pedod Prev Dent 2008;26(suppl 3):s91–s97.