Bruxism is frequently observed in patients with post-traumatic stress disorder

This study was conducted at the University of São Paulo and published in Clinical Oral Investigations; the authors emphasize the importance of collaboration between dentists and psychiatrists to improve diagnosis and treatment.

By Julia Moióli  |  Agência FAPESP – According to a study published in Clinical Oral Investigation, patients with post-traumatic stress disorder (PTSD) frequently report teeth clenching or grinding during the day – a behavior named awake bruxism. The clinical study included approximately 80 patients, both cases and controls, and underscored the importance of collaboration between dentists and psychiatrists in diagnosing these two health conditions. 

PTSD is a concept that originated in the United States, initially based on the behavior exhibited by war veterans. Over time, it has expanded to include urban violence. About 4% of individuals exposed to violent or accidental traumatic events, such as combat, torture, death threats, stray bullets, natural disasters, severe injuries, physical or sexual violence, and kidnappings, will develop PTSD.

“In the São Paulo metropolitan area, over 50% of the population has been exposed to some traumatic event, and this estimate is comparable to conflict zones. Therefore, understanding the potential long-term psychological and physical manifestations of PTSD is essential as they can persist for years after the trauma,” said Yuan-Pang Wang, a researcher from Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (IPq-FMUSP) and co-author of the study. 

The symptoms may include distressing, involuntary, and recurring memories of the traumatic event, negative emotional states, self-destructive behavior, irregular sleep patterns, and dissociative reactions (alterations in consciousness, memory, identity, emotion, perception of the environment, and behavior control), among others. However, few studies have investigated the relationship between PTSD and orofacial pain and bruxism, which is characterized by repetitive activity of the masticatory muscles. The prevalence of bruxism in the general population ranges from 8% to 30%. 

This study was supported by FAPESP, and patients diagnosed with PTSD at the ‘Trauma Ambulatory’ of the Institute of Psychiatry at FMUSP were invited to undergo a clinical examination aimed at evaluating their oral health. 

According to the researchers, patients showed self-reported bruxism and a decrease in pain threshold following the clinical examination.

“Oral hygiene status was not associated with this type of stress,” says Ana Cristina de Oliveira Solis, the first author of the study. “The periodontal evaluation, which also included the evaluation of plaque and gingival bleeding, showed that patients with PTSD had similar oral hygiene levels compared to the control group. However, these patients experienced more pain after probing”.
 
Multidisciplinary treatment

According to the researchers, bruxism is no longer considered an isolated behavior but rather evidence of a major underlying problem. “Our research showed that bruxism and pain after dental clinical examination may be a manifestation of PTSD at the oral level, and suggests collaboration among psychiatrists, psychologists, and dentists for screening and treating both health conditions,” says Solis. 

For this reason, the researcher recommends that during the oral clinical examination, dentists should consider reports of pain, and analyze the possibility of dealing with a patient with psychiatric or psychological symptoms. 

“A patient who has experienced a traumatic event may feel ashamed to talk about it and seek professional assistance; on the other hand, seeking dental care is much more common and frequent. For this reason, it is beneficial to incorporate mental health screening tools into dental practices and apply them to these patients. It is also important to understand how to advise patients with psychiatric or psychological symptoms to seek mental health assistance,” says Solis.

Psychiatrists and psychologists can inquire about oral health symptoms, such as bruxism, muscle pain, and temporomandibular joint (TMJ) pain, in patients with PTSD. If necessary and when appropriate, they should refer them to the dentist to improve their quality of life.

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