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Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children

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Abstract

Objectives

This cross-sectional school-based study explored the influence of malocclusion on temporomandibular disorders (TMD) pain complaints, and whether this association would be mediated by sleep bruxism in a representative sample of 7- to 8-year-old children.

Methods

Path analysis estimated direct, indirect, and total effects of occlusal features on sleep bruxism and TMD pain in 7- to 8-year-old children. Occlusal features were assessed with Dental Aesthetic Index (DAI), orofacial pain complaints using the TMD pain screener, possible sleep bruxism based on self-reports, and probable sleep bruxism based on self-reports combined with clinical findings. Structural equation modeling analyzed data with confounding factors.

Results

From 580 participants, possible sleep bruxism was observed in 136 children (31.5%), probable sleep bruxism in 30 children (6.7%), and TMD pain complaints in 78 children (13.8%). Malocclusion had no direct effect on either possible sleep bruxism [standardized coefficient (SC) 0.000; p = 0.992], or TMD pain complaints (SC – 0.01; p = 0.740). When probable sleep bruxism was set as the mediator of interest, malocclusion did not directly affect probable sleep bruxism (SC 0.01; p = 0.766), nor TMD pain complaints (SC – 0.02; p = 0.515). A direct effect of probable sleep bruxism on TMD pain complaints was observed with an SC of 0.60 (p < 0.001). However, in neither case, malocclusion indirectly affected TMD pain complaints via bruxism.

Conclusion

Malocclusion in 7- to 8-year-old children did not directly influence possible or probable sleep bruxism or TMD pain complaints. Instead, probable sleep bruxism was strongly associated with TMD pain complaints.

Clinical significance

The impact of occlusal features on TMD pain complaints and bruxism has been a long-standing controversy in dentistry. However, the scientific literature linking this association may be inconsistent, mainly due to biased sample selection methods with inadequate consideration of confounders. Further research should try to identify additional risk factors for TMD pain in addition to probable sleep bruxism in children.

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Funding

This study was partly funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

Author information

Authors and Affiliations

  1. Graduate Program in Dentistry, Federal University of Pelotas (UFPel), Pelotas, RS, Brazil

    João Pedro Caetano, Marilia Leão Goettems & Noéli Boscato

  2. National Dental Centre Singapore, National Dental Research Institute Singapore, Singapore, Singapore

    Gustavo G. Nascimento

  3. Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore

    Gustavo G. Nascimento

  4. Graduate Program in Health & Behavior, Catholic University of Pelotas (UCPel), Pelotas, RS, Brazil

    Karen Jansen & Ricardo Azevedo da Silva

  5. Section for Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark

    Peter Svensson

  6. Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus, Denmark

    Peter Svensson

  7. Faculty of Odontology, Malmö University, Malmö, Sweden

    Peter Svensson

  8. Department of Restorative Dentistry, Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Gonçalves Chaves 457, Room 505, Pelotas, Brazil

    Noéli Boscato

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  1. João Pedro Caetano
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  2. Marilia Leão Goettems
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  3. Gustavo G. Nascimento
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  4. Karen Jansen
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  5. Ricardo Azevedo da Silva
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  6. Peter Svensson
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  7. Noéli Boscato
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Contributions

M.L.G., K.J., R.A.S, G.G.N, P.S. and N.B. conceived the ideas; J.P.C., M.L.G and N.B. collected the data; G.G.N analyzed the data; J.P.C and NB writing the original Draft; and J.P.C, M.L.G., K.J., R.A.S, G.G.N, P.S. and N.B. writing, review & editing.

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Correspondence to Noéli Boscato.

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Caetano, J.P., Goettems, M.L., Nascimento, G.G. et al. Influence of malocclusion on sleep bruxism and orofacial pain: data from a study in school children. Clin Oral Invest 28, 142 (2024). https://doi.org/10.1007/s00784-024-05545-1

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