Bruxism is common in people with post-traumatic stress disorder

According to an article published in the Clinical Oral Investigations journal, people with post-traumatic stress disorder (PTSD) often report clenching or grinding their teeth repeatedly throughout the day, a condition known as diurnal (or diurnal) bruxism. Its prevalence in the general population ranges from 8% to 30%.

The study, which included a clinical examination of 76 patients and a control group, highlights the importance of collaboration between dentists and psychiatrists to more accurately diagnose both health problems.

Post-traumatic stress disorder was first diagnosed in the United States among war veterans, but has since been recognized in victims of urban violence. About 4% of people exposed to violence or accidents such as combat, torture, the threat of imminent death, stray bullets, natural disasters, severe injuries, sexual assault, kidnapping, etc. Are believed to suffer from PTSD.

“Given that more than half the population of the metropolitan area of São Paulo [in Brazil] has been exposed to some type of urban trauma, comparable to populations in areas of civil conflict, it is critical to understand the possible psychological and physical manifestations of PTSD that may persist in for many years after the injury,” said Yuan-Pan Wang, penultimate author of the paper and a researcher at the Institute of Psychiatry at the University of São Paulo Medical School (FM-USP).

PTSD symptoms include recurring flashbacks, negative emotional states, self-destructive behavior, sleep problems with nightmares, and dissociation (altered consciousness, memory, identity, emotions, perception of the environment, and behavioral control), among others. There is limited research on orofacial pain and bruxism as symptoms of PTSD.

In this study, patients diagnosed with PTSD at the FM-USP Institute of Psychiatry underwent a clinical examination to assess their oral health. According to the researchers, in addition to self-reported bruxism, they also had a lower pain threshold after the examination.

"Oral hygiene was not associated with the problem," said Ana Cristina de Oliveira Solis, the paper's first author. “Periodontal examinations that included measurements of bacterial plaque and gingival bleeding [or bleeding on probing] showed that patients with PTSD and controls had similar levels of oral health. However, patients with PTSD experienced greater pain after probing.”

Multimodal approach to treatment

Bruxism is no longer seen as an isolated symptom, but is considered evidence of a wider problem, researchers say. “Our study showed that PTSD can manifest itself orally, such as bruxism and increased levels of pain after a clinical dental examination. This requires collaboration between psychiatrists, psychologists and dentists in screening and treating both health conditions,” Solis said.

Dentists should consider the patient's self-reported pain during clinical examinations and consider the possibility that the patient may have undiagnosed psychiatric problems.

“If a patient has had a traumatic experience, they may be embarrassed to talk about it or see a therapist. On the other hand, the habit of going to the dentist is much more common and frequent. For this reason, psychiatric screening tools should be used in routine patient care, and patients should be encouraged to seek therapeutic help,” she said.

Psychiatrists can ask patients with PTSD about symptoms of orofacial pain, such as bruxism, muscle pain, and temporomandibular joint pain, and refer them to a dentist if necessary to provide multimodal treatment and improve their quality of life.