Association between sleep bruxism, awake bruxism, perceived stress and coping strategies among dental students: a cross-sectional study

Abstract

Bruxism is a common condition that can adversely affect quality of life and may be associated with tooth wear, temporomandibular disorders, and failures of dental restorations. The aim of this cross-sectional study was to investigate whether sleep bruxism (SB) and/or awake bruxism (AB) were associated with perceived stress levels and coping strategies among undergraduate dental students. The study was conducted among undergraduate dental students at Medipol University Faculty of Dentistry, Istanbul, Türkiye. Data were collected using a self-administered questionnaire consisting of demographic information, bruxism-related questions, the 8-item Perceived Stress Scale (PSS), and the 30-item Ways of Coping Inventory (WOCI). Sleep bruxism was assessed using questionnaire items based on the American Academy of Sleep Medicine criteria and a previously published epidemiological study, whereas awake bruxism was determined based on self-reported awareness of clenching or grinding during wakefulness within the previous six months. The PSS and WOCI were administered using their validated Turkish versions. Group comparisons were performed using Student’s t-test and chi-square test. Binary logistic regression analyses were conducted to adjust for potential confounding factors. Of the 650 students enrolled during the 2017–2018 academic year, 570 completed the questionnaires. The mean age was 21.08 ± 2.13 years; 58.9% were female and 41.1% were male. The prevalence of sleep bruxism and awake bruxism was 57.4% ( n = 327) and 39.5% ( n = 225), respectively. Perceived stress levels were significantly higher in participants with sleep bruxism than in those without sleep bruxism ( p = 0.011), but did not differ according to awake bruxism status ( p = 0.406). Participants with sleep bruxism demonstrated higher emotion-focused, and problem-focused coping scores (all p < 0.05), whereas participants with awake bruxism showed lower problem-focused coping scores than those without awake bruxism ( p = 0.018). Multivariable analyses showed that perceived stress (OR=1.034, 95% CI: 1.007–1.062), problem-focused coping (OR=1.024, 95% CI: 1.009–1.039) and emotion-focused coping (OR=1.035, 95% CI: 1.006–1.066) remained independently associated with sleep bruxism. In contrast, only problem-focused coping remained independently associated with awake bruxism (OR=0.984, 95% CI: 0.969–0.998). Within the limitations of this study, sleep bruxism was associated with higher perceived stress levels and greater use of coping strategies, whereas awake bruxism was associated with reduced use of problem-focused coping despite similar perceived stress levels. These findings suggest that sleep bruxism and awake bruxism may have different psychosocial characteristics and should be evaluated separately in future research and clinical practice.