Bruxism is common in people with post-traumatic stress disorder

According to an article published in the journal Clinical Oral Investigations, people with post-traumatic stress disorder (PTSD) often report persistent clenching or grinding of their teeth throughout the day, a condition known as daytime (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 who have been exposed to violence or accidents such as combat, torture, imminent death, stray bullets, natural disasters, severe injuries, sexual abuse, kidnapping, etc., are thought to suffer from PTSD.

“Given that more than half of the population of the São Paulo metropolitan area [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 can persist for years after the trauma,” said Yuan-Pan Wang, the paper’s second-to-last author and a researcher at the Institute of Psychiatry at the University of São Paulo School of Medicine (FM-USP).

Symptoms of PTSD include recurring memories, negative emotional state, self-destructive behavior, sleep problems with nightmares, and dissociation (altered consciousness, memory, identity, emotions, perception of the environment, and behavioral control), among others. There are few studies focusing 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. In addition to self-reported bruxism, they also showed a lower pain threshold after the examination, according to the researchers.

“Oral hygiene was not associated with the problem,” said Ana Cristina de Oliveira Solís, the paper’s first author. “Periodontological examination, which included measuring bacterial plaque and gingival bleeding [or bleeding on probing], showed that PTSD patients and controls had similar levels of oral health. However, PTSD patients had more pain after probing.”

Multimodal approach to treatment

According to the researchers, bruxism is no longer seen as an isolated symptom, but as evidence of a larger problem. “Our study showed that PTSD can manifest itself orally, in the form of bruxism and increased pain levels after a clinical dental examination. This requires a collaborative effort between psychiatrists, psychologists, and dentists in screening and treating both health conditions,” Solis said.

Dentists should take into account the patient's self-reported pain during clinical examinations and consider the possibility that the patient has undiagnosed psychiatric problems.

"If a patient has had a traumatic experience, they may be embarrassed to talk about it or to 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 orofacial pain symptoms 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.