227 Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012

SHORT COMMUNICATIONS

Sleep bruxism, painful temporomandibular

disorders, and self reported headache in a

sample population of adolescents

Giovana Fernandes, DDS, MSc

; Ana L Franco, DDS, MSc

; Fernanda Bonafé, SS DDS

;

Daniela Gonçalves, AG DDS, PhD

; Cinara Camparis, M DDS, PhD

1,2,3

Graduated Student,

Assistant Professor,

Associated Professor, Araraquara Dental School, UNESP –

Universidade Estadual Paulista, Department of Dental Materials and Prosthodontics, Araraquara, SP, Brazil

Fernandes G, Franco AL, Bonafé F, Gonçalves D, Camparis C. Sleep bruxism, painful temporomandibular

disorders, and self reported headache in a sample population of adolescents. Headache Medicine. 2012;3(4):220-2

INTRODUCTION

Headache (HA) is the most common manifestation

of pain in adolescence. Its prevalence rate is 51% in

adolescents and it is being perceived as a significant health

problem by pediatricians and parents.

(1)

Moreover, HA is

a frequent cause of disability, affecting the adolescence

life.

(2)

Investigations of risk factors for HA are essential to

prevention and treat this neurological disorder to minimize

its impact on quality of life.

Among the risk factors for HA, temporomandibular

disorder (TMD) and sleep bruxism (SB) have been

considered. HA are often observed in adolescents

diagnosed with TMD

(3)

and SB adolescents frequently

reported HA.

(6)

However, there is a lack of population-based studies

and a multiple association among SB, HA and TMD are

not explored. Based on these statements, the aim of the

present study is to investigate a possible association among

these three entities.

MATERIAL AND METHOD

The sample consisted of public school students, 11

to 16 years aged, from Araraquara – SP, Brazil. Overall,

24 public schools were visited and 3,117 adolescents

Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012 228

increase the risk for headache self-report. The association

between TMD and SB had significantly increased the risk

for headache self-report (OR=7.8; 95% CI=4.81-12.62),

followed by painful TMD only (OR=4.2; 95% CI=2.89-

6.01) (Table 4).

DISCUSSION

To the best of our knowledge, studies investigating

the multiple associations among painful TMD, SB, and

HA in a sample population of adolescents are missing.

were invited to participate. This study received full approval

of the Research Ethic Committee of Faculdade de

Odontologia de Araraquara, UNESP – Universidade

Estadual Paulista (process # 70/10).

For TMD pain characterization and HA assessment,

data were obtained from Research Diagnostic Criteria for

Temporomandibular Disorders (RDC/TMD) Axis I (intra-

examiner kappa values range from 0.529 to 0.884), in

addition to questions #3 (Have you had pain in the face,

jaw, temple, in front of the ear or in your ear in the past

month?), #4 (How many time did your facial pain begin

for the first time?), #14 (Have you ever had your jaw lock

or catch so that it won´t open all the way) and #18 (During

the last six months have you had a problem with

headaches or migraines?) (kappa= 0.688) of Axis II

history questionnaire.

(5)

SB was diagnosed according to

validated

(6)

clinical criteria proposed by the American

Academy of Sleep Medicine.

(7)

Data were analyzed by

chi-square and Odds Ratio (OR) test with a 95%

confidence interval (CI) and the significance level adopted

was 0.05.

RESULT

The sample consisted of 1,122 adolescents (54.7%

girls), with average age of 12.7 years. It was found

association among SB, painful TMD and headache self-

report (p<0.0001). The SB increased the risk for painful

TMD (OR=2.5; 95% CI=1.91-3.39) (Table 1).

SHORT COMMUNICATIONS

Similarly, painful TMD and SB increased the risk for

headache self-report. The magnitude of association was

higher for painful TMD (OR=5.1; 95% CI=3.76-6.83),

followed by SB (OR=1.7; 95% CI=1.30-2.21) (Tables 2

and 3).

When the sample was stratified by the presence of

SB and painful TMD, the presence of SB only did not

229 Headache Medicine, v.3, n.4, p.198-235, Oct./Nov./Dec. 2012

Since all those conditions are highly prevalent and present

great impact on individuals' lives, our findings contribute

to the current knowledge. Our study found association

among these three entities.

The present study showed that SB patients presented

a greater risk of painful TMD and it is suggested that

when painful TMD remains over the course of time, there

may be several mechanisms involved. The main

mechanisms are peripheral and central sensitization. At

the periphery, the sensitivity of nociceptors can be altered

by various substances released after tissue injury or

inflammation (post-exercise muscle soreness), and can

modify the excitatory potential of pain receptors,

facilitating neuronal transmission, featuring a peripheral

sensitization. If the peripheral sensitization is continuous

and it comes from deep structures, a central process is

established. This source of ongoing pain could act in

the perpetuation of TMD.

(8)

Therefore, SB could be

considered a risk factor for TMD.

An important result found was the increased odds

for HA self-report notably in patients with painful TMD

and SB. It can be suggested that since TMD has been

deeply associated with HA3, SB could be a risk factor

for TMD8 and this, in turn, a risk factor for headache

self-report.

However, attention should be taken when interpreting

the results because some limitations might be identified.

The present study is a cross-sectional model and thus only

provides a possible association and not a cause-and-

effect relationship. Moreover, the HA was not diagnosed,

but was based on adolescent's response. Future studies

with an accurate diagnose using the international

classification of headache society are highly

recommended.

SHORT COMMUNICATIONS

In conclusion, the present study shows that SB - painful

TMD greatly increases the risk for adolescent´s headache

self-report. For this reason, it was strongly recommend

interaction between neurologists and dentists when

evaluating and managing adolescents suffering from

facial pain and HA.

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