Perceived stress and bruxism in university students

Depression and Its Determinant Factors Among University of Gondar Medical and Health Science Students, Northwest Ethiopia: Institution-Based Cross-Sectional Study

BACKGROUND

Depression is a common mental disorder characterized by loss of interest or pleasure. Prevalence of depression is varied in different groups and countries. No adequate study has been undertaken in Ethiopia. This study aimed to determine the prevalence of depression and determinant factors among University of Gondar Medical and Health Sciences students, Northwest Ethiopia, 2019.

METHODS

An institution-based cross-sectional study was carried out using simple random sampling technique to select study participants and the study was conducted from June to July 2019. We used self-administered second edition of Beck's Depression Inventory (BDI-II) to collect data on depressive symptoms. The sample size was determined using a single population proportion formula. We entered the data using Epi Info 7 and then exported into Stata 14 for analysis. A binary logistic regression was used to identify determinant factors of depression. In the final model, a variable with a p<0.05 was considered as a significant factor for depression by an adjustment of odds ratio with 95% of uncertainty interval (UI).

RESULTS

Three hundred and eighty-three students completed the questionnaire with 97.7% response rate. The mean age of participants was 20.8 (±1.83, 18-34) years. The prevalence of depression was 34.73% (95% UI: 29.94-39.52%). The odds of having depression was higher among students who came from rural family (AOR=1.67, 95% UI: 1.02-2.72), who experienced tooth grinding (AOR=2.79, 95% UI: 1.36-5.74), who had night sleep disturbances (AOR=1.95, 95% UI: 1.17-3.25), who reported daytime sleepiness (AOR=1.93, 95% UI: 1.16-3.20), who had reported stress (AOR=4.20, 95% UI: 1.90-9.26), and those studying Health sciences (AOR=2.65, 95% UI: 1.34-5.26).

CONCLUSIONS

The prevalence of depression among university students was high which could lead to loss of personal control, disturbed learning capacity, and social interaction. Preventive strategies such as life skills training should be given for prevention and management of depression particularly targeting students coming from a rural family, those with stress, and having poor sleep quality.

Correlation between Sleep Bruxism, Stress, and Depression-A Polysomnographic Study

Background and objectives: Sleep bruxism is a common phenomenon that can affect approximately 13% of adult population. It is estimated that bruxism can be caused by three types of factors: biological, psychological, and exogenous. There are many scientific reports about the coexistence of bruxism, stress, and psychoemotional disorders. The aim of this study is to evaluate the possible correlation between occurrence of sleep bruxism and perceived stress and depressive symptoms. Material and methods: The material of this study consisted of 77 patients of Clinic of Prosthetic Dentistry operating at the Department of Prosthetic Dentistry, Wroclaw Medical University, Poland in which after using guidelines of the American Academy of Sleep Medicine probable sleep bruxism was fund. Patients then underwent video-polysomnography. Exposure to perceived stress was evaluated with Perceived Stress Scale-10 (PSS-10). Occurrence of depressive symptoms was evaluated with Beck’s Depression Inventory (BDI). Results: The analysis showed lack of statistically significant correlation between Bruxism Episodes Index (BEI) and Perceived Stress Scale–10 and Beck’s Depression Inventory scores (p = 0.64, p = 0.65; respectively), also when comparing study group (bruxers) and control group (non-bruxers) (p = 0.88, p = 0.77; respectively). Conclusion: Intensity of sleep bruxism was not statistically significantly correlated with self-reported perceived stress and depression. This issue requires further research.

Spray and stretch technique and its effects on mouth opening

STATEMENT OF PROBLEM

Mandibular mouth opening through passive stretching may be an awkward and painful experience for patients with orofacial pain. Whether a spray technique would reduce such discomfort is unclear.

PURPOSE

The purpose of this clinical study was to determine whether the use of a spray technique would be an effective method of increasing maximal mouth opening (MMO) without passive stretching to avoid patient discomfort.

MATERIAL AND METHODS

A sample of 61 participants, 33 men and 28 women, without orofacial pain was selected from a general dental office, and a sample of 60 participants, 30 men and 30 women, was selected from a cohort of over 750 patients with orofacial pain from an oral surgery department. The presence of orofacial pain in the patient group was verified and recorded by means of palpation of the temporomandibular joints (TMJs) and masticatory, neck, and shoulder muscles. All participants in the study were instructed to open their mouth maximally to permit insertion of a TMJ equilateral triangle and the measurement of their MMO twice. Then, the participants were informed that a vapocoolant would be sprayed twice on both cheeks from the mandibular angle to the temple area. After spraying, the participants were requested to open their mouth maximally, and again the interincisal distance was measured twice. For analysis of the variables, a 2-way ANOVA was used with estimates for group effects and a correction for sex. A covariance model was used to test the effect of age (α=.05).

RESULTS

Testing for age revealed an effect for both study groups (P=.032), but not for sex (P=.074). Testing baseline values of maximal mouth opening for the studied groups revealed no significant difference (P=.175), although for sex, it did (P=.008). The relative gain as a percentage of increase in mouth opening led to similar results, comparable with the values of the absolute increase in magnitude (P<.001 for the study groups and P=.090 for sex). Testing the effect of age in a covariance model did not lead to a significant result (P=.73).

CONCLUSIONS

The spray and stretch technique increased maximal mouth opening in most participants, more so in participants with orofacial pain than in the control group and more in women than in men. Pain from passive stretching can be prevented.

The Bruxoff Device as a Screening Method for Sleep Bruxism in Dental Practice

Sleep bruxism (SB) is a masticatory muscle activity during sleep and a common phenomenon. Severe SB can have a serious impact on the success of dental treatment. Reliable methods of screening and diagnosing patients with SB are crucial. Therefore, in this study, a Bruxoff device as a potential screening and diagnostic method for sleep bruxism was evaluated. A total of 60 adults participated in this study: 35 patients with symptoms of bruxism (study group) and 25 asymptomatic patients (control group). Data were recorded using Bruxoff. All symptomatic patients participating in the study turned out to be bruxers, while not all asymptomatic patients turned out to be non-bruxers according to the Bruxoff device. Bruxoff is a simple screening device that can be safely used to evaluate masseter muscle activity during sleep. Since the device does not have a built-in microphone and/or video camera and, therefore, cannot record grinding sounds, the objective capabilities of Bruxoff as a single diagnostic device for sleep bruxism are limited.

Association of anthropometric status, perceived stress, and personality traits with eating behavior in university students

PURPOSE

We investigated the association of anthropometric status, perceived stress, and personality traits with eating behavior in university students.

METHODS

The participants, 1546 Japanese university students (964 males, 582 females), completed a questionnaire which asked for their current height and weight, ideal height and weight, eating behaviors, perceived stress, and personality traits.

RESULTS

Restrained eating was higher in normal-weight participants compared with underweight participants in both males and females (p < 0.001, both males and females). Restrained eating in normal-weight males was significantly lower in normal-weight females (p < 0.001). In addition, normal-weight males reported less stress than normal-weight females (anxiety/uncertainty, p = 0.037; tiredness/physical responses, p < 0.001; autonomic symptoms, p < 0.001; depression/feeling, p < 0.001) and underweight males (tiredness/physical responses, p = 0.018; autonomic symptoms, p = 0.001). Moreover, among normal-weight males, neuroticism was significantly lower compared with normal-weight females (p < 0.001). In multiple regression analysis, male participants revealed positive association between restrained eating and body mass index (β = 0.199, p < 0.001) or body mass index difference (β = - 0.170, p = 0.001). In contrast, female revealed more significant associations between emotional and external eating and perceived stress or personality traits compared with males.

CONCLUSIONS

These results indicate that associations between eating behavior and anthropometric status or psychological factors are different by each eating behavior, which is partly influenced by gender difference.

LEVEL OF EVIDENCE

V, cross-sectional descriptive study.

The correlation between sleep bruxism, salivary cortisol, and psychological status in young, Caucasian healthy adults

Objective: To analyze the association between sleep bruxism (SB), salivary cortisol, and psychological state in healthy adults.Methods: Sixty healthy students (with or without SB) were included in the study. The subjects completed a questionnaire that evaluated the presence of SB and analyzed the general and work-related psychological states and job-related frustration. Clinical examinations of TMJs and dental wear were performed. The salivary cortisol was determined using ELISA technique.Results: Subjects with SB had a general status characterized by anxiety or stress compared to subjects without SB. They also presented a work-induced depressive or anxious attitude compared to healthy individuals. The salivary cortisol levels were higher in subjects with SB and in females and were correlated with subjects' general anxiety, but not with a job-induced psychological state.Conclusion: SB is correlated with general and job-induced psychological changes. Salivary cortisol could be a non-invasive marker for the evaluation of SB severity.

Occlusion time analysis in military pilots affected by bruxism

Military pilots are characterized by peculiar job conditions related to intense accelerative stresses. For this, they frequently report work-related neck and back pain and are affected by bruxism. The aim of this case-control study is to analyze the occlusion time (OT) in a sample of military pilots affected by bruxism, compared with healthy non-pilot subjects. 14 military pilots, all males (mean age 35.14 ± 2.32 y), affected by bruxism, were compared with an age matched control group of 14 male subjects (mean age 32.29 ± 4.84 y). The T-Scan computerized occlusal analysis system (Tek-Scan Inc., Boston, MA, USA) was used to record the subjects' occlusion times during 4 mandibular opening-closing movements. Military pilots affected by bruxism showed a statistically significant lower (reduced of 85%) mean OT, compared with control subjects (p < 0.0001). Military pilots are characterized by a highly reduced occlusion time compared to healthy non-pilot subjects. This feature could not be only related with the presence of bruxism but with their particular clinical job-related condition that causes different dental and stomatognathic system problems. Further studies are encouraged to enhance the scientific knowledge in this field.

Occlusion time analysis in military pilots affected by bruxism

Military pilots are characterized by peculiar job conditions related to intense accelerative stresses. For this, they frequently report work-related neck and back pain and are affected by bruxism. The aim of this case-control study is to analyze the occlusion time (OT) in a sample of military pilots affected by bruxism, compared with healthy non-pilot subjects. 14 military pilots, all males (mean age 35.14 ± 2.32 y), affected by bruxism, were compared with an age matched control group of 14 male subjects (mean age 32.29 ± 4.84 y). The T-Scan computerized occlusal analysis system (Tek-Scan Inc., Boston, MA, USA) was used to record the subjects' occlusion times during 4 mandibular opening-closing movements. Military pilots affected by bruxism showed a statistically significant lower (reduced of 85%) mean OT, compared with control subjects (p < 0.0001). Military pilots are characterized by a highly reduced occlusion time compared to healthy non-pilot subjects. This feature could not be only related with the presence of bruxism but with their particular clinical job-related condition that causes different dental and stomatognathic system problems. Further studies are encouraged to enhance the scientific knowledge in this field.

Insomnia and the level of stress among students in Krakow, Poland

INTRODUCTION

Stress and insomnia are increasing problems in young people in highly developed countries. They influence both the physical and psychological aspects of life and seem to be related to each other. Various strategies to cope with stress exist and can be used to reduce its level. The main goal of our study was to find a relationship between insomnia, stress, stress-coping strategies and selected social and medical factors among students.

METHODS

A cross-sectional study was conducted in March 2017 among students of seven public Krakow universities, using the Perceived Stress Scale 10, an abbreviated version of the Coping Orientation to Problems Experienced inventory (mini-COPE inventory) and the Athens Insomnia Scale. In the statistical analysis, the chi-square, Student's t test and Spearman's rank correlation coefficient were used.

RESULTS

A total of 264 students aged 22.22±1.5 years were involved in the study. High stress levels occurred in 10% of the respondents. A statistically higher level of stress was revealed in people suffering from chronic diseases (p=0.006) and in cigarette smokers (p=0.004). The most common stress-coping strategies were active coping and planning. Insomnia was present in 19.7% of the students. Insomnia level was correlated with the intensity of perceived stress (p=0.00; r=0.44).

CONCLUSIONS

According to our study, one tenth of Krakow students perceive a high level of stress, and one fifth of the respondents suffer from insomnia. There is a strong positive correlation between level of insomnia and level of stress. To ensure high quality of life, problems such as stress and insomnia should be taken into consideration by every general practitioner.

Bruxismo do sono: estudo de base populacional em pessoas com 18 anos ou mais na cidade de Rio Grande, Rio Grande do Sul

RESUMO: Objetivos: Avaliar a prevalência do bruxismo do sono, bem como seus principais sinais e sintomas, na cidade de Rio Grande, Rio Grande do Sul. Avaliar a associação do bruxismo do sono com sexo, idade, escolaridade e estresse psicológico. Método: O estudo foi do tipo transversal. Uma amostra representativa da população (1.280 pessoas residentes na zona urbana da cidade com idade maior ou igual a 18 anos de idade) foi entrevistada. A avaliação do bruxismo do sono foi realizada por meio de questionário baseado nos critérios diagnósticos da Classificação Internacional de Distúrbios do Sono. Resultados: A prevalência de bruxismo do sono encontrada na população foi de 8,1% (intervalo de confiança de 95% - IC95% - 6,6 - 9,5). Entre os sinais e sintomas da disfunção utilizados para o diagnóstico de bruxismo do sono, o desgaste dentário (70,3%) e a dor nos músculos mastigatórios (44,5%) foram os mais frequentemente relatados pelas pessoas que declararam ranger os dentes durante o sono. Não houve diferença significativa na prevalência de bruxismo do sono entre os sexos. A faixa etária com mais de 40 anos teve maior prevalência de bruxismo do sono. A disfunção foi associada a um maior nível de escolaridade (razão de prevalência - RP = 1,92; IC95% 1,35 - 2,72) e de estresse psicológico (RP = 1,76; IC95% 1,11 - 2,81). Conclusão: O bruxismo do sono tem uma importante prevalência na população em geral, causando diversos danos ao sistema estomatognático. O estresse psicológico é um fator de risco para essa disfunção.

Study of Associated Factors With Probable Sleep Bruxism Among Adolescents

STUDY OBJECTIVES

To evaluate the prevalence of probable sleep bruxism (SB) and its association with sleep features, orthodontic fixed appliance wearing, and extraoral and intraoral clinical signs and symptoms in a population of adolescents.

METHODS

Two hundred thirty-nine 12-year-old adolescents enrolled in private and public schools in Brumadinho, southeast Brazil, and their parents were invited to participate. They answered a questionnaire containing information regarding adolescents' sleep features and history of SB. Extraoral and intraoral examination was performed to identify some clinical signs (ie, absence of lip competence, presence of mouth breathing, clicks in the temporomandibular joint [TMJ], tooth wear) and symptoms (ie, pain in the masseter muscle upon palpation), and ongoing orthodontic treatment with fixed appliances. Parental report and clinical examination were used to determine probable SB. Descriptive statistics and logistic regression were performed to identify association of probable SB with independent variables.

RESULTS

Of 239 adolescents initially selected, 231 (96.6%) participated in the study. Prevalence of probable SB was 16.9%. Adolescents who snored during sleep (odds ratio [OR] = 3.14; 95% confidence interval [CI] = 1.47-6.70), adolescents who did not have clicks in the TMJ (OR = 3.37; 95% CI = 1.11-10.15), and those who wore orthodontic appliances (OR = 2.72; 95% CI = 1.04-7.14) were more likely to be in the group with probable SB.

CONCLUSIONS

Snoring, absence of clicks in the TMJ, and fixed appliance wearing were associated with probable SB among adolescents. This study adds to the ongoing research on SB in adolescents and its associated factors.

COMMENTARY

A commentary on this article appears in this issue on page 1281.

A Self-Reported Association between Temporomandibular Joint Disorders, Headaches, and Stress

AIMS AND OBJECTIVES

Temporomandibular joint disorder (TMD) is an umbrella term for a number of conditions in the area of the joint, temple, and masticatory system. Many of those with TMD also suffer from headaches and anxiety. The aims and objectives of this study were to determine if there exists an association between the Diagnostic Criteria of TMD (DC/TMD) symptom questionnaire and report of headaches as well as stress.

MATERIALS AND METHODS

A cross-sectional study was implemented via the use of the DC/TMD symptom questionnaire and the perceived stress scale (PSS). This was distributed conveniently among dental students in a multi-dental school setting in Riyadh, Saudi Arabia, and was completed by 152 dental students. Odds ratios, Chi-square, and their corresponding 95% confidence intervals are reported. Statistical significance was set at P ≤ 0.05.

RESULTS

Those who ticked yes for pain on the TMD pain screener for pain with chewing hard or tough food, pain on mouth opening and lateral excursion, and pain with jaw habits as parafunction were at an odds risk from twice to thrice as likely to experience headaches. Similarly, those with poor coping skills on the PSS were more likely to have headaches (P = 0.002). Likewise, positive answers on the screener and symptom questionnaire were relevant with higher stress scores on the PSS.

CONCLUSION

This study clarifies and reiterates the intertwined power of both stress and headaches; the former being a role player in TMD progression and the latter its product. TMD is unfortunately on the rise; it should not be brushed off as a nuisance. A multidisciplinary approach in diagnosis and treatment of both TMD and headaches by a team of orofacial pain specialist, neurologist, psychiatrist and/or psychologist, and physical therapists to untangle the deceiving presentation of both conditions would not only provide a more favorable prognosis but also improve cost and time expenditures.

Reliability and validity of the student stress inventory-stress manifestations questionnaire and its association with personal and academic factors in university students

BACKGROUND

Stress affects us in every environment and it is also present in the educational sphere. Previous studies have reported a high prevalence of stress in university students. The Student Stress Inventory-Stress Manifestations (SSI-SM), identify stressors and evaluate stress manifestations in adolescents but its validity in university students remains uncertain.

OBJECTIVES

We aimed to determine the internal consistency and validity of an adapted version of the Student Stress Inventory-Stress Manifestations (SSI-SM) for university students and to investigate if high stress levels are associated with personal and academic factors.

DESIGN AND METHODS

In this quantitative, descriptive, cross-sectional study, we included 115 university students of the Nursing Degree during the second semester of the 2014/2015 academic year. Information about personal issues, lifestyle and academic performance was recorded and the stress was evaluated with the SSI-SM questionnaire. The internal consistency and homogeneity of the SSI-SM questionnaire was tested and a factorial analysis was performed.

RESULTS

After the homogeneity analysis, the final version of the SSI-SM questionnaire included 19 items, with a Cronbach's alpha of 0.924. In the factorial analysis, 4 factors were found ('Self-concept', 'Sociability', 'Uncertainty' and 'Somatization'; all Cronbach's alpha >0.700). Students with higher values on the SSI-SM were, in overall, women (41.0 ± 12.7 vs. 33.2 ± 9.5; p = 0.001) and had significantly more family conflicts (47.6 ± 13.8 vs. 35.2 ± 9.6; p < 0.001), consumed less alcohol (R = -0.184, p = 0.048), slept less hours (R = -0.193, p = 0.038) and had worse academic performance in Clinical Nursing (36.3 ± 10.4 vs. 41.2 ± 13.3, p = 0.039).

CONCLUSIONS

After exclude three items of the original SSI-SM, higher scores in the SSI-SM are correlated with stress level in a cohort of university students of the Nursing Degree. Family conflicts, female gender, absence of alcohol consumption, few sleep hours and poor academic performance are associated with higher stress levels.

Relationship of self-reported sleep bruxism and awake bruxism with chronotype profiles in Italian dental students

OBJECTIVES

A cross-sectional study was performed to assess the association between possible sleep bruxism (SB) and awake bruxism (AB) with sleep characteristics and chronotype (i.e. circadian cycle preference).

METHODS

One-hundred-nineteen young adults filled out a self-reported questionnaire to assess SB and AB, a questionnaire about daily life aspects, as well as the Morningness-Eveningness Questionnaire (MEQ) to profile chronotype.

RESULTS

The frequency of self-reported SB and AB was 25.2% and 37.0%, respectively. Both SB and AB were significantly more frequent in females than males. Most participants had an intermediate chronotype profile (n = 85; 71.4%). Neither SB (p = 0.556) nor AB (p = 0.334) were associated with chronotype. Nightmares were more prevalent among individuals with possible SB (38.3%). Difficulty concentrating in daily activities was more frequently reported among individuals with AB (51.9%).

CONCLUSION

There was no association between possible SB and AB or the chronotype profiles among Italian dental students.