|Year : 2016 | Volume
| Issue : 1 | Page : 14-19
Bruxism experience among undergraduates of a Nigerian university
Clement Chinedu Azodo, Patrick I Ojehanon
Department of Periodontics, University of Benin, Benin City, Nigeria
|Date of Web Publication||11-Aug-2016|
Clement Chinedu Azodo
Department of Periodontics, University of Benin Teaching Hospital, Room 21, 2nd Floor, New Dental Complex, Benin City 300001
Source of Support: None, Conflict of Interest: None
Objective: To determine self-reported bruxism experience among the undergraduates of a Nigerian university, other associated parafunctional habits and oral health problems.
Materials and Methods: This cross-sectional study was conducted on undergraduates dwelling in University of Benin, main campus hostel located in Ugbowo, Benin City, Nigeria. The 640 participants that met the inclusion were randomly recruited from four hostels (two males and two females) during the weekend. A self-developed validated questionnaire was the data collection tool.
Results: Out of the 578 (response rate = 93.2%) study participants, aged between 15 and 48 years with a mean age of 23.6 ± 8.5, 143 reported bruxism, giving 24.7% prevalence. This was significantly associated with gender. The reported patterns of bruxism were awake (48.3%), nocturnal (15.4%), and diurnal (36.4%). The prevalence of nail biting and anxiety/stress was 56.6% and 29.9%, respectively. These were significantly higher in bruxists than nonbruxists. More of the participants, who reported chewing/biting biro as well as tobacco and alcohol consumption, also reported bruxism. Oral health problems reported include tooth mobility (9.5%), shocking sensation (40.3%), chewing difficulty (6.7%), temporomandibular joint noise/or pain (5.4%), and jaw injury (7.6%). These conditions were significantly more common among those who reported bruxism.
Conclusion: Data from this study revealed that one out of every four studied participants is a bruxist. There is need for the dentists to suspect bruxism in undergraduates presenting with oral health problems such as shocking sensation, tooth mobility, nail biting, chewing difficulty, anxiety/stress, jaw injury, joint noise and pain on mouth opening/closing, to give a holistic care.
Keywords: Bruxism; oral health issues; parafunction; undergraduates
|How to cite this article:|
Azodo CC, Ojehanon PI. Bruxism experience among undergraduates of a Nigerian university. Indian J Multidiscip Dent 2016;6:14-9
| Introduction|| |
Bruxism, regarded as a forcible clenching and grinding of the dentition, is a common parafunctional habit with the highest prevalence found between the second and fifth decades of life. , The centrally-mediated theory views bruxism as a sleep-related disturbance, whereas the local mechanical theory views it as an occlusion-related problem. ,, Bruxism is then considered as a common sleep disorder although the diurnal and awake types have been reported. ,, Sleep bruxism appears to be due a disturbance in the dopaminergic system and the episodes are part of the sleep arousal response.  Although the etiology of sleep bruxism is uncertain, factors such as smoking, alcohol, drugs, systemic diseases, stress, trauma, and heredity have been reported to play important roles while occlusal discrepancies and the anatomy of the bony structures of the orofacial region, a minor role. ,
Bruxism is considered to be an important etiological factor of oral diseases ,,, This may either be due to the detrimental motor activity of exerting undue force on the dentition or to the associated precipitated stress resulting in manifestations of symptoms on the teeth, periodontium, and musculoskeletal system. 
Tertiary education in Nigeria is quite challenging and is potentially stressful because admission into the universities is highly competitive, economy downturn has led to the reduction of subsidy by the government, and school fees in public universities are also on the increase despites the dwindling facilities. The suboptimal facilities in academic and residential environments undoubtedly exert negative impact on the health and well-being of the undergraduates. The incessant labor crisis and a huge graduate unemployment are also significant stressors of the Nigerian undergraduates. The orofacial region is a common site for physical manifestations of stress and they occur in form of parafunctional habits, aphthous ulcers, psychological halitosis, burning mouth syndrome, temporomandibular joint (TMJ) dysfunction syndrome, and other orofacial psychogenic pains.  The epidemiology of bruxism has been relatively neglected as no comprehensive study on bruxism in Nigeria or other countries in the region exist in the literature. The scanty information on epidemiology of bruxism were reported as part of studies , on habit and tooth wears lesions among adult male rural dwellers, and the occupational stress evaluation among dental professionals in Nigeria, thereby explaining the paucity of information on the characteristics of self-reported bruxists. The objective of the study was to determine self-reported bruxism experience among undergraduates of a Nigerian university, other associated parafunctional habits and oral health problems.
| Materials and Methods|| |
Ethical approval for this study was obtained from the University of Benin Teaching Hospital Research and Ethics Committee. Informed consent was obtained from the participants.
This cross-sectional study was conducted among undergraduates dwelling in University of Benin main campus hostel located in Ugbowo, Benin City, Nigeria.
Undergraduates dwelling in the four major hostels of University of Benin main campus who gave informed consent were included in this study.
Undergraduates who were noninhabitants of four major hostels of University of Benin main campus, those that did not give informed consent and unavailable during the study period were excluded from the study.
The multistage sampling technique was employed to recruit 640 participants which exceeded the minimum sample size of 192 calculated using Cochran's formula for epidemiological studies.  n = z2 P (1 − P)/d2 Where n = sample size, z = z statistics for a level of confidence (set at 1.96 corresponding to 95.0% confidence level), P = prevalence = 13.0%,  q = 1 - P, and d = degree of accuracy desired (error margin) =5%.
In the first stage, the four main males and females hostels out of the seven hostels in the University of Benin main campus were conveniently selected because the residents of these hostels comprised students of all the faculties in the University. In the second stage, twenty rooms were selected from the 240 rooms that constituted a hostel using systemic sampling technique with the first room and every subsequent twelfth room selected. In the third stage, occupants of the room were selected based on the average of eight occupants per room giving a total of 160 participants per hostel.
Data collection tool
The participants were studied using self-developed validated questionnaire. This self-administered questionnaire elicited information on demographic characteristics (age, gender, course of study, academic level), bruxism experience, pain/or noise from TMJ, chewing difficulty, shocking sensation, stress/anxiety, and dental care experience.
The data were subjected to descriptive statistics using Statistical Package for the Social Sciences (Chicago, IL) version 17.0. Test of significance was done using either Chi-square or Fisher's exact test and statistically significant value was set at P < 0.05. For the purpose of analysis, the age of the participants was categorized less or equal to 21 years and older than 21 years; courses as science-related and nonscience-related courses and year of study as lower and higher academic levels.
| Results|| |
A total of 578 (response rate = 90.3%) individuals aged between 15 and 48 years with a mean age of 23.6 ± 8.5 years participated in the study. The majority of the participants were younger or equal to 21 years - 329 (56.9%), females - 321 (55.6%), studying science-related courses - 375 (64.9%), and lower academic levels - 358 (61.9%). Of the 578 participants that completed the study, 143 of them reported bruxism giving 24.7% prevalence. Gender had statistical significant association with bruxism with males reporting more bruxism. However, age, course of study, and academic level in the university were not significantly associated with bruxism [Table 1]. The reported patterns of bruxism were awake 69 (48.3%), nocturnal 22 (15.4%), and diurnal 52 (36.4%) [Table 2]. Bruxists and nonbruxists exhibited no significant difference in their satisfaction with dental appearance, perceived oral health, and oral health practices in this study [Table 3]. Anxiety/stress was reported by 29.9% of the participants. Bruxists (39.2%) significantly reported more anxiety/stress than nonbruxists (26.9%) (P = 0.005). Nail biting was reported by more than half (56.6%) of the participants. Bruxists (69.2%) indulged more in nail biting than nonbruxists (52.4%) (P = 0.001). About two-third (64.5%) of the participants reported biro chewing/biting. Bruxists significantly reported this habit more than the nonbruxists (P = 0.037).
|Table 3: Oral health practices, self-rated oral health and dental appearance satisfaction among bruxists and nonbruxists |
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Only 2.1% of the participants had ever used tobacco. Bruxists significantly indulged in tobacco use more than the nonbruxists (P = 0.004). Less than half (40.5%) of the participants had ever consumed alcohol. Bruxists significantly indulged in alcohol consumption more than the nonbruxists (P = 0.001) [Table 4].
A total of 9.5% of the participants reported tooth mobility. Bruxists (15.4%) reported more tooth mobility than nonbruxists (4.4%) (P = 0.006). Less than half (40.3%) of the participants reported shocking sensation. Overall, bruxists (53.8%) reported more shocking sensation than nonbruxists (35.9%) (P = 0.006). Chewing difficulty was reported by 6.7% of the participants and bruxists (11.2%) reported more chewing difficulty than nonbruxists (5.3%) (P = 0.015). TMJ noise/pain was reported by 5.4% of the participants and bruxists (30.4%) reported more TMJ noise/pain than nonbruxists (3.9%) (P = 0.007). Previous jaw injury experience was reported by 7.6% of the participants and bruxists (13.3%) reported more previous jaw injury experience than nonbruxists (5.7%) (P = 0.003) [Table 5].
| Discussion|| |
The self-reported prevalence of bruxism in this study was lower than the values reported among citizens of the island of Sardinia in Italy (27.2%),  residents of Beirut in Lebanon (33.9%),  and police officer in the Military Police of the State of São Paulo, Brazil (32.5%).  However, it was higher than 21.6% reported in Istanbul, Turkey,  and values in reports among American undergraduates (18.8%),  adult male Nigerian in Igbo-Ora (13.0%),  media personnel in Finnish Broadcasting Company (10.6%),  and Nigerian dental professionals (5.7%).  This may be due to the fact that undergraduates in a developing country undergo stress from academic activities, irregularities of amenities of the university and aspiration actualization anxiety. The role that psychological variables play in the development of this problem was also noted in this study as bruxists were significantly more anxious/stressed than nonbruxists (39.2% vs. 26.9%).
Males significantly reported bruxism more than females which were similar to report of study among Japanese working population  but contrasted with findings of a study in Istanbul, Turkey.  The mounted responsibilities and challenges facing males in paternalistic society such as Nigeria may explain this gender difference.
Awake bruxism was the dominantly reported pattern of bruxism in this study with males reporting more awake and diurnal bruxism and female reporting more nocturnal bruxism. Participants more than 21 years reported more awake and nocturnal bruxism, whereas those ≤21 years had more diurnal bruxism. Participants studying science-related and nonscience-related courses had nearly the same pattern of bruxism but those of lower academic level had more diurnal while those of higher levels had more awake and nocturnal.
Bruxism is a pathological activity of the stomatognathic system that involves tooth grinding and clenching during parafunctional jaw movements and a number of local, systemic, psychological, and hereditary etiological factors have been implicated.  Stress contributes etiologically to bruxism as bruxers report more symptoms of stress than the nonbruxers and overall stressful life events are associated with multiple parafunctional oral habits. , In this study, stress/anxiety was associated with bruxism which is consistent with the literature on state of anxiety and depression as antecedents of bruxism.  The explanation of the link between stress and bruxism may lie in previous reports that cited masticatory organ as an emergency exit during the periods of psychic overloading.  Bruxists reported higher history of jaw injury. Although the pattern of injury was not assessed in this study, the established relationship between occlusal discrepancy and bruxism may be the explanation. The prevalence of self-reported bruxism was associated with tooth loss, male, smoking, snoring, sleep talking, and a history of childhood teeth grinding.  Smokers had a 2.72-fold higher risk of bruxism than nonsmokers.  In this study, bruxists were more tobacco users and alcohol consumers and this concurred with Alves-Rezende et al.  report among Brazilian dental students. Bruxism is associated with oral complaints-related anxiety but not with more general oral health complaints (unhealthy gingiva, gingival bleeding, and canker sores).  This is in tandem with the findings of this study.
Tokiwa et al.  concluded that grinding patterns during sleep bruxism should be considered as a probable causative factor in the development of dental problems related to clinical attachment level, tooth mobility, noncarious lesion, and hypersensitivity. In this study, bruxists had significantly more shocking sensation than nonbruxists. This may occur due to the loss of tooth substance as dental attrition may differentiate self-reported bruxers from nonbruxer as posterior or anterior dental attrition, abfractions, and occlusal pits are associated with self-reported bruxism.  The excessive force of bruxism on diminuted crown of teeth from wear and fractures result in occlusal trauma manifesting as tooth mobility as noted in this study.
Parafunction is considered fundamental to early diagnosis of TMJ problems, which is the most useful way to avoid a dysfunctional state of the stomatognathic system.  Impaired general health and awareness of oral parafunctions have been reported to be related to the presence of severe TMJ.  Bruxism is one of the most prevalent predisposing factors of temporomandibular disorders.  In this study, 7.6% of participants reported TMJ noise/or pain experience. Bruxism was also found to be associated with chewing difficulty and TMJ noise/or pain. Similarly, a positive correlation between self-reported bruxism and self-reported jaw functional limitation has been reported.  The tissues of the masticatory system adapt to this bruxism behavior, but in some individuals, the capacity for adaption will be exceeded by the cumulative forces of this mandibular parafunctional behavior, resulting in pain and dysfunction of the masticatory system.  Previous report of sleep and wake-time parafunctions frequent association with signs and symptoms suggestive of temporomandibular disorders exist in the literature.  The excessive force on joint, retained lactic acid due to excessive muscle activity cause pain and also higher prevalence of incisor dentine wear suggestive of a forward mandible posture in bruxists contributes the temporomandibular disorders.  The association between bruxism, shocking sensation, tooth mobility, nail biting, chewing difficulty, anxious/stress, jaw injury, and joint noise/pain on mouth opening and/closing concurred with the need for multidisciplinary treatment plan for cases of bruxism. 
The report of this study may be limited by the fact it is solely on self-report as other objective methods of assessment of bruxism such as clinical oral examination and electromyography do exist. However, self-reporting is accepted mode of evaluation as it will help to establish if the problem exists and facilitates the utilization of other more objective evaluation methods.
| Conclusion|| |
Data from this study revealed that one out of every four studied participants is a bruxist. Etiological factors of bruxism in term of anxiety/stress, nail biting, tobacco use, alcohol consumption, previous jaw injury and its manifestations and complications of bruxism such as shocking sensation, tooth mobility, chewing difficulty, and TMJ noise/or pain were evident more in the self-reported bruxists. There is therefore a need for dentists to suspect bruxism in undergraduates presenting with oral health problems such as shocking sensation, tooth mobility, nail biting, chewing difficulty, anxiety/stress, jaw injury, joint noise and pain on mouth opening/closing, to give a holistic care.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]