Temporo-Mandibular Disorders and bruxism among social phobia outpatients

BACKGROUND: Anxiety and selective serotonin reuptake inhibitor (SSRI) therapy are both considered aggravating factors for awake and sleep-bruxism and clenching. The relationship between anxiety and bruxism is mostly based on data collected from non-clinical populations, although some data are available on medicated schizophrenia patients. Objectives: To evaluate the presence of Temporomandibular Disorders and bruxism among people with SP compared with age and gender matched control group without a mental disorder. The working hypotheses were that SP patients would present a higher prevalence of bruxism, and a positive relation would be found between the severity of the SP and the presence of TMD/bruxism METHODS: Participants included SP outpatients who were either drug naïve or treated with SSRIs, and healthy individuals (N=23, 17, 33, respectively). A structured diagnostic interview was used for psychiatric diagnosis, and Leibowitz Social Anxiety Scale (LSAS) and Beck Depression Inventory (BDI) for assessing the severity of SP and depression. TMJ status and oral parafunctional activity (PF) was evaluated using a validated questionnaire and dental examination. RESULTS:Awake-bruxism (OR=23.7, 95%CI=2.94-190.6 ,p=0.03), "Jaw Play" (OR=3.5, 95%CI=1.01-12.03, p=0.04), the presence of at least one PF (OR=5.8, 95%CI=1.83-18.6 ,p=0.003 ), as well as disc displacement (p=0.047) and an inclination (p=0.077) towards sleep-bruxism, were all more prevalent in SP patients than in control subjects. Drug-naive and SSRI-treated SP patients did not differ on any of the demographic, clinical and TMJ measures. Severity of social anxiety score, but not depression, robustly predicted the presence of PF (p<0.002). CONCLUSIONS: Social anxiety, but not depression severity, is associated with higher risk of oral awake movements and bruxism. 1. Chronic SSRI treatment of SP did not affect bruxism. 2. Patients of both anxiety and dental clinics may benefit from denture and anxiety screening tools. 5. Effective treatment of SP may mitigate bruxism.