Oral behaviors, bruxism, malocclusion and painful temporomandibular joint clicking: is there an association?

Abstract The present cross-sectional case-control study aimed to determine if there is an association between specific oral behaviors, sleep bruxism (SB), awake bruxism (AB), and painful temporomandibular joint (TMJ) clicking. Ninety individuals were dived into three groups; Group 1 (n = 30): painful TMJ clicking; Group 2 (n = 30): painless TMJ clicking; and Group 3 (n = 30): control group. The following clinical data were studied: oral behaviors (unilateral chewing, gum chewing, nail biting, foreign objects biting, leaning with jaw against the hand, and sleeping in a position that pressures the jaw), SB, AB (including the frequency in 10 days, evaluated by ecological momentary assessment), and malocclusions investigated based on clinical inspections (anterior open bite, posterior cross-bite, abnormal overbite/overjet, occlusal guidance, mediotrusive and/or laterotrusive interferences, retruded contact position to maximum intercuspation slide, missing posterior teeth). All statistical tests (Kolmogorov-Smirnov, chi-square, and one-way ANOVA) were performed with a 5% significance level. Group 1 had the highest frequency of and a significant association with leaning with jaw in the hand, sleeping position that pressures the jaw, gum chewing, nail biting, and AB (p<0.05). Gum chewing, nail biting, and AB were associated with Group 2 only when compared to Group 3 (p<0.05). No significant difference among groups was found for other behaviors (unilateral chewing and foreign objects biting), SB, and all malocclusions (p>0.05). It can be concluded that patients with painful TMJ clicking had a higher frequency of and a significant association with some specific harmful behaviors and AB.摘要 本横断面病例对照研究旨在探讨特定口腔行为、睡眠磨牙症（sleep bruxism, SB）、清醒磨牙症（awake bruxism, AB）与疼痛性颞下颌关节（temporomandibular joint, TMJ）弹响之间的关联。本研究共纳入90名受试者，分为三组，每组各30例：组1（n=30）为疼痛性TMJ弹响组，组2（n=30）为无痛性TMJ弹响组，组3（n=30）为对照组。本研究分析的临床资料包括：口腔行为（单侧咀嚼、嚼口香糖、咬指甲、咬异物、用手托颌以及睡眠时压迫颌部的睡姿）、SB、AB（含10天内的发作频率，通过生态瞬时评估法进行评测），以及基于临床检查的错𬌗畸形（包括前牙开𬌗、后牙反𬌗、异常覆𬌗/覆盖、咬合引导、非工作侧和/或工作侧咬合干扰、后退接触位至牙尖交错位的滑动、后牙缺失）。所有统计学检验（Kolmogorov-Smirnov检验、卡方检验、单因素方差分析）均以5%作为显著性水准。结果显示，组1出现用手托颌、压迫颌部的睡姿、嚼口香糖、咬指甲及AB的频率最高，且与上述因素存在显著关联（p<0.05）。仅当与组3比较时，组2的嚼口香糖、咬指甲及AB才表现出显著关联（p<0.05）。其余口腔行为（单侧咀嚼、咬异物）、SB以及所有错𬌗畸形在三组间均无显著差异（p>0.05）。综上可得出结论：疼痛性TMJ弹响患者存在更多特定有害口腔行为及AB，且二者存在显著关联。