Accepted Manuscript

Title: Personality traits and dental anxiety in self-reported

bruxism. A cross-sectional study

Authors: J. Montero, C. Gómez-Polo

PII: S0300-5712(17)30160-4
DOI: http://dx.doi.org/doi:10.1016/j.jdent.2017.07.002
Reference: JJOD 2802

To appear in: Journal of Dentistry

Received date: 19-1-2017

Revised date: 27-6-2017
Accepted date: 1-7-2017

Please cite this article as: Montero J, Gómez-Polo C.Personality traits and
dental anxiety in self-reported bruxism.A cross-sectional study.Journal of Dentistry
http://dx.doi.org/10.1016/j.jdent.2017.07.002

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Personality traits and dental anxiety in self-reported bruxism. A cross-sectional study

SHORT TITLE: Personality Profile and dental anxiety of bruxers

Montero J1, Gómez-Polo C2.

1 Javier Montero. DDS. PhD in Dentistry. Tenured Lecturer in Prosthodontics Department of

Surgery. Faculty of Medicine. University of Salamanca. Campus Miguel de Unamuno. PC:

37007. Salamanca. Spain. javimont@usal.es.

2 Cristina Gómez-Polo. PhD in Dentistry. Associate Professor in Prosthodontics Department of

Surgery. Faculty of Medicine. University of Salamanca. Campus Miguel de Unamuno. PC:

37007. Salamanca. Spain. crisgodent@hotmail.com.

Correspondence to:

Dr. Javier Montero PhD in Dentistry. Graduate in Odontology. Tenured Lecturer of

Prosthodontics. Clínica Odontológica. Facultad de Medicina. C/ Alfonso X el Sabio S/N.

Campus Miguel de Unamuno. PC: 37007. Salamanca. Spain. Phone: 0034 923291996 Fax:

0034 923294868

ABSTRACT

OBJECTIVES: The aim of this study was to investigate the association between psychological

factors (Personality and Dental anxiety) with self-reported bruxism-related symptoms.

METHODS: 526 subjects, over 18 years old and not seeking dental treatment, were recruited

from the families and acquaintances of dental students from the University of Salamanca.

Bruxism activity was estimated by means of a six-item questionnaire aimed at recording

common bruxism-related symptoms and clenching/grinding awareness. The Spanish version of

the modified dental anxiety scale (MDAS) was used to determine the level of anxiety perceived

in 5 typical scenarios of dental assistance. The NEO-FFI inventory was applied to assess

personality profiles associated with 5 different factors (neuroticism, extroversion, openness,

agreeableness, and conscientiousness). Pearson correlations, Student T-tests, and logistic

regression modelling were used for the statistical analyses.

RESULTS: Thirty-five point nine percent of this adults sample was classified as being bruxers,

where sleep bruxers comprised more than half of the sample at 20.2%. Bruxers tended to

perceive more anxiety in all of the situations included within the MDAS, where they exhibited a

higher level of phobia towards the teeth scaling and local anaesthetic injection. The risk of being

considered a bruxer is reduced with age (OR: 0.99), and increases proportionally for some

personality traits, such as neuroticism (OR: 1.06) and extraversion(OR: 1.04), to the MDAS total

score (OR: 1.08) and in smokers (OR: 1.61), after controlling for all potentially confounding

factors.

CONCLUSIONS: Self-reported bruxism is significantly associated to several personality traits

(mainly neuroticism and extraversion) and to the level of dental anxiety (MDAS score).

Clinical significance: Clinicians should be aware of the typical psychological profiles of

patients who experience bruxism and the relationship with dental phobias.

Keywords: self-reported bruxism, personality traits, dental anxiety, NEO-FFI, MDAS.

INTRODUCTION

Bruxism is an oral condition of great interest to researchers, clinicians and patients in the dental,

neurological and sleep medicine domains. According to Lobbezzo et al. [1] bruxism is a

repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by

bracing or thrusting of the mandible. Bruxism has two distinct circadian manifestations: it can

occur during sleep (indicated as sleep bruxism) or during wakefulness (indicated as awake
bruxism).

To date, the aetiology of bruxism has not been completely determined, but there is consensus

about its multifactorial nature. In the past, peripheral factors like occlusal discrepancies or

several morphological deviations in the orofacial region were considered capable of initiating

and perpetuating non-functional masticatory movements that try to minimize the impact of such

anomalies in the stomatognathic system [2]. However, such factors are now known to play only

a minor role, if any. Nowadays, the focus is centred on causes related to pathophysiological and

psychological factors.

Recent works [2-5] support the idea that some psychological factors, such as personality and

stress, could modulate the occurrence and severity of such parafunctional behaviour. In the

classical study by Ramfjord published in 1961, [6] the role of “neurotic tensions” in the aetiology

of bruxism was determined. Latter Olkinuora [7] demonstrated that bruxers were emotionally

out of balance and that they tended to develop more psychosomatic disorders, because their

personality profile was characterized by perfectionism and an increased tendency towards

anger and aggression.

In 1993, Fisher & O'toole reported that [8] the personality of bruxers differed significantly from

non-bruxers. In general, it was observed that chronic bruxers are shy, stiff, cautious, and aloof,

preferring things rather than people, avoiding compromises, rigid in their ways, affected by

feelings of inferiority, impeded in expressing themselves, apprehensive, and given to worrying.

A few years later Kampe et al. observed that bruxers, in terms of personality, tended to score

higher in somatic anxiety and muscular tension and lower in socialization [9].

A recent systematic review focussing on the role of psychological factors in the aetiology of

bruxism in adults reported the major personality traits that characterize bruxers (eg,

aggressiveness, neuroticism, perfectionism, and stress sensitivity), occurring mainly during

wakefulness [10]. Thus, the idea than not all types of personalities are equally susceptible to the

bruxism disorder seems to be supported by the literature.

Personality can be defined as the dynamic organization of the psychobiological systems that

modulate adaptation to changing environments through several personality traits, which are

long-lasting patterns of how we perceive, relate to, and think about oneself, other people and
the world as a whole [11]. Since bruxism is likely to be a result of emotional tension and

psychosocial disorders that force the subject to respond with a prolonged contraction of his/her

masticatory muscles [10], it could be argued that some personality traits, such as neuroticism,

extraversion, and conscientiousness may underlie the behaviour related to bruxism. In addition,

more anxiety and phobias have been reported in association with bruxism [12].

Nowadays, there is a lack of research that focuses on evaluating the global personality profile

and the level of dental anxiety among bruxers. The present study aims to assess the

association between psychological factors (Personality and Dental anxiety) with self-reported

bruxism-related symptoms.

METHODS

A cross-sectional study was carried out on five hundred and twenty-six subjects, over 18 years

old and not seeking dental treatment, which were recruited using a snowball technique from the

families and acquaintances of dental students from the University of Salamanca during the

Christmas holidays in 2015. Students were instructed to collect data from both gender and from

distinct age intervals in order to have a broad spectrum of age with balanced gender. A written

informed consent was obtained from all individual included within the study, in accordance with

the Bioethics Committee of the University of Salamanca. The sample size was estimated for

detecting significant differences in personality scores using the t-test for independent groups,

with a power of 95% and a significance level of two-side alpha=0.05, using the data dispersion

values from the first 100 subjects of the pilot study (2 units of mean differences and 7 units of

common standard deviation), resulting in a minimum of 320 subjects for such bivariate analysis.

But in order to maintain enough effective sample size with which to explore the multi-factorial

nature of the personality among self-reported bruxers and also for compensating missing data

we decided to over recruit the initial sample. In the 526 subjects that comprised the main study,

were already included the initial 100 subjects of the pilot study. The final response rate of this

survey was 92%.

For all participants, sociodemographic (age, gender, education, and etc.) and behavioural data

(brushing habits, smoking and dental attendance patterns) were collected in a face-to-face

interview performed by the dental students. Moreover, the prosthodontics status, the number of
standing teeth and occlusal units were registered by inspection, for capturing clinical variables

that could be potentially related with the psychological background or with the awareness of

bruxism or acting as confounding factors for the logistic regression analyses. Given the

simplicity of such exploration and that all the students were trained with this methodology from

the clinical practices, no calibration was made. Additionally, a self-completed questionnaire,

consisting of several items regarding bruxism-related symptoms, dental anxiety and personality

traits, was also obtained from all participants. The various sections within this questionnaire are

described in the following paragraphs.

Bruxism activity was estimated by means of a six-item questionnaire with good face and content

validity [13], which was previously used by Pintado et al. for similar studies [14]. The items were

answered dichotomically with either a ‘yes’ or a ‘no’. The patients were instructed to answer

‘yes’ only if they considered that their habit was frequent enough to be clinically relevant (i.e.

more frequent than 3x/week and/or several hours per day).

Subjects classified as bruxers gave a positive response to at least two of the following six

items:


1. Has anyone heard you grinding your teeth at night?

2. Is your jaw ever fatigued or sore on awakening in the morning?


3. Are your teeth or gums ever sore on awakening in the morning?


4. Do you ever experience temporal headaches on awakening in the morning?


5. Are you ever aware of grinding your teeth during the day?


6. Are you ever aware of clenching your teeth during the day?

Among bruxers we distinguished between diurnal and nocturnal activities based on the bruxism-

related symptoms. Hence we considered awake bruxers if at least one of the affirmative

responses to the questionnaire was in the items 5 or 6; whereas the sleep bruxers were those

subjects whose all the affirmative responses were in the items 1-4.

The Spanish version of the Modified Dental Anxiety Scale (MDAS) was used to determine, on a

5-point Likert scale format (not anxious=1 to extremely anxious=5), the level of anxiety

acknowledged by subjects in the 5 common situations during dental office assistance. [15]. To
do this, two scoring strategies were used. The total score was obtained by adding up all of the

item responses, as recommended by the developers of the MDAS_TS. In addition, we also

counted the number of items recorded as very anxious or extremely anxious (coded as 4 and 5,

respectively) in order to obtain a useful quantitative variable proportional to the level of dental

anxiety (MDAS_SC).

For the global personality assessment, the Spanish Version of the NEO-FFI inventory (60-items)

was applied to identify the participants’ personality profiles [16]. It was derived from a factor

analysis on the scores of the original extended inventory (240 items) developed by Costa &

McCrae [17]. The 60 items were divided conceptually into 5 factors (neuroticism, extroversion,

openness, agreeableness and conscientiousness), which are widely accepted as the five basic

domains of the human personality.

These five relatively independent personality dimensions are Neuroticism (i.e. a predisposition

towards negative affect expressed through anxiety, depression and hostility), Extroversion (i.e. a

desire for both a greater quantity and intensity of interpersonal interaction), Openness (i.e. a

tendency to seek new experiences and perspectives), Agreeableness (i.e. a perspective that

emphasizes positive qualities in others and offers an accommodating social presence), and

Conscientiousness (i.e. a quality associated with persistence and attention-to-detail in goal-

directed behaviors).

The responses were coded on a 5-point Likert scale (from strongly disagree=1 to strongly

agree=5). For each factor, the additive score was calculated by adding up the response codes

coherently oriented towards the trait being assessed (because some items were inversely set).

The potential range of scores of each domain was 0 to 48 points and the average of scores was

calculated within subgroups. The higher the scores on a give domain the stronger the

personality trait.

The inter-group comparisons for qualitative (nominal and ordinal) and quantitative variables

were done using the Chi-squared test and ANOVA test with Post Hoc Bonferroni correction,

respectively. Using Pearson coefficients, we studied the linear relationship between the scores

obtained for bruxism symptoms, anxiety and personality. Finally, we calculated a forward
stepwise logistic regression model as a function of all of the sociodemographic, behavioural and

clinical and personality-related variables for predicting the risk of being a self-reported bruxer.

The predictive capacity of the model was calculated with the R2 of Nagelkerke.

The Statistical Package for the Social Sciences v.20. (SPSS Inc., Chicago, IL) was used for the

statistical analyses. The cut-off level for statistical significance was 0.05. We used the STROBE

guidelines for reporting this study.

RESULTS

As depicted in Table 1, the sample was comprised of adults aging between 18-94 years old

(mean age=43.7±19.0 years), equally distributed by gender, with a high educational level

(51.1% university degrees), and living in urban areas (65.4%). In terms of behavioural traits,

77% of the sample was non-smokers, generally showed good oral health habits (71.1% brushed

their teeth at least twice a day), and 42.4% regularly visited the dentist (Table 1). Regarding the

prosthodontics status, the majority of the sample did not wear any type of dental prosthesis

(65.2%) and on average had 11.5±4.1 occlusal units (antagonistic fixed teeth in contact during

the maximal intercuspal position).

In Table 2, the responses regarding the self-reported bruxism activities and strategies are

depicted. The most prevalent activities identified from the 6-item questionnaire for assessing

bruxism were: item nº6: clenching the teeth during the day (30.2%) and item nº4: experiencing

temporal headaches on awakening in the morning (27.6%). According to these responses,

35.9% of the sample was classified as being bruxers, and in particular sleep bruxers (20.2% of

the sample). Among the bruxers, 70% believed that their symptoms were stress-related and

21.7% had worn occlusal splints, which are mostly effective at reducing related symptoms

(78%). More than 60% of the bruxers acknowledged that they had teeth and joint damage due

to bruxism activity, but only 22.8% of them recognised the need for treatment.

Regarding the psychological factors behind bruxism, Table 3 shows that the bruxers’ personality

scores were significantly higher in neuroticism, extraversion and openness and lower in

conscientiousness. Except for conscientiousness no significant differences were found in the

average scores of the personality traits between awake and sleep bruxers. Moreover, the

number of items recorded as very or extremely anxious was higher among sleep bruxers for the
MDAS (1.1±1.5) than non bruxers (0.7±1.3). In addition the sleep bruxers tended to perceive

more anxiety in all the MDAS situations, with a phobia towards the teeth scaling and local

anaesthetic injection being significantly more prevalent. Furthermore, smoking was significantly

more common in bruxers (29.6%) than in non-bruxers (19.6%).

By means of Pearson’s coefficients it was observed that the number of self-reported symptoms

(depicted in Table 2) was significantly correlated with neuroticism (r=0.25;p<0.001), openness

(0.11; p<0.01), agreeableness (r=-0.10; p<0.05), conscientiousness (r=-0.11; p<0.05), the

MDAS-TS(r=0.09; p<0.05) and the MDAS-SC (r=0.12; p<0.01).

The logistic regression model highlighted that the risk of being classified as a bruxer was

reduced with age, and increased proportionally with some personality traits, such as neuroticism

and extraversion, in relation to to the MDAS total score, and in smokers, after controlling for all

potentially confounding factors (Table 4).

DISCUSSION

This study assesses the psychological background (Personality/Anxiety) of self-reported

bruxism, which is an emerging line of research that focuses on the central causes of bruxism, as

has been recently highlighted [2, 10]. However, to date, there is still a need for researchers to

identify the personality traits associated with individuals who perceive they suffer from bruxism-

related symptoms.

Although, the cross-sectional design of this study did not allow conclusions to be drawn

regarding the causal relationship between psychological factors and self-reported bruxism, this

work carried out on a large convenience sample might contribute to the understanding of the

association between personality, anxiety and self-reported bruxism. In addition, the existence of

some shared pathogenetic pathways has been previously reported elsewhere [18].

We decided to over recruit the sample, because since this is an exploratory study then the

bigger the sample the clearer the picture of the potential predictors or confounders of the

multifactorial construct associated with the self-reported bruxism. With the snowball technique

the oversampling is a common event that increases the analytic power. We think that the

snowballing recruitment technique is a cost-effective method for cross-sectional studies with

exploratory purposes.

To our knowledge this is one of the first studies assessing the personality of self-reported

bruxers by using a widely accepted questionnaire based on the five-factor domains universally

accepted in differential psychology [19]. The NEO-FFI has been translated into several different

languages and is known to be valid and applicable to a number of different contexts, according

to McCrae & Costa [20], being currently considered the gold standard for assessing the

personality of the human being. This self-completed inventory of 60 items provides a quick,

reliable, and accurate assessment of the five personality domains and is particularly useful

when global information on personality is needed. The data obtained from our study are in

agreement with data reported for the distinct personality domains in the Spanish validation study

[19], in which neuroticism had an average score of 20.5±7.5, agreeableness: 30.0±5.9,

conscientiousness: 30.5±6.6 and extraversion: 31.7±6.7. However, in the reference study [19]

reported a higher level for openness with an average score of 28.3±6.7, among the Spanish

general population [19]. This difference in openness could be due to the socio-educational

profile of the sample. In the reference population study the sample was younger and belonged

to a higher educational level, where 65% of the sample was university students, and 27% were

health education professionals (i.e. working face-to-face with customers/users).

Here, we have observed, after applying logistic regression, that the level of neuroticism and

extraversion is proportional to the risk of becoming a bruxer (Table 4). The neurotic profile of

bruxers has already been described by classical studies decades ago, [6, 7] where the term

“neurotic tensions” was associated with the etiopathology of bruxism. However, in contrast to

what has been proclaimed by authors such as Fisher & O'toole, [8] who reported that chronic

bruxers achieved lower scores in interpersonal warmth and boldness, and higher scores for

insecurity and tension, we have observed that self-reported bruxers are significantly more

extroverted. Specifically, we have observed that in general bruxers tend to experience a higher

level of joy and excitement when chatting in social relationships. Conversely, Fisher & O'toole

[8] found that bruxers tended to worry with feelings of anxiousness, guilt, and tension.

Furthermore, according to our linear correlation analysis, it was detected that the number of

bruxism-related items and the level of openness are significant and directly correlated, which
implies that bruxers are more open-minded, have greater intellectual or artistic interests and are

less bored. Future studies are needed to address these contradicting results, although, several

hypotheses could be raised to explain this discrepancy. Probably, the most plausible

explanation for this finding could rely on the fact that Fisher & O’toole clinically assessed

bruxism primarily on chronic periodontal patients [8]. They determined the bruxism based on the

specific history of pain and dysfunction, awareness of the bruxism and the objective abrasion of

tooth surfaces [8]. Hence, it might be argued that patients classified in their study as chronic

bruxers, had suffered from higher levels of chronic pain/dysfunction and presented more

evidently worn teeth. It has been clearly determined that patients of chronic pain have higher

anxiety, depression, and as a consequence developed less facets of extraversion and

openness [21]. It seems plausible to presume that there exists a higher social impact on chronic

patients with evidently worn teeth than those without this condition. Therefore, bruxing should

be conceived as an expressive neurotic behaviour that reveals conflicting feelings of those who

manifest it, and ultimately, as a peculiar type of coping with stressful events.

Regarding the bruxism diagnosis methodology, it should be mentioned that there are various

ways to assess bruxism activity; while questionnaires are the most commonly used method and

are mainly carried out within large sample populations. Although there is a lack of universally

accepted criteria for the diagnosis of bruxism, [22] a simple questionnaire based on yes or no

answers about the participants’ awareness of bruxism has been frequently used in

epidemiological studies [23]. In this study we used the typical set of six items with the same

dichotomous response that was initially used by Pintado et al., [14] and later by other authors

[24] for detecting bruxers.

However, one must bear in mind that in this study we only detected possible bruxers according

to a recent international consensus, which suggests that a diagnostic grading system of

“possible”, “probable”, and “definite” sleep or awake bruxism should be adopted for clinical and

research purposes, depending on the methodology applied [1]. Self-reported bruxism by means

of a questionnaire and/or the anamnestic part of a clinical examination would only detect

“possible” sleep or awake bruxism, while “probable” sleep or awake bruxism should be based

on both self-reported bruxism and the specific clinical examination [1]. The “definite” sleep or

awake bruxism would also require a polysomnographic or electromyograhic assessment,

respectively [1]. The accuracy of these diagnostic methods is unclear, (sensitivity and

specificity) but we believe that for the investigative purposes of this study, the questionnaire-

based assessment would present greater sensitivity and lower specificity than exhaustive

clinical assessments, because anamnesis is the first step in diagnosing possible bruxism (high

sensitivity tool) that should be latter confirmed by more specific assessments (oral examination,

electromyography, polysomnography…)[1]. However, the awareness of the bruxism needs to be

explored in future studies, where self-reported bruxism is complemented with other specific

clinical assessments in order to confirm the possible cases and types of bruxism.

In this study we have found that both awake and sleep bruxers share a comparable personality

profile, despite they are currently considered distinct entities (i.e. awake bruxism being an oral

habit; and sleep bruxism being a sleep disorder). Our findings support the current theory that

characterises bruxism as a multifactorial disorder, which may share some neurological deficits

with other centrally mediated conditions. Our results are in agreement with those obtained in a

recent study performed on Turkish adults, which found that bruxers differed significantly in terms

of depression, anxiety, hostility, phobic anxiety, paranoid ideation, and other psychological-

related attributes [25]. Other authors have revealed that mood disorders are more prevalent

among bruxers [26], suggesting that bruxers are probably chronic worriers.

Additionally, there is evidence regarding the effect of gender on dental attrition, where males

have a higher risk than females of tooth wear [27]; however, a recent systematic review stated

that bruxism activities are unrelated to sex, but are related to a decrease associated with age

[28]. We agree with the abovementioned statement, since we found, within a logistic regression

model, that the prevalence of bruxism activity decreased with age, but was unrelated to gender

(Table 4).

Regarding the association of bruxism and dental fear, we found that bruxers reported

significantly higher anxiety according to the MDAS [15]. Recently Winocur et al. demonstrated a

significant association between bruxers and dental fear among 480 Israeli adults, using the

same methodology (i.e. questionnaire-based determination of bruxim and dental anxiety) [29].

The rationale of this association may rely upon the fact that personality modulates all human

behaviour and that specifically, the level of neuroticism increases emotional stress
(susceptibility to negative emotions). Neuroticism is quite likely to disturb the quality of sleep

during the night among sleep bruxers [18] and could therefore increase the parafunctional

activities during the day for awake bruxers [4].

An important fact, which should be taken into account before the interpretation of our findings, is

that the level of neuroticism-related traits may bias the self-reported health or symptoms

assessment, since it is proportional to the susceptibility to experiencing negative emotions [30].

Therefore, since we estimated bruxism based on a self-completed questionnaire, it may be

plausible that the strong association found between several personality traits and bruxism would

be reduced if a confirmatory assessment of bruxism had been implemented.

All the psychological factors analysed in this study came directly from the subjects, whose

perceptions regarding personality traits and bruxism-related symptoms have demonstrated a

significant and strong association. We are well aware that the information gathered by some

personality profiles might be altered (overscored or underscored), but in this study we wanted to

capture the subjects’ own perception of themselves, rather than a clinical-based rating, in order

to visualize and quantify this association. A major limitation might come from the fact that

bruxism could be a considered a subconscious disorder that may not be accurately reflected

using self-assessment. It should also be acknowledged that the convenience sample used for

this study may be adequate for exploring the potential associations and to create hypothesis on

which future works might be based, but it is not representative of the general population, and

thus all the associations and scores reported here should be taken with caution.

CONCLUSIONS

Self-reported bruxism is significantly associated to several personality traits (mainly neuroticism

and extraversion) and to the level of dental anxiety (assessed by the MDAS score).

ACKNOWLEDGEMENTS

-Conflict of Interest: Montero J declares that he has no conflict of interest. Gómez-Polo C

declares that she has no conflict of interest.

-Funding: The work was supported by Advances in Oral Health Group of the University of

Salamanca (Spain).
-Ethical approval: All procedures performed in this study were in accordance with the ethical

standards of the institutional and/or national research committee and with the 1964 Helsinki

declaration and its later amendments or comparable ethical standards.

-Informed consent: Informed consent was obtained from all individual participants included in

the study.
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 Table 1. Sociodemographic, behavioral and clinical description of the study
sample (n=526)

SOCIODEMOGRAPHICS Mean SD
Age(years) 43.7 19.0
Age groups N %
<=34 years 210 39.9
35-64 years 236 44.9
>=65 years 80 15.2
Gender
Women 262 49.8
Men 264 50.2
Educational level
Secondary School 130 24.7
High School 127 24.1
University 269 51.1
Residence
Urban 344 65.4
Rural 182 34.6
Behaviour N %
Brushing
once/day 152 28.9
twice or more/day 374 71.1
Smoking habit
yes 121 23.0
no 405 77.0
Visits to dentist
Regular 223 42.4
Problem-based 303 57.6
Clinical Variables N %
Prosthodontic Status
Complete Denture 37 7.0
Removable Partial Dentures 48 9.1
Tooth-supported fixed partial dentures 98 18.6
Natural dentition 343 65.2
Occlusal status Mean SD
Number of Standing teeth in maxilla 12.1 3.9
Number of Standing teeth in mandible 12.2 3.7
Number of Occlusal Units 11.5 4.1
Table 2. Description of the bruxing activity and the symptoms management in the
study sample (n=526)

Anamnestic Questionnaire Regarding Bruxing Activity Prevalence

of affirmative
respondents
Self-report Bruxism according to Pintado et al [14] N %
1. Has anyone heard you grinding your teeth at night? 110 20.9
2. Is your jaw ever fatigued or sore on awakening in the morning?
 127 24.1
3. Are your teeth or gums ever sore on awakening in the morning?
 123 23.4
4. Do you ever experience temporal headaches on awakening in the 145 27.6
morning?
5. Are you ever aware of grinding your teeth during the day? 58 11.0
6. Are you ever aware of clenching your teeth during the day?
 159 30.2
Prevalence of Self-reported Bruxim N %
Non Bruxers (less than two affirmative items) 337 64.1
Mild Bruxers (two or three affirmative items) 113 21.5
Hard Bruxers (4-6 affirmative items) 76 14.4
Type of Self-reported bruxism N %
Non bruxers 337 64.1
Awake bruxers (affirmative responses including items nº 5 or nº 6) 83 15.8
Sleep bruxers (only affirmative responses to items nº1-4) 106 20.2
Symptoms management strategies in bruxers (n=189)
Do you know the occlusal splint for reducing such symptoms? 111 58.7
Drugs intake for reducing such symptoms 22 11.6
Perceived Treatment needs 43 22.8
Do you believe your symptoms are Stress-related 133 70.4
Which tissues are being damaged because of the bruxism activity
Teeth 129 68.3
Joint 114 60.3
Gums 77 40.7
Have you ever wear an occlusal splint 41 21.7
If Yes, Was it effective in reducing your symptoms? 32 78.0
 Table 3. Description of the personality traits and the dental anxiety status in bruxers
and non-bruxers

Non-Bruxers Awake Bruxers Sleep Bruxers

(n=337; 64.1%) (n=83; 15.8%) (n=106; 20.2%)
PERSONALITY TRAITS Mean sd Mean sd Mean sd
NEUROTICISM†† (a,b/a,c) 18.7 7.4 22.0 7.9 21.2 7.0
EXTROVERSION† 29.9 7.2 31.6 8.0 31.0 7.1
OPENNESS†(a,c) 24.5 7.7 26.2 8.2 26.4 7.9
AGREEABLENESS 31.0 6.6 30.4 7.0 30.2 6.8
CONSCIENTIOUSNESS††(a,c/b,c) 32.2 6.8 32.3 6.8 29.3 6.4
DENTAL ANXIETY Mean sd Mean sd Mean sd
MDAS-TS (Total score by 10.8 4.7 11.1 5.0 11.8 5.1
summing items codes)
MDAS-SC: (number of items 0.7 1.3 0.8 1.5 1.1 1.5
reported as very or extreme
anxious) †(a,c)
Prevalence of extreme N % N % N %
anxiety within the following
situations of the MDAS
Going for dental treatment 25 7.4 8 9.6 14 13.2
Sitting in the Waiting Room 32 9.5 9 10.8 16 15.1
Drilling a Tooth 80 23.7 25 30.1 33 31.1
Scaling and polishing teeth* 30 8.9 8 9.6 19 17.9
Injecting local anaesthesia* 65 19.3 18 21.7 33 31.1
* Statistically significant comparisons after Chi Square tests (p<0.05)
** Statistically significant comparisons after Chi Square tests (p<0.01)
†Statistically significant inter-group comparisons according to ANOVA test (p<0.05)
††Statistically significant inter-group comparisons according to ANOVA test (p<0.01)
(a,b,c) These letters besides the symbol † indicate the subgroups (a=Non-bruxers; b=Awake-bruxers; c=Sleep-bruxers) that are
statistically different after Post Hoc Bonferroni correction.
Table 4. Logistic regression model (forward stepwise) for predicting the risk of being classified
as bruxer after including all the potential predictors (sociodemographic, behavioural, clinical
and personality-related)

Parameters β p-value OR CI-95% OR

Lower Upper
Age -0.01 0.036 0.99 0.98 0.99
Neuroticism Score 0.06 0.0001 1.06 1.03 1.09
Extraversion Score 0.03 0.016 1.04 1.01 1.06
MDAS Total Score 0.08 0.035 1.08 1.01 1.16
Smoker 0.48 0.029 1.61 1.05 2.48
Chi: 42.75, df:5; p-value<0.001. R2 de Nagelkerke=0.11