RESUMO

BACKGROUND: Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes. AIM: To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents. DESIGN: A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis. RESULTS: PSB and PAB are related to each other, with moderate and positive correlation (ß = .390). Poor sleep quality and higher household income had a direct effect on both PSB (ß = -.138; ß = .123, respectively) and PAB (ß = -.155; ß = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (ß = -.102). Adolescents that drool on the pillow (ß = .184) and/or have agitated sleep (ß = .104) tend to have PSB. CONCLUSION: Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

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RESUMO

O bruxismo do sono tem etiologia multifatorial e pode estar associado ao uso de smartphones. O objetivo deste estudo transversal foi avaliar a associação do provável bruxismo do sono relacionado à atividade de ranger os dentes (PBS-R) com características de uso do smartphone em adolescentes. O Comitê de Ética em Pesquisa institucional aprovou o estudo (CAAE: 91561018.5.0000.5149), realizado com adolescentes de 12 a 19 anos, de escolas públicas e privadas de Belo Horizonte. Os pais responderam a um questionário com informações sociodemográficas e uso de medicamentos do filho. Os adolescentes responderam a um questionário com dados sobre características do sono, auto relato do bruxismo do sono, satisfação de vida e o uso de smartphone. Posteriormente, foram examinados nas escolas por uma pesquisadora calibrada, para avaliar a presença de sinais e sintomas intraorais (desgaste dentário por atrição, língua edentada, linha alba) e extraorais (selamento labial, dor à palpação dos músculos masseter e temporal bilateral; estalido/desvios na articulação temporomandibular), associados ao PBS-R. Como variáveis de confusão avaliou-se a satisfação de vida, através da Escala Multidimensional de Satisfação de Vida para Adolescentes (EMSVA) e a postura cervical anteriorizada, por serem fatores, encontrados na literatura, associados tanto à atividade do PBS quanto ao uso do smartphone. A postura cervical foi avaliada através da fotogrametria digital, para determinar o ângulo craniovertebral (ACV). As fotografias foram analisadas através do software SAPO®, para mensurar a alteração postural. O PBS-R foi categorizado através de uma escala de gravidade em leve, moderado e grave. Análises descritivas e regressão hierárquica de Poisson foram realizadas (p<0,05). Quatrocentos e três adolescentes, com média de idade de 14,4 anos (+1,60) participaram do estudo, sendo que 234 (58,1%) eram meninas e 99,7% tinham smartphone próprio. A prevalência de PBS-R foi de 20,1%. Para regressão multivariada de Poisson, o modelo hierárquico final ajustado, demonstrou que o PSB-R não foi associado ao uso de smartphone e que adolescentes que relataram má qualidade do sono (RP = 3,001; IC = 1,439-6,256; P = 0,003) apresentaram maior gravidade de PBS-R. Concluiu-se que o uso de smartphone não foi associado ao PBS-R, e que esta condição apresentou maior gravidade entre adolescentes com relato de pior qualidade do sono.

Sleep bruxism has a multifactorial etiology and may be associated with the use of smartphones. The aim of this cross-sectional study was to evaluate the association of probable sleep bruxism related to teeth-grinding activity (PSB-G) with smartphone use characteristics in adolescents. The Institutional Research Ethics Committee approved the study (CAAE: 91561018.5.0000.5149), conducted with adolescents from 12 to 19 years old, from public and private schools in Belo Horizonte. Parents answered a questionnaire with sociodemographic information and medication use of their child. The adolescents answered a questionnaire with data on sleep characteristics, self-reported sleep bruxism, life satisfaction and smartphone use. As confounding variables, life satisfaction was assessed using the Multidimensional Life Satisfaction for Adolescents Scale (MLSAS), anterior cervical posture and self-reported sleep quality, as these are factors found in the literature, associated with both PSB activity and the use of the smartphone. Subsequently, they were examined in schools by a calibrated researcher to assess the presence of signs and symptoms associated with PSB-G, intraoral (attrition, edentulous tongue, linea alba) and extraoral (lip sealing, pain on palpation of the masseter and temporalis bilateral muscles; click / deviations in the temporomandibular joint). PSB-G was categorized using a severity scale as mild, moderate and severe. Cervical posture was assessed by digital photogrammetry to determine craniovertebral angle (CVA). The photographs were analyzed using SAPO® software to measure postural change. Descriptive analyzes and Poisson hierarchical regression were performed (p <0.05). Four hundred and three adolescents, with a mean age of 14.4 years (+1.60) participated in the study, 234 (58.1%) were girls and 99.7% had their own smartphone. The prevalence of PBS-R was 20.1%. For multivariate Poisson regression, the adjusted final hierarchical model, considering the variable 'life satisfaction' at level four, showed that adolescents who reported poor sleep quality (PR = 3.001; CI = 1.439-6.256; P = 0.003) had more severe PSB-G. It was concluded that adolescents with a history of worse sleep quality had higher severity of PSB-G in the present sample.

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