Awake bruxism, temporomandibular disorders, and quality of life in dental students during COVID-19 lockdown: association with mental health




Bruxism; Temporomandibular joint disorders; Anxiety; Depression; Quality of life.


The aim of this study was to assess the prevalence of awake bruxism (AB), temporomandibular disorders (TMD), quality of life (QoL), and their association with anxiety, depression, and stress levels, during COVID-19 lockdown. To this aim, 268 final-year dental students were asked about AB and TMD-related pain. QoL, anxiety and depression, and stress sensitivity were evaluated with the WHOQOL-bref instrument, the Hospital Anxiety and Depression Scale, and the Perceived Stress scale, respectively. Associations were tested by independent t-test, chi-square test, and simple regression analysis (α = 0.05). AB and TMD symptoms were reported by 54.8% and 64.2% of the volunteers, respectively, which presented worse quality of life (P < 0.05). Regression models showed that anxiety, depression, and stress predicted AB (P < 0.001) and QoL (P = 0.0001). Final-year dental students demonstrated high prevalence of self-reported AB and TMD, both of which correlated with lower QoL and were predicted by psychological factors.  

Author Biographies

Mariana Barbosa Câmara-Souza, University of Campinas

Piracicaba denatl School, University of Campinas

Fabiana Han Na Kim, University of Campinas

Piracicaba Dental School, University of Campinas


Asquini, G., Bianchi, A. E., Borromeo, G., Locatelli, M. & Falla, D. (2021). The impact of Covid-19-related distress on general health, oral behaviour, psychosocial features, disability and pain intensity in a cohort of Italian patients with temporomandibular disorders. PLoS One, 16, e0245999.

Botega, N. J., Bio, M. R., Zomignani, M. A., Garcia, C. Jr. & Pereira, W. A. (1995). Mood disorders among inpatients in ambulatory and validation of the anxiety and depression scale HAD. Rev Saude Publica, 29, 355-363.

Cao, W., Fang, Z., Hou, G., Han, M., Xu, X., Dong, J. & Zheng, J. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res, 287, 112934.

Chow, J. C. & Cioffi, I. (2019). Effects of trait anxiety, somatosensory amplification, and facial pain on self-reported oral behaviors. Clin Oral Investig, 23, 1653-1661.

De La Torre Canales, G., Câmara-Souza, M. B., Muñoz Lora, V. R., Guarda-Nardini, L., Conti, P. C., Rodrigues Garcia, R. M., Del Bel Cury, A. A. & Manfredini, D. (2018). Prevalence of psychosocial impairment in temporomandibular disorder patients: a systematic review. J Oral Rehabil, 45, 881-889.

Dragun, R., Veček, N. N., Marendić, M., Pribisalić, A., Đivić, G., Cena, H., Polašek, O. & Kolčić, I. (2020). Have Lifestyle Habits and Psychological Well-Being Changed among Adolescents and Medical Students Due to COVID-19 Lockdown in Croatia? Nutrients, 13(1), 97.

Emodi-Perlman, A., Eli, I., Smardz, J., Uziel, N., Wieckiewicz, G., Gilon, E., Grychowska, N. & Wieckiewicz, M. (2020). Temporomandibular Disorders and Bruxism Outbreak as a Possible Factor of Orofacial Pain Worsening during the COVID-19 Pandemic-Concomitant Research in Two Countries. J Clin Med, 9, 3250.

Fernandes, M. A., Vieira, F. E. R., Silva, J. S. E., Avelino, F. V. S. D. & Santos, J. D. M. (2018). Prevalence of anxious and depressive symptoms in college students of a public institution. Rev Bras Enferm, 71, 2169-2175.

Fleck, M. P. A., Louzada, S., Xavier, M., Chachamovich, E., Vieira, G., Santos, L. & Pinzon, V. (2000). Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica, 34, 178-183.

Gonzalez, Y. M., Schiffman, E., Gordon, S. M., Seago, B., Truelove, E.L., Slade, G. & Ohrbach, R. (2011). Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity. J Am Dent Assoc, 142(10), 1183-1191.

Khademi, F., Moayedi, S., Golitaleb, M. & Karbalaie, N. (2020). The COVID-19 pandemic and death anxiety in the elderly. Int J Ment Health Nurs, 1, 10.1111/inm.12824.

Lobbezoo, F., Ahlberg, J., Raphael, K. G., Wetselaar, P., Glaros, A. G., Kato, T., Santiago, V., Winocur, E., De Laat, A., De Leeuw, R., Koyano, K., Lavigne, G. J., Svensson, P. & Manfredini, D. (2018). International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil, 45, 837-844.

Lövgren, A., Österlund, C., Ilgunas, A., Lampa, E. & Hellström, F. (2018). A high prevalence of TMD is related to somatic awareness and pain intensity among healthy dental students. Acta Odontol Scand, 76, 387-393.

Markiewicz, M. R., Ohrbach, R. & McCall, W. D. Jr. (2006). Oral behaviors checklist: reliability of performance in targeted waking-state behaviors. J Orofac Pain, 20, 306-316.

Medeiros, R.A., Vieira, D.L., Silva, E. V. F. D., Rezende, L. V. M. L., Santos, R. W. D. & Tabata, L. F. (2020). Prevalence of symptoms of temporomandibular disorders, oral behaviors, anxiety, and depression in Dentistry students during the period of social isolation due to COVID-19. J Appl Oral Sci, 28, e20200445.

Odriozola-González, P., Planchuelo-Gómez, Á., Irurtia, M. J. & de Luis-García, R. (2020). Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res, 290, 113108.

Ohrbach, R. (2016). Diagnostic criteria for temporomandibular disorders: assessment instruments. Pereira Jr., F. J., Gonçalves, D. A. G., (2016). Critérios de Diagnóstico para Desordens Temporomandibulares: Protocolo Clínico e Instrumentos de Avaliação: Brazilian Portuguese Version. Trans.

Palinkas, L.A., Johnson, J. C. & Boster, J. S. (2004). Social support and depressed mood in isolated and confined environments. Acta Astronaut, 54, 639-647.

Poluha, R. L., De la Torre Canales, G., Bonjardim, L. R. & Conti, P. C. R. (2021). Clinical variables associated with the presence of articular pain in patients with temporomandibular joint clicking. Clin Oral Investig, 25(6), 3633-3640.

Przystańska, A., Jasielska, A., Ziarko, M., Pobudek-Radzikowska, M., Maciejewska-Szaniec, Z., Prylińska-Czyżewska, A., Wierzbik-Strońska, M., Gorajska, M. & Czajka-Jakubowska, A. (2019). Psychosocial predictors of bruxism. Biomed Res Int, 2019, 2069716.

Quadri, M. F., Mahnashi, A., Al Almutahhir, A., Tubayqi, H., Hakami, A., Arishi, M. & Alamir, A. (2015). Association of awake bruxism with khat, coffee, tobacco, and stress among Jazan University Students. Int J Dent, 2015, 842096.

Reis, R. S., Hino, A. A. & Añez, C. R. (2010). Perceived stress scale: reliability and validity study in Brazil. J Health Psychol, 15, 107-114.

Shahid, Z., Kalayanamitra, R., McClafferty, B., Kepko, D., Ramgobin, D., Patel, R., Aggarwal, C. S., Vunnam, R., Sahu, N., Bhatt, D., Jones, K., Golamari, R. & Jain, R. (2020). COVID-19 and Older Adults: What We Know. J Am Geriatr Soc, 68, 926-929.

Silva, P. G. B., de Oliveira, C. A. L., Borges, M. M. F., Moreira, D. M., Alencar, P. N. B., Avelar, R. L., Bitu Sousa, R. M. R. & Sousa, F. B. (2021). Distance learning during social seclusion by COVID-19: Improving the quality of life of undergraduate dentistry students. Eur J Dent Educ, 25, 124-134.

Skevington, S. M. (2007). Encyclopedia of Stress. Oxford: Elsevier.

Szczepańska, A. & Pietrzyka, K. (2021). The COVID-19 epidemic in Poland and its influence on the quality of life of university students (young adults) in the context of restricted access to public spaces. Z Gesundh Wiss, 7, 1-11.

The WHOQOL Group. (1998). The World Health Organization Quality of Life assessment (WHOQOL): Development and general psychometric properties. Soc Sci Med, 46, 1569–1585.

Vedolin, G. M., Lobato, V. V., Conti, P. C. & Lauris, J. R. (2009). The impact of stress and anxiety on the pressure pain threshold of myofascial pain patients. J Oral Rehabil, 36, 313-321.

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S. & Ho, R. C. (2020). Immediate Psychological Responses and Associated Factors during the Initial Stage of the 2019 Coronavirus Disease (COVID-19) Epidemic among the General Population in China. Int J Environ Res Public Health, 17, 1729.

Wang, Z. H., Yang, H. L., Yang, Y. Q., Liu, D., Li, Z. H., Zhang, X. R., Zhang, Y. J., Shen, D., Chen, P. L., Song, W. Q., Wang, X. M., Wu, X. B., Yang, X. F. & Mao, C. (2020). Prevalence of anxiety and depression symptom, and the demands for psychological knowledge and interventions in college students during COVID-19 epidemic: A large cross-sectional study. J Affect Disord, 275, 188-193.




How to Cite

CÂMARA-SOUZA, M. B. .; KIM, F. H. N. .; GARCIA, R. C. M. R. . Awake bruxism, temporomandibular disorders, and quality of life in dental students during COVID-19 lockdown: association with mental health . Research, Society and Development, [S. l.], v. 11, n. 7, p. e7311729589, 2022. DOI: 10.33448/rsd-v11i7.29589. Disponível em: Acesso em: 5 jul. 2022.



Health Sciences