Association Between Sleep Bruxism and Alcohol, Caffeine, Tobacco, and Drug Abuse

ORIGINAL CONTRIBUTIONS
ARTICLE 1
COVER STORY
Association between sleep bruxism

and alcohol, caffeine, tobacco, and
drug abuse
A systematic review
Eduardo Bertazzo-Silveira, DDS; Cristian Maikel ABSTRACT

Kruger; Isabela Porto De Toledo, BS; André Luís
Porporatti, DDS, MSc, PhD; Bruce Dick, MD, MSc, PhD; Background. The aim of this systematic review was to answer
Carlos Flores-Mir, DDS, MSc, PhD; Graziela De Luca the focused question, “In adults, is there any association between
Canto, DDS, MSc, PhD sleep bruxism (SB) and alcohol, caffeine, tobacco, or drug abuse?”
Types of Studies Reviewed. This systematic review
included studies in which the investigators assessed SB diagnosis
B
ruxism is defined as “repetitive jaw- by using questionnaires, clinical assessment, or polysomnography
muscle activity characterised by clench- and evaluated its association with alcohol, caffeine, tobacco, or
ing or grinding of the teeth and/or by drug abuse. The authors graded SB as possible, probable, or
bracing or thrusting of the mandible.”1 definitive. The authors developed specific search strategies for
Bruxism has 2 distinct circadian manifestations: Latin American and Caribbean Health Sciences Literature, Psy-
it can occur during sleep (sleep bruxism [SB]) or cINFO, PubMed, ScienceDirect, and Web of Science. The authors
during wakefulness (awake bruxism).2 Investiga- searched the gray literature by using Google Scholar and Pro-
tors in systematic reviews (SRs) have postulated Quest. The authors evaluated the methodological quality of the
an estimated prevalence of bruxism from 8% to included studies by using the Meta-Analysis of Statistics Assess-
31.4%.3,4 SB decreases over time, ment and Review Instrument.
from an estimated prevalence of Results. From among 818 studies, the authors selected 7 for
14% in children5 to approxi- inclusion in which samples ranged from 51 through 10,229 par-
mately 13% in adults3 and 3% in ticipants. SB was associated highly with alcohol and tobacco use.
the elderly population.3 In 1 study, the investigators noted a positive and weak association
The International Classifica- for heavy coffee drinkers. The odds for SB seem to increase almost
tion of Sleep Disorders Third 2 times for those who drank alcohol, almost 1.5 times for those
Edition6 has classified SB as a who drank more than 8 cups of coffee per day, and more than 2
movement disorder associated times for those who were current smokers. The abuse of meth-
with sleep, and it can be related to ylenedioxymethamphetamine associated with SB remained
several consequences such as tooth wear, tooth without sufficient evidence.
fractures, toothaches, periodontal problems, muscle Conclusions and Practical Implications. On the basis of
fatigue, and headaches.7,8 Although SB has been limited evidence, SB was associated positively with alcohol,
linked to intrinsic factors such as stress level and caffeine, and tobacco. The association between the studied drugs
genetic factors, the etiology and risk factors for could not be discredited; however, there is still a need for stronger
SB are not understood fully from the available evidence based on studies with greater methodological rigor.
Key Words. Alcohol abuse; caffeine; tobacco smoking; drug
This article has an accompanying online continuing education abuse; bruxism; review literature.
activity available at: http://jada.ada.org/ce/home. JADA 2016:147(11):859-866
Copyright ª 2016 American Dental Association. All rights http://dx.doi.org/10.1016/j.adaj.2016.06.014
reserved.
JADA 147(11) http://jada.ada.org November 2016 859

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literature.9,10 Study results have suggested an association search by using Google Scholar and ProQuest. We limited
between SB and drugs such as caffeine, alcohol, and the Google Scholar search to the first 15 result pages.
illegal drugs such as methylenedioxymethamphetamine eTable 1 (available online at the end of this article) pro-
(MDMA), also known as ecstasy.7,11,12 Nevertheless, vides more information about the search strategies. We
consistent evidence regarding these actual associations also hand searched the reference lists of relevant articles,
is scarce. Also, we could not identify SRs involving this and we consulted experts to identify any studies that could
topic. Thus, the purpose of this SR was to answer the have been missed in the electronic database searches.
following focused question, “In adults, is there any Search. We managed the references and removed
association between SB and alcohol, caffeine, tobacco, the duplicates by using reference manager software
or drug abuse?” (EndNote Basic, Thomson Reuters). We conducted the
database search on May 20, 2015, and updated it on April
METHODS 20, 2016.
Protocol and registration. We performed this SR by Study selection. We selected the final studies ac-
adhering to the Preferred Reporting Items for Systematic cording to a 2-phase process. In phase 1, 3 reviewers
Reviews and Meta- (E.B.S., C.M.K., I.P.T.) independently evaluated the titles
Analyses Checklist.13 and abstracts of all identified electronic database cita-
We registered the tions. They discarded any studies that did not appear to
SR protocol on the fulfill the inclusion criteria. In phase 2, they applied the
Prospective Register of Systematic Reviews (Centre same selection criteria to the full articles to confirm their
for Reviews and Dissemination, University of York, eligibility. Disagreements were solved in either phase by
Heslington, York, United Kingdom; and the National means of discussion and mutual agreement. A fourth
Institute for Health Research, London, United Kingdom) author (A.L.P.) was involved when we did not reach a
under the number CRD42015024078.14 consensus required to make a final decision.
Inclusion and exclusion criteria. We selected obser- Data collection process and data items. We per-
vational studies conducted in adults in which the in- formed the data collection process independently (E.B.S.,
vestigators evaluated the association between SB and C.M.K., I.P.T.) and cross-checked all information to
alcohol, caffeine, tobacco, or drug abuse. We applied no ascertain the completeness of the retrieved data. From all
language or time restrictions. We accepted professionally included studies, we recorded author, year of publication,
determined or self-reported use, including illegal drugs, country, sample size, demographic features of the sam-
caffeine, alcohol, and tobacco (smoked or not). SB diag- ple, and results concerning the association between SB
nosis had to be made with the aid of questionnaires, and alcohol, caffeine, tobacco, or drug abuse. If the
clinical assessment, or polysomnography (PSG). For the required data were not included in articles, we tried to
classification of SB in each of the selected studies, we used contact the authors to retrieve the missing information.
the diagnostic grading system Lobbezoo and colleagues1 Risk of bias within the studies. Two independent
proposed. This grading system suggested that possible SB reviewers (E.B.S., I.P.T.) evaluated the quality of the
should be based on self-report by means of questionnaires included studies by using the Meta-Analysis of Statistics
or the anamnestic part of a clinical examination. Probable Assessment and Review Instrument (MAStARI).15 We
SB should be based on self-report and the results of the used different MAStARI questionnaires according to the
inspection part of a clinical examination. Definite SB design of the included studies: cross-sectional or
should be based on self-report, clinical examination re- descriptive studies and cohort or case-control studies.
sults, and a PSG recording, likely along with audio or Both questionnaires consist of 9 questions that were
video recordings.1 We excluded studies according to the answered with yes, no, unclear, or not applicable,
following criteria: reviews, letters, conference abstracts, enabling assessment of the studies as having a high,
and personal opinions; studies in which the sample moderate, or low risk of bias according to the score
included children or adolescents who could not be dis- obtained. We categorized the risk of bias as high when
cerned from adult samples; studies in which the sample the study reached a yes score of 49% or less, moderate
included diagnosed craniofacial genetic syndromes or when the study reached a yes score of 50% to 69%, and
neuromuscular diseases; studies in which the sample low when the study reached a yes score of 70% or more.15
included patients taking medicines; and studies with the
same sample reported in another included study.
Information sources. With the help of a health sci-
ABBREVIATION KEY. CNS: Central nervous system. EMG:
ences librarian, we selected appropriate truncation and Electromyography. LILACS: Latin American and Caribbean
word combinations and adapted them for these databases: Health Sciences Literature. MAStARI: Meta-Analysis of
Latin American and Caribbean Health Sciences Litera- Statistics Assessment and Review Instrument. MDMA:
ture, PsycINFO, PubMed, ScienceDirect, and Web of Methylenedioxymethamphetamine. NA: Not applicable. PSG:
Science. In addition, we performed a partial gray literature Polysomnography. SB: Sleep bruxism. SR: Systematic review.
860 JADA 147(11) http://jada.ada.org November 2016

Summary measures.
We considered any LILACS PsycINFO PubMed ScienceDirect Web of Science
outcome measurements (n = 15) (n = 80) (n = 316) (n = 99) (n = 139)
that the investigators
used in the publications Records identified through first database search
Identification
to evaluate the associa- (n = 649)
tion between SB and
alcohol, caffeine, to-
Records after duplicates removed
bacco, or drug abuse. (n = 471)
These included risk ratio,
odds ratio (OR), or risk ProQuest Google Scholar
difference for dichoto- (n = 12) (n = 141)
mous outcomes and
mean difference or
Records screened from ProQuest
standardized mean dif- (n = 0)
ference for continuous
outcomes. Records from search update Records screened from Google Scholar
Synthesis of results. (April 20, 2016) (n = 0)
Screening
We performed a (n = 194)
descriptive analysis of Experts (n = 0)
the results. We planned
a meta-analysis with a
group of studies in which Reference lists from selected studies
Records screened from (n = 0)
the investigators had research update
ported enough data; (n = 0)
however, we found that
the methodological het- Full-text articles assessed Full-text article exclusion reasons
erogeneity was too high for eligibility in phase 2 (n = 22)
• Reviews, letters, conference
to find reliable results. (n = 29)
Eligibility
abstracts, and personal opinions

Dividing studies into (n = 9)
categories according to • Studies in which sample included
drugs left us with a children or adolescents (n = 3)
• Studies in which sample included
scarce quantity for a craniofacial genetic syndromes or
proper meta-analysis, neuromuscular diseases (n = 0)
so we did not conduct • Studies in which sample included
patients in treatment with
a meta-analysis. medications (n = 3)
Included
• Studies with different objectives

RESULTS (n = 6)
Studies included in • Studies with same sample
Study selection. We reported in another included
qualitative synthesis
identified 649 articles (n = 7) study (n = 1)
across the 5 databases. We
removed the duplicates
and obtained 471 cita- Figure. Flow chart of the literature search and selection criteria. LILACS: Latin American and Caribbean Health
tions. Also, we identified Sciences Literature. Source: Liberati and Colleagues.13
141 studies from Google
Scholar and 12 from Pro-
Quest. The search update on April 20, 2016, retrieved 194 Study characteristics. Among the 7 selected studies,
new citations, making a total of 818 studies to be analyzed participants’ ages ranged from 18 through 55 years.
in phase 1. After title and abstract reading, we acquired Sample sizes ranged from 51 through 10,229 participants.
29 potentially useful studies for phase 2. Thereafter, we The criteria we used for SB classification in the studies
excluded 22 for various reasons (eTable 2, available online were questionnaire,11,16-18 questionnaire with clinical
at the end of this article). In the end, we included only 7 assessment,19 questionnaire with electromyography
articles in the qualitative synthesis; we initially identified (EMG),20 and questionnaire with PSG.21 Questionnaires
all of them from the main electronic search. The figure13 were the most widely used form of classification across the
shows a flow chart describing the process of identification, selected studies. We graded SB as possible in 4 studies,11,16-18
inclusion, and exclusion of studies. probable in 2 studies,19,20 and definite in 1 study.21

TABLE
Summary of descriptive characteristics of the 7 included studies.
GROUP STUDY, NO. OF AGE, Y* SB† ASSOCIATION, FINDINGS, STATISTICAL STUDY
COUNTRY CASES/ DIAGNOSTIC WHEN PRESENT WHEN ANALYSIS AND TYPE
NO. OF METHODS, PRESENT FINDINGS
CONTROLS GRADE‡
Alcohol Hojo and 23/28 23 (1.9) Questionnaire Mean (standard Coefficient ¼ Linear regression Cross-
colleagues, and EMG,§ deviation) muscle 0.51; 95% analysis: positive sectional
20
2007, probable SB activity duration CI,¶ 0.20- correlation between
Japan calculated at EMG 0.82; ethanol and
with alcohol R ¼ 0.60; masseter muscle
consumption adjusted activity duration
2
(35.2 [14.6]) and R ¼ 0.33 (P ¼ .003)
without alcohol
consumption
(30.3 [22.9])
Rintakoski 2,906/7,323 44 (7.79) Questionnaire, Binge drinking#: Binge Multinomial logistic Cohort
and possible SB 6%** (n ¼ 2,791) drinking: regression analysis:
Kaprio, OR,¶¶ 1.8; independent
2013,11 Light alcohol 95% CI, association of
Finland consumption††: 1.36-2.39 alcohol consumption
4%** (n ¼ 3,656) with SB (P ¼ .017)
Heavy
Moderate alcohol drinking: OR,
consumption‡‡: 1.7; 95% CI,
4%** (n ¼ 3,613) 1.11-2.67
Heavy alcohol
consumption§§:
7%** (n ¼ 1,485)
Caffeine Rintakoski 2,906/7,323 44 (7.79) Questionnaire, High caffeine Model I‡‡‡: Multinomial logistic Cohort
and possible SB consumption##: OR ¼ 1.9; regression analysis:
Kaprio, 7%** (n ¼ 943) 95% CI, independent
2013,11 1.38-2.66 association of
Finland Moderate caffeine coffee consumption
consumption***: Model II‡‡‡: with SB (P ¼ .017)
4%** (n ¼ 5,924) OR, 1.4; 95%
CI, 1.01-1.98
Light caffeine
consumption†††:
4%** (n ¼ 2,737)
* Data are the mean (standard deviation) or age range.
† SB: Sleep bruxism.
‡ The authors used the grading system from Lobbezoo and colleagues.1
§ EMG: Electromyography.
¶ CI: Confidence interval.
# Binge drinking is drinking more than 1 bottle of wine, one-half of a bottle of spirits, or the equivalent amount of other alcoholic beverages on the
same occasion at least once a month.
** Weekly bruxism compared with never bruxism in model I, adjusted for age and sex.
†† Light alcohol consumption is 1 to 2 glasses per week.
‡‡ Moderate alcohol consumption is 3 or more glasses per week.
§§ Heavy alcohol consumption is more than 7 glasses per week for women or more than 14 glasses per week for men.
¶¶ OR: Odds ratio.
## High caffeine consumption is 6 or more cups per day.
*** Moderate caffeine consumption is 3 to 5 cups per day.
††† Light caffeine consumption is 1 to 2 cups per day.
‡‡‡ Model I: adjusted for age and sex; model II: adjusted for age, sex, and smoking status.
§§§ MDMA: Methylenedioxymethamphetamine.
¶¶¶ NA: Not applicable.
### Values calculated by the authors.
**** M: Male.
†††† F: Female.
‡‡‡‡ Heavy tobacco smoker indicates more than 20 cigarettes per day.
§§§§ Light tobacco smoker indicates fewer than 10 cigarettes, daily or not.
Investigators in 4 studies11,17,19,21 focused on the associ- Investigators in 1 of the studies11 appraised 3 drugs simul-
ation of SB and tobacco, investigators in 2 studies11,20 taneously: alcohol, caffeine, and tobacco.1 Despite our
examined the effect of alcohol, investigators in 1 study11 intention of evaluating the association of SB and other
examined the effect of caffeine, and investigators in drugs of abuse such as methamphetamine, cocaine, heroin,
another 2 studies16,18 looked at the effects of MDMA. and marijuana, we did not identify any studies that met the

TABLE (CONTINUED)
GROUP STUDY, NO. OF AGE, Y* SB† ASSOCIATION, FINDINGS, STATISTICAL STUDY

COUNTRY CASES/ DIAGNOSTIC WHEN PRESENT WHEN ANALYSIS AND TYPE
NO. OF METHODS, PRESENT FINDINGS
CONTROLS GRADE‡
Drug Peroutka 100/NA¶¶¶ 18-25 Questionnaire, Acute reported NA Analysis by means Descriptive
Abuse and possible SB bruxism or tooth of percentage:
(MDMA§§§) colleagues, grinding: 65% no significant
1988,16 (n ¼ 100) association between
Canada MDMA consumption
and prolonged
occurrence of
bruxism
Cohen, 500/NA 18-25 Questionnaire, Acute reported NA Analysis by means Descriptive
1995,18 possible SB bruxism or tooth of percentage:
United grinding: 54% no significant
States (n ¼ 270###) association between
MDMA consumption
and prolonged
occurrence of
bruxism
Tobacco Lavigne 682/1,192 Smokers Questionnaire SB: 12% (n ¼ 82) OR, 1.9; 95% t test and odds ratio Cross-
and with SB: and CI, 1.37-2.63 analysis: tooth sectional
colleagues, 24.5 (4.7) polysomnography, grinding prevalence,
1997,21 definite SB in SB compared
Canada Nonsmokers groups, significantly
with SB: higher for smokers
28.6 (4.7) than for nonsmokers
(P < .001)
Ahlberg 131/74 46 (6) Questionnaire High SB: 43.2% OR, 2.9; 95% Logistic regression Cohort
and and clinical (n ¼ 32###) CI, 2.26-3.61 model analysis: SB
colleagues, examination, Low SB: 24.4% significantly more
2004,19 probable SB (n ¼ 32###) prevalent among
Finland smokers (P ¼ .005)
Rintakoski 1,003/2,121 24 (23-27) Questionnaire, Weekly SB: Heavy Multinomial logistic Cohort
and possible SB Former tobacco tobacco regression analysis:
colleagues, smoker: 7.6% smoker: heavy smokers were
2010,17 (M****), 8.2% (F††††) OR, 2.45; more than twice-
Finland Heavy tobacco 95% CI, weekly bruxers
smoker‡‡‡‡: 10.3% 1.75-3.44 (P < .001)
(M), 16.3% (F)
Light tobacco Smokeless tobacco
smoker§§§§: 6.3% emerged as an
(M), 11.1% (F) independent risk
Never smoker: 6.1% factor for bruxism
(M), 7.8% (F)
Rarely SB:
Former tobacco
smoker: 21.6% (M),
22.6% (F)
Heavy tobacco
smoker: 28.2% (M),
23.4% (F)
Light tobacco
smoker: 24.2% (M),
24.1% (F)
Never smoker:
20.8% (M), 20.5%
(F)
Rintakoski 2,906/7,323 44 (7.79) Questionnaire, Current tobacco Current Multinomial logistic Cohort
and possible SB smoker: 7%** tobacco regression analysis:
Kaprio, (n ¼ 2,623) smoker: no significant
2013,11 OR, 2.9; 95% association
Finland Former tobacco CI, 2.26-3.61 between tobacco
smoker: 3%** consumption and SB
(n ¼ 2,296)
Light tobacco
smoker§§§§: 1%**
(n ¼ 332)

adopted eligibility criteria. The table1,11,16-21 summarizes the 5 times more grinding episodes in smoking bruxers
descriptive characteristics of the included studies. (mean, 35) than in nonsmoking bruxers (mean, 7).
Risk of bias within studies. Even though none of the Rintakoski and colleagues17 reported that weekly
studies fulfilled all MAStARI methodological criteria,15 (frequent) and rarely (nonfrequent) possible SB was
approximately 60% of the studies had scores higher than more associated with tobacco smokers than nonsmokers.
65%. Three studies11,17,20 had a low risk of bias according to Heavy smokers were more than twice as likely to be
the score obtained. Two studies19,21 had a moderate risk of weekly bruxers than were those who had never smoked
bias, and another 2 studies16,18 had high risk of bias. (OR, 2.45; 95% CI, 1.75-3.44; P < .001). We found no
eTables 3 and 4 (available online at the end of this article) significant interactions for the association between
provide more information about the MAStARI scores. alcohol, caffeine, and tobacco in the study11 in which the
Results of individual studies. Alcohol. Hojo and investigators appraised these 3 drugs, thus, indicating
colleagues20 performed a study to determine whether the possible independent effects of the study variables on SB.
amount of alcohol intake was associated with masseter Drug abuse (MDMA). Cohen and colleagues18 con-
muscle activity recorded during sleep in 51 participants. ducted a descriptive study in 1995, with subjective reports
For this article, we graded SB as probable. The study on the effects of the use of MDMA. All 500 participants
revealed that the mean (standard deviation) duration of had taken MDMA on at least 1 occasion. Fifty-four percent
muscle activity was 35.2 (14.6) seconds in alcohol con- of the participants related bruxism as an immediate
sumers and 30.3 (22.9) seconds in those who did not use physical effect, and none of the participants reported
alcohol. Linear regression analysis revealed a positive bruxism as a long-term or recurring physical effect. Per-
correlation between alcohol and masseter muscle activity outka and colleagues16 reported subjective effects for
duration (coefficient ¼ 0.51; 95% confidence interval MDMA. All 100 participants admitted using the drug. The
[CI], 0.20-0.82; R ¼ 0.60; adjusted R2 ¼ 0.33; P ¼ .003). frequency of use ranged from 1 to 38 doses of the drug.
Rintakoski and Kaprio11 studied multiple drugs as risk Sixty-five percent of participants related bruxism as
factors for SB, using a sample from the longitudinal an acute effect of MDMA. A day after drug ingestion,
Finnish twin cohort study. The 10,229 participants no reports of bruxism were registered (subacute effects),
answered a questionnaire regarding bruxism habits and although 2% (2 of 100) reported long-term effects; 1
the use of legal psychoactive substances. For this article, we claimed a tendency to clench his teeth when anxious for
graded SB as possible. The authors found that both binge months after 2 separate doses, and a second attributed
drinking (OR, 1.8; 95% CI, 1.36-2.39) and heavy drinking increased emotionality to the effects of 3 separate doses.
(OR, 1.7; 95% CI, 1.11-2.67) were associated with SB. For both MDMA studies, we graded SB as possible.
Caffeine. Rintakoski and Kaprio11 also found that Synthesis of results. Alcohol, caffeine, tobacco, drug
consumption of more than 8 cups of coffee per day was abuse (MDMA). Both binge drinking and heavy drinking
associated with weekly (frequent) bruxism regardless of increased the odds (almost 2 times) for probable or
smoking status. This association occurred in model I, possible SB (Hojo and colleagues,20 Rintakoski and Kap-
adjusted for age and sex, and model II, adjusted for age, rio11). Consumption of more than 8 cups of coffee per day
sex, and smoking status (model I: OR, 1.9; 95% CI, 1.38- slightly increased the odds (almost 1.5 times) for possible
2.66; model II: OR, 1.4; 95% CI, 1.01-1.98). SB (Rintakoski and Kaprio11). Current smoking increased
Tobacco. According to the same study, Rintakoski and the odds (more than 2 times) for possible, probable, and
Kaprio11 found that current smoking remained an inde- definite SB (Rintakoski and Kaprio,11 Ahlberg and col-
pendent risk factor for SB in all models (OR, 2.9; 95% CI, leagues,19 Lavigne and colleagues,21 and Rintakoski and
2.26-3.61; P < .001). Ahlberg and colleagues19 analyzed colleagues17). The abuse of MDMA associated with SB
questionnaires from frequent and nonfrequent bruxers. remained without sufficient evidence.16,18 We could not
Among the 131 participants in the low-bruxer group, 24.4% assess other drugs through the included studies.
were smokers; among the 74 participants in the high- Risk of bias across studies. The main concern about
bruxer group, 43.2% were smokers. The authors found that the studies included was the representativeness of the
probable SB was more frequent in the smoker group samples. We could not find homogeneity for question 1
(P ¼ .005) than in nonsmokers. In addition, smokers (“was the study based on a random or pseudorandom
were 1.2 to 4.9 times more likely to report frequent bruxism sample?”) for cross-sectional studies and questions 1
than were nonsmokers (OR, 2.4; 95% CI, 1.2-2.4; P ¼ .01). (“was the sample representative of patients in the pop-
Lavigne and colleagues21 tested tobacco smoking as an ulation as a whole?”) and 7 (“were the outcomes of
exacerbating or risk factor for definitive SB. SB preva- people who withdrew described and included in the
lence was significantly higher for smoking bruxers analysis?”) for cohort studies.15
(12.0%; 82 of 682 participants) than for nonsmoking
bruxers (6.7%; 80 of 1,192 participants; P < .001). The DISCUSSION
odds of smoking participants reporting tooth grinding In this SR, we investigated the association between SB
was higher (OR, 1.9; 95% CI, 1.37-2.63), and there were and alcohol, caffeine, tobacco, or drug abuse. Although

the first studies with results supporting this argument consumption, heavy alcohol consumption, and heavy
date back to more than 45 years ago,22,23 and results smoking) were more likely to experience SB.11,12
from some studies have suggested these associations In descriptive studies16,18 based on subjective reports
before,7,11,12,24,25 conclusive evidence has not been found of the effects of MDMA, bruxism was 1 of the reported
until now. Our SR results indicate that SB seems to be symptoms. Nevertheless, the association of SB and
associated with use of alcohol, caffeine, and tobacco, but MDMA has not been studied, leaving this association
there is not enough scientific evidence to confirm or unclear. Furthermore, the authors16,18 did not specify
discredit the association between SB and drug abuse. correctly what type of bruxism was being studied, sug-
Investigators in a previous review24 pointed out that gesting that the effect may be that of tooth grinding as an
controlled clinical experiments on the effects of drugs on acute effect. Investigators in studies involving MDMA
the central nervous system (CNS) are difficult to conduct commonly attribute episodes of bruxism as an usual
because of their effects on the participants’ mental and symptom and even rate it as 1 of the most disturbing side
physical health and their ethical implications. The au- effects.16,18,31,32 However, these studies are based primarily
thors stated that the issues regarding drug mechanisms on small samples, case reports, narrative reviews, and
and their association with SB were beyond the limita- anecdotal presuppositions.
tions of the review and that there were insufficient Findings from a 2015 study indicated that dentists
evidence-based data to draw definitive conclusions.24 should focus on insightful clinical interviewing of their
Alcohol can disrupt sleep consolidation and affect patients because results revealed that screening patients
sleep stage distribution, causing an acute increase in the for SB by using American Academy of Sleep Medicine
local concentration of serotonin, opioids, and dopamine criteria is effective, especially in the presence of muscle
in the brain.26,27 In another study,20 the investigators fatigue and temporal headaches, considered as good
estimated alcohol raised the risk of experiencing tools with which to screen patients with SB.33 Effective
masseter muscle activity when ingested at bedtime, screening can increase the likelihood of more appro-
increasing EMG duration by more than 5 seconds. This priate selection of patients to refer for PSG. It is
increase of muscular activity suggests an increase in SB important to establish the criteria proposed by the
events. Accordingly, the authors pointed out binge American Academy of Sleep Medicine34 for the correct
drinking, passing out because of excessive alcohol con- diagnosis of SB.
sumption, and drinking alcohol at bedtime as important The diagnosis of SB may be considered difficult because
risk factors for SB.11,12,20 The intake of large quantities of of the requirement of several SB diagnostic criteria and the
alcohol in a short period results in toxic effects on the fact that the most affordable ways to assess SB are through
brain and also may be related to the CNS disturbance the use of questionnaires and clinical examinations. In
that could set off or exacerbate SB.11,12,20 addition to these methods, there are more effective—but
Caffeine is a CNS stimulant, and it is the world’s most costly—clinical diagnostic tests that use EMG or PSG.
widely consumed psychoactive drug. Investigators have These methods are considered the most accurate tests and
assessed it frequently in the literature.11,12,28 Consumption are the criterion standard for SB assessment.1 Despite an
of a high quantity of coffee raised the risk of occurrence abundance of techniques, valid diagnostic tools that could
of SB.11,12 However, these findings remain controversial. be used widely are still scarce. To avoid different diag-
Investigators found significant associations between nostic criteria that could lead to questionable conclusions,
caffeine use and SB, but only when caffeine was we suggest that health care professionals and researchers
consumed in a high quantity.11,12 apply the grading system proposed by Lobbezoo and
Tobacco is used widely because of its psychoactive ef- colleagues1 until widely available, cost-effective, and reli-
fect. Lavigne and colleagues21 reported that there were 5 able diagnostic tools are developed.
times more grinding episodes in smokers than in non- Because results of our SR indicated that there is
smokers. However, the authors point to limitations of some available evidence of the possible association
their study; they did not take the lack of control of nicotine between SB and alcohol, caffeine, and tobacco, dentists
dose, the smoking habit duration, and the degree of should be aware of this possibility during the first
dependence into account.21 In addition, in the study dental appointment. It is important to include in the
conducted by Ahlberg and colleagues,19 probable SB was anamnesis questions regarding the use of these sub-
significantly more prevalent among smokers. Possible stances, and the dose taken, to take management pre-
explanations were that nicotine may affect the smoker’s cautions in these patients and improve outcomes.
pain response centrally or that tobacco use may reduce the This knowledge also may aid in the diagnosis of SB.
blood supply to tissues.29 Results from longitudinal Dentists should advise their patients to reduce or
studies17 based on questionnaires and large samples also eliminate the excessive use of alcohol, caffeine, and
indicated that possible SB was significantly more common tobacco and also may refer patients to an addiction
among smokers. In studies with twins,11,17,30 participants specialist if needed. The limitations regarding ethics
with more unhealthy habits combined (heavy coffee when studying drugs of abuse make it considerably

more difficult to conduct studies and find relevant re- 9. Thompson BA, Blount BW, Krumholz TS. Treatment approaches to
bruxism. Am Fam Physician. 1994;49(7):1617-1622.
sults and to implement a reasonable and appropriate 10. Hermesh H, Schapir L, Marom S, et al. Bruxism and oral parafunc-
study design. tional hyperactivity in social phobia outpatients. J Oral Rehabil. 2015;42(2):
90-97.
CONCLUSIONS 11. Rintakoski K, Kaprio J. Legal psychoactive substances as risk factors
for sleep-related bruxism: a nationwide Finnish twin cohort study. Alcohol
There is not enough scientific evidence to confirm or Alcohol. 2013;48(4):487-494.
discredit the association between SB and drugs. On the 12. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism
basis of the limited available evidence, SB was associated in the general population. Chest. 2001;119(1):53-61.
positively with alcohol, tobacco, and caffeine. It seems that 13. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for
reporting systematic reviews and meta-analyses of studies that evaluate
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cups of coffee per day, and more than 2 times for those 14. Booth A, Clarke M, Ghersi D, et al. An international registry of
systematic-review protocols. Lancet. 2011;377(9760):108-109.
who are current smokers. Further studies are required to 15. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’
shed more light on these possible associations. n Manual: 2014 Edition. Adelaide, South Australia, Australia: The Joanna
Briggs Institute; 2014.
SUPPLEMENTAL DATA 16. Peroutka SJ, Newman H, Harris H. Subjective effects of 3,4-
methylenedioxymethamphetamine in recreational users. Neuro-
Supplemental data related to this article can be found at psychopharmacology. 1988;1(4):273-277.
http://dx.doi.org/10.1016/j.adaj.2016.06.014. 17. Rintakoski K, Ahlberg J, Hublin C, et al. Tobacco use and reported
bruxism in young adults: a nationwide Finnish twin cohort study. Nicotine
Dr. Bertazzo-Silveira is a master of science student, Oral Diagnostics, Tob Res. 2010;12(6):679-683.
Department of Dentistry, Federal University of Santa Catarina, Florianóp- 18. Cohen RS. Subjective reports on the effects of the MDMA (“ecstasy”)
olis, Santa Catarina, Brazil. experience in humans. Prog Neuropsychopharmacol Biol Psychiatry. 1995;
Mr. Kruger is a dentistry graduate student, Department of Dentistry, 19(7):1137-1145.
Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil. 19. Ahlberg J, Savolainen A, Rantala M, Lindholm H, Kononen M.
Ms. Porto De Toledo is a speech-language pathologist, Department of Reported bruxism and biopsychosocial symptoms: a longitudinal study.
Speech-Language Pathology, Federal University of Santa Catarina, Flo- Community Dent Oral Epidemiol. 2004;32(4):307-311.
rianópolis, Santa Catarina, Brazil. 20. Hojo A, Haketa T, Baba K, Igarashi Y. Association between the
Dr. Porporatti is an adjunct professor, Brazilian Centre for Evidence- amount of alcohol intake and masseter muscle activity levels recorded
Based Research, Department of Dentistry, Federal University of Santa during sleep in healthy young women. Int J Prosthodont. 2007;20(3):
Catarina, Campus Universitário-Trindade, Florianópolis, Santa Catarina, 251-255.
Brazil 88040-900, e-mail [email protected]. Address corre- 21. Lavigne GJ, Lobbezoo F, Rompre PH, Nielsen TA, Montplaisir J.
spondence to Dr. Porporatti. Cigarette smoking as a risk factor or an exacerbating factor for restless legs
Dr. Dick is an associate professor, Department of Anesthesiology and Pain syndrome and sleep bruxism. Sleep. 1997;20(4):290-293.
Medicine, Psychiatry, and Pediatrics, Faculty of Medicine and Dentistry, 22. Lewis SA, Oswald I, Dunleavy DL. Chronic fenfluramine adminis-
University of Alberta, Edmonton, Alberta, Canada. tration: some cerebral effects. Br Med J. 1971;3(5766):67-70.
Dr. Flores-Mir is a professor, School of Dentistry, Faculty of Medicine and 23. Ashcroft GW, Eccleston D, Waddell JL. Recognition of amphetamine
Dentistry, University of Alberta, Edmonton, Alberta, Canada. addicts. Br Med J. 1965;1(5426):57.
Dr. De Luca Canto is an associate professor, Brazilian Centre for 24. Winocur E, Gavish A, Voikovitch M, Emodi-Perlman A, Eli I. Drugs
Evidence-Based Research, Department of Dentistry, Federal University of and bruxism: a critical review. J Orofac Pain. 2003;17(2):99-111.
Santa Catarina, Florianópolis, Santa Catarina, Brazil, and an adjunct assis- 25. Raúl R, Enrique R, Martín S, Andrés R, Fernando M. Drug depen-
tant professor, School of Dentistry, Faculty of Medicine and Dentistry, dence, bruxism and temporomandibular disorders. Odontoestomatologia.
University of Alberta, Edmonton, Alberta, Canada. 2014;16(24):26-33.
26. Agarwal DP, Goedde HW. Human aldehyde dehydrogenases: their
Disclosure. None of the authors reported any disclosures. role in alcoholism. Alcohol. 1989;6(6):517-523.
27. Gallo LM, Lavigne G, Rompre P, Palla S. Reliability of scoring EMG
1. Lobbezoo F, Ahlberg J, Glaros AG, et al. Bruxism defined and graded: orofacial events: polysomnography compared with ambulatory recordings.
an international consensus. J Oral Rehabil. 2013;40(1):2-4. J Sleep Res. 1997;6(4):259-263.
2. Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology 28. Gurpegui M, Jurado D, Luna JD, et al. Personality traits associated
of bruxism. J Orofac Pain. 2009;23(2):153-166. with caffeine intake and smoking. Prog Neuropsychopharmacol Biol
3. Lavigne GJ, Montplaisir JY. Restless legs syndrome and sleep bruxism: Psychiatry. 2007;31(5):997-1005.
prevalence and association among Canadians. Sleep. 1994;17(8):739-743. 29. Li CY, Mao X, Wei L. Genes and (common) pathways underlying
4. Carra MC, Huynh N, Lavigne G. Sleep bruxism: a comprehensive drug addiction. PLoS Comput Biol. 2008;4(1):e2.
overview for the dental clinician interested in sleep medicine. Dent Clin 30. Rintakoski K, Ahlberg J, Hublin C, et al. Bruxism is associated with
North Am. 2012;56(2):387-413. nicotine dependence: a nationwide Finnish twin cohort study. Nicotine Tob
5. Manfredini D, Restrepo C, Diaz-Serrano K, Winocur E, Lobbezoo F. Res. 2010;12(12):1254-1260.
Prevalence of sleep bruxism in children: a systematic review of the liter- 31. Murray JB. Ecstasy is a dangerous drug. Psychol Rep. 2001;88(3):
ature. J Oral Rehabil. 2013;40(8):631-642. 895-902.
6. American Academy of Sleep Medicine. Sleep-related bruxism. In: The 32. Maloney WJ, Raymond G. The significance of ecstasy use to dental
International Classification of Sleep Disorders. 3rd ed. Darien, IL: American practice. N Y State Dent J. 2014;80(6):24-27.
Academy of Sleep Medicine; 2014:189-192. 33. Palinkas M, De Luca Canto G, Rodrigues LA, et al. Comparative
7. de la Hoz-Aizpurua JL, Diaz-Alonso E, LaTouche-Arbizu R, capabilities of clinical assessment, diagnostic criteria, and poly-
Mesa-Jimenez J. Sleep bruxism: conceptual review and update. Med Oral somnography in detecting sleep bruxism. J Clin Sleep Med. 2015;11(11):
Patol Oral Cir Bucal. 2011;16(2):e231-e238. 1319-1325.
8. De Luca Canto G, Singh V, Bigal ME, Major PW, Flores-Mir C. 34. Morgenthaler TI, Deriy L, Heald JL, Thomas SM. The evolution of
Association between tension-type headache and migraine with sleep the AASM clinical practice guidelines: another step forward. J Clin Sleep
bruxism: a systematic review. Headache. 2014;54(9):1460-1469. Med. 2016;12(1):129-135.

eTABLE 1
Database search strategy.*
DATABASE SEARCH STRATEGY
PubMed (“bruxism”[MeSH† Terms] OR “bruxism”[All Fields] OR “sleep bruxism”[MeSH Terms]) AND (“ethanol”
[MeSH Terms] OR “ethanol”[All Fields] OR “alcohol”[All Fields] OR “alcohols”[MeSH Terms] OR
“tobacco”[MeSH Terms] OR “tobacco”[All Fields] OR “tobacco products”[MeSH Terms] OR “smoking”
[MeSH Terms] OR “nicotine”[MeSH Terms] OR “nicotine”[All Fields] OR “cigarette”[All Fields] OR “cigarette
smoking”[All Fields] OR “substance-related disorders”[MeSH Terms] OR “substance-related disorders”
[All Fields] OR “drug addiction”[All Fields] OR “drug abuse”[All Fields] OR “drugs”[All Fields] OR “drug”
[All Fields] OR “legal highs”[All Fields] OR “street drugs”[MeSH Terms] OR “street drugs”[All Fields] OR
“recreational drugs”[All Fields] OR “cannabinoids”[MeSH Terms] OR “cannabinoids”[All Fields] OR “central
nervous system stimulants”[MeSH Terms] OR “central nervous system stimulants”[All Fields] OR
“hallucinogens”[MeSH Terms] OR “hallucinogens”[All Fields] OR “psychedelics”[All Fields] OR “caffeine”
[MeSH Terms] OR “caffeine”[All Fields] OR “ephedrine”[MeSH Terms] OR “ephedrine”[All Fields] OR
“cannabis”[MeSH Terms] OR “cannabis”[All Fields] OR “marijuana”[All Fields] OR “dissociatives”[All Fields]
OR “deliriants”[All Fields] OR “depressants”[All Fields] OR “psychoactive”[All Fields] AND (“plants”[MeSH
Terms] OR “plants”[All Fields] OR “plant”[All Fields] OR “drugs”[All Fields] OR “drug”[All Fields])) OR
“methamphetamine”[MeSH Terms] OR “methamphetamine”[All Fields] OR “amphetamines”[MeSH
Terms] OR “amphetamines”[All Fields] OR “heroin”[MeSH Terms] OR “heroin”[All Fields] OR “ecstasy”
[All Fields] OR “central nervous system stimulants”[Pharmacological Action] OR “central nervous system
stimulants”[MeSH Terms] OR “central nervous system stimulants”[All Fields] OR “hypnotics and
sedatives”[Pharmacological Action] OR “hypnotics and sedatives”[MeSH Terms] OR “lysergic acid
diethylamide”[MeSH Terms] OR “lysergic acid diethylamide”[All Fields] OR “lsd”[All Fields] OR “crack
cocaine”[MeSH Terms] OR “crack cocaine”[All Fields] OR “cocaine”[MeSH Terms] OR “cocaine”[All Fields]
OR “opium”[MeSH Terms] OR “opium”[All Fields] OR “narcotics”[Pharmacological Action] OR “narcotics”
[MeSH Terms] OR “narcotics”[All Fields] OR “narcotic”[All Fields])
PsycINFO, ScienceDirect, Web of (“bruxism” OR “sleep bruxism”) AND (“ethanol” OR “alcohol” OR “alcohols” OR “tobacco” OR “tobacco
Science, ProQuest products” OR “smoking” OR “nicotine” OR “cigarette” OR “cigarette smoking” OR “substance-related
disorders” OR “drug addiction” OR “drug abuse” OR “drugs” OR “drug” OR “legal highs” OR “street drugs”
OR “recreational drugs” OR “cannabinoids” OR “central nervous system stimulants” OR “hallucinogens”
OR “psychedelics” OR “caffeine” OR “ephedrine” OR “cannabis” OR “marijuana” OR “dissociatives” OR
“deliriants” OR “depressants” OR “psychoactive” AND (“plants” OR “plants” OR “drugs” OR “drug”)) OR
“methamphetamine” OR “amphetamines” OR “heroin” OR “ecstasy” OR “central nervous system
stimulants” OR “hypnotics and sedatives” OR “lysergic acid diethylamide” OR “lsd” OR “crack cocaine” OR
“cocaine” OR “opium” OR “narcotics” OR “narcotic”)
Latin American and Caribbean Health (“bruxism” OR “sleep bruxism” OR “bruxismo”) AND (“etanol” OR “álcool” OR “álcoois” OR “alcohol”
Sciences Literature OR “tabaco” OR “fumo” OR “nicotina” OR “cigarro” OR “cigarrillo” OR “transtornos relacionados a
substâncias” OR “trastornos relacionados con sustancias” OR “vício em drogas” OR “abuso de drogas” OR
“drogas” OR “droga” OR “drogadicción” OR “drogodependencia” OR “drogas ilícitas” OR “drogas lícitas”
OR “drogas legales” OR “drogas recreacionais” OR “canabis” OR “cannabis” OR “canabinóide” OR
“marijuana” OR “marihuana” OR “estimulantes do sistema nervoso central” OR “estimulantes del sistema
nervioso central” OR “alucinógenos” OR “psicodélicos” OR “cafeína” OR “maconha” OR “dissociativos”
OR “deliriantes” OR “opiáceo” OR “opióides” OR “psicoativos” OR “metanfetamina” OR “meth” OR
“anfetaminas” OR “heroína” OR “ecstasy” OR “estimulantes” OR “sedativos” OR “LSD” OR “dietilamida do
ácido lisérgico” OR “crack” OR (“crack” AND “cocaína”) OR “cocaína” OR “opium” OR “opio” OR
“narcóticos” OR “narcótico” OR “narcótica” OR “narcóticas” OR “drogas narcóticas” OR “estupefaciente”)
Google Scholar With all of the words: bruxism
With the exact phrase: sleep bruxism
With at least 1 of the words: narcotics, caffeine, tobacco, alcohol, drugs
Where my word occurs: anywhere in the article
150 most relevant hits (15 pages)
* The search was performed April 20, 2016.
† MeSH: Medical Subject Headings.
JADA 147(11) http://jada.ada.org November 2016 866.e1

eTABLE 2
Excluded articles with reasons.
STUDY REASON FOR EXCLUSION*
Hartmann, 1979e1 1
Liester and Colleagues, 1992e2 3
Madrid and Colleagues, 1998e3 1
Vollenweider and Colleagues, 1998e4 4
Milosevic and Colleagues, 1999e5 3
Murray, 2001e6 1
Ohayon and Colleagues, 2001e7 2
Chuajedong and Colleagues, 2002e8 4
Winocur and Colleagues, 2002e9 3
Johansson and Colleagues, 2004e10 4
McGrath and Chan, 2005e11 2
Rhodus and Little, 2005e12 1
Donaldson and Goodchild, 2006e13 1
Goodchild and Donaldson, 2007e14 4
Hamamoto and Rhodus, 2009e15 1
Dinis-Oliveira and Colleagues, 2010e16 1
Oklahoma Dental Association, 2010e17 1
Rintakoski and Colleagues, 2010e18 5
Shetty and Colleagues, 2010e19 4
Bellini and Colleagues, 2011e20 4
Maloney and Raymond, 2014e21 1
Raúl and Colleagues, 2014e22 2
* 1: Reviews, letters, conference abstracts, and personal opinions; 2:
Studies in which the sample included children or adolescents; 3:
Studies in which the sample included patients taking medicines; 4:
Studies with different objectives; and 5: Studies with the same
sample reported in another included study.
866.e2 JADA 147(11) http://jada.ada.org November 2016

eTABLE 3
Cross-sectional and descriptive studies.
QUESTION PEROUTKA AND COHEN, LAVIGNE AND HOJO AND
COLLEAGUES, 1988e23 1995e24 COLLEAGUES, 1997e25 COLLEAGUES, 2007e26
Was the study based on a random or pseudorandom N* N N N
sample?
Were the criteria for inclusion in the sample clearly Y† Y Y Y
defined?
Were confounding factors identified and strategies N N N Y
to deal with them stated?
Were outcomes assessed using objective criteria? N N Y Y
If comparisons are being made, was there sufficient NA‡ NA Y Y
description of the groups?
Was the follow-up performed over a sufficient N N NA NA
period?
Were the outcomes of people who withdrew N N U§ Y
described and included in the analysis?
Were the outcomes measured in a reliable way? N N Y Y
Was an appropriate statistical analysis used? N N Y Y
Yes Score, % 11.11 11.11 55.55 77.77
Risk of Bias¶ High High Moderate Low
* N: No.
† Y: Yes.
‡ NA: Not applicable.
§ U: Unclear.
¶ We assessed the risk of bias by using the Meta-Analysis of Statistics Assessment and Review Instrumente27 critical appraisal tool. We categorized the
risk of bias as high when the study reached a yes score up to 49%, moderate when the study reached a yes score of 50% to 69%, and low when the
study reached a yes score of more than 70%.
eTABLE 4
Cohort and case-controlled studies.
QUESTION AHLBERG AND RINTAKOSKI AND RINTAKOSKI AND
COLLEAGUES, 2004e28 COLLEAGUES, 2010e29 KAPRIO, 2013e30
Was the sample representative of patients in the N* N N
population as a whole?
Were the patients at a similar point in the course of their Y† Y Y
condition or illness?
Had bias been minimized in relation to the selection of Y Y Y
cases and controls?
Were confounding factors identified and strategies to N Y Y
deal with them stated?
Were the outcomes assessed using objective criteria? Y Y Y
Was follow-up performed over a sufficient period? Y Y Y
Were the outcomes of people who withdrew described N N N
and included in the analysis?
Were the outcomes measured in a reliable way? Y Y Y
Was an appropriate statistical analysis used? Y Y Y
Yes Score, % 66.66 77.77 77.77
Risk of Bias‡ Moderate Low Low
* N: No.
† Y: Yes.
‡ We assessed the risk of bias by using the Meta-Analysis of Statistics Assessment and Review Instrumente27 critical appraisal tool. We categorized the
risk of bias as high when the study reached a yes score up to 49%, moderate when the study reached a yes score of 50% to 69%, and low when the
study reached a yes score of more than 70%.
JADA 147(11) http://jada.ada.org November 2016 866.e3

Supplementary References e17. Meth mouth and teeth. J Okla Dent Assoc. 2010;101(8):30.
e18. Rintakoski K, Ahlberg J, Hublin C, et al. Bruxism is associated with
e1. Hartmann E. Alcohol and bruxism. N Engl J Med. 1979;301(6):333-334. nicotine dependence: a nationwide Finnish twin cohort study. Nicotine
e2. Liester MB, Grob CS, Bravo GL, Walsh RN. Phenomenology and Tob Res. 2010;12(12):1254-1260.
sequelae of 3,4-methylenedioxymethamphetamine use. J Nerv Ment Dis. e19. Shetty V, Mooney LJ, Zigler CM, Belin TR, Murphy D, Rawson R.
1992;180(6):345-352. The relationship between methamphetamine use and increased dental
e3. Madrid G, Madrid S, Vranesh JG, Hicks RA. Cigarette smoking and disease. JADA. 2010;141(3):307-318.
bruxism. Percept Mot Skills. 1998;87(3 pt 1):898. e20. Bellini M, Marini I, Checchi V, Pelliccioni GA, Gatto MR. Self-
e4. Vollenweider FX, Gamma A, Liechti M, Huber T. Psychological and assessed bruxism and phobic symptomatology. Minerva Stomatol. 2011;
cardiovascular effects and short-term sequelae of MDMA (“ecstasy”) in MDMA- 60(3):93-103.
naive healthy volunteers. Neuropsychopharmacology. 1998;19(4):241-251. e21. Maloney WJ, Raymond G. The significance of ecstasy use to dental
e5. Milosevic A, Agrawal N, Redfearn PJ, Mair LH. The occurrence of practice. N Y State Dent J. 2014;80(6):24-27.
toothwear in users of ecstasy (3,4-methylene-dioxymethamphetamine). e22. Raúl R, Enrique R, Martín S, Andrés R, Fernando M. Drug
Community Dent Oral Epidemiol. 1999;27(4):283-287. dependence, bruxism and temporomandibular disorders. Odontoestoma-
e6. Murray JB. Ecstasy is a dangerous drug. Psychol Rep. 2001;88(3):895-902. tologia. 2014;16(24):26-33.
e7. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism e23. Peroutka SJ, Newman H, Harris H. Subjective effects of 3,
in the general population. Chest. 2001;119(1):53-61. 4-methylenedioxymethamphetamine in recreational users. Neuro-
e8. Chuajedong P, Kedjarune-Leggat U, Kertpon D, Chongsuvivat- psychopharmacology. 1988;1(4):273-277.
Wong V, Benjakul P. Associated factors of tooth wear in southern e24. Cohen RS. Subjective reports on the effects of the MDMA
Thailand. J Oral Rehabil. 2002;29(10):997-1002. (“ecstasy”) experience in humans. Prog Neuropsychopharmacol Biol
e9. Winocur E, Gavish A, Voikovitch M, Emodi-Perlman A, Eli I. Drugs Psychiatry. 1995;19(7):1137-1145.
and bruxism: a critical review. J Orofac Pain. 2002;17(2):99-111. e25. Lavigne GJ, Lobbezoo F, Rompre PH, Nielsen TA, Montplaisir J.
e10. Johansson A, Unell L, Carlsson GL, Soderfeldt B, Halling A, Cigarette smoking as a risk factor or an exacerbating factor for restless legs
Widar F. Associations between social and general health factors and syndrome and sleep bruxism. Sleep. 1997;20(4):290-293.
symptoms related to temporomandibular disorders and bruxism in a e26. Hojo A, Haketa T, Baba K, Igarashi Y. Association between the
population of 50-year-old subjects. Acta Odontol Scand. 2004;62(4):231-237. amount of alcohol intake and masseter muscle activity levels recorded
e11. McGrath C, Chan B. Oral health sensations associated with illicit during sleep in healthy young women. Int J Prosthodont. 2007;20(3):
drug abuse. Br Dent J. 2005;198(3):159-162; dicussion 147. 251-255.
e12. Rhodus NL, Little JW. Methamphetamine abuse and “meth mouth”. e27. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’
Northwest Dent. 2005;84(5):29,31,33-27. Manual: 2014 Edition. Adelaide, South Australia, Australia: The Joanna
e13. Donaldson M, Goodchild JH. Oral health of the methamphetamine Briggs Institute; 2014.
abuser. Am J Health Syst Pharm. 2006;63(21):2078-2082. e28. Ahlberg J, Savolainen A, Rantala M, Lindholm H, Kononen M.
e14. Goodchild JH, Donaldson M. Methamphetamine abuse and Reported bruxism and biopsychosocial symptoms: a longitudinal study.
dentistry: a review of the literature and presentation of a clinical case. Community Dent Oral Epidemiol. 2004;32(4):307-311.
Quintessence Int. 2007;38(7):583-590. e29. Rintakoski K, Ahlberg J, Hublin C, et al. Tobacco use and reported
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dentistry. Oral Dis. 2009;15(1):27-37. Tob Res. 2010;12(6):679-683.
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866.e4 JADA 147(11) http://jada.ada.org November 2016


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ORIGINAL CONTRIBUTIONS

Association between sleep bruxism

Eduardo Bertazzo-Silveira, DDS; Cristian Maikel ABSTRACT

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abstracts, and personal opinions

• Studies with different objectives

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GROUP STUDY, NO. OF AGE, Y* SB† ASSOCIATION, FINDINGS, STATISTICAL STUDY

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