The Prevalence of Awake and Sleep Bruxism of Afghan Youths Aged 15-26-year-old, a cross-sectional study

The Prevalence of Awake and Sleep Bruxism of Afghan Youths Aged 15-26-year-old, a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Prevalence of Awake and Sleep Bruxism of Afghan Youths Aged 15-26-year-old, a cross-sectional study Shamila Azimi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4143261/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background An agreement proposal based on the idea that bruxism is a "repetitive jaw activity" that can happen while sleep (sleep bruxism) or during waking (awake bruxism) was released by an international group of bruxism experts in 2013. Aim to determine the prevalence of awake and sleep bruxism among Afghan youth in Kabul city aged 15–26 years. Methods a cross-sectional questionnaire-based study has been carried out in two academic centers located in Kabul city. A total of 173 students of both genders participated in the study. Sleep and Awake Bruxism, chewing difficulties, joint noise, facial pain, anxiety, and stress were evaluated in the questionnaire. Data were gathered and input into SPSS 20.0. Results 173 male and female students in various age categories made up the initial study population. 96 females and 77 males. The results show there is No significant association between Bruxism and Gender. 109 (63.3%) reported not experiencing any form of bruxism (neither sleep nor awake). (10.3%) participants experiencing both AB and SB. (16.1%) experiencing SB and (10.3%) reported AB. overall 64 of the participants (36.7%) had bruxism which was (23%) were girls and (13.7%) were boys. This difference was not statistically significant the most frequent symptoms associated with dysfunction of the masticatory system were neck pain (28.2%), followed by joint noises (27.3%), facial pain (19.1%), and pain and difficulties in chewing (16.1%). Conclusion more than one-third of Afghan youths had a positive response regarding awake and sleep bruxism, and there was a strong correlation between bruxism, chewing difficulties, and facial pain. The youth reported varying levels of anxiety and stress, more investigations are needed to perform. Dentistry Medical Informatics Bruxism facial pain chewing difficulties stress/anxiety Afghans Figures Figure 1 Introduction There was significant discussion regarding the definition of bruxism. An agreement proposal based on the idea that bruxism is a "repetitive jaw activity" that can happen while sleep (sleep bruxism) or during waking (awake bruxism) was released by an international group of bruxism experts in 2013 1 . In 2018, it was proposed that awake bruxism is a masticatory activity of muscles that manifests as frequent or continuous mandibular clenching and/or tooth contact during wakefulness 2 . This type of behavior isn't always associated with other daily habits like biting one's lips or pens, etc. Muscle mastication during sleep, known as sleep bruxism, can be classified as rhythmic (phasic) or non-rhythmic (tonic). In healthy individuals, none of the kinds of bruxism are classified as a movement condition or a sleep disorder 2 . Each of the definitions ( 1 , 2 ) defines bruxism as a repeated muscular action that results in teeth clenching or grinding. The epidemiology data for both awake and sleep bruxism have shown significant variance 3 . The primary causes of these disparate prevalence results are the variations in definitions, diagnostic techniques, population attributes, and research methodologies among various investigations. Despite this high frequency, research on the age distribution of sleep bruxism consistently finds a declining tendency in prevalence as age increases 4–6 . The range of bruxism prevalence is relatively large: 4.1–59.2% for sleep bruxism and 2.7–57.3% for awake bruxism 7 . Clinical diagnosis of teeth grinding is only possible in cases of ignorance. Abnormal tooth wear is the most prevalent clinical sign of bruxism 8 . Additional symptoms include headaches, neck discomfort, temporomandibular problems, jaw pain upon waking up, tooth fractures, tooth sensitivity, and failures to repair teeth. A few parafunctional behaviors associated with bruxism are biting one's cheek, pressing one's teeth against the tongue, and experiencing a burning feeling on the tongue 9 . The causes, processes, and consequences of bruxism are unknown 7 . The precise etiology of bruxism is yet unknown and may have multiple contributing factors. In certain instances, bruxism is impacted by psychological and stress variables 8 . In social, professional, educational, and psychological contexts, the term "stress" is widely used and understood 10 . Overstressing students in higher education can have detrimental effects on their academic performance as well as their psychological, emotional, and health results. In recent years, more research has been done on the connection between student stress and bruxism. With its transitional character, demands, and difficulties, an educational setting can either teach students how to deal with it or remain oblivious to it and become vulnerable to its harmful effects 10 . Stressors in students' lives include schoolwork, relationships, the environment, schedules, and financial circumstances 11 . The lack of research on the subject of bruxism among students in Afghanistan's universities, academic institutes, and other institutions might be interpreted as evidence of the uniqueness of this study. Thus, the prevalence of awake and sleep bruxism among Afghan youth in Kabul city aged 15–26 years is examined in this study. Methodology The purpose of the study was to determine the prevalence of awake and sleep bruxism among young Afghans 15–26-year-olds living in Kabul, The following criteria for inclusion were used in the selection of participants: Ages 15 to 26 years old, people who had agreed to participate at the time of the study, and students enrolled in educational centers are the first three criteria. However, those who were mentally or physically handicapped were not allowed to participate in this study. The Dari language was used to compose the questionnaire. Twenty subjects participated in a pre-test and validation of the questionnaire to evaluate its responsiveness, clarity, and level of expertise. Ethical Clearance The study received ethical approval from the research ethics committee of Kabul University of Medical Sciences. Data was collected from students in two academic centers located in Kabul city. The researcher and the teachers handed questionnaires to the students in the classrooms after coordinating with the management of the academic centers. The researcher was not acquainted with any of the students personally and was not granted access to their personal information. Students were urged to participate after receiving a thorough explanation of the purpose and significance of the study. They received guarantees that the research would remain fully anonymous and that declining to take part would not have any negative effects on their academic record. Participants informed consent was sought before completing the questionnaire. Questionnaire The questionnaire was broken up into three sections: the first asked questions about name, age, and gender; the second section included yes/no questions about the major factors. joint noise, facial pain, neck ache, and difficulty chewing 12, Awake and sleep bruxism 13–14 . The final section consisted of multiple-choice questions to gauge the degree of anxiety 15 and stress 16 The following variables were assessed: Do you experience pain in your jaws, face, ears, or in front of your ears? (Facial pain). Do you get neck pain? (Neck Pain). Do you experience any difficulty in chewing? (Chewing difficulties). "Have you noticed that you clench your jaws or grind your teeth while you're asleep, or have you been told this by someone else?" (Yes, no) Sleep bruxism (SB). "Have you ever noticed that when you're awake, you're clenching or grinding your teeth?" (Yes, no) Awake bruxism (AB). Does the sound of your jaw click or pop when you open and close it, or when you chew? (Joint noise) When you open or close your mouth, or when you are chewing, does your jaw create a scraping or grating sound? (Joint noise). To find out how frequently each of the seven main items—such as worrying excessively about various things, feeling worried that something terrible might happen, or being unable to stop or control worrying—has bothered participants over the last two weeks, participants are questioned. Every item is evaluated using a Likert scale ranging from 1–4 (not at all - almost every day). Four severity levels were derived from the index scores of the answers: 0 representing no anxiety at all, 1 representing mild anxiety, 2 representing moderate anxiety, and 3 representing severe anxiety (anxiety). Participants were asked to rate their frequency of experiencing stress or a particular emotion. On a 5-point rating system from 0 to 4, each thing is ranked as "Never," "Rarely," "Sometimes," "Fairly Often," and "Very Often." The overall score is between 0 and 40. The scale underwent continuous variable analysis (stress). Data were gathered and input into SPSS 20.0. For qualitative characteristics like gender and bruxism prevalence, descriptive statistics were calculated as frequencies and percentages. The chi-square test was used to stratify bruxism among age and gender categories. P-values below 0.05 were regarded as significant. Results A cross-sectional study using questionnaires was conducted among educational centers in Kabul. Using a random sampling technique, 173 (96 female and 77 male) students in various age categories made up the initial study population. The results show there is No significant association between Bruxism and Gender. Considering Table 1, most participants were between the ages of 24-26. Table 1 sample size by age and sex groups Gender Boys Girls Total 77 96 173 44.5% 55.5% 100% Age group 15–17 year 18–20 year 21–23 year 24–26 year 17 19 49 83 10.1% 11.3% 29.2% 49.4% The final study sample was 173 of whom 109 (63.3%) reported not experiencing any form of bruxism (neither sleep nor awake). 18 (10.3%) participants experienced both AB and SB. 28 (16.1%) experienced SB and 18 participants (10.3%) reported AB. overall 64 of the participants (36.7%) had bruxism which was (23%) was girls and (13.7%) was boys. This difference was not statistically significant. Table 2 describes the prevalence of bruxism by gender and the number Gender Both SB and AB SB only AB only Neither SB nor AB Boys Girls Total 10 8 18 9 19 28 5 13 18 53 56 109 At least more than 80% of participants reported different degrees of anxiety and stress, severe anxiety was found in 10.3% of participants, moderate anxiety in 43.1% of the participants, and mild anxiety among 27.6%. More details are in Table 3. Table 3 shows frequencies and percentages of study variables by gender Total (n) Total % Girls (n) Boys (n) Chi-square p-value SB Yes No 28 109 16.1% 83.9% 19 77 9 68 2.068 0.150 AB Yes No 18 109 10.3% 89.7% 13 83 5 72 2.277 0.131 SB+AB Yes No 18 108 10.3% 89.7% 7 89 10 67 1.564 0.211 Facial pain Yes No 33 140 19.1% 80.9% 16 79 17 60 6.739 > 0.009 Chewing difficulties Yes No 28 146 16.1% 83.9% 12 84 16 61 5.452 > 0.02 Neck pain Yes No 49 124 28.2% 71.8% 24 72 25 52 4.731 0.30 TMJ noises Yes No 47 125 27.3% 72.7% 28 68 18 57 1.363 0.243 Anxiety None Mild Moderate Severe 33 48 75 18 19% 27.6% 43.1% 10.3% 16 24 44 12 17 23 31 6 4.238 0.237 Stress Never Mild Moderate Severe 26 70 58 19 15% 40.5% 33.5% 11% 10 40 31 14 16 30 26 5 5.988 0.112 Discussion The maxillofacial region may be negatively impacted by muscular activities such as bruxism during sleep or while awake 1 . Based on self-report questionnaires, which indicate the lowest (or "possible") grade of bruxism diagnosis, an epidemiological study was conducted to make the diagnosis of bruxism 1–2 . Electromyography for awake bruxism and polysomnography for sleep bruxism are required for a definitive diagnosis. Unfortunately, it is not possible to do such tests in an epidemiological study. In research such as this one, self-reported surveys are a standard instrument 14,17–18 . Overall, 36.7% of participants had a bruxism habit, according to our findings. This is comparable to results from studies by Nagarale R. et al. (2022) 8 , Cavallo P. et al. (2016) 10 , and Andrew T. C. et al. (2005) 13 , which were 35.5%, 37.9%, and 38%, respectively. Greater than the research in Azodo CC, et al. (2016) 19 (24.7%). Additionally, it is lower than research conducted in Peshawar (45.38%) by Mohammad AK, et al. (2019) 20 and in Israel (56.6%) by Winocur E, et al. (2019) 7 . The current study's findings about the prevalence of bruxism differ from previous research due to possible causes such as demographics, socioeconomic status, cultural influences, geographic location, and diagnostic criteria and indices. The study's sample of students had a higher prevalence of SB (16.1%) than AB (10.3%). These findings are consistent with research conducted in Canada 21 (SB 15% and AB 12.4%), Germany 14 (SB 14.8% and AB 8.7%), Nigeria 19 (SB 15.4%), and Israel 7 (14.8%). Conversely, Brazil's 22 results show that bruxism is more common among dentistry students there (AB 36.5% and SB 21.5%), in Nigeria 19 (AB 48.3%), Israel 7 (AB 34.5%), and Iraq 23 (AB 15.7% and SB 9.62%). This is because student life is full of demands and pressures, which can cause stress and then cause people to clench their teeth in an attempt to release tension 24 . This can be because academic pressures and societal inconsistencies in the form of amenities cause stress for students in developing nations. 55.5% of the participants were female; this might be attributed to the shutting of universities, the prohibition on girls above the sixth grade continuing their education, their inability to work, and other similar condemnations. These factors may also be the main causes of the significant number of girls having turned to learning institutions in Kabul. The results of this study indicated that there is no gender difference in bruxism. Friedman Rubin et al. reported similar outcomes 25 . However, they used orphans in their study, with the incidence of TMJ problems serving as the secondary outcome. However, according to a study performed on dental students at Necmettin Erbakan University, ladies were more likely than males to have bruxism 26 . Students who bruxed often experienced neck aches, joint noise, and facial pain, respectively. That may be the reason behind it; bruxism is a pathological activity of the stomatognathic system characterized by clenching and grinding of the teeth during abnormal movements of the jaw; several etiological causes, including systemic, psychological, genetic, and local, have been identified 27 . Stress has a role in the etiology of bruxism, as those who brux more frequently than those who do not, and stressful life events, in general, are linked to some parafunctional oral behaviors 28 . A possible explanation for the connection between bruxism and stress can be found in earlier studies that mentioned the masticatory organ as a last resort during episodes of psychic overloading 29 . The best strategy to prevent the stomatognathic system from becoming dysfunctional is to diagnose TMJ issues early, and parafunction is thought to be essential for this purpose 30 . Severe TMJ has been linked to a decreased understanding of oral parafunctional and impaired general health. One of the most common risk factors for temporomandibular disorders is bruxism 31–32 . In this study, 28.2% of patients reported having neck pain, while 27.3% experienced TMJ noise or pain. Additionally, it was shown that bruxism was linked to trouble chewing and TMJ pain or noise. Similarly, it has been reported that there is a positive association between self-reported bruxism and self-reported jaw functional restriction 33 . The masticatory system's tissues adjust to the bruxism behavior; nevertheless, in certain people, the cumulative stresses of this mandibular parafunction activity will exceed the tissues' ability to adapt, leading to masticatory system malfunction and pain 34 . Previous literature reports on the common relationship between sleep and wake-time parafunctions and symptoms and indications suggestive of temporomandibular disorders 35 .The study's report might be restricted because it only used self-report, even though there are alternative objective ways to measure bruxism, like clinical oral examination and electromyography. Nonetheless, self-reporting is a recognized style of evaluation since it makes it easier to use other, more objective evaluation techniques and helps determine whether an issue exists 19 . More than 80% of the study's participants reported increased levels of tension and anxiety, which may have something to do with Afghanistan's unfavorable political and economic circumstances. There is evidence that the psychoemotional component plays a significant role in the etiology of bruxism 1–36 . The degree of stress and anxiety were its primary constituents. Stress appears to be a factor in both sleep and waking bruxism, in addition to dental anxiety and gagging 37 . Compared to those who did not brux, patients who reported bruxism claimed to be under more emotional stress. This supported earlier research that indicated personality traits and stress were factors in the etiology of bruxism 36,37 . Conclusion More than one-third of Afghan youths had positive responses regarding awake and sleep bruxism, and there is a strong correlation between bruxism, chewing difficulties, and facial pain. The youth reported varying levels of anxiety and stress. As a research plan, we propose that additional studies be conducted to differentiate between bruxism during sleep and bruxism during awakening, taking into account the corresponding etiology. Additionally, we propose to evaluate the association between bruxism and stressors, potentially comparing different populations to account for the effects of various socio-cultural and academic settings. Strengths and limitations The strength of this research is that it is the first study of its kind undertaken in Afghanistan among health professions students, with no previous reports. Furthermore, this study was supervised and confirmed following the ethical principles (10 specific Helsinki principles: scientific requirements and research protocols, informed consent, privacy and confidentiality, research registration and publications, and so on) of Kabul University of Medical Sciences' research ethics committee. Since female students are not permitted to attend universities, we conducted that survey at academic centers in Kabul, which was the only location where we could reach both genders. This data is not sufficient to resolve and find the whole answers to questions; it is just a sample of data from Kabul. So, there is a need for broader data to cover most of the Afghan population. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Disclosure The authors declare no competing interests in this work. References Lobbezoo F, Ahlberg J, Glaros A, Kato T, Koyano K, Lavigne G, et al. Bruxism defined and graded: an international consensus. Journal of oral rehabilitation. 2013;40(1):2-4. Lobbezoo F, Ahlberg J, Raphael K, Wetselaar P, Glaros A, Kato T, et al. International consensus on the assessment of bruxism: Report of a work in progress. Journal of oral rehabilitation. 2018;45(11):837-44. Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake‐time tooth clenching in a 7‐to 17‐yr‐old population. European journal of oral sciences. 2011;119(5):386-94. Manfredini D, Winocur E, Guarda-Nardini L, Paesani D, Lobbezoo F. Epidemiology of bruxism in adults: a systematic review of the literature. 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Oral Rehabil. 2013, 40 , 2–4. Manfredini, D.; Serra-Negra, J.; Carboncini, F.; Lobbezoo, F. Current Concepts of Bruxism. Int. J. Prosthodont. 2017, 30 , 437–438. De Leeuw, L.R.; Klasser, G.D. Orofacial Pain. In Guidelines for Assessment, Diagnosis, and Management , 5th ed.; Quintessence Publishing Co., Inc.: Chicago, IL, USA, 2013. E. Winocur, N. Uziel, T. Lisha, C. Goldsmith, I. Eli. Self-reported Bruxism – association with perceived stress, motivation for control, dental anxiety, and gagging. Journal of Oral Rehabilitation. 2010;87:1365-2842. Fischer WF, O’toole ET. Personality characteristics of chronic bruxers. Behav Med. 1993;19:82–86. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4143261","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":282261873,"identity":"65b13091-b8bf-4239-b860-b8035b760dfa","order_by":0,"name":"Shamila Azimi","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0003-0146-8118","institution":"Kabul University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Shamila","middleName":"","lastName":"Azimi","suffix":""}],"badges":[],"createdAt":"2024-03-21 11:48:29","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-4143261/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4143261/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53255713,"identity":"314a0476-b6e1-4c2b-b5ec-67abebbf5733","added_by":"auto","created_at":"2024-03-22 13:29:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":17800,"visible":true,"origin":"","legend":"\u003cp\u003eBruxism distribution\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4143261/v1/e62b563dbea6d65f24e7ac4f.png"},{"id":53256555,"identity":"ba768b42-2032-4c59-b775-89a3bafee3ea","added_by":"auto","created_at":"2024-03-22 13:37:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":254946,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4143261/v1/d94ff0a2-0737-4930-a62c-88414b916838.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eThe Prevalence of Awake and Sleep Bruxism of Afghan Youths Aged 15-26-year-old, a cross-sectional study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThere was significant discussion regarding the definition of bruxism. An agreement proposal based on the idea that bruxism is a \"repetitive jaw activity\" that can happen while sleep (sleep bruxism) or during waking (awake bruxism) was released by an international group of bruxism experts in 2013\u003csup\u003e1\u003c/sup\u003e. In 2018, it was proposed that awake bruxism is a masticatory activity of muscles that manifests as frequent or continuous mandibular clenching and/or tooth contact during wakefulness\u003csup\u003e2\u003c/sup\u003e. This type of behavior isn't always associated with other daily habits like biting one's lips or pens, etc. Muscle mastication during sleep, known as sleep bruxism, can be classified as rhythmic (phasic) or non-rhythmic (tonic). In healthy individuals, none of the kinds of bruxism are classified as a movement condition or a sleep disorder\u003csup\u003e2\u003c/sup\u003e. Each of the definitions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) defines bruxism as a repeated muscular action that results in teeth clenching or grinding.\u003c/p\u003e \u003cp\u003eThe epidemiology data for both awake and sleep bruxism have shown significant variance\u003csup\u003e3\u003c/sup\u003e. The primary causes of these disparate prevalence results are the variations in definitions, diagnostic techniques, population attributes, and research methodologies among various investigations. Despite this high frequency, research on the age distribution of sleep bruxism consistently finds a declining tendency in prevalence as age increases \u003csup\u003e4\u0026ndash;6\u003c/sup\u003e. The range of bruxism prevalence is relatively large: 4.1\u0026ndash;59.2% for sleep bruxism and 2.7\u0026ndash;57.3% for awake bruxism\u003csup\u003e7\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eClinical diagnosis of teeth grinding is only possible in cases of ignorance. Abnormal tooth wear is the most prevalent clinical sign of bruxism\u003csup\u003e8\u003c/sup\u003e. Additional symptoms include headaches, neck discomfort, temporomandibular problems, jaw pain upon waking up, tooth fractures, tooth sensitivity, and failures to repair teeth. A few parafunctional behaviors associated with bruxism are biting one's cheek, pressing one's teeth against the tongue, and experiencing a burning feeling on the tongue\u003csup\u003e9\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe causes, processes, and consequences of bruxism are unknown\u003csup\u003e7\u003c/sup\u003e. The precise etiology of bruxism is yet unknown and may have multiple contributing factors. In certain instances, bruxism is impacted by psychological and stress variables\u003csup\u003e8\u003c/sup\u003e. In social, professional, educational, and psychological contexts, the term \"stress\" is widely used and understood\u003csup\u003e10\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOverstressing students in higher education can have detrimental effects on their academic performance as well as their psychological, emotional, and health results. In recent years, more research has been done on the connection between student stress and bruxism. With its transitional character, demands, and difficulties, an educational setting can either teach students how to deal with it or remain oblivious to it and become vulnerable to its harmful effects\u003csup\u003e10\u003c/sup\u003e. Stressors in students' lives include schoolwork, relationships, the environment, schedules, and financial circumstances\u003csup\u003e11\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe lack of research on the subject of bruxism among students in Afghanistan's universities, academic institutes, and other institutions might be interpreted as evidence of the uniqueness of this study. Thus, the prevalence of awake and sleep bruxism among Afghan youth in Kabul city aged 15\u0026ndash;26 years is examined in this study.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eThe purpose of the study was to determine the prevalence of awake and sleep bruxism among young Afghans 15\u0026ndash;26-year-olds living in Kabul, The following criteria for inclusion were used in the selection of participants: Ages 15 to 26 years old, people who had agreed to participate at the time of the study, and students enrolled in educational centers are the first three criteria. However, those who were mentally or physically handicapped were not allowed to participate in this study. The Dari language was used to compose the questionnaire. Twenty subjects participated in a pre-test and validation of the questionnaire to evaluate its responsiveness, clarity, and level of expertise.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical Clearance\u003c/h2\u003e \u003cp\u003e The study received ethical approval from the research ethics committee of Kabul University of Medical Sciences. Data was collected from students in two academic centers located in Kabul city. The researcher and the teachers handed questionnaires to the students in the classrooms after coordinating with the management of the academic centers. The researcher was not acquainted with any of the students personally and was not granted access to their personal information. Students were urged to participate after receiving a thorough explanation of the purpose and significance of the study. They received guarantees that the research would remain fully anonymous and that declining to take part would not have any negative effects on their academic record. Participants informed consent was sought before completing the questionnaire.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eQuestionnaire\u003c/h2\u003e \u003cp\u003eThe questionnaire was broken up into three sections: the first asked questions about name, age, and gender; the second section included yes/no questions about the major factors. joint noise, facial pain, neck ache, and difficulty chewing\u003csup\u003e12,\u003c/sup\u003e Awake and sleep bruxism\u003csup\u003e13\u0026ndash;14\u003c/sup\u003e. The final section consisted of multiple-choice questions to gauge the degree of anxiety\u003csup\u003e15\u003c/sup\u003e and stress\u003csup\u003e16\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe following variables were assessed: Do you experience pain in your jaws, face, ears, or in front of your ears? (Facial pain). Do you get neck pain? (Neck Pain). Do you experience any difficulty in chewing? (Chewing difficulties). \"Have you noticed that you clench your jaws or grind your teeth while you're asleep, or have you been told this by someone else?\" (Yes, no) Sleep bruxism (SB). \"Have you ever noticed that when you're awake, you're clenching or grinding your teeth?\" (Yes, no) Awake bruxism (AB). Does the sound of your jaw click or pop when you open and close it, or when you chew? (Joint noise) When you open or close your mouth, or when you are chewing, does your jaw create a scraping or grating sound? (Joint noise). To find out how frequently each of the seven main items\u0026mdash;such as worrying excessively about various things, feeling worried that something terrible might happen, or being unable to stop or control worrying\u0026mdash;has bothered participants over the last two weeks, participants are questioned. Every item is evaluated using a Likert scale ranging from 1\u0026ndash;4 (not at all - almost every day). Four severity levels were derived from the index scores of the answers: 0 representing no anxiety at all, 1 representing mild anxiety, 2 representing moderate anxiety, and 3 representing severe anxiety (anxiety). Participants were asked to rate their frequency of experiencing stress or a particular emotion. On a 5-point rating system from 0 to 4, each thing is ranked as \"Never,\" \"Rarely,\" \"Sometimes,\" \"Fairly Often,\" and \"Very Often.\" The overall score is between 0 and 40. The scale underwent continuous variable analysis (stress).\u003c/p\u003e \u003cp\u003eData were gathered and input into SPSS 20.0. For qualitative characteristics like gender and bruxism prevalence, descriptive statistics were calculated as frequencies and percentages. The chi-square test was used to stratify bruxism among age and gender categories. P-values below 0.05 were regarded as significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA cross-sectional study using questionnaires was conducted among educational centers in Kabul. Using a random sampling technique, 173 (96 female and 77 male) students in various age categories made up the initial study population.\u0026nbsp;The results show there is No significant association between Bruxism and Gender. Considering Table 1, most participants were between the ages of 24-26.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003esample size by age and sex groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBoys\u003c/p\u003e\n\u003cp\u003eGirls\u003c/p\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003cp\u003e96\u003c/p\u003e\n\u003cp\u003e173\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e44.5%\u003c/p\u003e\n\u003cp\u003e55.5%\u003c/p\u003e\n\u003cp\u003e100%\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge group\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15\u0026ndash;17 year\u003c/p\u003e\n\u003cp\u003e18\u0026ndash;20 year\u003c/p\u003e\n\u003cp\u003e21\u0026ndash;23 year\u003c/p\u003e\n\u003cp\u003e24\u0026ndash;26 year\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.1%\u003c/p\u003e\n\u003cp\u003e11.3%\u003c/p\u003e\n\u003cp\u003e29.2%\u003c/p\u003e\n\u003cp\u003e49.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe final study sample was 173 of whom 109 (63.3%) reported not experiencing any form of bruxism (neither sleep nor awake). 18 (10.3%) participants experienced both AB and SB. 28 (16.1%) experienced SB and 18 participants (10.3%) reported AB. overall 64 of the participants (36.7%) had bruxism which was (23%) was girls and (13.7%) was boys. This difference was not statistically significant.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003edescribes the prevalence of bruxism by gender and the number\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eBoth SB and AB\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSB only\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAB only\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNeither SB nor AB\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBoys\u003c/p\u003e\n\u003cp\u003eGirls\u003c/p\u003e\n\u003cp\u003eTotal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53\u003c/p\u003e\n\u003cp\u003e56\u003c/p\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAt least more than 80% of participants reported different degrees of anxiety and stress, severe anxiety was found in 10.3% of participants, moderate anxiety in 43.1% of the participants, and mild anxiety among 27.6%. More details are in Table 3.\u003c/p\u003e\n\u003ctable border=\"1\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 3\u003c/p\u003e\n\u003cp\u003eshows frequencies and percentages of study variables by gender\u003c/p\u003e\n\u003c/caption\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal (n)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal %\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u003cstrong\u003eGirls (n)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u003cstrong\u003eBoys (n)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u003cstrong\u003eChi-square \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eSB\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16.1%\u003c/p\u003e\n\u003cp\u003e83.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003cp\u003e77\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e9\u003c/p\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e2.068\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eAB\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003cp\u003e109\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10.3%\u003c/p\u003e\n\u003cp\u003e89.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e13\u003c/p\u003e\n\u003cp\u003e83\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e2.277\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.131\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eSB+AB\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003cp\u003e108\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10.3%\u003c/p\u003e\n\u003cp\u003e89.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7\u003c/p\u003e\n\u003cp\u003e89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e67\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e1.564\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.211\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eFacial pain\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003cp\u003e140\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e19.1%\u003c/p\u003e\n\u003cp\u003e80.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e79\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e6.739\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026gt; 0.009\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eChewing difficulties\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16.1%\u003c/p\u003e\n\u003cp\u003e83.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003cp\u003e84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e5.452\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026gt; 0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eNeck pain\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e28.2%\u003c/p\u003e\n\u003cp\u003e71.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e4.731\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.30\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eTMJ noises\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYes \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003cp\u003e125\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e27.3%\u003c/p\u003e\n\u003cp\u003e72.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e28\u003c/p\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e1.363\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.243\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eAnxiety\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNone \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMild \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSevere \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e33\u003c/p\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003cp\u003e75\u003c/p\u003e\n\u003cp\u003e18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e19%\u003c/p\u003e\n\u003cp\u003e27.6%\u003c/p\u003e\n\u003cp\u003e43.1%\u003c/p\u003e\n\u003cp\u003e10.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e17\u003c/p\u003e\n\u003cp\u003e23\u003c/p\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003cp\u003e6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e4.238\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.237\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"150\"\u003e\n\u003cp\u003eStress\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNever \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMild \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eModerate \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSevere \u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"78\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003cp\u003e70\u003c/p\u003e\n\u003cp\u003e58\u003c/p\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"96\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e15%\u003c/p\u003e\n\u003cp\u003e40.5%\u003c/p\u003e\n\u003cp\u003e33.5%\u003c/p\u003e\n\u003cp\u003e11%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"84\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10\u003c/p\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16\u003c/p\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003cp\u003e26\u003c/p\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e5.988\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"90\"\u003e\n\u003cp\u003e0.112\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe maxillofacial region may be negatively impacted by muscular activities such as bruxism during sleep or while awake\u003csup\u003e1\u003c/sup\u003e. Based on self-report questionnaires, which indicate the lowest (or \"possible\") grade of bruxism diagnosis, an epidemiological study was conducted to make the diagnosis of bruxism\u003csup\u003e1\u0026ndash;2\u003c/sup\u003e. Electromyography for awake bruxism and polysomnography for sleep bruxism are required for a definitive diagnosis. Unfortunately, it is not possible to do such tests in an epidemiological study. In research such as this one, self-reported surveys are a standard instrument \u003csup\u003e14,17\u0026ndash;18\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003e Overall, 36.7% of participants had a bruxism habit, according to our findings. This is comparable to results from studies by Nagarale R. et al. (2022)\u003csup\u003e8\u003c/sup\u003e, Cavallo P. et al. (2016)\u003csup\u003e10\u003c/sup\u003e, and Andrew T. C. et al. (2005)\u003csup\u003e13\u003c/sup\u003e, which were 35.5%, 37.9%, and 38%, respectively. Greater than the research in Azodo CC, et al. (2016)\u003csup\u003e19\u003c/sup\u003e (24.7%). Additionally, it is lower than research conducted in Peshawar (45.38%) by Mohammad AK, et al. (2019)\u003csup\u003e20\u003c/sup\u003e and in Israel (56.6%) by Winocur E, et al. (2019)\u003csup\u003e7\u003c/sup\u003e. The current study's findings about the prevalence of bruxism differ from previous research due to possible causes such as demographics, socioeconomic status, cultural influences, geographic location, and diagnostic criteria and indices.\u003c/p\u003e \u003cp\u003eThe study's sample of students had a higher prevalence of SB (16.1%) than AB (10.3%). These findings are consistent with research conducted in Canada\u003csup\u003e21\u003c/sup\u003e (SB 15% and AB 12.4%), Germany\u003csup\u003e14\u003c/sup\u003e (SB 14.8% and AB 8.7%), Nigeria\u003csup\u003e19\u003c/sup\u003e (SB 15.4%), and Israel\u003csup\u003e7\u003c/sup\u003e (14.8%). Conversely, Brazil's\u003csup\u003e22\u003c/sup\u003e results show that bruxism is more common among dentistry students there (AB 36.5% and SB 21.5%), in Nigeria\u003csup\u003e19\u003c/sup\u003e (AB 48.3%), Israel \u003csup\u003e7\u003c/sup\u003e(AB 34.5%), and Iraq\u003csup\u003e23\u003c/sup\u003e (AB 15.7% and SB 9.62%). This is because student life is full of demands and pressures, which can cause stress and then cause people to clench their teeth in an attempt to release tension\u003csup\u003e24\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis can be because academic pressures and societal inconsistencies in the form of amenities cause stress for students in developing nations. 55.5% of the participants were female; this might be attributed to the shutting of universities, the prohibition on girls above the sixth grade continuing their education, their inability to work, and other similar condemnations. These factors may also be the main causes of the significant number of girls having turned to learning institutions in Kabul. The results of this study indicated that there is no gender difference in bruxism. Friedman Rubin et al. reported similar outcomes\u003csup\u003e25\u003c/sup\u003e. However, they used orphans in their study, with the incidence of TMJ problems serving as the secondary outcome. However, according to a study performed on dental students at Necmettin Erbakan University, ladies were more likely than males to have bruxism\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStudents who bruxed often experienced neck aches, joint noise, and facial pain, respectively. That may be the reason behind it; bruxism is a pathological activity of the stomatognathic system characterized by clenching and grinding of the teeth during abnormal movements of the jaw; several etiological causes, including systemic, psychological, genetic, and local, have been identified\u003csup\u003e27\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eStress has a role in the etiology of bruxism, as those who brux more frequently than those who do not, and stressful life events, in general, are linked to some parafunctional oral behaviors\u003csup\u003e28\u003c/sup\u003e. A possible explanation for the connection between bruxism and stress can be found in earlier studies that mentioned the masticatory organ as a last resort during episodes of psychic overloading\u003csup\u003e29\u003c/sup\u003e. The best strategy to prevent the stomatognathic system from becoming dysfunctional is to diagnose TMJ issues early, and parafunction is thought to be essential for this purpose\u003csup\u003e30\u003c/sup\u003e. Severe TMJ has been linked to a decreased understanding of oral parafunctional and impaired general health. One of the most common risk factors for temporomandibular disorders is bruxism\u003csup\u003e31\u0026ndash;32\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn this study, 28.2% of patients reported having neck pain, while 27.3% experienced TMJ noise or pain. Additionally, it was shown that bruxism was linked to trouble chewing and TMJ pain or noise. Similarly, it has been reported that there is a positive association between self-reported bruxism and self-reported jaw functional restriction \u003csup\u003e33\u003c/sup\u003e. The masticatory system's tissues adjust to the bruxism behavior; nevertheless, in certain people, the cumulative stresses of this mandibular parafunction activity will exceed the tissues' ability to adapt, leading to masticatory system malfunction and pain\u003csup\u003e34\u003c/sup\u003e. Previous literature reports on the common relationship between sleep and wake-time parafunctions and symptoms and indications suggestive of temporomandibular disorders\u003csup\u003e35\u003c/sup\u003e.The study's report might be restricted because it only used self-report, even though there are alternative objective ways to measure bruxism, like clinical oral examination and electromyography. Nonetheless, self-reporting is a recognized style of evaluation since it makes it easier to use other, more objective evaluation techniques and helps determine whether an issue exists\u003csup\u003e19\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMore than 80% of the study's participants reported increased levels of tension and anxiety, which may have something to do with Afghanistan's unfavorable political and economic circumstances. There is evidence that the psychoemotional component plays a significant role in the etiology of bruxism\u003csup\u003e1\u0026ndash;36\u003c/sup\u003e. The degree of stress and anxiety were its primary constituents. Stress appears to be a factor in both sleep and waking bruxism, in addition to dental anxiety and gagging\u003csup\u003e37\u003c/sup\u003e. Compared to those who did not brux, patients who reported bruxism claimed to be under more emotional stress. This supported earlier research that indicated personality traits and stress were factors in the etiology of bruxism \u003csup\u003e36,37\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eMore than one-third of Afghan youths had positive responses regarding awake and sleep bruxism, and there is a strong correlation between bruxism, chewing difficulties, and facial pain. The youth reported varying levels of anxiety and stress. As a research plan, we propose that additional studies be conducted to differentiate between bruxism during sleep and bruxism during awakening, taking into account the corresponding etiology. Additionally, we propose to evaluate the association between bruxism and stressors, potentially comparing different populations to account for the effects of various socio-cultural and academic settings.\u003c/p\u003e "},{"header":"Strengths and limitations","content":"\u003cp\u003eThe strength of this research is that it is the first study of its kind undertaken in Afghanistan among health professions students, with no previous reports. Furthermore, this study was supervised and confirmed following the ethical principles (10 specific Helsinki principles: scientific requirements and research protocols, informed consent, privacy and confidentiality, research registration and publications, and so on) of Kabul University of Medical Sciences' research ethics committee. Since female students are not permitted to attend universities, we conducted that survey at academic centers in Kabul, which was the only location where we could reach both genders.\u003c/p\u003e\u003cp\u003eThis data is not sufficient to resolve and find the whole answers to questions; it is just a sample of data from Kabul. So, there is a need for broader data to cover most of the Afghan population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eDisclosure\u003c/h2\u003e \u003cp\u003eThe authors declare no competing interests in this work.\u003c/p\u003e "},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLobbezoo F, Ahlberg J, Glaros A, Kato T, Koyano K, Lavigne G, et al. Bruxism defined and graded: an international consensus. 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Uziel, T. Lisha, C. Goldsmith, I. Eli. Self-reported Bruxism \u0026ndash; association with perceived stress, motivation for control, dental anxiety, and gagging. Journal of Oral Rehabilitation. 2010;87:1365-2842. \u003c/li\u003e\n\u003cli\u003eFischer WF, O\u0026rsquo;toole ET. Personality characteristics of chronic bruxers. Behav Med. 1993;19:82\u0026ndash;86. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kabul Medical University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Bruxism, facial pain, chewing difficulties, stress/anxiety, Afghans","lastPublishedDoi":"10.21203/rs.3.rs-4143261/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4143261/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn agreement proposal based on the idea that bruxism is a \"repetitive jaw activity\" that can happen while sleep (sleep bruxism) or during waking (awake bruxism) was released by an international group of bruxism experts in 2013.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eto determine the prevalence of awake and sleep bruxism among Afghan youth in Kabul city aged 15–26 years.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ea cross-sectional questionnaire-based study has been carried out in two academic centers located in Kabul city. A total of 173 students of both genders participated in the study. Sleep and Awake Bruxism, chewing difficulties, joint noise, facial pain, anxiety, and stress were evaluated in the questionnaire. Data were gathered and input into SPSS 20.0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e173 male and female students in various age categories made up the initial study population. 96 females and 77 males. The results show there is No significant association between Bruxism and Gender. 109 (63.3%) reported not experiencing any form of bruxism (neither sleep nor awake). (10.3%) participants experiencing both AB and SB. (16.1%) experiencing SB and (10.3%) reported AB. overall 64 of the participants (36.7%) had bruxism which was (23%) were girls and (13.7%) were boys. This difference was not statistically significant the most frequent symptoms associated with dysfunction of the masticatory system were neck pain (28.2%), followed by joint noises (27.3%), facial pain (19.1%), and pain and difficulties in chewing (16.1%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003emore than one-third of Afghan youths had a positive response regarding awake and sleep bruxism, and there was a strong correlation between bruxism, chewing difficulties, and facial pain. The youth reported varying levels of anxiety and stress, more investigations are needed to perform.\u003c/p\u003e","manuscriptTitle":"The Prevalence of Awake and Sleep Bruxism of Afghan Youths Aged 15-26-year-old, a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 13:29:31","doi":"10.21203/rs.3.rs-4143261/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63ef1198-c1b2-4687-8e1b-9e9ffcc7407b","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":29761577,"name":"Dentistry"},{"id":29761578,"name":"Medical Informatics"}],"tags":[],"updatedAt":"2024-03-22T13:29:31+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-22 13:29:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4143261","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4143261","identity":"rs-4143261","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}