Association Between Social Determinants of Health and Probable Bruxism in Schoolchildren: Cross-Sectional Study

Association Between Social Determinants of Health and Probable Bruxism in Schoolchildren: 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 Association Between Social Determinants of Health and Probable Bruxism in Schoolchildren: Cross-Sectional Study Letícia Angonesi Quadros, Vitória de Oliveira Chami, Jessica Klockner Knorst, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6298538/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 Objective To evaluate the association between social determinants of health and probable sleep and wake bruxism in schoolchildren. Methods A cross-sectional study was designed in which schoolchildren aged 8 to 12 years were evaluated. Bruxism assessment involved a clinical examination and the application of the structured questionnaire which generated a bruxism score. Social determinants of health, such as sex, age, skin color, family income, caffeine consumption, physical activity and stress, were measured through a structured questionnaire and open-ended questions administered to parents or guardians. Unadjusted and adjusted Poisson regression analyses were used to assess the association of predictor variables (social determinants of health) with probable bruxism. Results Twenty-seven schoolchildren were evaluated. In the unadjusted analysis, male patients and those with a family income of less than one minimum wage had higher overall bruxism scores (p < 0.01). Patients who were stressed, consumed high amounts of caffeine, and did not regularly participate in sports also had higher overall bruxism scores (p < 0.01). In the adjusted analysis, stressed patients had bruxism scores 2.54 times higher than non-stressed (RR 2.54; 95% CI 1.38–4.68). Individuals from families with an income below the minimum wage had higher bruxism scores compared to those with a family income equal to or above the minimum wage (RR 2.47; 95% CI 1.41–4.32). Male individuals had bruxism scores 2.01 times higher than female schoolchildren (RR 2.01; 95% CI 1.05–3.82). Conclusion Schoolchildren with a family income of less than one minimum wage, who were stressed, and who were male had higher scores of bruxism. Social determinants of health Sleep bruxism Awake bruxism Child INTRODUCTION Bruxism is characterized by repetitive activity of the masticatory muscles and clenching or grinding the teeth (Lobbezoo et al., 2018 ). The complex and multifactorial etiology of bruxism makes it difficult to diagnose (Oliveira et al., 2015 ). Moreover, there are many risk factors associated with it, such as genetics, anxiety, nervousness, passive smoking, snoring, restless sleep, sleeping with the light on, noise in the room, sleeping fewer than 8 hours a night, headaches, problems with colleagues, emotional symptoms and mental health problems (Serra- Negra et al., 2014 ; Guo et al., 2018 ). At present, Bruxism is subdivided into two subtypes: sleep bruxism and awake bruxism, according to the classification of the 2018 International Bruxism Assessment Consensus (Lobbezoo et al., 2018 ). At this Consensus meeting, sleep bruxism was defined as involuntary muscular activity of the masticatory muscles, which may be rhythmic (phasic), non-rhythmic (tonic) or mixed. Whereas awake bruxism was defined as muscular activity of the masticatory muscles characterized by repetitive or sustained contact of the teeth and/or reinforcements or pushes of the jaw while the patient is awake. When both types occur in healthy individuals, they are not considered disorders, but rather a behavior that can be a risk factor for health (Lobbezoo et al., 2018 ). The prevalence of bruxism in children varies greatly, from 3.5–40.6%, according to a systematic review (Canto et al., 2015 ), sleep bruxism is the most prevalent type, ranging from 3–49%, decreasing to 1–15% in adult life (Melo et al., 2019 ). According to the International Consensus on Bruxism, it can be diagnosed by means of instrumental approaches, such as computerized systems for recording data of polysomnography, the gold standard, and non-instrumental approaches, such as self-report of bruxism (Lobbezoo et al., 2013 ). Bruxism can be diagnosed considering it to be possible bruxism, probable bruxism and definitive bruxism (Lobbezoo et al., 2018 ). Bruxism is considered possible when there is a report from third parties, who hear noises or tooth grinding while the patient sleeps. Bruxism is considered probable when there are evident clinical signs of bruxism, with positive or negative self-reports from the patient. Whereas it is considered definitive when there are clinical signs as well as confirmation by polysomnography, electromyography, or momentary ecological assessment (Lobbezoo et al., 2018 ). Bruxism can negatively affect patients' quality of life, in addition to causing damage to the periodontium, tooth wear, tooth loss, pain in the facial muscles and temporomandibular joint (Renner et al., 2012; Lobbezoo et al., 2018 ). Furthermore, many studies have associated bruxism with emotional and psychosocial factors such as anxiety and stress in children (Canto et al, 2015 ; Brancher et al, 2020 ; Almeida Leite et al. 2020). In children, bruxism is an important public health problem, as it directly affects the quality of life of patients, especially those who feel pain (Guo et al., 2018 ). A study conducted by Serra- Negra, in 2009 reported that a high degree of responsibility, neuroticism and individual personality traits are determining factors for the development of sleep bruxism in children. Corroborating these data, in 2018, a systematic review also described a high degree of responsibility in children as a factor related to bruxism (Guo et al., 2018 ). Moreover, in 2020 a study reported that children with emotional symptoms and peer relationship problems among schoolchildren, were 1.75 times more likely to develop bruxism (Brancher et al., 2020 ). Although some studies have described an association between some social determinants of health and bruxism, the literature still lacks further clarification relative to bruxism in schoolchildren. Therefore, the aim of this study was to evaluate the association between probable bruxism, during sleep and awake, in schoolchildren and social determinants of health, such as: profound changes in the child's life, stress, high caffeine consumption, social activity and reduced physical fitness, family income, skin color, sex and age of students. The conceptual hypothesis of the study was that social determinants of health influence the rates of bruxism in the children evaluated. MATERIALS AND METHODS This was a cross-sectional study submitted to and approved by the Research Ethics Committee of the xxxxxxxxxxxx (CAAE: xxxxxxxxx), conducted between April 2019 and October 2020. This manuscript followed the STROBE guideline protocol for cross-sectional studies (Von Elm et al., 2007). Schoolchildren aged between 8 and 12 years participated in the research voluntarily. They were patients who sought care at the xxxxxx children's dental clinic, in the city of xxxxxxxx. Those included in the study were in the mixed dentition phase and had undergone rapid maxillary expansion for the treatment of maxillary atresia associated with apparent or relative posterior crossbite, as it was a previous sample. Those who presented with syndromes, showed cognitive and/or neurological changes, as well as those who used anticoagulant medications (AASM, 2005) or any class of neurological medication were excluded from the study, all this information was collected through anamnesis. Authorization for children to participate was granted by means of the Term of Free and Informed Consent (ICF) signed by the parents or guardians and the children approved the Minor's Assent Form. The patients included had previously undergone a dental evaluation, in which a general health anamnesis was obtained, an intraoral clinical examination was performed. In addition, a socioeconomic questionnaire, a questionnaire to assess possible bruxism in schoolchildren and a questionnaire to assess the social determinants of health were administered to those responsible for the children. The clinical examination was performed by a single examiner trained and calibrated by an experienced researcher. For calibration, both professionals carried out a clinical assessment of the presence or absence of tooth wear in the maxillary canines (Piyawattanataworn W et al., 2020) in 20 children in the same age range as those in the sample. Inter-examiner (Kappa = 0.76) and intra-examiner (Kappa = 0.78) agreement values were adequate. Evaluation of the social determinants of health The social determinants were defined according to the conceptual model proposed by the World Health Organization (WHO) (Solar, O.; Irwin, A., 2010 ) and were assessed by means of a questionnaire, in which there were questions about physical exercise, social activity, doses of coffee and/or chimarrão /mate (a traditional xxxxxxx yerba mate infusion that contains caffeine) (Table 1 ). To answer the question about physical exercise, the patient could choose between response options with scores ranging from zero to four (0 = none, 1 = very little, 2 = little, 3 = moderate, 4 = regular). Whereas for social activity, the score could vary from zero to three (0 = none, 1 = very little, 2 = moderate, 3 = active). For doses of coffee and chimarrão , scores ranged from zero to three (0 = does not drink, 1 = one to three doses, 2 = two to four doses, 3 = more than six doses). Furthermore, one question asked whether the patient had recently undergone any life changes, such as: death of someone close to them, separation from parents and change of school; and whether the patient experienced any acute stress event, which could be answered with yes or no. Finally, a question relative to the average family income was asked using an open question: “Last month, what was the total amount, in reais, received by all the people who live in your house? (including amounts of salaries, family allowance, pension, retirement, and other income)”. For statistical analysis, physical exercise was categorized into three levels: none, little, or a lot. A score of 0 was considered none, scores of 1 and 2 were considered little, and scores of 3 and 4 were considered a lot. Social activity was categorized similarly: a score of 0 was considered none, scores of 1 and 2 were considered little, and a score of 3 was considered a lot. Caffeine consumption was also categorized into three levels: a score of 0 was considered none, scores of 1 and 2 were considered little, and a score of 3 was considered a lot. Recent life changes were dichotomized into yes or no. Finally, the variable of family income was dichotomized into less than one minimum wage or equal/greater than one minimum wage (brazilian minimum wage is equivalent to U $ 259,15). Table 1 Questionnaire on social determinants of health Exercises None Very little A little Moderate Regular Social activity None Very little Moderate Active Doses of coffee Does not drink coffee 1 to 2 doses 3 to 4 doses More than 6 doses Chimarrão/herb tea Does not drink it 1 to 2 “mate” herb tea 3 to 4 “mate” herb teas More than 6 “mate” herb teas Assessment of probable bruxism in schoolchildren To assess probable bruxism, a retrospective questionnaire was used as a tool, structured by the researchers, applied to those responsible. This questionnaire was adapted for children using the Oral Behaviors Checklist (OBC), contained in the DC-TMD (Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments - Brazilian Portuguese ) (Ohrbach et al., 2016). The assessment of bruxism was conducted after rapid maxillary expansion, as it increases the upper airways (Caprioglio et al., 2014 ). The questionnaire consists of fifteen questions, three of which refer to the sleep period, seven to waking up and five to the awakened period, as shown in Table 2 . Each question could score between 0 and 4 points, with the higher value being related to the greater frequency of observing the symptoms. In addition to the questionnaire, dental wear in the maxillary canines was evaluated, according to previous literature (Piyawattanataworn W et al., 2020), therefore, the diagnosis of bruxism could be considered probable, according to Lobbezoo and collaborators (2013). For descriptive analysis, sleep bruxism was considered present when the patient exhibited signs of dental wear and responded positively to the first question of the questionnaire. Awake bruxism was considered present when the patient exhibited signs of dental wear and responded positively to the question 11 of the questionnaire. For regression analysis, the general bruxism score was considered. As the bruxism questionnaire had not previously been validated, its reliability was tested using internal consistency tests, test-retest measures, and Spearman's correlation coefficient. Probable bruxism was assessed after rapid maxillary expansion since the influence of posterior crossbite on bruxism in children has previously been described (Diéguez-Pérez, Ticona-Flores, Prieto-Regueiro, 2023). Table 2 Questionnaire for Assessing Possible Bruxism in Schoolchildren. During sleep, does your child (a) Never Less than one night per month 1 to 3 nights per month 1 to 3 nights per week 4 or more nights per week Grind or clench his/her teeth during sleep? Snore? Show signs of suffocating? On waking, does your child (a) Never Less than one night per month 1 to 3 nights per month 1 to 3 nights per week 4 or more nights per week Report pain in the face? Report tiredness in the face? Report headache in the temporal region? Experience locking or rigidness in the jaw? Sensitive teeth or gums? Dry mouth? Stuffy or blocked nose? While your child is awake, does he/she (a) Never A short part of the time Some part of the time The higher part of the time All the time /constantly Clench, grind or bite down on his/her teeth Hold, tighten or tense the muscles while he/she isn’t chewing or biting down on his/her teeth? Place his/her tongue between his/her teeth? Bite his/her nails? Bite or hold objects between his/her teeth? Data analysis Data were analyzed using Stata 14.1 (StataCorp. 2014. Stata Statistical Software: Release 14.1. College Station, TX: StataCorp LP). A descriptive analysis of the sample was performed according to demographic socioeconomic and behavioral characteristics. Unadjusted and adjusted Poisson regression analysis was performed to evaluate the impact of predictor variables on probable bruxism. Variables that presented p < 0.20 in the unadjusted model were included in the adjusted model. The results are presented as Rate Ratio (RR) and 95% confidence interval (95% CI). P < 0.05 was considered significant. RESULTS Of the 27 individuals of whom the study sample was composed, 52.6% were diagnosed with probable sleep bruxism, 31.5% with awake bruxism, approximately 63% were female and 83% had white skin color. The mean age was 9,1 years (SD 1.46) years. Relative to family income, the majority of individuals belonged to families with income below 1 Brazilian minimum wage (BMW) (84.4%). Considering behavioral variables, the majority of individuals had a high consumption of mate or caffeine (67.7%). Furthermore, the majority of individuals practiced physical exercise regularly or moderately (83.3%), were not stressed (63.2%) and had not undergone recent changes in life (78.7%) (Table 3 ). Table 3 Demographic, socioeconomic, psychosocial, and behavioral characteristics of the individuals included in the study, xxxxxx (n = 27). Variables Total Social determinants of health N % Sex Female 17 63.0 Male 10 37.0 Age ≤ 9 years 18 66.6 > 9 years 9 33.4 Skin color White 20 83.3 Nonwhite 4 16.7 Family Income ≥ 1 BMW 3 13.6 < 1 BMW 19 84.4 Mate and coffee Low consumption 6 33.3 High consumption 12 67.7 Physical exercise Regular or moderate 15 83.3 Very little or nothing 3 16.7 Stress Absent 12 63.2 Present 7 38.8 Change in life No 14 78.7 Yes 5 26.3 Outcome Mean SD Bruxism score 3.2 4.9 Values below 27 are due to missing data; BMW, Brazilian minimum wage; SD, standard deviation; *Fisher's exact test; ☨ T -test. Table 4 presents the crude and adjusted analysis of the association between predictor variables and general bruxism scores. In the unadjusted analysis, male individuals with lower family income had higher overall scores for probable bruxism (p < 0.01). Considering the social determinants of health, individuals who had a high consumption of mate or caffeine, did not exercise regularly and had an acute stress event also had higher levels of probable bruxism (p < 0.01). The adjusted analysis showed that individuals from families who received less than 1 BMW also had higher scores for probable bruxism (RR 2.47; 95% CI 1.41–4.32). Individuals who experienced an acute stress event, reported by their parents, had bruxism scores 2.54 times higher than their peers (RR 2.54; 95% CI 1.38–4.68). Finally, male individuals had probable sleep bruxism scores 2.01 times higher when compared with female students (RR 2.01; 95% CI 1.05–3.82). Table 4 Unadjusted and adjusted analysis of the association between predictor variables at the beginning of the study and overall scores of bruxism, xxxxxx (n = 27). Variables General scores of bruxism Unadjusted RR (95% IC) p-value Adjusted RR(95% IC) Sociodemographic variables Sex 9 years 1.32 (0.86–2.02) Skin color 0.531 White 1 (reference) - Nonwhite 1.16 (0.72–1.89) Family Income < 0.001 ≥ 1 BMW 1 (reference) 1 (reference) < 1 BMW 2.66 (1.64–4.32) 2.47 (1.41–4.32)* Psychosocial and Behavioral Variables Mate and coffee < 0.01 Low consumption 1 (reference) 1 (reference) High consumption 2.18 (1.27–3.76) 1.35 (0.75–2.47) Physical exercise < 0.01 Regular or moderate 1 (reference) 1 (reference) Very little or nothing 2.04 (1.28–3.26) 2.25 (0.99–5.09) Stress < 0.001 Absent 1 (reference) 1 (reference) Present 4.08 (2.58–6.46) 2.54 (1.38–4.68)* Change in life 0.353 No 1 (reference) - Yes 1.23 (0.78–1.94) RR., rate ratio, CI. Confidence interval DISCUSSION The aim of the present study was to evaluate the association between probable sleep and awake bruxism, and social determinants of health in schoolchildren. The results obtained in this cross-sectional study partially confirmed the conceptual hypothesis, as some social determinants of health evaluated demonstrated an association with higher bruxism scores, such as: family income below one minimum wage, presence of acute stress event in children reported by parents, and being of the male sex. In the present study, students who experienced an acute stress event had bruxism scores 2.54 times higher when compared with their peers. This result agrees with a systematic review conducted in 2018, which listed anxiety and nervousness as risk factors for bruxism in children (Guo et al., 2018 ). Moreover, other authors have concluded that a high degree of responsibility, neuroticism and individual personality traits were also determining factors for the development of bruxism (Serra- Negra et al., 2009). Canto and collaborators, in 2015, also showed a positive association between bruxism and anxiety/stress in schoolchildren aged 6 to 11 years. This association could be attributed with the hypothesis that sleep bruxism may act as a mechanism for releasing tension accumulated during the day. The result of the present study also showed that children whose family income was lower than 1 BMW had bruxism scores 2.47 times higher when compared with those of children whose family income was higher than or equal to 1 BMW. Amaral and collaborators, in 2022, evaluated 556 children aged 7 to 8 years old, used questionnaires to determine the socioeconomic level, and clinical examination together with self-report from those responsible for the children, to determine the presence or absence of bruxism. According to the authors, children belonging to families with low socioeconomic status had a higher prevalence of probable sleep bruxism. Another study also concluded that children from lower social classes had a high prevalence of sleep bruxism (Bach et al., 2019 ). The supposition is that this association may be based on the influence of unfavorable socioeconomic conditions that could increase levels of stress and anxiety. Moreover, it is possible that children from families with lower incomes could have worse sleeping conditions, as there may be several people in the same room, and it would be more difficult to control light, noise, and temperature, which are capable of influencing sleep bruxism. Another plausible explanation for this correlation could be that families with lower incomes often share sleeping spaces, facilitating easier observation of bruxism in children and thereby increasing the probability of its reported incidence. Furthermore, in the present research, an association was observed between sex and bruxism, in which male students had bruxism scores 2.01 times higher when compared with female students. This result agreed with a study conducted in Piauí - Brazil, in which male children had a higher prevalence of sleep bruxism (Sousa et al., 2018). Corroborating these results, Lam and collaborators, in 2011 and Guo and collaborators, in 2018, showed a higher prevalence of sleep bruxism in male children. Finally, a study conducted in 2012 showed that the female sex was a protective factor (PR = 0.78) for bruxism in children (Renner et al., 2012). A study by Serra- Negra and collaborators (2010) however, found no difference in prevalence between the sexes. The result of this research could be attributed to a number of factors, including the possibility that in some contexts, girls may demonstrate less agitated behavior than boys (Renner et al., 2012). Moreover, it is important to consider that boys could frequently be faced with social pressures relative to s agitated/aggressive behaviors that could induce them to repress their emotions this could contribute to the occurrence of bruxism (Renner et al., 2012). Initially, bruxism showed a positive association with caffeine consumption in the students evaluated, however, this association was not maintained in the adjusted analysis. In spite of this, it is important to highlight this association since studies conducted with adults have shown that patients who drink coffee had more episodes of bruxism when compared with non-coffee-drinkers (Bertazzo-Silveira et al., 2016; Goldstein, Desatis, Goodacre, 2020; Frosztega et al.,2023). According to a note published in November 2022, by the Brazilian Society of Pediatrics (SBP), there is no global consensus or recommendation regarding safe levels of caffeine consumption by children and adolescents, however it is known that caffeine does not bring health benefits to this population, but rather losses such as delayed neurocognitive development, risks of dependence and intoxication (Bispo et al.,2022). This may perhaps be the reason why studies with children do not investigate caffeine consumption. Nevertheless, it is extremely important for parents and guardians to know which foods contain caffeine in their composition, such as: soft drinks, chocolate drinks, infusions, teas and coffees. In this context, it is essential for further research to be conducted for the purpose of evaluating the potential effects of caffeine consumption on bruxism in children. Another notable finding from our study is the relationship between physical exercise and bruxism. Initially observed in our unadjusted analysis, this association did not maintain significance after adjusting for other variables, though the confidence interval (0.99–5.09) suggests a marginally nonsignificant trend. A larger sample size might have yielded different results. Importantly, our research highlights the role of physical activity in stress management, which demonstrated a positive link with bruxism. Additionally, physical activity has been shown to support mental health (Rodriguez-Ayllon et al., 2019) and improve sleep quality in patients (Zhao, Lu, Yi., 2023). Therefore, further investigation into this relationship is crucial. One of the strengths of this research is its focus on caffeine consumption among schoolchildren, as such investigations are typically conducted only with adults due to the recommendation against caffeine intake during childhood. However, in xxxxxxxx,xxxxx, chimarrão (traditional xxxxxxx, xxxx yerba mate infusion, which contains caffeine) is consumed from an early age, and many schools provide coffee during snack breaks. Finally, we emphasize that multivariate analysis was performed. Regarding the limitations of our study, it is important to note the use of a convenience sample and non-validated questionnaires. However, it is crucial to acknowledge that no validated questionnaire exists in the literature specifically for diagnosing probable bruxism in children. Despite our small sample size, we were able to identify significant associations. Furthermore, our evaluation focused solely on dental wear in canines, without assessing other potential indicators such as linea alba and tongue indentations. Therefore, future studies should consider using representative samples with larger cohorts and validating questionnaires specific to pediatric bruxism. This approach will contribute to more robust findings and enhance the reliability of conclusions drawn from such research. CONCLUSION Based on the results of this research, it can be concluded that: students who had a family income lower than one minimum wage, those who presented an acute stress event, and being of the male sex showed higher bruxism scores. Declarations Author Contribution Leticia Angonesi Quadros, Vitória de Oliveira Chami conceptualized and designed the manuscript, wrote the initial draft, and participated in the critical review and revision of the manuscript. Vilmar Antonio Ferrazzo, Jéssica Klockner Knorst, and Mariana Marquezan conceptualized and designed the manuscript, coordinated and supervised the manuscript development, and provided a critical review of the manuscript. All authors reviewed and approved the final manuscript for submission and agreed to be accountable for all aspects of the work. The authors declare no conflicts of interest. 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International consensus on the assessment of bruxism: Report of a work in progress. J Oral Rehabil ., 45(11), 837-844, Nov, 2018; https://doi.org/10.1111/joor.12663 MELO G, DUARTE J, PAULETTO P, PORPORATTI AL, STUGINSKI-BARBOSA J, WINOCUR E, FLORES-MIR C, CANTO GL. Bruxism: An umbrella review of systematic reviews. J Oral Rehabil. , 46(7):666-690, Jun. 2019; https://doi.org/10.1111/joor.12801 OLIVEIRA MT, BITTENCOURT ST, MARCON K, DESTRO S, PEREIRA JR. Sleep bruxism and anxiety level in children. Braz Oral Res [online], 29(1):1-5, 2015; https://doi.org/10.1590/1807-3107bor-2015.vol29.0024 OHRBACH R, editor. Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments. Version 15 May 2016. www.rdc-tmdinternational.org PIYAWATTANATAWORN W, SIRITAPETAWEE M, CHATRCHAIWIWATANA S, PAPHANGKORAKIT J. Validity of Wear at the Upper Canine’s Cusp Tip in Predicting Sleep Bruxism. J Med Assoc Thai . ;103: 7-12, 2020. RENNER AC, DA SILVA AAM, RODRIGUEZ JDM, SIMÕES VMF, BARBIERI MA, BETTIOL H, THOMAZ EBAF, SARAIVA MC. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol. , 40(3):277-87, Jun. 2012; https://doi.org/10.1111/j.1600-0528.2011.00644.x RODRIGUEZ‑AYLLON et al. Role of Physical Activity and Sedentary Behavior in the Mental Health of Preschoolers, Children and Adolescents: A Systematic Review and Meta‑Analysis. Sports Med., 49(9), Sep. 2019; https://doi.org/10.1007/s40279-019-01099-5 SERRA- NEGRA JM, RAMOS-JORGE ML, FLORES-MENDOZA CE, PAIVA SM, PORDEUS IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent. , 19(5), 309-17, Sep. 2009; https://doi.org/10.1111/j.1365-263x.2009.00973.x SERRA- NEGRA JM, PAIVA SM, SEABRA AP, DORELLA C, LEMOS BF, PORDEUS IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. European Archives of Paediatric Dentistry ., 11(4):192-5, Aug. 2010; https://doi.org/10.1007/bf03262743 SERRA- NEGRA JM, PAIVA SM, FULGÊNCIO LB, CHAVEZ BA, LAGE CF, PORDEUS IA. Environmental factors, sleep duration, and sleep bruxism in Brazilian schoolchildren: a case-control study. Sleep Med ., 15(2):236-9, Feb. 2014; https://doi.org/10.1016/j.sleep.2013.08.797 SOLAR, O.; IRWIN, A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice) . London: UCL, 2010. https://www.who.int/publications/i/item/9789241500852 SOUSA HCS, DE LIMA MDM, NETA NBD, TOBIAS RQ, DE MOURA MS, MOURA LFAD. Prevalência e fatores associados ao bruxismo do sono em adolescentes de Teresina, Piauí. Rev. bras. epidemiol . 21, 2018; https://doi.org/10.1590/1980-549720180002 VON ELM E, ALTMAN DG, EGGER M, POCOCK SJ, GOTZSCHE PC, VANDENBROUCKE JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Lancet , 2007; https://doi.org/10.1016/s0140-6736(07)61602-x ZHAO H, LU C, YI C.Physical Activity and Sleep Quality Association in Different Populations: A Meta-Analysis. Int J Environ Res Public Health , Jan. 2023; https://doi.org/10.3390/ijerph20031864 Additional Declarations No competing interests reported. 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. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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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-6298538","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440070593,"identity":"68f7a121-6f94-4c1c-b7b8-c09a3edda580","order_by":0,"name":"Letícia Angonesi Quadros","email":"data:image/png;base64,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","orcid":"","institution":"Universidade Federal de Santa Maria","correspondingAuthor":true,"prefix":"","firstName":"Letícia","middleName":"Angonesi","lastName":"Quadros","suffix":""},{"id":440070594,"identity":"4953cd54-1822-4b3c-aaa6-a139483ea9f4","order_by":1,"name":"Vitória de Oliveira Chami","email":"","orcid":"","institution":"Military, Santa Maria, RS, Brazil","correspondingAuthor":false,"prefix":"","firstName":"Vitória","middleName":"de Oliveira","lastName":"Chami","suffix":""},{"id":440070595,"identity":"d7755200-5db4-450b-84bc-708d1177e577","order_by":2,"name":"Jessica Klockner Knorst","email":"","orcid":"","institution":"Universidade Federal de Santa Maria","correspondingAuthor":false,"prefix":"","firstName":"Jessica","middleName":"Klockner","lastName":"Knorst","suffix":""},{"id":440070596,"identity":"59bd8500-3861-4850-82af-2a0a284a5c09","order_by":3,"name":"Vilmar Antonio Ferrazzo","email":"","orcid":"","institution":"Universidade Federal de Santa Maria","correspondingAuthor":false,"prefix":"","firstName":"Vilmar","middleName":"Antonio","lastName":"Ferrazzo","suffix":""},{"id":440070597,"identity":"9631b3e7-e77d-4cb1-9107-bdd34fdb9999","order_by":4,"name":"Mariana Marquezan","email":"","orcid":"","institution":"Universidade Federal de Santa Maria","correspondingAuthor":false,"prefix":"","firstName":"Mariana","middleName":"","lastName":"Marquezan","suffix":""}],"badges":[],"createdAt":"2025-03-24 22:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6298538/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6298538/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":80471300,"identity":"e45c0aa0-92d7-41a5-ad42-3d7fc3e66380","added_by":"auto","created_at":"2025-04-13 08:01:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":973673,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6298538/v1/50e41121-f7c4-49f0-8fe2-02a5761c7f96.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eAssociation Between Social Determinants of Health and Probable Bruxism in Schoolchildren: Cross-Sectional Study\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eBruxism is characterized by repetitive activity of the masticatory muscles and clenching or grinding the teeth (Lobbezoo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). The complex and multifactorial etiology of bruxism makes it difficult to diagnose (Oliveira et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Moreover, there are many risk factors associated with it, such as genetics, anxiety, nervousness, passive smoking, snoring, restless sleep, sleeping with the light on, noise in the room, sleeping fewer than 8 hours a night, headaches, problems with colleagues, emotional symptoms and mental health problems (Serra- Negra et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Guo et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAt present, Bruxism is subdivided into two subtypes: sleep bruxism and awake bruxism, according to the classification of the 2018 International Bruxism Assessment Consensus (Lobbezoo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). At this Consensus meeting, sleep bruxism was defined as involuntary muscular activity of the masticatory muscles, which may be rhythmic (phasic), non-rhythmic (tonic) or mixed. Whereas awake bruxism was defined as muscular activity of the masticatory muscles characterized by repetitive or sustained contact of the teeth and/or reinforcements or pushes of the jaw while the patient is awake. When both types occur in healthy individuals, they are not considered disorders, but rather a behavior that can be a risk factor for health (Lobbezoo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of bruxism in children varies greatly, from 3.5\u0026ndash;40.6%, according to a systematic review (Canto et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), sleep bruxism is the most prevalent type, ranging from 3\u0026ndash;49%, decreasing to 1\u0026ndash;15% in adult life (Melo et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAccording to the International Consensus on Bruxism, it can be diagnosed by means of instrumental approaches, such as computerized systems for recording data of polysomnography, the gold standard, and non-instrumental approaches, such as self-report of bruxism (Lobbezoo et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Bruxism can be diagnosed considering it to be possible bruxism, probable bruxism and definitive bruxism (Lobbezoo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Bruxism is considered possible when there is a report from third parties, who hear noises or tooth grinding while the patient sleeps. Bruxism is considered probable when there are evident clinical signs of bruxism, with positive or negative self-reports from the patient. Whereas it is considered definitive when there are clinical signs as well as confirmation by polysomnography, electromyography, or momentary ecological assessment (Lobbezoo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBruxism can negatively affect patients' quality of life, in addition to causing damage to the periodontium, tooth wear, tooth loss, pain in the facial muscles and temporomandibular joint (Renner et al., 2012; Lobbezoo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Furthermore, many studies have associated bruxism with emotional and psychosocial factors such as anxiety and stress in children (Canto et al, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Brancher et al, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Almeida Leite et al. 2020).\u003c/p\u003e \u003cp\u003eIn children, bruxism is an important public health problem, as it directly affects the quality of life of patients, especially those who feel pain (Guo et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). A study conducted by Serra- Negra, in 2009 reported that a high degree of responsibility, neuroticism and individual personality traits are determining factors for the development of sleep bruxism in children. Corroborating these data, in 2018, a systematic review also described a high degree of responsibility in children as a factor related to bruxism (Guo et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, in 2020 a study reported that children with emotional symptoms and peer relationship problems among schoolchildren, were 1.75 times more likely to develop bruxism (Brancher et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e Although some studies have described an association between some social determinants of health and bruxism, the literature still lacks further clarification relative to bruxism in schoolchildren. Therefore, the aim of this study was to evaluate the association between probable bruxism, during sleep and awake, in schoolchildren and social determinants of health, such as: profound changes in the child's life, stress, high caffeine consumption, social activity and reduced physical fitness, family income, skin color, sex and age of students. The conceptual hypothesis of the study was that social determinants of health influence the rates of bruxism in the children evaluated.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003eThis was a cross-sectional study submitted to and approved by the Research Ethics Committee of the xxxxxxxxxxxx (CAAE: xxxxxxxxx), conducted between April 2019 and October 2020. This manuscript followed the STROBE guideline protocol for cross-sectional studies (Von Elm et al., 2007).\u003c/p\u003e \u003cp\u003eSchoolchildren aged between 8 and 12 years participated in the research voluntarily. They were patients who sought care at the xxxxxx children's dental clinic, in the city of xxxxxxxx. Those included in the study were in the mixed dentition phase and had undergone rapid maxillary expansion for the treatment of maxillary atresia associated with apparent or relative posterior crossbite, as it was a previous sample. Those who presented with syndromes, showed cognitive and/or neurological changes, as well as those who used anticoagulant medications (AASM, 2005) or any class of neurological medication were excluded from the study, all this information was collected through anamnesis. Authorization for children to participate was granted by means of the Term of Free and Informed Consent (ICF) signed by the parents or guardians and the children approved the Minor's Assent Form.\u003c/p\u003e \u003cp\u003eThe patients included had previously undergone a dental evaluation, in which a general health anamnesis was obtained, an intraoral clinical examination was performed. In addition, a socioeconomic questionnaire, a questionnaire to assess possible bruxism in schoolchildren and a questionnaire to assess the social determinants of health were administered to those responsible for the children. The clinical examination was performed by a single examiner trained and calibrated by an experienced researcher. For calibration, both professionals carried out a clinical assessment of the presence or absence of tooth wear in the maxillary canines (Piyawattanataworn W et al., 2020) in 20 children in the same age range as those in the sample. Inter-examiner (Kappa\u0026thinsp;=\u0026thinsp;0.76) and intra-examiner (Kappa\u0026thinsp;=\u0026thinsp;0.78) agreement values were adequate.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEvaluation of the social determinants of health\u003c/h2\u003e \u003cp\u003eThe social determinants were defined according to the conceptual model proposed by the World Health Organization (WHO) (Solar, O.; Irwin, A., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) and were assessed by means of a questionnaire, in which there were questions about physical exercise, social activity, doses of coffee and/or \u003cem\u003echimarr\u0026atilde;o\u003c/em\u003e/mate (a traditional xxxxxxx yerba mate infusion that contains caffeine) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). To answer the question about physical exercise, the patient could choose between response options with scores ranging from zero to four (0\u0026thinsp;=\u0026thinsp;none, 1\u0026thinsp;=\u0026thinsp;very little, 2\u0026thinsp;=\u0026thinsp;little, 3\u0026thinsp;=\u0026thinsp;moderate, 4\u0026thinsp;=\u0026thinsp;regular). Whereas for social activity, the score could vary from zero to three (0\u0026thinsp;=\u0026thinsp;none, 1\u0026thinsp;=\u0026thinsp;very little, 2\u0026thinsp;=\u0026thinsp;moderate, 3\u0026thinsp;=\u0026thinsp;active). For doses of coffee and \u003cem\u003echimarr\u0026atilde;o\u003c/em\u003e, scores ranged from zero to three (0\u0026thinsp;=\u0026thinsp;does not drink, 1\u0026thinsp;=\u0026thinsp;one to three doses, 2\u0026thinsp;=\u0026thinsp;two to four doses, 3\u0026thinsp;=\u0026thinsp;more than six doses). Furthermore, one question asked whether the patient had recently undergone any life changes, such as: death of someone close to them, separation from parents and change of school; and whether the patient experienced any acute stress event, which could be answered with yes or no. Finally, a question relative to the average family income was asked using an open question: \u0026ldquo;Last month, what was the total amount, in reais, received by all the people who live in your house? (including amounts of salaries, family allowance, pension, retirement, and other income)\u0026rdquo;. For statistical analysis, physical exercise was categorized into three levels: none, little, or a lot. A score of 0 was considered none, scores of 1 and 2 were considered little, and scores of 3 and 4 were considered a lot. Social activity was categorized similarly: a score of 0 was considered none, scores of 1 and 2 were considered little, and a score of 3 was considered a lot. Caffeine consumption was also categorized into three levels: a score of 0 was considered none, scores of 1 and 2 were considered little, and a score of 3 was considered a lot. Recent life changes were dichotomized into yes or no. Finally, the variable of family income was dichotomized into less than one minimum wage or equal/greater than one minimum wage (brazilian minimum wage is equivalent to U\u003cspan\u003e$\u003c/span\u003e259,15).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestionnaire on social determinants of health\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercises\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery little\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eA little\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eModerate Regular\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVery little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eActive\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoses of coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoes not drink coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 to 2 doses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 to 4 doses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMore than 6 doses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChimarr\u0026atilde;o/herb tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoes not drink it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 to 2 \u0026ldquo;mate\u0026rdquo; herb tea\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 to 4 \u0026ldquo;mate\u0026rdquo; herb teas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMore than 6 \u0026ldquo;mate\u0026rdquo; herb teas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment of probable bruxism in schoolchildren\u003c/h3\u003e\n\u003cp\u003eTo assess probable bruxism, a retrospective questionnaire was used as a tool, structured by the researchers, applied to those responsible. This questionnaire was adapted for children using the \u003cem\u003eOral Behaviors Checklist\u003c/em\u003e (OBC), contained in the DC-TMD \u003cem\u003e(Diagnostic Criteria for Temporomandibular Disorders: Assessment Instruments - Brazilian Portuguese\u003c/em\u003e) (Ohrbach et al., 2016). The assessment of bruxism was conducted after rapid maxillary expansion, as it increases the upper airways (Caprioglio et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2014\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe questionnaire consists of fifteen questions, three of which refer to the sleep period, seven to waking up and five to the awakened period, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Each question could score between 0 and 4 points, with the higher value being related to the greater frequency of observing the symptoms. In addition to the questionnaire, dental wear in the maxillary canines was evaluated, according to previous literature (Piyawattanataworn W et al., 2020), therefore, the diagnosis of bruxism could be considered probable, according to Lobbezoo and collaborators (2013). For descriptive analysis, sleep bruxism was considered present when the patient exhibited signs of dental wear and responded positively to the first question of the questionnaire. Awake bruxism was considered present when the patient exhibited signs of dental wear and responded positively to the question 11 of the questionnaire. For regression analysis, the general bruxism score was considered. As the bruxism questionnaire had not previously been validated, its reliability was tested using internal consistency tests, test-retest measures, and Spearman's correlation coefficient.\u003c/p\u003e \u003cp\u003eProbable bruxism was assessed after rapid maxillary expansion since the influence of posterior crossbite on bruxism in children has previously been described (Di\u0026eacute;guez-P\u0026eacute;rez, Ticona-Flores, Prieto-Regueiro, 2023).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuestionnaire for Assessing Possible Bruxism in Schoolchildren.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuring sleep, does your child (a)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than one night per month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 to 3 nights per month\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 to 3 nights per week\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 or more nights per week\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrind or clench his/her teeth during sleep?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSnore?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShow signs of suffocating?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOn waking, does your child (a)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than one night per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 to 3 nights per month\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 to 3 nights per week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 or more nights per week\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReport pain in the face?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReport tiredness in the face?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReport headache in the temporal region?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExperience locking or rigidness in the jaw?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSensitive teeth or gums?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDry mouth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStuffy or blocked nose?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhile your child is awake, does he/she (a)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eA short part of the time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSome part of the time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eThe higher part of the time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAll the time /constantly\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClench, grind or bite down on his/her teeth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHold, tighten or tense the muscles while he/she isn\u0026rsquo;t chewing or biting down on his/her teeth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace his/her tongue between his/her teeth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBite his/her nails?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBite or hold objects between his/her teeth?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using Stata 14.1 (StataCorp. 2014. Stata Statistical Software: Release 14.1. College Station, TX: StataCorp LP). A descriptive analysis of the sample was performed according to demographic socioeconomic and behavioral characteristics.\u003c/p\u003e \u003cp\u003eUnadjusted and adjusted Poisson regression analysis was performed to evaluate the impact of predictor variables on probable bruxism. Variables that presented p\u0026thinsp;\u0026lt;\u0026thinsp;0.20 in the unadjusted model were included in the adjusted model. The results are presented as Rate Ratio (RR) and 95% confidence interval (95% CI). P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 27 individuals of whom the study sample was composed, 52.6% were diagnosed with probable sleep bruxism, 31.5% with awake bruxism, approximately 63% were female and 83% had white skin color. The mean age was 9,1 years (SD 1.46) years. Relative to family income, the majority of individuals belonged to families with income below 1 Brazilian minimum wage (BMW) (84.4%). Considering behavioral variables, the majority of individuals had a high consumption of mate or caffeine (67.7%). Furthermore, the majority of individuals practiced physical exercise regularly or moderately (83.3%), were not stressed (63.2%) and had not undergone recent changes in life (78.7%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic, socioeconomic, psychosocial, and behavioral characteristics of the individuals included in the study, xxxxxx (n\u0026thinsp;=\u0026thinsp;27).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSocial determinants of health\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonwhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e 1 BMW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 1 BMW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMate and coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular or moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e83.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery little or nothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOutcome\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBruxism score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eValues below 27 are due to missing data; BMW, Brazilian minimum wage; SD, standard deviation;\u003c/p\u003e \u003cp\u003e*Fisher's exact test; ☨ T -test.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the crude and adjusted analysis of the association between predictor variables and general bruxism scores. In the unadjusted analysis, male individuals with lower family income had higher overall scores for probable bruxism (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Considering the social determinants of health, individuals who had a high consumption of mate or caffeine, did not exercise regularly and had an acute stress event also had higher levels of probable bruxism (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). The adjusted analysis showed that individuals from families who received less than 1 BMW also had higher scores for probable bruxism (RR 2.47; 95% CI 1.41\u0026ndash;4.32). Individuals who experienced an acute stress event, reported by their parents, had bruxism scores 2.54 times higher than their peers (RR 2.54; 95% CI 1.38\u0026ndash;4.68). Finally, male individuals had probable sleep bruxism scores 2.01 times higher when compared with female students (RR 2.01; 95% CI 1.05\u0026ndash;3.82).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eUnadjusted and adjusted analysis of the association between predictor variables at the beginning of the study and overall scores of bruxism, xxxxxx (n\u0026thinsp;=\u0026thinsp;27).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eGeneral scores of bruxism\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003cp\u003eRR (95% IC)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003cp\u003eRR(95% IC)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eSociodemographic variables\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.94 (1.28\u0026ndash;2.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.01 (1.05\u0026ndash;3.82)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026le;\u003c/span\u003e9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt; 9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.32 (0.86\u0026ndash;2.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin color\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.531\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNonwhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.16 (0.72\u0026ndash;1.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e 1 BMW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; 1 BMW\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.66 (1.64\u0026ndash;4.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.47 (1.41\u0026ndash;4.32)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ePsychosocial and Behavioral Variables\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMate and coffee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh consumption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.18 (1.27\u0026ndash;3.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.35 (0.75\u0026ndash;2.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegular or moderate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVery little or nothing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.04 (1.28\u0026ndash;3.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.25 (0.99\u0026ndash;5.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.08 (2.58\u0026ndash;6.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.54 (1.38\u0026ndash;4.68)*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChange in life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.23 (0.78\u0026ndash;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eRR., rate ratio, CI. Confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe aim of the present study was to evaluate the association between probable sleep and awake bruxism, and social determinants of health in schoolchildren. The results obtained in this cross-sectional study partially confirmed the conceptual hypothesis, as some social determinants of health evaluated demonstrated an association with higher bruxism scores, such as: family income below one minimum wage, presence of acute stress event in children reported by parents, and being of the male sex.\u003c/p\u003e \u003cp\u003eIn the present study, students who experienced an acute stress event had bruxism scores 2.54 times higher when compared with their peers. This result agrees with a systematic review conducted in 2018, which listed anxiety and nervousness as risk factors for bruxism in children (Guo et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, other authors have concluded that a high degree of responsibility, neuroticism and individual personality traits were also determining factors for the development of bruxism (Serra- Negra et al., 2009). Canto and collaborators, in 2015, also showed a positive association between bruxism and anxiety/stress in schoolchildren aged 6 to 11 years. This association could be attributed with the hypothesis that sleep bruxism may act as a mechanism for releasing tension accumulated during the day.\u003c/p\u003e \u003cp\u003eThe result of the present study also showed that children whose family income was lower than 1 BMW had bruxism scores 2.47 times higher when compared with those of children whose family income was higher than or equal to 1 BMW. Amaral and collaborators, in 2022, evaluated 556 children aged 7 to 8 years old, used questionnaires to determine the socioeconomic level, and clinical examination together with self-report from those responsible for the children, to determine the presence or absence of bruxism. According to the authors, children belonging to families with low socioeconomic status had a higher prevalence of probable sleep bruxism. Another study also concluded that children from lower social classes had a high prevalence of sleep bruxism (Bach et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). The supposition is that this association may be based on the influence of unfavorable socioeconomic conditions that could increase levels of stress and anxiety. Moreover, it is possible that children from families with lower incomes could have worse sleeping conditions, as there may be several people in the same room, and it would be more difficult to control light, noise, and temperature, which are capable of influencing sleep bruxism. Another plausible explanation for this correlation could be that families with lower incomes often share sleeping spaces, facilitating easier observation of bruxism in children and thereby increasing the probability of its reported incidence.\u003c/p\u003e \u003cp\u003eFurthermore, in the present research, an association was observed between sex and bruxism, in which male students had bruxism scores 2.01 times higher when compared with female students. This result agreed with a study conducted in Piau\u0026iacute; - Brazil, in which male children had a higher prevalence of sleep bruxism (Sousa et al., 2018). Corroborating these results, Lam and collaborators, in 2011 and Guo and collaborators, in 2018, showed a higher prevalence of sleep bruxism in male children. Finally, a study conducted in 2012 showed that the female sex was a protective factor (PR\u0026thinsp;=\u0026thinsp;0.78) for bruxism in children (Renner et al., 2012). A study by Serra- Negra and collaborators (2010) however, found no difference in prevalence between the sexes. The result of this research could be attributed to a number of factors, including the possibility that in some contexts, girls may demonstrate less agitated behavior than boys (Renner et al., 2012). Moreover, it is important to consider that boys could frequently be faced with social pressures relative to s agitated/aggressive behaviors that could induce them to repress their emotions this could contribute to the occurrence of bruxism (Renner et al., 2012).\u003c/p\u003e \u003cp\u003eInitially, bruxism showed a positive association with caffeine consumption in the students evaluated, however, this association was not maintained in the adjusted analysis. In spite of this, it is important to highlight this association since studies conducted with adults have shown that patients who drink coffee had more episodes of bruxism when compared with non-coffee-drinkers (Bertazzo-Silveira et al., 2016; Goldstein, Desatis, Goodacre, 2020; Frosztega et al.,2023). According to a note published in November 2022, by the Brazilian Society of Pediatrics (SBP), there is no global consensus or recommendation regarding safe levels of caffeine consumption by children and adolescents, however it is known that caffeine does not bring health benefits to this population, but rather losses such as delayed neurocognitive development, risks of dependence and intoxication (Bispo et al.,2022). This may perhaps be the reason why studies with children do not investigate caffeine consumption. Nevertheless, it is extremely important for parents and guardians to know which foods contain caffeine in their composition, such as: soft drinks, chocolate drinks, infusions, teas and coffees. In this context, it is essential for further research to be conducted for the purpose of evaluating the potential effects of caffeine consumption on bruxism in children.\u003c/p\u003e \u003cp\u003eAnother notable finding from our study is the relationship between physical exercise and bruxism. Initially observed in our unadjusted analysis, this association did not maintain significance after adjusting for other variables, though the confidence interval (0.99\u0026ndash;5.09) suggests a marginally nonsignificant trend. A larger sample size might have yielded different results. Importantly, our research highlights the role of physical activity in stress management, which demonstrated a positive link with bruxism. Additionally, physical activity has been shown to support mental health (Rodriguez-Ayllon et al., 2019) and improve sleep quality in patients (Zhao, Lu, Yi., 2023). Therefore, further investigation into this relationship is crucial.\u003c/p\u003e \u003cp\u003eOne of the strengths of this research is its focus on caffeine consumption among schoolchildren, as such investigations are typically conducted only with adults due to the recommendation against caffeine intake during childhood. However, in xxxxxxxx,xxxxx, \u003cem\u003echimarr\u0026atilde;o\u003c/em\u003e (traditional xxxxxxx, xxxx yerba mate infusion, which contains caffeine) is consumed from an early age, and many schools provide coffee during snack breaks. Finally, we emphasize that multivariate analysis was performed.\u003c/p\u003e \u003cp\u003eRegarding the limitations of our study, it is important to note the use of a convenience sample and non-validated questionnaires. However, it is crucial to acknowledge that no validated questionnaire exists in the literature specifically for diagnosing probable bruxism in children. Despite our small sample size, we were able to identify significant associations. Furthermore, our evaluation focused solely on dental wear in canines, without assessing other potential indicators such as linea alba and tongue indentations. Therefore, future studies should consider using representative samples with larger cohorts and validating questionnaires specific to pediatric bruxism. This approach will contribute to more robust findings and enhance the reliability of conclusions drawn from such research.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eBased on the results of this research, it can be concluded that: students who had a family income lower than one minimum wage, those who presented an acute stress event, and being of the male sex showed higher bruxism scores.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLeticia Angonesi Quadros, Vit\u0026oacute;ria de Oliveira Chami conceptualized and designed the manuscript, wrote the initial draft, and participated in the critical review and revision of the manuscript. Vilmar Antonio Ferrazzo, J\u0026eacute;ssica Klockner Knorst, and Mariana Marquezan conceptualized and designed the manuscript, coordinated and supervised the manuscript development, and provided a critical review of the manuscript. All authors reviewed and approved the final manuscript for submission and agreed to be accountable for all aspects of the work. The authors declare no conflicts of interest.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe authors declare that data is available upon request.\u003c/p\u003e\n\u003ch3\u003eDECLARATION OF INTEREST STATEMENT\u003c/h3\u003e\n\u003cp\u003eThe authors report no conflict of interest\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eALMEIDA LEITE CM, STUGINSKI-BARBOSA J, CONTI PCR. How psychosocial and economic impacts of COVID-19 pandemic can interfere on bruxism and temporomandibular disorders?. \u003cstrong\u003eJ Appl Oral Sci\u003c/strong\u003e., 28, 2020; https://doi.org/10.1590/1678-7757-2020-0263\u003c/li\u003e\n \u003cli\u003eAMARAL CC, FERNANDEZ MS, JANSEN K, DA SILVA, RA, BOSCATO N, GOETTEMS ML. Daily screen time, sleep pattern, and probable sleep bruxism in children: A cross- sectional study. \u003cstrong\u003eOral Dis\u003c/strong\u003e. 29 (7) 2888-2894, Oct. 2023; https://doi.org/10.1111/odi.14395\u003c/li\u003e\n \u003cli\u003eBACH SL, MOREIRA FP, GOETTEMS ML, BRANCHER LC, OSES JP, DA SILVA RA, JANSEN K. Salivary cortisol levels and biological rhythm in schoolchildren with sleep bruxism. \u003cstrong\u003eSleep Med.\u0026nbsp;\u003c/strong\u003e2019; https://doi.org/10.1016/j.sleep.2018.09.031\u003c/li\u003e\n \u003cli\u003eBERTAZZO-SILVEIRA E, KRUGER CM, DE TOLEDO IP, PORPORATTI AL,DICK B, FLORES-MIR C, CANTO GL. Association between sleep bruxism and alcohol, caffeine, tobacco, and drug abuse. A systematic review. \u003cstrong\u003eJ Am Dent Assoc\u003c/strong\u003e., 147(11):859-866, Nov. 2016; https://doi.org/10.1016/j.adaj.2016.06.014\u003c/li\u003e\n \u003cli\u003eBISPO AJB, BRASILEIRO DA, MADEIRA IR, ASSAD RR, KASSAR SB, COSTA SMR, SIH TM. 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Preval\u0026ecirc;ncia e fatores associados ao bruxismo do sono em adolescentes de Teresina, Piau\u0026iacute;. \u003cstrong\u003eRev. bras. epidemiol\u003c/strong\u003e. 21, 2018; https://doi.org/10.1590/1980-549720180002\u003c/li\u003e\n \u003cli\u003eVON ELM E, ALTMAN DG, EGGER M, POCOCK SJ, GOTZSCHE PC, VANDENBROUCKE JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. \u003cstrong\u003eLancet\u003c/strong\u003e, 2007; https://doi.org/10.1016/s0140-6736(07)61602-x\u003c/li\u003e\n \u003cli\u003eZHAO H, LU C, YI C.Physical Activity and Sleep Quality Association in Different Populations: A Meta-Analysis. \u003cstrong\u003eInt J Environ Res Public Health\u003c/strong\u003e, Jan. 2023; https://doi.org/10.3390/ijerph20031864\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","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":"Social determinants of health, Sleep bruxism, Awake bruxism, Child","lastPublishedDoi":"10.21203/rs.3.rs-6298538/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6298538/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the association between social determinants of health and probable sleep and wake bruxism in schoolchildren.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was designed in which schoolchildren aged 8 to 12 years were evaluated. Bruxism assessment involved a clinical examination and the application of the structured questionnaire which generated a bruxism score. Social determinants of health, such as sex, age, skin color, family income, caffeine consumption, physical activity and stress, were measured through a structured questionnaire and open-ended questions administered to parents or guardians. Unadjusted and adjusted Poisson regression analyses were used to assess the association of predictor variables (social determinants of health) with probable bruxism.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eTwenty-seven schoolchildren were evaluated. In the unadjusted analysis, male patients and those with a family income of less than one minimum wage had higher overall bruxism scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Patients who were stressed, consumed high amounts of caffeine, and did not regularly participate in sports also had higher overall bruxism scores (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In the adjusted analysis, stressed patients had bruxism scores 2.54 times higher than non-stressed (RR 2.54; 95% CI 1.38\u0026ndash;4.68). Individuals from families with an income below the minimum wage had higher bruxism scores compared to those with a family income equal to or above the minimum wage (RR 2.47; 95% CI 1.41\u0026ndash;4.32). Male individuals had bruxism scores 2.01 times higher than female schoolchildren (RR 2.01; 95% CI 1.05\u0026ndash;3.82).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSchoolchildren with a family income of less than one minimum wage, who were stressed, and who were male had higher scores of bruxism.\u003c/p\u003e","manuscriptTitle":"Association Between Social Determinants of Health and Probable Bruxism in Schoolchildren: Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-11 13:48:15","doi":"10.21203/rs.3.rs-6298538/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":"22b607c9-2efa-42f5-bb11-5c5c97d306c3","owner":[],"postedDate":"April 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-13T07:53:27+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-11 13:48:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6298538","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6298538","identity":"rs-6298538","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}