title: Are mental health problems and depression associated with bruxism in children?
abstract: OBJECTIVE
  Previous studies have found an association between bruxism and emotional and behavioral problems in children, but reported data are inconsistent. The objective of this study was to estimate the prevalence of bruxism, and of its components clenching and grinding, and its associations with mental problems and depression.
  
  
  METHODS
  Data from two Brazilian birth cohorts were analyzed: one from 869 children in Ribeirão Preto - RP (São Paulo), a more developed city, and the other from 805 children in São Luís - SL (Maranhão). Current bruxism - evaluated by means of a questionnaire applied to the parents/persons responsible for the children - was defined when the habit of tooth clenching during daytime and/or tooth grinding at night still persisted until the time of the assessment. Additionally, the lifetime prevalence of clenching during daytime only and grinding at night only was also evaluated. Mental health problems were investigated using the Strength and Difficulties Questionnaire (SDQ) and depression using the Children's Depression Inventory (CDI). Analyses were carried out for each city: with the SDQ subscales (emotional symptoms, conduct problems, peer problems, attention/hyperactivity disorder), with the total score (sum of the subscales), and with the CDI. These analyses were performed considering different response variables: bruxism, clenching only, and grinding only. The risks were estimated using a Poisson regression model. Statistical inferences were based on 95% confidence intervals (95% CI).
  
  
  RESULTS
  There was a high prevalence of current bruxism: 28.7% in RP and 30.0% in SL. The prevalence of clenching was 20.3% in RP and 18.8% in SL, and grinding was found in 35.7% of the children in RP and 39.1% in SL. Multivariable analysis showed a significant association of bruxism with emotional symptoms and total SDQ score in both cities. When analyzed separately, teeth clenching was associated with emotional symptoms, peer problems, and total SDQ score; grinding was significantly associated with emotional symptoms and total SDQ score in RP and SL. Female sex appeared as a protective factor for bruxism, and for clenching and grinding in RP. Furthermore, maternal employment outside the home and white skin color of children were associated with increased prevalence of teeth clenching in SL.
  
  
  CONCLUSIONS
  Mental health problems were associated with bruxism, with teeth clenching only and grinding at night only. No association was detected between depression and bruxism, neither clenching nor grinding. But it is necessary to be cautious regarding the inferences from some of our results.
authors: Public Health Department, Federal University of Maranhão, São Luís, Maranhão, Brazil. rw310@terra.com.br
authors: Andréa Coimbra
authors: AC
authors: Renner
authors: Antônio Augusto Moura
authors: AA
authors: da Silva
authors: Juliana Dalla Martha
authors: JD
authors: Rodriguez
authors: Vanda Maria Ferreira
authors: VM
authors: Simões
authors: Marco Antonio
authors: MA
authors: Barbieri
authors: Heloísa
authors: H
authors: Bettiol
authors: Erika Bárbara Abreu Fonseca
authors: EB
authors: Thomaz
authors: Maria da Conceição
authors: Mda C
authors: Saraiva
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002012:Bruxism / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003863:Depression / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D015999:Multivariate Analysis; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012737:Sex Factors; D020186:Sleep Bruxism / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires