Possível bruxismo do sono e em vigília na infância: prevalência, fatores associados e análise de caminhos

Abstract

Bruxism is a behavior with multifactorial etiology that remains underexplored, especially in early childhood. This thesis comprises two articles that evaluated the prevalence, associated factors, and pathways for possible sleep bruxism (PSB) and possible awake bruxism (PAB) in children. Article I assessed the association between parenting styles, children's personality traits, and the severity of PSB. Article II identified the pathways influencing PSB and PAB. This study, approved by the ethics committee, involved 301 parents/caregivers of children aged four to seven years residing in Divinópolis, Minas Gerais. Parents/caregivers whose children were using anticonvulsants or had syndromes and/or neurological disorders were excluded. Data were collected through an electronic questionnaire on Google Forms, completed by the parents/caregivers. Initially, ten schools (five public and five private) were selected for convenience, and teachers distributed the survey link in WhatsApp® groups. Snowball sampling was subsequently used, inviting parents/caregivers to share the survey with others who had children in the specified age range. Socioeconomic characteristics collected included the child's sex and age, family income, education level, and family composition. Parenting styles (authoritarian, permissive, and authoritative) and children's personality traits (psychoticism, extraversion, and neuroticism) were assessed using the Brazilian versions of the Parenting Styles and Dimensions Questionnaire and the Eysenck Personality Questionnaire Junior, respectively. The higher reported frequency of PSB (grinding and bracing) and PAB (grinding and clenching) in the previous two weeks was used to classify the severity of the behaviors as absent, mild, and moderate/severe. Children's sleep characteristics, such as duration, quality, snoring, and drooling on the pillow, were also assessed. The prevalence of PSB and PAB was 31.1% and 16.3%, respectively. Through multinomial logistic regression, Article I revealed that the male sex (OR=2.07; 95% CI=1.09–3.91) and snoring (OR=2.98; 95% CI=1.55–5.73) were associated with mild PSB. Male sex (OR=2.61; 95% CI=1.20–5.70) and high neuroticism (OR=2.27; 95% CI=1.06–4.86) were associated with moderate/severe PSB. More authoritative parenting attitudes reduced the likelihood of moderate/severe PSB (OR=0.37; 95% CI=0.16–0.86). Article II, through path analysis, showed that less authoritative parenting attitudes indirectly contribute to PSB and PAB, mediated by high neuroticism (β=−0.217; P<0.01) and poor sleep quality (β=−0.189; P=0.01). PSB and PAB are related to each other (β=0.517; P=0.04). Male sex (β=0.183; P<0.01), high psychoticism (β=0.323; P=0.02), and insufficient sleep (β=0.069; P=0.01) had a direct effect on PSB. The child's age has a direct effect on PSB (β=0.287; P<0.01) and PAB (β=−0.189; P=0.01). In conclusion, Article I found that more authoritative parenting attitudes, high neuroticism, and snoring were associated with the severity of PSB. Article II concluded that less authoritative parenting attitudes, high neuroticism and psychoticism, sex, age, and insufficient sleep influenced PSB. PAB was influenced by age and poor sleep quality.