The clinical study included approximately 80 patients, both cases and controls and underscored the importance of collaboration between dentists and psychiatrists in diagnosing these two health conditions.
PTSD is a concept that originated in the United States, initially based on the behavior exhibited by war veterans. Over time, it has expanded to include urban violence. About four per cent of individuals exposed to violent or accidental traumatic events, such as combat, torture, death threats, stray bullets, natural disasters, severe injuries, physical or sexual violence, and kidnappings, will develop PTSD.
Yuan-Pang Wang, a researcher from Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Pauloand co-author of the study, said, “In the São Paulo metropolitan area, over 50 per cent of the population has been exposed to some traumatic event, and this estimate is comparable to conflict zones. Therefore, understanding the potential long-term psychological and physical manifestations of PTSD is essential as they can persist for years after the trauma.”
The symptoms may include distressing, involuntary, and recurring memories of the traumatic event, negative emotional states, self-destructive behaviour, irregular sleep patterns, and dissociative reactions (alterations in consciousness, memory, identity, emotion, perception of the environment, and behaviour control), among others.
However, few studies have investigated the relationship between PTSD and orofacial pain and bruxism, which is characterised by repetitive activity of the masticatory muscles. The prevalence of bruxism in the general population ranges from eight to 30 per cent.
According to the researchers, patients showed self-reported bruxism and a decrease in pain threshold following the clinical examination.
“Oral hygiene status was not associated with this type of stress,” says Ana Cristina de Oliveira Solis, the first author of the study. “The periodontal evaluation, which also included the evaluation of plaque and gingival bleeding, showed that patients with PTSD had similar oral hygiene levels compared to the control group. However, these patients experienced more pain after probing.”
Multidisciplinary treatment
According to the researchers, bruxism is no longer considered an isolated behaviour but rather evidence of a major underlying problem.
Ana added, “Our research showed that bruxism and pain after dental clinical examination may be a manifestation of PTSD at the oral level, and suggests collaboration among psychiatrists, psychologists, and dentists for screening and treating both health conditions.”
For this reason, the researcher recommends that during the oral clinical examination, dentists should consider reports of pain and analyse the possibility of dealing with a patient with psychiatric or psychological symptoms.
Ana said, “A patient who has experienced a traumatic event may feel ashamed to talk about it and seek professional assistance; on the other hand, seeking dental care is much more common and frequent. For this reason, it is beneficial to incorporate mental health screening tools into dental practices and apply them to these patients. It is also important to understand how to advise patients with psychiatric or psychological symptoms to seek mental health assistance.”