Impact of Distress Level, Sleep Quality and Occlusal Trauma on Periodontal Status Among Bruxers

Impact of Distress Level, Sleep Quality and Occlusal Trauma on Periodontal Status Among Bruxers - a Cross Sectional Study

Increased distress levels and impaired sleep quality are known to exacerbate bruxism by enhancing masticatory muscle activity, leading to excessive and prolonged occlusal forces. These abnormal forces may result in occlusal trauma, which can compromise the adaptive capacity of the periodontal tissues by increasing tooth mobility, widening the periodontal ligament space, and accelerating alveolar bone loss, particularly in the presence of existing periodontal inflammation. Although occlusal trauma alone may not initiate periodontal disease, it can act as an important modifying factor in disease progression. Despite the recognized individual associations of distress, sleep quality, bruxism, and periodontal health, limited evidence exists regarding their combined impact on periodontal status among bruxers. Therefore, evaluating the influence of distress level, sleep quality, and occlusal trauma on periodontal status is essential to better understand disease progression and to facilitate comprehensive, multidisciplinary management strategies for individuals with bruxism.

Study Overview

• Status: Not yet recruiting
• Conditions: Periodontitis; Bruxism; Sleep Quality; Occlusal Trauma; Distress Level
• Intervention / Treatment: Other: Pittsburgh Sleep Quality Index (PSQI)

Detailed Description

The periodontium in sleep bruxism patients suffers from excessive occlusal force for long periods of time during sleep, the function of the periodontium in such patients may differ from that in patients without sleep bruxism.

Bruxism is associated with tooth wear, chipping, cracking, and fracture, tooth mobility, gingival recession, pain, and sensitivity. Tooth mobility can be a serious consequence of bruxism. Tooth mobility has been described as one of the common clinical signs of occlusal trauma. Progressive mobility may be suggestive of ongoing occlusal trauma, but assessments at different time points are necessary to make this determination.

Bruxism has multifactorial etiologies involving central nervous system regulation, psychosocial factors such as stress, and peripheral influences such as occlusal interferences. Psychological stress and poor sleep quality are commonly reported in individuals with sleep bruxism. Sleep disturbances have been linked to elevated muscle activity and increased parafunctional events, potentially contributing to adverse oral health outcomes. Additionally, poor sleep quality has been associated with diminished overall health and may exacerbate inflammatory responses, which are central to periodontal disease progression. These may contribute to adverse oral health outcomes by preventing the "rest and repair" cycle necessary for tissue health. Stress levels and poor sleep quality negatively affect systemic health. These effects are mediated through direct mechanisms such as systemic inflammation, oxidative stress, and immune system impairment, as well as indirect mechanisms involving associated compensatory behaviors. Given that inflammation and oxidative stress are key components in the pathogenesis of periodontitis. Previous epidemiological studies have identified high perceived stress and poor sleep quality as modifiable risk indicators for periodontitis. When stress levels remain chronically elevated and recovery is insufficient due to poor sleep quality, chronic allostatic load responses and dysregulated immune and inflammatory processes are further activated. Therefore, it can be hypothesized that the combined presence of high stress and poor sleep quality may have a more pronounced detrimental effect on the periodontium than either factor alone.

However, inconsistent and conflicting findings have been reported between relationship of stress, sleep quality, and bruxism as a result, highlighting the need for integrated evaluation of these factors within dental research.

In the context of bruxism, occlusal trauma is significant because the repetitive nature of occlusal loading may potentiate periodontal tissue destruction beyond the effects of microbial plaque alone.

Given the multifactorial nature of bruxism and periodontal disease, understanding how psychological (stress), psychological and behavioral (sleep quality), and mechanical (occlusal trauma) factors influence periodontal health in bruxers could enhance diagnostic precision and therapeutic strategies. This study aims to evaluate these relationships to clarify their impact on periodontal status.

• Study Type: Observational
• Enrollment (Estimated): 128

Contacts and Locations

• Study Contact: Name: Shubham Singh Kaur, BDS; Phone Number: +91 8168143428; Email: kaurqismat1511@gmail.com
• Study Contact Backup: Name: Rajinder Kumar Sharma, MDS; Phone Number: +91 9416358222; Email: rksharmamds@yahoo.in

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Systemically healthy patients with generalized periodontitis diagnosed with bruxism, aged 30-45years will be recruited in the study from OPD of Periodontology. Recruitment of the patients for the study will be based on eligibility criteria after obtaining informed and written consent.

Description

Inclusion Criteria:

Test Group:

• Adults aged 30-45 years
• Patients diagnosed with periodontitis according to the 2017 World Workshop classification of periodontal and peri-implant diseases and conditions.
• Patients who are probable bruxers according to BRUXSCREEN-Q
• Minimum of 20 natural teeth

Control Group:

• Adults aged 30-45 years
• Patients diagnosed with periodontitis according to the 2017 World Workshop classification of periodontal and peri-implant diseases and conditions.
• Patients who are not probable bruxers according to BRUXSCREEN-Q
• Minimum of 20 natural teeth

Exclusion Criteria:

• Systemic conditions affecting periodontium (e.g., diabetes, auto immune disorders)
• History of drugs having the potential impact on periodontal status like phenytoin, cyclosporin, calcium-channel blockers or antidepressant drugs
• Patients with pulpal pathology
• Pregnant or lactating females

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
probable bruxers according to bruxscreen-q with periodontitis; Periodontal parameters will be assessed which include clinical attachment level (CAL), periodontal pocket depth (PPD), bleeding on probing (BOP), Gingival index (GI), Tooth mobility will be assessed using a modified Lindhe and Nyman(1975) degree classification. Stress level will be assessed by HADS 14, DASS 21, Sleep quality will be assessed with PSQI	Other: Pittsburgh Sleep Quality Index (PSQI); these scale were assessed using questionnaires in both the groups; Other Names: Depression Anxiety Stress Scales-21
patient who are non bruxers according to bruxscreen-q; Periodontal parameters will be assessed which include clinical attachment level (CAL), periodontal pocket depth (PPD), bleeding on probing (BOP), Gingival index (GI), Tooth mobility will be assessed using a modified Lindhe and Nyman(1975) degree classification. Stress level will be assessed by HADS 14, DASS 21, Sleep quality will be assessed with PSQI	Other: Pittsburgh Sleep Quality Index (PSQI); these scale were assessed using questionnaires in both the groups; Other Names: Depression Anxiety Stress Scales-21

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pittsburgh Sleep Quality Index (PSQI)	The Pittsburgh Sleep Quality Index (PSQI) will be used to assess sleep quality in both groups. The PSQI is a self-reported questionnaire that measures sleep quality and disturbances over a 1-month time interval. It yields a global score ranging from a minimum of 0 to a maximum of 21, where higher scores indicate worse sleep quality (a score greater than 5 indicates severe difficulties in at least two areas, or moderate difficulties in more than three areas).	baseline
Depression Anxiety Stress Scales - 21	The Depression Anxiety Stress Scales - 21 (DASS-21) will be used to assess psychological distress levels among both groups. It is a 21-item self-report questionnaire designed to measure the negative emotional states across three distinct subscale: depression, anxiety, and stress. Each subscale range from a minimum of 0 to a maximum of 42, where a lesser number indicates normal emotional state and a higher number signifies a increased severity of psychological distress. Clinically, lower scores falling within the ranges of 0-9 for Depression, 0-7 for Anxiety, and 0-14 for Stress designate a "Normal" status.For Depression, scores progress through Mild (10-13), Moderate (14-20), Severe (21-27), and Extremely Severe (28+) bands. For Anxiety, elevated scores represent Mild (8-9), Moderate (10-14), Severe (15-19), and Extremely Severe (20+) levels.	baseline
Hospital Anxiety and Depression Scale - 14	The Hospital Anxiety and Depression Scale (HADS) will be used to assess psychological distress levels among both groups. The HADS is a 14-item self-report rating scale containing two distinct 7-item subscales: one for anxiety (HADS-A) and one for depression (HADS-D). For each subscale, final scores range from a minimum of 0 to a maximum of 21, where a lesser number indicates a better outcome (absence of distress) and a higher number signifies a worse outcome (increased severity of anxiety or depressive symptoms). Clinically, scores on either subscale are categorized into specific bands to interpret severity: a lower score between 0-7 represents a "Normal" or non-case state, whereas higher scores indicate elevated distress progression across Mild/Borderline abnormal (8-10), Moderate/Abnormal (11-14), and Severe/Severe abnormal (15-21) brackets.	baseline

Collaborators and Investigators

• Sponsor: Postgraduate Institute of Dental Sciences Rohtak
• Investigators: Study Director: Rajinder Kumar Sharma, MDS, Post Graduate Institute Of Dental Sciences, Rohtak

Study record dates

Study Major Dates

• Study Start (Estimated): June 22, 2026
• Primary Completion (Estimated): December 27, 2027
• Study Completion (Estimated): December 27, 2027

Study Registration Dates

• First Submitted: May 22, 2026
• First Submitted That Met QC Criteria: May 22, 2026
• First Posted (Actual): May 29, 2026

Study Record Updates

• Last Update Posted (Actual): June 3, 2026
• Last Update Submitted That Met QC Criteria: June 1, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: sleep quality; occlusal trauma; bruxism; periodontits; distress level
• Additional Relevant MeSH Terms: Periodontal Diseases; Mouth Diseases; Stomatognathic Diseases; Nervous System Diseases; Mental Disorders; Tooth Diseases; Sleep Wake Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Behavior; Habits; Periodontitis; Bruxism; Sleep Initiation and Maintenance Disorders
• Other Study ID Numbers: Shubham Singh perio 26/56

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No