Interaction between awake and sleep bruxism is associated with increased presence of painful temporomandibular disorder

Aims: To explore whether awake bruxism (AB) and sleep bruxism (SB) interact in their associations with painful temporomandibular disorders (TMD) and whether the interaction is multiplicative or additive. Methods: In this case-control study, all participants (n = 705) were part of the multicenter Validation Project and were recruited as a convenience sample of community cases and controls as well as clinic cases. Logistic regression analyses were applied to test for the association between self-reported bruxism (AB and/or SB) and the presence of painful TMD. Odds ratios (ORs) with 95% confidence intervals (CIs) were computed. Regression models included an interaction term to test for multiplicative interaction. Additive interaction was calculated as the relative excess risk due to interaction (RERI). Results: Based on logistic regression analyses adjusted for age and gender, the main effects for both AB (OR = 6.7; 95% CI: 3.4 to 12.9) and SB (OR = 5.1; 95% CI: 3.1 to 8.3) were significant. While the multiplicative interaction (OR = 0.57; 95% CI: 0.24 to 1.4) was not significant, the results indicated a significant positive additive interaction (RERI = 8.6; 95% CI: 1.0 to 19.7) on the OR scale. Conclusion: This study has demonstrated that AB and SB are associated with an increased presence of painful TMD, and that both types of bruxism are not independently associated, but interact additively. As such, the presence of each factor amplifies the effect of the other. Keywords: awake bruxism (AB), interaction effect, pain, sleep bruxism (SB), temporomandibular disorders (TMD)