Investigation of Respiratory Functions, Respiratory Muscle Strength, Balance and Sleep Quality in Patients With Bruxism

NCT ID: NCT07294833

Last Updated: 2025-12-19

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

34 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-06-01

Study Completion Date

2024-07-01

Brief Summary

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It has been reported that patients with bruxism frequently present with upper respiratory tract symptoms such as rhinitis, sinusitis, and mouth breathing. Upper respiratory tract infections have been shown to reduce lung volumes, and individuals with bruxism commonly exhibit forward head posture, which is known to negatively affect postural balance. However, no studies have investigated respiratory function or respiratory muscle strength in patients with bruxism, and the number of studies evaluating balance in this population is limited. The aim of the present study is to assess respiratory function, respiratory muscle strength, balance, and sleep quality in individuals with bruxism and to compare these outcomes with those of healthy controls.

Detailed Description

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Bruxism is defined as an involuntary, irregular, or rhythmic parafunctional oral activity characterized by clenching or grinding of the teeth, without serving any functional chewing purpose. Various central, pathophysiological, psychosocial, morphological, environmental, and biological factors have been proposed in the etiology of sleep bruxism. Three subtypes of bruxism are described: awake (diurnal) bruxism, which occurs during wakefulness; sleep (nocturnal) bruxism, which occurs during sleep; and combined bruxism, in which features of both are present. Common symptoms include temporomandibular joint pain, discomfort in the masticatory and cervical muscles, headaches-particularly in the temporal region-poor sleep quality, fatigue, and recurrent migraine attacks. Increasing evidence suggests that respiration plays a notable role in the pathophysiology of sleep bruxism. Researchers have reported specific alterations in breathing patterns among affected individuals, proposing that sleep is often associated with a mandibular open or retruded position, which may lead to reduced airway patency due to relaxation of the tongue muscles. It has also been suggested that sleep bruxism may be associated with reduced airway flow or increased upper airway resistance, particularly in individuals who tend to sleep in the supine position.

Clinicians are encouraged to consider the coexistence of sleep-related breathing disturbances-such as snoring, upper airway resistance, or apnea-hypopnea-in patients presenting with sleep bruxism. Snoring, the most common initial respiratory disturbance during sleep, is defined as an oropharyngeal sound resulting from turbulent airflow that causes vibration of soft tissues. In addition, patients with bruxism frequently experience symptoms associated with upper respiratory tract involvement, including rhinitis, sinusitis, and mouth breathing. Upper respiratory tract infections have been shown to reduce lung volumes, and mouth breathing is thought to influence cerebral oxygenation and provoke involuntary contractions of the facial musculature, potentially triggering sleep bruxism. Despite these associations, no studies to date have investigated pulmonary function or respiratory muscle strength in individuals with bruxism.

Bruxism is also associated with dental damage, temporomandibular joint dysfunction, headaches, and postural alterations. These findings indicate that bruxism affects not only the masticatory muscles but also the craniofacial complex and the musculature of the neck and shoulders. Previous studies have demonstrated that individuals with bruxism, particularly children, exhibit a more pronounced forward head posture compared with non-bruxism controls. A forward shift of the head increases the mechanical load on the cervical region and can alter the body's center of gravity, potentially contributing to muscular imbalance and impairments in postural stability. Thus, head posture should be considered in the clinical evaluation of bruxism. Although balance has been examined in individuals with temporomandibular joint dysfunction, studies focusing specifically on balance in patients with bruxism are lacking, and research including bruxism populations within broader temporomandibular dysfunction cohorts remains limited.

Sleep is a vital physiological process during which sensory perception and neuromuscular function are restored and hormonal rhythms are regulated. It consists of multiple stages that differ physiologically and interact with circadian mechanisms to regulate the sleep-wake cycle. When sleep is disrupted-by sleep bruxism, chronic insomnia, narcolepsy, sleep apnea, or other disorders-functional alterations in sleep architecture may occur, negatively affecting quality of life and contributing to public health concerns. Despite the known associations between bruxism, respiratory disturbances, postural alterations, and sleep disruption, no studies have investigated respiratory muscle strength or pulmonary function specifically in individuals with bruxism, and only a few studies have evaluated balance in this population.

The aim of the present study is to assess respiratory muscle strength, respiratory function, balance, and sleep quality in individuals with bruxism using valid, reliable, and objective measurement methods, and to compare these findings with those of healthy controls. This work seeks to address important gaps in the literature and contribute novel insights into the multisystem effects of bruxism.

Conditions

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Bruxism Respiratory Function Sleep Quality Balance

Keywords

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bruxism respiratory functions respiratory muscle strength balance sleep quality

Study Design

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Observational Model Type

OTHER

Study Time Perspective

RETROSPECTIVE

Study Groups

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Individuals with bruxism

Information about the diagnostic required for the study, type of bruxism, duration of symptoms, duration of diagnosis were recorded from the patient's files. All assessments were performed once, in a temperature-controlled, quiet laboratory setting, by experienced physiotherapists. The evaluated parameters included pulmonary function, respiratory muscle strength, balance performance, and sleep quality.

No interventions assigned to this group

Health Controls

All assessments were performed once, in a temperature-controlled, quiet laboratory setting, by experienced physiotherapists. The evaluated parameters included pulmonary function, respiratory muscle strength, balance performance, and sleep quality.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

* Aged 18-65 years.
* Diagnosed with sleep or awake bruxism by a dentomaxillofacial radiologist.
* Diagnosis was based on subjective reports and clinical assessment according to the Standardised Tool for the Assessment of Bruxism (STAB) framework.
* Classified as probable bruxism, defined as the presence of:
* Self-reported behaviors (e.g., grinding, clenching, bracing), and
* Clinical signs (e.g., tooth wear, linea alba, masseter hypertrophy).


* Aged 18-65 years.
* Recruited through public campus advertisements.
* Matched for age and sex with the bruxism group.
* No history or symptoms of bruxism, confirmed by self-report and clinical examination.

Exclusion Criteria

* History of smoking.
* Respiratory conditions affecting pulmonary function (e.g., obstructive sleep apnea, chronic obstructive pulmonary disease, asthma).
* Difficulty understanding or following instructions.
* Presence of any dental or temporomandibular disorder other than bruxism.
* History of masseter botulinum toxin injection or facial/cervical trauma.
* Current use of sedatives, muscle relaxants, or centrally acting medications.
* Active orthodontic treatment.
* History of COVID-19 infection within the last six months.
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Gazi University

OTHER

Sponsor Role lead

Responsible Party

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Meral Boşnak Güçlü

Prof. Dr.

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Betül Yoleri, MSc

Role: STUDY_CHAIR

Gazi University

Meral Boşnak Güçlü, Prof

Role: STUDY_DIRECTOR

Gazi University

Musa Güneş, PhD

Role: PRINCIPAL_INVESTIGATOR

Karabük University

Nebiha Gözde İspir, MD

Role: PRINCIPAL_INVESTIGATOR

Gazi University

Okan Karaoğlu, Pt

Role: PRINCIPAL_INVESTIGATOR

Gazi University

Dilek Kaya, Pt

Role: PRINCIPAL_INVESTIGATOR

Gazi University

Locations

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Gazi University Faculty of Health Sciences Department of Cardiopulmonary Physiotherapy and Rehabilitation, Ankara, Çankaya 06490

Ankara, Çankaya, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Castroflorio T, Bargellini A, Rossini G, Cugliari G, Deregibus A. Sleep bruxism in adolescents: a systematic literature review of related risk factors. Eur J Orthod. 2017 Feb;39(1):61-68. doi: 10.1093/ejo/cjw012. Epub 2016 Feb 15.

Reference Type RESULT
PMID: 26884421 (View on PubMed)

Manfredini D, Bucci MB, Sabattini VB, Lobbezoo F. Bruxism: overview of current knowledge and suggestions for dental implants planning. Cranio. 2011 Oct;29(4):304-12. doi: 10.1179/crn.2011.045.

Reference Type RESULT
PMID: 22128671 (View on PubMed)

Cuccia A, Caradonna C. The relationship between the stomatognathic system and body posture. Clinics (Sao Paulo). 2009;64(1):61-6. doi: 10.1590/s1807-59322009000100011.

Reference Type RESULT
PMID: 19142553 (View on PubMed)

Fabozzi A, Steffanina A, Nicolai A, Olmati F, Bonini M, Palange P. The Impact of Lung Function on Sleep Monitoring in Obstructive Sleep Apnea Associated with Obstructive Lung Diseases: Insights from a Clinical Study. J Clin Med. 2024 Oct 17;13(20):6189. doi: 10.3390/jcm13206189.

Reference Type RESULT
PMID: 39458139 (View on PubMed)

Shaffer SW, Teyhen DS, Lorenson CL, Warren RL, Koreerat CM, Straseske CA, Childs JD. Y-balance test: a reliability study involving multiple raters. Mil Med. 2013 Nov;178(11):1264-70. doi: 10.7205/MILMED-D-13-00222.

Reference Type RESULT
PMID: 24183777 (View on PubMed)

Laveneziana P, Albuquerque A, Aliverti A, Babb T, Barreiro E, Dres M, Dube BP, Fauroux B, Gea J, Guenette JA, Hudson AL, Kabitz HJ, Laghi F, Langer D, Luo YM, Neder JA, O'Donnell D, Polkey MI, Rabinovich RA, Rossi A, Series F, Similowski T, Spengler CM, Vogiatzis I, Verges S. ERS statement on respiratory muscle testing at rest and during exercise. Eur Respir J. 2019 Jun 13;53(6):1801214. doi: 10.1183/13993003.01214-2018. Print 2019 Jun.

Reference Type RESULT
PMID: 30956204 (View on PubMed)

Johnson JD, Theurer WM. A stepwise approach to the interpretation of pulmonary function tests. Am Fam Physician. 2014 Mar 1;89(5):359-66.

Reference Type RESULT
PMID: 24695507 (View on PubMed)

Other Identifiers

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Gazi2710

Identifier Type: -

Identifier Source: org_study_id