Did Perceived Stress Influence Possible Sleep Bruxism and Awake Bruxism in Dentistry Students During COVID-19 Pandemic? A Web-Based Cross-Sectional Study

Souza, Smyrna Luiza Ximenes de; Cavalcanti, Alessandro Leite

doi:10.1590/pboci.2024.059

Smyrna Luiza Ximenes de Souza Corresponding author: Smyrna Luiza Ximenes de Souza E-mail:smyrnaximenes@gmail.com

Conceptualization

Formal Analysis

Investigation

Writing

Original Draft

Writing

Review

Editing

All authors declare that they contributed to critical review of intellectual content

approval of the final version to be published

Post-graduate Program in Dentistry, School of Dentistry, State University of Paraiba, Campina Grande, PB, Brazil

https://orcid.org/0000-0003-2271-9916

Alessandro Leite Cavalcanti

Conceptualization

Methodology

Formal Analysis

Data Curation

Writing

Review

Editing

Supervision

Project Administration

All authors declare that they contributed to critical review of intellectual content

approval of the final version to be published

Post-graduate Program in Dentistry, School of Dentistry, State University of Paraiba, Campina Grande, PB, Brazil

https://orcid.org/0000-0003-3572-3332

Corresponding author: Smyrna Luiza Ximenes de Souza E-mail:smyrnaximenes@gmail.com

Academic Editor: Alidianne Fábia Cabral Cavalcanti

Conflict of Interest

The authors declare no conflicts of interest.

	Stage of Dental School
Variables	Beginning	Middle	End	p-value	Overall
	N (%)	N (%)	N (%)		N (%)
Sociodemographic Characteristics
Sample Size	133 (34.0)	118 (30.2)	140 (35.8)		391 (100.0)
Age, yr - Median (IQR) ^κ κ The age was expressed in the median and interquartile range (IQR) because of the non-Gaussian distribution of data;	20 (3.0)	22 (2.0)	25 (3.0)	0.000^α α p-value provided by Kruskal-Wallis test;	22 (4.0)
Sex
Male	40 (30.1)	41 (34.7)	37 (26.4)	0.349^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	118 (30.2)
Female	93 (69.9)	77 (65.3)	103 (73.6)		273 (69.8)
Marital Status
Unmarried	98 (73.7)	85 (72.0)	90 (64.3)	0.197^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	273 (69.8)
Married	35 (26.3)	33 (28.0)	50 (35.7)		118 (30.2)
Income (Brazil)
< 3 Minimum Wage	95 (71.4)	81 (68.6)	62 (44.2)	0.000^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	238 (60.9)
> 3 Minimum Wage	38 (28.6)	37 (31.4)	78 (55.7)		153 (39.1)
Academic Context
Type of Institution
Public	88 (66.7)	59 (51.8)	77 (55.0)	0.040^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	224 (58.0)
Private	44 (33.3)	55 (48.2)	63 (45.0)		162 (42.0)
Financial Aid^η η Financial aid considered only students who belong to private institutions;
Yes	34 (77.3)	33 (60.0)	42 (66.7)	0.049^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	109 (67.3)
No	10 (22.7)	22 (40.0)	21 (33.3)		53 (32.7)
Behavioral Circumstances
Physical Activity
Yes	86 (64.7)	68 (57.6)	93 (66.4)	0.313^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	247 (63.2)
No	47 (35.3)	50 (42.4)	47 (33.6)		144 (36.8)
Psychotropic Use
Yes	8 (6.8)	13 (11.0)	12 (8.6)	0.490^£ £ p-value provided by the Chi-Square test. The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	34 (8.7)
No	124 (93.2)	105 (89.0)	128 (91.4)		357 (91.3)

	Stage of Dental School
Variables	Beginning	Middle	End	p-value	Overall
	N (%)	N (%)	N (%)		N (%)
Perceived Stress
Low to Moderate	89 (66.9)	88 (74.6)	105 (75.0)	0.256^£ £ p-value provided by Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	282 (72.1)
High	44 (33.1)	30 (25.4)	35 (25.0)		109 (27.9)
Awake Bruxism
Yes	51 (38.3)	66 (55.9)	76 (54.3)	0.007^£ £ p-value provided by Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	193 (49.4)
No	82 (61.7)	52 (44.1)	64 (45.7)		198 (50.6)
Sleep Bruxism
Yes	46 (34.6)	52 (44.1)	57 (40.7)	0.293^£ £ p-value provided by Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	155 (39.6)
No	87 (65.4)	66 (55.9)	83 (59.3)		236 (60.4)
COVID-19 Fear
Low	106 (79.7)	95 (80.5)	116 (82.8)	0.787^£ £ p-value provided by Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	317 (81.1)
Moderate to High	27 (20.3)	23 (19.5)	24 (17.2)		74 (18.9)

	Stage of Dental School
	Beginning				Middle				End
Variables	Perceived Stress				Perceived Stress				Perceived Stress
	Low to Moderate	High	p-value	Low to Moderate		High	p-value	Low to Moderate		High	p-value
	N (%)	N (%)		N (%)		N (%)		N (%)		N (%)
Sociodemographic Characteristics
Age, yr - Median (IQR)^κ κ The age was expressed in the median and interquartile range (IQR) because of the non-Gaussian distribution of data;	20 (3)	20 (3)	0.795^α α p-value provided by Kruskal-Wallis test;	22 (2)		22 (2)	0.970^α α p-value provided by Kruskal-Wallis test;	24 (3)		24 (2)	0.400^α α p-value provided by Kruskal-Wallis test;
Sex
Male	31 (34.8)	9 (20.5)	0.082^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	37 (42.0)		4 (13.3)	0.004^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	31 (29.5)		6 (17.1)	0.150^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Female	58 (65.2)	35 (79.5)		51 (58.0)		26 (86.7)		74 (70.5)		29 (82.9)
Marital Status
Unmarried	65 (73.0)	33 (75.0)	0.809^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	68 (77.3)		17 (56.7)	0.030^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	68 (64.8)		22 (62.9)	0.839^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Married	24 (27.0)	11 (25.0)		20 (22.7)		13 (43.3)		37 (35.2)		13 (37.1)
Income (Brazil)
< 3 Minimum Wage	62 (69.7)	33 (75.0)	0.521^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	56 (63.6)		25 (83.3)	0.045^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	49 (46.7)		13 (37.1)	0.326^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
> 3 Minimum Wage	27 (30.3)	11 (25.0)		32 (36.4)		5 (16.7)		56 (53.3)		22 (62.9)
Academic Context
Type of Institution
Public	56 (63.6)	32 (72.7)	0.296^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	46 (53.5)		13 (46.4)	0.516^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	56 (53.3)		21 (60.0)	0.492^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Private	32 (36.4)	12 (27.3)		40 (46.5)		15 (53.6)		49 (46.7)		14 (40.0)
Financial Aid^η η Financial aid considered only students who belong to private institutions;
Yes	24 (75.0)	10 (83.3)	0.497^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	26 (65.0)		7 (46.7)	0.358^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	32 (65.3)		10 (71.4)	0.726^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	8 (25.0)	2 (16.7)		14 (35.0)		8 (53.3)		17 (34.7)		4 (28.6)
Behavioral Circumstances
Physical Activity
Yes	60 (67.4)	26 (59.1)	0.345^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	35 (39.8)		15 (50.0)	0.328^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	71 (67.6)		22 (62.9)	0.605
No	29 (32.6)	18 (40.9)		53 (60.2)		15 (50.0)		34 (32.4)		13 (37.1)
Psychotropic Use
Yes	3 (3.4)	6 (13.6)	0.027^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	6 (6.8)		7 (23.3)	0.013^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	9 (8.6)		3 (8.6)	1.000^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	86 (96.6)	38 (86.4)		82 (93.2)		23 (76.7)		96 (91.4)		32 (91.4)

	Stage of Dental School
	Beginning			Middle			End
Variables	Awake Bruxism			Awake Bruxism			Awake Bruxism
	No	Yes	p-value	No	Yes	p-value	No	Yes	p-value
	N (%)	N (%)		N (%)	N (%)		N (%)	N (%)
Sociodemographic Characteristics
Age, yr - Median (IQR)^κ κ The age was expressed in the median and interquartile range (IQR) because of the non-Gaussian distribution of data;	20 (3)	20 (2)	0.132 ^α α p-value provided by Kruskal-Wallis test;	21 (2)	22 (2)	0.672^α α p-value provided by Kruskal-Wallis test;	24 (3)	24 (4)	0.689^α α p-value provided by Kruskal-Wallis test;
Sex
Male	24 (29.3)	16 (31.4)	0.797^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	14 (35.0)	27 (34.6)	0.967^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	23 (35.9)	14 (18.4)	0.019^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Female	58 (70.7)	35 (68.6)		26 (65.0)	51 (65.4)		41 (64.1)	62 (81.6)
Marital Status
Unmarried	60 (73.2)	38 (74.5)	0.865^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	34 (85.0)	51 (65.4)	0.025^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	42 (65.6)	48 (63.2)	0.762^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Married	22 (26.8)	13 (25.5)		6 (15.0)	27 (34.6)		22 (34.4)	28 (36.8)
Income (Brazil)
< 3 Minimum Wage	60 (73.2)	35 (68.6)	0.573^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	30 (75.0)	51 (65.4)	0.287^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	24 (37.5)	38 (50.0)	0.138^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
> 4 Minimum Wage	22 (26.8)	16 (31.4)		10 (25.0)	27 (34.6)		40 (62.5)	38 (50.0)
Academic Context
Type of Institution
Public	49 (60.5)	39 (76.5)	0.058^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	21 (55.3)	38 (50.0)	0.596^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	39 (60.9)	38 (50.0)	0.195^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Private	32 (39.5)	12 (23.5)		17 (44.7)	38 (50.0)		25 (39.1)	38 (50.0)
Financial Aid^η η Financial aid considered only students who belong to private institutions;
Yes	25 (79.8)	9 (75.0)	0.162^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	10 (58.8)	23 (60.5)	0.863^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	15 (60.0)	27 (71.1)	0.290^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	7 (21.2)	3 (25.0)		7 (41.2)	15 (39.5)		10 (40.0)	11 (28.9)
Behavioral Circumstances
Physical Activity
Yes	54 (65.9)	32 (62.7)	0.715^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	24 (60.0)	44 (56.4)	0.709^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	47 (73.4)	46 (60.5)	0.107^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	28 (34.1)	19 (37.3)		16 (40.0)	34 (43.6)		17 (26.6)	30 (39.5)
Psychotropic Use
Yes	6 (7.3)	3 (5.9)	0.749^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	5 (12.5)	8 (10.3)	0.713^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	4 (6.2)	8 (10.5)	0.368^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	76 (92.7)	48 (94.1)		35 (87.5)	70 (89.7)		60 (93.8)	68 (89.5)

	Stage of Dental School
	Beginning			Middle			End
Variables	Sleep Bruxism			Sleep Bruxism			Sleep Bruxism
	No	Yes	p-value	No	Yes	p-value	No	Yes	p-value
	N (%)	N (%)		N (%)	N (%)		N (%)	N (%)
Sociodemographic Characteristics
Age, yr - Median (IQR) ^κ κ The age was expressed in the median and interquartile range (IQR) because of the non-Gaussian distribution of data;	20 (3)	20 (2)	0.853 ^α α p-value provided by Kruskal-Wallis test;	21.5 (2)	22 (2)	0.927^α α p-value provided by Kruskal-Wallis test;	24 (3)	24 (3)	0.089 ^α α p-value provided by Kruskal-Wallis test;
Sex
Male	31 (35.6)	9 (19.6)	0.055^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	24 (36.4)	17 (32.7)	0.678^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	26 (31.3)	11 (19.3)	0.113^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Female	56 (64.4)	37 (80.4)		42 (63.6)	35 (67.3)		57 (68.7)	46 (80.7)
Marital Status
Unmarried	63 (72.4)	35 (76.1)	0.685^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	50 (75.8)	35 (67.3)	0.310^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	48 (57.8)	42 (73.7)	0.054^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Married	24 (27.6)	11 (23.9)		16 (24.2)	17 (32.7)		35 (42.2)	15 (26.3)
Income (Brazil)
< 3 Minimum Wage	63 (72.4)	32 (69.6)	0.729^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	49 (74.2)	32 (61.5)	0.140^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	38 (45.8)	24 (42.1)	0.667^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
> 4 Minimum Wage	24 (27.6)	14 (30.4)		17 (25.8)	20 (38.5)		45 (54.2)	33 (57.9)
Academic Context
Type of Institution
Public	54 (62.8)	34 (73.9)	0.196^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	34 (53.1)	25 (50.0)	0.740^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	44 (53.0)	33 (57.9)	0.568^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Private	32 (37.2)	12 (26.1)		30 (46.9)	25 (50.0)		39 (47.0)	24 (42.1)
Financial Aid^η η Financial aid considered only students who belong to private institutions;
Yes	26 (81.2)	8 (66.7)	0.274^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	17 (56.7)	16 (64.0)	0.812^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	29 (74.4)	13 (54.2)	0.224^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	6 (18.8)	4 (33.3)		13 (43.3)	9 (36.0)		10 (25.6)	11 (45.8)
Behavioral Circumstances
Physical Activity
Yes	57 (65.5)	29 (63.0)	0.777^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	28 (42.4)	22 (42.3)	0.990^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	58 (69.9)	35 (61.4)	0.297
No	30 (34.5)	17 (37.0)		38 (57.6)	30 (57.7)		25 (30.1)	22 (38.6)
Psychotropic Use
Yes	6 (6.9)	3 (6.5)	0.935^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	7 (10.6)	6 (11.5)	0.872^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	4 (4.8)	8 (14.0)	0.056^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	81 (93.1)	43 (93.5)		59 (89.4)	46 (88.5)		79 (95.2)	49 (86.0)

	Stage of Dental School
	Beginning			Middle			End
Variables	COVID-19			COVID-19			COVID-19
	Low	Moderate to High	p-value	Low	Moderate to High	p-value	Low	Moderate to High	p-value
	N (%)	N (%)		N (%)	N (%)		N (%)	N (%)
Sociodemographic Characteristics
Age, yr - Median (IQR) ^κ κ The age was expressed in the median and interquartile range (IQR) because of the non-Gaussian distribution of data;	20 (3)	20 (3)	0.878^α α p-value provided by Kruskal-Wallis test;	22 (2)	21 (3)	0.814^α α p-value provided by Kruskal-Wallis test;	24 (2)	24 (4)	0.853^α α p-value provided by Kruskal-Wallis test;
Sex
Male	34 (32.1)	6 (22.2)	0.319^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	35 (36.8)	6 (26.1)	0.331^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	33 (28.4)	4 (16.7)	0.233^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Female	72 (67.9)	21 (77.8)		60 (63.2)	17 (73.9)		83 (71.6)	20 (83.3)
Marital Status
Unmarried	77 (72.6)	21 (77.8)	0.588^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	71 (74.7)	14 (60.9)	0.184^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	76 (65.5)	14 (58.3)	0.504^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Married	29 (27.4)	6 (22.2)		24 (25.3)	9 (39.1)		40 (34.5)	10 (41.7)
Income (Brazil)
< 3 Minimum Wage	73 (68.9)	22 (81.5)	0.195^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	65 (68.4)	16 (69.6)	0.915^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	50 (43.1)	12 (50.0)	0.536^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
> 4 Minimum Wage	33 (31.1)	5 (18.5)		30 (31.6)	7 (30.4)		66 (56.9)	12 (50.0)
Academic Context
Type of Institution
Public	69 (65.7)	19 (70.4)	0.647^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	51 (54.8)	8 (38.1)	0.165^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	65 (56.0)	12 (50.0)	0.589^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
Private	36 (34.3)	8 (29.6)		42 (45.2)	13 (61.9)		51 (44.0)	12 (50.0)
Financial Aid^η η Financial aid considered only students who belong to private institutions;
Yes	27 (75.0)	7 (87.5)	0.690^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	25 (60.5)	8 (61.5)	0.378^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	31 (60.8)	11 (91.7)	0.090^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	9 (25.0)	1 (12.5)		17 (40.5)	5 (38.5)		20 (39.2)	1 (8.3)
Behavioral Circumstances
Physical Activity
Yes	70 (66.0)	16 (59.3)	0.511^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	54 (56.8)	14 (60.9)	0.726^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	75 (64.7)	18 (75.0)	0.329
No	36 (34.0)	11 (40.7)		41 (43.2)	9 (39.1)		41 (35.3)	6 (25.0)
Psychotropic Use
Yes	6 (5.7)	3 (11.1)	0.314^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	11 (11.6)	2 (8.7)	0.692^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.	8 (6.9)	4 (16.7)	0.126^£ £ p-value provided by the Chi-Square test; The beginning of the course represents the 1 to 4 semesters, the middle of the course 5 to 7 semesters, and the end of the course 8 to 10 semesters.
No	100 (94.3)	24 (88.9)		84 (88.4)	21 (91.3)		108 (93.1)	20 (83.3)

Variables (Reference)	Model 1 (Beginning)			Model 2 (Middle)			Model 3 (End)			Model 4 (Overall)
	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value
Sex (Female)	1.91	(0.76-4.80)	0.168	5.71	(1.63-20.0)	0.006	2.09	(0.75-5.81)	0.158	2.47	(1.39-4.39)	0.002
Income (More than 3 MW)	0.89	(0.36-2.23)	0.811	0.32	(0.09-0.87)	0.032	1.73	(0.74-4.02)	0.202	0.84	(0.51-1.36)	0.475
Type of Institution (Private)	0.63	(0.25-1.55)	0.312	1.04	(0.39-2.77)	0.935	0.72	(0.31-1.65)	0.433	0.68	(0.41-1.12)	0.125
Physical Activity (Yes)	0.96	(0.41-2.23)	0.923	0.52	(0.20-1.39)	0.195	0.77	(0.32-1.80)	0.544	0.74	(0.45-1.19)	0.214
Psychotropic Use (Yes)	4.33	(0.90-20.9)	0.071	6.91	(1.63-29.17)	0.009	0.92	(0.22-3.90)	0.912	2.53	(1.18-5.43)	0.017
COVID-19 Fear (Moderate-High)	5.61	(2.18-14.4)	0.000	1.36	(0.42-4.35)	0.609	3.40	(1.29-8.94)	0.013	3.03	(1.75-5.25)	0.000
	Statistics
Overall Statistics	23.02 (0.001)			22.17 (0.001)			10.72 (0.040)			38.45 (0.000)
Hosmer-Lemeshow test	0.141			0.794			0.424			0.354
Nagelkerke R Square	0.222			0.263			0.109			0.137

		Model 1 (Beginning)			Model 2 (Middle)			Model 3 (End)			Model 4 (Overall)
	Variables	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value
Awake Bruxism	Perceived Stress	2.76	(1.31-5.81)	0.008	1.51	(0.54-3.53)	0.346	1.16	(0.54-2.52)	0.695	1.60	(1.03-2.50)	0.039
					Statistics
	Overall Statistics	7.214 (0.007)			0.904 (0.342)			0.154 (0.695)			4.316 (0.038)
	Nagelkerke R Square	0.072			0.01			0.001			0.02
	ROC Analysis AUC (95% CI)	0.61 (0.51-0.71)			0.50 (0.40-0.61)			0.50 (0.40-0.60)			0.55 (0.50-0.61)
Sleep Bruxism		OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value
	Perceived Stress	2.02	(0.96-4.27)	0.066	0.80	(0.34-1.86)	0.604	1.32	(0.61-2.85)	0.488	1.29	(0.82-2.02)	0.270
					Statistics
	Overall Statistics	3.376 (0.066)			0.271 (0.602)			0.480 (0.488)			1.212 (0.27)
	Nagelkerke R Square	0.035			0.03			0.005			0.004
	ROC Analysis AUC (95% CI)	0.61 (0.51-0.71)			0.50 (0.40-0.61)			0.50 (0.40-0.60)			0.50 (0.44-0.56)

		Model 1 (Beginning)			Model 2 (Middle)			Model 3 (End)			Model 4 (Overall)
	Variable	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value	OR	95% CI	p-value
Awake Bruxism	Sleep Bruxism	0.268	(0.13-0.57)	0.001	0.195	(0.09-0.44)	<0.001	0.159	(0.07-0.35)	<0.001	0.201	(0.13-0.31)	<0.001
					Statistics
	Overall Statistics	12.227 (0.000)			17.234 (0.000)			24.690 (0.000)			55.356 (0.000)
	Nagelkerke R Square	0.121			0.182			0.218			0.179
	ROC Analysis AUC (95% CI)	0.65 (0.55-0.75)			0.69 (0.59-0.78)			0.70 (0.62-0.79)			0.68 (0.63-0.74)

[1] Corresponding author: Smyrna Luiza Ximenes de Souza E-mail:smyrnaximenes@gmail.com

Brasil

Brasil

Did Perceived Stress Influence Possible Sleep Bruxism and Awake Bruxism in Dentistry Students During COVID-19 Pandemic? A Web-Based Cross-Sectional Study

ABSTRACT

Objective:

Material and Methods:

Results:

Conclusion: