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Similar Stressors Different Expression: Ethnic Disparities in Temporomandibular Disorders and Bruxism During Wartime.

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Title: Similar Stressors Different Expression: Ethnic Disparities in Temporomandibular Disorders and Bruxism During Wartime.
Authors: Emodi-Perlman A; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel., Masarwe K; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel., Mahajne N; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel., Keren L; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel., Eli I; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Source: Journal of oral rehabilitation [J Oral Rehabil] 2026 Aug; Vol. 53 (8), pp. 1509-1516. Date of Electronic Publication: 2026 Apr 17.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Blackwell Scientific Publications Country of Publication: England NLM ID: 0433604 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2842 (Electronic) Linking ISSN: 0305182X NLM ISO Abbreviation: J Oral Rehabil Subsets: MEDLINE
Imprint Name(s): Original Publication: Oxford, Blackwell Scientific Publications.
MeSH Terms: Bruxism*/psychology , Bruxism*/ethnology , Temporomandibular Joint Disorders*/psychology , Temporomandibular Joint Disorders*/ethnology , Jews*/psychology , Jews*/statistics & numerical data , Stress, Psychological*/ethnology , Stress, Psychological*/psychology , Arabs*/psychology , Arabs*/statistics & numerical data, Humans ; Female ; Cross-Sectional Studies ; Male ; Adult ; Adaptation, Psychological ; Surveys and Questionnaires ; Middle Aged ; Young Adult ; Subjective Stress
Abstract: Background: War, an intense and enduring source of stress, exerts wide-ranging impacts on psychological well-being, provoking significant stress and anxiety reactions even in individuals not directly exposed to combat.
Objective: To examine how ethnicity influences bruxism and temporomandibular disorders (TMD) during an armed conflict.
Methods: In a cross-sectional design, 895 subjects from two ethnic origins (595 Jews and 301 Arabs) were evaluated through an online survey. The assessment tools covered demographic data, TMD screening, subject-based sleep bruxism (SB), subject-based awake bruxism (AB) including grinding, clenching, teeth contact, and bracing behaviours, along with measures of psychological distress (Patient Health Questionnaire-4), perceived stress (Perceived Stress Scale), and resilient coping (Brief Resilient Coping Scale).
Results: Arab participants reported the greatest psychological distress and perceived stress, yet they also displayed the strongest resilient coping. Regression analyses identified a distinct pattern in the Arab group regarding TMD and bruxism. Compared with a Jewish reference group, Arabs had markedly higher odds of TMD (OR = 2.58) and higher odds of grinding (OR = 1.81). In contrast, they showed lower odds for sleep bruxism (OR = 0.55) and awake bruxism behaviours of teeth contact (OR = 0.44) and bracing (OR = 0.55).
Conclusion: The elevated TMD risk among Arab participants (more than double that of Jewish participants) suggests combined effects of chronic psychosocial stress and potential barriers to accessing health care. These findings highlight the need for culturally informed approaches to diagnosing and treating TMD and bruxism, particularly during periods of widespread societal stress.
(© 2026 The Author(s). Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)
References: F. Lobbezoo, J. Ahlberg, K. G. Raphael, et al., “International consensus on the assessment of bruxism: Report of a work in progress,” Journal of Oral Rehabilitation 45, no. 11 (2018): 837–844, https://doi.org/10.1111/joor.12663.
M. C. Verhoeff, F. Lobbezoo, J. Ahlberg, et al., “Updating the Bruxism Definitions: Report of an International Consensus Meeting,” Journal of Oral Rehabilitation 52, no. 9 (2025): 1335–1342, https://doi.org/10.1111/joor.139853.
D. Manfredini, J. Ahlberg, G. Aarab, et al., “Standardized Tool for the Assessment of Bruxism,” Journal of Oral Rehabilitation 51, no. 1 (2024): 29–58, https://doi.org/10.1111/joor.13411.
A. Bracci, F. Lobbezoo, B. Häggman‐Henrikson, et al., “Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations,” Journal of Clinical Medicine 11, no. 17 (2022): 5083, https://doi.org/10.3390/jcm11175083.
J. Smardz, H. Martynowicz, A. Wojakowska, M. Michalek‐Zrabkowska, G. Mazur, and M. Wieckiewicz, “Correlation between Sleep Bruxism, Stress, and Depression ‐ A Polysomnographic Study,” Journal of Clinical Medicine 8, no. 9 (2019): 1344, https://doi.org/10.3390/jcm8091344.
D. Manfredini, A. Arreghini, L. Lombardo, et al., “Assessment of Anxiety and Coping Features in Bruxers: A Portable Electromyographic and Electrocardiographic Study,” Journal of Oral and Facial Pain and Headache 30, no. 3 (2016): 249–254, https://doi.org/10.11607/ofph.1616.
X. A. Soto‐Goñi, F. Alen, L. Buiza‐González, et al., “Adaptive Stress Coping in Awake Bruxism,” Frontiers in Neurology 11 (2020): 564431. Published 2020 Dec 9, https://doi.org/10.3389/fneur.2020.564431.
S. Sato and R. Slavicek, “The masticatory organ and stress management,” International Journal of Stomatology & Occlusion Medicine 1 (2008): 51–57, https://doi.org/10.1007/s12548‐008‐0010‐8.
O. I. Saracutu, D. Manfredini, A. Bracci, E. Ferrari Cagidiaco, M. Ferrari, and A. Colonna, “Self‐reported mandible bracing and teeth clenching are associated with anxiety and depression traits in a group of healthy young individuals,” Journal of Oral and Facial Pain and Headache 38, no. 4 (2024): 85–90, https://doi.org/10.22514/jofph.2024.041.
A. Emodi‐Perlman, I. Eli, J. Smardz, et al., “Temporomandibular Disorders and Bruxism Outbreak as a Possible Factor of Orofacial Pain Worsening during the COVID‐19 Pandemic: Concomitant Research in Two Countries,” Journal of Clinical Medicine 9, no. 10 (2020): 3250, https://doi.org/10.3390/jcm9103250.
T. Shalev‐Antsel, O. Winocur‐Arias, P. Friedman‐Rubin, et al., “The continuous adverse impact of COVID‐19 on temporomandibular disorders and bruxism: comparison of pre during and post‐pandemic time periods,” BMC Oral Health 23, no. 1 (2023): 716, https://doi.org/10.1186/s12903‐023‐03447‐4.
S. Baziliansky and W. Sowan, “Acute Stress Disorder in Israeli Civilians in Reaction to the October 7 War,” Stress and Health 41, no. 2 (2025): e70024, https://doi.org/10.1002/smi.70024.
Y. Levi‐Belz, Y. Groweiss, C. Blank, and Y. Neria, “PTSD, depression, and anxiety after the October 7, 2023, attack in Israel: a nationwide prospective,” Clinical Medicine 68 (2024): 102418, https://doi.org/10.1016/j.eclinm.2023.102418.
C. L. Edwards, R. B. Fillingim, and F. Keefe, “Race, ethnicity and pain,” Pain 94, no. 2 (2001): 133–137, https://doi.org/10.1016/S0304‐3959(01)00408‐0.
A. Goreis, F. Asbrock, U. M. Nater, and R. Mewes, “What Mediates the Relationship Between Ethnic Discrimination and Stress? Coping Strategies and Perceived Social Support of Russian Immigrants in Germany,” Frontiers in Psychiatry 11 (2020): 557148, https://doi.org/10.3389/fpsyt.2020.557148.
Y. Mayer, N. Shiffman, E. Bergmann, et al., “Mental Health Outcomes of Arab and Jewish Populations in Israel a Month after the Mass Trauma Events of October 7, 2023: A Cross‐Sectional Survey of a Representative Sample,” Psychiatry Research 339 (2024): 116042, https://doi.org/10.1016/j.psychres.2024.116042.
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C. Brugger, B. Abu Hamad, J. Hattendorf, M. S. Winkler, and N. Probst‐Hensch, “Changes in psychological distress during conflict escalation in an adult population‐based cohort in the Gaza Strip (2020–2025): a longitudinal analysis,” Clinical Medicine 90 (2025): 103647, https://doi.org/10.1016/j.eclinm.2025.103647.
A. Laufer, A. Khatib, M. Finkelstein, and G. Klien, “The Psychological Impact of the October 7 Hamas Terror Attack on Jewish and Arab Emerging Adults in Israel,” International Journal of Psychology 60, no. 4 (2025): e70089, https://doi.org/10.1002/ijop.70089.
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E. Schiffman, R. Ohrbach, E. Truelove, et al., “Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group,” Journal of Oral and Facial Pain and Headache 28, no. 1 (2014): 6–27, https://doi.org/10.11607/jop.1151.
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A. Emodi‐Perlman, A. Y. Czygrinow, D. Manfredini, A. Bracci, N. Ventura, and I. Eli, “Awake oral behaviours associated with temporomandibular‐related pain symptoms in a non‐patient student population‐ A dual assessment approach,” Journal of Oral and Facial Pain and Headache 39, no. 3 (2025): 66–76, https://doi.org/10.22514/jofph.2025.048.
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Grant Information: 3737/24 The Israel science foundatiom
Contributed Indexing: Keywords: armed conflict; bruxism; ethnicity; psychological; resilience; temporomandibular disorders
Entry Date(s): Date Created: 20260418 Date Completed: 20260713 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13358408
DOI: 10.1111/joor.70205
PMID: 41999075
Database: MEDLINE
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  Data: Similar Stressors Different Expression: Ethnic Disparities in Temporomandibular Disorders and Bruxism During Wartime.
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  Data: <searchLink fieldCode="AU" term="%22Emodi-Perlman+A%22">Emodi-Perlman A</searchLink>; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.<br /><searchLink fieldCode="AU" term="%22Masarwe+K%22">Masarwe K</searchLink>; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.<br /><searchLink fieldCode="AU" term="%22Mahajne+N%22">Mahajne N</searchLink>; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.<br /><searchLink fieldCode="AU" term="%22Keren+L%22">Keren L</searchLink>; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.<br /><searchLink fieldCode="AU" term="%22Eli+I%22">Eli I</searchLink>; Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Grey Faculty of Medicine and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Blackwell+Scientific+Publications%22">Blackwell Scientific Publications </searchLink><i>Country of Publication: </i>England <i>NLM ID: </i>0433604 <i>Publication Model: </i>Print-Electronic <i>Cited Medium: </i>Internet <i>ISSN: </i>1365-2842 (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%220305182X%22">0305182X </searchLink><i>NLM ISO Abbreviation: </i>J Oral Rehabil <i>Subsets: </i>MEDLINE
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  Data: <i>Original Publication</i>: Oxford, Blackwell Scientific Publications.
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  Data: <searchLink fieldCode="MM" term="%22Bruxism%22">Bruxism*</searchLink>/<searchLink fieldCode="MM" term="%22Bruxism+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Bruxism%22">Bruxism*</searchLink>/<searchLink fieldCode="MM" term="%22Bruxism+ethnology%22">ethnology</searchLink> <br /><searchLink fieldCode="MM" term="%22Temporomandibular+Joint+Disorders%22">Temporomandibular Joint Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Temporomandibular+Joint+Disorders+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Temporomandibular+Joint+Disorders%22">Temporomandibular Joint Disorders*</searchLink>/<searchLink fieldCode="MM" term="%22Temporomandibular+Joint+Disorders+ethnology%22">ethnology</searchLink> <br /><searchLink fieldCode="MM" term="%22Jews%22">Jews*</searchLink>/<searchLink fieldCode="MM" term="%22Jews+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Jews%22">Jews*</searchLink>/<searchLink fieldCode="MM" term="%22Jews+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Stress%2C+Psychological%22">Stress, Psychological*</searchLink>/<searchLink fieldCode="MM" term="%22Stress%2C+Psychological+ethnology%22">ethnology</searchLink> <br /><searchLink fieldCode="MM" term="%22Stress%2C+Psychological%22">Stress, Psychological*</searchLink>/<searchLink fieldCode="MM" term="%22Stress%2C+Psychological+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Arabs%22">Arabs*</searchLink>/<searchLink fieldCode="MM" term="%22Arabs+psychology%22">psychology</searchLink> <br /><searchLink fieldCode="MM" term="%22Arabs%22">Arabs*</searchLink>/<searchLink fieldCode="MM" term="%22Arabs+statistics+%26+numerical+data%22">statistics & numerical data</searchLink><br /><searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Female%22">Female</searchLink> ; <searchLink fieldCode="MH" term="%22Cross-Sectional+Studies%22">Cross-Sectional Studies</searchLink> ; <searchLink fieldCode="MH" term="%22Male%22">Male</searchLink> ; <searchLink fieldCode="MH" term="%22Adult%22">Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Adaptation%2C+Psychological%22">Adaptation, Psychological</searchLink> ; <searchLink fieldCode="MH" term="%22Surveys+and+Questionnaires%22">Surveys and Questionnaires</searchLink> ; <searchLink fieldCode="MH" term="%22Middle+Aged%22">Middle Aged</searchLink> ; <searchLink fieldCode="MH" term="%22Young+Adult%22">Young Adult</searchLink> ; <searchLink fieldCode="MH" term="%22Subjective+Stress%22">Subjective Stress</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Background: War, an intense and enduring source of stress, exerts wide-ranging impacts on psychological well-being, provoking significant stress and anxiety reactions even in individuals not directly exposed to combat.<br />Objective: To examine how ethnicity influences bruxism and temporomandibular disorders (TMD) during an armed conflict.<br />Methods: In a cross-sectional design, 895 subjects from two ethnic origins (595 Jews and 301 Arabs) were evaluated through an online survey. The assessment tools covered demographic data, TMD screening, subject-based sleep bruxism (SB), subject-based awake bruxism (AB) including grinding, clenching, teeth contact, and bracing behaviours, along with measures of psychological distress (Patient Health Questionnaire-4), perceived stress (Perceived Stress Scale), and resilient coping (Brief Resilient Coping Scale).<br />Results: Arab participants reported the greatest psychological distress and perceived stress, yet they also displayed the strongest resilient coping. Regression analyses identified a distinct pattern in the Arab group regarding TMD and bruxism. Compared with a Jewish reference group, Arabs had markedly higher odds of TMD (OR = 2.58) and higher odds of grinding (OR = 1.81). In contrast, they showed lower odds for sleep bruxism (OR = 0.55) and awake bruxism behaviours of teeth contact (OR = 0.44) and bracing (OR = 0.55).<br />Conclusion: The elevated TMD risk among Arab participants (more than double that of Jewish participants) suggests combined effects of chronic psychosocial stress and potential barriers to accessing health care. These findings highlight the need for culturally informed approaches to diagnosing and treating TMD and bruxism, particularly during periods of widespread societal stress.<br /> (© 2026 The Author(s). Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.)
– Name: Ref
  Label: References
  Group: RefInfo
  Data: F. Lobbezoo, J. Ahlberg, K. G. Raphael, et al., “International consensus on the assessment of bruxism: Report of a work in progress,” Journal of Oral Rehabilitation 45, no. 11 (2018): 837–844, https://doi.org/10.1111/joor.12663.<br />M. C. Verhoeff, F. Lobbezoo, J. Ahlberg, et al., “Updating the Bruxism Definitions: Report of an International Consensus Meeting,” Journal of Oral Rehabilitation 52, no. 9 (2025): 1335–1342, https://doi.org/10.1111/joor.139853.<br />D. Manfredini, J. Ahlberg, G. Aarab, et al., “Standardized Tool for the Assessment of Bruxism,” Journal of Oral Rehabilitation 51, no. 1 (2024): 29–58, https://doi.org/10.1111/joor.13411.<br />A. Bracci, F. Lobbezoo, B. Häggman‐Henrikson, et al., “Current Knowledge and Future Perspectives on Awake Bruxism Assessment: Expert Consensus Recommendations,” Journal of Clinical Medicine 11, no. 17 (2022): 5083, https://doi.org/10.3390/jcm11175083.<br />J. Smardz, H. Martynowicz, A. Wojakowska, M. Michalek‐Zrabkowska, G. Mazur, and M. Wieckiewicz, “Correlation between Sleep Bruxism, Stress, and Depression ‐ A Polysomnographic Study,” Journal of Clinical Medicine 8, no. 9 (2019): 1344, https://doi.org/10.3390/jcm8091344.<br />D. Manfredini, A. Arreghini, L. Lombardo, et al., “Assessment of Anxiety and Coping Features in Bruxers: A Portable Electromyographic and Electrocardiographic Study,” Journal of Oral and Facial Pain and Headache 30, no. 3 (2016): 249–254, https://doi.org/10.11607/ofph.1616.<br />X. A. Soto‐Goñi, F. Alen, L. Buiza‐González, et al., “Adaptive Stress Coping in Awake Bruxism,” Frontiers in Neurology 11 (2020): 564431. Published 2020 Dec 9, https://doi.org/10.3389/fneur.2020.564431.<br />S. Sato and R. Slavicek, “The masticatory organ and stress management,” International Journal of Stomatology & Occlusion Medicine 1 (2008): 51–57, https://doi.org/10.1007/s12548‐008‐0010‐8.<br />O. I. Saracutu, D. Manfredini, A. Bracci, E. Ferrari Cagidiaco, M. Ferrari, and A. Colonna, “Self‐reported mandible bracing and teeth clenching are associated with anxiety and depression traits in a group of healthy young individuals,” Journal of Oral and Facial Pain and Headache 38, no. 4 (2024): 85–90, https://doi.org/10.22514/jofph.2024.041.<br />A. Emodi‐Perlman, I. Eli, J. Smardz, et al., “Temporomandibular Disorders and Bruxism Outbreak as a Possible Factor of Orofacial Pain Worsening during the COVID‐19 Pandemic: Concomitant Research in Two Countries,” Journal of Clinical Medicine 9, no. 10 (2020): 3250, https://doi.org/10.3390/jcm9103250.<br />T. Shalev‐Antsel, O. Winocur‐Arias, P. Friedman‐Rubin, et al., “The continuous adverse impact of COVID‐19 on temporomandibular disorders and bruxism: comparison of pre during and post‐pandemic time periods,” BMC Oral Health 23, no. 1 (2023): 716, https://doi.org/10.1186/s12903‐023‐03447‐4.<br />S. Baziliansky and W. Sowan, “Acute Stress Disorder in Israeli Civilians in Reaction to the October 7 War,” Stress and Health 41, no. 2 (2025): e70024, https://doi.org/10.1002/smi.70024.<br />Y. Levi‐Belz, Y. Groweiss, C. Blank, and Y. Neria, “PTSD, depression, and anxiety after the October 7, 2023, attack in Israel: a nationwide prospective,” Clinical Medicine 68 (2024): 102418, https://doi.org/10.1016/j.eclinm.2023.102418.<br />C. L. Edwards, R. B. Fillingim, and F. Keefe, “Race, ethnicity and pain,” Pain 94, no. 2 (2001): 133–137, https://doi.org/10.1016/S0304‐3959(01)00408‐0.<br />A. Goreis, F. Asbrock, U. M. Nater, and R. Mewes, “What Mediates the Relationship Between Ethnic Discrimination and Stress? Coping Strategies and Perceived Social Support of Russian Immigrants in Germany,” Frontiers in Psychiatry 11 (2020): 557148, https://doi.org/10.3389/fpsyt.2020.557148.<br />Y. Mayer, N. Shiffman, E. 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      – SubjectFull: Bruxism ethnology
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      – SubjectFull: Temporomandibular Joint Disorders psychology
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              Text: 2026 Aug
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