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Oral Maxillofac Surg Clin North Am. 2018 Aug;30(3):369-379. doi: 10.1016/j.coms.2018.04.011. Epub 2018 Jun 1.

The Role of Stress in the Etiology of Oral Parafunction and Myofascial Pain.

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Department of Oral Diagnostic Sciences, University at Buffalo School of Dental Medicine, 355 Squire, Buffalo, NY 14214, USA. Electronic address:
Department of Neuroscience, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples Federico II, Via Pansini 5-80131-Naples, Italy.


Oral parafunction during waking comprises possible behaviors that can be measured with a comprehensive checklist or behavioral monitoring. Multiple studies lead to largely consistent findings: stressful states can trigger parafunctional episodes that contribute to myofascial pain. However, this simple causal pathway coexists with at least 3 other pathways: anxiety and stress are potent direct contributors to pain, pain results in maladaptive behaviors such as parafunction, and parafunction may be a coping response to potential threat coupled with hypervigilance and somatosensory amplification. Awake parafunction remains an important risk factor for myofascial pain onset and overuse models alone of causation are insufficient.


Behavior; Myofascial pain; Oral parafunction; Pain; Stress; Temporomandibular disorders

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