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

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.