Exploring the Interplay of Stress, Sleep Quality, and Lifestyle Factors in Bruxism Among Undergraduate Students in Saudi Arabia: A Cross-Sectional Study

Background: Bruxism, a repetitive clenching or grinding of teeth, is a prevalent yet under-recognized issue among university students. Its etiology is multifactorial, often involving psychological stress, poor sleep quality, and unhealthy lifestyle behaviors. Despite increasing evidence linking these variables, limited research has examined these associations within Middle Eastern populations. Objectives: This study aimed to assess the proportion screening positive for bruxism risk among Saudi undergraduate students and to investigate its associations with perceived stress, sleep quality, and lifestyle factors. Methods: A cross-sectional survey was conducted among 335 Saudi undergraduate students aged 18–25 years. Data were collected using the 25-item BRUXiq self-assessment questionnaire, the 11-item Stress Self-Assessment Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and demographic and behavioral questions. Descriptive statistics, Chi-square tests, Mann–Whitney U tests, Spearman’s correlations, and binary logistic regression were performed. Results: A total of 198 participants (59.1%) screened positive for bruxism risk according to the BRUXiq criterion, whereas 137 (40.9%) screened negative. Participants with a positive BRUXiq screen exhibited significantly higher stress scores (p < 0.001) and poorer sleep quality (p < 0.001). Multivariable logistic regression showed that higher stress scores (OR = 1.123, 95% CI [1.08, 1.17]) and poorer sleep quality (OR = 1.188, 95% CI [1.07, 1.31]) were independently associated with greater odds of a positive BRUXiq screen. No significant associations were found for smoking, stimulant use, physical activity, or academic year. Conclusions: A positive BRUXiq screening result was common among the participating students and was associated with higher stress and poorer sleep quality. Because bruxism was assessed using a self-report screening questionnaire, the findings should not be interpreted as the prevalence of clinically confirmed bruxism. These findings underscore the importance of psychological support services and sleep hygiene education within university health programs as potential supportive strategies that require further evaluation.