Which factor is primarily linked to bruxism during sleep?

Bruxism during sleep is primarily linked to stress, as it is often a manifestation of psychological tension or anxiety. Stress can lead to muscle tension and a heightened state of arousal, which may trigger or exacerbate teeth grinding during sleep. Individuals experiencing high levels of stress may subconsciously clench their jaws or grind their teeth as a physical outlet for their anxiety, often without awareness of the behavior occurring while they sleep.

While teeth misalignment, dietary habits, and existing oral pathology can play a role in contributing factors to bruxism, they are not as directly correlated with sleep bruxism as stress is. Misalignment may lead to discomfort that can result in grinding, but it is often the stress that initiates the behavior during sleep.