Understanding bruxism in children and adolescents

Musculoskeletal differences in the craniomandibular region of children and adolescents with and without bruxism: A comparative study

OBJECTIVE

To analyse the relationship between bruxism and musculoskeletal parameters of the cervical and mandibular regions in children and adolescents.

METHODS

A comparative cross-sectional study was performed with subjects from 6 to 16 years. Subjects were divided into bruxism (any type) and control groups. Descriptive data, jaw opening, upper cervical spine mobility, myofascial trigger points (MTPs) and muscular tension of the jaw and neck muscles, the activation pattern of neck flexors and activation of Deep Neck Flexors (DNF) were registered and compared between groups.

RESULTS

121 subjects participated in the study. Children and adolescents reporting bruxism showed a significant reduction in the contraction of DNF (p = .034) and the activation ratio (p = .035) compared to controls. Besides, MTPs of both masseters were significantly more frequent in subjects reporting bruxism (p = .001-0.002). No differences were found in other measurements.

CONCLUSION

Bruxism is related to a weaker contraction of DNF, a lower activation ratio, and a higher number of MTPs in masseters.

Sleep Bruxism in Children: A Narrative Review

Sleep bruxism, characterized by involuntary grinding or clenching of the teeth and/or by bracing or thrusting of the mandible during sleep, is common in children. Sleep bruxism occurs while the patient is asleep. As such, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in children. A search was conducted in May 2023 in PubMed Clinical Queries using the key terms "Bruxism" OR "Teeth grinding" AND "sleep". The search strategy included all observational studies, clinical trials, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. According to the International classification of sleep disorders, the minimum criteria for the diagnosis of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at least three months) tooth grinding sounds during sleep and (2) at least one or more of the following (a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache; or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism, "possible" sleep bruxism can be diagnosed based on self-report or report from family members of tooth-grinding sounds during sleep; "probable" sleep bruxism based on self-report or report from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of bruxism (e.g., abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or tongue/lip indentation); and "definite" sleep bruxism based on the history and clinical findings and confirmation by polysomnography, preferably combined with video and audio recording. Although polysomnography is the gold standard for the diagnosis of sleep bruxism, because of the high cost, lengthy time involvement, and the need for high levels of technical competence, polysomnography is not available for use in most clinical settings. On the other hand, since sleep bruxism occurs while the patient is asleep, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. In clinical practice, the diagnosis of sleep bruxism is often based on the history (e.g., reports of grinding noises during sleep) and clinical findings (e.g., tooth wear, hypertrophy and/or tenderness of masseter muscles). In childhood, sleep-bruxism is typically self-limited and does not require specific treatment. Causative or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity should be limited before going to bed. For adults with frequent and severe sleep bruxism who do not respond to the above measures, oral devices can be considered to protect teeth from further damage during bruxism episodes. As the orofacial structures are still developing in the pediatric age group, the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy is not a favorable option and is rarely used in children. Current evidence on the effective interventions for the management of sleep bruxism in children is inconclusive. There is insufficient evidence to make recommendations for specific treatment at this time.

Prevalence of Sleep Bruxism Reported by Parents/Caregivers in a Portuguese Pediatric Dentistry Service: A Retrospective Study

The definition of sleep bruxism (SB) has changed over the years, and although it is no longer defined as a disorder, it is considered a risk factor that can result in prejudicial systemic and stomatognathic issues. The prevalence of SB in children is variable among studies, and its decrease during adolescence is a controversial matter among authors. We aimed to determine SB prevalence and assess its trend with age in a sample of pediatric patients who frequented the Lisbon Pediatric Dentistry Service. We conducted a retrospective observational study based on information provided by patients’ parents/caregivers and without examination or polysomnography examination. Data were collected between August 2019 and December 2020 by five dentists. A total of 1900 patients were included, 50.6% and 49.4% of which were male and female, respectively. Of the total sample, 334 (17.6%, 95% confidence interval of 15.9–19.4%) had bruxism, corresponding to 18.9% and 16.2% of male and female patients, respectively (p = 0.121). SB was reported in 20.7% of patients 0–6 years old, in 19.4% of those 7–11 years old, and in 14.6% of those 12–17 years old. In conclusion, SB showed a slightly higher prevalence among male pediatric patients, but further studies are needed to rule out confounding factors.

Prevalence of tooth grinding in children and adolescents with neurodevelopmental disorders: A systematic review and meta-analysis

AIM

To conduct a systematic review and meta-analysis on the prevalence of tooth grinding and/or clenching (TGC) in children and adolescents with a neurodevelopmental disorder or other developmental condition.

METHODS

A search was performed in seven databases, two sources of grey literature and reference lists of included studies. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. We used random-effects models with Freeman-Tukey double arcsine transformation for the meta-analyses.

RESULTS

After selection, 77 of the 2240 studies met inclusion criteria and were categorised by disability and type of TGC (reported, clinically observed and definitive). The pooled prevalence of reported TGC in individuals with attention-deficit hyperactivity disorder was 57.6% (95% CI [confidence interval]: 49.5-65.6), 50.4% (95% CI: 35.5-65.4) in individuals with autism spectrum disorder, 67% (95% CI: 59.2-74.8) in cerebral palsy and 68.2% (95% CI: 59.8-76.6) in Down syndrome. Pooled prevalence of clinically observed TGC was 57.5% (95% CI: 31.6-83.4) in autism spectrum disorder and 71.9% (95% CI: 52.4-91.4) in cerebral palsy. Individuals with attention-deficit hyperactivity disorder presented 39.8% (95% CI: 24-55.6) of definitive TGC.

CONCLUSION

Prevalence of reported, clinically observed, and definitive TGC varies according to disabilities, although due to high heterogeneity the result should be interpreted with caution. Variations exist mainly due to sampling bias and the use of non-validated methods to assess TGC. CRD42020212640.

Quality of life of children with sleep bruxism

AIM

The aim of this study was to compare the Quality of life (QoL) of children with and without sleep bruxism in Chennai population.

MATERIALS AND METHODS

A cross-sectional study was conducted with participants of both genders assigned as bruxers (n = 36) and non-bruxers (n = 36) from different regions of Chennai with the age range of 6-12 years. Parents/Caregivers answered a questionnaire in the waiting room. The QoL was assessed using the Oral Health Impact Profile (OHIP-14). OHIP-14 was analyzed by Mann-Whitney U test.

RESULTS

The sociodemographic characteristics presented no significant differences between bruxers and non-bruxers (P > 0.005). There was a significant difference in QoL between the case and control group (<0.001). Bruxers had worse QoL than controls.

CONCLUSION

Sleep bruxism may be associated with a negative impact on QoL.

Origanum majorana Essential Oil Inhalation during Neurofeedback Training Reduces Saliva Myeloperoxidase Activity at Session-1 in Bruxistic Patients

Introduction: Bruxism affects teeth and provokes sleep alterations. We evaluated whether saliva Myeloperoxidase (MPO) activity could be reduced after 21 neurofeedback training (NO) sessions in Origanum majorana (AE) bruxistic-treated patients (n = 12 patients, 120 saliva samples). The term divergence evaluates cerebral activity, which was compared between bruxistic patients with/without this essential oil exposure during 21 NO training sessions (n = 12, n = 120 saliva samples). The nasal filter used allow us to vehiculizate this Origanum majorana essential oil in patients. MPO activity was measured in six training NO sessions (Session S1, 6, 12, 18, 21). We included a total of 104 patients and 500 saliva samples. Results: there was a fast reduction in MPO activity after NO session-1 in bruxistic patients; divergence (an index of NO training brain efficacy) is the difference in cerebral activity found between pre-training and post-training levels. Thus, Divergence can fluctuate during NO training before reaching a final calm state after many sessions (21). Repeated NO training lead to habituation in so far as cerebral activity as well as MPO activity after 21 training sessions. Origanum majorana essential oil modulates cerebral activity at certain training sessions in bruxistic patients. Stress levels were reduced on the perceived stress scores (PSS: Cohen Scale) after 21 NO sessions than for those bruxistic without NO training sessions. Conclusions: MPO activity could predict stress level in bruxistic patients and repeated NO reduced their stress level; Origanum majorana essential oil enhanced these anxiolytic effects.