Bruxism in Children and Adolescents with Down Syndrome: A Comprehensive Review

Sleep bruxism and sleep respiratory disorders in children and adolescents: A systematic review

OBJECTIVE

Sleep bruxism (SB) is a repetitive rhythmic and nonrhythmic activity. It can be a comorbid condition for other disorders, such as sleep breathing disorders (SBD). However, a clear causal link between these factors is yet to be established. Moreover, this relationship is even more unknown in children. Thus, this systematic review aimed to determine the relationship between SB and SBD in children and teenagers and consolidate the current knowledge about the possible association between both phenomena at the pediatric age.

MATERIALS AND METHODS

Advanced searches were performed in five electronic databases with the last search updated on February 1, 2023. The methodological quality of the selected studies was analyzed using the quality assessment tool for experimental bruxism studies.

RESULTS

Twenty-nine of 6378 articles were selected for detailed analyses. Most articles found a comorbid relationship between SB and SBD, though no study analyzed a temporary relationship. Due to the heterogeneity of the studies, a meta-analysis could not be performed.

CONCLUSION

Despite the limitations of this systematic review, it can be concluded that there is an association between SB and SBD in children. However, the level of evidence is low.

Prevalence of malocclusions and parafunctional habits in pediatric patients with developmental dyslexia

Objective

The study aimed to assess the prevalence of dental malocclusion, orthodontic parameters, and parafunctional habits in children with developmental dyslexia (DD).

Methods

Forty pediatric patients (67.5% boys and 32.5% girls, mean age: 11.02 ± 2.53 years, range: 6-15 years) with DD were compared with 40 age- and sex-matched healthy participants for prevalence of dental malocclusion, orthodontic parameters, and parafunctional habits. Dental examinations were performed by an orthodontist.

Results

Pediatric patients with DD exhibited a significantly higher prevalence of Angle Class III malocclusion (22.5% vs. 5.0%, P = 0.024), deep bite (27.5% vs. 7.5%, P = 0.019), midline deviation (55.0% vs. 7.5%, P < 0.0001), midline diastemas (32.5% vs. 7.5%, P = 0.010), wear facets (92.5% vs. 15.0%, P < 0.0001), self-reported nocturnal teeth grinding (82.5% vs. 7.5%, P < 0.0001), nail biting (35.0% vs. 0.0%, P < 0.0001), and atypical swallowing (85.0% vs. 17.5%, P < 0.0001) compared to that in healthy controls.

Conclusions

Pediatric patients with DD showed a higher prevalence of Class III malocclusion, greater orthodontic vertical and transverse discrepancies, and incidence of parafunctional activities. Clinicians and dentists should be aware of the vulnerability of children with dyslexia for exhibiting malocclusion and encourage early assessment and multidisciplinary intervention.

Assessment and Rehabilitation Intervention of Feeding and Swallowing Skills in Children with Down Syndrome Using the Global Intensive Feeding Therapy (GIFT)

BACKGROUND

Children with Down syndrome (DS) experience more difficulties with oral motor skills, including chewing, drinking, and swallowing. The present study attempts to measure the preliminary effectiveness of Global Intensive Feeding Therapy (GIFT) in DS. GIFT is a new rehabilitation program addressing the specific difficulties and needs of each child, focusing on sensory and motor oral abilities. It follows an intensive schedule comprising 15 sessions over 5 consecutive days, with 3 sessions per day. The principles of GIFT are applied with specific objectives for DS.

METHODS

GIFT was preliminarily implemented among 20 children diagnosed with DS. To measure the efficacy of GIFT, the Karaduman Chewing Performance Scale (KCPS), the International Dysphagia Diet Standardization Initiative (IDDSI), and the Pediatric Screening-Priority Evaluation Dysphagia (PS-PED) were used. Data were analyzed using the Wilcoxon signed-rank test before (T0) and after intervention (T1) and at one-month follow-up (T2). The effect size was also measured for specific outcomes, using Kendall's W.

RESULTS

Our findings revealed that children with DS showed no risk of dysphagia according to the PS-PED (mean score 2.80). Furthermore, statistically significant improvements in chewing performance were observed, as measured by the KCPS (p < 0.01), as well as in texture acceptance and modification, as measured by the IDDSI post-intervention (p < 0.01). For both the KCPS and IDDSI, a large effect size was found (Kendall's W value > 0.8). Parents/caregivers continued using GIFT at home, and this allowed for a positive outcome at the one-month follow-up.

CONCLUSIONS

GIFT proved to be effective in the rehabilitation of feeding and swallowing disorders in children with DS, as well as for food acceptance.

Bruxism in a Child with Trisomy 21 (Down Syndrome)-Case Report

Bruxism has been defined in recent years and analyzed in detail as the repetitive activity of the muscles of the masticatory system. Both adults and children experience two different forms of bruxism: daytime and nighttime bruxism. According to the WHO, bruxism affects 5% to 50% of the world's pediatric population. The symptoms of this disease include tooth wear and fractures, temporomandibular disorders, headaches, behavioral and sleep disorders, and parafunctional habits such as nail biting. According to scientists, psychosocial factors are the most likely factors causing bruxism in children. To this day, we do not have established standards of treatment for children, especially for those with disabilities. The issue of bruxism in children with Down syndrome (DS) is still unexplained. Anatomical abnormalities in the facial skeleton, reduced muscle tone, personality traits, and sleep problems in these people may cause the symptoms of bruxism. Our study aimed to present a clinical case of a 13-year-old girl with DS and symptoms of bruxism. Diagnostics and dental examination in children with intellectual disabilities and a lack of understanding of the disease create a great challenge for the treatment team, including the dentist, physiotherapist, psychologist, and family. Creating standards for treating and preventing bruxism symptoms is demanding, among other things, due to the lack of sufficient scientific research.

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 Malocclusions in Down Syndrome Population: A Cross-Sectional Study

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10-18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

Obstructive Sleep Apnoea in Children with Down Syndrome: A Multidisciplinary Approach

A comprehensive evaluation of obstructive sleep apnoea (OSA) may allow for the development of more efficient management of Down syndrome (DS). We aimed to evaluate the effect of a multidisciplinary approach to DS with OSA. A total of 48 DS children aged 4−12 years were prospectively investigated with nasal endoscopy, orthodontic examination, and overnight polygraphy (PG); the Italian Child Sleep Habits Questionnaire (CSHQ-IT) was filled out by the mothers. The total CSHQ-IT score was 63 (96% of children reporting sleep problems). The major ear, nose, and throat characteristics were enlarged palatine tonsils (62%), adenoid tonsils (85%), and chronic rhinosinusitis (85%). DS children showed orthognathic profile in 68% of cases, class I relationship in 63%, and cross-bite in 51%. PG revealed OSA in 67% of cases (37% mild, 63% moderate−severe). The oxygen desaturation index (ODI) was higher in the group with OSA (5.2) than with non-OSA (1.3; p < 0.001). The ODI was higher (p = 0.001) and SpO2 lower (p = 0.03) in children with moderate−severe OSA than with mild OSA. The apnoea−hypopnea index (AHI) and percentage time with SpO2 < 90% were higher in DS children with grade III than with grade I or II adenoids (5 vs. 1, p = 0.04, and 1.2 vs. 0.1, p = 0.01, respectively). No significant correlations were found between PG and the total CSHQ-IT score or orthodontic data. However, children showing associated cross-bite, grade III adenoids and size 3 or 4 palatine tonsils showed higher AHI and ODI than those without (p = 0.01 and p = 0.04, respectively). A coordinated multidisciplinary approach with overnight PG is a valuable tool when developing diagnostic protocols for OSA in DS.

Down Syndrome Children, Malocclusion Characteristics and the Need for Orthodontic Treatment Needs (IOTN): A Cross-Sectional Study

The purpose of the present study was to assess the characteristics of malocclusion and determine the orthodontic treatment needs of a group of children with Down syndrome. The study group comprised 23 children aged 10–14 years with Down syndrome who were attending special schools. A clinical examination was performed to measure several parameters that assessed malocclusion as well as classifications based on the Index of Orthodontic Treatment Need (IOTN-DC). When the dental health component (DHC) of the IOTN-DC was considered, results showed that a high percentage of children involved in the current study needed orthodontic treatment (81.9%). Moreover, 59.1% showed Angle’s class-III malocclusion compared to 36.4% who showed class I. However, the differences between the IOTN-DC values for the boys and girls were not statistically significant (p > 0.05). The present study has concluded that a higher percentage of children, suffering from Down syndrome, had very severe malocclusion; therefore, treatment can be considered mandatory. Similarly, more than three-fourths of the children with Down syndrome had visited a dental clinic at least once during their life. However, 30.4% of the children’s mothers have mentioned that they had not visited any orthodontic clinic. Therefore, there is a need to develop awareness and knowledge among the parents of children suffering from Down syndrome.