Basics
Description
- Bruxism is defined as habitual nonfunctional forceful contact of teeth, which is involuntary. These movements can include excessive grinding, clenching, or rubbing of teeth.
- Other nonfunctional (or "parafunctional"¯) oral habits include movements not involved with normal chewing, swallowing, or speaking, such as chewing pencils, nails, cheek, or lip.
- Sleep bruxism should be distinguished from daytime awake bruxism.
- Awake bruxism is rare with little or no audible sound during clenching, compared to the loud grinding sound commonly occurring in sleep bruxism.
Epidemiology
- May occur throughout life but frequently tends to peak in early childhood, then decreases with age
- Infants have been known to grind their teeth during the eruption of primary teeth.
- May be temporarily or intermittently present, which makes diagnosis difficult
- Recent systematic review of literature reported no gender differences in prevalence. Previous studies suggested girls may be more affected than boys.
- Some studies support higher incidence in children with developmental disabilities, Down syndrome, sleep disorders, and autism.
- No genetic mechanism has been explained. Based on self-reports, 20-50% of children with sleep bruxism have an immediate family member who experienced bruxism as a child.
Prevalence
In children, prevalence in the literature is highly variable with a range of 4-40%. Prevalence decreases with increasing age. Sleep bruxism progressively diminishes around 9-10 years of age.
Etiology
The exact cause is not known. It is likely to be a multifactorial process including pathophysiologic, psychologic, or morphologic factors.
- Awake bruxism is more commonly associated with psychosocial factors and psychopathologic symptoms.
- Dental factors (current evidence suggests that they play a small role, only ~10% of cases)
- Occlusal interferences, including malocclusions, in which teeth do not interdigitate smoothly
- High dental restorations (e.g., fillings or crowns)
- Intraoral irritation (e.g., sharp tooth cusp)
- Teething
- Psychological factors
- Nervous tension (related to stress, anger, and aggression)
- Personality disorders
- Posttraumatic stress disorder
- Common systemic factors
- Moving between levels of sleep
- Sleep-disordered breathing
- Snoring and sleep apnea
- Tonsil/adenoid hypertrophy
- Neurodevelopmental disorders (e.g., cerebral palsy)
- Brain injury
- ADHD
- Other possible factors
- Asthma
- Allergies
- Nasal obstruction
- Exposure to secondhand smoke
- Medications (amphetamines, antidepressants-particularly serotonin reuptake inhibitors)
Diagnosis
- Teeth
- Wearing of facets, abraded areas
- Extreme wear of primary teeth is occasionally observed; however, pulp or nerve damage is rare.
- Broken dental restorations
- Loose teeth
- Progression of periodontal disease (gingival inflammation, recession, and alveolar bone loss)
- Pain or sensitivity
- Muscular symptoms of the head and neck muscles, most often seen in the lateral pterygoids followed by the medial pterygoids and masseters
- Frequent headache or migraines
- Parasomnias
- Temporomandibular joint (TMJ) disorders
- Symptoms (pain, clicking, popping when opening or closing)
- Limited mandibular range of motion
Differential Diagnosis
- Dental erosion
- Drug reaction
- Gastroesophageal reflux
- Seizures
- Sleep disorder
- Stress
Treatment
Medication
- Analgesics or anti-inflammatory medications (e.g., ibuprofen) for management of symptoms
- Rarely used
- Muscle relaxants for symptoms
- Mild anxiolytics if anxiety plays an etiologic role
General Measures
- Often, children outgrow bruxism and no treatment is indicated.
- When treatment is needed, it is best managed in a multiprofessional team approach including a dentist.
- Patient and family education: Ensure that the bruxism itself does not become an issue, generating increased stress for the child.
- Plastic or vinyl bite guard (must not interfere with normal dental growth and development)
- Stress counseling
- Identify and address sources of stress.
- Meditation
- Music therapy
- Biofeedback exercises
- Acupressure and/or acupuncture
- Counseling/psychotherapy
Additional Therapies
- Rarely used
- Occlusal adjustment (selective tooth grinding to balance the bite): There is no evidence-based support. Because of inadequate data regarding their usefulness, irreversible therapies should be avoided.
- Tonsillectomy and adenoidectomy
Complementary & Alternative Therapies
- Warm compresses for muscle or TMJ symptoms
- Limiting affected muscle activity (e.g., "do not open wide,"¯ "take small bites,"¯ "avoid chewing gum"¯) may help reduce TMJ symptoms.
Inpatient Considerations
- Treatment for bruxism is rarely indicated for children in the inpatient setting.
- Therapy is justified if damage to the permanent dentition or periodontal structures is observed.
- For neurologically impaired patients with acute self-injurious issues, bite blocks or mouth props can be protective. Patients who exhibit chronic chewing may require the fabrication of custom-fitted mouth guards, which may require the use of deep sedation or general anesthetic procedures to construct the appliance. The risk of these procedures would need to be weighed against the benefit of the bite guard.
Ongoing Care
Follow-up Recommendations
Patient Monitoring
The large majority of bruxism in children stops without any therapy. Monitor for significant associated problems; recommend treatment if damage to permanent dentition and/or periodontal structures occurs.
Prognosis
- There are no data to indicate a cause-and-effect relationship exists for bruxism in childhood continuing into adulthood.
- Preschool- and school-age children
- Ensure that all children establish a dental home by 1 year of age.
- Typically ceases without therapeutic intervention
- Associated problems are rare.
- Monitor for associated conditions.
- Adolescents
- More commonly benefit from therapeutic intervention
- Associated problems (e.g., attrition of teeth; muscular, TMJ symptoms) may also require therapy.
- Special-needs children
- Long-term prognosis is poor.
- Children who are comatose or those who have suffered traumatic brain injuries or neurologically impaired may be managed by the use of prefabricated bite blocks or, in rare cases, by the fabrication of custom-fitted mouth guards to minimize risk of damage to lips or tongue. Intraoral botulinum-A injections have relieved the spasticity.
Additional Reading
- American Academy of Pediatric Dentistry. Guidelines on acquired temporomandibular disorders in infants, children, and adolescents. Reference manual 2012-2013. Pediatr Dent. 2012;34:258-263.
- Cheifetz AT, Osganian SK, Allred EN, et al. Prevalence of bruxism and associated correlates in children as reported by parents. J Dent Child (Chic). 2005;72(2):67-73. [View Abstract]
- Dahshan A, Patel H, Delaney J, et al. Gastroesophageal reflux disease and dental erosion in children. J Pediatr. 2002;140(4):474-478. [View Abstract]
- Eftekharian A, Raad N, Gholami-Ghasri N. Bruxism and adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2008;72(4):509-511. [View Abstract]
- Lavigne GJ, Khoury S, Abe S, et al. Bruxism physiology and pathology: an overview for clinicians. J Oral Rehabil. 2008;35(7):476-494. [View Abstract]
- Lindemeyer RG. Bruxism in children. Dimens Dent Hyg. 2011;9:60-63.
- Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain. 2009;23(2):153-166. [View Abstract]
- Manfredini D, Restrepo C, Diaz-Serrano K, et al. Prevalence of sleep bruxism in children: a systematic review of the literature. J Oral Rehabil. 2013;40(8):631-642. [View Abstract]
- Motta LJ, Martins MD, Fernandes KP, et al. Craniocervical posture and bruxism in children. Physiother Res Int. 2011;16(1):57-61. [View Abstract]
- Norwood KW Jr, Slayton RL; Council on Children With Disabilities, et al. Oral health care for children with developmental disabilities. Pediatrics. 2013;131(3):614-619. [View Abstract]
- Ortega AO, Guimar £es AS, Ciamponi AL, et al. Frequency of parafunctional oral habits in patients with cerebral palsy. J Oral Rehabil. 2007;34(5):323-328. [View Abstract]
Codes
ICD09
- 306.8 Other specified psychophysiological malfunction
- 327.53 Sleep related bruxism
ICD10
- F45.8 Other somatoform disorders
- G47.63 Sleep related bruxism
SNOMED
- 191983006 Bruxism (teeth grinding) (disorder)
- 274950005 Sleep-related bruxism (disorder)
FAQ
- Q: What is the recommendation for nighttime bruxism management in a preschool child?
- A: The majority of bruxism in children stops without any therapy. Considering the controversial nature of treatment modalities, it is prudent to advise no treatment for childhood bruxism and to advise the parents that the condition is common and the child will outgrow the condition.
- Q: Does bruxism in a child result in problems with the permanent teeth or with the TMJ?
- A: There is no evidence that bruxism in children leads to problems during adolescence or later.
- Q: What is the recommendation for bruxism management in a child with snoring or tonsil/adenoid hypertrophy?
- A: Studies have shown a higher incidence of bruxism among children with tonsil hypertrophy and sleep apnea and a decrease in bruxism after adenotonsillectomy. Bruxism alone, without evidence of upper airway obstruction, would not currently be an indication for adenotonsillectomy. Physicians should assess children with bruxism for upper airway obstruction and refer when indicated.