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22-08-2011 | Article

Bruxism in the young associated with physical and behavioral problems


Free abstract

MedWire News: Sleep-related bruxism (SB) and wake-time tooth clenching (TC) are associated with a number of physical and behavioral issues in children and adolescents, Canadian researchers have found.

Bruxism (grinding of teeth and clenching of the jaw) is common among children and adolescents and can occur during sleep (SB) or during the waking hours (TC). While both types of activity are associated with detrimental consequences on orofacial structures (temporomandibular disorders [TMDs], pain, muscle fatigue, and tooth wear), SB is also associated with sleep dysfunction and behavioral problems (attention deficit, poor school performance).

To further evaluate the prevalence of reported SB and TC in a pediatric population, Maria Clotilde Carra and colleagues (University of Montreal, Canada) assessed 604 children and adolescents (aged 7-17 [mean age 13] years) who were seeking orthodontic treatment at a single dental center.

All participants underwent an orthodontic clinical evaluation, examining standard dental, skeletal, functional, and esthetic factors, and answered a four-section questionnaire consisting of questions in terms of medical and dental history, bruxism, sleep disorders, and daytime behaviors.

In the entire study population, 15% reported SB and 12% reported TC. The study population was then split into three groups: control (n=220), SB (n=58), and TC (n=42). The SB group comprised mainly children (≤12 years, 67%) and the TC group contained predominantly adolescents (≥13 years, 79%).

For the signs and symptoms of TMD, the prevalence of tooth-wear complaints was significantly higher in the SB (14%) and TC (10%) groups compared with controls (2%), although once age was controlled for, only the SB group had a higher risk (adjusted odds ratio [AOR]=8.8). Both groups also had higher incidences of TMD joint clicking and locking, jaw muscle fatigue, and difficulties in yawning. The SB group also experienced more frequent headaches than the control group (12.1% vs 4.1%).

Both SB and TC groups reported more sleep problems than controls. Both groups experienced higher levels of daytime sleepiness (7% vs 19% vs 2%, for SB, TC, and control groups, respectively), feeling unrefreshed in the morning (22% vs 52% vs 10%), and difficulty waking in the morning (28% vs 50% vs 11%).

Several behavioral issues were higher in both the SB and TC groups compared with the controls including 'not listening when spoken to', being 'easily distracted', and fidgeting'.

For the SB group versus the controls, the largest significant AORs were for: jaw-muscle fatigue (10.5), tooth wear (8.8), and daytime sleepiness (7.4). For the TC group the largest significant AORs were: jaw-muscle fatigue (13.5), difficulties in yawning (10.9), and daytime sleepiness (9.1).

Writing in the European Journal of Oral Sciences, Carra and co-authors conclude that "the present study supports, at least in a pediatric population seeking orthodontic treatment, that SB and wake-time bruxism are two different conditions with little overlap."

They go on to say that "subjects reporting the presence of specific orofacial, sleep, or behavioral complaints may be at risk for developing further health problems. It is therefore mandatory that dentists investigate children and adolescents with SB and wake-time TC in the presence of sleep or behavioural complaints or reports."

By Iain Bartlett