Respiratory disorders and the prevalence of sleep bruxism among schoolchildren aged 8 to 11 years

Global Prevalence of Sleep Bruxism and Awake Bruxism in Pediatric and Adult Populations: A Systematic Review and Meta-Analysis

Background/Objectives: The purpose of this systematic review was to assess the global prevalence of sleep bruxism and awake bruxism in pediatric and adult populations. Methods: This systematic review was conducted by analyzing studies published from 2003 to 2023. The following keyword combination was utilized: prevalence, epidemiology, population, and bruxism. The PubMed database was analyzed, supplemented by manual searches using the Google search. Additionally, the snowballing procedure method was applied. A double assessment of the quality of publications was carried out to preserve the highest possible quality of evidence (e.g., Joanna Briggs Institute critical appraisal checklist). Analyses were conducted using the R statistical language. Results: The global bruxism (sleep and awake) prevalence is 22.22%. The global sleep bruxism prevalence is 21% and awake prevalence is 23%. The occurrence of sleep bruxism, based on polysomnography, was estimated at 43%. The highest prevalence of sleep bruxism was observed in North America at 31%, followed by South America at 23%, Europe at 21%, and Asia at 19%. The prevalence of awake bruxism was highest in South America at 30%, followed by Asia at 25% and Europe at 18%. Conclusions: One in four individuals may experience awake bruxism. Bruxism is a significant factor among women. It was observed that age is a significant factor for the occurrence of sleep bruxism in women. Among the limitations of the study is the lack of analysis of the prevalence of bruxism in Africa and Australia due to not collecting an adequate sample for analysis. The study was registered in the Open Science Framework (10.17605/OSF.IO/ZE786).

Secondary bruxism: A valid diagnosis or just a coincidental finding of additional masticatory muscle activity? A narrative review of literature

INTRODUCTION

Bruxism is defined as a repetitive masticatory muscle activity that can manifest it upon awakening (awake bruxism-AB) or during sleep (sleep bruxism-SB). Some forms of both, AB and SB can be associated to many other coexistent factors, considered of risk for the initiation and maintenance of the bruxism. Although controversial, the term 'secondary bruxism' has frequently been used to label these cases. The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques, however, are important factors to be considered when judging the literature findings. The use (and abuse) of drugs, caffeine, nicotine, alcohol and psychoactive substances, the presence of respiratory disorders during sleep, gastroesophageal reflux disorders and movement, neurological and psychiatric disorders are among these factors. The scarcity of controlled studies and the complexity and interactions among all aforementioned factors, unfortunately, does not allow to establish any causality or temporal association with SB and AB. The supposition that variables are related depends on different parameters, not clearly demonstrated in the available studies.

OBJECTIVES

This narrative review aims at providing oral health care professionals with an update on the co-risk factors and disorders possibly associated with bruxism. In addition, the authors discuss the appropriateness of the term 'secondary bruxism' as a valid diagnostic category based on the available evidence.

CONCLUSION

The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques found in many studies preclude any solid and convincing conclusion on the existence of the 'secondary' bruxism.

Factors associated with preschool children's sleep bruxism

OBJECTIVE

To evaluate the prevalence of sleep bruxism, related factors, and quality of life of preschool children and their families.

METHOD

The sample was 475 children between 4 and 5 years old enrolled in schools in the city of Bauru-Brazil. Parents/legal guardians answered two questionnaires, one to assess the presence of bruxism and related factors and another that was the validated Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Intraoral clinical examination was performed by two trained examiners (Kappa = 0.82) within the school environment. The data were analyzed using statistics and the Mann-Whitney, Kruskal-Wallis, and Spearman correlation coefficient. The significance level was p < 0.05.

RESULTS

The prevalence of sleep bruxism was 47.4%. The highest prevalence was related to Class I canines and marked overjet, oral habits, such as nail biting, lip biting, chewing gum, and mouth breathing. Children with agitated sleep, reports of headache, and those considered aggressive, anxious, and/or shy were also more related.Conclusion: In the studied sample, sleep bruxism prevalence was high and related to important oral and general factors. Data also indicated SB as the main factor that interfered in the OHRQoL of children and their families.

Sleep Bruxism in Children—What Can Be Learned from Anamnestic Information

Sleep bruxism (SB) is a masticatory muscle activity during sleep, and its clinical manifestation in young children is still unclear. The aim of the present study was to evaluate the role of anamnestic information in predicting possible SB in children aged 4–12 years. In a cross-sectional retrospective exploratory study, the dental files of 521 children were examined with regard to the following anamnestic information: gender, age, medical conditions associated with ear, nose, and throat (ENT), respiratory disorders, use of methylphenidate (Ritalin), oral habits, and bruxing during sleep. A child was defined as presenting possible SB when a positive report was received from parents regarding such behavior (SB positive, No. = 84). There were no age- and/or gender-wise differences between SB-positive children and children whose parents did not report SB behavior (SB negative). SB-positive children suffered more from ENT and respiratory disorders than children without SB. Additionally, the use of pacifiers/finger sucking, as well as snoring, were more common among SB-positive children as compared to their SB-negative counterparts (Chi-square). The variables which were found to significantly increase the odds of possible SB in children were mouth breathing, ENT problems, and use of a pacifier or finger sucking (forward stepwise logistic regression). Clinicians should look for clinical signs of possible SB in children whose anamnesis reveals one or more of these anamnestic signals.

Association between possible awake bruxism and bullying among 8- to 11-year-old children/adolescents

BACKGROUND

Bruxism is characterized by tooth grinding and/or clenching.

AIM

To evaluate the association between possible awake bruxism (PAB) and bullying among individuals aged 8-11 years.

DESIGN

A representative cross-sectional study was conducted with 434 eight- to eleven-year-old children/adolescents. Parents/caregivers answered a questionnaire to provide data on sociodemographic characteristics. Children/adolescents answered a questionnaire about the occurrence of PAB. The Olweus Bully/Victim Questionnaire was used. The Poisson regression analysis was performed.

RESULTS

Of the 434 children/adolescents, 209 (48.2%) were boys and 225 (51.8%) were girls. The mean age of the children/adolescents was 9.14 years (±1.00). Children/adolescents who were victims of bullying (PR = 1.52, 95% CI = 1.14-2.04, P = .005) and bullies-victims (PR = 2.08, 95% CI = 1.36-3.17, P = .001) presented a higher frequency of PAB than those who were not involved in bullying.

CONCLUSION

Children/adolescents who were bullying victims and bullies-victims had a higher frequency of PAB.

Health behaviors and multimorbidity associated with bruxism: Population-based study

OBJECTIVES

Determine the prevalence of possible bruxism in the adult population of Campinas, Brazil, and investigate its association with health behaviors, health status, and multimorbidity.

METHODS

A population-based cross-sectional study was conducted with data from the 2014/2015 Campinas Health Survey. The sample was composed of 1986 adults (≥20 years of age). The data were collected with the aid of a pre-coded questionnaire, and the dependent variable was self-reported bruxism (possible bruxism). The prevalence of possible bruxism was estimated according to the independent variables (health-related behaviors, morbidities, demographic and socioeconomic characteristics). A hierarchical model was employed using stepwise backward regression in two stages. Principal component analysis was also performed to identify multimorbidity patterns.

RESULTS

The prevalence of possible bruxism was 13.6%. Associations were found with the consumption of alcoholic beverages, sleep quality, and the number of chronic diseases/health problems. Bruxism was more associated with multimorbidity pattern 2, which was composed of asthma, rhinitis, sinusitis, dizziness/vertigo, migraine/headache, emotional/mental problem, back pain, and allergy.

CONCLUSION

The present findings justify the planning of actions directed at reducing the consumption of alcoholic beverages and can help guide the health actions of the multidisciplinary team, prioritizing a reduction in the harm caused by the simultaneous presence of health problems associated with possible bruxism.

Breathing problems, being an only child and having parents with possible sleep bruxism are associated with probable sleep bruxism in preschoolers: a population-based study

PURPOSE

To determine the prevalence of probable sleep bruxism (SB) in preschoolers and associated factors.

METHODS

A cross-sectional, population-based study was carried out with 862 dyads of parents/preschoolers aged 5 from Teresina, Brazil. Data collection was performed through a questionnaire answered by parents/guardians about socioeconomic, demographic, and health condition data. Each child was examined for diagnosis of probable SB based on the presence of dental wear associated or not with the report of teeth grinding by parents/guardians. The analysis of independent variables was stratified into four levels of determinants: demographic characteristics of the child (distal), characteristics of the family, environmental factors (intermediate), and health conditions (proximal). Descriptive analysis and bivariate and multivariate Poisson's regression were performed using a hierarchical approach (p < 0.05).

RESULTS

The prevalence of probable SB was 36%. In the final adjusted multivariate hierarchical model, a preschooler who was the only child (PR = 1.25; 95%CI = 1.02-1.51), with breathing problems (PR = 1.43; 95%CI = 1.19-1.73), and having parents/guardians with possible sleep bruxism (PR = 1.65; 95%CI = 1.32-2.07) had a higher prevalence of probable SB.

CONCLUSION

The prevalence of probable SB in preschoolers was high and associated with the condition of being an only child, the presence of breathing problems, and having parents/guardians with possible sleep bruxism.

Association of facial type with possible bruxism and its related clinical features in adolescents: A cross-sectional study

OBJECTIVES

The assessment of bruxism and its clinical characteristics is acknowledged in literature. This study aimed to evaluate the association of adolescents' facial patterns with bruxism and its related clinical features in the form of signs and symptoms.

MATERIALS AND METHODS

Four hundred and three adolescents answered a questionnaire evaluating sleep bruxism (SB) and awake bruxism (AB). Parents/caregivers answered a questionnaire evaluating the adolescents' sleep features (drooling on the pillow, snoring). Adolescents' facial (dolichofacial/brachyfacial/mesofacial) and clinical features (pain in masseter/temporal muscle, indentations marks on the tongue, linea alba, tooth attrition, mouth's maximum opening and masseter electrical activity) were evaluated. Multinomial regression was performed. Odds ratio (OR) and confidence intervals (CI) were provided.

RESULTS

Brachyfacial adolescents were less likely to present possible AB compared to mesofacials (OR=0.46, CI=0.21-0.98). Brachyfacial adolescents were more likely to present pain in the temporal muscle (OR=6.59, CI=2.18-19.87) and a higher number of posterior teeth with attrition (OR=1.25, CI=1.02-1.57) compared to mesofacials. Dolichofacial adolescents were more likely of not presenting pain in the masseter muscle (OR=2.23, CI=1.03-4.83), had a higher mouth's maximum opening (OR=1.43, CI=1.04-1.97), had a higher number of posterior teeth with attrition (OR=1.17, CI=1.00-1.37) and were more likely to drool on the pillow (OR=2.05, CI=1.15-3.67) compared to mesofacials. Dolichofacial adolescents were more likely of not presenting pain in the temporal muscle (OR=6.36, CI=2.30-17.54), to present themselves without marks on the tongue (OR=2.26, CI=1.09-4.69) and present a higher mouth's maximum opening (OR=2.09, CI=1.40-3.13) compared to brachyfacials.

CONCLUSION

Bruxism and its clinical features differ among dolichofacial, brachyfacial and mesofacial adolescents.

Correlation between Parental-Reported Tooth Grinding and Sleep Disorders: Investigation in a Cohort of 741 Consecutive Children

Purpose

A possible relationship between sleep bruxism (SB) and several sleep disorders has been suggested in children, which could influence sleep quality and quality of life. This study aims to assess such correlations in a large sample of school children.

Methods

Parents of 741 consecutive children aged between 8 and 12 years filled the Sleep Disturbance Scale for Children (SDSC). It evaluated 45 items grouped in 8 components: duration of night-time sleep, sleep latency, bedtime problems, sleep quality, night awakenings, nocturnal symptoms, morning symptoms, and daytime sleepiness. An item evaluating parental-reported tooth grinding was also included. Correlation analysis was performed between parental-reported tooth grinding and all the other items.

Results

A significant correlation between parental-reported tooth grinding and several sleep disorders concerning bedtime problems, night awakenings, nocturnal symptoms, and morning symptoms has been found. In general, correlation strength of significant pairs was low, ranging from 0.092 (sleep apnea) to 0.234 (movement while falling asleep).

Conclusions

Parental-reported tooth grinding in children is correlated, even if weakly, with some sleep disorders concerning the sphere of bedtime problems, night awakenings, nocturnal symptoms, breathing symptoms, and morning symptoms. Further studies are needed to confirm these findings, with particular regard to the consistency of correlation outcomes between the parental reports and the sleep laboratory measures.

Genetic Polymorphisms in ACTN3 Contribute to the Etiology of Bruxism in Children

Objective: Bruxism is a condition defined as a masticatory muscle activity with an unexplored genetic background. The aim of this study was to evaluate the association between genetic polymorphisms in ACTN3 and bruxism. Study design: A total of 151 biological-unrelated children, aged 7-12 years were included in a case control ratio of 1:1.5. The data collection was performed during interview and clinical examination. Saliva samples were collected from all children and 3 genetic polymorphisms in the ACTN3 (rs678397, rs1671064 and rs1815739) were selected for genotyping using real time PCR. Pearson chisquare calculation was used to assess Hardy-Weinberg equilibrium and to evaluate the association between genotypes and alleles frequencies for each genetic polymorphism in the co-dominant and recessive models. An alpha of 5% was used. Results: The genetic polymorphisms rs678397, rs1671064 and rs1815739 were associated with bruxism in the co-dominate model and in the recessive model (p<0.05). Allele distribution was also associated with bruxism for the polymorphisms rs678397 and rs1671064 (p<0.05). Conclusion: The genetic polymorphisms rs678397, rs1671064 and rs1815739 in ACTN3 are associated with bruxism and can contribute to the etiology of this condition in children.

Is there association between dental malocclusion and bruxism? A systematic review and meta-analysis

OBJECTIVES

Given that current literature largely dissociates dental malocclusion and bruxism, the objective of this study was to gather, through a systematic review, scientific evidence to support their relationship.

METHODOLOGY

This study was performed according to the PECO strategy (where P = general population; E = dental malocclusion; C = no dental malocclusion; and O = bruxism). Literature searches were conducted without language or date restrictions in the following databases: PubMed, Scopus, the Web of Science, the Cochrane Library, LILACS/BBO via VHL and the grey literature. The search strategy included Medical Subject Headings/DECs, synonyms and free terms relevant to each database, with no age restrictions applied. Once the relevant data were extracted from the articles, the Fowkes and Fulton guidelines were followed to assess the quality and risk of bias. For quantitative analysis, dental malocclusions were divided into groups according to their type in order to perform odds ratio (OR) meta-analyses with 95% confidence intervals (CI) using the Review Manager software program (Cochrane, London, UK). The level of certainty of evidence was demonstrated through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE).

RESULTS

After 1,502 studies found, 10 studies were included for qualitative analysis and nine for quantitative synthesis. Four studies presented high methodological quality. Five meta-analyses suggested a non-association between bruxism and Angle class I (OR: 1.05, 95% CI: 0.41-2.69; P = .92; I²  = 84%), Angle class II (OR: 1.49, 95% CI: 0.77-2.87; P = .23; I²  = 71%) or Angle class III (OR: 0.77, 95% CI: 0.31-1.93; P = .58; I²  = 0%). Bruxism was associated with children who did not present with a posterior crossbite (OR: 0.70, 95% CI: 0.51-0.96; P = .03; I²  = 27%) and present crowding (OR: 1.53, 95% CI: 1.03-2.26; P = .03; I²  = 0%). The GRADE analysis presented a very low quality of evidence.

CONCLUSION

Individuals who present with bruxism have a greater chance of crowding. However, bruxism is not associated with the presence of any of the other malocclusions evaluated.

Influence of respiratory allergy and restless sleep on definite sleep bruxism: a cross-sectional clinical study

OBJECTIVE

This cross-sectional clinical study evaluated the associations between sociodemographic, occupational, clinical conditions, psychological and sleep quality variables on definite sleep bruxism (SB).

METHODS

All records obtained from adults (aged 20-60 years) and the elderly (aged >60 years) who had undergone polysomnography (PSG) at a private medical outpatients' clinic from July 2017 to February 2018 were reviewed. Data from a questionnaire, based on the criteria of the American Academy of Sleep Medicine (AASM), were also gathered. Definite SB data pattern distribution was analyzed, and multivariate Poisson regression with robust variance was used to assess the associations between definite SB diagnosis, determined via PSG recordings, and the independent variables. A significance level of 5% was adopted.

RESULTS

A total of 240 individuals were included in the study and the SB prevalence was 7.08% (n = 17). The adjusted Poisson regression analysis revealed association between definitive SB and individuals with respiratory allergy (PR = 3.63; 95% CI:1.01-13; P = 0.047) and restless sleep (PR = 2.97; 95% CI:1.04-8.50; P = 0.042).

CONCLUSION

This study found associations between definite SB and clinical conditions (respiratory allergy) and sleep behavior (restless sleep). Knowledge regarding factors associated with definite SB can contribute to decision making in the clinical setting and management strategies involving a multidisciplinary approach.

The association between allergic rhinitis and sleep: A systematic review and meta-analysis of observational studies

This systematic review and meta-analysis examines the associations of allergic rhinitis with sleep duration and sleep impairment. Observational studies published before August 2019 were obtained through English language literature searches in the PubMed, Embase, and CINAHL databases. Mean differences and odds ratios with 95% confidence intervals were extracted and used for meta-analysis. Heterogeneity was confirmed by the I2-heterogeneity test. Subgroup analysis was conducted to evaluate the influence of study design. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to determine the level of evidence. In total, 2544 records were identified through database searches; 914 duplicate records were excluded, 1452 records were removed after screening of titles and abstracts, 151 records were excluded after full-text screening, and 27 articles were included in the final meta-analyses. A total of 240,706,026 patients (19,444,043 with allergic rhinitis) were considered. No significant difference in sleep duration between the allergic rhinitis and the control groups was found. Patients with allergic rhinitis presented with significantly higher sleep quality scores, sleep disturbances scores, and sleep latency scores; more frequent use of sleep medications; and lower sleep efficiency as measured by the Pittsburgh Sleep Quality Index and polysomnography. Meta-analyses for adjusted odds ratios showed that allergic rhinitis was also associated with higher risks of nocturnal dysfunctions, including insomnia, nocturnal enuresis, restless sleep, sleep-disordered breathing, obstructive sleep apnea, and snoring. Meta-analysis for adjusted odds ratio also showed that allergic rhinitis was associated with daytime dysfunction, including difficulty waking up, daytime sleepiness, morning headache, and the use of sleep medications. The overall quality of evidence ranged from low to very low, indicating that caution is required when interpreting these results. This study demonstrates that there is a significant association of AR with sleep characteristics.

Probable Sleep Bruxism in Children and its Relationship with Harmful Oral Habits, Type of Crossbite and Oral Breathing

Objective: To establish the prevalence of Probable Sleep Bruxism (PSB) and its association with gender, breast or bottle-feeding, posterior and anterior crossbite, oral habits and oral breathing. Study Design: Consists of a cross-sectional study in which 151 children were submitted to a clinical oral examination for the evaluation of tooth wear, muscle discomfort and the presence of anterior and/or posterior crossbite. Parents/caregivers were asked about the frequency of teeth grinding during the child's sleep and the occurrence of harmful oral habits, as well as the type of childbirth and breastfeeding. Data were statistically analyzed through Chi-square or Fisher's exact tests at a 5% level of significance to determine an association among variables. Results: The prevalence of PSB was of 27.8% among the examined children. Among the analyzed variables, only oral breathing was statistically associated to PSB (p < 0.001), and it was verified that children with oral breathing are 2.71 times more likely to present sleep bruxism. Conclusions: The prevalence of PSB in schoolchildren was high and the disorder was associated with oral breathing. Thus, pediatric dentists have an important role in the diagnosis of sleep bruxism and in monitoring breathing-related disorders.

Prevalence of probable sleep bruxism and associated factors in Brazilian schoolchildren

AIM

To determine the prevalence of probable sleep bruxism (PSB) and associated factors among schoolchildren.

DESIGN

This cross-sectional study was carried out with a representative sample of 440 schoolchildren. The children were submitted to a clinical oral examination for the evaluation of tooth wear and/or muscle discomfort. Parents/caregivers filled out a questionnaire with information related to characteristic sounds of sleep bruxism, sociodemographic factors, and the presence of harmful oral habits of children. The stress of the mothers was measured through the Lipp's Stress Symptoms Inventory for Adults (LSSI) instrument. The child's stress was measured through the Child Stress Scale (CSS). Data analysis included descriptive analysis and hierarchical Poisson regression (95% CI, P < 0.05).

RESULTS

The prevalence of PSB was 40.0% (n = 176). The final Poisson regression model showed that PSB was significantly more prevalent in children with a history of nail biting (PR: 1.50; 95% CI: 1.19-1.90; P = 0.001) and biting objects (PR: 1.30; 95% CI: 1.03-1.63; P = 0.025) and less prevalent among girls (PR: 0.78; 95% CI: 0.63-0.98; P = 0.033).

CONCLUSIONS

The prevalence of PSB in schoolchildren was high. Schoolchildren with a history of nail biting and biting objects had a higher prevalence of PSB.

Sleep behaviors in children with different frequencies of parental-reported sleep bruxism

OBJECTIVE

Knowledge on the relationship between sleep bruxism (SB) and sleep behaviors in children is still fragmental, especially when socioeconomic factors are concerned. To assess sleep behaviors in children with different frequencies of proxy-reported SB.

METHODS

Parents of 1475 Colombian children, aged 9.8±1.6years, belonging to 3 different social layers, filled out a questionnaire on their childreńs sleep (Childreńs Sleep Habits Questionnaire [CSHQ]). Differences in sleep behaviors were assessed for the total sample and the three socioeconomic layers, using one-way ANOVA and Bonferroni post-hoc tests or Kruskal-Wallis and Dunn's post-hoc tests, based on the normality of outcome variables.

RESULTS

Most sleep patterns and daytime sleepiness were similar for children with different frequencies of proxy-reported SB, without differences among socioeconomic layers, whilst sleep disorders and parasomnias increased with the frequency of proxy-reported SB, independently on the socioeconomic layer (Bonferroni post-hoc<0.001). The association between sleep-related habits and the frequency of proxy-reported SB was different for each socioeconomic layer.

CONCLUSION

Among the various sleep behaviors under investigation, some sleep disorders and parasomnias seem to be associated with parental-reported SB in children. The influence of socioeconomic conditions on sleep behaviors seems not relevant. Based on these results, more specific studies on the association between different sleep behaviors are needed.

CLINICAL SIGNIFICANCE

Sleep behaviors, sociodemographic and socioeconomic features are correlated with SB in adults. However, in children, good evidence about this topic is lacking. This article give information to help clinicians evaluating sleep behaviors, sociodemographic and socioeconomic characteristics, when assessing sleep bruxism, based on evidence.