The prevalence of sleep bruxism and associated factors in children: a report by parents

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).

Sleep bruxism: The past, the present, and the future-evolution of a concept

BACKGROUND

The concept of sleep bruxism (SB) has evolved exponentially over the past several decades. Many theories and hypotheses have been proposed as to the definition, pathophysiology, and management of SB, from the early 1960s through the present. The role of peripheral factors, such as dental occlusion, in the pathogenesis of SB has been discarded.

TYPES OF STUDIES REVIEWED

The authors searched several electronic databases (ie, PubMed, Google Scholar, Web of Science, Embase, and Ovid MEDLINE) for studies on bruxism. The search was conducted from January 1961 through May 2023 and yielded 4,612 articles, of which 312 were selected for comprehensive review after eliminating duplicates and nonfocused articles.

RESULTS

There has been an evident progressive shift from the role of peripheral factors, such as dental occlusion, to more central factors, such as the involvement of a central pattern generator as well as the autonomic nervous system, in the genesis of bruxing movements. There is continued robust interest in the dental community to elucidate the contributing factors involved in SB.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The neurophysiology of SB appears to be leaning more toward central rather than peripheral factors. There is increasing evidence of the role of the autonomic nervous system, genetics, and comorbidities in the genesis of SB. The scientific literature seems to refute the role of dental occlusion in the causation of bruxing movements. As per the literature, there has been a paradigm shift in the definition and genesis of SB and its possible dental implications and management, which also highlights the need for succinct scientific studies in this regard.

Sleep bruxism in children and adolescents-A scoping review

BACKGROUND AND OBJECTIVE

This review paper focuses on sleep bruxism (SB) in children and adolescents. It aims to assess the landscape of knowledge published in the last 20 years.

METHODS

A total of 144 relevant publications from 386 previously identified through Medline were included, of which 83 were on possible SB, 37 on probable SB, 20 on definite SB and 4 were non-applicable. The review places emphasis on the recent evidence on prevalence, pathophysiology, diagnosis and management of SB in children and adolescents, with special focus on probable and definitive SB.

RESULTS

The prevalence ranges from 5% to 50% depending on the age range and on the SB diagnosis (possible, probable or definitive). The pathophysiology is multifactorial, arousal associated and with behavioural problems and sleep disorders (obstructive sleep apnoea, snoring, nightmares) as risk factors, as well as respiratory conditions (allergies, oral breathing). Screening should include questionnaires and dental assessment. Instrumental recording is helpful to confirm diagnosis although more studies are needed to validate this approach in children. SB management includes controlling orofacial and dental consequences and assessing for any other comorbidity. Management options include occlusal splints, oral appliances (advancement mandibular), rapid maxillary expansion and some medications, although this last option is supported by limited evidences in children.

CONCLUSION

Suggestions of future topics in research are delivered to better understand comorbidities, diagnosis and management with improved outcomes compared to what is currently available.

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.

Bruxism, parafunctional oral habits and oral motor problems in children with spastic cerebral palsy: A cross-sectional study

BACKGROUND

Individuals with spastic cerebral palsy are more predisposed to parafunctional oral activities and oral motor problems because of spasticity.

OBJECTIVES

The aim of the study was to evaluate the relationship between the gross motor function classification system score (GMFCS), age, bruxism, parafunctional oral habits and oral motor problems in children with cerebral palsy.

METHODS

This cross-sectional study included 63 children with spastic cerebral palsy, aged 3-18 years, with developmental disabilities. The relationship between parentally reported bruxism, parafunctional oral activity rates, oral motor problems, and GMFCS was analysed.

RESULTS

The prevalence of bruxism was 52.4%, and the rate decreased as age increased. There was a greater likelihood of bruxism in individuals with tongue thrust (OR [95% CI] = 8.15 [1.4-47.3]) and swallowing problems (OR [95% CI] = 5.78 [1.3-24.68]).

CONCLUSION

In children with spastic cerebral palsy, bruxism and the rate of parafunctional oral habits were high, thus affecting oral motor activities. A relationship was found between oral motor problems and increased GMFCS levels, but no relationship was found between bruxism and GMFCS levels. Children with spastic cerebral palsy who display tongue thrust or swallowing problems have an increased likelihood of presenting with bruxism.

Prevalence of Possible Sleep Bruxism and Its Association with Social and Orofacial Factors in Preschool Population

The prevalence of bruxism in the preschool population varies according to different investigations. The aim of this study was to investigate the prevalence of sleep bruxism and its relationship with social and orofacial factors in children aged 3 to 5 years. Three hundred forty-three preschool children were divided into two groups, one with nocturnal bruxism, as reported by parents, and another without this disorder. Questionnaires were distributed to the parents to determine the children's family social status and parafunctional habits at the time of the study. The clinical inspection confirmed the presence of certain parafunctional habits and the children's occlusal characteristics. The data obtained were analysed using descriptive statistics such as frequency chi-square tests to identify the influence of qualitative variables. Of the total sample, 28.9% of preschoolers presented sleep bruxism. The highest prevalence was observed in boys (61.6%) at the age of 5 years (41.4%). Characteristics associated with this pathology were lip incompetence, open bite, crossbite, and overbite, with p < 0.05. Sleep bruxism in preschool children has a higher prevalence in boys and is more frequently expressed from 5 years of age. Open bite, overbite, and crossbite should be considered factors associated with parafunction.

Probable bruxism effects on masseter muscle thickness in children: ultrasonographic evaluation

OBJECTIVE

To compare the masseter muscle thickness (MMT) of patients with probable sleep/awake bruxism and controls without bruxism in mixed dentition as measured with ultrasonography (USG), and to calculate the correlation of MMT with body mass index (BMI).

STUDY DESIGN

The diagnosis of probable bruxism was established based on the parents' reports of the children's behavior, habits, and discomfort, and the presence of clinical signs and symptoms such as attrition-type wear on the teeth and the presence of discomfort, fatigue, and/or pain in the jaw muscles on palpation during clinical examination. The bruxist study group and the control group each included 28 children. MMT was measured separately in relaxed and contracted positions in both groups using USG. The height and weight of the patients were recorded in order to calculate BMI. Statistical analysis was performed with significance established at P < .05.

RESULTS

MMT was found to be significantly larger in the study patients than in controls on the right and left sides in the relaxed and contracted positions (P < .001). No statistically significant correlation was found between MMT and BMI (P ≥ .134).

CONCLUSIONS

MMT as measured with USG can be a beneficial approach in diagnosing bruxism in children. The lack of correlation between MMT and BMI indicates that BMI would not be helpful in diagnosing bruxism.

Prevalence of Bruxism among the Students of Gulf Medical University: A Cross-Sectional Questionnaire Study

Introduction:

Bruxism is a multifactorial phenomenon that involves grinding or clenching of teeth. The parafunctional habit includes abnormal tooth wear, tooth fracture, pain, and tooth mobility, along with headaches and facial muscle hypertrophy. It is imperative for students to be conscious of teeth grinding along with its possible causes. The student will be alert to visit the dentist if required and contribute to the recognition of etiological factors, to eliminate them.

Objective:

This study aims to find the prevalence and understanding of bruxism among Gulf Medical University (GMU) students.

Materials and Methods:

A cross-sectional, questionnaire-based study was conducted among 451 GMU students. The parameters for data collection were age, gender, prevalence, associated signs and symptoms, causes, genetic predisposition, time of day, and effect on the appearance of teeth.

Results:

While 35.9% were unaware, 41.7% of our samples reported bruxism. The majority recognized temporomandibular joint and facial pain as causative, and 24.8% reported symptoms. Headache (26.4%) was prime and 7.5% were associated with fracture and abnormal tooth wear to bruxism (38.1%) experienced night bruxism. A significant number of students (32.4%) identified abnormal anterior teeth relationship as the cause and (64.3%) associated bruxism and esthetics.

Conclusion:

Nearly 41.7% of the students reported bruxism. Around 35.9% of the samples were uninformed. Nearly 20.8% believed that bruxism had genetic relevance. Nearly 51.9% of the participants were asymptomatic. Around 38.1% had night bruxism and 32.4% identified abnormal anterior teeth relationship as the cause. The majority of the sample (64.3%) connected bruxism to negative effects on teeth and esthetics.

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.

Nocturnal events in children: When and how to evaluate

Nocturnal events of wide variety and concern are frequently reported by patients and their caregivers. To evaluate suspected abnormal events, primary care physicians must first be familiar with normal behaviors, movements and breathing patterns. Abnormal nocturnal events can then be categorized as nocturnal seizure, parasomnia, sleep-related movement disorder or sleep-related breathing disorder. Diagnoses in the above categories can be made clinically; however, it is important to know when to refer for additional evaluation. Comprehensive literature review was undertaken of nocturnal and sleep-related disorders. This guide reviews nocturnal seizures, normal and abnormal nonepileptic movements and behaviors, discusses broad indications for referral for electroencephalography (EEG) or polysomnography (PSG), and guides counseling and management for patients and their families, ultimately aiding in interpretation of both findings and prognosis. Epilepsy syndromes can result in seizures during sleep or adjacent periods of wakefulness. Parasomnias and sleep-related movement disorders tend to also occur in childhood and may be distinguished clinically. Referral to additional specialists for specific studies including EEG or PSG can be necessary, while other times a knowledgeable and vigilant clinician can contribute to a prompt diagnosis based on clinical features. Nocturnal events often can be managed with parental reassurance and watchful waiting, but treatment or evaluation may be needed. Sleep-related breathing disorders are important to recognize as they present very differently in children than in adults and early intervention can be life-saving. This review should allow both primary and subspecialty non-neurologic pediatric and adolescent health care providers to better utilize EEG and PSG as part of a larger comprehensive clinical approach, distinguishing and managing both epileptic and nonepileptic nocturnal disorders of concern while fostering communication across providers to facilitate and coordinate better holistic long-term care of pediatric and adolescent patients.

Restless sleep in children: A systematic review

This systematic review assessed the prevalence of restless sleep in children, documented the association of restless sleep with other conditions, and summarized the existing evidence regarding whether restless sleep should be considered a distinct sleep disorder. A comprehensive search of electronic databases was performed using the broad search term "restless sleep" in all fields. Of the 266 articles retrieved, 107 were retained for inclusion in this review. The majority (n = 93) were observational studies. The studies were grouped under several pathologic/condition categories: sleep-disordered breathing (n = 19); adenotonsillectomy (n = 7); respiratory disorders, otitis media, and smoke exposure (n = 12); sleep-related movement disorders and restless sleep disorder (n = 11); neurologic or psychiatric disorders (n = 7); Down syndrome/other neurodevelopmental disorders (n = 10); sleep-related bruxism and other sleep disorders (n = 7); and restless sleep in the general population/mixed clinical samples (n = 18). A high prevalence of restless sleep was found in children with many of these underlying conditions, likely related to associated inherent sleep disruption and frequent awakenings (e.g., apnea and periodic limb movements), pain, sleep instability, and caregiver perception. The majority of studies identified restless sleep as reported by the caregiver, only 34 studies attempted to define restless sleep further. Four studies provided supportive evidence for designating restless sleep as an independent sleep disorder, restless sleep disorder (RSD). This review highlights the fact that the prevalence, etiology and sequelae (including daytime impairments) of restless sleep in children are important topics deserving of further research and that clinical definitions based on empirical evidence need to be developed. The designation of "primary" versus "secondary" restless sleep may be a useful construct, especially with regard to developing clinical trials and treatment algorithms.

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.

Knowledge of parents/caregivers about the sleep bruxism of their children from all five Brazilian regions: A multicenter study

BACKGROUND

Sleep bruxism (SB) is a masticatory muscle activity that affects children. Parents' knowledge is important for its identification and report to dentists.

AIM

To investigate parents' knowledge about SB among their children.

DESIGN

A cross-sectional study included 1325 parents of children from dental clinics of seven institutions from all regions of Brazil. Parents answered questions about child's sleep, knowledge about SB and its occurrence among children and parents. SB definition given by parents was dichotomized as "correct"/"incorrect", based on the American Academy of Sleep Medicine definition. Descriptive, bivariate and multivariate analyses were performed (P < 0.05).

RESULTS

Most parents (57.3%) did not know what SB is and 88.9% would like to receive more information. SB prevalence among parents was 15.4% and 24.0% among children. Between parents who correctly defined SB, its prevalence increased to 27.5% among parents and 40.6% among children. Parents whose children had/have SB, who would like to receive more information about SB and were from the North, Central-West, Southeast, and South regions were more likely to define SB correctly (P > 0.05).

CONCLUSION

There is a lack of knowledge of parents about SB. SB among children, parents' interest in receiving more information and their location were factors associated to their knowledge.

Risk factors associated with reported bruxism among children and adolescents with Down Syndrome

Objective: Identify factors associated with the prevalence of reported bruxism in children/adolescents with Down Syndrome (DS). Methods: The study included 112 children/adolescents with DS and their parents/caregivers. Oral habits, pacifier/finger sucking, upper respiratory infections (<six months), and breathing type (nasal/buccal) were diagnosed. Reported bruxism was recorded through parents' report ("Does your child have audible teeth grinding?"). Results: Children/adolescents 8-12 years of age were 1.15 times more likely to belong to the group with reported bruxism (1.42-3.14). Children/adolescents 5-7 years of age were 3.38 times more likely to belong to the group with reported bruxism (1.26-9.03). Children/adolescents classified as mouth breathers were 2.87 times more likely to belong to the group with reported bruxism (1.18-6.98). Conclusion: Age and mouth breathing were associated with reported bruxism. Earlier interventions should be provided in order to limit and minimize possible damage that can affect childrens' quality of life.