Risk factors related to sleep bruxism in children: A systematic literature review

Sleep hygiene measures combined with mindfulness meditation in the management of sleep bruxism in children: A randomized controlled clinical trial

BACKGROUND

Sleep hygiene measures and meditation may reduce stress and improve sleep quality, but their effect on the occurrence of sleep bruxism in children has not yet been investigated.

AIM

To explore the effects of sleep hygiene measures combined with mindfulness meditation (relaxation audio) in the management of probable sleep bruxism (SB) in children.

DESIGN

This clinical trial (no. NCT04501237) randomized 36 children with 3-8 years of age. Probable SB detection was performed according to the criteria established by the International Consensus on The Assessment of Bruxism-2018. Intervention group was instructed to practice sleep hygiene measures and mindfulness meditation (i.e., the use of a digital app to broadcast audio relaxation) each night before bedtime for 5 weeks; control group did not receive guidance for therapies. Parents completed a bruxism diary for 5 weeks, and the outcome was the number of SB episodes-day reported in the week (ranging from 0 to 7) in each period. A multilevel mixed-effects Poisson regression model was performed.

RESULTS

A total of 32 children (mean age: 6.1 years) completed the study. The children who received the therapies related to sleep hygiene measures and mindfulness meditation had a reduction in the SB incidence rate ratio (IRR) of 46% (IRR = 0.54 [Confidence Interval 95%, 0.45-0.65]) during a 5-week observation period. The sensitivity analyses did not show relevant changes in the measure of the effect.

CONCLUSION

Sleep hygiene measures combined with mindfulness meditation reduced the SB in children.

Bruxism management in individuals with autism spectrum disorder and down syndrome - A systematic review

BACKGROUND

In dentistry, association between bruxism and individuals with autism spectrum disorders (ASD) and Down Syndrome (DS) is high. Bruxism is one of the most common oral and psychophysiological disorders, that is still an unsolved issue with limited data.

OBJECTIVES

The purpose of this systematic review (SR) was to evaluate evidence about bruxism and its management in individuals with ASD and DS.

MATERIALS AND METHODS

The researchers performed an electronic search using keywords on three databases, reference lists and complemented by manual searching from January 2000 to February 2023 to find out the relevant documents. An extensive literature review using the "Preferred Reporting Items for Systematic Review and Meta Analysis" method was carried out. PICO parameters were formulated, and studies risk of bias was evaluated using the JBI critical appraisal checklist tool for case reports.

RESULTS

Out of 527 documents, 8 case studies and one review paper were identified as final articles for data synthesis. The findings showed, bruxism was reduced for all the participants with ASD and DS after implementation of functional analysis or dental treatment.

CONCLUSION

The current SR found that despite the positive results of all the studies, there was a lack of evidence due to a limited number of studies and only case studies were conducted through functional analysis and dental treatment.

NOVELTY

This SR is the first study on bruxism treatments in individuals with ASD and DS that included all the available studies (n = 9) since last 23 years and the first study that specifically addresses the incorporation of case reports in a systemic review.

Association between perfectionism, personality traits and probable sleep bruxism in Spanish schoolchildren: A case-control study

BACKGROUND

The aetiology of Sleep bruxism includes specific personality traits, related to perfectionism.

AIM

To investigate the relationship between probable sleep bruxism (PSB) and personality traits in children and their parents, determining whether children with PSB and their parents are more perfectionists.

DESIGN

This case-control study included 104 children aged 8-9 years, 52 cases and 52 controls. A clinical examination was performed on the children who completed the Big Five Personality Questionnaire (BFQ-NA) and the Child Perfectionism Inventory. Parents completed a bruxism diagnostic questionnaire according to the AASM criteria, BFQ and Frost multidimensional perfectionism scale questionnaires. t-Tests for independent samples and multivariate logistic regression models were used for statistical analysis.

RESULTS

A significant relationship between PSB and a self-demanding personality (OR = 1.11, p = .01), restless sleep (OR = 4.41, p = .004), and a family history of clenching and grinding teeth (OR = 3.07, p = .0006) was found in a binary logistic regression model. When adjusted, only restless sleep showed a significant relationship with PSB (p = .03, OR 3.32, 95% CI 1.13-9.81).

CONCLUSION

Children whose parents reported as clenching or grinding their teeth while asleep in the previous 6 months, and who were found to have abnormal dental wear, had significantly more nightmares, sleep disruption, daytime sleepiness, family history of bruxism, and tended to be more perfectionist.

Influence of psychiatric symptom profiles of parents on sleep bruxism intensity of their children

OBJECTIVE

The objective of this study was to evaluate the effects of parental anxiety, depression levels and psychiatric symptom profiles of parents on the occurrence of sleep bruxism in children.

MATERIAL & METHODS

This cross-sectional study was carried out with a sample of 94 children aged 6 to 12 years, divided into two groups: with sleep bruxism (bruxism group-BG) and without sleep bruxism (control group-CG). Beck Depression Inventory (BDI), Symptom Checklist (SCL-90-R), Symptom Checklist and Screen for Child Anxiety Related Emotional Disorders-Parent (SCARED-P) scale were used to assess anxiety and depression levels of parents. All questionnaires were filled out by parents of children. Intraoral and extraoral examinations were carried out of children in the clinic and sleep bruxism was determined. All stress conditions were investigated by logistic regression analysis. In the comparison of the qualitative data, chi-square and Fisher exact tests were used.

RESULTS

The data revealed that participants whose mothers had high anxiety and interpersonal sensitivity scores, and participants whose fathers had a medium level of obsessive-compulsive disorder were more likely to have an SB problem (p < 0.05). According to the results of BDI, the fathers' results between the BG and the CG were not statistically significant (p > 0.05). However, the mothers' results between the BG and the CG were statistically significant (p < 0.05) When all subscales of SCARED-P were evaluated, the separation anxiety disorder subscore was statistically significant in the bruxism group.

CONCLUSION

The psychological status of parents is a significant risk factor associated with SB development in school-age children.

Common Childhood Sleep Problems and Disorders

BACKGROUND

Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children.

OBJECTIVE

To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents.

METHODS

A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled.

RESULTS

Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized.

CONCLUSION

Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.

Obstructive sleep apnea: a follow-up program in its relation to temporomandibular joint disorder, sleep bruxism and orofacial pain

OBJECTIVE

To evaluate the correlation between obstructive sleep apnea (OSA) and temporomandibular joint (TMJ) morphology, tooth wear condition, orofacial pain through a follow-up program.

MATERIALS AND METHODS

Seventy one OSA patients were divided into three groups according to their (apnea hypopnea index) AHI: mild group (n = 23), moderate group (n = 24), and severe group (n = 24). All patients had OSA therapies around six months after confirm the diagnosis of OSA. The tooth wear score and orofacial pain condition of all patients were recorded via clinical examination. Cone beam computed tomography (CBCT) images were also taken when confirm the diagnosis of OSA (T0), 6 months after the diagnosis (T1), and 6 months after the OSA treatment (T2). Parameters indicating the condylar morphology and joint space were evaluated. The differences of clinical symptoms and TMJ conditions among T0, T1 and T2 time point were detected in the three groups respectively. The changes in T1-T0 and T2-T1 of all descriptions among three groups were also compared. The correlations between AHI and clinical symptoms were detected with Spearman correlation analysis.

RESULTS

In mild group, there was no difference in all clinical symptoms and TMJ morphology among the three time points. Both in moderate and severe group, the condylar volume, superficial area, wear score, visual analogue scales (VAS), and R value (indicating condyle position) displayed significant differences among the three time points (P < 0.05). From T0 to T1, mild group displayed fewer decreases in the condylar volume and superficial area and fewer increases in wear score than that in moderate and severe group (P < 0.05). From T1 to T2, there was a greatest reduction in severe group for R value, and significant difference in the description of VAS and R value were found among the three groups. AHI was negatively correlated condylar volume and condylar superficial area, and was positively correlated with tooth wear score and VAS (P < 0.05).

CONCLUSION

Moderate to severe OSA will aggravate orofacial pain and tooth wear, affect TMJ volume and superficial area, even change the location of condyles. Appropriate OSA therapies may be effective ways to alleviate these adverse effects in long-term.

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.

Prevalence of Oral Parafunctional Habits in Children and Related Factors: An Observational Cross-sectional Study

Aim

Parafunctional habits cause movements indicating their effect as functional and structural disorders such as malocclusion and temporomandibular joint changes in the oral and dental organs. This cross-sectional study was conducted to investigate the prevalence and factors associated with parafunctional habits in 6-12-year-old children in Qom, Iran.

Materials and methods

This analytical cross-sectional study was performed on 403 6-12-year-old schoolchildren of Qom, Iran. Data collection tools included a demographic questionnaire and a checklist prepared along with a clinical examination. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with chi-square and analysis of variance (ANOVA) tests.

Results

The mean age of children was 8.9 ± 2.03 years. Bruxism was more common than other parafunctional habits (22.6%). There was a significant relationship between oral habits with children's gender and age (p <0.001). However, there was no significant relationship between oral habits and other variables such as underlying disease, economic status and parent's smoking (p >0.05).

Conclusions

Given the relatively high prevalence of parafunctional habits in children, it seems that children should be investigated for the presence of such habits in order to provide the necessary education to parents and perform dental interventions to prevent complications from oral habits. Dental interventions at a younger age are easier to conduct and have a more effective preventive role.

How to cite this article

Mehdipour A, Aghaali M, Janatifar Z, et al. Prevalence of Oral Parafunctional Habits in Children and Related Factors: an Observational Cross-sectional Study. Int J Clin Pediatr Dent 2023;16(2):308-311.

Possible sleep bruxism and biological rhythm in school children

OBJECTIVE

To verify whether children with possible sleep bruxism (PSB) had alterations in biological rhythm and to explore the possible factors involved, such as sleep characteristics, screen time, breathing, sugary food consumption, and clenching teeth during wakefulness reported by parents/guardians.

METHODOLOGY

Data were collected through online interviews with 178 parents/guardians of students aged 6 to14 years from Piracicaba, SP, BR, when the BRIAN-K scale was answered, which is composed of four domains (1) sleep; (2) daily routine activities; (3) social behavior; (4) eating; questions about predominant rhythms (willingness, concentration, and change day to night). Three groups were formed: (1) without PSB (WPSB), (2) with PSB sometimes (PSBS), and (3) with PSB frequently (PSBF).

RESULTS

Sociodemographic variables were similar between groups (P > 0.05); the total value of the BRIAN-K was significantly higher for the PSBF group (P < 0.05); the first domain (sleep) presented significantly higher values for the PSB groups (P < 0.05); no significant difference for other domains and predominant rhythms occurred (P > 0.05). The involved factor that differed between groups was clenching teeth, as the number of children with PSBS was significantly higher (χ2, P = 0.005). The first domain of the BRIAN-K (P = 0.003; OR = 1.20), and clenching teeth (P = 0.048; OR = 2.04) were positively associated with PSB.

CONCLUSION

Difficulties in maintaining sleep rhythm and clenching teeth during wakefulness reported by parents/guardians may determine a greater chance to increase the frequency of PSB.

CLINICAL RELEVANCE

Good sleep seems to be important to maintain a regular biological rhythm and may reduce the frequency of PSB in the 6-14 age group.

Associated factors and treatment options for sleep bruxism in children: an umbrella review

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options.

Are lower urinary tract conditions more common in children with sleep bruxism?

INTRODUCTION

Sleep bruxism is a parasomnia caused by rhythmic and non-rhythmic activity of the masticatory muscles during sleep. Prevalence of sleep bruxism is reported up to 40.6% in the literature. Sleep bruxism is a multifactorial issue and associated with multiple dental complications, sleep-related disorders, and psychosocial problems. We aimed to investigate if children with sleep bruxism suffer more from lower urinary tract conditions.

MATERIALS AND METHODS

Prospectively 128 children were included in this study. Sixty-four children constituted in the bruxism group and 64 children constituted in the control group. Children who admitted to the pediatric dentistry clinic with bruxism symptoms were recruited in the bruxism group. Control group constituted of consecutive 64 children who admitted to the pediatric dentistry clinic for routine dental examination. Parents were asked to fill out a questionnaire including Dysfunctional Voiding and Incontinence Scoring System (DVISS) form. Children's demographic data, presence of urinary frequency, presence of urgency, behaviour of voiding postponement, presence of daytime urinary incontinence, presence of enuresis nocturna, presence of fecal incontinence, presence of constipation, status of circumcision, and presence of bruxism related symptoms were recorded. Children with a DVISS score above 8 were considered to have functional voiding disorder. All children underwent a dental examination.

RESULTS

The mean age of children was 73.3 ± 26.9 months. For all children (n = 128), the girl to boy ratio was 40:88. Mean DVISS score was 2.5 ± 3.8 and the mean QOL score was 0.1 ± 0.4 for all children. Eight (6.3%) children were found to have functional voiding disorder based on the DVISS score. There was no statistically significant difference for any lower urinary tract condition between the bruxism group and the control group (Table). Children with bruxism significantly had more tooth wear and masseter muscle hypertrophy (<0.001 and < 0.05).

DISCUSSION

Sleep bruxism has been linked to a number of health issues including dental, systemic and psychosocial problems. Tooth wears, fatigue/pain in chewing muscles, gum recession, facial pain, masseter muscle hypertrophy and temporomandibular joint damage are the main complications of bruxism. Moreover, bruxism has been associated with systemic diseases and sypmtoms like asthma, respiratory illnesses, enuresis nocturna, anxiety, and stress.

CONCLUSIONS

Children with sleep bruxism suffer more from tooth wear, masseter muscle hypertrophy, and regional pain over the jaw. Additionally morning fatigue, relationship issues, and respiratory illnesses are more common in bruxist children. Lower urinary tract conditions are not more frequent in children with sleep bruxism.

Association between the severity of possible sleep bruxism and possible awake bruxism and attrition tooth wear facets in children and adolescents

OBJECTIVE

To evaluate the association between the severity of possible sleep bruxism (PSB) and possible awake bruxism (PAB) and attrition tooth wear facets (ATWF) in children/adolescents.

METHODS

Four hundred-thirty-four children/adolescents enrolled in schools in Lavras, Brazil, participated in this cross-sectional study. Caregivers answered a questionnaire about their childrens' PSB. Children/adolescents answered a questionnaire about the occurrence of PAB.

RESULTS

ATWF among individuals without PSB and PAB was lower than those with moderate/severe PSB (p = 0.038) and moderate/severe PAB (p = 0.003). ATWF in anterior teeth was lower among individuals without PSB compared to those with mild (p = 0.015) and moderate/severe PSB (p = 0.032). ATWF in posterior teeth was lower among individuals without PAB compared to those with mild (p = 0.046) and moderate/severe PAB (p = 0.017).

CONCLUSION

The number of attrition tooth wear facets is proportional to the severity of PSB and PAB.

Sleep bruxism and obstructive sleep apnea: association, causality or spurious finding? A scoping review

Study Objectives

To evaluate the available evidence on the putative relationships between sleep bruxism (SB) and, obstructive sleep apnea (OSA) to assess the extent of research on this topic, and to formulate suggestions for future research.

Methods

A scoping review including studies examining temporal and overall association and prevalence of SB and OSA was performed. Six main databases and gray literature were searched. The studies selection was conducted by three independent reviewers. A narrative synthesis of the results was carried out.

Results

Thirteen studies in adults and eight studies in children were finally included. The median of concomitant conditions prevalence was 39.3% in adults and 26.1% in children. Marked methodological variability was identified among studies in adults and even more when we compared detection methods in children. No significant association between OSA and SB emerged in most studies in adults, while an association may be possible in children.

Conclusions

Based on the current literature, it is not possible to confirm that there is a relationship between SB and OSA in adults. In patients under pediatric care, although this association seems plausible, there is currently insufficient supportive evidence. Standardized validated methodologies for identifying SB should be consistently used in both populations before reaching any conclusion regarding such association. Furthermore, assessment of shared phenotypes between patients with SB and patients with OSA may reveal new insights that will contribute to personalized approaches aiming to optimize the management of such comorbidities.

Validation of Sleep Bruxism Questionnaire Toward the Experience of Jaw Pain and Limitation of Jaw Movement in Saudi Arabian Adolescents

Background: Bruxism in children and adolescents is underreported and needs strong awareness among parents. No study has attempted to validate the sleep bruxism questionnaire, particularly in Saudi adolescents.

Objective: This study aims to validate the sleep bruxism questionnaire on the experience of jaw pain and limitation of jaw movement in Saudi adolescents from 10 to 19 years of age.

Methods: This study was a cross-sectional (survey) study in which we distributed an Arabic translation of a questionnaire on sleep bruxism among 200 parents of patients who attended the dental clinics of the Faculty of Dentistry, King Abdulaziz University Hospital, Jeddah, Saudi Arabia, for treatment. Cronbach's alpha and interclass correlation coefficients were checked for reliability and internal consistency of the items. For validity, convergent validity analysis was accomplished by analyzing temporomandibular disorder and sleep bruxism. The response rate was 85%.

Results: There was a weak association between jaw pain with jaw lock (coefficient value = 0.249) and bruxism (coefficient value = 0.287). Bruxism and jaw lock had a robust correlation (coefficient value = 0.920).

Conclusion: The Arabic version of the sleep bruxism questionnaire is reliable and valid for assessing sleep bruxism toward the experience of jaw pain and limitation of jaw movement in Saudi Arabian adolescent patients.

Sleep Bruxism in Children: Etiology, Diagnosis, and Treatment-A Literature Review

(1) Background: Bruxism, a condition characterized by grinding and involuntary clenching of the teeth, is a risk factor for the development of masticatory dysfunction. It can occur together with sleep disturbances and may be associated with abnormal body movements, breathing difficulties, increased muscle activity, and heart rate disturbances. This disorder is becoming an important dental concern in children. (2) Methods: A literature review was carried out based on a search in PubMed and Google Scholar databases for articles on bruxism in children, published between 2014 and 2021. The etiology, diagnosis, and treatment of bruxism in children were of particular interest in the study. (3) Results: A total of 40 articles were included in the review. The analyzed studies indicated that the prevalence rates of bruxism in children vary widely from 13% to 49%. The etiology of bruxism is complex and incomprehensible, and the main diagnostic criteria for this condition in children are subjective observation, clinical history, and clinical examination. The recommended therapy for sleep bruxism in children is physiotherapy and psychotherapy. (4) Conclusions: Dentists and primary care physicians should correctly diagnose bruxism in children, educate parents, prevent potential consequences for oral health, and identify possible comorbidities. Appropriate clinical guidelines for the treatment and prophylaxis of bruxism in children should also be developed.

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

The role of bruxism in children and adolescents with Down syndrome, the most often diagnosed congenital syndrome, is still unclear. Therefore, this study aims to conduct a narrative review of the literature about bruxism in children and adolescents with Down syndrome to identify the prevalence, risk factors, and possible treatments of this disorder. Although an accurate estimate of its prevalence could not be inferred, it appears that bruxism is more prevalent in Down syndrome individuals rather than in the general pediatric population. No gender difference was observed, but a reduction in its prevalence was described with increasing age (around 12 years). The variability in the diagnostic techniques contributed to the heterogeneity of the literature data. Clinicopathological features of Down syndrome, such as muscle spasticity, oral breathing, and a predisposition to obstructive sleep apnea, may suggest a higher prevalence of bruxism in this patient group. Finally, given the paucity of studies on the management of bruxism in this population, it was not possible to outline a standard protocol for the non-invasive treatment of cases in which an observational approach is not sufficient.

Is There Association Between Stress and Bruxism? A Systematic Review and Meta-Analysis

This systematic review and meta-analysis aimed to investigate a possible association between stress and bruxism in humans. This study was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines under the code CRD42020188862, and the searches were performed on the following databases: PubMed, Scopus, Web of Science, Cochrane, LILACS, OpenGrey, and Google Scholar. This systematic review evaluated observational studies in adult humans with and without stress to verify the association between bruxism and the presence of stress. The risk of bias was evaluated through the Joanna Briggs Institute Critical Appraisal Tools for Analytical Cross-Sectional Studies. In quantitative analysis, the Odds Ratio (OR) and their 95% confidence interval (CI) were calculated through a fixed-effect model. Furthermore, a summary of the overall strength of evidence was presented using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). A total of 1,458 studies were identified, and six were included in this systematic review. Two studies included were classified with a low risk of bias, and the others were classified with a moderate risk of bias. In three articles, a meta-analysis was performed and showed an association between these two factors (OR 2.07 [1.51, 2.83], p < 0.00001, I ² = 45%). Besides that, a low certainty of the evidence was detected among this association. Stressed individuals show a higher chance of presenting bruxism when compared to healthy individuals. Despite the low heterogeneity found in the quantitative analysis among the articles reporting an association between stress and bruxism, further studies with similar methods are necessary to understand this relationship better.

Bruxism: Best Evidence Consensus Statement

PURPOSE

The purpose of this Best Evidence Consensus Statement is to report on the prevalence, potential causes or association, treatment and cure of bruxism.

MATERIALS AND METHODS

A literature search limited to Clinical Trials, Randomized Controlled Trials, Systematic Reviews and Meta Analyses, with the key words bruxism, and prevalence identified 22 references, bruxism and causation 21, bruxism, and treatment 117, and bruxism and cure none.

RESULTS

Prevalence received 5 references which were relevant to the question researched. Causation received 11 relevant references, treatment 34 relevant references and cure none. Eighteen additional references were culled from the reference lists in the aforementioned articles.

CONCLUSIONS

Due to variations in demographics and the dependence on anamnestic data, the true prevalence of bruxism in any specific population is unknown. There is moderate evidence that psychosocial factors such as stress, mood, distress, nervousness, and feeling blue are associated with sleep bruxism (SB) as well as caffeine, alcohol, and smoking. There is no consensus on what symptoms of SB or awake bruxism (AB) should be treated. There is some evidence that occlusal devices and bio feedback therapies can be utilized in SB treatment. There is conflicting evidence in the use of Botulinum toxin A and no compelling evidence for the use of drug therapy to treat SB. There is not an established cure for bruxism. The clinician is best served in using caution in the dental rehabilitation of patients with severe occlusal wear.

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.

[Bruxism: Classification, Diagnostics and Treatment]

Bruxism: Classification, Diagnostics and Treatment Abstract. Bruxism, the grinding or clenching of teeth, is common in the population. Stress, anxiety syndromes and genetic disposition seem to be dominant factors that lead to increased muscle tension. A distinction is made between two circadian manifestations, sleep and wake bruxism. Bruxism is a major risk factor for tooth structure and dentures. The diagnosis is based on a targeted medical history and examination. Sleep bruxism can be demonstrated by electromyography and video recording in the sleep laboratory. The treatment aims to protect the hard tooth substance and preserve the denture using occlusal splints. Relaxation exercises can improve bruxism. Specialized physiotherapy can improve tension, pain and restricted movement. Botulinum toxin treatment reduces the subjective complaints during the period of action.

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.

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.

A polysomnographic study on the relationship between sleep bruxism intensity and sleep quality

Objective: To evaluate the correlation between the Bruxism Episodes Index (BEI) that determines the number of bruxism episodes per hour of sleep and sleep quality as measured by the Pittsburgh Sleep Quality Index (PSQI).Methods: Seventy-seven participants (56 women and 21 men) in which probable sleep bruxism was diagnosed using guidelines of the American Academy of Sleep Medicine underwent video-polysomnography. Sleep quality was measured using PSQI.Results: The analysis showed the lack of a statistically significant correlation between the BEI and PSQI scores (p = 0.55). Analysis also showed that the study group (bruxers) and control group (non-bruxers) did not differ significantly in terms of PSQI scores (p = 0.88).Conclusion: The intensity of bruxism seems not to affect the quality of sleep. However, the topic of the relationship between sleep quality and the occurrence of sleep bruxism requires further research, taking into account co-occurring sleep disorders and sleep architecture.

Behavioral and clinical aspects associated with probable sleep bruxism in early childhood

Abstract Introduction Although many studies are being carried out with sleep bruxism, the literature points to a lack of studies with methodological quality in children. Objective To evaluate the behavioral and clinical aspects associated with probable sleep bruxism in early childhood. Material and method A cross-sectional observational study carried out with 371 children between 4 and 6 years of age. Parents answered a questionnaire with aspects related to their children's sleep behavior. Among the clinical characteristics, the presence of lip sealing, clicking, teeth marks on the jugal mucosa, and the side of the tongue was evaluated. Tooth wear was assessed using the BEWE index criteria. Simple logistic regression models were adjusted for each independent variable, estimating the gross odds ratios with the respective 95% confidence intervals. Variables with P <0.20 in the individual analyzes were adjusted in a multiple logistic regression model, with those with P ≤ 0.05 remaining in the model. Result 42.4% of parents reported that their children gritted their teeth while sleeping. Children who showed wear on their teeth were 1.53 times more likely to grind their teeth. There was no significant association with the other variables analyzed (P > 0.05). Conclusion Behavioral aspects were not associated with probable sleep bruxism. Among the clinical characteristics evaluated, tooth wear showed an association, which may indicate the probable bruxism of sleep in early childhood.

Changes in heart rate related to rhythmic masticatory muscle activities and limb movements in patients with sleep bruxism

Most sleep bruxism (SB) episodes are accompanied by an increase in sympathetic tone and heart rate (HR). To characterise heart rate (HR) changes in relation to rhythmic masticatory muscle activities (RMMAs) in SB patients, polysomnographic recordings were performed on 10 SB patients and 11 normal controls. The duration of movement events, amplitude and duration of HR increases, and time to reach HR peak associated with RMMAs and limb movements (LMs) were determined, and the relationships of the parameters of HR increases with types of movements and RMMAs were analysed. All of the parameters of HR increases associated with three types of movements (RMMAs, RMMAs + LMs and LMs) and masseter activities (phasic, tonic and mixed) were significantly different (two-way ANOVA, P < .001 for all) in both SB patients and controls. The duration of RMMAs/LMs was positively correlated with the parameters (SB patients: R²  = .24-.85, P < .0001; controls: R²  = .23-.68, P < .0001). The amplitude of HR increases was also positively correlated with respiration changes in the SB patients (R²  = .3258, P < .0001) and controls (R²  = .09469, P < .05). The proportions of phasic RMMAs associated with awakenings, microarousals and no cortical arousals were significantly different and so were the proportions of tonic and mixed RMMAs (Friedman's tests, P < .05-.001). The HR increases associated with RMMAs may be intrinsic to the cortical arousal response and autonomic activation, and differences in HR increases associated with different types of movements and RMMAs might be related to the changes in respiration and differences in cortical arousal levels.

Correlation between Sleep Bruxism, Stress, and Depression-A Polysomnographic Study

Background and objectives: Sleep bruxism is a common phenomenon that can affect approximately 13% of adult population. It is estimated that bruxism can be caused by three types of factors: biological, psychological, and exogenous. There are many scientific reports about the coexistence of bruxism, stress, and psychoemotional disorders. The aim of this study is to evaluate the possible correlation between occurrence of sleep bruxism and perceived stress and depressive symptoms. Material and methods: The material of this study consisted of 77 patients of Clinic of Prosthetic Dentistry operating at the Department of Prosthetic Dentistry, Wroclaw Medical University, Poland in which after using guidelines of the American Academy of Sleep Medicine probable sleep bruxism was fund. Patients then underwent video-polysomnography. Exposure to perceived stress was evaluated with Perceived Stress Scale-10 (PSS-10). Occurrence of depressive symptoms was evaluated with Beck’s Depression Inventory (BDI). Results: The analysis showed lack of statistically significant correlation between Bruxism Episodes Index (BEI) and Perceived Stress Scale–10 and Beck’s Depression Inventory scores (p = 0.64, p = 0.65; respectively), also when comparing study group (bruxers) and control group (non-bruxers) (p = 0.88, p = 0.77; respectively). Conclusion: Intensity of sleep bruxism was not statistically significantly correlated with self-reported perceived stress and depression. This issue requires further research.

Treatments of sleep bruxism in children: A systematic review and meta-analysis

Objective: Treatment of sleep bruxism (SB) in children is not well established. The aim of this study was to develop evidence-based recommendations on SB therapy in children between the ages of 2 and 17. Methods: A systematic review and meta-analysis was conducted. Literature searches were performed using MedLine (PubMed), Web of Science, Scopus, and the Cochrane Library (November 30 2017). Results: The search strategy identified 268 potential articles; 10 papers were included in the qualitative synthesis and 3 in the meta-analysis, for a total of 94 patients. Hydroxyzine therapy showed the strongest efficacy on SB (OR 10.63; CI 95%, 1.48 to 76.08). Flurazepam and Melissa officinalis therapies presented lower grades of association with decreased SB symptoms. Conclusions: Data on treatments of SB in children are limited. Future studies with a proper design, conducted on a meaningful number of patients, and based on standardized and developed diagnostic criteria are desperately needed.

Heart rate changes associated with rhythmic masticatory muscle activities and limb movements in sleep bruxers: Preliminary findings

Objective: To investigate the relationship of rhythmic masticatory muscle activities (RMMAs) and limb movements (LMs) with heart rate (HR) acceleration. Methods: The amplitude and duration of HR increases, the time to reach peak HR associated with RMMAs/LMs during sleep, duration of movement events, and their relationships with cortical arousal levels were determined in 9 sleep bruxers and 10 normal controls. Results: A total of 48.15% and 49.44% HR increased before the onset of RMMAs/LMs in the sleep bruxers and controls, respectively. All of the parameters of HR increases were significantly different between the sleep bruxers and the controls (p < 0.05-0.001) and between different cortical arousal levels (p < 0.01), and the duration of RMMAs/LMs was positively correlated with the parameters (Sleep bruxers: r² = 0.18-0.88, p < 0.0001; Controls: r² = 0.16-0.78, p < 0.0001). Discussion: These data suggest the HR increases are associated with the movement events and changes in cortical arousal levels in the sleep bruxers and controls. Abbreviations: LMs: Limb movements; HR: Heart rate; RMMAs: Rhythmic masticatory muscle activities; SB: Sleep bruxism; PSG: Polysomnographic; EEG: Electroencephalographic; PLMS: Periodic leg movements; SSRIs: Selective serotonin reuptake inhibitors; ECG: Electrocardiographic; EOG: Electrooculographic; EMG: Electromyographic; SD: Standard deviation; Fig: Figure; SEM: Standard error of mean; N1: Non-rapid eye movement sleep stage 1; N2: Non-rapid eye movement sleep stage 2; N3: Non-rapid eye movement sleep stage 3; REM: Rapid eye movement ; NA: No arousal; mAR: Microarousal; AW: Awakening.

Prevalence and associated factors to sleep bruxism in adolescents from Teresina, Piauí

INTRODUCTION

Sleep bruxism (SB) is defined as a repetitive jaw muscle activity whose epidemiology in adolescents has been little studied. This cross-sectional study aimed to determine the prevalence of sleep bruxism and associated factors in adolescents.

METHODOLOGY

The sample consisted of 594 students aged 11 to 14 years old from Teresina, Piauí, Brazil. Self-administered questionnaire was answered by parents/caregivers and dental clinical examination was performed. Pearson's chi-squared test was used to assess the association between SB and independent variables. Poisson regression analysis with robust variance was applied, with results expressed in prevalence ratio (PR).

RESULTS

The prevalence of SB in adolescents was 22.2%. Multivariate analysis showed a higher prevalence of SB in male gender adolescents (PR = 1.41; 95%CI 1.04 - 1.89), presenting snoring (PR = 1.39; 95%CI 1.02 - 1.89) and difficulty falling asleep (PR = 1.92; 95%CI 1.38 - 2.66).

CONCLUSION

SB is a frequent condition in adolescents, and the factors associated with its prevalence were: male sex, snoring and difficulty falling asleep.

The phenotype, psychotype and genotype of bruxism

Bruxism is a jaw muscle activity that involves physio-pathological, psycho-social, hereditary and genetic factors. The purpose of this study was to determine the associations between self-reported bruxism, anxiety, and neuroticism personality trait with the rs6313 polymorphism in the gene HTR2A. A sample of 171 subjects of both sexes (14-53 years of age) was included. The control group (group 1, n=60) exhibited no signs or symptoms of bruxism. The case group had signs and symptoms of bruxism (n=112) and was subdivided into group 2, bruxism during sleep (n=22); group 3, awake bruxism (n=44); and group 4 combined bruxism (n=46). As diagnostic tools, the Self-Reported Bruxism Questionnaire (SBQ), the Beck Anxiety Inventory (BAI) and the Eysenck Personality Questionnaire Revised-Abbreviated (EPQR-A) were used. HTR2A (rs6313) SNPs were determined by qPCR for all the participants. The packages SPSS, maxLik and EPI-INFO were used for data analysis. The combined bruxism group reported higher scores in bruxism symptoms, mean = 32.21; anxiety symptoms, mean = 14.80; and neuroticism, mean = 3.26. Combined bruxism was associated with a higher degree of neuroticism (OR=15.0; CI 1.52-148.32) and anxiety in grade 3-moderate (OR=3.56; CI 1.27-10.03), and grade 4-severe (OR=8.40; CI 1.45-48.61), as determined using EPISODE computer software. Genotypic homogeneity analysis revealed no significant differences in allele frequency (P=0.612) among the four groups. The population was in Hardy-Weinberg equilibrium (maxLik package). In conclusion, the three instruments confirm traits of bruxism, anxiety and neuroticism in individuals with bruxism. These data were ratified when the sample was divided by genotypic homogeneity. On the other hand, there was no significant difference between the groups in the SNPs rs6313 from the HTR2A gene.

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.

Agreement between two different approaches to assess parent-reported sleep bruxism in children

INTRODUCTION

Parents' report is the most used method for the study of sleep bruxism (SB) in children, especially in research with large samples. However, there is no consensus about the questions used to assess SB, what may difficult the comparisons between studies.

OBJECTIVE

The aim of this research was to evaluate the agreement between two different approaches to assess possible sleep bruxism (PSB) in children using parents' report.

METHODS

This cross-sectional study was conducted with 201 parents/caregivers. Prior to the questionnaire completion, all participants received a standard explanation of SB concept. Subsequently, the parents/caregivers answered a general question (GQ) and a frequency-time question (FTQ) about SB, and the answers were compared.

RESULTS

The majority of the participants were the children's mothers (73%) and the childrens mean age was 7.5 years (SD: 2.25). PSB frequency in children did not differ statistically through the two questions [GQ: 30.7% (CI95%: 24.2 - 37.1) and FTQ: 26.6% (CI95%: 20.4 - 32.8)], and an almost perfect agreement was observed between the answers (kp=0.812). Nevertheless, the FTQ showed a more coherent relation with the factors already recognized as associated with childhood bruxism than GQ.

CONCLUSIONS

Different approaches result in similar PSB frequency, however, they show different ability to identify PSB associated factors and suggest the need of questions including frequency and time in further studies.

Annual review of selected scientific literature: Report of the committee on scientific investigation of the American Academy of Restorative Dentistry

STATEMENT OF PROBLEM

It is clear the contemporary dentist is confronted with a blizzard of information regarding materials and techniques from journal articles, advertisements, newsletters, the internet, and continuing education events. While some of that information is sound and helpful, much of it is misleading at best.

PURPOSE

This review identifies and discusses the most important scientific findings regarding outcomes of dental treatment to assist the practitioner in making evidence-based choices. This review was conducted to assist the busy dentist in keeping abreast of the latest scientific information regarding the clinical practice of dentistry.

MATERIAL AND METHODS

Each of the authors, who are considered experts in their disciplines, was asked to peruse the scientific literature published in 2015 in their discipline and review the articles for important information that may have an impact on treatment decisions. Comments on experimental methodology, statistical evaluation, and overall validity of the conclusions are included in many of the reviews.

RESULTS

The reviews are not meant to stand alone but are intended to inform the interested reader about what has been discovered in the past year. The readers are then invited to go to the source if they wish more detail.

CONCLUSIONS

Analysis of the scientific literature published in 2015 is divided into 7 sections, dental materials, periodontics, prosthodontics, occlusion and temporomandibular disorders, sleep-disordered breathing, cariology, and implant dentistry.

Sleep bruxism in adolescents: a systematic literature review of related risk factors

BACKGROUND

Multiple risk factors have been associated to sleep bruxism (SB). Nevertheless, there are still many unsolved issues concerning the etiology of SB that have consequences on the clinical management strategies.

OBJECTIVE

Systematically review the literature to assess the relationship between risk factors and SB symptoms in adolescents (age 11-19 years).

SEARCH METHODS AND SELECTION CRITERIA

PubMed, Embase, Scopus, Cochrane Oral Health Group's Trial Register and Cochrane Register of Controlled Trials, Web of Science, LILACs, and SciELO were searched to identify all peer-reviewed articles potentially relevant to the review.

DATA COLLECTION AND ANALYSIS

The risk of bias was assessed according to the guidelines from the Cochrane handbook for systematic reviews of interventions, with reporting in agreement to the preferred reporting items for systematic reviews and meta-analyses guidelines.

RESULTS

Four out of the 4546 initially identified articles were selected. According to the grading of recommendations assessment, development and evaluation assessment (GRADE), the magnitude of agreement was almost perfect for all checklist items. Sleep disturbances, and snoring in particular, headache, jaw muscle fatigue, and tooth wear seem to be associated to SB in adolescents from 11 to 19 years old.

LIMITATIONS

Despite the large interest of the scientific community in the field of oral parafunctions, only four articles met the eligibility criteria. Furthermore only associations and not definite cause-effect relationships were highlighted in the selected articles.

CONCLUSIONS

Sleep disturbances presented the strongest association with SB while very few occlusal features had a moderate association. As a common sense the investigation of sleep respiratory disorders could be of great help in the management of SB in adolescents.