Environmental factors, sleep duration, and sleep bruxism in Brazilian schoolchildren: a case-control study

Daily screen time, sleep pattern, and probable sleep bruxism in children: A cross-sectional study

OBJECTIVE

This study aimed to evaluate the prevalence of probable sleep bruxism (SB) in children aged 7-8 years and its association with sleep pattern and the time spent using devices with a screen.

MATERIAL AND METHODS

A cross-sectional study was conducted with children from Pelotas, Brazil (n = 556). Parents/caregivers were interviewed and provided demographic/socioeconomic information, children's daily screen time, nighttime tooth grinding or clenching, sleep duration and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-sleep domain). Probable SB was determined based on a positive clinical inspection with/without a positive parental/caregiver's reports of tooth clenching or grinding. Hierarchical Poisson regression was performed.

RESULTS

The prevalence of probable SB was 15.83% (n = 88). There was no difference in the probable SB prevalence according to the daily screen time (p = 0.744), and low family socioeconomic status was associated with higher SB prevalence (Prevalence Ratio [PR] = 1.95; 95% Confidence Interval [95% CI]: 1.21-3.17; p = 0.006). Higher scores in the sleep domain of the BRIAN-K scale were associated with probable SB [PR = 1.07; 95% CI: 1.01-1.30; p = 0.013].

CONCLUSIONS

Difficulties in maintaining sleep and low family socioeconomic status were associated with probable SB in schoolchildren, while screen time spent using devices with a screen was not associated.

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.

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.

A world panorama of bruxism in children and adolescents with emphasis on associated sleep features: A bibliometric analysis

BACKGROUND AND OBJECTIVES

To present a world panorama of the published papers on bruxism in children and adolescents, emphasising the characteristics of studies related to the sleep features of these patients.

METHODS

Literature searches were conducted in six databases without language or date restrictions. Data on the titles, types of study, main subjects, countries of origin, keywords, years of publication, authors and their network collaborations, journals and sleep studies were extracted and analysed using VantagePoint™ software.

RESULTS

A total of 725 studies met the eligibility criteria. Most included only children (75.31%), with observational design (66.34%), and risk or aetiology (53.93%) as the main subject. Brazil (18.06%) and Brazilian authors (54.84%) had the largest number of studies, with a low amount of network collaboration. The Journal of Oral Rehabilitation published most of the studies (6.2%); publications in this field have grown considerably from 2000 to 2020. Of the studies, 123 (16.96%) included sleep studies; night sweating, restless sleep, sleep talking, mouth breathing, snoring, obstructive sleep apnoea syndrome, sleep-disordered breathing, nightmares, poor sleep quality and duration, and daytime naps were significantly associated with bruxism in most.

CONCLUSION

Studies on bruxism in children and adolescents have increased in the past 20 years, with most being observational, and risk or aetiology as the main subject. Brazil and the Journal of Oral Rehabilitation have published most in the field. Sleep studies have shown some features associated with bruxism, such as night sweating, restless sleep, somniloquy, snoring, breathing problems, nightmares, daytime naps, and poor sleep quality and duration.

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.

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.

[Obstructive Sleep disordered breathing, sleep bruxism and periodontal diseases]

Sleep disordered breathing (SDB) may be associated with sleep bruxism and periodontal diseases. Through a review of the current literature, this article aims to describe the characteristics of sleep bruxism and its relationship with SDB as well as the current evidence supporting an association between periodontal diseases and SDB. Sleep bruxism is characterized by muscle clenching and tooth grinding during sleep, typically during N2 sleep stage and in association with micro-arousals. The probability of observing sleep bruxism is almost 4 times higher in the presence of SDB, with a close temporal relationship between the episode of upper airway obstruction or oxygen desaturation and the episode of bruxism, which most often occurs in the 0-10 seconds following the obstruction. These findings support the hypothesis that sleep bruxism is triggered by SDB and may have a "protective" role being a muscular activity that helps restore the permeability of the upper airways. On the other hand, SDB have been linked to periodontal diseases. Periodontal diseases are inflammatory and dysbiotic disorders that can have a negative impact on oral health (leading to the destruction of the periodontium and tooth loss) and on general health. Recently, it has been observed that SDB patients have a 1.6 to 4-fold higher risk of having or developing severe periodontitis, suggesting that SDB may be a new risk factor for periodontal diseases. Dentists, who are part of the team of sleep medicine specialists, have a key role in the detection, prevention and treatment of SDB and their relationship with sleep bruxism and periodontal diseases.

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.

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.

Salivary cortisol levels and biological rhythm in schoolchildren with sleep bruxism

OBJECTIVE

Salivary cortisol levels and biological rhythms could be hypothesized as part of the multifactorial framework that explains bruxism etiology. The objective of this study was to examine salivary cortisol levels and biological rhythms in schoolchildren with sleep bruxism (SB).

METHODS

This is a cross-sectional study with a school-based sample. The Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K) was used to evaluate biological rhythms. Salivary samples were collected by the spitting method. The salivary cortisol level was measured by electrochemiluminescence. The criteria proposed by the American Academy of Sleep Medicine (AASM) were used to evaluate SB.

RESULTS

The SB prevalence was 16%. The SB presence was associated with belonging to families of lower economic status (p = 0.003). In addition, children with SB showed greater difficulty in maintaining biological rhythm (p = 0.002) and had higher levels of salivary cortisol (p = 0.034) compared with children without SB.

CONCLUSIONS

Higher levels of cortisol and disruption of biological rhythm was associated with SB in schoolchildren.

Study of Associated Factors With Probable Sleep Bruxism Among Adolescents

STUDY OBJECTIVES

To evaluate the prevalence of probable sleep bruxism (SB) and its association with sleep features, orthodontic fixed appliance wearing, and extraoral and intraoral clinical signs and symptoms in a population of adolescents.

METHODS

Two hundred thirty-nine 12-year-old adolescents enrolled in private and public schools in Brumadinho, southeast Brazil, and their parents were invited to participate. They answered a questionnaire containing information regarding adolescents' sleep features and history of SB. Extraoral and intraoral examination was performed to identify some clinical signs (ie, absence of lip competence, presence of mouth breathing, clicks in the temporomandibular joint [TMJ], tooth wear) and symptoms (ie, pain in the masseter muscle upon palpation), and ongoing orthodontic treatment with fixed appliances. Parental report and clinical examination were used to determine probable SB. Descriptive statistics and logistic regression were performed to identify association of probable SB with independent variables.

RESULTS

Of 239 adolescents initially selected, 231 (96.6%) participated in the study. Prevalence of probable SB was 16.9%. Adolescents who snored during sleep (odds ratio [OR] = 3.14; 95% confidence interval [CI] = 1.47-6.70), adolescents who did not have clicks in the TMJ (OR = 3.37; 95% CI = 1.11-10.15), and those who wore orthodontic appliances (OR = 2.72; 95% CI = 1.04-7.14) were more likely to be in the group with probable SB.

CONCLUSIONS

Snoring, absence of clicks in the TMJ, and fixed appliance wearing were associated with probable SB among adolescents. This study adds to the ongoing research on SB in adolescents and its associated factors.

COMMENTARY

A commentary on this article appears in this issue on page 1281.

Association of possible sleep bruxism in children with different chronotype profiles and sleep characteristics

Sleep bruxism (SB) in children has been associated with several sleep characteristics, which may alter their sleep pattern. This change affects the internal biological clock and consequently the chronotype profile. The aim of this study was to evaluate the existence of an association between possible SB in children with specific chronotype profiles and sleep characteristics. The study included 207 parents/guardians of children aged between 3 and 12 years who were waiting for their children's dental treatment at the Pediatric Dentistry Clinic of the Federal University of Rio de Janeiro, Brazil. A questionnaire on the socio-demographic characteristics of parents and children as well as on the features of the children's sleep was applied. In addition, the CIRENS scale (Circadian Energy Scale) was completed by the parents to identify the children's chronotype. A chi-squared test was used to determine the association between possible SB, the chronotype, and sleep characteristics. A multiple logistic regression model was implemented to observe the influence of chronotype, age, and other independent variables on the possible SB. The logistic regression model demonstrated that nocturnal agitation (p = 0.009; OR = 3.42) and nightmares (p = 0.045; OR = 3.24) were associated with possible SB in children. Although no significant association (p = 0 .089) between the chronotype profile and possible SB was observed in the 3 to 5 years age group, a proportional difference was observed between the chronotype categories in this age group-12.5% of children with SB had a morning type, while 26.4% had an intermediate type and 47.8% an evening type compared to those without possible SB. Nocturnal agitation and nightmares were associated with possible SB. In addition, young children with an evening chronotype had a tendency toward possible SB.

Bruxism and quality of life in schoolchildren aged 11 to 14

The purpose of this study is to assess quality of life in relation to oral health in schoolchildren with sleep bruxism. It is a transversal observational study of 594 schoolchildren (aged 11-14) of the municipality of Teresina, in the Brazilian State of Piauí. Quality of life was assessed through the Brazilian version of the CPQ11-14 questionnaire, in the short form (ISF:16).The presence of sleep bruxism was assessed from reports by the people legally responsible for the children. The results were analyzed by: calculation of an Odds Ratio (OR) estimate of chances; descriptive analysis; a Pearson Chi-squared test; a Likelihood Ratio test; and multiple logistic regression. A statistically significant association was found between sleep bruxism and the total score on the CPQ11-14 (p < 0.001), and with the scores in two domains: functional limitation (p = 0.033);and social wellbeing (p= 0.020).No association was found between quality of life and the variables gender or age. The final regression model showed that the presence of sleep bruxism increases the chance of having a greater effect on quality of life (ORadj=1.82 (1.54 - 2.10), IC = 95%).It is concluded that sleep bruxism had a negative impact on the quality of life of the schoolchildren, principally in the two domains functional limitations and changes in social wellbeing.

Diagnostic accuracy of the use of parental-reported sleep bruxism in a polysomnographic study in children

BACKGROUND

Polysomnography (PSG) is the gold standard for sleep bruxism (SB) diagnosis. PSG/SB children's criteria are not available; thus, parental-report SB is widely used.

AIM

Assessing the diagnostic accuracy of parental report of sleep tooth grinding (STG) with a PSG/SB diagnosis in children, adopting adult criteria.

DESIGN

Thirty-seven children from clinics of Universidad CES were included. Parents filled the Children's Sleep Habits Questionnaire (CSHQ) assessing the single-observation report - CSHQ - of STG with a No/Yes answer and five ordinal answers. A 5-day diary reporting the presence/absence of STG (multiple-observation report) was also completed. Each child underwent a single-night PSG study. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, likelihood ratios, Spearman correlation coefficient, and Cohen's kappa coefficient were used to analyze data.

RESULTS

Single observation, using No/Yes answer, showed acceptable specificity and NPV, while low PPV and sensitivity. Accuracy and likelihood ratios were low. When using the five ordinal answers, weak correlation and fair agreement (r = 0.34 and κ = 0.40) with PSG/SB adult criteria were found. Multiple-observation evaluation of STG presented moderate correlation and agreement (r = 0.50 and κ = 0.48).

CONCLUSIONS

Although multiple-observation report achieved better agreement than single-observation report, our results failed supporting the validity of report strategies for the diagnosis of SB in children, as an equivalent of PSG/SB adult criteria.

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.

Sleep Bruxism, Awake Bruxism and Sleep Quality among Brazilian Dental Students: A Cross-Sectional Study

The aim of the study was to evaluate the association of sleep bruxism, awake bruxism and sleep quality among dental students of the Federal University of Minas Gerais, Belo Horizonte, Brazil. A cross-sectional study was performed including 183 Brazilian dental students aged from 17 to 46 years old. The complete course curriculum consists of 9 semesters. Students enrolled in the first semester, the middle semester and the final semester of the course participated in the survey. The PSQI-BR (the Brazilian version of the Pittsburgh Sleep Questionnaire Index) was used for data collection. The PSQI-BR was distributed during lecture classes. Sleep bruxism and awake bruxism diagnosis was based on self-reported data. Descriptive analysis, Kruskal-Wallis, Mann-Whitney and Poisson regression with robust estimator were the statistical tests used. Sleep bruxism prevalence was 21.5% and awake bruxism prevalence was 36.5%. Sleep duration components were associated with sleep bruxism (PR=1.540; 95% CI: 1.00-2.37) and awake bruxism (PR=1.344; 95% CI: 1,008-1,790). There was an association between awake bruxism and habitual sleep efficiency component (PR=1.323; 95% CI: 1.03-1.70). Sleep disturbance component and awake bruxism were associated (PR=1.533; 95% CI: 1.03-2.27). Poor sleep quality was an important factor among dental students, who reported sleep bruxism as well as among those who presented awake bruxism