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

Probable sleep and awake bruxism in adolescents: A path analysis

BACKGROUND

Bruxism has a multifactorial etiology, including the influence of sleep characteristics and chronotypes.

AIM

To identify the pathways that influence the occurrence of probable sleep bruxism (PSB) and probable awake bruxism (PAB) in adolescents.

DESIGN

A total of 403 adolescents, aged 12-19 years, participated in the study. Parents/caregivers filled out a questionnaire about sociodemographic issues and the adolescent's health conditions, and the adolescents about sleep characteristics, occurrence of bruxism (based on previous study and the International Consensus of Bruxism), and chronotype (Circadian Energy Scale). Clinical examinations were performed. Statistical analysis included descriptive analysis and path analysis.

RESULTS

PSB and PAB are related to each other, with moderate and positive correlation (β = .390). Poor sleep quality and higher household income had a direct effect on both PSB (β = -.138; β = .123, respectively) and PAB (β = -.155; β = .116, respectively). Chronotype had a direct effect on PSB, in such a way that adolescents with a morningness chronotype tend to have PSB (β = -.102). Adolescents that drool on the pillow (β = .184) and/or have agitated sleep (β = .104) tend to have PSB.

CONCLUSION

Poor sleep quality, household income, morningness chronotype profile, drooling on the pillow, and agitated sleep influence the paths taken by PSB. PAB was influenced by the quality of sleep and family income.

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).

The effect of sleep disorders, school jet lag, and anxiety in students 8-10 years of age on traumatic dental injuries

BACKGROUND/AIM

Traumatic dental injuries (TDI) constitute a public health problem. The aim of the present study was to investigate whether sleep disorders, school jet lag, and anxiety are associated with TDI in schoolchildren 8-10 years of age.

METHODS

An analytical, cross-sectional study was conducted with 739 pairs of parents/guardians and children enrolled in public and private schools. The parents/guardians answered a socioeconomic questionnaire, the Sleep Disturbance Scale for Children, Circadian Energy Scale, and Revised Children's Manifest Anxiety Scale. Four examiners underwent calibration exercises for the diagnosis of TDI (K > 0.80) using the criteria proposed by Andreasen (2007). A directed acyclic graph was used for the formulation of the theoretical model and statistical adjustments. Unadjusted and adjusted robust binary logistic regression analyses were performed (α = 5%).

RESULTS

The prevalence of TDI was 16.2%. The following variables remained associated with the outcome in the final model: family income less than or equal to the minimum monthly wage (OR = 1.77; 95% CI: 1.09-2.88; p = .02), child's height >137.6 cm (OR = 1.68; 95% CI: 1.06-2.64; p = .02), the occurrence of school jet lag (OR = 2.12; 95% CI: 1.27-3.53; p = .004), anxiety (OR = 1.77; 95% CI: 1.04-3.00; p = .04) and sleep disorders (OR = 1.63; 95% CI: 1.38-1.93; p = .05).

CONCLUSION

Children from families with a lower income, taller children, those with school jet lag, those with anxiety and those with sleep disorders had a greater occurrence of TDI.

Clinical and instrumental features in 82 patients with insufficient sleep syndrome

Insufficient sleep syndrome possibly represents the worldwide leading cause of daytime sleepiness, but remains poorly recognised and studied. The aim of this case series is to comprehensively describe a cohort of patients with insufficient sleep syndrome. Eighty-two patients were studied concerning demographic and socio-economic features, medical, psychiatric and sleep comorbidities, substance use, sleep symptoms, actigraphy, video-polysomnography, multiple sleep latency tests and treatment. The typical patient with insufficient sleep syndrome is a middle-aged adult (with no difference of gender), employed, who has a family, often carrying psychiatric and neurological comorbidities, in particular headache, anxiety and depression. Other sleep disorders, especially mild sleep apnea and bruxism, were common as well. Actigraphy was a valuable tool in the characterisation of insufficient sleep syndrome, showing a sleep restriction during weekdays, associated with a recovery rebound of night sleep during weekends and a high amount of daytime sleep. An over- or underestimation of sleeping was common, concerning both the duration of night sleep and daytime napping. The average daily sleep considering both daytime and night-time, weekdays and weekends corresponds to the recommended minimal normal duration, meaning that the burden of insufficient sleep syndrome could mainly depend on sleep fragmentation and low quality. Sleep efficiency was elevated both in actigraphy and video-polysomnography. Multiple sleep latency tests evidenced a tendency toward sleep-onset rapid eye movement periods. Our study offers a comprehensive characterisation of patients with insufficient sleep syndrome, and clarifies their sleeping pattern, opening avenues for management and treatment of the disorder. Current options seem not adapted, and in our opinion a cognitive-behavioural psychotherapy protocol should be developed.

The association between chronotype profile and temporomandibular disorders among college students

BACKGROUND

Temporomandibular joint disorders (TMDs) are common in young adults, and the link between chronotype profile and TMDs is unclear.

OBJECTIVE

This study examined TMD prevalence and chronotype distribution and explored the relationship between chronotype and TMDs in young adults.

MATERIALS AND METHODS

A total of 663 students from Sichuan University completed questionnaires. Chronotype profiles were assessed using the Morningness-Eveningness Questionnaire, and TMDs were screened using the Fonseca Memory Index. To validate the findings, 68 TMD patients and 136 controls were enrolled.

RESULTS

The prevalence of TMDs was 69.7%, with significant differences among chronotype profiles. The intermediate profile was the most common chronotype. Eveningness profile was associated with higher TMDs prevalence and severity. Muscle pain and side movement difficulty scores were higher in eveningness and intermediate profiles. Female gender (OR 2.345; 95% CI 1.668-3.297) was a TMD risk factor, while morningness profile (OR 0.537; 95% CI 0.297-0.970) was protective. Validation with TMD patients and controls supported these findings, showing higher eveningness profile prevalence in the TMD groups.

CONCLUSIONS

TMDs have a high prevalence in college students, chronotype profiles shown to be associated with TMDs. Morningness is the protection factor in TMDs and PT, eveningness is a risk factor for IT.

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.

Obstructive Sleep Apnea in Developmental Age: 22-Item Pediatric Sleep Questionnaire for an Observational Descriptive Investigation

The aim of this paper is to perform an observational descriptive study of the Obstructive Sleep Apnea Syndrome (OSAS) in a population of children by evaluating the prevalence and role of sex and age variables. The 22-item Pediatric Sleep Questionnaire (PSQ) was administered to parents of children aged 3 to 12 years. The questionnaire is a very simple tool since it allows for the indication of patients with possible OSAS diagnosis through a cut-off of 0.33. The anonymous diagnostic questionnaire, available in digital format, was administered to the population under study by a link or QR code. Only the questionnaires completed in all their parts were recorded and analyzed. Eight hundred and thirty-two questionnaires were collected. One hundred and fifty-four subjects obtained a PSQ score > 0.33 and the prevalence of OSAS was 18.51%. The Chi-square test showed a statistically significant association between the PSQ score > 0.33 and male sex. The higher prevalence of subjects with a value of PSQ > 0.33 (n = 277) are aged 3-4-5 years, followed by the 6-7-8 range in the group with PSQ score > 0.33, p < 0.05. The prevalence of OSAS was 18.51% in children aged 3 to 12 years. The variables male biological sex and the age group 3-8 year were statistically significant for subjects with OSAS diagnosis. This study underlines the use of the 22-item Pediatric Sleep Questionnaire as a first screening tool to identify children at risk of OSAS.

Chronotype Profile, Stress, Depression Level, and Temporomandibular Symptoms in Students with Type D Personality

Background: Despite a growing interest in the types of human circadian activity, different chronotypes and personality-related issues have been rarely studied. It has already been emphasized that ‘stress personality’ is considered a risk factor for certain psychosomatic diseases and may be a temporomandibular disorders (TMDs) predictor. Therefore, an attempt has been made to analyze the chronotypes, stress levels, stress factors, and the occurrence of depression and TMDs in students with type D personalities. People with this personality trait tend to experience negative emotions more—depression, anxiety, anger, or hostility—yet may have a negative image of themselves and report somatic complaints. Aim: The aim of this study was to analyze the importance of the chronotype profile for the level of stress perceived, as well as for the occurrence of depression and TMDs in people with type D personalities. Material and Methods: The study has been conducted on a group of 220 physical therapy students. The study group G1 consisted of 110 participants with type D personalities, the control group G2 consisted of the same number of participants without the stress personality. All participants have been analyzed for the chronotype (MEQ), stress perception (PSS10), the occurrence of depression (Beck scale-BDI), the occurrence of TMDs symptoms and have completed the stress factor assessment questionnaire during the study, followed by DS14 questionnaire—a tool for assessing the prevalence of type D personality. Results: In students with type D personalities (G1), the definitely evening and evening chronotypes have been significantly more predominant than in the control group (G2). A significantly higher number of stressors and TMDs symptoms have been observed in the respondents from the G1 group than in the control group (<0.001). Univariate logistic regression analysis showed that type D personality was strongly associated with a more frequent occurrence of all TMD symptoms. Additionally, a significant influence of the evening chronotype on the occurrence of type D personality was observed. Among the potential confounding variables, female gender and a mild and moderate degree of depression have an impact on the occurrence of type D personality (p < 0.05). In the multivariate model, adjusted with the above-mentioned factors, an increased risk of the type D personality trait was found. Conclusion: The evening chronotype and type D personality may imply greater feelings of stress, greater depression, and more frequent symptoms of TMDs in young adults.

Circadian preference and its relationship with possible sleep and awake bruxism in adults assisted by the public health system

Modern lifestyle and social demands induce changes in sleep routines that may not meet individual circadian preferences (chronotype). Such changes may be associated with the development of unhealthy lifestyles and the emergence of diseases relevant to public health services, such as obesity, hypertension, and diabetes mellitus, as well as sleep bruxism (SB) and awake bruxism (AB). The present study aimed to assess the relationship between the evening, morning or intermediate chronotypes with the report of possible SB and AB in adult individuals assisted by the Family Health Strategy (FHS). The selection of participants was performed through probabilistic cluster analysis. The sample size (n = 384) was calculated to include a representative sample of the 52,628 adults registered in the FHS of a countryside city located in the Southeast Region of Brazil. The Morningness-Eveningness Questionnaire (MEQ) was used to determine the chronotype, and Questionnaire-Based Self-Reported Bruxism was used for identifying possible SB and AB. The following clinical and social-behavioral variables were also evaluated: age, sex, BMI, income, physical activity, schooling, alcohol consumption and smoking, chronic diseases and depression. Two logistic regression models were used: one for SB and one for AB. Possible SB was associated with female sex, lack of physical activity and income above 2 minimum wages. Regarding chronotype, a 19% reduction in the chance of possible SB was observed in morning individuals compared to evening individuals (p = .017). Possible AB was associated with younger individuals, smoking and depression. In conclusion, compared with the evening circadian preference, the morning circadian preference was associated with greater protection against possible SB in an adult population assisted by the FHS.

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.

Influence of the practice of sports, sleep disorders, and habits on probable sleep bruxism in children with mixed dentition

OBJECTIVE

Investigate the association between sleep disorders and probable sleep bruxism (SB) in children eight to ten years of age.

METHODS

A cross-sectional study was conducted with 739 schoolchildren in Brazil. Parents/guardians answered a sociodemographic questionnaire, the sleep disturbance scale for children, and the Circadian Energy Scale. Parafunctional habits were evaluated using the Nordic Orofacial Test-Screening. Multivariate logistic regression was performed (α = 5%), and a directed acyclic graph was used in the statistical model.

RESULTS

The prevalence of probable SB was 9.1% and 58.6% of the children had sleep disorders. In the final model, having unmarried parents/guardians (OR = 1.98; 95% CI: 1.07-3.65), exhibiting parafunctional habits (OR = 2.02; CI: 1.01-4.06), not practicing sports (OR = 1.92; CI: 1.04-3.54), sleep-wake transition disorders (SWTD) (OR = 2.01; 95%CI: 1.12-3.62), and excessive daytime sleepiness (EDS) (OR = 2.17; 95%CI: 1.11-4.29) were significant associated with probable SB.

CONCLUSION

The occurrence of probable sleep bruxism was influenced by the marital status of the parents/guardians, parafunctional habits, the non-practice of sports, and sleep disturbance (SWTD and EDS). This research contributes to the planning of public policies that include educational regimens at school to prevent sleep disorders and favor the reduction in sleep bruxism prevalence.

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.

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

OBJECTIVES

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

METHODOLOGY

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

RESULTS

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

CONCLUSION

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

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.

Chronodentistry: the role & potential of molecular clocks in oral medicine

Molecular clocks help organisms to adapt important physiological functions to periodically changing conditions in the environment. These include the adaption of the 24 h sleep-wake rhythm to changes of day and night. The circadian clock is known to act as a key regulator in processes of health and disease in different organs. The knowledge on the circadian clock led to the development of chronopharmacology and chronotherapy. These fields aim to investigate how efficiency of medication and therapies can be improved based on circadian clock mechanisms. In this review we aim to highlight the role of the circadian clock in oral tissues and its potential in the different fields of dentistry including oral and maxillofacial surgery, restorative dentistry, endodontics, periodontics and orthodontics to trigger the evolving field of chronodentistry.

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.