Prevalence of probable sleep bruxism and associated factors in Brazilian schoolchildren

Sleep bruxism and sleep respiratory disorders in children and adolescents: A systematic review

OBJECTIVE

Sleep bruxism (SB) is a repetitive rhythmic and nonrhythmic activity. It can be a comorbid condition for other disorders, such as sleep breathing disorders (SBD). However, a clear causal link between these factors is yet to be established. Moreover, this relationship is even more unknown in children. Thus, this systematic review aimed to determine the relationship between SB and SBD in children and teenagers and consolidate the current knowledge about the possible association between both phenomena at the pediatric age.

MATERIALS AND METHODS

Advanced searches were performed in five electronic databases with the last search updated on February 1, 2023. The methodological quality of the selected studies was analyzed using the quality assessment tool for experimental bruxism studies.

RESULTS

Twenty-nine of 6378 articles were selected for detailed analyses. Most articles found a comorbid relationship between SB and SBD, though no study analyzed a temporary relationship. Due to the heterogeneity of the studies, a meta-analysis could not be performed.

CONCLUSION

Despite the limitations of this systematic review, it can be concluded that there is an association between SB and SBD in children. However, the level of evidence is low.

Oral issues and childhood stress in eight-to-ten-year-old schoolchildren: a case-control study

OBJECTIVE

The aim of the present study was to investigate whether oral problems, harmful oral habits, and sociodemographic factors are associated with the occurrence of stress in schoolchildren.

MATERIALS AND METHODS

A case-control study nested within a cross-sectional study was conducted with a sample of 375 schoolchildren eight to ten years of age in the city of Diamantina, Brazil. The case group (with childhood stress) and control group (without childhood stress) were matched for age and sex at a 1:4 ratio (75 cases to 300 controls). Data collection involved the self-administration of a questionnaire by parents/caregivers addressing sociodemographic characteristics and the child's history of harmful oral habits. The children answered the Child Stress Scale (CSS) and underwent a clinical oral examination to determine the presence/absence of dental caries, malocclusion, and traumatic dental injuries. Data analysis involved the calculation of frequencies, the chi-square test, and conditional logistic regression (95% CI; p ≤ 0.05).

RESULTS

The final adjusted conditional logistic regression model showed that dental caries (OR = 1.78, 95% CI: 1.01 - 3.14, p = 0.044) and biting objects (OR = 1.81, 95% CI: 1.02 - 3.22, p = 0.041) remained associated with stress in the schoolchildren analysed.

CONCLUSION

The present results showed that children with dental caries and the habit of biting objects were more likely to have childhood stress.

CLINICAL RELEVANCE

The study allows paediatric dentists to expand their knowledge with regards to the influence of oral problems and harmful habits on the occurrence of childhood stress and serves as a guide for decision-making related to oral problems in schoolchildren.

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).

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.

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.

The Influence of Steroid Hormones on Tooth Wear in Children and in Adolescents

(1) Background: From a young age, boys are more often affected by tooth wear than girls. This suggests an influence of the male sex hormone (testosterone) on the aetiology of tooth wear. The aim of the present study was to investigate the incidence of tooth wear in relation to steroid hormone levels in children. (2) Methods: 1022 test persons aged between 10 and 18 (491 male, 531 female) from the LIFE Child study underwent medical and dental examination. Tooth wear was measured through clinical inspection. Blood samples were taken to determine hormone levels (testosterone, SHBG). The level of free testosterone was calculated from the ratio of testosterone to SHBG. Using multivariable methods, the incidence of tooth wear was analyzed as a function of hormone levels, while controlling for confounders such as age, sex, social status, and orthodontic treatment. (3) Results: The incidence of tooth wear increased with age in both sexes. Boys showed significantly more often attrition facets than girls (17.5% vs. 13.2%, p < 0.001). Subjects with tooth wear showed significantly higher free testosterone levels than those without (males: p < 0.001, females: p < 0.05). After controlling for confounding variables, the risk of tooth wear increased by approximately 30.0% with each year of life (odds ratio [OR]boys = 1.29, 95% confidence interval [CI] = 1.04−1.56; [OR]girls = 1.32, 95% CI = 1.08−1.61). In addition, the risk of tooth wear increased by 6.0% per free testosterone scale score only in boys (OR = 1.06, 95% CI = 1.01−1.12). (4) Conclusions: Tooth wear is common in children and in adolescents, and it increases steadily with age in both sexes. The stronger increase and the higher prevalence among male adolescents can be explained by the additional effect of free testosterone.

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.

Association of probable bruxism with periodontal status: A cross-sectional study in patients seeking periodontal care

OBJECTIVE

The goals of this study were to investigate the prevalence of probable bruxism in a group of patients seeking a periodontal care and the association between probable bruxism and periodontal status.

BACKGROUND

The results of previous studies evaluating the relationship between bruxism and periodontitis are contradictory. In addition, the relationship between probable bruxism and periodontitis in adults has not been evaluated, yet. Therefore, new studies are required in this field to clarify the relationship between bruxism and periodontitis.

METHODS

Patients seeking periodontal care at a university periodontology unit were considered in this study. Their periodontal diagnosis, number of missing teeth, presence of probable bruxism, and sociodemographic characteristics were recorded. The periodontal status of each study participant was defined according to the latest consensus of the American Association of Periodontology/European Federation of Periodontology, and the 2018 consensus report on the assessment of bruxism was used to evaluate probable bruxism. A multiple logistic regression analysis was performed to determine the effects of bruxism on periodontitis.

RESULTS

A total of 541 patients (289 females and 252 males, mean age 42.1 ± 15.9 years) were enrolled in the present study. The prevalence of probable bruxism was 36.6%. Additionally, 40.9% of the study population was diagnosed with periodontitis. The probable bruxers were older (P < 0.001), had a higher number of missing teeth (P < 0.001), and had poor periodontal status (P < 0.001). The multivariate logistic regression analysis suggested that probable bruxism was associated with periodontitis, after adjusting relevant factors (odds ratio: 2.243, 95% CI: 1.465-3.434, P < 0.001).

CONCLUSIONS

It was observed that the prevalence of probable bruxism was 36.6% and probable bruxers showed higher odds of periodontitis. Future studies with prospective randomized design should be conducted to confirm these results among a larger study population.

Social, emotional, and behavioral problems and parent-reported sleep bruxism in schoolchildren

BACKGROUND

A number of theories associate emotional factors with the triggering of sleep bruxism (SB). Few studies have used validated instruments to assess psychological characteristics and SB in children. In this study, the authors aimed to assess the prevalence of parent-reported SB in children and its association with social, emotional, and behavioral problems.

METHODS

The authors conducted a cross-sectional study with a school-based sample at 20 public schools in Brazil. Parents or caregivers provided information related to tooth-grinding sounds during sleep and about children's social, emotional, and behavioral problems by using the Strength and Difficulties Questionnaire. Analyses were carried out considering each subscale of the Strength and Difficulties Questionnaire and the total score. The authors estimated prevalence ratios by using a Poisson regression model. Statistical inferences were based on 95% confidence intervals.

RESULTS

A total of 556 children aged 8 years were included. Prevalence of SB was 30.83%. Results of an adjusted analysis showed a significant association of SB with higher scores on total difficulties (overall score) (P < .001) and emotional symptoms (P < .001) and peer relationship problems (P = .010) subscales.

CONCLUSIONS

Parental reports of emotional and behavioral problems were associated with a higher prevalence of SB in schoolchildren.

PRACTICAL IMPLICATIONS

This study's results contribute to those of previous investigations about the association between psychological characteristics and SB. Interdisciplinary research involving dentistry and psychology may improve the understanding of bruxism.

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.