Prevalence of bruxism among Mexican children with Down syndrome

The use of botulinum toxin for grinding in patients with Rett syndrome-Case report

AIMS

Rett syndrome (RTT) is a neurodevelopmental disorder caused by a mutation in the methyl-CpG-binding protein 2 (MECP2) gene. It is characterized by profound and severe motor disability. Patients with RTT grind their teeth, causing damage to their permanent teeth. This article aims to describe the case of an 8-year-old child with RTT and the methods of botulinum toxin-based treatment for teeth grinding.

METHODS AND RESULTS

Surface electromyography (sEMG) was used to monitor the effects of treatment. The masseter and temporal muscles, responsible for the elevation of the mandible, were injected with botulinum toxin. The results of the sEMG examination performed 1 week, 1 month and 4 months after toxin administration were compared to the sEMG conducted before treatment. The research demonstrates a significant reduction in both grinding frequency and tension of the masseter and temporal muscles.

CONCLUSION

Possible adverse effects after chronic use of botulinum toxin were discussed. The article also emphasizes the need for masticatory muscle rehabilitation during botulinum toxin therapy. However, it is necessary to repeat this procedure on a larger group of children with RTT to establish our efforts' efficacy.

Secondary bruxism: A valid diagnosis or just a coincidental finding of additional masticatory muscle activity? A narrative review of literature

INTRODUCTION

Bruxism is defined as a repetitive masticatory muscle activity that can manifest it upon awakening (awake bruxism-AB) or during sleep (sleep bruxism-SB). Some forms of both, AB and SB can be associated to many other coexistent factors, considered of risk for the initiation and maintenance of the bruxism. Although controversial, the term 'secondary bruxism' has frequently been used to label these cases. The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques, however, are important factors to be considered when judging the literature findings. The use (and abuse) of drugs, caffeine, nicotine, alcohol and psychoactive substances, the presence of respiratory disorders during sleep, gastroesophageal reflux disorders and movement, neurological and psychiatric disorders are among these factors. The scarcity of controlled studies and the complexity and interactions among all aforementioned factors, unfortunately, does not allow to establish any causality or temporal association with SB and AB. The supposition that variables are related depends on different parameters, not clearly demonstrated in the available studies.

OBJECTIVES

This narrative review aims at providing oral health care professionals with an update on the co-risk factors and disorders possibly associated with bruxism. In addition, the authors discuss the appropriateness of the term 'secondary bruxism' as a valid diagnostic category based on the available evidence.

CONCLUSION

The absence of an adequate definition of bruxism, the non-distinction between the circadian manifestations and the report of many different measurement techniques found in many studies preclude any solid and convincing conclusion on the existence of the 'secondary' bruxism.

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.

Prevalence of bruxism in down syndrome patients: A systematic review and meta-analysis

BACKGROUND

Bruxism is a parafunctional activity characterised by grinding or clenching of teeth and is a common oral health concern in individuals with down syndrome (DS). Understanding the prevalence of bruxism in this population is crucial for developing effective management strategies. This systematic review and meta-analysis is aimed to investigate the prevalence of bruxism among individuals with DS and explore its association with other oral health issues.

METHODS

A comprehensive search was conducted across multiple electronic databases to identify relevant studies. Cross-sectional and observational studies were included. Data on bruxism prevalence and associated factors were extracted, and a meta-analysis was performed using both fixed-effects (FE) and random-effects (RE) models of MedCalc software. Heterogeneity among studies was assessed using I2 statistics. New Castle-Ottawa Scale was used to evaluate methodological quality of the included studies.

RESULTS

Eight studies met the pre-defined inclusion criteria and were included in the analysis. Seven studies used a questionnaire to assess bruxism. The pooled proportion estimate for occurrence of DS across the included studies was found to be 0.33 (95% CI: 0.22-0.45) as per the RE model and 0.35 (95% CI: 0.31-0.450) as per FE model in the quantitative analysis. All studies exhibited good methodological quality.

CONCLUSION

This systematic review and meta-analysis provide evidence of a significant prevalence of bruxism among individuals with DS. The findings highlight the association of bruxism with other oral health issues and specific chromosomal abnormalities. Comprehensive oral health assessments, including diagnostic procedures like Polysomnography, are essential for addressing the unique oral health needs of individuals with DS. Further studies are recommended with a valid tool for the diagnosis. Early interventions and management strategies need to be tailored to this population, considering the multifaceted nature of oral health concerns in individuals with DS.

Sleep and behavioral problems in Down syndrome: differences between school age and adolescence

Background

Individuals with Down syndrome (DS) are at risk of developing sleep problems. In spite of the well-established knowledge on the presence of sleep difficulties in DS individuals and the associated emotional and behavioral problems, less is known about the possible differences in the kind of associations between sleep and emotional/behavioral problems across different age ranges.

Methods

In this retrospective study, we included 289 participants with DS aged 6-18 years with the aims to explore differences in the distribution of sleep problems between specific age groups (school age vs. adolescence) and to identify specific age-based associations between sleep problems and emotional/behavioral problems.

Results

Some differences in the distribution of sleep problems have emerged between age groups. Moreover, differences in the patterns of association between emotional/behavioral difficulties and sleep problems-in particular, sleep-related breathing difficulties and parasomnias-have been observed. However, sleep-wake transition disorders and excessive daily somnolence appear to be related to emotional and behavioral problems (both internalizing and externalizing), in general, across school age and adolescence.

Discussion

These results remark the importance of appropriate neuropsychiatric and psychological evaluation taking into account the age-specific needs and features of individuals with DS.

Prevalence of tooth grinding in children and adolescents with neurodevelopmental disorders: A systematic review and meta-analysis

AIM

To conduct a systematic review and meta-analysis on the prevalence of tooth grinding and/or clenching (TGC) in children and adolescents with a neurodevelopmental disorder or other developmental condition.

METHODS

A search was performed in seven databases, two sources of grey literature and reference lists of included studies. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. We used random-effects models with Freeman-Tukey double arcsine transformation for the meta-analyses.

RESULTS

After selection, 77 of the 2240 studies met inclusion criteria and were categorised by disability and type of TGC (reported, clinically observed and definitive). The pooled prevalence of reported TGC in individuals with attention-deficit hyperactivity disorder was 57.6% (95% CI [confidence interval]: 49.5-65.6), 50.4% (95% CI: 35.5-65.4) in individuals with autism spectrum disorder, 67% (95% CI: 59.2-74.8) in cerebral palsy and 68.2% (95% CI: 59.8-76.6) in Down syndrome. Pooled prevalence of clinically observed TGC was 57.5% (95% CI: 31.6-83.4) in autism spectrum disorder and 71.9% (95% CI: 52.4-91.4) in cerebral palsy. Individuals with attention-deficit hyperactivity disorder presented 39.8% (95% CI: 24-55.6) of definitive TGC.

CONCLUSION

Prevalence of reported, clinically observed, and definitive TGC varies according to disabilities, although due to high heterogeneity the result should be interpreted with caution. Variations exist mainly due to sampling bias and the use of non-validated methods to assess TGC. CRD42020212640.

Electromyography of diurnal bruxism during assessment and treatment

Diurnal bruxism among individuals with intellectual disabilities is often measured on the basis of its auditory products, thereby precluding the contingent presentation of stimuli during silent bruxism events. Electromyography (EMG) offers a technological solution to the identification of all bruxism events. EMG has not been previously evaluated in nonvocal clients with intellectual disabilities in the context of functional analysis and treatment. In the current series of analyses, we suggest a set of methods to implement EMG technology with this population. In Analysis 1, we propose a strategy for systematically identifying bruxism events. In Analysis 2 we evaluate an EMG staff-training package with naïve interventionists without past experience with EMG technology. Finally, Analysis 3 presents a practical example of this method during the functional analysis and treatment of a client with frequent diurnal bruxism.

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.

Bruxism Throughout the Lifespan and Variants in MMP2, MMP9 and COMT

Bruxism is a masticatory muscle activity characterized by grinding of the teeth and clenching of the jaw that causes tooth wear and breakage, temporomandibular joint disorders, muscle pain, and headache. Bruxism occurs in both adults and children. Clinical characteristics and habits were evaluated in an adult sample. Moreover, we used DNA samples from 349 adults and 151 children to determine the presence of association with specific genes. Genomic DNA was obtained from saliva. The markers rs2241145 and rs243832 (metalloproteinase 2 (MMP2)), rs13925 and rs2236416 (metalloproteinase 9 (MMP9)), and rs6269 (cathecol-o-methyltransferase (COMT)) were genotyped. Data were submitted to statistical analysis with a significance level of 0.05. In adults, in univariate logistic regression, presence of caries, attrition, and use of alcohol were increased in bruxism individuals (p < 0.05). In addition, in adults, there was an association between bruxism and MMP9 (rs13925, p = 0.0001) and bruxism and COMT (rs6269, p = 0.003). In children, a borderline association was observed for MMP9 (rs2236416, p = 0.08). When we performed multivariate logistic regression analyses in adults, the same clinical characteristics remained associated with bruxism, and orthodontic treatment was also associated, besides rs13925, in the AG genotype (p = 0.015, OR_a: 3.40 (1.27-9.07)). For the first time, we provide statistical evidence that these genes are associate with bruxism.

Occlusal device with extraoral retention: An occlusal technique for patients with Down syndrome

Temporomandibular disorders associated with bruxism have a high prevalence rate in the overall population, including individuals with Down syndrome (DS). Occlusal devices have been prescribed for the treatment of temporomandibular disorders and prevention of tooth wear due to bruxism. Patients with DS have restrictions concerning treatment with occlusal devices, with an increased risk of swallowing and asphyxia, because of limitations with cognitive ability and motor deficiency. Therefore, an occlusal device with extraoral retention was developed to improve the safety for a patient with DS. An extraoral transverse rod was connected to the occlusal device to prevent it from being swallowed. The patient used the device safely for 4 weeks.

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

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

Dimensions of central incisors, canines, and first molars in subjects with Down syndrome measured on cone-beam computed tomographs

INTRODUCTION

The literature on tooth dimensions in subjects with Down syndrome (DS) is scarce. To our knowledge, no studies have yet been published in which the morphometry of the teeth in DS subjects has been determined using computed tomography.

METHODS

The study group consisted of 40 subjects with DS, aged 10 to 40 years. An age- and sex-matched control group was selected. Cone-beam computed tomography images were retrieved from the archive of the Santiago de Compostela University in Spain. The maxillary central incisors, canines, and first molars were evaluated. The following variables were analyzed: overall tooth length, crown height, root length, mesiodistal diameter, vestibular-palatine diameter, crown-to-root ratio, and cervical circumference.

RESULTS

The teeth of subjects with DS were smaller than those of the controls, although the crown-to-root ratio was maintained. No clear sexual dimorphism was detected, but the root lengths of the incisors were greater in male subjects. Crown height, mesiodistal diameter, and crown-to-root ratio showed progressive reductions with age. There appeared to be a degree of "fluctuating dental asymmetry" with respect to vestibular-palatine diameter and cervical circumference.

CONCLUSIONS

Our findings confirm microdontia of the permanent teeth and progressive reductions in tooth sizes with age in persons with DS. These variations might be relevant to orthodontic treatment planning.

Sleep disorders and their clinical significance in children with Down syndrome

AIM

Our aim was to review basic aspects of sleep disorders in children with Down syndrome in the light of present-day findings of such disorders in children in general, including other groups of children with developmental disabilities.

METHODS

A literature search of adverse developmental effects of sleep disturbance, types of sleep disturbance in children with Down syndrome, their aetiology, including possible contributions of physical and psychiatric comorbidities and medication effects, principles of assessment and diagnosis, and treatment issues, was carried out.

RESULTS

Sleep disturbance is particularly common in children with developmental disorders including Down syndrome. Although there are just three basic sleep problems (sleeplessness or insomnia, excessive daytime sleepiness, and parasomnias) there are many possible underlying causes (sleep disorders), the nature of which dictates the particular treatment required. In children with Down syndrome, in addition to the same influences in other children, various comorbid physical and psychiatric conditions are capable of disturbing sleep. Possible adverse medication effects also need to be considered.

INTERPRETATION

Screening for sleep disorders and their causes should be routine; positive findings call for detailed diagnosis. Management should acknowledge the likely multifactorial aetiology of the sleep disorders in Down syndrome. Successful treatment can be expected to alleviate significantly the difficulties of both child and family.

Severity of occlusal disharmonies in down syndrome

Objective. To quantify the severity of malocclusion and dental esthetic problems in untreated Down syndrome (DS) and untreated non-Down syndrome children age 8–14 years old using the PAR and ICON Indices. Materials and Methods. This retrospective study evaluated pretreatment study models, intraoral photographs, and panoramic radiographs of 30 Down syndrome and two groups of 30 non-Down syndrome patients (private practice and university clinic) age 8–14 years. The models were scored via PAR and ICON Indices, and descriptive characteristics such as Angle classification, missing or impacted teeth, crossbites, open bites, and other dental anomalies were recorded. Results. The DS group had significantly greater PAR and ICON scores, as well as 10 times more missing teeth than the non-DS group. The DS group possessed predominantly Class III malocclusions, with the presence of both anterior and posterior crossbites in a majority of the patients. The non-DS group had mostly Class I or II malocclusion with markedly fewer missing teeth and crossbites. The DS group also had more severe malocclusions based upon occlusal traits such as open bite and type of malocclusion. Conclusion. The DS group had very severe malocclusions, while the control group from the university clinic had more severe malocclusions than a control group from a private practice.