Relationship between Bruxism and Malocclusion among Preschool Children in Isfahan

Sleep Bruxism in Children: A Narrative Review

Sleep bruxism, characterized by involuntary grinding or clenching of the teeth and/or by bracing or thrusting of the mandible during sleep, is common in children. Sleep bruxism occurs while the patient is asleep. As such, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in children. A search was conducted in May 2023 in PubMed Clinical Queries using the key terms "Bruxism" OR "Teeth grinding" AND "sleep". The search strategy included all observational studies, clinical trials, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. According to the International classification of sleep disorders, the minimum criteria for the diagnosis of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at least three months) tooth grinding sounds during sleep and (2) at least one or more of the following (a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache; or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism, "possible" sleep bruxism can be diagnosed based on self-report or report from family members of tooth-grinding sounds during sleep; "probable" sleep bruxism based on self-report or report from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of bruxism (e.g., abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or tongue/lip indentation); and "definite" sleep bruxism based on the history and clinical findings and confirmation by polysomnography, preferably combined with video and audio recording. Although polysomnography is the gold standard for the diagnosis of sleep bruxism, because of the high cost, lengthy time involvement, and the need for high levels of technical competence, polysomnography is not available for use in most clinical settings. On the other hand, since sleep bruxism occurs while the patient is asleep, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. In clinical practice, the diagnosis of sleep bruxism is often based on the history (e.g., reports of grinding noises during sleep) and clinical findings (e.g., tooth wear, hypertrophy and/or tenderness of masseter muscles). In childhood, sleep-bruxism is typically self-limited and does not require specific treatment. Causative or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity should be limited before going to bed. For adults with frequent and severe sleep bruxism who do not respond to the above measures, oral devices can be considered to protect teeth from further damage during bruxism episodes. As the orofacial structures are still developing in the pediatric age group, the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy is not a favorable option and is rarely used in children. Current evidence on the effective interventions for the management of sleep bruxism in children is inconclusive. There is insufficient evidence to make recommendations for specific treatment at this time.

3D Resin-coated pressure sensor response for bite force assessment: A pilot study

Background

Occlusal splints with sensors help in the bruxism diagnosis and monitoring, by recording the patient's bite force. The aim of this study was to evaluate the accuracy of a pressure sensor when it is covered with different thicknesses of a 3D printing resin (Anycubic 405nm Translucent Green UV Resin, Anycubic, UK).

Methods

In this preliminary study, the evaluated sensor (FlexiForce A201 Sensor, Tekscan) was firstly calibrated without any type of cover material, and later tested with 3D printing resin with different thicknesses (1 mm, 1.15 mm, 1.4 mm and 1.6 mm). The load tests were performed by a force tester (MultiTest 2.5 dV, Mecmesin).

Results

When the pressure sensor was covered with resin of 1mm and 1.6 mm thick specimens, a higher difference was found between the applied load and the corresponding sensor reading.

Conclusion

It was concluded that it is possible to use this type of pressure sensor and that it showed better accuracy with the 1.15 mm and 1.4 mm 3D printing resin covering.

Lockdown impact on lifestyle and its association with oral parafunctional habits and bruxism in a Spanish adolescent population

AIM

To analyse the possible association between decreased physical and social activity and an increase in the use of mobile devices, internet, and social networks with increased anxiety and the appearance of oral parafunctions and bruxism for adolescents before and during COVID-19.

DESIGN

A total of 213 adolescents attended private clinics at two different times: before lockdown (T0) and after completion of total lockdown (T1). In T0 and T1, a clinical examination was carried out to assess dental wear (IA) and only in T1 were they given the self-report questionnaire which focuses on the periods before and during lockdown (self-reported bruxism, state anxiety, mobile phone and internet, social network use, physical and social activity, and questions on parafunctions).

RESULTS

There were a decrease in physical activity at T0-T1 and an increase in social media use, internet, state anxiety, and clinical and self-reported bruxism at T0-T1. There was a positive correlation between increased self-reported bruxism, increased social media use, mobile device use, and state anxiety.

CONCLUSIONS

There has been a change in adolescent lifestyle during lockdown with an increase in the prevalence of oral parafunctions and bruxism. In particular, the increase in the use of social networks at night and also in anxiety levels during lockdown were associated with of the increase in self-reported bruxism.

Investigating the effect of bruxism on maxillary arch length and width in children using three-dimensional digital model analysis

Background

Bruxism is defined as repetitive jaw-muscle activity characterized by the grinding and clenching of teeth. The prevalence of bruxism in children is extensive, and it can cause irregularities in dental arches. The study aimed to investigate the presence of any effects of bruxism on maxillary arch length and width in children using three-dimensional (3D) digital model analysis.

Method

This study evaluated 30 children with bruxism. For every child with bruxism, a case control without bruxism was selected and matched for gender, age, and dentition. Digital models of the patients’ maxilla were obtained with a 3D intraoral scanner, and width and length measurements between the reference points on the maxilla were obtained on the digital models.

Results

The mean age of the study group was 9.13 ± 1.27. Insıgnificance differences were found between females and males within and between groups in terms of maxillary width and length. Insignificant difference was found between the control and study groups when the lengths of 3R-3L, 4R-4L, 5R-5L, 6R-6L, and IP-M were compared (p > 0.05).

Conclusion

Based on the study results, there were no differences in the maxillary arch length and width in patients with bruxism and patients without bruxism.

Prevalence of Malocclusion in Permanent Dentition of Iranian Population: A Review Article

BACKGROUND

The aim of this study was systematic review and meta-analysis of prevalence in current and relevant literature about this developmental disorder to present the profile of malocclusion in Iran.

METHODS

This review study was carried out with systematically identified and critically assessed studies reporting malocclusion prevalence among Iranian population in permanent dentition. National and international databases were searched for articles about prevalence of malocclusion by Angle classification in different regions of Iran from 1994 to 2015. After applying inclusion and exclusion criteria, the quality of articles was checked by professional checklist. Data extraction and meta-analysis was performed. A random-effect model was employed. Publication bias was checked.

RESULTS

Of 2768 articles, 21 cases were included. The pooled prevalence of malocclusion was about 87% (95% CI: 78.3-92.2) in Iranian population; however, the prevalence of malocclusion across individual studies varied considerably (ranging from 23.7% to 99.7%). Prevalence of normal occlusion, class I, II and III malocclusion were reported as 13.3% (CI 95%: 7.8-21.7), 50.7% (CI 95%: 42.9-58.4), 21% (CI 95%: 17.5-25.1), 5.5% (CI 95%: 3-10); respectively. Maximum prevalence of malocclusion was in the East of Iran.

CONCLUSION

The results showed a high prevalence of malocclusion in Iranian population. The baseline information could be appropriately utilized for the future planning to meet the orthodontic treatment need among the Iranian population.

Evaluation of stomatognathic problems in children with osteogenesis imperfecta (osteogenesis imperfecta - oi) - preliminary study

According to epidemiological data, muscular dysfunctions of the masticatory system occur in 15-23% of the population. Preventive examinations of functional disorders of the stomatognathic system are, therefore, of particular importance. A distinct group of patients exposed to dysfunctions in the area of the masticatory organ locomotor apparatus comprises those with genetic diseases characterised by disorders in collagen formation. One of such diseases is osteogenesis imperfecta (OI) and dentinogenesis imperfecta that usually goes together with the former.

AIM

The objective of this work was to evaluate the frequency with which particular disorders of the masticatory organ locomotor apparatus occur within the group of patients with osteogenesis imperfecta.

MATERIAL AND METHODS

The study was performed on patients of the Orthopaedic Clinic of the Polish-American Paediatric Institute in Kraków. The mean age of the children was 7.9 years. In all the cases, a genetic diagnosis of OI has been confirmed. The research methods were based on an in-depth interview on family diseases, pregnancy, postnatal period, feeding, subjective assessment of dysfunctions in the stomatognathic system. An examination of the deformations in the stomatognathic system and the skeleton was conducted, as well as an examination of the trauma and tone of the jaw. The relationship between breastfeeding and swallowing and speech disorders was also evaluated. The impact of intubation on mandibular ranges was investigated.

RESULTS

The results obtained were subjected to statistical analysis on the basis of which conclusions were drawn concerning disorders in the stomatognathic system which tend to occur in children with OI. The renunciation of breastfeeding significantly contributes to sucking and swallowing disorders, rumen disorders, as well as biomechanical disorders in the temporomandibular joint. A significant dependence between breastfeeding and swallowing problems was found, whereas there was no such dependence with respect to speech impediments.

CONCLUSIONS

The results of the research conducted led to the following conclusions: 1. Among pediatric patients with OI there are disorders in the stomatognathic system. The most common dysfunctions are: abdominal, swallowing and sucking disorders, abnormal muscle structure of the rumen and biomechanical disorders in the temporomandibular joints. Breastfeeding significantly contributes to swallowing disorders. 2. The therapeutic process involving children with OI requires the cooperation of specialists in orthopedics, pediatrics, physiotherapy, orthodontics and neurologopedics to carry out comprehensive diagnostics and treatment tailored to the individual needs of the patient. 3. In order to draw final conclusions, there is a need for more research by means of objective tools, such as EMG and a condensate recorder.

Dentine sensitivity risk factors: A case-control study

Objective:

To identify the clinical and psychological risk factors associated with dentine hypersensitivity (DH) in order to provide an early diagnosis and preventive therapy.

Materials and Methods:

A nested case–control study was design between 2011 and 2012. A total of 61 DH cases and 122 controls participated in this investigation. Cases and controls were matched for sex, group of age and socioeconomic status in a ratio of 1:2. DH to different stimuli such as cold, heat, acid, and sweet was asked in patient interviews, and dental examinations were used to detect DH. Clinical and psychological risk factors such as dental hygiene, periodontal disease, acid diet, alcohol consumption, psychological stress, and psychopathological symptoms were inquired. Psychological stress was measured through the PSS-10 and psychopathological symptoms were evaluated by SCL-90-R in Spanish. Descriptive and univariate binary logistic regression analysis were performed to estimate the association between clinical and psychological risk factors and the presence of DH.

Results:

Toothpaste abrasivity (odds ratio [OR] 1.881, 95% confidence interval [CI] 1.010–3.502, P = 0.045), gingival recession (OR 2.196, 95% CI 1.020–4.728, P = 0.041), and periodontal therapy (OR 5.357, 95% CI 2.051–13.993, P < 0.001) were associated with DH. Subjects with perceived stress (OR 1.211, 95%, CI 0.518–2.833, P = 0.658), obsessive-compulsive (OR 1.266, 95%, CI 0.494–3.240, P = 0.623) and hostility (OR 1.235, 95%, CI 0.507–3.007, P = 0.642) symptoms had a clinical greater odd of DH.

Conclusion:

Oral hygiene products and periodontal conditions are important risk factors for DH. Individuals with perceived stress, obsessive-compulsive, and hostility symptoms may increase a clinical risk for this entity. Targeting to dental counseling focused on oral hygiene products, periodontal therapy and a psychological evaluation may be promising in DH prevention.

Skeletal malocclusion: a developmental disorder with a life-long morbidity

The likelihood of birth defects in orofacial tissues is high due to the structural and developmental complexity of the face and the susceptibility to intrinsic and extrinsic perturbations. Skeletal malocclusion is caused by the distortion of the proper mandibular and/or maxillary growth during fetal development. Patients with skeletal malocclusion may suffer from dental deformities, bruxism, teeth crowding, trismus, mastication difficulties, breathing obstruction and digestion disturbance if the problem is left untreated. In this review, we focused on skeletal malocclusion that affects 27.9% of the US population with different severity levels. We summarized the prevalence of class I, II and III of malocclusion in different ethnic groups and discussed the most frequent medical disorders associated with skeletal malocclusion. Dental anomalies that lead to malocclusion such as tooth agenesis, crowding, missing teeth and abnormal tooth size are not addressed in this review. We propose a modified version of malocclusion classification for research purposes to exhibit a clear distinction between skeletal vs. dental malocclusion in comparison to Angle’s classification. In addition, we performed a cross-sectional analysis on orthodontic (malocclusion) data through the BigMouth Dental Data Repository to calculate potential association between malocclusion with other medical conditions. In conclusion, this review emphasizes the need to identify genetic and environmental factors that cause or contribute risk to skeletal malocclusion and the possible association with other medical conditions to improve assessment, prognosis and therapeutic approaches.