Tuesday, April 10, 2007

Treatment Approaches for Bruxism in Children

Sleep problems are frequent among healthy school going children seen at general pediatric practice. Sleep related problems were reported in 42.7% children that included nocturnal enuresis (18.4%), sleep talking (14.6%), bruxism (11.6%) nightmares (6.8%), night terrors (2.9%) snoring (5.8%) and sleepwalking (1.9%). Bruxism is a destructive habit. It is defined as the nonproductive diurnal or nocturnal clenching or grinding of the teeth.

Bruxism happens in about 15 percent of youngsters and in as many as 96 percent of grown-ups. The etiology of bruxism is unclear. It has been linked with stress, occlusal disorders, allergies and sleep positioning. In addition, type A personality behavior combined with stress is more predictive of bruxism. Because of its nonspecific pathology, bruxism may be difficult to diagnose.

Beside complaints from sleep partners, clenching-grinding, sleep bruxism, myofacial pain, craniomaxillofacial musculoskeletal pain, temporomandibular disorders, oro-facial pain, fibromyalgia, and chronic fatigue spectrum disorders are linked. The main clinical signs of bruxism comprise tooth wear, tooth mobility, hypertrophy masticatory muscles, and tender joints. Other symptoms of bruxism are multiple and diverse. They include temporomandibular joint pain and dysfunction, head and neck pain, erosion, abrasion, loss of and damage to supporting structures, headaches, oral infection, tooth sensitivity muscle pain and spasm, disturbance of aesthetics, and interference and oral discomfort.

Treatment for bruxism may be simple or complex, depending on the nature of the disorder. Severe bruxism disorders are difficult to treat and their prognoses also may be questionable. Children with bruxism are generally managed with observation and reassurance. Most of the children's bruxism habit will disappear naturally as they grow up. Adults may be managed with stress reduction therapy, modification of sleep positioning, drug therapy, biofeedback training, physical therapy and dental evaluation. Correction of the malocclusion with orthodontic procedures, restorative procedures, or occlusal adjustment by selective grinding will not control the bruxism habit.

What about prevention? Researchers have found only a weak correlation between different types of morphologic malocclusion such as Class II and III molar relationship, deep bite, overjet, and dental wear or grinding. Moreover, there is no correlation between periodontal disease and bruxism in children. Because the malocclusions' status in children does not increase the probability of bruxism, early orthodontic treatment (braces) to prevent bruxism is not scientifically justified.

Bruxism is a destructive habit that may result in severe dental deterioration. Bruxism in childhood may be a persistent trait. The occlusal trauma and tooth wear in childhood bruxism can be succeeded by increased anterior tooth wear 20 years later. If your child has significant tooth attrition, dental mobility or tooth fracture may happen. Therefore, it is mandatory to take your child to your dentist for evaluation.