If you are a dentist, pediatric dentist, or orthodontist, you have probably heard about bruxism in children. Childhood bruxism is a common condition that affects many children and can have a significant impact on dental health. When a child clenches or grinds their teeth, it can cause damage to the teeth, jaw, and mouth muscles, but there is also much more behind this activity. How is bruxism in children diagnosed, and what treatments are available? In this article, we will explain everything you need to know about bruxism in children, according to the changes that have occurred since 2018, when we stopped understanding bruxism as an occlusion problem or considering it a parafunction, to approaching it as a symptom of an alteration in the central nervous system.

Definition of childhood bruxism

Childhood bruxism is a common activity in which a child involuntarily clenches or grinds their teeth due to an alteration in the central nervous system, specifically in the dopamine and serotonin neurotransmitters. It can occur both during the day and during the night and can be an indication of an underlying health problem. Bruxism in children can affect children's oral conditions and cause problems in cognitive development by affecting sleep cycles, among many other things. It is important for healthcare professionals to be informed about the symptoms and causes of bruxism in children in order to identify and address it appropriately.

Prevalence of childhood bruxism

The prevalence of childhood bruxism is a topic of great interest to dentists, pediatric dentists, and orthodontists, as this condition is quite common in children and can have significant consequences for their quality of life. In this regard, it is essential for parents to be informed about the symptoms of childhood bruxism and to know how to act if they suspect their child grinds their teeth. If they notice that the child clenches or grinds their teeth at night, it is necessary to inform the dentist or pediatric dentist so that a detailed evaluation can be carried out.

The treatment of childhood bruxism, although it is more appropriate to speak of an approach, involves the work of a transdisciplinary team that can correct the factors that trigger it, such as stress or anxiety, airway obstruction, gastroesophageal reflux, screen exposure, sugar consumption, or other underlying diseases. With early detection and appropriate treatment, it is possible to eliminate or reduce bruxism in children.

Causes of bruxism in children

Biological factors

Biological factors that can contribute to childhood bruxism include alterations in the airways, either due to narrowing or obstructions, gastroesophageal reflux, and sleep apnea, among others. These factors can lead to the appearance of childhood bruxism either as a protective mechanism of the body or as a manifestation of the condition itself.

On the other hand, dental wear, so commonly associated with bruxism, may or may not appear in childhood bruxism. Dental wear occurs when the outer layer of the tooth wears away over time, but it is not always due to the friction of the teeth. This wear can be the result of oral acidity due to reflux or the use of oral inhalers.

In addition, there are other biological factors that can contribute to childhood bruxism, such as the facial bone structure of the airways and the presence of emotional developmental problems in childhood. It is important for dentists, pediatric dentists, and orthodontists to be trained to identify these biological factors and treat them appropriately to prevent childhood bruxism.

Psychological factors

Psychological factors are another of the causes of childhood bruxism. In some cases, this involuntary activity of clenching or grinding teeth may be related to emotional and psychological factors affecting the child. The child's age and background can be important factors to consider in evaluating the psychological factors associated with childhood bruxism.

Bruxism can be related to stress and anxiety associated with school, sports, and other activities.

The child's background can also be an important factor in the development of childhood bruxism. For example, children from homes with high levels of stress or conflict may be at higher risk of developing bruxism. In addition, children who have suffered some type of emotional or physical trauma may be more prone to developing bruxism.

It is important for dentists, pediatric dentists, and orthodontists to be trained to identify the psychological factors associated with childhood bruxism. Treatments or approaches may include behavioral therapy, stress management, and relaxation techniques to help the child control their emotional state and, consequently, bruxism.

Environmental factors

Environmental factors can have a significant impact on childhood bruxism. Among the most common environmental factors are overexposure to recreational screens and diets rich in added sugars.

Sleep problems can also be an important factor in the development of childhood bruxism. Children who do not get enough sleep or who experience sleep problems, such as insomnia or sleep apnea, may have a higher risk of developing bruxism. In addition, lack of physical activity can contribute to the development of childhood bruxism, as children who do not get enough physical activity may experience elevated levels of stress and muscle tension.

It is important for dentists, pediatric dentists, and orthodontists to be trained to identify the environmental factors associated with childhood bruxism. Treatments may include stress reduction, sleep improvement, and the promotion of an active and healthy lifestyle to help the child control bruxism.

Diagnosis of childhood bruxism

Clinical evaluation

Clinical evaluation is an important tool for diagnosing childhood bruxism. For this purpose, the global committee of experts has recently validated the STAB (Standardized Tool for the Assessment of Bruxism) tool for both children and adults and has defined the approach processes for bruxism evaluation. It is important for dentists, pediatric dentists, and orthodontists to be trained to carry out an adequate clinical evaluation to identify childhood bruxism and determine the best course of treatment.

The clinical evaluation of childhood bruxism may include a detailed review of the child's medical and dental history, as well as a physical examination of the mouth and teeth, to identify important signs and symptoms. It will also be necessary to evaluate sleep routines, diet, social environment, and consider some manifestations such as headaches, earaches, and neck pain. Early identification of these signs and symptoms is essential for the proper diagnosis and treatment of childhood bruxism.

It is important to note that the diagnosis of childhood bruxism is not based solely on the presence of physical signs and symptoms. Professionals should consider the psychological and environmental factors that may be contributing to childhood bruxism. An adequate clinical evaluation and having a transdisciplinary team of professionals to support the diagnosis and approach of the triggering factors can help identify these factors and develop a comprehensive and effective treatment plan.

Complementary diagnostic techniques

Complementary diagnostic techniques can be useful in the identification and diagnosis of childhood bruxism, especially in cases where physical signs and symptoms are not clear. Polysomnography is a complementary diagnostic technique that can be used to assess muscle activity during sleep and determine if the child is clenching or grinding their teeth. This technique can provide valuable information on the frequency and duration of teeth grinding during sleep, although it is not necessary in all patients.

Polysomnography helps identify the time and duration of teeth grinding, and also helps record other signs and symptoms associated with childhood bruxism, such as snoring and sleep apnea.

It is important to note that these complementary diagnostic techniques should be used in combination with clinical evaluation and a review of the child's history and environment to obtain an accurate diagnosis of childhood bruxism.

Consequences of childhood bruxism

Dental damage

Childhood bruxism can have long-term consequences for dental health. Dental wear is often considered one of the most common consequences, although, as we have already mentioned, it does not necessarily always occur. When there is oral acidity in addition to bruxism, there is a greater risk of dental wear, and this aspect should be addressed to avoid the consequences of this wear.

Orofacial pain and discomfort

Childhood bruxism can cause long-term orofacial pain and discomfort. Children who experience bruxism may experience headaches, earaches, neck pain, and jaw pain. Additionally, it can cause pain and discomfort in the face and neck muscles, which can interfere with the child's daily activities and affect their quality of life.

Chronic orofacial pain can have a significant impact on the child's quality of life and their ability to participate in daily activities such as eating, speaking, sleeping, and studying. Additionally, chronic pain can affect the child's mental and emotional health, leading to anxiety, depression, and sleep problems.

These pains and discomforts can be treated with multidisciplinary therapeutic approaches that include behavioral therapy, pharmacological therapy, and physical therapy. Behavioral therapy can include relaxation techniques and biofeedback to reduce muscle tension and anxiety associated with bruxism. Pharmacological therapy may include the use of medications to reduce pain and inflammation, as well as to treat anxiety and stress. Physical therapy may include physiotherapy and massage to reduce muscle tension and improve blood circulation in the orofacial area.

Sleep problems

Childhood bruxism is, in fact, caused by sleep problems. Children who experience bruxism have nocturnal micro-arousals, especially in the NREM phase, which greatly interferes with the consolidation of learning that the brain performs while sleeping.

It is important to address sleep problems associated with childhood bruxism to prevent complications and improve the child's quality of life. Therefore, knowledge of dental sleep medicine is essential to acquire tools that allow for supporting patients with bruxism. Treatment ranges from analyzing conditions such as sleep apnea, routines, and environments where the child sleeps.

Eating problems

Childhood bruxism can affect or stem from children's diets. Studies show a high correlation between high consumption of added sugar in children and the presence of bruxism.

The underlying causes of childhood bruxism, such as stress and anxiety, can contribute to eating problems by affecting the child's appetite and their ability to eat properly. In these cases, the tendency towards soft or high-sugar diets that seek to improve food intake in children can alter the masticatory and swallowing process, thereby affecting the facial bone and muscle development structures of growing children.

In a proper approach to bruxism, it may be necessary to implement changes in the child's diet, which is why it is important to work closely with the child's healthcare team to ensure that eating problems are effectively addressed and to promote the child's long-term health and well-being.

Treatment of childhood bruxism with different therapies

Behavioral therapy

Behavioral therapy is one of the most effective options for treating childhood bruxism if its origin is emotional. This therapy focuses on changing the child's behavior patterns. Some common techniques include progressive muscle relaxation, cognitive-behavioral therapy, and biofeedback.

Progressive muscle relaxation is a technique in which the child learns to consciously and controlledly relax the muscles of their body. This can help reduce muscle tension. Cognitive-behavioral therapy focuses on changing the child's thought and behavior patterns, while biofeedback uses sensors to measure muscle tension and teach the child to control it. It is important to work with an interdisciplinary team to determine the best course of treatment for each child.

Pharmacological therapy

Pharmacological therapy can be an option in the treatment of childhood bruxism, especially in severe cases where pain affects the child's quality of life. However, it is important to note that pharmacological therapy will only control the symptoms, but will not prevent the child from continuing to grind their teeth.

It is important to consider that pharmacological therapy should be used in conjunction with other treatments and only as a way to contain symptoms, not as a therapeutic mechanism. Furthermore, professionals should be cautious when prescribing medication to children, especially those who are still developing.

Oral appliances

Oral appliances are a common treatment option for childhood bruxism and occlusal splints are one of the most widely used, but the truth is that unless used for a maximum duration of three weeks and with the intention of helping to reduce muscle inflammation, it is NOT an alternative for addressing bruxism.

Other orthopedic oral appliances can be used for palate expansion or improvements in airway dimensions. If bruxism originates from these conditions, such appliances can help reduce or eliminate bruxism by correcting the underlying condition that triggers it.

It is important to remember that each child is different and requires a personalized treatment plan for their bruxism, and that each of these devices has its own advantages and disadvantages, and the choice of the most appropriate one will depend on the origin of the bruxism and the transdisciplinary management it receives.

Learn more in our entry on approaches to childhood bruxism.

 

Prevention of childhood bruxism

Healthy habits

Preventing childhood bruxism involves implementing healthy habits that promote a balanced oral and emotional system in children. It is important to educate parents and children about the causes of childhood bruxism and to foster a calm and relaxing environment at home.

Healthy habits include creating a regular and appropriate sleep routine for the child, reducing stress at home, promoting physical and recreational activities, regulating the use of recreational screens, and adopting a balanced diet that includes foods rich in vitamins and minerals important for dental health.

It is important for children to maintain good oral hygiene and visit the dentist regularly to detect and treat any dental problems in time. The prevention of bruxism in children requires a transdisciplinary approach that involves the dentist, parents, and the child. By promoting healthy habits and a relaxed and calm home environment, childhood bruxism can be prevented, and long-term oral and emotional health can be promoted.

Preventive therapy

In the preventive therapy of childhood bruxism, the aim is to prevent the development of clenching and grinding habits. It is important for dentists, pediatric dentists, and orthodontists to be trained to identify the underlying causes of childhood bruxism and provide effective preventive therapy.

Among the most common preventive therapies are cognitive-behavioral therapy, progressive muscle relaxation therapy, and biofeedback therapy. These therapies focus on addressing the underlying causes of childhood bruxism, such as stress and muscle tension, and teaching children techniques to relax and control muscle tension.

In addition, recommendations can be provided to promote healthy habits, such as a balanced diet, regular exercise, and good sleep habits. 

Conclusions

Summary of key points

In conclusion, childhood bruxism is common in the child population and is the product of an alteration of the central nervous system, especially of dopamine and serotonin neurotransmitters, and therefore requires adequate and timely intervention by duly trained professionals. 

Clinical evaluation and accurate diagnosis are essential to determine the underlying cause of childhood bruxism and develop an effective treatment plan. By understanding bruxism as a symptom and not as the disease, the treatments or rather, the approach to bruxism include behavioral and pharmacological therapies, as well as oral devices, changes in diet, and sleep routines.

Bruxism speaks and we must listen to it to find the correct cause of its origin and truly offer an effective solution to patients. A solution that will not always be dental. As dentists, pediatric dentists, and orthodontists, it is important to stay updated on the latest strategies and treatments for childhood bruxism, especially since 2018, all previous ideas about bruxism and its relationship with occlusion or parafunction issues were disproven.