Children Who Grind Their Teeth Are Anxious and Withdrawn, Experts Reveal

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Bruxism, also known as teeth grinding, is a condition characterized by involuntary or semi-voluntary activity of the masticatory muscles (muscles involved in chewing). It is prevalent in both children and adults

Research from the American Academy of Sleep Medicine (AASM) points towards an indirect effect of teeth-grinding on 1,956 preschoolers and parental observations of withdrawn behaviour and difficulty adjusting to preschool (around 14-17%). 

Over a third (36.8%) of preschoolers without a night guard were said to grind their teeth at least once a week, with a smaller portion (6.7%) reported to do it four or more times a week.

Teeth Grinding (Bruxism) and Anxiety

Anxiety is characterized by heightened Central Nervous System (CNS) activity, which manifests in increased muscle tone and hyperarousal while sleeping. This hyperarousal is believed to trigger involuntary jaw movements leading to teeth grinding or sleep bruxism. 

The stress hormone cortisol is known to be elevated in anxious individuals. Cortisol influences sleep, which promotes lighter sleep stages where teeth grinding is more frequent. Dopamine and serotonin are neurotransmitters in sleep regulation and emotional processing. Imbalances in these systems associated with anxiety contribute to the likelihood of bruxism. 

Understanding Nighttime Bruxism in Children

Estimates regarding the prevalence of nighttime bruxism in children vary widely, ranging from 13% to 30%. Children with nighttime bruxism may exhibit various clinical manifestations, such as:

  • Audible grinding sounds during sleep (reported by parents)
  • Excessive tooth wear, particularly on the chewing surfaces (observed by a dentist)
  • Jaw pain or tenderness
  • Headaches upon waking

Epidemiology and Classification

The prevalence of bruxism remains elusive due to challenges in diagnosis. Estimates for sleep bruxism range from 8% to 30% in adults and 3% to 20% in children.

Subjectivity of Diagnosis

Reliance on parental reports for diagnosis introduces inherent subjectivity. Parents might not always be aware of grinding and clenching sounds while sleeping. So, misinterpretations of normal jaw movements during sleep could inflate the reported prevalence.

Detection Methods

Dental clinical examinations identify tooth wear patterns suggestive of bruxism, but these are not always definitive. Specialized sleep studies (polysomnography) also objectively monitor sleeping patterns and muscle activity, but their use in children is often limited due to cost and logistical difficulties.

Bruxism can be further classified based on its characteristics:

Nocturnal Bruxism (NB)This is the most common form, characterized by involuntary teeth grinding or clenching while sleeping.
Awake Bruxism (AB)This involves conscious or semi-conscious clenching or grinding of teeth while awake. It is often associated with habits like nail-biting or pen-chewing.
Primary BruxismThis refers to bruxism that occurs in the absence of any identifiable underlying medical or dental condition.
Secondary BruxismThis type of bruxism arises due to an underlying medical or dental condition such as malocclusion (misaligned teeth), sleep disorders like sleep apnea, or certain medications.

Dentures and Bruxism: The Detrimental Effects

Bruxism exerts significant forces on the upper teeth, and dentures are not immune to these damaging effects.

Teeth Fracture and Breakage

Repeated grinding and clenching forces can cause chipped teeth. Intense pressure of the upper teeth and lower teeth grinding can cause cracks, chips, or complete fractures in the front teeth. These may require proper care or restorative dental procedures, which adds to the burden on both the child and the parents.

Eroding Tooth Enamel

The constant friction (of the upper and lower teeth) caused by grinding can erode tooth enamel. It can expose the dentin layer underneath and increase sensitivity to hot water and cold stimuli. In severe cases, bruxism can lead to significant flattening of the cusps (chewing surfaces) or even tooth fractures.

TMJ Disorders

Temporomandibular Joint Disorders have a range of conditions affecting the jaw joint and surrounding muscles. Bruxism is considered a potential risk factor for TMJ disorders in children. It can lead to symptoms like jaw pain, facial pain, clicking sounds, and difficulty chewing.

Increased Wear

The friction generated during bruxism can accelerate wear and tear on the denture base material. This leads to a poor fit and necessitates denture relining or replacement sooner than anticipated.

Bone Resorption

Teeth grinding can exacerbate bone resorption in the jaw, which is an ongoing process after tooth loss. This further compromises the fit and stability of dentures.

Night Guard As a Way to Prevent Grinding

Also known as occlusal splints or bite guards, are dental appliances custom-fit for wearing during sleep bruxism (nighttime teeth grinding). They represent a treatment modality for teeth grinding or clenching.

Dental guards function through several mechanisms to manage teeth grinding:

Physical BarrierCreates a physical barrier between the upper and lower teeth. It prevents direct contact between opposing teeth, which protects them from the wear and tear associated with grinding teeth or clenching.
Muscle RelaxationPromote a more relaxed jaw position, which can potentially reduce muscle tension and hyperactivity associated with sleep apnea, facial pain, and teeth grinding.
Reduced NoiseDampens the audible sounds produced by teeth grinding. Improves sleep quality for both the bruxist and their sleep partner.

Types of Customized Night Guard

  • Hard Night Guard: Custom-made mouth guards use hard acrylic. Offers a high degree of protection against tooth wear.
  • Soft Night Guard: Constructed from delicate materials, like thermoplastic. They offer a comfortable fit.
  • Combination Mouth Guards: Feature a hard outer shell with a softer inner layer to fit comfortably in your mouth. These mouth guards provide comfort and protection for teeth and gums.

Custom vs. Over-the-Counter (OTC) Cost

  • Most custom-mouth night guard cost from $300 to $800 or more. This price reflects the individualized design, high-quality materials, and professional expertise involved in their creation.
  • Over-the-counter (OTC) night guards are significantly less expensive, typically costing between $20 and $50. However, they are pre-formed and may not provide a perfect fit for every individual. This can lead to discomfort, reduced effectiveness, and potentially even contribute to jaw problems.

Alternative Treatments to Bruxism

Electromyography (EMG) in Bruxism Research

EMG is a non-invasive technique for measuring the electrical activity of skeletal muscles. During an EMG examination, electrodes are placed on the skin overlying specific muscles. These electrodes capture the electrical signals generated by muscle fibres during contraction. The EMG signal is then amplified, processed, and displayed visually or as an audible recording.

Quantify Muscle ActivityEMG allows researchers to quantify the intensity and length of muscle activity in the masticatory muscles (muscles involved in chewing) during sleep or wakefulness.
Differentiate Bruxism from Normal ActivityEMG can help differentiate between bruxism episodes and normal jaw movements that occur during sleep and wear braces.
Investigate Underlying MechanismsBy analyzing EMG activity patterns, researchers can explore the potential links between bruxism and factors like stress, anxiety, and sleep disorders.

CBT and Relaxation Training for Bruxism Management

CBT is a well-established psychotherapeutic intervention with proven efficacy in managing various conditions, including anxiety and stress. Here’s how CBT is applied to bruxism treatment:

  • CBT helps patients identify situations or thoughts that trigger bruxism episodes.
  • CBT techniques help patients challenge and modify negative thought patterns that add to anxiety or stress. By restructuring these thought patterns, patients reduce their emotional arousal and lessen the likelihood of bruxism episodes.
  • CBT incorporates relaxation techniques like deep breathing exercises or progressive muscle relaxation. These techniques help patients manage stress and anxiety in the moment, reducing muscle tension and bruxism activity.
  • Biofeedback, sometimes used in conjunction with CBT, provides real-time feedback on physiological responses like muscle tension. This allows patients to control their muscle activity and promote relaxation, potentially reducing bruxism episodes.

 

dental night guards

 

Manage Bruxism with a Custom Mouth Guard 

While teeth grinding is common in children and adults, it could be a sign of underlying anxiety or difficulty adjusting. If you’re concerned about teeth grinding, you can let them wear a custom-fit night guard for prevention. Visit your trusted dentist at Westgate Dental Centre for an initial consultation regarding teeth-grinding issues.

A licensed dentist can provide a gentle checkup, discuss treatment options, and offer guidance to improve your child’s oral health. Don’t wait for serious symptoms; schedule an appointment today.

Frequently Asked Questions

Teeth grinding in children can be caused by several factors, including anxiety, but not always. Other potential causes include teething pain, misaligned teeth, or even allergies.

A warm compress applied to the jaw before bed can promote relaxation. Ensuring your child gets adequate sleep and avoiding caffeine or sugary drinks before bedtime can also contribute to a calmer sleep environment. However, consulting a dentist for a proper diagnosis and treatment plan is always recommended.

Many children do outgrow teeth grinding as they mature. However, for some children, it can persist into adulthood. A dentist can monitor the grinding and adjust treatment plans as needed. Early diagnosis and intervention help prevent long-term complications like jaw pain or damaged teeth.

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