Introduction

The word bruxism is taken from the Greek word brychein which means gnashing / grinding of teeth. Bruxism is the medical term for grinding, gnashing or clenching your teeth. This condition affects both kids and adults. Some people unconsciously clench their teeth together during the day, often when they feel anxious or tense whereas most kids who have bruxism - and some adults with the condition grind or gnash their teeth during sleep, usually in the early part of the night. In most cases, bruxism is mild and may not even require treatment. However, it can be frequent and violent and can lead to jaw disorders, headaches, damaged teeth and other problems.

Types

Depending on time of occurrence bruxism can be divided as:

Daytime bruxism/diurnal bruxism

It is the conscious or subconscious grinding of teeth usually during the day. It can occur along with parafunctional habits such as chewing pencils, nails, cheeks and lips.

Night-time bruxism/ nocturnal bruxism

It is the subconscious grinding of teeth at night during sleep. Also called sleep bruxism.

When bruxism can hit your child?

Bruxism may commence in infancy with the eruption of the first primary tooth. Infants with no teeth to oppose the newly erupted teeth have been seen to lacerate the opposing gum pad. It is common in young children, but usually goes away by the age of 10 years. In adults, the condition is common between the late teen years.

In children, bruxism may be related to growth and development. A child may brux because presence of malocclusion. Other common factors can be the presence of intestinal parasites, tension, anger, allergy problems, or as a response to pain from an earache or teething. Bruxism occurs in up to 30 percent of children, often around the ages of 5 and 6 years. It's particularly common in children with cerebral palsy or severe mental retardation. But most children outgrow bruxism before they get their permanent teeth.

What causes bruxism?

The etiology is multifactorial and has been reported to include:

In some cases, bruxism isn't caused by stress or dental problems. It can be a complication of another disorder, such as Huntington's disease or Parkinson's disease. It is neurodegenerative disease in which there are essential tremors of hands, body and jaw which may cause involuntary bruxism. It can also be an uncommon side effect of some psychiatric medications including antidepressants.

Screening and diagnosis

People with sleep bruxism usually aren't aware of the habit, so they aren't diagnosed with the condition until complications occur. That's why it's important to know the signs and symptoms of bruxism and to seek regular dental care.

Signs and symptoms of bruxism

Occlusal trauma can result in tooth mobility which may be more in morning because of the bruxism activity in night.

1. Tooth may show presence of:
   1. Non functional occlusal wear patterns.
   2. Increased tooth sensitivity from excessive abrasion of enamel.
   3. Atypical wear facets as shiny uneven occlusal wear with sharp edges.
   4. Pulpal sensitivity to cold
   5. Fracture of tooth crown or restorations
   6. Loosening of teeth especially during morning after waking.
2. Muscular problems
   1. Tenderness to jaw muscles i.e. lateral pterygoid and masseter
   2. Muscular fatigue on waking
   3. Hypertrophy of masseter
3. T.M.J disorders
   1. Temporomandibular dysfunction and pain- Bruxism is believed to be one of the leading causes of temporomandibular disorders (TMDs)
4. Headache
5. Other signs and symptoms
   1. Sound grinding and tapping sounds
   2. Soft tissue trauma
   3. Small ulcerations or ridging on the buccal mucosa opposite the molar teeth

Sleep bruxism often exerts remarkably powerful forces on teeth, gums, and joints. One estimate puts it at three times the forces generated during chewing (Castaneda, 1992), while another puts it at ten times—powerful enough to crack a walnut (Murray, 1998).

Why are these forces so high?

First, the bruxing activity is not under control of the conscious, rational, brain, which might have moderated or prevented the act from occurring. Second, when one eats, the chewing force is applied in part to the food, not to the teeth; but when one bruxes, the entire force is applied directly to the teeth.

How to control bruxism?

1. Avoid consumption of caffeine containing food and drinks like tea, coffee, chocolates etc.
2. Avoid chewing gums as it stimulates jaw muscles.
3. Avoid alcohol as it may intensify teeth grinding.
4. Stop the habit of chewing pencils or pens.
5. Practice stretching exercises and massage to relax muscles.

Treatment

In many cases, no treatment is necessary. Many kids outgrow bruxism without special treatment, and many adults don't brux badly enough to require therapy. However, if the problem is severe, the spectrum of bruxism management ranges from patient/parent education, occlusal splints and psychological techniques to medications.

• Occlusion adjustments

  Occlusal interferences or malocclusion may trigger bruxism particularly if it is combined with nervous tension. Therefore occlusal adjustment should be the first approach to the problem if interferences are present.

• Psychotherapy

  Counselling the patient to decrease his tension and create habit awareness may result in an increase in voluntary control that can lead to reduced tooth para-functions.

• Occlusal splint

  Vulcanite splints (bite plate) have been recommended to cover the surfaces of all the teeth which will prevent damage to the teeth when bruxism occurs. Mouth protectors/ night guards are the physical barriers between the upper and lower jaws to protect them from further tooth damage and also reduce the teeth grinding sound at night.

• Stress management

  If child grinds his or her teeth because of tension or fear, it may help to talk about your child's fears just before bed or to help your child relax with a warm bath or a favourite book.

• Restorative treatment

  If the abrasion is so severe that penetration into the pulp chamber is imminent, pulpal therapy with full coverage stainless steel crowns is indicated.

• Medications

  In general, medications aren't very effective for treatment of bruxism. In some cases, your doctor may suggest taking a muscle relaxant before bedtime.

References

1. Dental clinics of North America, paediatric dentistry. 2000.
2. McDonald, Avery, Dean. Dentistry for the Child and Adolescent. 8th edition; 2004; Mosby Publications.
3. Pinkham, Casamassimo, Fields, McTigue, Nowak. Paediatric Dentistry. Infancy through Adolescense. 4th edition; 2005; Saunders Company.
4. Richard J. Mathewson. Fundamentals of pediatric dentistry. 3rd edition, 1995, Quintessence Publishing Co.
5. Shobha Tandon. Textbook of Pedodontics. 1st edition; 2001; Paras Publications
6. Sidney B. Finn. Clinical Pedodontics. 4th edition; 2004; Saunders Company.
7. S.G Damle. Textbook of Pediatric Dentistry. 2nd edition; 2002; Arya Publishing House.