Is there a treatment option for bruxism in children (primary and mixed dentition)?
This question was submitted by a general dentist: Is there a treatment option for bruxism in children (primary and mixed dentition)? I realize that any fabricated appliance may have issues with both long term stability (mouth is changing rapidly) as well as compliance.
Dr. Michael Casas provided this quick initial response.
Dr. Michael Casas is Associate Professor in the Faculty of Dentistry at the University of Toronto and Director of Dentistry Clinics at Sick Kids Hospital.
Bruxism is common in neurologically typical 5 to 6 year old children with prevalence rates approximating 15%. Older children and young adults demonstrate rates of bruxism closer to 5%. It has been suggested that central nervous system maturation, in particular, development of neural pathways between the cerebral cortex and brainstem central pattern generators leads to moderation or extinction of bruxism in many children by age 6 to 8. As the maturation of relevant cortical-brainstem pathways is coincident with eruption of the first permanent molars and incisors, attrition occurring as a consequence of bruxism is largely confined to the primary dentition. Few children experience attrition to the point of pulp exposure and abscess. For those children with extensive tooth wear, appliances to mitigate attrition are commonly not well tolerated, so patient compliance is poor. Stainless steel crowns have inadequate physical properties to resist perforation secondary to bruxism.
That bruxism is common and few children experience negative consequences from this behavior suggests that treatment is infrequently, if ever, indicated.
References
Kuch EV, Till MJ, Messer LB: Bruxing and Non-bruxing children: A comparison of their personality traits. Pediatric Dentistry, 1 (3): 182-7 (1979)
Miller AJ: The neuroscientific principles of swallowing and dysphagia. Singular Publishing Group, Inc. San Diego, USA, (1999) pp.159-177
this post still doesn’t answer the question it has posed!!
would be nice to know if Dr. Cassas has any recommendations for those who need intervention.
Nocturnal bruxism in children could be a sign of mouth breathing and/or sleep apnea. The use of a myofunctional trainer such as the Myobrace trainer can be used to correct improper tongue posture and eliminate the mouth breathing which may be contributing to the bruxism. It is important to look at the airway and facial development of the child and not just the teeth.
In my 40+ years as an orthodontist I have seen hundreds of children, between the ages of 5 and 9 who brux. However, very few of them experienced TMJ symptoms, even when their deciduous teeth have been abraded to within 3 millimetres of their gingival margins. I believe these children, during this period of social, emotional, physical, and dental development, anticipate each day as a new and exiting adventure, incorporate an excessive amount of pent-up energy to release, which is clinically manifested through the masseter and temporalis muscles, and thence through the teeth, as excessive compressive loads ( in the range of 2,000 to 3,000 psi (pounds per square inch), which is a sufficiently-strong enough force to abrade deciduous teeth.
On the other end of the scale, are the teenagers and adults whose masticatory muscles are maturing, or that have matured to full strength. This group of people/patients, if they are experiencing stress at work and/or home, and internalize it (beat up on themselves), and who are also afflicted with a moderate-to severe dento-skeletal malocclusion (crossbite,deep overbite anterior openbite, 5mm or larger overjet, skeletal asymmetry) have a tendency to brux, grind, and/or clench with compressive loads of greater than 5,000 psi ( 2 and a 1/2 times normal occlusion), which can abrade permanent tooth enamel, fracture crowns/restorations, cause vertical enamel fractures, cause permanent teeth to move out of alignment, can contribute to gingival dehiscence, can also cause masticatory myospasm, chronic frontal headaches, chronic condylar meniscus displacement, condylar osteoarthritic degeneration, as well as, severe TMJ dysfunction. There is still much controversy, confusion and conjecture on this subject amongst dental, medical and other health professionals. Somewhere in the range of 50 textbooks and/or chapters in textbooks have been written on TMJ dysfunction, it’s etiology, and it’s sequela, during the last 40 years, however, still more research needs to be done.
Notwithstanding, from my experience of treating several hundreds of TMJ patients, who were afflicted with any of the malocclusions alluded to previously, achieving harmony, balance, and stability, amongst the teeth, jaws, muscles of mastication, and mandibular condyles went a long way to achieving success in resolving the patients’ jaw joint pain, crepitus and TMJ dysfunction.