Sleep bruxism, or teeth grinding is a relatively common condition during sleep in young children.
Emerging research suggests that it can often be a marker for obstructed breathing during sleep. Read more to find out why it is worth a visit with a dentist trained in dental sleep medicine for assessment.
Which children are at risk of teeth grinding?
Whilst traditionally, popular belief has linked teeth grinding in children with anxiety and stress, the scientific evidence for this is relatively weak.
Although we do not fully understand the precise events that lead to teeth grinding, there is solid evidence that links it with certain risk factors.
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°parasomnias or movement disorders during sleep – such as bedwetting, sleep talking and sleep walking °sleep disordered breathing or snoring °enlarged tonsils and adenoids certain anti-depressant medications called selective serotonin inhibitors
The strongest evidence links sleep bruxism with breathing, and it has been suggested that grinding helps to open up the airway in some patients.
How does a specially trained dentist assess a child with sleep bruxism?
Your dentist will be aware of any medical conditions or medications that may contribute to night time grinding. They will ask questions about their sleep to rule out snoring, sleep disturbed breathing or parasomnias.
They will ask questions to gauge sleep patterns, the quality of sleep and enquire about symptoms of disturbed sleep including how easy your child is to rouse in the morning, daytime sleepiness, and behavioural or attention concerns.
Before looking in their mouth, it is possible to identify children at risk of obstructed sleep breathing by casually observing your child at the start of the appointment.
Signs that may indicate obstructed breathing include open mouth posture, mouth breathing, dry or cracked lips, venous pooling or dark circles under the eyes, and certain patterns of facial growth.
Inside the mouth, they will assess how crowded the oral aspect of the airway looks or whether there are enlarged tonsils visible and notice if there is a dry mouth and accompanying gingivitis around the upper front teeth or a general increased risk of tooth decay.
Any positive findings of obstructed airways combined with a positive history of symptoms can then be referred to an ENT specialist for further investigation.
There is limited evidence to support treatment options such as behavioural modification and dental appliances. Therefore only children with severe tooth damage or those with pain or breathing disturbances need to be referred for care.
If sleep bruxism is accompanied by obstructed airways, one of the most common procedures that may be offered by an ENT is the removal of the adenoids and tonsils.
These tissues are the most common sites of airway obstruction in children as they are commonly enlarged within a narrow child sized airway.
This relatively common surgical procedure is aimed primarily at clearing the airway to allow improved breathing and achieve improved sleep quality. At a critical time of brain development, this can help avoid long term behavioural and neurocognitive consequences that are now being linked to obstructed sleep.
Studies have also demonstrated that approximately 2/3 of children who grind their teeth and have this procedure done will also stop teeth grinding. This leaves 1/3 who continually grind their teeth, which could potentially be related to their generally small sized airway.
It therefore should not be a primary treatment option for teeth grinding, but many patients will benefit from a reduction in sleep bruxism in addition to improved quality of sleep with this procedure.