Bruxism in Children: A Warning Sign for Psychological Problems
Andréa Gonçalves Antonio, DDS; Viviane Santos da Silva Pierro, DDS; Lucianne Cople Maia, DDS, MSD, PhD
Dr. Antonio Email: agantonio2002@ yahoo.com.br
Bruxism is nonfunctional clenching or grinding of the teeth. It is a destructive habit that may result in tooth wear. Althoughresearch on bruxism is extensive, its etiology remains debatable. The literature suggests that bruxism is correlated with both experienced and anticipated life stress. The purpose of this report is to describe 2 cases of severe bruxism in children of similar age with different life histories and to discuss the factors that could have triggered this parafunctional condition.
© J Can Dent Assoc 2006;72(2):155–60 This article has been peer reviewed.
MeSH Key Words: bruxism/etiology; bruxism/psychology; child
ruxism is involuntary, excessive grinding, clenching or rubbing of teeth during nonfunctional movements of the masticatory system.1,2 Reported prevalence in children ranges from 7% to 15.1%,3–5 with girls apparently more frequently affected.6 Bruxism can occur during the day ornight.7 Generally, patients clench their teeth throughout the day and gnash and clench them during sleep. 8 However, nocturnal bruxism is more frequent; it varies with the individual and has been related to emotional or physical stress.9 Bruxism usually causes tooth wear as evidenced by wear facets that can range from mild to severe and can be localized or found throughout the dentition.9 Other traumato the dentition and supporting tissues include thermal hypersensitivity, tooth hypermobility, injury to the periodontal ligament and periodontium, hypercementosis, fractured cusps and pulpitis and pulpal necrosis.2 Various theories regarding the etiology of bruxism have been reported and they fall
into the following categories: occlusionrelated, 2,10,11 psychological9,12,13 and originatingwithin the central nervous system.11 Before instituting any therapeutic measures, the practitioner must look at all the medical and dental data, particularly because the etiology of bruxism may be multifactorial.2,14 Therapeutic approaches can include occlusal adjustment of dentition, use of interocclusal appliances,15 behaviour modification13 and pharmaceuticals.16 Owing to inconsistent supportfor a physical propensity for bruxism, some researchers have explored the effect of life events on this activity.1 In this report, we describe 2 cases of severe bruxism in children with different life histories and discuss the possible factors that could have triggered this parafunctional condition. Case Reports The case reports are of 2 children referred to the pediatric dental clinic of a publicuniversity in Rio de Janeiro, Brazil. The chief complaint of both mothers was the presence of tooth wear in their children’s dentition.
JCDA • www.cda-adc.ca/jcda • March 2006, Vol. 72, No. 2 •
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Figure 1a: Frontal view of the patient’s occlusion.
Figure 1b: Pronounced wear in all anterior primary teeth and worn occlusal facets in teeth 55, 65, 75, 74 and 84.Figure 1c: Radiography conﬁrms the wear and fractures in the primary teeth, as well as lack of damage to the supporting tissues.
A 6-year-old boy was brought to the pediatric dental clinic by his mother. On history, his mother revealed that he gnashed his teeth at night, but she could not tell for how long this had been going on. The child’s medical history showed chronic respiratoryproblems, due to allergy, and an absence of gastroesophageal reﬂux. No previous dental treatment was reported. Ingestion of acid drinks or medication was denied. Although the mother described the child as highly excitable, during the consultation he was extremely shy and introspective. His mother reported that they lived in a violent area, where shootings frequently occurred and that her child...