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Bruxism in Children-A Systematic Review

Bruxism in Children-A Systematic Review

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BRUXISM IN CHILDREN-A SYSTEMATIC REVIEW, U.P.STATE DENTAL JOURNAL, Dr. Ravi Shankar TL , Dr. Anand Singh , Dr. Varon Gupta, UPSDJ Volume28 (2)April2010, Bruxism, Bruxofacets, Grinding, Oral Habit.
BRUXISM IN CHILDREN-A SYSTEMATIC REVIEW, U.P.STATE DENTAL JOURNAL, Dr. Ravi Shankar TL , Dr. Anand Singh , Dr. Varon Gupta, UPSDJ Volume28 (2)April2010, Bruxism, Bruxofacets, Grinding, Oral Habit.

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UPSDJVolume
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U.P.STATE
DENTAL
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JOURNAL
BRUXISM
IN
CHILDREN-
A
SYSTEMATIC
REVIEW
Dr. Ravi Shankar TL *, Dr. Anand Singh, ** , Dr. Varon Gupta***
ABSTRACT
KEY
WORDS:
Bruxism, Bruxofacets, Grinding,Oral Habit
INTRODUCTION
At the present time, bruxism is the term applied toeither the static or dynamic contact or occlusion
ofthe
teeth at times other than normal functions such asmastication and swallowing, which may includeclenching, gnashing, grinding and tapping of teeth.Although bruxism was introduced in the dentalliterature as "bruxomania" by Marie and Pietkiewkzin 1907', where it was described as the habit
of
grinding the teeth, it has become a subject
of
intenseinvestigation since then. The term "bruxism" wasintroduced in the dental literature by Frohman in1931. In 1936, Miller suggested that the term"bruxomania" be used to denote day time habitualgrinding
of
the teeth, while the term "bruxism" beused to denote nocturnal grinding. Previous studieshave focussed mainly on the adult population. Onlyrecently has interest been shown in this phenomenonoccurring in children and a number
of
studies provedthat bruxism is an oral habit that is indulged in bymany children.Bruxism usually refers to a nocturnal subconsciousactivity, but can occur during the day or night and maybe petformed consciously or subconsciously.'
It
is aconscious activity when parafunctional activities areincluded in the definition, e.g., chewing
of
pencil,nails, cheeks and lips.The terms "neuralgia traumatica", "karolyi-effect"and "occlusal habit neurosis" have all been used torefer to some form
of
teeth-grinding, clenching,tapping, orpressing
of
theteethdayornight.The aim
ofthis
review is to assess the current state
of
literature regarding clinical features, currentetiological concepts and therapies
of
bruxism inchildren.
Material
&Method:
In the literature more than 400 articles on the bruxismin children are available. However, we haveconsidered studies on children aged between 3yrs 12yrs. Studies were included fromPubMed, GoogleSeholar Search, Medline Database and the Collegelibrary. Case reports, reports with review andsystematic review articles written in English, wereincluded for consideration in our review.The reported incidence
of
bruxism in childrenvaries from 5% to 81% which is comparable to 15% to88% reported in adults.' However, the incidence
of
bruxism as determined by the signs
of
bruxism andnot through questioning alone is much higher as in thestudy
of
Lindqvist who reported that 47%
of
thechildren had atypical wear facets compared to 15%reporting from-parents: Kuch showed 15.4%
of
thechildren showed clinical evidence
of
wear facets, butno history from the parents.'
Physiology of
Bruxism
Bruxism occurs during sleep from the disturbance
of
the normal physiological rest position
of
themandible resulting from the forceful rhythmicalcontractions
of
the masseter, temporal is and thelateral pterygoid muscles.Scharer stated that in animals' grinding likemovements are elicited primarily by stimulation
of
the amygdaloid nucleus, i.e., from the limbic system.'the limbic system is considered as the connectingbrain structure between the conscious and voluntary
cortex
and the
vegetative centres
of
the
hypothalamus. This is an area with the closeproximity
of
stimulated reactions like aggression orfright. Tranquilizers used often in bruxing patients arealso effective within the limbic system. Therefore, ithas been speculated that tensions in man, whichmanifest themselves through bruxism, originatepartially within the limbic system.'Bruxism is performed on subconscious reflexcontrolled level. Various studies deal with therelationship between bruxism and sleep patterns.Takahama first showed from EEG that bruxismusually occurs during light sleep with brain wavechanges evidencing inereased activity
of
the cortex.He considered bruxism to be related to theAutonomous Nervous System because
of
irregularbreathing and increased pulse rate.Clarke
&
Townsend" suggested bruxism may beassociated with the REM phase
of
sleep that has beensaid to occur on average every 90 minutes during thenight and to last for between 5
&
20 minutes. Butothers studies have stated that there is no relation.Clinical features
of
bruxism
'Reader
Dept. of Preventive
&
Community Dentistry.
".lR-II.
Dept. of Oral Medicine
&
Radiology,"'JR-JI
Dept.
of
Preventive
&
Community Dentistry, Kothiwal Dental College Moradabad.
 
in increased loads to the teeth and facial pains inchildren.
Temporomandibular
Joint
TMJ disturbances and pain are in many cases the
The
following signs and symptoms may be seenindividually or in different combinations and may be
present
at
different times: tooth mobility,
nonfunctional patterns
of
occlusal wear, muscular
UPSDJ
Volume 28 (2) April 2010
and
TMJ
fatigue, headaches, grind or tapping soundsand soft tissue trauma. These signs and symptoms
of
bruxism depend on:
(I)
frequency
of
bruxing, (2) theintensity with which the patient is bruxing,
(3)
the age
of
the patient which may be associated with theduration
of
the habit.
Tooth
mobility! Occlusal
Trauma
Bruxism can result in tooth mobility. Highermobility values in the morning are observed whichcould be from bruxing activities during the sleepingperiod.
It
has been suggested that bruxism might be anessential factor for the spread
of
gingivitis into thedeeper periodontal structures and alveolar bone
loss.'
Tooth
Structure wear
Nonfunctional patterns
of
occlusal
wear
can beobserved as signs
of
bruxism. Bruxism can lead toincreased tooth sensitivity from excessive abrasion
of
the enamel. The enamel prisms are fractured fromhigh muscle forces generated during sleep and laterground down by the
jaw
movements. This issupported by the fact that people in industrializedcountries are living on a rather soft diet and thusabrasion
of
tooth structure is from bruxism in mostcases.In a study
of7
to
15
year old children, it was foundthat attrition in the permanent dentition increasedsignificantly with age in all regions except in the
molar
region on comparison between
11
and
15
yearsold children. In the oldest age group 14% had dentinvisible on at least one incisor. This 14% attrition inolderage groups included cuspid teeth.'
The
enamel
of
primary teeth is thin, and onoccasion wear facets can be extensive even withnormal wear. In some children most
ofthe
enamel anddentin is worn
off
by bruxism. Fortunately suchattrition stimulates the odontoblasts to produceadditional dentin which protects the pulp. Sometimesthe pulp may be exposed which results in a dentalabscess." However, facets on the cuspid
of
children
may
mean that wear is still taking place as the cuspids
have
recently
erupted."
Bruxism
canoccur
periodically.
It
is possible for example, that the facets
were
caused by grinding while the tooth becameadjusted to the occlusal plane and that bruxism laterceased.'
Musculature
Of
all the oral structures stressed through bruxisticforces, pain can most easily be elicited in themusculature. The most common symptom
of
bruxismis, therefore, tenderness
of
the
jaw
muscles,especially to palpation. Muscular tiredness uponawakening can also be a complaint. In addition to painin the muscles, hypertrophy
of
the masseter musclehas also been described uni-or bilaterally. Fatigue
of
the muscles
ofthe
neck is also observed."In bruxism, isometric exercise
of
the elevator
jaw
muscles can generate intense muscle forces resultingresult
of
bruxism. Along with the pain in the
joint
itself, the associated muscles can also be painful. Thepain is usually dull and mostly unilateral. Crepitationand
clicking within
the
joint,
restriction
of
mandibular movements and
jaw
deviations can oftenbe observed.'In her study, Egermark-Eriksson" found TMJdisturbance occurred more frequently in girls thanboys and more in
15
years old than the younger agegroups. Muscle tenderness also increased with age.She also reported a positive correlation betweensubjective symptoms and muscular tenderness.
Headaches
Egermark-Eriksson" found a correlation betweenheadaches and dental wear and observed thatheadaches increased with age, and in older children itis more common in girls. The headaches are often
of
the muscular contraction type, which suggests thatpain in the muscles is the underlying cause.
Other
signs
and
symptomsSounds
of
Bruxism:
Grinding or tapping sounds
of
bruxism are usually
reported
by parents or asibling. Except for children who have organic braindiseases, it is not common for children to brux withthe same amount
of
audible intensity during the timethat they are awake.Soft tissue
trauma:
Small ulcerations or ridging on the buccal mucosaopposite the molar teeth on one or both sides
of
theoral cavity has been observed in
children."
EtiologyThe etiology
of
bruxismisstillcontroversial. Manyauthors claim a multifactorial cause
12
Four groups
of
etiologic factors can be distinguished.
1.
Morphologic factors
(e.g., dental occlusion and anatomy
of
the orofacialskeleton) are thought to be involved in the etiology
of
bruxism. Local factors within the stomatognathicsystem malocclusions, faulty restorations, calculusand periodontitis and especially traumatic-occlusalrelationships and functionally incorrect occlusionsare mentioned as being responsible for bruxism.'Occlusal
interferences
or
deflective occlusal
contacts, which act as "triggers" that elicit bruxismare the most important local etiological factors.Three types
of
oeclusal anomalies significantlycorrelated with occlusal interferences: incisorcrossbite, postnormal occlusion and buccal crossbiteof the posterior teeth. Crossbites are found more inyounger age group and in those with sueking habits.
"These
children are also found to have musculartenderness more often." Lindqvist considered thecuspid teeth as an etiological factor in bruxism. Sheshowed that children who had cuspid teeth inocclusion showed significantly more frequentextreme lateral contact facets, which could be fromthecuspidspreventingnormal movement
of
the lower
----------------------I§_

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