What is the diagnosis and treatment for a 5-year-old child with severe bruxism (teeth grinding)?

From the Guidelines

For a 5-year-old with severe teeth grinding (bruxism), I strongly recommend consulting with a pediatric dentist for a comprehensive evaluation and potential referral to a specialist, as indicated by the American Board of Pediatric Dentistry 1. This is because pediatric dentists have specialized training in infant and early child oral disease risk assessment, anticipatory guidance, and behavior guidance, making them well-equipped to address bruxism in children. Some key points to consider in managing childhood bruxism include:

• A custom-fitted night guard from a pediatric dentist can protect the teeth, though some children may resist wearing it
• Stress reduction techniques before bedtime, such as warm baths, gentle massage, bedtime stories, or calming music, can help alleviate anxiety that contributes to grinding
• Ensuring good sleep hygiene with a consistent bedtime routine and adequate sleep (10-13 hours for this age) is crucial
• Avoiding caffeine and sugary foods/drinks, especially in the evening, can also help reduce grinding
• Most childhood bruxism resolves on its own without treatment as children grow, but severe cases may require professional intervention, such as dental evaluation and potential treatment for underlying conditions like malocclusion or posterior crossbite 1. It's essential to note that while medication is rarely needed for childhood bruxism, it might be considered in extreme cases under medical supervision, and a pediatric dentist or pediatrician can provide guidance on the best course of treatment. Additionally, the American Academy of Pediatrics recommends a comprehensive evaluation for any child presenting with symptoms of bruxism, including a review of medical history, physical examination, and potential referral to a specialist 1. Overall, a pediatric dentist is the best professional to consult for a comprehensive evaluation and treatment plan for a 5-year-old with severe teeth grinding.

From the Research

Definition and Prevalence of Bruxism

• Bruxism is an oral parafunction characterized by the involuntary clenching or grinding of the teeth during sleep or daytime 2
• It is a movement disorder that can be classified as awake or sleep bruxism, with sleep bruxism showing no gender prevalence 3
• The true prevalence of bruxism in any specific population is unknown due to variations in demographics and dependence on anamnestic data 4

Causes and Risk Factors of Bruxism

• Psychosocial factors such as stress, mood, distress, nervousness, and feeling blue are associated with sleep bruxism 4
• Caffeine, alcohol, and smoking are also associated with sleep bruxism 4
• The use of certain medications or stimulants, such as antipsychotics and SSRI-type antidepressants, can promote the onset of bruxism 2
• Faulty occlusion is one of the most common causes of bruxism, leading to temporomandibular joint pain 5

Treatment and Management of Bruxism

• Occlusal devices and biofeedback therapies can be utilized in the treatment of sleep bruxism 4
• Botulinum toxin type A (BTX-A) has shown significant pain and sleep bruxism frequency reduction compared to placebo or conventional treatment 6
• Occlusal splints combined with muscle massage have shown some benefit in pain reduction 6
• There is no evidence to support the recommendation of biofeedback therapy and drug therapy for the treatment of bruxism 6

Considerations for a 5-Year-Old with Severe Teeth Grinding

• It is essential to consider the potential causes and risk factors of bruxism in children, such as psychosocial factors and the use of certain medications or stimulants 2, 4
• A comprehensive evaluation and diagnosis by a dentist or a specialist are necessary to determine the best course of treatment for a 5-year-old with severe teeth grinding 3, 5