Management of Teeth Grinding (Bruxism) in Children
In children, bruxism is typically self-limited and does not require specific treatment; management focuses on observation, reassurance, sleep hygiene optimization, and elimination of triggering factors, with dental referral reserved only for cases with significant tooth damage or associated complications. 1
Initial Approach: Observation and Reassurance
Children with bruxism should be managed primarily with observation and reassurance, as this condition is common (occurring in approximately 15% of children) and usually resolves spontaneously without intervention. 2
The self-limited nature of childhood bruxism means that watchful waiting is appropriate for most cases, with no specific treatment required unless complications develop. 1
Sleep Hygiene and Behavioral Modifications
Bedtime should be relaxed and enjoyable, with mental stimulation and physical activity limited before going to bed, as stress and anxiety are considered dominant factors leading to increased muscle tension in bruxism. 3, 1
The importance of sleep hygiene cannot be over-emphasized in managing childhood bruxism. 1
Causative or triggering factors should be eliminated if possible, including addressing emotional stressors that may contribute to teeth grinding. 1
When to Refer to a Pediatric Dentist
Dental referral is mandatory if significant tooth attrition, mobility, or fracture occurs. 2 Specifically, refer to a pediatric dentist when:
- There is abnormal tooth wear visible on examination. 1
- The child develops masticatory pain or fatigue, headaches, or tooth sensitivity. 2
- Oral infection or temporomandibular joint disorders are present. 2
- The child has oral habits that may require intervention to prevent or improve dental malocclusion. 4
Diagnostic Considerations
"Possible" sleep bruxism can be diagnosed based on parent or family member reports of tooth-grinding sounds during sleep occurring at least three nights per week for at least three months. 1
"Probable" sleep bruxism requires both the history of grinding sounds plus clinical findings such as abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or tongue/lip indentation. 1
While polysomnography is the gold standard for definitive diagnosis, it is not necessary or practical in most clinical settings due to high cost and technical requirements. 1
Treatment Modalities to Avoid in Children
Oral devices (occlusal splints) should be used with extreme caution in children, as the orofacial structures are still developing and the benefits and risks must be carefully weighed. 1 These devices are more appropriate for adults with frequent and severe bruxism. 1
Pharmacotherapy is not a favorable option and is rarely used in children for bruxism management. 1
Associated Conditions Requiring Evaluation
Consider that bruxism may be associated with other sleep disorders such as obstructive sleep apnea syndrome, and child bruxers may require careful medical evaluation to rule out such potential interactions. 5
Nocturnal enuresis (bedwetting) could be a predisposing factor for sleep bruxism in children, as it causes emotional stress and negatively impacts self-esteem; addressing the enuresis may help alleviate associated bruxism. 5
Common Pitfalls
Do not rush to aggressive interventions such as occlusal splints or pharmacotherapy in children, as current evidence on effective interventions for childhood sleep bruxism is inconclusive and there is insufficient evidence to make recommendations for specific treatment. 1
Avoid attributing bruxism solely to occlusal factors, as there is limited evidence supporting the role of occlusal disorders in the etiology of sleep bruxism. 6
Do not overlook the psychological component—stress reduction and addressing emotional triggers are key components of management. 2, 3