What is the recommended treatment approach for a child diagnosed with sleep bruxism?

Sleep Bruxism in Children: Recommended Treatment Approach

Sleep bruxism in children is typically self-limited and does not require specific treatment; management should focus on eliminating triggering factors, optimizing sleep hygiene, and providing reassurance to parents, with intervention reserved only for cases causing significant complications. 1

Initial Assessment and Diagnosis

Diagnosis relies primarily on parental report of tooth-grinding sounds during sleep combined with clinical examination findings such as abnormal tooth wear, masseter muscle hypertrophy or tenderness, and tongue/lip indentations. 1, 2 Polysomnography, while the gold standard, is not practical or necessary in most clinical settings due to high cost and technical requirements. 1

Key Clinical Findings to Assess:

• Tooth wear patterns and fractures 2
• Masseter muscle hypertrophy or tenderness 1
• Tongue or lip indentations 1
• Temporomandibular disorders or jaw locking upon awakening 1
• Morning jaw muscle fatigue, pain, or headaches 1

First-Line Management: Conservative Approach

Sleep Hygiene Optimization

The cornerstone of management is improving sleep hygiene, as sleep disturbances are among the most strongly associated factors with pediatric bruxism. 2

• Establish relaxed, enjoyable bedtime routines 1
• Limit mental stimulation and physical activity before bed 1
• Address underlying sleep disturbances including sleep-disordered breathing, which may contribute to bruxism 2

Identification and Elimination of Triggering Factors

Screen for and address associated conditions including:

• Psychosocial stressors and anxiety 2
• Parafunctional habits 2
• Sleep-disordered breathing or obstructive sleep apnea 2
• Behavioral and personality factors 2

When to Consider Intervention

Active treatment is indicated only when complications arise from bruxism, not for bruxism itself. 3 Most cases in childhood are self-limited and resolve without intervention. 1

Protective Oral Appliances

For children with frequent, severe bruxism causing significant tooth damage who do not respond to conservative measures, oral appliances may be considered to protect teeth from further damage. 1 However, the developing orofacial structures in children require careful consideration of benefits versus risks before using oral devices. 1

Pharmacological Options (Rarely Used)

Pharmacotherapy is not a favorable option and is rarely used in children. 1 Limited evidence exists:

• Hydroxyzine showed the strongest efficacy in reducing sleep bruxism symptoms (OR 10.63; 95% CI, 1.48-76.08) in meta-analysis 4
• Flurazepam and Melissa officinalis showed lower grades of association with decreased symptoms 4
• Botulinum toxin to masticatory muscles may reduce bruxism frequency in adults but concerns exist regarding adverse effects, and this approach is not established in children 3

Evidence Limitations and Clinical Reality

Current evidence on effective interventions for sleep bruxism in children is inconclusive, with insufficient evidence to make recommendations for specific treatment. 1 The prevalence varies widely from 13% to 49% in different studies, reflecting diagnostic challenges. 5

Conservative approaches are strongly recommended given the self-limited nature of childhood bruxism and lack of evidence for active interventions. 2 Management should follow a biopsychosocial model, addressing sleep quality, stress, personality traits, and any associated headaches. 2

Parental Education and Follow-Up

Educate parents that childhood bruxism is typically benign and self-resolving. 1 Focus counseling on:

• Recognition that most cases do not require treatment 1
• Importance of sleep hygiene measures 1
• Monitoring for potential complications including significant tooth wear or temporomandibular symptoms 2
• When to seek further evaluation if symptoms worsen or complications develop 5

Common Pitfalls to Avoid

• Do not pursue irreversible occlusal adjustments, as they have no evidence basis in bruxism management 3
• Avoid routine polysomnography unless other sleep disorders are suspected, as it is impractical and unnecessary for diagnosis in most cases 1
• Do not initiate pharmacotherapy as first-line treatment given the self-limited nature and lack of evidence in children 1
• Recognize that oral appliances in children require special consideration due to developing dentition and orofacial structures 1