How should I manage a child's nighttime bruxism?

Management of Childhood Nighttime Bruxism (Teeth Grinding During Sleep)

In most children, sleep bruxism is self-limited and requires only observation, reassurance, and optimization of sleep hygiene without specific treatment. 1, 2

Initial Assessment and Diagnosis

The diagnosis of sleep bruxism in children is primarily clinical and should include:

• Reports from parents or caregivers of grinding sounds during sleep (at least 3 nights per week for 3 months meets diagnostic criteria) 2
• Clinical examination for tooth wear, abnormal attrition, or tooth mobility 1, 2
• Assessment for morning jaw muscle fatigue, pain, or temporary headache 2
• Evaluation for hypertrophy or tenderness of masseter muscles and tongue/lip indentation 2

While polysomnography is the gold standard for definitive diagnosis, it is not necessary or practical in most clinical settings due to cost and technical requirements. 2

Identify and Address Underlying Contributors

Before initiating any specific treatment, evaluate for conditions that may trigger or worsen bruxism:

• Screen for sleep-disordered breathing and obstructive sleep apnea, as these commonly co-occur with bruxism and require separate management 3
• Assess for nocturnal enuresis (bedwetting), which can cause emotional stress that predisposes to bruxism 3
• Evaluate for anxiety, stress, or emotional factors that may be contributing 1, 4
• Review sleep positioning and sleep hygiene practices 1

First-Line Management: Observation and Sleep Hygiene

For most children with sleep bruxism, active intervention is not required:

• Provide reassurance to parents that childhood bruxism is typically self-limited and resolves without treatment 1, 2
• Implement excellent sleep hygiene: bedtime should be relaxed and enjoyable, with limited mental stimulation and physical activity before bed 2
• Establish consistent bedtime routines with fixed sleep and wake times 5
• Eliminate causative or triggering factors when identified 2

When to Consider Additional Interventions

Additional treatment should only be considered if there is:

• Significant tooth attrition, mobility, or fracture (requires mandatory dental referral) 1
• Persistent masticatory pain, fatigue, or temporomandibular joint disorders 1
• Severe symptoms not responding to conservative measures 1

Treatment Options for Severe Cases

If conservative management fails and symptoms are severe:

• Dental referral for evaluation and possible occlusal splint/oral device to protect teeth from further damage, though the benefits and risks must be carefully weighed in children since orofacial structures are still developing 1, 2
• Physiotherapy and psychotherapy are the recommended therapeutic approaches for persistent sleep bruxism in children 4
• Stress reduction therapy and relaxation exercises can improve bruxism symptoms 1, 6
• Biofeedback training may be considered in older children 1

Important Caveats

Pharmacotherapy is not a favorable option and is rarely used in children due to lack of evidence and potential risks. 2 Current evidence on effective interventions for managing sleep bruxism in children remains inconclusive, and there is insufficient evidence to recommend specific treatments beyond observation and sleep hygiene. 2, 4

Oral devices should be used cautiously in the pediatric population because orofacial structures are still developing, and the long-term effects on dental and jaw development must be considered. 2