Evaluation and Management of Sleep Bruxism in Children
Sleep bruxism in children is typically self-limited and does not require specific treatment; focus on identifying and eliminating causative factors while emphasizing sleep hygiene, with oral devices reserved only for severe cases in older children due to developing orofacial structures. 1
Diagnostic Approach
Clinical Diagnosis Criteria
The diagnosis of sleep bruxism in children relies primarily on:
- Parental reports of frequent tooth grinding sounds during sleep (at least 3 nights per week for at least 3 months) 1
- Clinical examination findings including abnormal tooth wear, masseter muscle hypertrophy or tenderness, tongue/lip indentation, transient morning jaw muscle fatigue or pain, temporary headache, or jaw locking on awakening 1
- Polysomnography is the gold standard but is not practical for routine clinical use due to high cost and technical requirements 1
Critical Screening for Underlying Conditions
Evaluate for conditions that commonly co-occur with or trigger bruxism:
- Screen for sleep-disordered breathing and obstructive sleep apnea by assessing for tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction—these three findings have a synergistic effect, with 90.9% of children having all three presenting with bruxism 2
- Assess for mouth breathing (awake or asleep), snoring, difficulty breathing, or gasping during sleep 2
- Evaluate for nocturnal enuresis (bedwetting), which causes emotional stress and may predispose to bruxism 3
- Screen for psychosocial distress and behavioral problems, as 40% of children with bruxism have elevated attention and behavior problems that correlate with arousal frequency 4
Management Strategy
First-Line: Conservative Approach
Reassurance and sleep hygiene are the cornerstones of management:
- Educate parents that childhood sleep bruxism is typically self-limited and resolves without intervention 1
- Implement strict sleep hygiene: bedtime should be relaxed and enjoyable, with limited mental stimulation and physical activity before bed 1
- Eliminate identified causative or triggering factors such as treating sleep-disordered breathing, addressing enuresis, or providing psychological support for stress 1, 3
When to Consider Oral Devices
Oral devices should be considered cautiously and only in specific circumstances:
- Reserve for frequent and severe bruxism that does not respond to conservative measures and is causing significant tooth damage 1
- Carefully weigh benefits versus risks in children, as orofacial structures are still developing 1
- The primary goal is tooth protection, not bruxism cessation 1
Avoid Pharmacotherapy
Pharmacological treatment is not recommended and is rarely used in children due to lack of evidence and potential adverse effects 1
Important Clinical Pitfalls
Do not overlook the association between bruxism and sleep disturbances:
- Children with bruxism have significantly higher arousal indices (36.7 vs 20.7 in controls), which may contribute to daytime attention and behavior problems 4
- Bruxism occurs most frequently in stage 2 and REM sleep, with arousals in 66% of cases 4
Do not miss comorbid sleep disorders:
- The synergistic effect of tonsillar hypertrophy, restricted tongue mobility, and nasal obstruction increases bruxism incidence from 8.6% (none present) to 90.9% (all three present) 2
- Treating underlying sleep-disordered breathing may resolve the bruxism entirely 3, 2
Recognize the behavioral impact:
- Children with bruxism are at higher risk for sleep disturbances based on Sleep Disturbance Scale for Children scores (45.1 vs 34.8 in controls) 2
- Addressing bruxism may improve daytime functioning, including attention and behavior 4
Current Evidence Limitations
There is insufficient evidence to recommend specific treatments for sleep bruxism in children at this time 1. The prevalence ranges widely from 13% to 49%, and while physiotherapy and psychotherapy are suggested, robust clinical guidelines for treatment and prophylaxis remain underdeveloped 5.