One of the most common questions that I get asked by parents is if their child grinding their teeth at night is worrisome. Grinding occurs when someone forcefully rubs the surfaces of their teeth together (either consciously or unconsciously) and creates a type of gritty noise (usually quite loudly). Many parents state to me that the noise can be so loud that they can hear it in another room and this of course concerns them that the child is actually damaging their mouth and teeth. It is also important for parents to know that, while the noise can certainly be unmistakable, it is possible for children to silently grind their teeth. While there have not yet been conclusive answers to determine why this happens or even a for sure way to predict if and when this will stop for your child; there are some things that parents should know. There has been a growing amount of research in the area that is both helpful and comforting to hear and this is what I will be sharing with you today, read on to have some of these common questions answered!
Is Grinding Normal Or Should I Worry?
The simple answer is that, yes grinding is normal, and for the most part you should not be worried about your toddler or young child. While grinding can occur in both children and adults, it is significantly more common in children. Not only this, but grinding also happens to be much more common in a person's sleep than it is during the daytime hours 1. Although many research studies vary in their reported percentage, night time grinding in children has been reported to be present in up to 88% of children 1. It is so common in fact that in my dental practice it is one of the questions that every new patient/parent gets asked so it can be noted and followed in the chart. In my 7 years of experience exclusively seeing children, I would say upwards of half of my patients have reports of night time grinding. Of this population of my own patients only once have I ever had to intervene with dental treatment to fix damaged teeth from grinding. What I typically say is that the noise is usually "All bark and no bite" ( no pun intended haha). By saying this I mean that although the noise can be very loud and worrisome to hear, typically the child is not doing excessive damage to the teeth. What dentists look for when examining a child for bruxism (the medical term for grinding) is to see if there are areas of wear that exist. These areas would appear and flattened, shiny, and even cupped out areas on the teeth. If the dentist sees such areas a closer exam is done to look for any signs of the tooth structure wearing close to the nerve which would appear on the tooth as a pink-red or greyish area near the center of the tooth. If wear near the nerve is found, the child will need to be closely monitored by the dentist and dental treatment may be necessary. Most children do seem to outgrow or diminish their grinding as their permanent first molars reach full occlusion, this differs from child to child but the average age being about 8. If your child still continues to grind heavily after this age, or if you see signs of wear on the permanent teeth, this is another instance when dental intervention is required.
Why Does My Child Grind?
While the reasons for grinding are extremely variable, there are several explanations that are agreed upon by many doctors and researchers. The first and most talked about explanation is that some children grind their teeth as a type of coping mechanism when going through certain emotional and psychological conditions such as stress, hyperactivity, and anxiety 2. Along these lines, if there are any recent major life changes such as moving homes or schools, a new sibling, death of a loved one; this may also trigger nocturnal bruxism. Another possible explanation is if a child has fairly crowded teeth or a crossbite, this can cause a type of pressure in the mouth that can trigger a neurologic impulse to grind 5. Yet another possible explanation can be summed up as a child's genetic makeup makes them more predisposed to grinding. Now, what specifically in the genes causes this is unknown but there does seem to be a familial disposition to grinding 4. And lastly,there have been certain medical conditions that are linked to bruxism and below I will talk about this a but further.
Is There Anything I Can Or Should Do?
Keep a close eye on changes to the appearance of your child's teeth, teeth should look as though they have "hills and valleys" as opposed to being flat straight across the surface. If your child tells you that their teeth hurt or that they are sensitive, you should always report this to your dentist even if it seems minor as it is typically much easier to help with a problem when it is caught early on. Another thing to watch for is your child reporting soreness or pain with the teeth or jaw muscles early in the morning as this can be a sign that they grind or clench at night, even in absence of you hearing it. And lastly, if your child has a chip on their tooth (especially without a known fall or bump to the face) then this should be reported to your dentist as well as this could be due to forceful grinding or clenching the teeth which can lead to a tooth chip. Regarding treatment options, most likely your dentist will reassure you that all is well and no treatment is indicated (unless the teeth are painful or the tooth nerve is involved) for the baby teeth. More concerning would be effects that begin to show up on permanent teeth, this may require your child wearing a device called a night guard which can prevent the grinding from damaging the surfaces of the permanent teeth. Typically night guards are not indicated for baby teeth or in young children as it can pose a choking hazard however your dentist will talk to you about the options so together you can choose what is best.
Can My Child's Grinding Be Associated With Any Other Medical Conditions?
Again, while there are no definitely answers to bruxism, there are groups of people that it seems to effect more than others. It is significantly more common in the special needs population, mostly with non verbal patients. This includes, but is not limited to, those with Cerebral Palsy, Autism, Down Syndrome, and those with conditions that require a child to be fed through a G-Tube or do not eat food by mouth 3 6. The reasons why there is a higher prevalence of grinding in this population can be due to any of the following factors: smaller skeletal structure, extreme crowding and malocclusion, hyperactive or skeletal musculature, or need for oral stimulation 3.
Some people have also associated bruxism with parasitic infections however no concrete evidence supports this 7. If you have reason to believe your child may be suffering from a parasitic infection or your child also displays symptoms of stomach pain, diarrhea, vomiting, or fatigue; be sure to speak with your child's physician so they can take the necessary steps to determine if this is the case.
For more information on techniques you can try to help your child with bruxism be sure to read this article from Kidshealth.org and to read more about what the American Academy of Pediatrics has to day about childhood bruxism be sure to read this article
1. Vieira- Andrade G. Racquel, Drumond L. Clarissa, Martins-Junior A. Paulo, et.al. Prevalence of sleep bruxism and associated factors in preschool children. 2014. Pediatric Dentistry 36(1) 46-50(5).
2. Cheifetz Andrew T., Osganian Stavroula K., Allred Elizabeth N., Needleman Howard L. Prevalence of bruxism and associated correlates in children as reported by parents. 2005. Journal of Dentistry For Children. 72(2) 67-73(7).
3. Santos, Maria Teresa Botti Rodrigues dos; Masiero, Danilo; Novo, Neil Ferreira; Simionato, Maria Regina Lorenzetti. Oral conditions in children with cerebral palsy. 2003. Journal of Dentistry For Children. 70(1) 40-46(7).
4. Lobbezoo F., Visscher CM., Ahlberg J., Manfredini D. Bruxism and genetics. A review of the literature. Journal of Oral Rehabilitation. 2014. Sep; 41(9):709-14.
5. Kataoka K., Ekuni D., Mizutani, S., et.al. Association between self-reported bruxism and malocclusion in university students: a cross-sectional study. Journal of Epidemiology. 2015. 25(6): 423-30.
6. Ella B., Ghorayeb I., Burbaud P., Guehl D. Bruxism in movement disorders: a comprehensive review. Journal of Prosthodontics. 2017. Oct.;26(7):599-605.
7. Diaz-Serrano, Kranya Victoria; Silva, Carolina Brunelli Alvares da; Albuquerque, Sergio de; et.al. Is there an association between bruxism and intestinal parasitic infestation in children? 2008. Journal of Dentistry For Children. 75(3) 276-279 (4).
Dr. Mikaeya Kalantari has been a practicing pediatric dentist for over 7 years working in both the children's hospital setting and private practice. She has had a wealth of experience treating children of all ages, and medical conditions. When it comes to serving children, she feels the importance of communication between the dentist and parent can not be emphasized enough. Dr. Kalantari practices in her family owned dental office in Mission Viejo, California.