Q. I have two questions regarding teeth grinding and dental care. First, can teeth grinding be stopped or, if not stopped, at least lessened? Is teeth grinding harmful?
Frequently, as pediatric dentists, we receive reports from parents that their children, either periodically or continually, grind their teeth. Teeth grinding, appropriately called bruxism, is the forceful grinding of the teeth and clenching of the jaws.
It more commonly noticed at nighttime, and is often called "nightgrinding." Parents can actually hear the grinding quite a distance from the child's bedroom, and it is interesting that the children are not aware that they possess this habit. This is one of the most common oral habits that we know, and it is extremely common in children with Cornelia de Lange.
The habit of bruxism can be caused by either a physiological, psychological or a simple dental problem. Professionals feel that teeth grinding can be a response to nervous tension and stress, mainly occurring in children who are highly strung and irritable. It has also been found to be a response to a more physiological problem of anal pruritus or pinworms. The severe itching associated with this condition will frequently cause the child to grind the teeth, thereby producing a counterirritant to the itching.
We also must take into consideration various interferences of the teeth, that is, a poor coming together of the upper teeth and the lower teeth. The response to this could be in the form of grinding in an attempt to reach a comfortable bite. We also find that there are a great number of patients with severe head trauma and its associated brain damage also expressing a great deal of bruxism.
Many parents are concerned about the possible damages from continual bruxism. A moderate amount of wearing away of the tips of the baby molars can be noted on any child. Those children that grind their teeth can show a greater amount of "occlusal wear" which is the flattening of the back teeth.
This is not necessarily a severe problem in the baby teeth, but can be very damaging in the permanent teeth. The constant clenching and the changes in the bite can produce problems in the temporomandibular joint. This is the area immediately in front of the ears where the lower jaw relates to the skull. The joint that is right there can develop arthritis-like symptoms due to the excessive pressures produced by the clenching of the teeth. As the child grows older and enters the second and third decade, one could feasibly find some changes in the temporomandibular joint that could mimic middle ear infections, thus, be very difficult to diagnose.
Treatment of this condition depends upon a couple of factors. If the clenching and grinding of the teeth is periodic and is not a routine occurrence, then no treatment is necessary As stated be- fore, the mere clenching of the teeth and grinding can be a nor- mal phenomenon found to a certain extent in almost any child.
If the bruxing is a daily occurrence, either throughout the day or throughout the nighttime, and if there has been some belief that the child may be in discomfort because of this, then we would recommend that a consultation with your pediatric dentist would be in order. The dentist can fabricate either a soft or a hard "bruxism appliance." This is essentially a mouth guard that can either be made out of soft rubber or hard acrylic and can be worn in the mouth during those periods of heavy grinding. These retainers can minimize the amount of dam- age that may occur to both the teeth and/or the temporomandibular joint. Sometimes, the use of these appliances can even eliminate the oral habit.
It is extremely difficult to totally stop the bruxing habit, but if we can at least control the dam- ages that it can cause, we will have helped our children. One could also consult with the speech pathologist, occupational therapists and/or physical therapists for oral exercises that may help to reduce the tension around the oral areas. Sometimes, exercises can be of great help.
Where there are occlusal interferences or a poor coming together of the upper and lower teeth, the dentist can, many times, adjust the bite so that a comfortable bite is attained. This can often eliminate the heavy clenching.
With the many approaches to treatment, we must say again, that it is very difficult to eliminate this problem, but the main goal has to be to eliminate the harmful effects and assist the child so that he or she may be comfortable and that all long-term deleterious effects of the grinding are eliminated.