Bruxism is a chronic clenching of the jaws and grinding of the teeth that affects many children, especially those under the age of 5. It occurs when children grind, clench or gnash their teeth. Bruxism tends to occur most often during deep sleep, particularly in the early part of the night. In addition, bruxism may occur during waking moments when a child feels particularly stressed or anxious.

The exact cause of bruxism remains unknown. It is more common in children whose top and bottom teeth are not aligned properly (malocclusion). Stress is also suspected as a major contributor to bruxism.

In most cases, bruxism is a minor condition that poses no real health threat to a child. However, in more severe cases, bruxing can cause morning jaw pain, headaches, or earaches. In extreme cases, tooth enamel may begin to wear down, exposing the inner surface of the teeth (dentin). Teeth also may become flattened or chipped.

Parents who notice signs of bruxism in their children are urged to schedule an appointment with the child’s dentist. In some cases, signs of bruxism – such as wearing of the teeth – may be noticed by the dentist during a routine dental exam.

Most cases of bruxism require no treatment and children are likely to outgrow the condition by age 10. However, treatment is necessary in more severe cases to prevent symptoms such as jaw pain or destruction of tooth enamel. A custom-fit mouth guard can protect the teeth during sleep. In rare cases, when children are highly stressed, they may benefit from psychotherapy or medication. As a last resort, orthodontics or even surgery may be performed to realign a child’s bite.

Bruxism is a chronic clenching of the jaws and grinding of the teeth that affects many children. Children under 5 have the highest rates of bruxism, which is particularly likely to involve the back teeth. In addition, many children who clench their teeth also grind them in a sideways, back-and-forth movement. Both clenching and grinding put pressure on the muscles, tissues and other structures surrounding the jaw. This may lead to jaw and ear pain, wearing down of the tooth enamel and other symptoms.

Bruxism tends to occur most often during deep sleep, particularly in the early part of the night. Many children are not aware that they clench or grind their teeth overnight. Bruxing may also occur during waking moments when a child feels particularly stressed or anxious. Girls and boys experience bruxism equally, although girls may be more likely to clench their teeth.

For reasons that are not completely understood, children tend to grind their teeth with less frequency as they get older. Most children stop grinding and clenching their teeth by age 10, after their permanent teeth erupt. Permanent teeth are more sensitive to pain than baby teeth, and this may discourage bruxing. However, other children continue to grind their teeth into adolescence and/or adulthood.

The exact cause of bruxism remains unknown, but it appears to occur more often in children whose top and bottom teeth are not aligned properly (malocclusion). Stress and suppressed frustration are suspected as major contributors to bruxism. Children may tend to grind their teeth more often before a big test or before a stressful event, such as an impending move to a new city. Friction with family or friends and general feelings of anxiety also can trigger bruxing. 

Some children may grind or clench their teeth in response to pain, such as the discomfort that accompanies earaches. Experts believe such clenching may be soothing to children in discomfort.

Children who have been diagnosed as hyperactive may be at increased risk for bruxism. It also is more common in children with medical conditions such as cerebral palsy and severe mental retardation. Use of antidepressants has been associated with some rare cases of bruxism.

In many cases, children will not experience any symptoms despite grinding their teeth or clenching their jaw. Parents who check in on their children during sleep, or siblings who share a room, may notice a grinding sound.

Problematic bruxing occurs most often in adults. However, some children also may experience symptoms that can become a health problem. Morning jaw pain, headaches, or earaches are sometimes associated with bruxism. In extreme cases, tooth enamel may begin to wear down, exposing dentin. Teeth also may become flattened or chipped. Other complications associated with severe bruxism include:

• Chewed tissue inside the cheek
  
  
• Increased tooth sensitivity to hot and cold
  
  
• Severe facial pain
  
  
• Jaw problems such as temporomandibular joint disorder (a disorder that occurs in the joints just in front of the ears)
  

Parents who notice signs of bruxism in their children are urged to consult with the child’s dentist. In other cases, signs of bruxism – such as wearing down of the top surfaces of the teeth – may be noticed by the dentist during a routine dental exam.

The dentist also will check for tenderness in the jaw muscles and other abnormalities of the mouth and jaw. X-rays may be ordered. If the dentist suspects bruxism, the child and parents may be asked several questions, such as:

• How does the child feel prior to bedtime?
• What does the child do prior to bedtime?
• Is the child worried about anything in particular?
• Is the child angry at someone or about something?

The dentist’s questions are designed to help determine whether a child’s bruxism is related to an anatomical problem such as misaligned teeth or an emotional problem such as excessive stress. This will help the dentist to come up with a more effective treatment plan.

In most cases, children outgrow bruxism without the need for treatment. However, treatment is sometimes necessary to prevent symptoms such as jaw pain or destruction of tooth enamel. When treatment is required, it focuses on managing clenching and grinding behaviors to the greatest extent possible.

Children who experience pain or wearing of the dental enamel may need to wear a custom-fitted mouth guard that protects their teeth during sleep. These mouth guards – also known as occlusal splints or nightguards –are usually effective in protecting a child’s teeth. There are many different types. Some fit over the top teeth, while others fit over the bottom teeth. Some are made of a soft rubbery material while others are made of a hard plastic material.

Over-the-counter mouth guards also are available and are less expensive than custom-made guards. However, they may not fit as well around the teeth and can dislodge during grinding or clenching.

In rare cases, children may be so stressed that they may benefit from psychotherapy and possibly medication. Children who learn techniques to better manage anxiety are likely to reduce their clenching and grinding.

Stress is believed to be a major contributor to bruxism. Parents can help reduce the incidence of grinding and clenching by encouraging their children to develop relaxation methods. Prior to bedtime, children can be encouraged to take a warm bath, listen to relaxing music or read a favorite book.

Parents are also urged to encourage their children to discuss any problems or concerns the children may be experiencing in their day-to-day lives. Helping children address such frustrations can go a long way toward reducing clenching and grinding.

In addition, parents are urged to encourage their children to engage in certain practices that will both relieve pain and discourage clenching and grinding. These include:

• Relax facial and jaw muscles during the day
• Apply warm moist compresses to sore muscles
• Avoid eating hard or chewy foods like nuts, candies and steak
• Drink plenty of water
• Get plenty of sleep

Preparing questions in advance can help patients and parents to have more meaningful discussions with their physicians regarding their or their child’s treatment options. The following questions related to bruxism may be helpful:

1. How can I discover whether or not my child is bruxing?
   
   
2. My child complains of jaw pain. Should I schedule an appointment with a dentist or with a pediatrician?
   
   
3. How will you diagnose my child’s bruxism?
   
   
4. What is the likely source of my child’s bruxism?
   
   
5. Why do you suspect that my child’s bruxing is serious enough to require treatment?
   
   
6. What are my child’s treatment options? What are the risks or drawbacks?
   
   
7. What are the potential consequences if my child’s bruxism is left untreated?
   
   
8. How can I teach my child to better relax?
   
   
9. What other steps can my child take to discourage bruxing?
   
   
10. Will my child eventually require orthodontics or surgery to straighten out his/her bite?