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Treatment Approaches for Bruxism in Children

Sleep problems are frequent among healthy school going children seen at general pediatric practice. Sleep related problems were reported in 42.7% children that included nocturnal enuresis (18.4%), sleep talking (14.6%), bruxism (11.6%) nightmares (6.8%), night terrors (2.9%) snoring (5.8%) and sleepwalking (1.9%). Bruxism is a destructive habit. It is defined as the nonproductive diurnal or nocturnal clenching or grinding of the teeth.

Bruxism happens in about 15 percent of youngsters and in as many as 96 percent of grown-ups. The etiology of bruxism is unclear. It has been linked with stress, occlusal disorders, allergies and sleep positioning. In addition, type A personality behavior combined with stress is more predictive of bruxism. Because of its nonspecific pathology, bruxism may be difficult to diagnose.

Beside complaints from sleep partners, clenching-grinding, sleep bruxism, myofacial pain, craniomaxillofacial musculoskeletal pain, temporomandibular disorders, oro-facial pain, fibromyalgia, and chronic fatigue spectrum disorders are linked. The main clinical signs of bruxism comprise tooth wear, tooth mobility, hypertrophy masticatory muscles, and tender joints. Other symptoms of bruxism are multiple and diverse. They include temporomandibular joint pain and dysfunction, head and neck pain, erosion, abrasion, loss of and damage to supporting structures, headaches, oral infection, tooth sensitivity muscle pain and spasm, disturbance of aesthetics, and interference and oral discomfort.

Treatment for bruxism may be simple or complex, depending on the nature of the disorder. Severe bruxism disorders are difficult to treat and their prognoses also may be questionable. Children with bruxism are generally managed with observation and reassurance. Most of the children’s bruxism habit will disappear naturally as they grow up. Adults may be managed with stress reduction therapy, modification of sleep positioning, drug therapy, biofeedback training, physical therapy and dental evaluation. Correction of the malocclusion with orthodontic procedures, restorative procedures, or occlusal adjustment by selective grinding will not control the bruxism habit.

What about prevention? Researchers have found only a weak correlation between different types of morphologic malocclusion such as Class II and III molar relationship, deep bite, overjet, and dental wear or grinding. Moreover, there is no correlation between periodontal disease and bruxism in children. Because the malocclusions’ status in children does not increase the probability of bruxism, early orthodontic treatment (braces) to prevent bruxism is not scientifically justified.

Bruxism is a destructive habit that may result in severe dental deterioration. Bruxism in childhood may be a persistent trait. The occlusal trauma and tooth wear in childhood bruxism can be succeeded by increased anterior tooth wear 20 years later. If your child has significant tooth attrition, dental mobility or tooth fracture may happen. Therefore, it is mandatory to take your child to your dentist for evaluation of bruxism.

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Understanding and fighting TMJ

A self-described fan of bubblegum, Norma Pelt has paid a high price for her love over the years.

Along with dizzy spells and a constant pain in her jaw, she said, repetitive chewing triggered powerful headaches, especially at night.

“It’s been very painful,” she said, describing her condition, which began 15 years ago, and was only recently diagnosed, during a flare-up, as a temporomandibular joint and muscle disorder.

The umbrella term refers to a group of conditions that cause varying degrees of pain and dysfunction in and around the temporomandibular jaw joint and the muscles that control their movement on each side of the head.

The National Institute of Dental and Craniofacial Research estimates about 10 million Americans have symptoms associated with these disorders, with 5 percent to 15 percent, like Pelt, experiencing the most common ones: pain and restricted jaw movement, often accompanied by a clicking or popping sound.

Women in their reproductive years are now considered nine times more likely to develop a TMJ disorder than men — a finding reshaping traditional assumptions about the causes lying behind these conditions, according to Dr. Christian Stohler, dean of the University of Maryland Dental School in Baltimore, Md.

“A lot has changed on the TMJ front in the last 15 years,” he says. “Today, we realize this is a highly complex disease involving many genes, hormones and a myriad of complex biologic factors.”

Although a number of existing treatments bring pain relief for most patients, Stohler says, they do not deal with the underlying disease process, a complex interplay of biologic factors that go beyond a misalignment of teeth or bite problems, once held solely responsible for these disorders.

They include genetic differences in pain perception or how an individual responds to pain, and the frequent presence of other painful conditions, such as fibromyalgia or rheumatoid arthritis, among others, which may mask or modify the symptoms of a TMJ problem.

“Most of these cases do resolve on their own, but some people suffer for years,” Stohler said. “And the more severe the case, the greater the likelihood that TMJ will coexist with other medical problems.”

In Pelt’s case, her jaw condition is moderate, according to her dentist, Dr. Michelle Dorsey, a solo practitioner on Merritt Island, Fla., who is centering treatment around a computer-guided sensing device, made by Tekscan.

“It tells me which tooth is hitting which tooth and with what force over time,” says Dorsey.

As part of her therapy, Pelt wears a customized splint at night.

The splint doesn’t just protect the teeth from being worn or cracked, Dorsey said, but it takes the pressure off the closing muscles in the mouth so they can relax and lengthen over time, allowing the joint to sit comfortably in the socket without pain.

“This is a process that takes time,” she says, with patients typically coming in for an hour once a week, possibly for many months. “It’s similar to physical therapy when you sprain your leg.”

As a dentist on the front lines, Dorsey said, she became interested in the jaw-pain disorders when she began developing her own problem, in which her teeth began to shift unexpectedly, leaving open areas of contact in her mouth.

Although she had no pain, she said, she had problems with food lodging in her teeth, which became “very annoying.”

So she decided to learn more about TMJ, studying “occlusion training” at the Dawson Academy in St. Petersburg, Fla., where she also underwent treatment, and a 25-month course at the University of Florida.

“I’ve seen about an 80 percent improvement in my own case, so far,” Dorsey says.

Pelt, too, said the subtle changes in her mouth during the past few months have begun to ease the pain.

“I’m not waking up with headaches any more and the dizziness has gone away,” says Pelt. “Since coming here, I’ve been much better.”

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Treatments for TMJ

In late 2005, the National Institutes of Health launched a seven-year clinical study to identify risk factors that contribute to the development of these jaw and muscle disorders.

During the study, which will track 3,200 healthy volunteers to see how many develop these conditions, scientists hope to get a clearer picture of early disease. That knowledge could lead to new approaches to treatment, refinements in diagnostic criteria and an ability to predict a person’s natural genetic susceptibility to chronic pain disorders or personalized medicine.

Closer to clinical use today are a number of designer drugs “that go to the heart of pain,” says Dr. Harold Menchel, a dentist who runs the TMJ & Facial Pain Institute in Broward County. “There’s a lot of newer biochemical stuff coming out.”

For now, however, in the absence of physician agreement over which treatments work best, and an array of doctors who treat TMJ — from rheumatologists, oral surgeons and dentists to neurologists and ear, nose and throat specialists — Menchel says a conservative, nonsurgical approach is warranted.

“In most cases, TMJ is a self-limiting entity,” he says, meaning they go away with minimal treatment over time. Only the most severe cases, about 5 percent, require surgical bite correction, Menchel said

“We shouldn’t do anything permanent,” Menchel stressed. “You treat the pain discomfort and restore function as best you can and as simply as you can — that’s the gold standard.”

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