Is Stress Ruining Your Smile? Doctor Explains Bruxism in Children

What is Bruxism and How Prevalent is it in Children?

According to Dr Saxena, “Bruxism is a condition having repetitive non-functional, involuntary grinding or clenching of teeth, either during sleep (nocturnal bruxism) or wakefulness (awake bruxism).”

Epidemiologic studies report the prevalence of bruxism in children between ~4% and 40%, often clustering around 14–20% among school-aged children. “Children who brux usually begin at 4–8 years of age, the numbers increase between 10 and 14 years of age, and then start declining after the age of 14 years,” she added.

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What Triggers Bruxism in Children?

Bruxism is now understood as a multifactorial biopsychosocial condition, combining central nervous system regulation, genetics, sleep architecture, and psychosocial stressors, rather than poor bite or malocclusion alone. 

Dr Saxena explained, “Stressful events such as parental divorce, moving, new school or sibling birth were reported to have a strong link to bruxism. Psychosocial stress elevates autonomic arousal and sympathetic activity, especially during REM sleep, which may precipitate grinding episodes. Emotional tension, thus, may manifest physically as jaw muscle hyperactivity.”

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Early Signs and Symptoms of Bruxism to Look Out For

Grinding during sleep that makes some noise, flattened teeth, a sore jaw when waking up, and even some headaches are some of the warning signs. Other children also portray symptoms such as biting their cheek, indentation on the tongue, disrupted sleep, or snoring. Dr Saxena advised to look for signs like:

 Parental/clinical warning signs:

• Audible teeth grinding noises during sleep, especially repetitive noise episodes or jaw clenching, are seen by the caregiver.
• Clinical features: worn-down teeth or enamel wear, indentations on tongue or cheeks, tension or hypertrophy of masseter muscles, morning jaw discomfort or headaches, reduced mouth opening.
• Associated signs: restless sleep, drooling, sleep talking, or snoring, common co-occurring parasomnias.

Risk Factors of Bruxism:

Look for Bruxism Risk Factors such as:

• Excessive anxiety.
• Excess of beverages containing caffeine (coffee, chocolate, and cola), cigarettes, narcotics, and the intake of any psychotropic drugs. 

Diagnostic criteria, according to the American Academy of Sleep Medicine review, to diagnose possible sleep bruxism, the criteria include parent-reported grinding sound ≥3–5 nights per week over 3–6 months, plus at least one clinical sign (tooth wear, muscle discomfort, hypertrophy). 

Long-term Effects of Bruxism

When not treated, bruxism may cause:

• Rubbing off the enamel of teeth. 
• Causes swelling of the jaw muscles.
• Develop a chronic jaw pain.
• Discomfort and Fatigue

Dr Saxena elaborated, “Yes, untreated bruxism affects a child’s dental development or causes long-term oral damage. Excessive tooth wear: Attrition of occlusal surfaces, even primary teeth, may occur prematurely. Hypertrophy of the masseter muscles occurs with voluntary forceful clenching. Discomfort, fatigue, or pain in the jaw muscles, transient, morning jaw-muscle pain and headaches.”

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What are the Treatment Options for Bruxism?

a) Stress-reduction & Behavioural Interventions: 

• Identify and reduce environmental stressors (exams, life changes).
• Behavioural therapy or child-appropriate cognitive-behavioural techniques to reduce anxiety.
• Address associated oral habits like nail biting or cheek chewing as stress outlets.

b) Protective Devices: 

• Occlusal splints/night guards: thin soft splints (fabricated or over-the-counter) protect teeth from wear, even though direct efficacy evidence is limited in young children.

c) Biofeedback & Emerging Tech: 

• EMG or sensory-feedback devices that gently alert the child to clenching episodes show promise in pilot studies, but large-scale efficacy data are still lacking.

 d) Medical Options (rare, only under specialist guidance): 

• Medications are rarely used in children except in severe, refractory cases.

 e) Address Comorbid Conditions:

•  If sleep‐disordered breathing (snoring, tonsil hypertrophy, mouth breathing) or ADHD/depression is present, treat the underlying cause; treating sleep apnea, for instance, may reduce bruxism episodes.

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Conclusion: Avoidable and Treatable

Bruxism, while not being a life-threatening disease, is a life-altering one that can cause serious health implications. However, it is not an untreatable problem, and treatments are available. Moreover, the biggest change that can stop bruxism early on is changing things at home, listening to your child and reducing their stress.