By: Dr. Jill Ombrello
Adult teeth grinding has been associated with stress, nerve damage, missing or damaged teeth or dental restorations, and anatomical and functional issues with the TMJ. More recently, as there has been an increase awareness of functional and sleep medicine, clinical researchers have also determined that there is a very high prevalence (77.8%) of sleep bruxism associated with patients presenting with obstructive sleep apnea syndrome[1] (“OSAS”; a syndrome most frequently associated with snoring and difficulty breathing at night).
So, if bruxism is associated with the stress and damage more often associated with an adult’s lifetime of function, why do young children and adolescents grind their teeth while their sleeping? Is that math test really that stressful? Is it genetic? Will they grow out of it? The answer is simple: NO!
Recent clinical research, as well as my own experience personally treating and overseeing the treatment of thousands of children have highlighted a clear correlation between sleep disordered breathing and teeth grinding. Teeth grinding can occur in a child as young as 2 years old, and unlike popular “soccer field sideline advice” you may hear from other parents, 90% of children will not grow out of this condition. In fact, over a third of the time, if left untreated, the clenching and grinding will actually get worse!
Why is childhood teeth grinding bad?
Well, to name just a few of the many side effects, bruxism can cause any number of the following:
Cracked teeth, causing pain, need for dental restoration or premature loss of tooth
Increased risk of cavities due to worn tooth enamel
Decreased vertical dimension of facial growth and development – this is a fancy way of saying that your teeth are supposed to be a particular height, and that height is critical for proper speech function, chewing and jaw function, and esthetically the human eye recognizes that there is a certain, natural length to a tooth that is both healthy and esthetically pleasing.
Decreased natural expansion, which leads to orthopedic and orthodontic crowding problems in the growing maxilla and mandible
Irreversible damage to pediatric and adult teeth
Why does grinding matter if the baby teeth are going to fall out eventually anyway?
This is actually a very logical question, and unless you’re either trained in the dental field OR you’ve been educated by a dental professional, I could easily see why a lot of parents do not prioritize baby teeth (clinically known as the “deciduous” teeth, or teeth that will be exfoliated). Making a case for the importance of baby teeth is only made more challenging because parents often partner with their pediatricians in understanding the health-related matters that are most important for their child at each developmental stage. Some physicians are spectacularly informed and make sure to either educate the parent(s) or encourage them to seek counsel of a trained dental professional; and some physicians have not had the opportunity or capacity to dig into the importance of baby teeth. This is not a finger-pointing blog; we understand that physicians have a lot to focus on and help their patients with, and it’s most likely not the individual healthcare providers’ fault, but more in line with the fact that the majority of medical schools only offer a lecture or two at best on dental health through the entire course of their on-average 8-year medical training career (insert eye roll emoji here).
Nonetheless, baby teeth are super important for a lot of different reasons. Below are some just to name a few:
Guiding bone growth to create space for the adult dentition, or teeth
Creating well aligned hard tissue structures that optimize myofunctional processes such as chewing, swallowing, and speaking
Supporting proper TMJ growth and health function
Chewing, or masticating, a healthy diet that includes crisp fruits and vegetables
Esthetics that can contribute to a positive self-esteem
So while yes, it is true, most all baby teeth will eventually fall out and be replaced by adult teeth, if these baby teeth are lost prematurely or damaged severely, that can contribute to major issues within the adult teeth. Additionally, if left untreated, then the child will likely continue to grind his or her teeth once their adult teeth erupt. Symptoms connected to adult teeth grinding include ear and neck pain, jaw or TMJ dysfunction or pain or popping/clicking, muscle aches, swelling, cracked teeth, periodontal disease, among other chronic conditions and symptoms.
Ok. Hopefully now I’ve sufficiently convinced you of why grinding your teeth is bad and also why baby teeth are so important. Next step, I’m sure you might be curious how and why sleep disordered breathing causes pediatric bruxism.
I had a broader discussion of sleep disordered breathing in this blog here, if you want to read more about it (that blog also includes a custom infographic that I randomly decided to include a cartoon version of myself in for no other reason than I thought it looked cool ;) worth checking out, in my biased opinion).
But if you don’t want to go down that rabbit’s hole, here’s the reader’s digest version:
A newer research initiative over the last decade has focused on finding the root cause of so many of the common conditions and chronic symptoms with which our children are plagued and in some cases, diagnosed; these conditions and symptoms include chronic allergies, attention-deficit conditions, headaches, poor behavior or school performance, prolonged bedwetting, snoring, mouth breathing, eczema, restless sleep, nightmares and night terrors, aggressive behavior, depression, daytime drowsiness, swollen tonsils, and asthma.
What this new wave of research has shown is that most of these symptoms are caused by unhealthy sleep or bad habits that cause breathing disorders, which are exacerbated at night. But for decades, instead of the root cause being identified and properly treated, we’ve medicated our children. We’ve put band-aids on chronic symptoms, basically subscribing these kids to a lesser quality of life. I’m not trying to be dramatic, but taking a medication every day that can help symptoms of a chronic condition but also possibly introduce side effects while never actually addressing the root cause is major compromise in the quality of a lifetime.
More specifically, sleep disordered breathing is caused by an airway that is obstructed, jaws that are too small or misaligned, and/or poor oral habits or chronic inflammation causing mouth breathing. Proper sleep is hugely important for a host of different reasons, most notably overall cellular rejuvenation, endocrine and immune system regulation, and neural function. However, when the child is not breathing correctly while asleep, the body is very smart and will try to move the lower jaw around and forward to expand the airway that sits behind the mandible. And it is this lower jaw moving around and forward, searching for a healthier position, that presents itself as grinding. The teeth are just collateral damage to a very smart, intuitive body desperately working to get the airflow it needs in the way it needs it.
Below is a CBCT to help explain what is going on. In the left image, this adolescent has her mouth open, which causes the mandible (or lower jaw) to move down and back, restricting the airway. In the image on the right, the patient has closed her jaws in the proper position, allowing for a larger volume in the airway. We use this as an example, however you can imagine that when a child has an underdeveloped mandible, which can commonly be referred to as a major overbite or overjet, this airway is restricted, and so the lower jaw will move throughout the night trying to open up the airway and get the flow the body and brain need.
Ok. By now, I hope we are on the same page on the following points:
Baby teeth are important.
Teeth grinding may be normal, but it is not healthy.
The root cause needs to be treated because otherwise, a child will not “grow out of” this symptom but instead, it will get worse.The root cause of teeth grinding is almost always sleep-disordered breathing.
If we aren’t on the same page on these items, please leave a comment below or chat me up in the box in the bottom righthand corner of your screen and let me know what questions you have. Because I’m sure if you have a question or don’t fully understand a concept I’m trying to explain here, I’m confident there are other concerned parents out there who are still confused or unsure as to what’s going on. I’d love the opportunity to help address those questions, allowing me to help more parents and ultimately their kiddos in achieving new levels of health and wellness.
Assuming we are on the same page because I'm awesome and obviously would never leave anything out (this is me being sarcastic, btw; I do my best to explain, but I know there's always more I can do, so just let me know what's missing), that takes us to the last segment of this lovely little blog…
How can we treat the root cause of sleep disordered breathing, which will inadvertently address the teeth grinding?
The good news is that there is a simple solution. There are a variety of intra-oral appliances that can be prescribed by a dentist to a child for the successful treatment of this condition and associated symptom. Our Super Health for Kids Program uses a variety of different removable appliances, or mouth guards, that do the following:
Work to properly position the jaws, teeth, tongue, and other intra-oral and extra-oral muscles so that the airway is large and can support the airflow needed during sleep
Facilitate nasal breathing, which is the healthiest form of breathing (story for another day: Why mouth breathing is unhealthy; send me a message if you’d like me to write this blog sooner rather than later)
Beyond direct benefits associated with eliminating teeth grinding and restoring proper health, these appliances have additional benefits:
Expand the jaws to create space need for adult teeth, decreasing or eliminating entirely the need for traditional orthodontics
Decrease or eliminate any other chronic inflammatory symptoms your child might have been experienced that has gone undiagnosed or misdiagnosed (for example, allergies, ADHD, prolonged bedwetting, restless sleep, aggressive behavior, swollen tonsils, depression, asthma, eczema)Holistic therapy for optimal growth and development
Correction of speech issues and tongue thrusts
Elimination of finger sucking habits or other poor oral habits
How are these "intra oral appliances" any different than a sports mouthguard, or a mouthguard I can purchase at a drugstore?
What a great question, random hypothetical parent! It's almost as if I've had this conversation before and answered these common questions ;)
These therapeutic appliances are in fact quite different than traditional "mouth guards" that many have seen or known. The traditional mouth guards are typically flat plan, hard plastic that do little else than separate the upper and lower teeth, redistributing the biting force. While this may help decrease the symptom of grinding, it causes a lot more negative side effects than it does benefits. For a child especially, having a mouth guard that separates the upper and lower jaw can cause improper growth and development, leading to TMJ and orthodontic issues as the adult teeth erupt.
Additionally, as previously shown with the CBCT images above, we know that whenever the upper and lower jaw are separated, the lower jaw rotates in such a way that it decreases the airway volume. There are other issues as well, but these I included these most detrimental to emphasize why that is an inferior treatment option that will lead to compromised outcomes.
But what if my child is amongst the rare few who grinds his or her teeth but does not have sleep disordered breathing?
This can absolutely happen. But it is the anomaly, not the norm. Some children do have nerve damage from a very early age. Some have genetic bone development abnormalities. Some may experience emotional, physical, or psychological trauma at a young age that may cause stress-induced clenching or grinding. This is all very true, but too often we think the rare diagnoses are in fact applicable to the masses, or we are so hyper-focused that we miss the big picture. Or maybe we’ve just been collaborating with a team of healthcare providers that is missing this critical component of preventive, comprehensive care.
That being said, we understand that there is not a one-size-fits-all diagnosis, and there certainly isn’t a one-size-fits-all solution. The great news is that you’ve already taken the first few steps towards finding a solution for your child:
You’re an engaged parent aware of the issues your child is facing and motivated to discover the best solution for your child
You’re getting educated; you’re not stopping at the advice that was given at one consult. Instead, you’re clearly searching for more information to confirm what you already know or to identify alternatives that you may have yet to discover
And if you think your child is grinding his or her teeth while sleeping, then an easy step 3 could be as simple as scheduling a consult for a comprehensive pediatric sleep exam by emailing or calling our office, or chatting with us in the box below right now.
[1] M Winkc, M Drummond, P Viana, JC Pinho, JC Winck. "Sleep bruxism associated with obstructive sleep apnoea syndrome - A pilot study using a new portable device". Portugese Journal of Pulmonology. Accepted 6 July 2016. Available online 24 August 2016.
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