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Pediatric Dental Month: Jaw Clenching in Kids

Updated: Mar 5

Wenjing Hu, Phyu Mi Ko

Project Smile Global

Feb 28, 2024

In the quiet of sleep, an unseen battle rages: teeth-gritting, muscles tensing, jaws

clenching. This silent foe is bruxism, also known as jaw clenching or teeth grinding. For this

weeks article for Pediatric Dental Month, let's explore this common condition. Though its causes remain puzzling, we'll delve into the world of clenched jaws and grinding teeth, uncovering the signs, exploring potential triggers, and shining a light on treatment options that can bring relief and restore peaceful slumber.

Jaw clenching or teeth grinding, more accurately termed bruxism, is "a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or by bracing or thrusting of the mandible (lower jaw)" (Saulue et al. 491). It affects both children and adults, occurring during the day (awake bruxism) or night (sleep bruxism) (Saulue et al. 492). Both involve grinding and clenching, but differ in context.

Awake bruxism (AB), as implied by the name, generally occurs when children are awake,

often due to stress or anxiety. SB occurs during sleep, and is considered a "physiologic orofacial motor behavior" (Saulue et al. 492). Oral sensitivity stems from neurological variances and manifests as a physical challenge tied to sensory processing. Children with conditions such as autism and septo-optic dysplasia, characterized by neurological disorders, often experience difficulties with sensory processing. It's crucial to differentiate oral sensitivity from oral defensiveness, the latter being a psychological concern rooted in past experiences (Nielsen). Essentially, it encompasses all the normal, physiological actions related to the mouth and face that are a part of our daily lives (Nielsen) The cause for SB remains unknown but may be partly due to the “reactivation of the autonomous and cerebral nervous systems during periods of instability during sleep (a process called sleep arousal)” (Saulue et al. 492). Moreover, SB can first occur in children as early as age one, with baby teeth eruption. It becomes most common between ages four to eight, peaking between ten and fourteen, and usually diminishes after fourteen (Saulue et al. 493). It diminishes due to the “basic chewing pattern of reciprocally activated antagonistic muscles” that improves chewing (Green et al. 2704). The excessive clenching and grinding of bruxism can lead to noticeable symptoms, including fatigue of the jaw muscles, difficulty opening the jaw, loud breathing or mouth breathing, temporomandibular joint (TMJ) issues, sleep discomfort, and worn-down teeth with sharp edges. For SB, grinding sounds might be audible (Saulue et al. 492).

Bruxism is attributed to various factors. It is considered multifactorial, with biological,

behavioral, environmental, social, emotional, and cognitive factors, alone or in combination,

contributing to the development of signs and symptoms of temporomandibular disorders.

(Horton et al. 295) The physiological development of dental occlusion is considered a normal

aspect, with the evolution of occlusion sometimes associated with parafunctional habits leading to excessive wear (Saulue et al. 491). Additionally, if daytime bruxism occurs, monitoring and interventions will be necessary, particularly in younger children (Saulue et al. 496).

The therapeutic options for SB in children, as outlined by Saulue and colleagues (2015),

present a challenging landscape. Currently, no therapy has demonstrated conclusive effectiveness in treating SB in this demographic. The available treatment approaches, while varying in efficacy, primarily focus on managing the potential consequences rather than directly addressing SB. The authors advocate for a comprehensive approach involving the elimination of comorbidities, such as sleep apnea, allergies, psychoactive drugs, stress-related factors, and neurologic conditions. Once these comorbidities are addressed, SB in children is considered a (para)physiologic oral parafunction, suggesting that it may necessitate long-term monitoring rather than immediate therapeutic intervention (Saulue et al. 503).

In conclusion, understanding bruxism in children requires a comprehensive approach that considers both physiological and pathological aspects. Early detection, monitoring, and

intervention are crucial for preventing long-term negative effects on oral health and overall well-being. Further research and collaboration between dental professionals and other healthcare practitioners are essential for developing effective therapeutic strategies for managing bruxism in the pediatric population.

Works Cited

Green, Jordan R., et al. “Development of Chewing in Children From 12 to 48 Months:

Longitudinal Study of EMG Patterns.” Journal of


Horton, Lauren M., et al. “Jaw Disorders in the Pediatric Population.” Journal of the

American Association of Nurse Practitioners, vol. 28, no. 6, June 2016, pp. 294–303.

Nielsen, Lilli. “Oral Motor Development Issues.” Active Learning Space - A Collaborative

Project of Penrickton Center for Blind Children, Perkins School for the Blind, and Texas

School for the Blind & Visually Impaired, 8 Feb. 2023,

Saulue, Paul, et al. “Understanding Bruxism in Children and Adolescents.” International

Orthodontics, vol. 13, no. 4, Dec. 2015, pp. 489–506.

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