Sleep Bruxism in Children: A Narrative Review
Authors: Leung Alexander K.C. , Wong Alex H.C. , Lam Joseph M. , Hon Kam L. 
Published: September 2023

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Sleep bruxism, characterized by involuntary grinding or clenching of the teeth and/or by
bracing or thrusting of the mandible during sleep, is common in children. Sleep bruxism occurs
while the patient is asleep. As such, diagnosis can be difficult as the affected child is usually unaware
of the tooth grinding sounds.

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This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in
children.

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A search was conducted in May 2023 in PubMed Clinical Queries using the key terms “Bruxism”
OR “Teeth grinding” AND “sleep”. The search strategy included all observational studies, clinical
trials, and reviews published within the past 10 years. Only papers published in the English literature
were included in this review.

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According to the International classification of sleep disorders, the minimum criteria for the diagnosis
of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at
least three months) tooth grinding sounds during sleep and (2) at least one or more of the following
(a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache;
or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism,
“possible” sleep bruxism can be diagnosed based on self-report or report from family members
of tooth-grinding sounds during sleep; “probable” sleep bruxism based on self-report or report
from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of
bruxism (e.g., abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or
tongue/lip indentation); and “definite” sleep bruxism based on the history and clinical findings and
confirmation by polysomnography, preferably combined with video and audio recording. Although
polysomnography is the gold standard for the diagnosis of sleep bruxism, because of the high cost,
lengthy time involvement, and the need for high levels of technical competence, polysomnography
is not available for use in most clinical settings. On the other hand, since sleep bruxism occurs
while the patient is asleep, diagnosis can be difficult as the affected child is usually unaware of the
tooth grinding sounds. In clinical practice, the diagnosis of sleep bruxism is often based on the history
(e.g., reports of grinding noises during sleep) and clinical findings (e.g., tooth wear, hypertrophy
and/or tenderness of masseter muscles).

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In childhood, sleep-bruxism is typically self-limited and does not require specific treatment. Causative
or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot
be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity
should be limited before going to bed. For adults with frequent and severe sleep bruxism who
do not respond to the above measures, oral devices can be considered to protect teeth from further
damage during bruxism episodes. As the orofacial structures are still developing in the pediatric
age group, the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy
is not a favorable option and is rarely used in children. Current evidence on the effective
interventions for the management of sleep bruxism in children is inconclusive. There is insufficient
evidence to make recommendations for specific treatment at this time.