Family and School Environmental Predictors of Sleep Bruxism in Children

Aims: To identify potential predictors of self-reported sleep bruxism (SB) within children's family and school environments. Methods: A total of 65 primary school children (55.4% males, mean age 9.3 ± 1.9 years) were administered a 10-item questionnaire investigating the prevalence of self-reported SB as well as nine family and school-related potential bruxism predictors. Regression analyses were performed to assess the correlation between the potential predictors and SB. Results: A positive answer to the self-reported SB item was endorsed by 18.8% of subjects, with no sex differences. Multiple variable regression analysis identified a final model showing that having divorced parents and not falling asleep easily were the only two weak predictors of self-reported SB. The percentage of explained variance for SB by the final multiple regression model was 13.3% (Nagelkerke's R² = 0.133). While having a high specificity and a good negative predictive value, the model showed unacceptable sensitivity and positive predictive values. The resulting accuracy to predict the presence of self-reported SB was 73.8%. Conclusion: The present investigation suggested that, among family and school-related matters, having divorced parents and not falling asleep easily were two predictors, even if weak, of a child's self-report of SB.

children; family; school; sleep bruxism

1. Lobbezoo F, Ahlberg J, Glaros A, et al. Bruxism defined and graded: An international consensus. J Oral Rehabil 2013;40:2–4.

2. Lobbezoo F, Van Der Zaag J, Naeije M. Bruxism: Its multi-ple causes and its effects on dental implants – An updated review. J Oral Rehabil 2006;33:293–300.

3. Koyano K, Tsukiyama Y, Ichiki R, Kuwata T. Assessment of bruxism in the clinic. J Oral Rehabil 2008;35:495–508.

4. Manfredini D, Lobbezoo F. Role of psychosocial factors in the etiology of bruxism. J Orofac Pain 2009;23:153–166.

5. Manfredini D, Lobbezoo F. Relationship between bruxism and temporomandibular disorders: A systematic review of literature from 1998 to 2008. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:e26–e50.

6. Manfredini D, Bucci MB, Bucci Sabattini V, Lobbezoo F. Bruxism: Overview of current knowledge and suggestions for dental implants planning. Cranio 2011;29:304–312.

7. Lavigne GJ, Khoury S, Abe S, Yamaguchi T, Raphael K. Bruxism physiology and pathology: An overview for clinicians. J Oral Rehabil 2008;35:476–494.

8. Restrepo CC, Gómez S, Manrique RD. Treatment of bruxism in children. A systematic review. Quintessence Int 2009;40: 849–855.

9. Egermark-Eriksson I, Carlsson GE, Ingervall B. Prevalence of mandibular dysfunction and orofacial parafunction in 7-, 11- and 15-year-old Swedish children. Eur J Orthod 1981;3:163–172.

10. Agargun MY, Cilli AS, Sener S, et al. The prevalence of parasomnias in preadolescent school-aged children: A Turkish sample. Sleep 2004;27:701–705.

11. Archbold KH, Pituch KJ, Panahi P, Chervin RD. Symptoms of sleep disturbances among children at two general pediatrics clinics. J Pediatr 2002;140:97–102.

12. Huynh N, Guilleminault C. Sleep bruxism in children. In: Lavigne GJ, Cistulli PA, Smith MT (eds). Sleep Medicine for Dentists. A Practical Overview. Chicago: Quintessence, 2009:123–132.

13. Petit D, Touchette E, Tremblay RE, Boivin M, Montplaisir J. Dyssomnias and parasomnias in early childhood. Pediatrics 2007;119:1016–1025.

14. Carra MC, Huynh N, Morton P, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population. Eur J Oral Sci 2011;119: 386–394.

15. Antonio AG, Pierro VS, Maia LC. Bruxism in children: A warning sign for psychological problems. J Can Dent Assoc 2006;72:155–160.

16. Restrepo CC, Vasquez LM, Alvarez M, Valencia I. Personality traits and temporomandibular disorders in a group of children with bruxing behavior. J Oral Rehabil 2008;35:585–593.

17. Manfredini D, Winocur E, Guarda-Nardini L, Lobbezoo F. Self-reported bruxism and temporomandibular disorders: Findings from two specialised centres. J Oral Rehabil 2012;39:319–325.

18. Manfredini D, Landi N, Fantoni F, Segù M, Bosco M. Anxiety symptoms in clinically diagnosed bruxers. J Oral Rehabil 2005;32:584–588.

19. Ahlberg J, Lobbezoo F, Ahlberg K, et al. Self-reported bruxism mirrors anxiety in adults. Med Oral Patol Oral Cir Buc 2013;18:e7–e11.

20. Ahlberg K, Ahlberg J, Könönen M, Partinen M, Lindholm H, Savolainen A. Reported bruxism and stress experience in media personnel with or without irregular shift work. Acta Odontol Scand 2003;61:315–318.

21. Nakata A, Takahashi M, Ikeda T, Hojou M, Araki S. Perceived psychosocial job stress and sleep bruxism among male and female workers. Community Dent Oral Epidemiol 2008;36:201–209.

22. Manfredini D, Visscher C, Guarda-Nardini L, Lobbezoo F. Occlusal factors are not related with self-reported bruxism. J Orofac Pain 2012;26:163–167.

23. Simola P, Niskakangas M, Liukkonen K, et al. Sleep problems and daytime tiredness in Finnish preschool-aged children—A community survey. Child Care Health Dev 2010; 36:805–811.

24. Laberge L, Tremblay RE, Vitaro F, Montplaisir J. Development of parasomnias from childhood to early adolescence. Pediatrics 2000;106:67–74.

25. Velez AL, Restrepo CC, Peláez A, et al. Head posture and dental wear evaluation of bruxist children with primary teeth. J Oral Rehabil 2007;34:663–670.

26. Díaz-Serrano KV, da Silva CB, de Albuquerque S, Pereira Saraiva Mda C, Nelson-Filho P. Is there an association between bruxism and intestinal parasitic infestation in chil-dren? J Dent Child 2008;75:276–279.

27. Restrepo CC, Sforza C, Colombo A, Peláez-Vargas A, Ferrario VF. Palate morphology of bruxist children with mixed dentition. A pilot study. J Oral Rehabil 2008;35:353–360.

28. Rugh JD. Psychological stress in orofacial neuromuscular problems. Int Dent J 1981;31:202–205.

29. Pierce CJ, Chrisman K, Bennett ME, Close JM. Stress, anticipatory stress, and psychologic measures related to sleep bruxism. J Orofac Pain 1995;9:51–56.

30. Manfredini D, Fabbri A, Peretta R, Guarda-Nardini L, Lob-bezoo F. Influence of psychological symptoms on home-recorded sleep-time masticatory muscles activity in healthy subjects. J Oral Rehabil 2011;38:902–911.

31. Vanderas AP, Menenakou M, Koumitzis T, Papagiannoulis L. Urinary catecholamine levels and bruxism in children. J Oral Rehabil 1999;26:103–110.

32. Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Pediatr Dent 2010; 4:192–195.

33. Renner AC, da Silva AA, Rodriguez JD, et al. Are mental health problems and depression associated with bruxism in children? Community Dent Oral Epidemiol 2012; 40:277–287.

34. Fukumizu M, Kaga M, Kohyama J, Hayes MJ. Sleep-related nighttime crying (yonaki) in Japan: A community-based study. Pediatrics 2005;115(suppl 1):217–224.

35. Borgers N, de Leeuw E, Hox JJ. Surveying children: Cognitive development and response quality in questionnaire research. In: Christianson A, Gustafson JR, Klevmarken A, Rosen B, Hansson KG, Granquist L (eds). Official Statistics in a Changing World. Stockholm: SCB, 1999:133–140.

36. Ng DK, Kwok KL, Cheung JM, et al. Prevalence of sleep problems in Hong Kong primary school children: A community-based telephone survey. Chest 2005;128: 1315–1323.

37. Shur-Fen Gau S. Prevalence of sleep problems and their association with inattention/hyperactivity among children aged 6-15 in Taiwan. J Sleep Res 2006;15:403–415.

38. Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Influence of psychosocial factors on the development of sleep bruxism among children. Int J Pediatr Dent 2009;19:309–317.

39. Watanabe T, Ichikawa K, Clark GT. Bruxism levels and daily behaviors: 3 weeks of measurement and correlation. J Orofac Pain 2003;17:65–73.