Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 3536
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents 
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 332-336  

Quality of life of children with sleep bruxism

Department of Paediatric and Preventive Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

Date of Submission24-Sep-2019
Date of Decision27-Nov-2019
Date of Acceptance12-Dec-2019
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Deepa Gurunathan
Department of Paediatric and Preventive Dentistry, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, 162, Poonamallee High Road, Chennai, Tamil Nadu - 600077
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jfmpc.jfmpc_820_19

Rights and Permissions

Aim: The aim of this study was to compare the Quality of life (QoL) of children with and without sleep bruxism in Chennai population.
Materials and Methods: A cross-sectional study was conducted with participants of both genders assigned as bruxers (n = 36) and non-bruxers (n = 36) from different regions of Chennai with the age range of 6–12 years. Parents/Caregivers answered a questionnaire in the waiting room. The QoL was assessed using the Oral Health Impact Profile (OHIP-14). OHIP-14 was analyzed by Mann–Whitney U test.
Results: The sociodemographic characteristics presented no significant differences between bruxers and non-bruxers (P > 0.005). There was a significant difference in QoL between the case and control group (<0.001). Bruxers had worse QoL than controls.
Conclusion: Sleep bruxism may be associated with a negative impact on QoL.

Keywords: Bruxism, quality of life, sleep

How to cite this article:
Suguna S, Gurunathan D. Quality of life of children with sleep bruxism. J Family Med Prim Care 2020;9:332-6

How to cite this URL:
Suguna S, Gurunathan D. Quality of life of children with sleep bruxism. J Family Med Prim Care [serial online] 2020 [cited 2021 Sep 27];9:332-6. Available from: https://www.jfmpc.com/text.asp?2020/9/1/332/276785

  Introduction Top

Sleep bruxism (SB) is “an oral parafunction characterized by grinding or clenching of the teeth during sleep that is associated with an excessive or intense sleep arousal activity.” The above definition is according to the International Classification of Sleep Disorders, second edition (ICSD-2). It has been noted down in the new sleep-related movement disorders category.[1],[2] SB is regarded as the most frequent parasomnias encountered by children.[3] The etiology of SB is complex and multifactorial demanding systemic, psychological, occupational, and genetic factors. Recurrent provocation during sleep, which is associated with increased anxiety and stress, is regarded as the main cause of poor sleep quality.[4] These variables influence the release of chemical mediators, which provoke catecholamine release, altering the initiation and maintenance of wakefulness and sleep.[5] Children with SB may have additional symptoms, such as temporomandibular disorders, presence of tooth wear facets,[6] headaches, earaches, and pain in the masticatory muscles.[7] According to Carra et al.[8] SB in young children can also be associated with fatigue of the masticatory musculature, headaches, and noisy breathing during sleep.[9],[10],[11] Bruxism is a result of stress and anxiety in children. Hence, pediatric dentist needs to play an important role in providing effective primary care leading to cessation of the habit.

Epidemiological studies showed that bruxism can be seen in all age groups but more common in the young population.[12] The literature reports prevalence rates of bruxism in children ranging between 14% and 20% while in adults ranging between 6% and 8% and it decreases with age.[12],[13]

The diagnosis of SB is usually based on an interview, clinical examination, and objective polysomnography (sleep test).[14] The most common method for diagnosing bruxism in children is parental reports of grinding the teeth.[1],[15],[16] Therefore, parents/caregivers play an important role in the detection of SB in children. However, detection is often impeded by a lack of prior knowledge regarding bruxism.[17] Occlusal splint can be given to patients to wear it during the night for treatment. Some studies suggest that psychological support can help children with bruxism.[18],[19],[20]

To the best of our knowledge, there have not been any studies on the quality of life of children in Chennai population. Consequently, the purpose of the present study was to evaluate the quality of life (QoL) of children with SB by means of a generic scale, in addition to the association of sociodemographic characteristics.

  Materials and Methods Top

Ethical approval

The present study was carried out in the Department of Paediatric and Preventive Dentistry, Saveetha Dental College, Chennai, after obtaining ethical clearance from the Institutional Ethical Committee (SRB/MDS/PEDO/18-19/0008) on 16/08/2018. After receiving clarification regarding the procedures, parents/caregivers who agreed to participate signed a statement of informed consent.

Sample selection

This study evaluated variables related to the QoL in children with (experimental, n = 36) and without SB (control, n = 36) from different regions of Chennai with the age range of 6–12 years who agreed to participate in the study and whose parents/caregivers also authorized participation. The inclusion criteria were the presence of mixed dentition with first permanent molars erupted, no history of trauma, and no previous orthodontic treatment. The exclusion criteria were: children outside the age range of 6–12 years, children with dental caries, toothache, early tooth loss, systemic and/or mental developmental disorders, use of medications that could interfere with the central nervous system, and/or children who did not accept taking part in the study.

The interviews were conducted using a prestructured questionnaire and data were collected directly from parents/caregivers. Two previously trained dentists conducted this process. The Quality of Life (QoL) of children with SB was evaluated by using the Portuguese version of the Oral Health Impact Profile (OHIP-14) questionnaire.[21],[22] OHIP-14 comprises 14 items distributed in seven dimensions: Functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap.[23] All participants were instructed to rate the frequency they experienced the impact of dental problems for each OHIP item. A 5-point Likert-like scale was used, and the answers “very often,” “fairly often,” “occasionally,” “hardly ever,” and “never” were scored from 4 to 0, respectively. The sum of all 14 items ranges from 0 (very good) to 56 (very poor). The parents/caregivers answered the questionnaire individually without consultations or discussions with colleagues or family. Upon completion, the questionnaire was immediately returned to the researcher and the participants received information on bruxism.

Statistical analysis

Statistical analysis was performed by calculating the means, frequencies, and standard deviation. The demographic characteristics of participants were analyzed by Chi-square test [Table 1]. The domain scores of OHIP-14 were obtained by summating responses to 7 corresponding items, and overall scores were derived by summating domain scores. A higher score represents poor QoL. Since the data did not follow normal distribution, non-parametric test was used in the data analysis. Mann–Whitney-U test was used to test the significant difference in 7 domains of OHIP-14 scores during the study period [Table 2]. All analysis was performed using social sciences software (SPSS) version 16.0 (SPSS, Chicago, Illinois, USA) with a significance level of 5%.
Table 1: Demographic characteristics of the sample

Click here to view
Table 2: Mean values and standard deviation of OHIP-14 domains from subjects with and without sleep bruxism

Click here to view

  Results Top

A total of 72 children participated in the study with both genders assigned as bruxers (n = 36) and non-bruxers (n = 36) with the age group of 6–12 years. The sociodemographic characteristics presented no significant differences between bruxers and non-bruxers [Table 1]. There was a significant difference in QoL between the case and control group [Table 2]. Across all of the seven OHIP-14 domains, there were significant differences in mean scores between the case and control groups: functional limitation (P < 0.001), physical disability (P < 0.001), pain (P < 0.001), psychological discomfort (P = 0.001), psychological disability (P < 0.001), social disability (P < 0.001), and handicap (P < 0.001).

Compared to controls, bruxers had the highest scores in all domains (P < 0.001), revealing the negative perception of oral health on the quality of life in this group [Table 2].

  Discussion Top

In the present study, most parents/caregivers were unaware of the meaning of bruxism, which may have led to an underestimation of the prevalence of this parafunctional habit. In the previous investigation, 61.9% of parents/caregivers lacked knowledge of SB and did not know what caused the condition (Tavares-Silva et al. 2016).[17] Therefore, there appear to be large gaps in knowledge about bruxism that need to be clarified by healthcare professionals. As childhood bruxism can persist into adulthood (Serra-Negra et al. 2009),[6] early diagnosis can help control the habit and prevent harm to components of the masticatory system (Serra-Negra et al. 2013).[24] Thus, knowledge of SB is essential and allows parents/caregivers to report the medical history and current medical status of their children with greater accuracy.

Some researchers report that bruxism is more prevalent in boys (Liu et al. 2005; Naha´s-Scocate et al. 2014).[25],[26] The present study is also in accordance with the literature, whereas other studies have found no significant association between SB and gender in a pediatric population (Bharti et al. 2006; Manfredini et al. 2013).[27],[28] A number of studies report that girls in the menarche phase may have sensory disorders in trigeminal muscles caused by sex hormones, which may be directly related to bruxism and temporomandibular disorder (Pereira et al. 2010; Fernandes et al. 2016).[29],[30] The present study showed that SB was more prevalent among older children (6–12 years). Some studies have shown a greater prevalence of SB in the mixed dentition (Restrepo et al. 2006; Kobayashi et al. 2012; Restrepo et al. 2016).[31],[32],[33] The premature appearance of some teeth, occlusal imbalances, and the possible effects of occlusal and periodontal forces may explain these associations (Restrepo et al. 2016).[33]

QoL is a global construct that emerges from several, overlapping aspects, or domains of life. In the last three decades, this construct has been developed quite extensively in research to assess the individual's perception of overall well-being. Thus, it is important to apply a reliable and valid instrument to assess patient's QoL. OHIP-14 is the most widely used indicator in evaluating QoL. OHIP-14 is a shorter version of OHIP-49 original version which was often not practical in a clinical setting because of its length and also because many questions were irrelevant to specific oral health states.[34]

Functional limitation affected the quality of life of the children of this sample with SB, and these results corroborate with the literature.[35],[36],[37] The domain of functional limitation comprises issues that deal with the children's experience as to difficulties in the physiological functions of biting or chewing food, pronouncing certain words, and eating or drinking hot or cold food. Physical pain domain demonstrated the impact on QoL by the second-highest mean scores in this study. This can be in accordance with the previous study by Rajagopalachari et al.[38] This can be explained by the fact that most of them visited the dentist only when they had pain. Monterio AAKS in his study stated that masticatory muscle activities could lead to muscle overloading which could be associated with local blood flow and microcirculation disorders, and pain derived from ischemia.[39] Another study by Raphael et al. mentioned that increase in muscular activities may lead to TMJ pain or masticatory muscle pain.[40] Physical disability domain had a negative impact on bruxers in the present study. This was similar to a study in the literature. According to Kobayashi et al., children with SB consequently required more chewing cycles to break down food into smaller particles.[32] Psychological domain too affected the QoL of children with bruxers compared to non-bruxers in the present study. This could be in accordance with Edward Kuch et al. study which suggested that bruxism may be a common childhood habit and at age 5–6 years, this habit appears to have little psychological significance.[41] Social disability domain comprises of thought disorders, conduct disorders, and antisocial disorders. All these have found to be higher in bruxers compared with non-bruxers in the present study. A study by Serra-Negra et al. and Restrepo et al. stated that neuroticism, perfectionism, aggressiveness, higher sensitivity to stress, and coping strategies were related to increased risk of developing bruxism.[6],[42],[43] The handicapped domain scored the second-lowest mean score in the present study and meant that, although children were in pain, they either did not feel handicapped or did not like to express such feelings.

The patient-reported outcomes were compared between bruxers and control subjects. The main finding was the worse QoL presented by volunteers with SB. The total domain scores of OHIP-14 indicated that bruxers had a negative perception of their QoL compared to controls.

The present study has the limitations inherent to a cross-sectional design and the answers to the questionnaire may have been subject to information bias. The under-notification of bruxism can occur when parents/caregivers are unaware of this habit in their children. Thus, longitudinal studies should be conducted to gain a better understanding of the causality of factors in the occurrence of this parafunctional habit.

  Conclusion Top

Males presented with higher association with this parafunctional habit. Moreover, the majority of parents/caregivers did not know the meaning of bruxism. The QoL of children with SB appears to be worse than that of children without SB. Thus, the SB had a negative impact on QoL. It creates an alarming need to focus on these risk groups with special emphasis on the factors contributing to the poor oral health status.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients/parents/caregivers have given their consent for their images and other clinical information to be reported in the journal. The patients/parents/caregivers understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

American Academy of Sleep Medicine. International Classification of Sleep Disorders Volume 2. Westchester, IL: American Academy of Sleep Medicine; 2005.  Back to cited text no. 1
Ahlberg K, Jahkola A, Savolainen A, Kononen M, Partinen M, Hublin C, et al. Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shif work. Head Face Med 2008;4:4.  Back to cited text no. 2
Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest 2001;119:53-61.  Back to cited text no. 3
Ahlberg J, Lobbezoo F, Ahlberg K, Manfredini D, Hublin C, Sinisalo J, et al. Self-reported bruxism mirrors anxiety and stress in adults. Med Oral Patol Oral Cir Bucal 2013;18:e7-11.  Back to cited text no. 4
Carra MC, Huynh N, Lavigne G. Sleep bruxism: A comprehensive overview for the dental clinician interested in sleep medicine. Dent Clin North Am 2012;56:387-413.  Back to cited text no. 5
Serra-Negra JN, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus IA. Infulence of psychosocial factors on the development of sleep bruxism among children. Int J Paediatr Dent 2009;19:309-17.  Back to cited text no. 6
Pizolato RA, Gaviao MB, Berretin-Felix G, Sampaio AC, Trindade Junior AS. Maximal bite force in young adults with temporomandibular disorders and bruxism. Braz Oral Res 2007;21:278-83.  Back to cited text no. 7
Carra MC, Huynh N, Morton P, Rompré PH, Papadakis A, Remise C, et al. Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7-17 yr old population. Eur J Oral Sci 2011;119:386-94.  Back to cited text no. 8
Pizzol KE, Carvalho JC, Konish F, Marcomini EMS, Giusti JSM. Bruxismo na infancia: Factors etiologicos e possiveis tratamentos. Rev Odontol UNESP 2006;35:157-63.  Back to cited text no. 9
Manfredini D, Lobbezoo F. Role of psychological factors in the etiology of bruxism. J Orofac Pain 2009,23:153-66.  Back to cited text no. 10
Michelotti A, Cioffi I, Festa P, Scala G, Farella M. Oral Parafunctions as risk factors for diagnostic TMD subgroups. J Oral Rehabil 2010;37:157-62.  Back to cited text no. 11
Uluocak GP. Internal migration has lived and experienced children's school adjustment. Dokuz Eylul Universitesi Buca Egitim Fakultesi Dergisi 2009;26:35-43.  Back to cited text no. 12
Van der M, Lobbezoo MJF, Aartman IH, Naeije M. Self-reported oral parafunctions and pain intensity in temporomandibular disorder patients. J Orofac Pain 2006;20:31-5.  Back to cited text no. 13
Huynh NT, Guilleminault C, Lavigne CJ, Cistulli PA, Smith MT. Sleep bruxism in children. In: Lavigne CJ, editor. Sleep Medicine for Dentists: A Practice Overview. 1st ed. Chicago: Quintessence Publishing Co Inc; 2009.  Back to cited text no. 14
Firmani M, Reyes M, Becerra N, Flores G, Weitzman M, Espinosa P. Sleep bruxism in children and adolescents. Rev Chil Pediatr 2015;86:373-9.  Back to cited text no. 15
Saulue P, Carra MC, Laluque JF, d'Incau E. Understanding bruxism in children and adolescents. Int Orthod 2015;13:489-506.  Back to cited text no. 16
Tavares-Silva C, Calabrio IR, Serra-Negra JM, Fonseca-Goncalves A, Maia LC. Knowledge of parents/guardians about nocturnal bruxism in children and adolescents. Cranio 2016;24:1-5.  Back to cited text no. 17
Castelo PM, Barbosa TS, Gaviao MB. Quality of life evaluation of children with sleep bruxism. BMC Oral Health 2010;10:16.  Back to cited text no. 18
Koyano K, Tsuliyama Y, Ichiki R, Kuwata T. Assessement of bruxism in the clinic. J Oral Rehabil 2008;35:495-508.  Back to cited text no. 19
Miamoto CB, Pereira LJ, Romes-Jorge ML, Marques LS. Prevalence and predictive factors of sleep bruxism in children with and without cognitive impairment. Braz Oral Res 2011;25:439-45.  Back to cited text no. 20
Oliveira BH, Nadanovsky P. Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community Dent Oral Epidemiol 2005;33:307-14.  Back to cited text no. 21
Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health 1994;11:3-11.  Back to cited text no. 22
John MT, Reissmann DR, Feuerstahler L, Waller N, Baba K, Larsson P, et al. Exploratory factor analysis of the Oral Health Impact Profile. J Oral Rehabil 2014;41:635-43.  Back to cited text no. 23
Serra-Negra JM, Tirsa-Costa D, Guimarães FH, Paiva SM, Pordeu IA. Evaluation of parents/guardian knowledge about the bruxism of their children: Family knowledge of bruxism. J Indian Soc Pedod Prev Dent 2013;31:153-8.  Back to cited text no. 24
[PUBMED]  [Full text]  
Liu X, Ma Y, Wang Y, Rao Y. Brief report: An epidemiologic survey of the prevalence of sleep disorders among children 2 to 12 years old in Beijing, China. Pediatrics 2005;115:266-8.  Back to cited text no. 25
Nahás-Scocate AC, Coelho FV, de Almeida VC. Bruxism in children and transverse plane of occlusion: Is there a relationship or not? Dental Press J Orthod 2014;19:67-73.  Back to cited text no. 26
Bharti B, Malhi P, Kashyap S. Patterns and problems of sleep in school going children. Indian Pediatr 2006;43:35-8.  Back to cited text no. 27
Manfredini D, Restrepo C, Diaz-Serrano K, Winocur E, Lobbezoo F. Prevalence of sleep bruxism in children: A systematic review of the literature. J Oral Rehabil 2013;40:631-42.  Back to cited text no. 28
Pereira LJ, Pereira-Cenci T, Del Bel Cury AA, Pereira SM, Pereira AC, Ambosano GM, et al. Risk indicators of temporomandibular disorder incidences in early adolescence. Pediatr Dent 2010;32:324-8.  Back to cited text no. 29
Fernandes G, Franco-Micheloni AL, Siqueira JT, Gonçalves DA, Camparis CM. Parafunctional habits are associated cumulatively to painful temporomandibular disorders in adolescents. Braz Oral Res 2016;30.  Back to cited text no. 30
Restrepo C, Peláez A, Alvarez E, Paucar C, Abad P. Digital imaging of patterns of dental wear to diagnose bruxism in children. Int J Paediatr Dent 2006;16:278-85.  Back to cited text no. 31
Kobayashi FY, Furlan NF, Barbosa TS, Castelo PM, Gavião MB. Evaluation of masticatory performance and bite force in children with sleep bruxism. J Oral Rehabil 2012;39:776-84.  Back to cited text no. 32
Restrepo CC, Tirado M, Jimenez KJ. Association of sleep bruxism and dental plaque factors on signs of periodontal disease in children in the mixed dentition. Int J Paediatr Dent 2016;26:477-85.  Back to cited text no. 33
Wong AH, Cheung CS, McGrath C. Developing a short form of oral health impact profile (OHIP) for dental aesthetic. Community Dent Oral Epidemiol. 2007;35:64-72.  Back to cited text no. 34
Costa AA, Ferreira MC, Serra-Negra JM, Pordeus IA, Pavia SM. Impact of wearing fixed orthodontic appliances on buccal health-related quality of life among Brazilian children. J Orthod 2011;38:275-81.  Back to cited text no. 35
O'brien C, Benson PE, Marshman Z. Evaluation of a quality of life measure for children with malocclusion. J Orthod 2007;34:185-93.  Back to cited text no. 36
Bendo CB, Pavia SM, Torres CS, Oliveira AC, Goursand D, Pordeus IA, et al. Association between treated/untreated traumatic dental injuries and impact on quality of life of Brazilian schoolchildren. Health Qual Life Outcomes 2010;8:114.  Back to cited text no. 37
Rajagopalachari US, Puranik MP, Sonde L. Impact of oral health on quality of life among police personnel in Bengaluru city, India: A cross-sectional survey. J Indian Assoc Public Health Dent 2015;13:42-7.  Back to cited text no. 38
  [Full text]  
Monterio AAKS. Estimation of blow flow by 133 Xe clearance in human masseter muscle during rest, endurance of isometric contraction, and recovery. Arch Oral Biol 1988;33:561-5.  Back to cited text no. 39
Raphael KG, Santiago V, Lobbezoo F. Is bruxism a disorder or a behaviour? Rethinking the international consensus on defining and grading of bruxism. J Oral Rehabil 2016;43:791-8.  Back to cited text no. 40
Kuch EV, Till MJ, Messer LB. Bruxing and non- bruxing children: A comparison of their personality traits. Pediatr Dent 1979;1:182-7.  Back to cited text no. 41
Restrepo CC, Vasquez LM, Alvarez M, Valencia I. Personality traits and temporomandibular disorders in a group of chidren with bruxing behaviour. J Oral Rehabil 2008;35:585-93.  Back to cited text no. 42
Ahmad MS, Bhayat A, Zafar MS, Al-Samadani KH. The impact of hyposalivation on quality of life (QoL) and oral health in aging population of Al Madinah Al Munawarrah. Int J Environ Res Public Health 2017;14:E445.  Back to cited text no. 43


  [Table 1], [Table 2]

This article has been cited by
1 Factors associated with preschool children’s sleep bruxism
Soraia Veloso da Costa,Bianca Katsumata de Souza,Thiago Cruvinel,Thais Marchini Oliveira,Natalino Lourenço Neto,Maria Aparecida Andrade Moreira Machado
CRANIO®. 2021; : 1
[Pubmed] | [DOI]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
   Materials and Me...
   Article Tables

 Article Access Statistics
    PDF Downloaded360    
    Comments [Add]    
    Cited by others 1    

Recommend this journal