Teeth grinding is more than just teeth grinding for children

Teeth grinding is more than just teeth grinding.

Let me repeat that again “teeth grinding is more than just teeth grinding”.

Have you ever walked by your sleeping child and hear an awful sound like nails being scratched on a chalkboard?

Teeth grinding, or the technical term bruxism, is the sound you may be hearing that is coming from your child. This occurs when teeth are contacting each other and abrade the biting surfaces in all different direction. Overtime these cause the teeth to shorten, become sensitive, chip and potentially crack.
This is also known as a form of a parafunction as para (other than the norm) and function (of normal physiological order) when there is an upset within the body system. Unfortunately, this occurs subconsciously (during sleep).

Clenching and grinding is not unique to just children alone, it happens to all ages of life. In particular, adulthood when the stresses of life are compounded together. Work, family, external stress and the never-ending cost of living can all contribute to your clenching and grinding. However, in children, we ask why are they grinding if they don’t have these stresses?

In most cases, many children are not under a lot of stress from lifestyle factors, so if we know that stress is one of the factors to causing bruxism/grinding? What other factors could be affecting a young child that’s grinding in their sleep?

This is where we look into physiological stress, and at True Smiles Dental, our dentists and oral health therapists explore breathing to assess and manage as a team with other medical professions.

The term “Sleep-disordered Breathing” (SDB) is a broad term that categorises the different diagnoses of unideal/interrupted breathing during sleep in both adults and children. The most common form of this is Obstructive Sleep Apnoea where some of you may know yourself or of a relative that wears a sleep machine (Central positive air pressure machine – CPAP) to help with their breathing.

As you can imagine, SDB presents itself when there is an obstruction along the path of our airway. Think of a hose in your garden, when running water through the hose and any where you step or squeeze the hose it will cause a blockage to the flow of water and of course, if there are multiple blockages along this hose, it even further propagates the barrier for the water to pass through.
This analogue also happens in the body, thus, this includes any abnormal structure or function of the nasal airway and jaws which are the main areas that we deal with as dental professions.

Oxygen is the main nutrient for cells and bodily function to continue to work. If a blockage occurs in our airways, then we have the potential to stop breathing, and thus restricting the much-needed oxygen required for our bodies to function. In others words, there are moments within their sleep where they are suffocating. As you can imagine, our brain is firing a million of signals to keep our body working whilst we sleep to ensure that our cells and tissues are getting the nutrients it needs to repair and function and to form new neural pathways to help create memory. But without oxygen, all of this is disrupted.

With limited oxygen, our body enters a fight-flight mode – your body begins to release more adrenaline and cortisol which causes our hearts to race, digestive system to shut down, blood glucose levels increase, mental acuteness elevates and eventually, grinding and clenching commences. In addition to grinding, in order to deal with the stress from lack of oxygen, the body also attempts to bring the jaw forward to relieve of any obstruction particularly when we are laying down, in turn, the tongue collapses into the airway.

As you’re reading this now try it out for yourself, hold your breath in as long as possible and eventually you will reach a point where you need to take a huge gasp of air with a slight sense of panic and relief at the end as you take your big gulp of air in. That is exactly what is happening in our sleep multiple times – in some cases, more than 10 times!

This “fight-flight” mode that we have is the exact same mechanism that is activated when we are placed in a stressful situation like if we were faced with our most feared thing in life. Imagine this happening multiple times during our sleep, as you can now picture then, not only is the sleep disrupted but this starts to affect us during the day!

Some of the more common symptoms children suffering from sleep disordered breathing face include:

• Increased anxiousness
• Less tolerable to stress
• Restless and unsettled
• Poor concentration
• Increased tiredness throughout the day

Returning to the implications of long term ‘increased’ adrenaline and cortisol release. This can lead to further long-term effects in our health.

• Chronic increased adrenaline release can be linked to higher blood pressure if associated with uncontrolled sleep apnoea. It can also disrupt the digestive process, risking nutrient uptake and optimal development in children
• Cortisol is a steroid hormone that is released as part of the process of fight-flight to activate certain inflammatory cells to engage our systems to fend off the threat. During the process of SDB, the chronic release of cortisol can be pathological and may place children at a younger age for chronic inflammation and thus, risk of inflammatory diseases such as diabetes and high blood pressure.

SDB is an epidemic in young children in Australia and most of the time, it goes unnoticed which is why the team at True Smiles Dental screen at a young age for signs of potential SDB, we may be able to prevent further systemic complications as they grow into adulthood and thus, improve their overall quality of life.

The most common areas that underlie the cause of obstruction along the airway are:

1. Enlarged tonsils and adenoids
2. Unaddressed and/or poor management of allergies
3. Narrow jaws and crowded teeth
4. Enlarged turbinates’
5. Sinusitis
6. Deviated septum
7. Trauma to nasal airway
8. Weak tongue

As such, it is important for health professionals, particularly dental professions that work closely in this region to screen for SDB. Your Dentist or Oral Health Therapist is in the best position to screen for this as we are already looking in your mouth!

At True Smiles Dental, our team of Dentists and Oral Health Therapists specialise in screening for these signs and providing a management plan to address the root cause of bruxism in children.
We examine the tonsils, grinding habits, sleeping habits, enquire about allergies and development of the jaw. When appropriate, we refer to a team of ENTs, sleep physicians and orthodontist that work closely to ensure that your child/ren do not suffer from the prolonged undiagnosed SDB.

In regard to narrow jaws and crowded teeth, we advocate for early intervention in orthodontic practice. As such, we refer for any signs of crossbite and narrow upper jaws at the young age of 8 to potentially initiate early expansion particularly when the bone is easily malleable and thus when influenced the jaw to expand optimally. In doing so, the nasal airway also expands with it as the roof of the mouth makes up the floor of the nasal airway.
There is rising evidence in the scientific literature that indicate that early expansion reduces enlarged tonsils and adenoids and thus, limits the need to undergo tonsil and adenoid removal surgery which can be costly and uncomfortable for the child.

Through this process, the desired result for your child to be breathing in the most optimal way is having their lip sealed, tongue on the roof to the mouth and nasal breathing which can only be achieved when all underlying issues of nasal congestion and restrictions are addressed. Altogether, we aim to maintain the physiological body systems working in harmony and at balance with one another.
Remember, this is just one aspect of the bigger picture of the health of a child. This part of health is also one that has not been addressed thoroughly in the past which why at True Smiles Dental, we have taken a proactive approach in exploring an area in which we are able to positively influence. As the saying goes, putting the mouth back into health!

So the next time you are asked if your child grinds or you notice your child’s teeth are getting shorter each time you have a look or chipping often, considering investigating further into their sleep quality.

If you would like to have a chat more with our Dentists and Oral Health Therapists, call us on (02) 7228 7272, or book online at https://truesmilesdental.com.au/appointments.

In the next blog post, we will talk more about the nuances of nasal breathing – why it is important and the health benefits, as well as the big muscle king – the tongue and its role in breathing, development and TMJ.