Bruxism—or the more familiar term, teeth grinding, is a condition where you grind, clench and gnash your teeth. People might unconsciously grind their teeth while they are awake but in most cases, they grind them during sleep. The latter is called Sleep Bruxism.

There are many views on why bruxism happens in the first place. One view is that it is a natural development of synaptic pruning—the natural rewiring of the brain—that can occur in children between 3 to 10 years of age. Another view is the lack of space in the jaw that leads to the tongue partially obstructing the airway. When this happens, the lower jaw will move forward to open up the airway and as a result, the lower teeth will inevitably grind against the upper teeth.

Why is Sleep Bruxism on children concerning?

Sleep Bruxism if occurs occasionally is less of a concern. For some children, it is a normal occurrence and will resolve on its own. However, for some other children, it may be an indication of underdeveloped jaws, poor tongue posture and result in sleep disruptions which can affect growth, memory consolidation and hormone regulation.

#1 Teeth wear, teeth crowding and underdeveloped jaws

Teeth wear

#1 Teeth wear, teeth crowding
and underdeveloped jaws

Bruxism has a strong association with the underdevelopment of the jaws. The underdevelopment of the jaws can lead to cosmetic concerns from teeth sticking out to a protruding lower jaw that may require surgery to correct in adulthood. This can be prevented with early intervention.

Bruxism can also result in cracked teeth, chipped teeth or cause teeth sensitivities from damaged tooth enamel (the hard surface surrounding the outer part of the tooth). Cracked teeth are less of a concern in baby teeth but when it occurs to an adult tooth, it may require a root canal treatment to treat the problem. This, too, can be avoided with early intervention.

#2 Sleep disruption

Sleep disruption

#2 Sleep disruption

Sleep bruxism is associated with micro-arousals during the sleep cycle. A sleep cycle consists of different stages involving Non-Rapid Eye Movement (NREM) and Rapid Eye Movement (REM) sleep. REM sleep generally occurs after NREM sleep. REM sleep is involved in memory consolidation amongst other benefits to the human body. Sleep bruxism is associated with micro-arousals that occur in the brain preventing a child or adult from progressing from NREM sleep to REM sleep. Several studies have shown the links between teeth crowding, mouth breathing, sleep bruxism, poor tongue muscle tone with increased levels of stress, anxiety, Attention Deficit Hyperactivity Disorders and hormone dysregulation.

As mentioned, if bruxism occurs occasionally, it is less of a concern. However, if it occurs frequently and especially if accompanied by other symptoms such as mouth breathing, tongue-tie, teeth crowding and poor development of the upper and lower jaws, then early intervention is important.

Poor quality of sleep also affects a myriad of health-related problems that revolve around hormone imbalances. Growth and development will be affected due to the reduction of growth hormone production in children lacking good quality sleep. These children may be associated with being underweight or overweight.

Bruxism is also related to the increased production of the stress hormone cortisol. Increased cortisol production affects neurogenesis (the formation of nerve connections within the brain) in the hippocampus (an area of the brain involved with learning and memory)

#3 Stress and anxiety

Stress and anxiety

 #3 Stress and anxiety

Children may also experience bruxism due to stress and anxiety. Bruxism may be an indication of sympathetic dominance (fight-or-flight response). Our bodies have a fight or flight response which is controlled by the sympathetic nervous system and a “rest, digest and relax” response which is dominated by the parasympathetic nervous system. I will discuss more on this in subsequent email articles.

Bruxism may be a manifestation of sympathetic dominance in children and adults. Our stressful lifestyles accompanied with excessive screen time and a diet of processed foods add lots of stress to our body to cope with leading to sympathetic dominance where our bodies are constantly in a fight or flight mode. During night time, this manifests in unconscious clenching and grinding of the teeth during sleep.

Practising good sleep hygiene such as avoidance of screen time 1-2 hours before bedtime, maintaining a healthy diet with lots of fruits and vegetables and cutting down on processed foods go a long way in reducing sympathetic dominance in our bodies.

What are the signs to look out for?

Sleep Bruxism

The first thing you can do is to check on your kid while they are asleep. If you hear harsh grinding and gnashing sounds, your child is most likely dealing with bruxism. Another noticeable symptom is when your child’s tooth surface is flat due to the repetitive grinding of teeth. Other signs to look out for are if your child sleeps on their tummy or sleeps with their mouths open. If they do so, simply use your fingers to close their lips or change their sleep posture so that they are sleeping on their sides. Sleeping on the side naturally places the tongue in a better position and prevents obstruction of the airway.

As much as it is important to self-diagnose, it is more advisable for you to bring your child to a dentist for a more accurate diagnosis. With regular dental checkups, your dentist can also detect the signs of teeth grinding early and suggest the right treatments accordingly.

Are you due for a dental checkup? Come book an appointment with us here!

Have a specific topic that you would like us to talk about? Just let us know!

References:

Machado, E., Dal-Fabbro, C., Cunali, P. A., & Kaizer, O. B. (2014). Prevalence of sleep bruxism in children: a systematic review. Dental press journal of orthodontics, 19(6), 54-61.

Lee, B. K., Glass, T. A., McAtee, M. J., Wand, G. S., Bandeen-Roche, K., Bolla, K. I., & Schwartz, B. S. (2007). Associations of salivary cortisol with cognitive function in the Baltimore memory study. Archives of general psychiatry, 64(7), 810-818.

You may look at oral piercing as just another form of accessory but is it actually safe? There are some safety issues and potential risks that need to be addressed when we talk about oral piercings. Dental pain, excessive bleeding, trauma to the tongue and infections are some of the common complications that can occur. If you already have an oral piercing, let us help you minimise the risks involved!

Oral piercings are defined as the insertion of rings, studs or pins to the oral cavity; a needle is used to create an opening in the mouth or areas around the mouth to keep oral accessories intact. Such oral cosmetics are commonly displayed on the lips, tongue, chin and cheeks!

Details on oral modifications

  • Oral piercings on the lips include:

Bottom lip, upper lip, bottom/upper side lip, double piercings on each corner of the bottom/upper lip, four piercings distributed on the edges of upper and lower lips, among others.

  • Oral piercings on the tongue include:

Midline tongue piercing, side tongue piercing, two piercings at the tip of the tongue, frenulum linguae piercing (the skin under your tongue that juts out and connects the bottom of your tongue to the floor of the mouth), tongue splitting (dividing the tongue into half) and so many more

  • Oral piercings on the cheek include:

Dimple piercings, dermal cheek piercing, cheekbone piercing, piercing on both apples of the cheek, just to name a few.

  • Oral piercings on the chin include:

Piercings directly under the bottom lip, side chin piercings, upper and lower chin piercings and many others.

Cosmetic oral modifications are not just limited to the lips, tongue, cheeks and chin. It is inclusive of the entire anatomy of the mouth such as the jawline, uvula, teeth, the roof of the mouth and the floor of the mouth. Oral piercings are growing in popularity and it is quite literally expanding into new areas! It has become a prominent fashion statement, body art and a means of self-expression in the millennial age.

Are there any repercussions to oral piercings?

How-long-do-they-last

Unfortunately, the list of complications attached to oral piercings is just as long as the list of oral piercings available. As with any puncture wound or incision, this type of accessory typically causes immediate complications such as excessive:

  • Pain
  • Swelling
  • Bleeding
  • Oral infection
  • Potential permanent scars

However, some complications are built up over time, which will require longer or more complicated oral remedies to take place. Late complications relating to oral cosmetics include:

  • Drainage of purulence
  • Damage of reactive tissues
  • Spontaneous bleeding
  • Dental pain
  • Trauma in the tongue
  • Palate trauma
  • Gum trauma
  • Gingival recession
  • Trauma in the mouth floor
  • Tooth loss
  • Tooth fractures

The wound associated with the insertion of oral accessories allows various microorganisms that normally inhabit the mouth to have direct access to enter the bloodstream and affect other body structures such as the heart or brain. Severe infections resulting from oral piercings are rare but can be potentially life-threatening. There have been reported cases of people suffering from Ludwig’s angina after getting oral piercings. Ludwig’s angina is a fast-spreading cellulitis involving the submandibular, sublingual and submental fascial spaces. Antibiotic therapy and possible surgical intervention are required to treat Ludwig’s angina.

Oral accessories may also break and cause choking or damage to your teeth while you sleep, talk or chew. They also cause:

  • Interference with speech patterns.
  • Involuntary drooling.
  • Difficulty in swallowing
  • Difficulties for dental X-rays to be taken

People with existing health concerns such as diabetes, haemophilia and autoimmune diseases are more vulnerable to oral complications due to the fact that it may take a longer period for them to heal from obtaining oral jewellery. These accessories can also trigger an immunemediated reaction based on the type of metal being used in the piercing.

Here’s what you need to know if you have oral piercings:

How-long-do-they-last

There are risks involved in getting an oral piercing but it does not mean everyone who has it is doomed. There are preventive measures you can take to ensure your safety:

  • Get your piercings done by a licensed practitioner who has good experience in doing
    oral piercings and maintains good infection control.
  • Maintain good oral hygiene and extra hygiene measures for the piercing. For example,
    brushing the tongue stud.
  • Maintain routine visits to your dentist

If you are thinking of getting yourself an oral piercing, reach out to us and let our dentists help you make an informed decision. Speaking of oral care, are you due for a dental checkup? If you are, come book an appointment with us!

Have an interesting topic you would like us to cover? Just let us know!

References:

(n.d.). Retrieved January 14, 2021, from
https://www.ada.org/en/member-center/oralhealth-topics/oral-piercingjewelry#:~:text=Oral%20piercing%20of%20the%20tongue,site%20for%20oral%2Dpiercing%20placement.

15, W. (2020, November 27). Tongue Piercings: Guide & Images. Retrieved January 14, 2021, from
https://authoritytattoo.com/tongue-piercing/

Definition-of-oral-piercing. (n.d.). Retrieved January 14, 2021, from
https://www.dentalcare.com/en-us/professional-education/ce-courses/ce423/definition-of-oral-piercing

Donnelly, W. (2016, April 25). Guide: Types of Mouth & Oral Piercings. Retrieved January 14, 2021, from
https://www.tattoodo.com/a/mini-guide-types-of-oral-piercings-7953

Oral (Lip and Tongue) Piercings: Risks, Home Care, and More. (2020, August 27). Retrieved January 14, 2021, from
https://www.webmd.com/oral-health/guide/oral-piercing

The Oral Cavity. (n.d.). Retrieved January 14, 2021, from
https://teachmeanatomy.info/head/organs/oral-cavity/

Vieira, E. P., Ribeiro, A. L. R., João de Jesus, V. P., & Alves Jr, S. D. M. (2011). Oral piercings: immediate and late complications. Journal of oral and maxillofacial surgery, 69(12), 3032-3037.

Your Complete Guide to Cheek Piercings (Pros, Cons and Tips). (n.d.). Retrieved January 14, 2021, from
https://www.jewelryshoppingguide.com/cheek-piercings-guide/