Indian Journal of Dental Research

ORIGINAL RESEARCH
Year
: 2014  |  Volume : 25  |  Issue : 1  |  Page : 9--13

Association between respiratory problems and dental caries in children with bruxism


Lara Jansiski Motta1, Carolina Carvalho Bortoletto2, Alyne Jacques Marques2, Raquel Agnelli Mesquita Ferrari2, Kristianne Porta Santos Fernandes2, Sandra Kalil Bussadori2,  
1 Department of Pediatric Dentistry, Nove de Julho University (UNINOVE), Sao Paulo, SP, Brazil
2 Rehabilitation Sciences Post Graduation Program, Nove de Julho University (UNINOVE), Sao Paulo, SP, Brazil

Correspondence Address:
Carolina Carvalho Bortoletto
Rehabilitation Sciences Post Graduation Program, Nove de Julho University (UNINOVE), Sao Paulo, SP
Brazil

Abstract

Context: Bruxism is the habit of clenching or grinding one«SQ»s teeth in non-functional activities and affects both children and adults alike. Respiratory problems, such as asthma and upper airway infections, are reported to be the etiological factors of bruxism. Aims: The aim of the present study was to determine whether there is an association between respiratory problems and dental caries in children who exhibit the habit of bruxism. Setting and Design: An observational cross-sectional study was carried out. Materials and Methods: Patient histories were taken and clinical exams were performed on 90 children for selection and allocation to one of two groups. For the determination of bruxism, a questionnaire was administered to parents/guardians and an oral clinical exam was performed based on the criteria of the American Academy of Sleep Medicine. Thirty-three male and female children between 4 and 7 years of age participated in the study - 14 children with bruxism and 19 children without bruxism. Statistical Analysis: The data were statistically analyzed using the chi-square test, with level of significance set at 5% (P < 0.05). Results: Mean age of the participants was 5.73 years. The male gender accounted for 45.5% (n = 15) of the sample and the female gender accounted for 54.5% (n = 18). A statistically significant association was found between respiratory problems and dental caries among the children with bruxism. Seventy-seven percent of the children with bruxism had caries and 62.5% the children with respiratory problems exhibited the habit of bruxism. Conclusions: There seems to be an association between bruxism, respiratory problems, and dental caries in children.



How to cite this article:
Motta LJ, Bortoletto CC, Marques AJ, Ferrari RM, Fernandes KS, Bussadori SK. Association between respiratory problems and dental caries in children with bruxism.Indian J Dent Res 2014;25:9-13


How to cite this URL:
Motta LJ, Bortoletto CC, Marques AJ, Ferrari RM, Fernandes KS, Bussadori SK. Association between respiratory problems and dental caries in children with bruxism. Indian J Dent Res [serial online] 2014 [cited 2020 Oct 26 ];25:9-13
Available from: https://www.ijdr.in/text.asp?2014/25/1/9/131047


Full Text

Bruxism is the habit of clenching or grinding one's teeth in non-functional activities. This habit affects both children and adults alike. Some individuals clench their teeth during waking hours, which is named diurnal bruxism, and others grind their teeth while sleeping (nocturnal bruxism). [1],[2] The etiology of this condition is not fully understood, as bruxism is a complex, multifactor disorder often associated with emotional stress, occlusal problems, or a combination of the two. [2],[3]

The literature describes different prevalence rates of bruxism in children. In a study carried out in Hong Kong using polysomnography for the assessment of sleep disorders in children, Kwok et al. [1] found a 8.5% frequency of bruxism. In Brazil, Valera et al. [4] used parent's reports for the assessment of nocturnal bruxism and found a 43% frequency of the condition. In American children, Cheifetz et al. [5] reported a 38% frequency of bruxism, based on parent's reports.

Besides the effect bruxism can have on the dentition, this condition can also affect the temporomandibular joint, cause headaches as well as behavioral and psychological effects. [6],[7]

Respiratory problems, such as asthma and upper airway infections, are reported to be etiological factors of bruxism. [8]

Moreover, associations between bruxism and allergic rhinitis, ear infection, and mouth breathing have been found. [9] The literature reveals a high frequency of bruxism among children with the mouth-breathing pattern stemming from different etiologies. [10] Due to the lack of nasal airflow, such children have a greater tendency toward rhinitis and ear infections resulting from the chronic inflammation of the nasal mucosa and hypoplasia of the paranasal sinuses. [10]

There is a close relationship between nasal obstruction and bruxism in children with allergies due to the allergic swelling of the acoustic meatus, which, in turn, leads to the emergence of bruxism in an effort to open the ear canals. [11]

Moreover, the association between mouth breathing and dento-maxillary conditions, such as protrusion, dental crowding, malocclusion, gingivitis, dental caries, and high curvature of the palate is widely described in the literature. [12],[13]

Dental caries is described as a multifactorial disease, in which the anatomy of the oral cavity, strength of the dental tissue, salivary composition, crevicular fluid, and diet are as important as the formation of bacterial plaque and the microorganisms that cause the disease. [14] Since 1970, there has been a considerable reduction in the prevalence of dental caries in the majority of developed countries. [15],[16] While a number of authors report improvements in oral health status in recent decades, [17],[18] dental caries remains a serious public health problem in Brazil [10] as well as in a large part of the world. [19] Some authors report that children with the mouth-breathing pattern have a greater chance of developing caries. [20]

According to Lupoli and Lockey, [21] many patients with temporomandibular disorder are mistakenly treated for sinusitis and unnecessarily prescribed antibiotics. [21] A number of authors report that children with bruxism often exhibit allergies, tonsillitis, rhinitis, non-nutritional oral habits, malocclusion, mouth breathing, and headaches. [13],[21],[22],[23] Bruxism is relatively common among children with asthma and upper airway infections, and can cause harm to the temporomandibular joint as well as facial alterations, daytime sleepiness, headaches, nocturnal restlessness, and bedwetting. Thus, there is a need to study the association between bruxism and respiratory problems in children. [21],[22],[23]

The aim of the present study was to determine whether there is an association between respiratory problems and dental caries in children with bruxism.

 Materials and Methods



This study received approval from the local Human Research Ethics Committee (process number: 82622/08). All parents/guardians were properly informed as to the objectives of the study and signed a statement of informed consent in compliance with Resolution 196/96 of the Brazilian National Health Council.

Children with either complete primary or mixed dentition who were not in dental treatment were included in the study and divided into two groups: those with bruxism and those without bruxism. For the diagnosis of bruxism, a questionnaire was administered to determine the occurrence of teeth clenching/grinding and a physical exam was performed for the determination of dental wear.

The data were collected by a single examiner assisted by an annotator. After the exam for signs of caries, the individuals were divided into two subgroups: those with caries and those without caries. Individuals with enamel lesions with signs of carious activity, surfaces with an opaque, chalky appearance and/or marginal gingivitis and/or carious lesion on the dentin were allocated to the group with caries, and those healthy dentition and no clinical signs of alterations were included in the group without caries. [24]

Breathing pattern was determined by a clinical evaluation and specific tests (mirror test and water holding test). All children were evaluated by an otolaryngologist for the confirmation of the diagnosis. The clinical examination included the presence/absence of the following signs: Long face, drooping eyes, dark circles around the eyes, thin upper lip, dry lips, hypotonic lips, inverted lower lip, narrow nostrils, high palate, inadequate lip seal, and anterior open bite. The mirror test involved the placement of a two-sided mirror under the nostrils to observe fogging on the upper portion (indicative of nasal breathing), lower portion (indicative of mouth breathing), or both faces (indicative of both nasal and mouth breathing). [25] The water holding test involved the child holding water in the mouth with the lips in contact and without swallowing for 3 min; children who were unable to maintain the lips in contact were considered mouth breathers. [25] When the patient history revealed respiratory problems, the individual was referred to an otolaryngologist for examination and the issuance of a medical report on the respiratory problems encountered [Figure 1]. The groups were evaluated and comparisons were made regarding nasal or mouth breathing, [26] respiratory problems, such as allergic rhinitis, asthma, and bronchitis based on the questionnaire administered to parents/guardians and the medical report, and the presence/absence of caries.{Figure 1}

 Results



[Table 1] displays the distribution of the overall sample according to gender, breathing pattern, respiratory problems, bruxism, and dental caries.

In the inter-group comparison, bruxism was found to be significantly associated with dental caries and respiratory problems [Table 2] and [Table 3]. The data were statistically analyzed using the chi-square test, with the level of significance set at 5% (P < 0.05).{Table 1}{Table 2}{Table 3}

Seventy-seven percent of the children with bruxism had caries and 62.5% the children with respiratory problems exhibited the habit of bruxism.

 Discussion



The findings of the present study demonstrate an association between bruxism, respiratory problems, and dental caries in children.

The findings are in agreement with those reported in previous studies demonstrating that a predominantly mouth-breathing pattern can cause both temporomandibular and postural disorders and is also considered a risk factor for dental caries and periodontal disease. [27],[28] The exact mechanisms for this are not yet fully clarified. However, dehydration of the gingival surface, reduced resistance of the epithelium to the formation of bacterial plaque, and the absence of salivary self-cleaning may be considered the probable causes. [27]

Both mouth breathing and bruxism can lead to craniofacial and postural alterations as well as problems with the facial muscles, occlusion, chewing, swallowing, sleep, concentration, and attention. [7],[27],[29],[30] Thus, the early diagnosis of these conditions is important so that timely therapeutic intervention can be performed when necessary. [25]

In the present study, the children with bruxism had a greater number of respiratory problems than those without this habit, which corroborates the findings of previous studies. [8],[11],[31],[32] Analyzing children with airway conditions, Grechi et al. [31] found a significant predominance of bruxism, which is in agreement with the findings reported in a number of studies in the literature. [30]

According to DiFrancesco et al., [8] children with obstructed airways tend to push the mandible forward and downward in order to improve the passage of air, which may stimulate the receptors of the upper airways to intensify tonus, leading to bruxism. In the present study, children with respiratory problems had a greater prevalence of bruxism, which may be related to the alteration in the mandible position reported by the authors cited.

While a number of authors report improvements in oral health status in recent decades, [17],[18] dental caries remains a serious public health problem in Brazil as well as a large part of the world. [10],[19] In the present study, the group of children with bruxism had a high frequency of dental caries. This may have occurred due to the harm bruxism can cause to the teeth in the form of incisal and occlusal wear as well as the reduction in salivary flow, which favors the appearance of caries. [33],[34] As bruxism and respiratory problems are conditions with an increasing incidence in the pediatric population, further studies that relate these two problems are needed in order to favor harmonious growth and development in children.

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