Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2013  |  Volume : 31  |  Issue : 3  |  Page : 153--158

Evaluation of parents/guardian knowledge about the bruxism of their children: Family knowledge of bruxism


Junia Maria Serra-Negra, Debora Tirsa-Costa, Flavia H Guimarães, Saul Martins Paiva, Isabela Almeida Pordeus 
 Department of Pediatric Dentistry and Orthodontics, Faculty of Dentistry, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

Correspondence Address:
Junia Maria Serra-Negra
Av Antonio Carlos, 6627, Dentistry School, UFMG-Campus Universitário Pampulha, Belo Horizonte, Minas Gerais-Zone Code:31270-901
Brazil

Abstract

Background/Aim: Bruxism is the habitual, involuntary grinding or clenching of the teeth that affects both children and adults. The aim of the present study was to assess the level of knowledge parents/guardians have about the bruxism of their children. Materials and Methods: A cross-sectional epidemiological study was developed for 221 parents/guardians of patients of the pediatric dentist in the Faculty of Dentistry of the Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil. A previously tested questionnaire, based on the criteria of the American Association of Sleep Medicine (AASM), was used to collect data from the participants in the waiting room of the clinics involved. Descriptive analysis was elaborated and the chi-squared test was applied (level of significance of 5%) using statistical software SPSS 17.0. Results: The majority of the participants were mothers of the patients (84.2%). The mean age of the parents/guardians was 36.6 years. The mean age of children was 7.6 years. In total, 76.6% of the mothers, 40.2% of the fathers, and 48% of the children reported having bruxism. The participants believed that bruxism was associated with emotional factors (63.8%) and/or mystical factors (20.4%). The majority reported having sought help from doctors (54.4%), followed by mystics (20.4%) and dentists (19.1%). A statistically significant association was found between bruxism and children with restless sleep (P < 0.001) and in cases where both the parents and children were affected by bruxism (P < 0.001). Conclusion: Families require greater clarification regarding the factors that trigger bruxism.



How to cite this article:
Serra-Negra JM, Tirsa-Costa D, Guimarães FH, Paiva SM, Pordeus IA. Evaluation of parents/guardian knowledge about the bruxism of their children: Family knowledge of bruxism.J Indian Soc Pedod Prev Dent 2013;31:153-158


How to cite this URL:
Serra-Negra JM, Tirsa-Costa D, Guimarães FH, Paiva SM, Pordeus IA. Evaluation of parents/guardian knowledge about the bruxism of their children: Family knowledge of bruxism. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2019 Aug 25 ];31:153-158
Available from: http://www.jisppd.com/text.asp?2013/31/3/153/117965


Full Text

 Introduction



Bruxism is a disease that is characterized by clenching and/or grinding the teeth and affects both children and adults. [1],[2] Teeth grinding commonly occurs during sleep, whereas teeth clenching is more common while awake [2],[3] during periods of worry, stress, and excitement, and is accompanied by a noticeable noise. [3],[4]

Different etiological factors, such as local, systemic, psychological, occupational, and hereditary factors, can be associated with the development of sleep disorders. [5],[6],[7],[8] The most common signs and symptoms are tooth wear, disorder in the support structures of the dental arches, pulpal hypersensitivity, tooth mobility, fractured cusps and restorations, pain, temporomandibular disorder, hypertrophy of the masseter muscle and headaches. [9],[10]

Detailed anamnesis as well as clinical intra and extraoral examinations are indispensible in determining a diagnosis of bruxism. [11],[12] In terms of the damage caused by the disease, three characteristics must be observed: The persistence of the habit, the intensity of the habit, and the duration of the periods of clenching and/or grinding. [11],[12]

Childhood bruxism may persist into adulthood. [5] Early diagnosis helps to provide a perspective of control, prevents damage to the components of the masticatory system, and promotes well-being and comfort. [10] It is essential, therefore, that parents seek help as soon as the abnormality has been identified. The participation of parents is fundamental as they can inform the medical history and current medical state of the child and other family members. [4],[13]

The aim of this study was to collect information on the parents' knowledge about bruxism to promote educational activities for families of pediatric patients in dental waiting rooms.

 Materials and Methods



The present study received approval from the Human Research Ethics Committee of the Federal University of Minas Gerais. A questionnaire was given to parents/guardians in the waiting room during their children's appointments at the pediatric dentist in the Faculty of Dentistry of the Federal University of Minas Gerais.

The Faculty of Dentistry of the Federal University of Minas Gerais is located in Belo Horizonte, in the state of Minas Gerais, an important industrial and cultural center in the southeast of the country (www.ufmg.br). The institution offers free care for lower classes carried out by undergraduate students.

The questionnaire was designed by a team of researchers based on the criteria of the American Association of Sleep Medicine. [1],[5],[14] This questionnaire was tested in a pilot study with 30 parents/guardians. The participants of the pilot study were not included in the main study and the instrument used in the pilot study did not require any alterations.

In total, 277 statements of informed consent were distributed and 221 parents/guardians agreed to participate in the study (79.8%). The parents/guardians answered the questionnaires individually, without consultation or discussion among partners. Once completed, they immediately delivered the questionnaire to the investigator. Illiterate parents/guardians did not participate in the present study. The confidentiality of the data was confirmed to the participants. The investigators did not affect the participant's answers in any way.

The questionnaire was composed of 17 questions, 12 of which were closed and 5 of which were open. The aim of the questions was to collect the following information: The age of the participants and the children; the sleep characteristics of the children; the hours of sleep; the type of sleep; if the child slept alone; if the parent/guardian suffered from bruxism; if the parent/guardian knew about bruxism and what causes bruxism; if the parent/guardian had sought help and if so, what type of help had been sought; if bruxism could affect the health of the participants and if the participants wanted to receive more information about bruxism. The open questions were How many hours of sleep your child has a night? Are you aware of what bruxism is?; What are causes of bruxism?; Would you sought help for treating bruxism?;Would you seek help?

A number of variables were discounted in order to facilitate the statistical data analysis. The quantity of hours the child slept, as reported by the parent/guardian, was divided into two groups: 8 h or less and more than 8 h. The age group of the children was also divided into two groups: 7 years or less and more than 7 years.

The questions related to the concept and cause of bruxism, and its consequences on health were open questions that were grouped by the investigators for the data analysis. The answers that classified bruxism as the act of grinding the teeth against each other or clenching them together were considered "correct", whereas those that addressed issues other than these were considered "wrong".

In the question related to seeking medical help, doctors and dentists were considered to be health professionals. A number of parents reported contacting faith healers, gurus, ministers, and priests to "cure" their child's bruxism. These individuals were classified in the "mystic" group for the data analysis.

There is also a mystic group in the question related to possible causes of bruxism. A number of parents/guardians reported that bruxism could be associated with "spiritual" influences, manifestations of evil spirits, supernatural influences, or witchcraft. These individuals were classified in the "mystical influence" group for the data analysis.

SPSS 17.0 software, descriptive analysis, and the chi-squared test (5% level of significance) were used for statistical analysis of the data.

 Results



In total, 221 parents/guardians, aged between 22 and 68 years (mean of 36.6 years) participated in the present study. The age of the children ranged from 5 to 11 years with a mean age of 7.6 years.

The majority of the questionnaires were completed by mothers of pediatric patients (84.2%), followed by grandparents (8.1%) and only 13 fathers (5.8%) [Table 1]. The majority of the children were female (65.2%) [Table 1].{Table 1}

According to the parents/guardians, bruxism was present in 48% of the children, in 40.2% of the fathers and in 76.6% of the mothers [Table 1].

Among all of the participants, 210 reported knowledge of bruxism (95%) and classified the parafunction correctly (95.5%) [Table 2].{Table 2}

A majority of the participants reported having sought help to clarify the problem (97.6%). In terms of the type of help sought, doctor was the most common (54.4%), followed by mystics (26.5%). Only 39 sought help from dentists (19.1%) [Table 2].

A majority of the participants believed that bruxism is caused by emotional factors (63.8%), whereas 45 participants associated the disease with mystical influences (20.4%) and only 23 (10.4%) thought that it is associated with dental problems [Table 2].

Associations between the presence of bruxism among the children and the variables reported by the parents were analyzed [Table 3]. No statistically significant difference was found between gender (P = 0.548), age (P = 0.059), and the presence of bruxism among the children [Table 3].{Table 3}

A statistically significant association was found between childhood bruxism and restless sleep (P < 0.001) [Table 3], as well as between childhood bruxism and bruxism in their father (P < 0.001) and mother (P = 0.042) [Table 3].

A majority of the parents/guardians who wanted to receive more information about bruxism (53.2%) had children with the disease (P = 0.014) [Table 3].

 Discussion



The family plays an important role in childhood development and children with sleep bruxism develop characteristic sounds generated by teeth grinding, which are easily detected by those who live with such individuals. [4],[5] Parents/guardians are the individuals who look after the health of the family unit. [13],[14],[15] Humans have taken many different approaches to try to understand and manage diseases, starting with the supernatural and mystical. [16],[17] Beliefs about the etiology of the disease are strongly associated with the type of treatment that will be sought by the patient. Historically, human beings have searched for mystical explanations for diseases when they do not understand what is happening to their body. [17],[18] This mystical idea was applied to bruxism by 20.4% of the participants and 26.5% of the participants sought help from somebody in the mystical area. These results suggest that families require greater clarifications about bruxism.

In spite of the fact that the majority of parents/guardians correctly described bruxism in the questionnaire (95.5%) and knew that the pathology involves dental issues and the muscles of mastication, only 19.1% sought help from a dentist. On the contrary, 54.4% sought medical assistance from a doctor. The pediatrician is the first health professional to establish contact with a child and thus, they play an important role in the diagnosis of this disorder. The pediatrician should recognize the problem and refer the patient to other health professionals, such as pediatric dentists and psychologists. [10]

Pediatricians and pediatric dentists should be able to understand the possible causes, clinical characteristics, signs and symptoms of the disease in childhood, identifying the problem as early as possible. Once the disease has been diagnosed, the patient must be referred to a specialist to provide effective and lasting treatment. According to Serra-Negra et al., [5] bruxism is multifactorial and there is an important association between personality traits and the presence of childhood bruxism. Multidisciplinary action during childhood can give a child the opportunity to learn to deal with their conflicts and tensions. [19]

In the present study, a statistically significant association was found between childhood bruxism and restless sleep in children (P < 0.001). Children with restless sleep are more likely to exhibit bruxism. [18] In medical circles, bruxism is classified as a parasomnia or sleep disorder. [1],[18]

Children may exhibit other common sleep disorders such as sleeptalking, sleepwalking, shouting, and crying during sleep. [7] It is possible that adverse situations during the day may lead to restless sleep at night, with above average levels of functional and parafunctional muscle contractions. [7],[8] Therefore, further awareness of the need for quality sleep is important. [7],[8],[20] A habit that affects an individual while they sleep is difficult to control or alter. However, habits that are exhibited during waking hours can be detected by family members, at school, and by health professionals, which helps in the preparation of preventative measures. [5],[10],[14],[21] A statistically significant association was found between the presence of bruxism in parents and their children (P < 0.001). A study of genetic predisposition reported that parents who exhibited this habit in their childhood often have children who grind or clench their teeth while asleep. [21] Contrary to this finding, a bibliographical review by Macedo et al.,[22] confirmed that no genetic markers were associated with the transmission of this habit. According to Moore et al., [7] there is a significant association between sleep disorders and family genetics. In the present study, the prevalence of bruxism was high: 76.6% of the mothers; 40.2% of the fathers; and 48% of the children. Another study that was developed in Brazil found a prevalence of 35.4% of sleep bruxism among children between 7 and 11 years of age. [14] The present study included any type of bruxism (clenching, grinding). Perhaps this explains the differences in the results found. There is a great discrepancy in the prevalence values of bruxism in the literature and this is a consequence of different data collection methods and the type of bruxism analyzed. [4],[6],[14],[19],[23]

The hereditary factor may be seen differently: Parents that have or had this problem feel impotent regarding the bruxism of their child. [24] They cannot help their child to overcome the problem because they themselves could not overcome it. [13] Similarly, one must consider that emotional conflicts may be transmitted through generations by interactions in which fear and anxiety prevail, thereby modeling the psyche and predisposing it to the use of certain neurotic mechanisms. [5] Further studies of family behavior associated with bruxism would be interesting and useful.

Only one parent/guardian answered for the customs of an entire family in the present study, which may have been a limitation. The majority of the sample was composed of mothers and they answered questions about their own bruxism, as well as that of their children and the fathers of their children. There may have been a margin of error and a possible recall bias effect in this question. Since the mother is the caregiver and the promoter of health in the family, [15] It is possible that the data collected provided a significant margin of truth.

A diagnosis of the disease in isolation is not sufficient to provide an exact idea of the prognosis or the type of treatment that the patient should receive. [17],[22] The treatment can involve a multiprofessional team: Doctors, dentists, psychologists, and audiologists. It is of paramount importance that education programs for families are promoted to elucidate the concepts, consequences, and interventions related to bruxism. Parents/guardians are aware of bruxism, although there are a number of distorted concepts that must be clarified.

 Conclusion



On the basis of this study's results, the following conclusions can be made:

Parents/guardians are aware of bruxism, although there are a number of distorted concepts that must be clarified. Distorted concepts about bruxism may lead families to seek help from people who are not qualified to provide treatment.

 Acknowledgments



All authors are very grateful with the parent/guardians which participation was essential.

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