The 4-year-old was active and healthy, but his parents still had many concerns, most of them not specifically medically related. One of the issues that bothered mom was her son's annoying teeth grinding habit.
Delving into the little boy's history, I could find nothing of real concern except that he seemed to be the boss of the family. While this had nothing to do with teeth grinding, it had everything to do with the conversation that followed, as I gently reminded the parents that they were the adults, their son was the 4-year-old, and they really needed to take back control of their household.
The easier part of the visit was handling the teeth grinding issue. Though the boy had an intact, gleaming set of teeth and no worrisome signs or symptoms of jaw problems or other medical risk factors, the 4-year-old still had not gone for his first dental visit. I seized upon mom's concern, and advised the parents to take their son for an initial - and overdue - evaluation by a dental professional.
Teeth grinding, also known as bruxism, is commonly seen, and heard, in children. Oral health experts at the American Academy of Pediatrics note that grinding usually occurs at night but is not limited to sleep time. Juvenile bruxism, often occurring during periods of tooth eruption, is found in about 50 percent of infants as they teeth, and among 30 percent of young school-aged children. The incidence of teeth grinding drops dramatically by age 7 or 8, and usually disappears by age 12 after all of a child's permanent teeth have come in.
The academy finds that the majority of cases of bruxism are due to unknown causes, though grinding has been linked to tooth malocclusion, sleep disorders, neurological abnormalities, certain medications, emotional stressors or simply childhood habit.
According to the AAP, treatment of teeth grinding in children under 8 is usually not necessary, though if any predisposing medical conditions are found, these should be addressed. Older kids may benefit from a night mouth guard, since persistent bruxism can lead to problems with headaches, TMJ (temporomandibular joint) issues, worn down tooth enamel, and root exposure.
The American Academy of Pediatric Dentistry agrees, stating that bruxism should be treated "when the habit is of sufficient persistence, duration or intensity to damage the permanent teeth or cause other complications which affect the child's well-being."
If bruxism affects medical or dental health, specialists at the Cleveland Clinic follow several steps, including the use of mouth guards when appropriate, with stress reduction therapies offered when psychological issues are found to be a contributing factor. Individuals with bruxism are urged to avoid alcohol, as well as foods and drinks with caffeine, as both products can stimulate grinding.
Chewing nonfood items such as pencils and gum is also discouraged, since this habitual chewing results in frequent jaw clenching that can lead to teeth grinding. Jaw muscles can also be trained to relax by periodically putting the tongue tip between the teeth during daytime hours, and by placing a warm washcloth over the TMJ area before bedtime.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.