Bruxism is a medical condition that makes reference to excessive grinding and clenching of the teeth without a functional purpose. This may happen during the day (awake or diurnal bruxism) or at night (nocturnal or sleep bruxism) while asleeep. Although mild cases may require no treatment excessive bruxism may lead to tooth wear, damaged teeth and restorations, jaw disorders including problems of the temporomadibular joint, and headaches. In some patients bruxism may be related to ear infections and a history of high stress or anxiety. Physical exam will reveal damaged teeth, chew marks on the cheekbones and tongue, and tooth sensitivity.

Bruxism is common in the general population affecting 8 to 16% of the adult population. Curiously awake bruxism occurs predominantly in females but no geneder bias is reported for sleep bruxism. In an oral health status survey that included 100 children with ASD and 100 neurotypicals self-injurious behaviors and bruxism were seen in 32% of children with ASD and only in 2% of neurotypicals (El Khatib et al., 2014). A smaller study by Orellana et al. (n=30 ASD and an equal number of controls) revealed that bruxism and oral dental problems were more frequent in the ASD individuals. Nocturnal bruxism may be more common in autistic individuals due to the large prevalence of sleep disorders as well as poorer dental hygiene and gingival condition of this population.

There are a number of case studies and blogs regarding autism and bruxism (see references). Among the more cited examples is the case report of a 4- year-old male child with autism with poor cognitive abilities whose bruxism and severe attrition of all primary teeth required placement of stainless steel crowns for all primary molars. Sometimes a multidisciplinary intervention is required. According to the Center for Autism and Related Disorders, inc (CARD) a combination of vocal and physical cueing can effectively treat teeth grinding in children with autism (Bebko and Lennox, 1988). The latter intervention may be of benefit for cases of diurnal (daytime) bruxism. The same makes use of home-based Applied Behavioral Analysis (ABA) therapy to implement a vocal prompt (e.g., saying “Ahhh”) whenever the child grinds his/her teeth. The vocal prompt is incompatible with teeth grinding. Other interventions for diurnal bruxism have included the use of protective devices (e.g., splints), the use of aversive procedures like the abrief application of an ice cube over the cheek), and functional communication training (Lang et al., 2013). Unfortunately, long term follow up regarding the effectiveness for many of these interventions is lacking.

Whenever bruxism causes pain you can try to apply an ice pack over the sore jaw muscles and avoid eating hard foods and chewing gum. To prevent damage of the teeth consult a dentist in regards to using a well-fitted splint or mouth guard. (For more on dental problems and autism see my previous blog: Dental care and autism http://bit.ly/23NvEkj ).

References

Armstrong A, Knapp VM, McAdam DB. Functional analysis and treatment of the diurnal bruxism of a 16-year-old girl with autism. J Appl Behav Anal 47(2):415-9, 2014.

Bebko JM, ennox C. Teaching the control of diurnal bruxism to two children with autism using a simple cueing procedure. Behavioral Tehrapy 19(2):249-255, 1988.

Blog: Autism- Day by Day. http://autismdaybyday.blogspot.com/2010/01/teeth-grinding-in-kids-with-asd.html. January 25, 2010

Blog: Teeth Grinding in Youngsters Bruxism: What Else Could You Do? http://howtostopgrinding.com/tag/teeth-grinding-in-children-with-autism. September 3, 2013.

El Khatib AA, Tekeya El, Tantawl E, Omar T. Oral health staus and behavious of children with Autis Spectrum Disorder: a case-control study. Int J Paediatr Dent 24(4):314-23, 2014.

Lang R, Davenport K, Britt C, Nincl J, Garner J, Moore M. Functional analysis and treatment of diurnal bruxism. J Appl Behav Anl 46(1):322-7, 2013.

Muthu MS, Prathibha KM. Management of a child with autism and severe bruxism: a case report. J Indian Soc Pedod Prev Dent 26(2):82-4, 2008.

Orellana LM, Silverstre FJ, Martinez-Snachis S, Martinez-Mihi V, Bautista D. Oral manifestations in a group of adults with autism spectrum disorder. Med Oral Cir Buccal 17(3):e4 15-9, 2012.