Teeth grinding can be normal in children, but not excessive teeth grinding. The most widely accepted causes of teeth grinding are stress and pain. There is, however, another possible cause, which is upper airway issue due to obstructions, or narrowing, such as the presence of enlarged adenoids, enlarged tonsils, nasal congestion, and tethered oral tissues (tongue ties and/or lip ties). This is when excessive teeth grinding may occur.
During sleep, if a child cannot breathe normally due to a narrowed upper airway, the brain gets deprived from Oxygen, causing it to repeatedly push the lower jaw forward to open up the airway. Hence, teeth grinding is a survival mechanism that can be an apparent warning sign of a child suffering from a sleep disorder.
Teeth grinding, as well as snoring, can lead to developing obstructive sleep apnoea. Children suffering from this sleeping disorder do not get good quality sleep, often restless, waking up multiple times during the night, may develop dysfunctional issues (such as bed-wetting and teeth grinding) and can be hyperactive during the day. Consequently, they develop behavioural problems and may struggle to keep up at school.
In the mouth, teeth grinding may cause damages, including severe wear of teeth, chipped teeth, dental crowding, abnormal bite due to the parafunctional shifting of the jaws, and trauma to the inside of the cheeks from accidental biting.
Just like snoring, when teeth grinding is excessive, an upper airway assessment by an Ear Nose and Throat specialist, or a sleep physician, may be advised. Widening of the narrowed upper airway is usually indicated. Depending on the core issues, in children, the treatment may range from removal of upper airway obstructions to breathing re-training.
From a dental perspective, widening the narrow jaw bones through orofacial myofunctional pre-orthodontic therapy, can also help in improving the upper airway patency, which may lead to the resolution of teeth grinding, snoring, improved sleep quality, and optimizing functional health, with the following goals:
- Tongue up against the roof of the mouth
- Lips always closed, except during eating and talking
- Breathe through the nose
- Swallow properly
Tethered oral tissues, such as tongue ties, lip ties and/or cheek ties, may need to be released to allow effective re-training of these orofacial muscles.