Bruxism - Teeth Grinding Isn't Always Harmless

When children are growing, there are several things you need to be aware of, their weight gain, their food intake and the general state of their health. Often parents tend to ignore the mouth, assuming that as long as teeth are brushed and general mouth hygiene is maintained, everything will be alright.

Teeth brushing and observing the regular milestones of milk and permanent teeth aren’t the only things that need to be observed, since there are many other problems that point out to underlying issues in children, which if not treated affect teeth and their physical health, as well as add to the stress as they grow up.

One such condition that many parents tend to overlook, is Teeth Grinding or Bruxism. Although not a symptom, it points to an underlying .

Teeth grinding, teeth gnashing, or the unconscious act of clenching and unclenching teeth is present in most kids, with 2-3 out of 10 children having this problem. Most children grow out of it by the age of 7 years, but many others carry this habit well into adulthood. 

 Although the reasons are unknown, experts have given a few reasons for this condition,

• Stress induced teeth grinding, especially when children aren’t able to cope with a new situation, such as a test at school or meeting new people. An argument with parents or siblings or arrival of a second sibling is also seen as a probable cause
•  Mal-aligned top and bottom teeth which causes irritation and subsequent teeth gnashing
•  Pain anywhere in the face is also a cause, whether earache or appearance of new teeth 
•  Hyperactivity and restlessness
•  Kids with medical conditions ( such as cerebral palsy) or who take certain medication.

 How does one whether your child is grinding their teeth?

Have you heard your child’s jaw moving continuously or regular sounds from their mouth during bedtime? If you hear them grind their teeth while asleep, without being aware of it, and they experience a painful jaw or mouth on waking up or pain when chewing, it indicates they suffer from the condition.

What harm can it cause?

Bruxism as such is a temporary harmless condition, and children most often outgrow it. In those children where this condition persists, symptoms of headache or earaches are often complained. 

What harm can it cause the teeth?

A side effect of bruxism is the harm it can do to the child’s teeth. Nightime grinding, gnashing and clenching the teeth, can wear down tooth enamel, gradually chip off teeth, make the tooth temperature sensitive and also cause lingering jaw and mouth problems and pain.

It is important to take the child to a pediatric dentist, before the condition causes severe irreparable damage to the teeth in the long run. A dentist will examine the child’s teeth for chipped tooth enamel, and any other wear and tear.  In addition questions related to stress or tension will try to be discerned.

All these observations will give the dentist information on whether the cause for bruxism is psychological (stress induced) or structural (misaligned teeth) and treat the child accordingly. 

 Treatment

While the condition is outgrown by most children, some kids who have severe pain and wearing out, are prescribed a mouthguard; a thin protective mouthpiece moulded to the child’s teeth that acts as a barrier between the opposing sets. This can take care of the major problem.

If the cause is emotional or psychological, the underlying cause needs to be found out by talking to the child, understand reasons that are upsetting them, and try and resolve the issue. If it seems more complicated, then their fears will need to be eased by counseling.

Bruxism usually stops when the milk teeth are lost. In few cases the condition might continue well into teenage years. The condition cannot altogether be avoided, because most often, it is a coping mechanism in children, and their natural reaction to growth and development. It can however be avoided by talking to children frequently, letting them open up and ensuring regular visits to the pediatric dentist are carried out for optimal dental health.

Fluoride: What parents need to know - Part 1

Many parents are confused about fluoride.

Is it good or bad for children?

What are the risks and benefits of fluoride?

In this blog post we will answer these and other questions.

What is fluoride?

Fluoride is the 13th most abundant element on the earth's crust. It is found naturally in rocks, soil, water and some foods. The level of fluoride in water varies greatly between different geographical areas. Fluoride can also be emitted into air and water as a waste product of some industries.

Is fluoride good or bad?

In low levels, fluoride is beneficial in protecting teeth from decay. 

If the right level of fluoride is available while teeth are forming it is incorporated into the developing enamel, making it more resistant to acid attack, which is the cause of tooth decay. Teeth that have developed under the influence of fluoride also tend to have shallower grooves, making them less prone to decay. Tooth enamel formation starts from 3 months after conception (in the womb) and is completed by around 8 years old, with the exception of the wisdom teeth.

Studies in both the USA and the UK have demonstrated the ability of an optimum level of fluoride in drinking water (either naturally occurring or added) to significantly reduce dental decay in both children and adults.

Fluoride is also beneficial after teeth come through. The surface enamel of teeth is weakened and dissolved by acid attacks which occur after consuming sugary or acidic food and drinks. However, enamel can remineralise, or repair, itself by taking in minerals from sailva. Low levels of fluoride present in saliva and dental plaque encourage remineralisation and therefore make it less likely that a cavity will be formed. The fluoride also becomes incorporated into the enamel surface making it stronger and more resistant to acid attack.

Recent scientific studies have also shown that fluoride is able to reduce the ability of plaque bacteria to produce acid.

Scientists now believe that the effect of fluoride after teeth erupt into the mouth is more important than during tooth development. These effects explain why the incidence of decay has generally decreased with the introduction of fluoride toothpastes.

So what's the problem with fluoride?

Like many other minerals, fluoride is toxic at very high concentrations, but it is very rare to be exposed to these levels. The problem with fluoride is when you swallow more than the recommended level over a long period of time. The most common problem that is seen with consuming moderate levels of excess fluoride is dental fluorosis.

Dental Fluorosis 

Individuals who are exposed to too high a level of fluoride in early childhood (up to 7 years old) are prone to dental fluorosis, or mottling of the teeth.

In its mildest form, the only sign of fluorosis may be white specks on the enamel surface. Teeth more severely affected show discolouration, often in bands or lines, and pitting. Although they are more resistant to decay, teeth with severe fluorosis have structurally weaker enamel. 

The amount of fluoride in drinking water varies greatly. The level of fluoride in freshwater, for example rivers and lakes, is usually low. However as water seeps through soil and rocks it becomes contaminated with various naturally occurring substances or pollutants. These contaminants also become more concentrated where the groundwater level dips. 

India has become increasingly dependent on groundwater, from wells or bore-wells, to meet demands for drinking water and in some areas, this contains much higher than the recommended level of fluoride.

The optimum level of fluoride in drinking water - to provide dental health benefits and minimise side effects - is 1mg per litre. In India, the permissible level is up to 1.5 mg/l. 

The Indian Department of Drinking Water Supply reported that 203 out of 593 districts have higher than permissible levels of fluoride in water.

As this map shows,almost all states in India have districts where groundwater contains excessive levels of fluoride. Even in Bangalore, the level of fluoride varies between different areas and during different seasons. As water quality is not well regulated, it is not always easy to know the levels of fluoride in a particular area.

In some areas, the level of fluoride in water is excessively high. In these areas skeletal fluorosis may also occur. This causes pain and stiffness in the joints and, in more severe cases, bone deformities.

It is recommended to drink bottled or filtered water and, in high fluoride areas, to avoid food and products containing fluoride. Not all water filters remove fluoride, those which work by reverse osmosis and ion exchange resin are able to remove about 90% of the fluoride. Bone char filters have been found to be even more effective in removing fluoride. It is difficult and expensive to remove fluoride from the ground water supply and, in rural areas, other sources of drinking water are not always easily available. Recharging groundwater using harvested rainwater can be useful in reducing levels of contamination.  

Slides used from: http://www.schools.indiawaterportal.org/wq-test/fluoride-factsheet


In the second part we will look at how fluoride can be used safely to benefit dental health.

How you can influence your child's dental health

Children learn by copying important adults in their lives. This is a natural process by which children learn about the world around them. 

Your behaviour, expressions  and reactions will usually have a greater impact on your child than what you say to them. 

Parents have a unique position of influence in their children's lives, as a role model and first teacher. This influence can have either a positive or negative effect. How can we use this influence in a positive way to improve our children's oral health?

• Parents choose what babies and young children eat. Parents usually introduce children to the same foods that they eat.  If children are given a healthy, balanced diet at an early age they are much more likely to choose a healthy diet themselves when they are older. 
• If you are constantly snacking on high fat and high sugar snacks your children are likely to do the same. When shopping, plan your meals and also think about healthy food to keep in the house for snacks when you or your children get hungry between meals. 
• For more information on a diet that is good for you teeth see this link.

• Give your children a good example to follow by letting them see you brushing your teeth regularly. 
• Teach your child about the importance of looking after their teeth. There are books and videos which can make learning fun.

• You will need to brush your child's teeth until they can learn to do it effectively for themselves from around six years old. Older children will still require encouragement and supervision. Also see post on top toothbrushing tips.
• Children whose parents regularly visit the dentist are more likely to do the same.
• Take your child to visit a dentist before they have any pain or problems. Find a dentist who is good with children. Regular check-ups enable the dentist to assess your child's risk for developing decay or gum disease and give preventive advice. Any problems can also be seen early and treated or prevented from progressing.

Did you know that children whose parents are anxious about visiting the dentist are much more likely to become anxious themselves? A recent study showed that parents' attitude towards dentistry are often passed on to their children.

Children look to their parents to learn how to respond  to a new situation and can pick up on their parent's anxiety. This means that some children are very anxious even before they first visit the dentist.

We will look at ways to help anxious children in a future post. For help on overcoming your own anxiety, see this blog (click for link)

Even if you are anxious, try not to let this show to your child. Avoid making negative remarks about the dentist in front of your children.

Once children get interested in looking after their teeth they can be encouraged to see the dentist as someone who helps them to stay healthy.

Protecting our children from abuse - Part 3

In the first post in this series we discussed the importance of good communication with our children for giving safety guidelines and listening to their concerns. In the second, we looked at signs of potential abuse and what to do if you know, or suspect a child is being abused.

In this post we will discuss safety guidelines for various situations.

Staying safe while out and about

Starting to go outside without adult supervision is an important part of growing up and gaining independence. You will need to decide how and when to start giving your child more freedom based on their age and maturity. 

Children need challenges and responsibilities, but they also need adults to support, guide and step in when needed. Children under eight years old should not be left to play out of sight or near busy roads.


Talk with your child about the following:

• That they must always tell you where they are going, what they are doing and who they are with.
• Warn them never to go into dangerous areas such as construction sites.
• Discuss what to do and who to contact in an emergency.
• Talk about bullying and what they should do if they are being bullied.
• Not to talk to adults they don't know and never to go off with an adult - even if they know them - without telling you first.
• If someone makes them feel uncomfortable, worried or scared to talk to someone in authority eg. police, park keeper, watchman. (If there is no one available speak to an adult with a child, if possible).
• Come home as quickly and safely as possible or, if you are out, go to a friend or neighbour's house whenever they feel worried or scared.

Schools, daycare, clubs and activities

When our children are at daycare, school or other organised activities we want to make sure that they are safe and well looked after. 

• Get recommendations from friends and family on the best school or club for your child.
• Make sure that the facilities are clean and safe and staff are caring and well trained.
• Ask about the school or club's policies on child protection and health and safety. 
• Always discuss with your child what they have been doing each day and allow them to share any problems or concerns.
• Maintain good communication with the teacher or organizer. This will enable you to discuss your child's progress and development, as well as any concerns or problems.

Leaving your child home alone

Before deciding whether it is safe to leave your child, or children, home alone consider these important factors:

• The age and maturity of the child.
• The place where the child will be left.
• How long and how often the child will be left alone.
• Whether there are any other children present and their ages.

Babies and young children should not be left alone, even for short periods of time. If possible, find a trusted adult who can look after your child while you are away.

If you do leave an older child alone make sure they are happy and confident about the arrangements. A child under 16 years old should never be left overnight.

Here are some guidelines to follow:

• Talk to your child about keeping safe at home and point out potential dangers.
• Put obvious dangers (eg. medicines, matches) out of child's reach.
• Leave a contact phone number and be available to answer it immediately.
• Give numbers of other trusted people they can contact if needed.
• Give clear instructions about what to do in an emergency and phone numbers for emergency services.
• Tell them not to answer the door to strangers.
• If they answer the phone, tell them to say mum and dad are busy (not out) and take the person's name and number.
• Tell your child when you will be back and make sure you are back on time.
• Talk with your child after you return home to discuss and problems or uncertainties.

On-line Safety

As computer, mobile and internet technology has progressed at a rapid pace over the last decade, our children often know more than we do. They may go on-line to connect with friends, make new ones, to browse the internet for information, chat with others and play games. The internet can be a very useful source of information. However, most children and many parents are unaware of potential dangers of being online.

The risks and dangers of being online:

• Exposure to pornography, violent games and videos and other inappropriate content
• Ignoring Age restrictions
• Cyber bullying
• Friending or communicating with people they don't know
• Sharing personal information
• Grooming and sexual abuse
• Addiction to computer games
• Gambling or running up debts

Guidelines for using the internet safely:

• Discuss with your child about the benefits and dangers of using the internet.
• Set rules and agree boundaries - this will depend upon your child's age and what you feel is appropriate.
• Explain that internet access is a privilege which can be taken away (by confiscating computers, smartphone etc.) if the rules are broken. 
• Know which websites your child is using and who they are talking to online.
• Explain that they should not share personal information online, and never accept friend request from someone they do not know.
• Limit the time your children can spend online and the material or websites they can access. 
• It is best to have the computer in a family area, so that you can monitor usage. If children and teenagers have an internet connect computer in their bedroom, or a smart phone they can go online anytime day or night, unsupervised.
• Use parental and privacy controls. These can be activated from the control panel of the computer or other device, on certain websites, or from a software package (some are free). Click here for more information on parental controls.
• No tool is 100% effective and these should not replace conversations with your child.
• Encourage your child to talk to you if they are concerned about anything they have seen, or communication they have received, on the internet.

Protecting our children from abuse - Part 2

In the second post in our series on protecting children from abuse we will look at signs that may indicate a child is being abused and what to do if you know, or suspect that abuse has occurred.

What is Child Sexual Abuse?

Child sexual abuse involves persuading or forcing a child to take part in sexual activities, exposing a child to adult sexuality or encouraging a child to behave in sexually inappropriate ways.

If we don't make a fuss about the abuse, won't a child forget it?

Children do not forget abuse, it can cause devastating emotional, physical and social effects for the child, even into adulthood. Adult survivors of child sexual abuse may develop harmful sexual behaviours, experience inability to trust close family and friends and have marital problems. If abuse is not reported once discovered, not only will the abuse continue, but the abuser is also likely to harm other children.

Signs could indicate abuse

The majority of children do not report abuse. They may feel too scared, fear that they will not be believed, or have been threatened by their abuser not to tell anyone. Changes in a child's behaviour may be the first sign that something is wrong. 

One or two of the following changes may be a normal part of development but more should raise suspicion of possible abuse:

• Nightmares or sleeping problems
• Becoming withdrawn or unusually clingy
• Changes in personality, become more insecure
• Problems with studies or missing school
• Excessive anger
• Sexual language or behaviour (inappropriate for the child's age)
• Going back to younger behaviours eg. thumb sucking, bed-wetting
• Sudden changes in eating habits
• Become secretive, not talking
• Shows signs of fear of, or avoids being alone with, a particular adult. 

If you suspect or discover that a child is being sexually abused, get professional advice (see options below).  Seek medical advice immediately if you see physical signs of abuse, such as unexplained soreness/bruising of genitals or symptoms of sexually transmitted diseases eg. an unusual discharge.


What to do if a child discloses that they have been abused

A very small proportion (estimated to be 12%) of abused children report it. Even then, the reporting is often ambiguous as they may be too shy to narrate the incident clearly, or a younger child may not have the vocabulary to explain what has happened.

Your response is crucial. If the adult does not believe the child, or makes them feel ashamed, they may never risk telling anyone again and the abuse will continue. 

For example, a child may say, "I don't like that Uncle."

If the adult replies "How can you speak like that, don't be so rude!" the child will feel scared and not give any further information.

However, if the adult responds, "I see, what happened?" the child is able to reveal the reason, which may, or may not arouse suspicion.

An abused child wants two things:

• to be believed
• for the abuse to stop

If a child confides in you about abuse

• Acknowledge the child's feelings and praise them for having the courage to come and tell you.
• Tell the child it is not his or her fault. Do not blame or accuse the child, even if they did not report the abuse when it started - the abuser is the one at fault.
• Do not ask the child to "forgive" "forget" or "adjust"
• Do not confront the alleged abuser - it may give them an opportunity to silence, confuse or threaten the child about speaking out. It may also place the child in danger.
• Tell the child that you would like to take the help of other trusted adults (eg. close family members, child welfare services, medical professionals or police) to help, with the child's permission. 
• Do not tell other people who are not directly required to help and support the child.

Childline has a national toll-free number - 1098 - which an adult who is concerned about a child, or children in distress, can call for help and advice.

In Bangalore, 3 new Collaborative Child Response Units (CCRU) have recently been set up at M.S. Ramaiah Hospital, Bangalore Baptist Hospital and KIMS Hospital. They liaise between children, their families, doctors and other authorities to provide medical, psycho-social and legal assistance. More CCRU's are to be set up in other districts of Karnataka.

It is possible to contact the CCRU's directly, but they also receive referrals from the police, child welfare services and Childline.

Due to the recent "Protection of Children from Sexual Offences Act - 2012"  it has become mandatory for any person having knowledge of a child being sexually abused to report the same to the Special Juvenile Police Unit or local police. A child need never go to a police station, police will come in plain clothes to visit the child and record the statement in the child's own words.

Protecting children is every adult's responsibility.

In the next section, we will discuss guidelines for keeping children safe in various situations, both at home and outside.