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 2

In Part 1 we discussed the benefits of fluoride and the risks of over-exposure to fluoride.

Fluoride can be useful in strengthening teeth and protecting them from decay, if used in the right way. 

As we discussed in the previous section, there is a risk of dental fluorosis, or mottling of teeth, if children swallow too much fluoride.

In this second part we will look at the uses of fluoride and safety guidelines.

Products which contain fluoride

Fluoride Toothpaste 

This is the most common application of fluoride as it can easily be used regularly at home. Regular use of fluoridated toothpastes has been shown to reduce tooth decay by up to 50%. 

Safety guidelines for using fluoride toothpaste:

• Young children who cannot spit out should use either plain drinking water or a training toothpaste which does not contain fluoride for brushing.
• Children generally learn to spit out from around 5 or 6 years old. At this stage fluoride toothpaste can be introduced with adult supervision.
• It is best to use a lower fluoride toothpaste up to 7 or 8 years old, when children still tend to swallow some paste and their developing teeth could still be at risk of fluorosis.
• The amount of fluoride is usually shown on the toothpaste packet in parts per million (ppm). In India, most adult toothpastes contain 1000 ppm and toothpastes designed for children often contain 500 ppm or less of fluoride. 
• No more than a small pea-sized amount of toothpaste should be used. Instruct your child to spit out after brushing and not to swallow it. 

• Keep toothpaste out of the reach of young children. Swallowing large amounts can cause stomach problems and other health issues. Seek immediate medical attention if a child swallows a large amount of toothpaste. 

Fluoride Mouthwash or Rinses

Mouthwashes are not recommended for children. If a teenager or young adult is at a high risk of cavities, or wearing braces which make their teeth more difficult to clean, their dentist may recommend a fluoride mouth rinse to be used at a different time from brushing. This should of course not be swallowed. Avoid mouthwashes that contain alcohol.

Fluoride Varnish

Fluoride varnishes are useful for children who are at a higher risk of tooth decay. As they contain a very high level of fluoride they can only be used by dentists and applied no more than twice a year. 

The varnish is painted onto teeth and sets quickly, sticking to the tooth surface to minimize swallowing and maximize its effect. If a tooth has very early dental caries in enamel, it can help to stop the decay and prevent it becoming a cavity. Fluoride varnish is also beneficial for sensitive teeth.

Glass Ionomer Fillings

Glass Ionomer is commonly used for fillings and sealants in baby teeth. In addition to being able to adhere directly to tooth surfaces it also releases small amounts of fluoride over an long period of time. The level of fluoride released is too low to cause any health problems but helps to prevent decay and the need for future fillings.

In Summary

When used in a controlled way, the benefits of fluoride outweigh the risks. 

Parents and dentists need to take into account the overall fluoride exposure from all sources when making decisions about the use of products or treatments which contain fluoride. 

In areas with high levels of fluoride in drinking water, fluorosis  (mottling and staining of the teeth) is common. In these areas it is wise to minimise fluoride exposure as much as possible. 

Dental Fluorosis

In areas where the is no significant fluoride in water the appropriate use of some fluoride therapies will be important in preventing decay.

If you need more information and advice, please speak to your dentist.

If you live in Bangalore, you can contact us at Small Bites, Exclusive Dental Care Centre for Children (click for link) where we will be happy to help.

How to help a child who is anxious about the dentist - Part 2

In the first part of this blog we discussed finding a child-friendly dentist and how to help your child before an appointment.

Maybe you have a dental appointment approaching. How can both you and your dentist make things easier for your child during their visit?

How can the dentist help my child?

Treatment room at Small Bites

• Taking things one step at a time will help to build up confidence. It is usually best to start with a check-up and simple cleaning before moving onto other treatment.  
• Young children are not able to sit still or concentrate for long periods of time, so visits are best kept shorter or have breaks when needed.
• The dentist may introduce a "stop signal," like raising a hand, that can be used so that your child can let the dentist know if they are not comfortable or need a break.
• Distraction can be used to give your child something else to think about other than the dental treatment. For example, music, cartoons on a TV screen or simply chatting about something else.
• A good dentist will explain things in a way that your child can understand as they go along. Long explanations and words may be confusing for your child. It is best to have a separate chat with parents while the child plays it the waiting room if required.
• The dentist can first explain, and then demonstrate any tools or materials before using them. For example, an instrument can be used on the back of the hand or finger nail before it is used in the mouth so your child knows what it feels like. 
• Although the dentist should be friendly with your child they may need to use a sterner tone of voice if a child is not listening and following instructions much the same as a schoolteacher would.

Certificate of Bravery

• Positive Reinforcement - when a child behaves and cooperates well they should be rewarded with praise, stickers, a small gift or "bravery" certificate.

Should parents stay in the room for dental treatment?

This depends on your child's age and behaviour. Young children (below 4 years) tend to experience separation anxiety and therefore it is usually advised that parents stay in the room. 

Some children "play up" to their parents and behave better when they are not in the room. One solution for this is to allow the parent or carer to stay in the treatment room whilst the child behaves well, but ask them to go to the waiting room if the child is not listening and following instructions.  

How can I help my child during a dental visit?

• In the previous post we discussed the importance of staying positive and encouraging your child. 
• For young children, you may need to help support your child on your lap while that dentist checks their teeth as shown in the picture.

• If your child makes a fuss try to remain calm. Dentists who treat children regularly will have seen their share of tantrums and be prepared for this. Allow the dentist to guide you on how to best support you child.  
• Some children will "act up" at the dentist to try to avoid treatment. If they are immediately taken out of the treatment room they are more likely to do the same thing the next time. Instead it should be explained to the child what needs to be accomplished in that visit. If cooperation is difficult it is better to achieve a lesser goal than planned, for example, placing a temporary filling, than abandon treatment altogether.

It is better to use rewards after the treatment is over than to promise bribes before hand. 

Show your child how proud you are of them for each new achievement.

Finally - Prevention is better than cure

Although, with some help, the majority of children can learn to cope with (or maybe even enjoy!) visiting the dentist the goal should be to prevent the need for dental treatment as far as possible.

It's a great feeling to take your child for a check up and be told that there are no cavities!

Here are some tips for preventing dental decay and gum disease:

• Thorough tooth brushing twice a day, morning and night. For more brushing tips see this post (click for link).
• Rinsing out the mouth with water after eating.
• Eating a healthy diet and making snacks and drinks, between meals, sugar free as far as possible. 
• Dental sealants are a coating placed on the biting surface of the back molar teeth by a dentist. They protect the narrow pits and grooves of the tooth which can be prone to decay. See this post for more information (click for link).
• Regular check-ups not only get your child used to visiting the dentist but enable any early signs of dental disease to be spotted and prevented from progressing into a bigger problem.

How to help a child who is anxious about the dentist - Part 1

Do you dread taking your child to the dentist? 

Are you worried about how your child will behave? 

Do you put off visiting the dentist until your child has toothache?

Maybe you are anxious yourself and don't know how to help you child overcome their fears?

In this two part blog we will look at ways in which you can make visiting the dentist less stressful, and maybe even enjoyable for you and your child.

Children are not born with a fear of going to the dentist. A small child visiting the dentist for the first time will not know what to expect, apart from what they have picked up from their parents and others around them. Therefore, it is important to try to give your child a positive view of dental health. Depending on your child's age, you can discuss or show them the importance of teeth and looking after them in an appropriate way. They can be encouraged to view the dentist as someone who helps them look after their teeth.

If you are anxious yourself, or have had a bad experience in that past, try not to talk about this in front of your child and advise other family members and friends to do the same. 


A recent study showed that parents' attitudes towards dentistry are often passed on to their children. Children are often listening in on our conversations with others, even while we think they are playing or doing something else. They even pick up on anxieties that we do not speak about by our expressions. If you have fear of the dentist you may find this 4 part blog (click for link) helpful for advice on overcoming your own anxiety.

Finding a child friendly dentist

Of course, it is important to find a dentist who is good with children. Not all dentists are good at, or enjoy, working with children. Find a practice where the dentist and their support staff relate well to your child and work to gain their trust so that your child can feel comfortable with them. The environment is also important in putting your child at ease and the decor should be fun. The waiting area should have toys, books or some form of entertainment to make waiting easier. 

Ask around for recommendations from friends and family or look at reviews from other parents. You can ask dental practices about their experience and expertise in treating children. Pediatric Dentists (or Pedodontists) are specialists in children's dentistry and usually have 3 years further training in Pediatric Dentistry after dental school. If you are in Bangalore, Small Bites in Indiranagar provides exclusive dental care for children. Here, we believe that every child deserves a good start in life with the best preventive dental care.

How can I help my child at home before a visit?

• Try to schedule the appointment at the best time for your child. Small children especially do not do so well if they are tired and hungry. 
• If you or your child are anxious, try to choose a time when the dentist is less busy to minimise waiting and so that there will be more time to discuss any issues and concerns. Even if this means that you have to take time off work it may be worth it for a first visit.
• Be positive. If your child is anxious, listen and show them you understand their concerns but express confidence that they will be okay. 
• Do not use words or scare stories that may upset your child. Even if you say "it's not going to hurt" the main word that your child will hear is "hurt", even though this may not have been in their mind before. 
  
• For young children, you could "play dentist" at home. You and your child can take it in turns to "be the dentist" and check each others teeth. Also try using your child's favourite soft toy or a puppet and "check their teeth." You can buy small plastic mouth mirrors for this, or just use your toothbrush. 
• If your child has a sibling, cousin or friend who is good with the dentist it may be helpful to visit the dentist with them first.
• There are many good children's books and videos available which can help children to understand about going to the dentist.
• If your child has had a difficult time at the dentist in the past, ask them about their concerns. Discuss these with your dentist to find ways to help your child before the next appointment.
• If one parent is particularly anxious, it may be better for the other parent, or another close relative, to bring the child for their appointments.

Ideally, a child's first experience at the dentist should not be for treatment. If at all possible, try to take your child just to see the dental practice and meet the dentist, or at most have a quick check-up, before they have any problems. This will help them to feel comfortable with the environment. 

At Small Bites we also have children's activities (advertised on our Facebook page - click for link) held in the clinic. This is a chance for children to get used to the environment and have fun on a separate day from any appointments. 

If your child, already has pain or problems before they have visited the dentist, don't worry. A good dentist will aim to alleviate the pain at a first visit but do further treatment as your child increases in confidence and cooperation.

Regular visits for check-ups will help your child. It is much better if they do not need treatment every time they have an appointment.

In the second part we will discuss ways that you and your dentist can help your child during their visit and some tips for preventing dental problems.

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.