Understanding Bruxism in Autism: Implications and Strategies

Bruxism in Autism

Bruxism, the involuntary grinding or clenching of teeth, is a complex phenomenon observed across various populations. This article looks into the relationship between bruxism and autism. It explores current research, potential mechanisms, and implications for care and management. I wrote it because I work with many non-verbal autistic children and often we face challenges in school understanding what their behaviour is trying to tell us. It is not uncommon for staff to record that behaviours “came out of the blue“. Despite functional analysis and other tools, there will be occasions where the trigger is a physical need, pain, or discomfort. Teeth grinding can be both a cause and a symptom of this.

Prevalence and Manifestations of Bruxism

Studies suggest higher rates of bruxism in autistic individuals compared to neurotypical populations. A 2022 meta-analysis by Granja et al. found a prevalence of 20.5% in autistic individuals. However, prevalence estimates vary widely across studies, ranging from 10% to 44%. Highlighting the challenges in accurate diagnosis and reporting of bruxism in autism.

Bruxism in autism can occur during sleep (sleep bruxism) or while awake (awake bruxism). Sleep bruxism is often characterised by repetitive jaw muscle activity and teeth grinding. Awake bruxism in autism may manifest as teeth clenching, often in response to stress or sensory stimuli. Some individuals may engage in teeth tapping or jaw movements as self-stimulatory behaviors.

Potential Causes of Teeth Grinding in Autistic Children

The cause of bruxism in autism is a combination of factors. There are various theories to explain why it is more common in this group.

1. Sensory Processing Differences: Many autistic individuals experience atypical sensory processing. Proprioceptive input from jaw clenching or grinding may serve as a form of self-regulation or sensory seeking behavior.
2. Stress and Anxiety: Autism is often associated with higher levels of anxiety, often caused by environmental or interaction issues. Bruxism may serve as a coping mechanism or manifestation of stress, particularly in situations of sensory overload or social challenges.
3. Sleep Disturbances: Sleep problems are common in autism. Disrupted sleep may contribute to increased nocturnal bruxism, though the exact relationship remains unclear.
4. Neurotransmitter Imbalances: Some researchers hypothesise that alterations in dopaminergic or serotonergic systems, implicated in both autism and bruxism, may play a role in the co-occurrence of these conditions.
5. Motor Control Differences: Autism is associated with variations in motor control and planning. These differences might contribute to increased oro-motor activities, including bruxism.
6. Medication Side Effects: Some medications used to manage autism symptoms have been associated with increased bruxism in some individuals. This is particularly true for selective serotonin reuptake inhibitors (SSRIs).

Diagnostic Challenges

Identifying bruxism in autistic individuals can be difficult due to communication differences and potential sensory sensitivities that complicate dental examinations. Parents often play a crucial role in recognising signs of bruxism, such as grinding sounds during sleep or observed jaw clenching during the day.

Polysomnography can provide objective data on sleep bruxism, but my son wont even wear a plaster so this may not be feasible or tolerable for all autistic individuals. Wearable devices for home monitoring are an emerging area of research.

Impact and Consequences

Chronic bruxism can lead to various oral health issues, including tooth wear, temporomandibular joint (TMJ) disorders, and headaches. These problems may be exacerbated in autism due to sensory sensitivities or difficulties in dental care. In some cases, severe bruxism can lead to dental fractures or damage to dental restorations. Gaining access to a specialist dentist familiar with working with autistic individuals or willing to make adjustments is really hard.

The impact of bruxism on sleep quality in autism is an area of ongoing research. Disrupted sleep due to bruxism may potentially exacerbate daytime behaviours and overall functioning.

Management Approaches

Managing bruxism in autism requires a multidisciplinary approach, considering the individual’s specific needs, sensory sensitivities, and co-occurring conditions. Some key strategies include:

1. Behavioural Interventions: For awake bruxism, awareness training and habit reversal techniques may be beneficial. These approaches aim to help individuals recognise and modify clenching behaviours.
2. Stress Reduction: Strategies to manage stress and anxiety, such as cognitive-behavioural therapy adapted for autism, mindfulness practices, or environmental modifications, may help reduce bruxism.
3. Sensory Interventions: Occupational therapy approaches targeting sensory processing may be helpful. This might include providing alternative forms of proprioceptive input or developing personalized sensory diets.
4. Oral Appliances: Night guards or splints can protect teeth from damage due to nocturnal bruxism. However, tolerability may be an issue for some autistic individuals due to sensory sensitivities.
5. Pharmacological Approaches: In severe cases, medications such as muscle relaxants or botulinum toxin injections may be considered. However, these approaches require careful evaluation of potential side effects and individual tolerance.
6. Sleep Hygiene: Improving overall sleep quality through consistent bedtime routines. Creating appropriate sleep environments. Addressing any co-occurring sleep disorders may indirectly help manage bruxism.
7. Dental Care: Regular dental check-ups are crucial for monitoring tooth wear and addressing any dental issues. Desensitisation techniques may be needed to help autistic individuals tolerate dental procedures. Teeth brushing itself is a challenge form many autistic children.

Other Oral Health Considerations For Autistic Children (And Adults)

When analysing the influence of Autism Spectrum Disorder (ASD) from a dental perspective, several significant factors come into play. These factors not only impact oral health but also present unique challenges in dental care and management for individuals with ASD.

Clinical Signs and Habits

Research has identified various clinical signs related to the stomatognathic system (complex of tissues and organs in the head and mouth that includes the teeth, jaws, and associated soft tissues) in autistic individuals. In addition to teeth grinding Al-Sehaibany (2017) noted a higher prevalence of oral habits and conditions, including:

1. Object Biting: Many individuals with ASD exhibit a habit of biting non-food objects, this may damage teeth and gums.
2. Mouth Breathing: This habit is more common among those with ASD and can lead to various oral health issues.
3. Digital Sucking: Prolonged thumb or finger sucking is observed more frequently in this population.

These habits and behaviours can significantly impact oral health. They can potentially lead to dental wear, misalignment, and increased risk of decay or gum disease.

Challenges in Oral Hygiene

One of the most crucial aspects of maintaining oral health is proper dental hygiene. However, this presents a significant challenge for many individuals with ASD. Fahlvik-Planefeldt and Herrström (2001) highlighted the difficulty in performing adequate dental hygiene among this population. This challenge exists whether the hygiene is performed by:

1. The individual with ASD themselves
2. Parents or caregivers assisting with oral care

Several factors contribute to this difficulty:

• Sensory sensitivities: Many individuals with ASD have heightened sensory sensitivities, making the sensation of brushing or flossing uncomfortable or overwhelming.
• Motor skill challenges: Some individuals may struggle with the fine motor skills required for effective brushing and flossing.
• Routine resistance: Changes in routine or introduction of new oral care practices may be met with resistance.
• Communication barriers: Explaining the importance of oral hygiene or providing instructions may be challenging due to communication differences.

These challenges in maintaining proper oral hygiene can lead to an increased risk of dental caries, gum disease, and other oral health issues in the ASD population.

Implications for Dental Care

The combination of increased prevalence of certain oral habits and difficulties in maintaining proper oral hygiene creates a unique set of challenges for dental professionals treating individuals with ASD. It necessitates:

1. Heightened awareness of potential oral health issues specific to this population
2. Tailored approaches to dental examinations and treatments
3. Collaborative efforts with caregivers to develop effective at-home oral care strategies
4. Consideration of sensory needs in the dental office environment
5. Patience and flexibility in providing dental care

Dental professionals can play a crucial role in promoting and maintaining oral health in individuals with ASD. They do this by understanding these specific challenges. They also adapt care approaches accordingly.

Clinical Implications

Healthcare providers working with autistic individuals should be aware of the increased prevalence of bruxism and its potential impacts. Regular screening and monitoring for signs of bruxism is recommended. This care could involve dentists, sleep specialists, occupational therapists, and mental health professionals.

Personalised approaches considering the individual’s sensory profile, communication abilities, and co-occurring conditions are essential for effective management. Educating parents and caregivers about signs of bruxism and potential management strategies is crucial, as they often play a key role in early identification and ongoing care.

Broader Considerations

The relationship between bruxism and autism is significant. It highlights the interconnected nature of oral health, neurological function, and overall well-being in this population. It underscores the need for holistic approaches to autism care that consider often overlooked aspects such as oral motor function and its broader impacts.

The variability in bruxism presentation among autistic individuals reflects the heterogeneity of autism itself, emphasizing the importance of individualized assessment and intervention.

Conclusion

Bruxism in autism represents a complex interplay of neurological, sensory, and behavioral factors. Its higher prevalence in this population warrants attention from clinicians and researchers alike. While significant progress has been made in recognizing and understanding this phenomenon, much remains to be explored. Continued research and clinical innovation are needed to develop more effective, autism-specific approaches to managing bruxism.

As our understanding evolves, so too should our approaches to care. We must always center the unique needs and experiences of autistic individuals in our efforts. This will support their oral health and overall well-being. By addressing bruxism in autism through a multidisciplinary, person-centered lens, we can work towards improving outcomes and quality of life for individuals across the autism spectrum.

References

Al-Sehaibany, F. S. (2017). Occurrence of oral habits among preschool children with Autism Spectrum Disorder. Pakistan Journal of Medical Sciences, 33(5), 1156-1160.

Fahlvik-Planefeldt, C., & Herrström, P. (2001). Dental care of autistic children within the non-specialized Public Dental Service. Swedish dental journal, 25(3), 113–118.

Gélica Lima Granja, Jhonatan Thiago Lacerda-Santos, Ramon Targino Firmino, & Fabiana Vargas-Ferreira. (2022, March 9). Occurrence of bruxism in individuals with autism spectrum disorder: A systematic review and meta-analysis. Retrieved September 15, 2024, from ResearchGate website: https://www.researchgate.net/publication/359121050_Occurrence_of_bruxism_in_individuals_with_autism_spectrum_disorder_A_systematic_review_and_meta-analysis

Seraj, B., Shahrabi, M., Ghadimi, S., Ahmadi, R., Nikfarjam, J., Zayeri, F., Taghi, F. P., & Zare, H. (2010). The Prevalence of Bruxism and Correlated Factors in Children Referred to Dental Schools of Tehran, Based on Parent’s Report. Iranian journal of pediatrics, 20(2), 174–180.