How would you manage sleep bruxism in special needs patients?

This summary is based on the article published in Research in Developmental Disabilities: Treatment of bruxism in individuals with developmental disabilities: a systematic review (September 2009)

Russell Lang, Pamela J. White, Wendy Machalicek, Mandy Rispoli, Soyeon Kang, Jeannie Aquilar, Mark O’Reilly, Jeff Sigafoos, Giulio Lancioni, Robert Didden

Context 

Individuals with developmental disabilities experience more oral and craniofacial diseases and injuries than the general population. (1) 

Bruxism is a serious psycho-physiological disorder and a common clinical issue in dentistry. (2) 

Although data are limited, bruxism appears to be more common in individuals with developmental disabilities, specifically, profound/severe mental retardation, autism spectrum disorders, and Down’s syndrome than other populations. (3-5)  

Assessment and treatment of bruxism is complicated by several factors, such as:

• The process of gathering dental information may be difficult to impossible due to communication impairments in individuals with developmental disabilities. (1, 5)
• Bruxism is more covert than other forms of challenging behaviours. (6)
• Bruxism has several potential etiologies each suggesting a different treatment approach (e.g., anatomical abnormalities, operant contingencies, or emotional stress). (7, 8) 

Purpose of the Review

• To describe the characteristics of studies on the treatment of bruxism among individuals with developmental disabilities, evaluate intervention outcomes, and appraise the certainty of the evidence for the existing corpus of intervention studies.
• To guide and inform practitioners in the assessment and treatment of bruxism in individuals with developmental disabilities.
• To identify gaps in the existing database so as to stimulate future research efforts aimed at developing new and more effective assessments and interventions for this harmful behaviour.

Key Messages

Bruxism has at least two potential etiologies:

• Anatomical or biological: may be caused by occlusal discrepancies that result in discomfort or tension (e.g., malocclusion, faulty restorations, rough cusp ends, and dental trauma. (8, 9) Effective treatment in these instances is likely to be dental based, taking into account that  such interventions should be used with caution and perhaps done in conjunction with behavioral interventions designed to increase tolerance for any dental device.
• Psychological. In these instances bruxism may be maintained by operant contingencies. In these cases effective treatment is likely to require some type of behavioral intervention (e.g., differential reinforcement and/or punishment, response blocking, prompting).

Although limited, the current research base suggests the potential value of using a two-step approach to the assessment and treatment of bruxism:

• First, a dental screening focusing on the identification of occlusal abnormalities and to assess the state of oral health is needed.
• Once issues arising from this assessment have been addressed, a behavioral assessment to screen for potential operant functions might be conducted (e.g., functional analysis procedures). (10)

References

1. DeMattei, R., Cuvo, A., & Maurizio, S. (2007). Oral assessment of children with an autism spectrum disorder. Journal of Dental Hygiene, 81, 1–11.
2. Glaros, A. G., & Rao, S. M. (1977). Bruxism: A critical review. Psychological Bulletin, 4, 767–781
3. Cocchi, R., & Lamma, A. (1999). Internal stress and bruxism: An investigation on children and young adults with or without Down’s Syndrome, with autism or other pervasive developmental disorders. Italian Journal of Intellectual Impairment, 12, 13–16.
4. DeMattei, R., Cuvo, A., & Maurizio, S. (2007). Oral assessment of children with an autism spectrum disorder.Journal of Dental Hygiene, 81, 1–11.
5. Dura, J. R., Torsell, A. E., Heinzerling, R. A., & Mulick, J. A. (1988). Special oral concerns in people with severe and profound mental retardation. Special Care in Dentistry, 8, 265–267.
6. Long, E. S., Miltenberger, R. G., & Rapp, J. T. (1998). A survey of habit behaviors exhibited by individuals with mental retardation. Behavioral Interventions, 13, 79–89.
7. Nadler, S. C. (1957). Bruxism, a classification: Critical review.  Journal of the American Dental Association, 54, 615–622.
8. Thompson, B. A., Blount, W. B., & Krumholz, T. S. (1994). Treatment approaches to bruxism.  American Family Physician, 49, 1617–1622.
9. Koyano, K., Tsukiyama, Y., Ichiki, R., & Kuwata, T. (2008). Assessment of bruxism in the clinic. Journal of Oral Rehabilitation, 35, 495–508.
10. Hanley, G. P., Iwata, B. A., & McCord, B. E. (2003). Functional analysis of problem behavior: A review. Journal of Applied Behavior Analysis, 36, 147–185.

 

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