Bruxism in children: night-time teeth grinding, parasites and when to see a dentist

What is bruxism in children?

Bruxism in children is repeated activity of the chewing muscles, involving grinding or clenching the teeth, most often during sleep. The American Academy of Pediatric Dentistry (AAPD) guidelines from 2024 distinguish sleep bruxism from awake bruxism, which involves clenching the teeth during the day.

The AAPD describes sleep bruxism as sleep-related muscle activity that may have a physiological, or even protective, role. Hearing grinding from your child’s bedroom at night therefore does not in itself mean something is wrong.

In children, diagnosis usually rests on the parent’s account and a dental examination. The authors of a 2024 meta-analysis note that most studies in children used questionnaires completed by carers, which introduces a risk of bias and helps explain why figures vary so widely between studies.

How common is teeth grinding in children, and does it go away?

Teeth grinding during sleep is common in children, but there is no single precise figure because studies use different methods. A 2024 meta-analysis by Polish authors estimated sleep bruxism among under-18s in Europe at 16% (6 studies, confidence interval from 10 to 25%).

A review of 22 studies from 2021 reported a higher prevalence of sleep bruxism in children, 31%, but the authors rated the quality of those studies as poor. The AAPD guidelines on the temporomandibular joint refer to roughly one child in four having possible or probable sleep bruxism, with no difference between girls and boys.

According to the AAPD, sleep bruxism is most common in childhood and becomes less frequent with age; its guidelines on dental development say childhood bruxism usually resolves on its own. However, the same joint guidelines cite a study in which childhood habits predicted similar habits 20 years later.

A balanced approach is therefore sensible: grinding eases without treatment in most children, but the dentist should examine their teeth at check-ups and assess any wear.

Bruxism in children: symptoms parents notice

The most common sign of bruxism in children is grinding heard at night by a parent or sibling, as the child is usually unaware of it. In the 2021 review of 22 studies, the findings most often described in children with sleep bruxism were wear of the primary canines (84%), tooth wear overall (74%) and headaches (53%).

However, the review’s authors did not find that grinding significantly increased the risk of tooth wear or headaches, and rated the certainty of the evidence as low or very low. The AAPD also lists chipped teeth, tooth impressions along the sides of the tongue, lip and cheek biting, and temporomandibular joint or facial pain among the possible effects.

Worn teeth are not always caused by grinding. The AAPD points out that the dentist distinguishes wear from erosion, which is the dissolution of enamel by acids from food or reflux, because each needs different management. The table sets out the signs parents most often notice.

Why do children grind their teeth? Causes and risk factors

Teeth grinding in children usually has several causes rather than one. The AAPD guidelines from 2024 list emotional stress, brain injury, neurological conditions and sleep disorders, adding that stress and psychosocial factors contribute to sleep bruxism in children over 6.

A 2015 systematic review found the strongest association with passive smoking and sleep disorders. Bruxism was more common in children heavily exposed to tobacco smoke (odds ratio 4.5) and those with sleep disorders (3.3), with weaker associations for neuroticism (1.9) and other parafunctional habits, such as nail biting (2.3).

Grinding often occurs alongside snoring or obstructive sleep apnoea. However, the AAPD notes that there is insufficient evidence to establish which causes which or the order in which they develop, so a child who snores needs medical assessment regardless of their teeth.

Children with neurological conditions grind their teeth more often. The AAPD reports, for example, that children with spastic cerebral palsy have parafunctional habits and bruxism more often, so their teeth and joint should be checked regularly.

Teeth grinding in children and parasites: what do studies say?

The belief that teeth grinding in a child means parasites, most often threadworms, is not supported by research. In a Brazilian case-control study from 2008 involving 57 children aged 6 to 11, intestinal parasites were found in 30% of children with bruxism and 41% without it; the difference was not significant.

The authors state explicitly that there had previously been no empirical evidence of such an association, and their findings did not confirm one. The study was small, but the AAPD guidelines from 2024 do not mention parasites at all when describing the causes of childhood bruxism.

Threadworm infection has its own distinct symptoms. The NHS, Britain’s public health service, lists mainly intense itching around the anus or vagina, especially at night, as well as irritability and waking at night; teeth grinding is not on that list.

If you suspect threadworms, speak to a paediatrician or pharmacist and discuss the grinding separately with a dentist. Grinding alone is not a basis for diagnosing parasites in a child.

When should a child who grinds their teeth see a dentist or doctor?

Take a child who grinds their teeth to a dentist if the teeth are visibly wearing down, chipping or painful, and to a paediatrician if grinding is accompanied by symptoms of sleep-disordered breathing. The AAPD lists snoring, observed pauses in breathing, restless sleep, daytime sleepiness and bedwetting among these symptoms. Reasons to arrange a visit include:

• Loud snoring, pauses in breathing during sleep or consistently sleeping with an open mouth.
• Restless sleep, daytime sleepiness or behavioural difficulties, and bedwetting.
• Flattened, chipped or sensitive teeth, including primary teeth.
• Jaw, facial or head pain, especially just after waking.
• Difficulty opening the mouth wide or pain when biting.

How is childhood bruxism treated, and is a splint needed?

Treatment of childhood bruxism usually starts with monitoring and explaining grinding to parents, rather than appliances. The AAPD lists a wide range of management options: educating parents and children, occlusal splints, behavioural methods, psychological support and medicines, chosen according to the cause and severity of symptoms.

Evidence for the effectiveness of specific methods is limited. A review of 7 randomised trials published in 2023 found no significant improvement with occlusal splints or physiotherapy compared with a control group; the authors considered improvements with some medicines and plant extracts insufficient to establish a treatment protocol.

Splints also have practical limitations in young children. The AAPD notes that growth of the alveolar processes and erupting teeth make splints difficult to use in the mixed dentition, roughly between ages 6 and 11, so a dentist decides whether to use one after an examination.

If grinding accompanies snoring or apnoea, sleep-related breathing is investigated first, as this is a medical problem needing separate treatment. Everyday measures the AAPD recommends for joint problems include sufficient uninterrupted sleep, reducing stressors and avoiding prolonged chewing of hard foods or gum. Splints and treatment of adult bruxism are covered in a separate article.

Childhood bruxism at DentalBlue

DentalBlue in Białystok provides paediatric dentistry as one of its five specialist teams. At the visit, the dentist examines the child’s teeth, including signs of wear and chipping, and assesses the bite; any X-ray needed is taken in the clinic’s own radiology unit. In the clinic’s paediatric dentistry price list, “Konsultacja stomatologiczna” (dental consultation) costs 300 zł and “Wizyta Adaptacyjna” (familiarisation visit) 250 zł. The final scope and cost are agreed at the visit, and prices may change.