Bruxism and adenotonsillectomy
Introduction
Last few decades have witnessed a renaissance at sleep research particularly about basic science, epidemiology and disorders of sleep in children. Sleep bruxism is defined as teeth grinding or clenching during sleep [1] and has been considered for many years as an arousal response [2]. Sleep bruxism could function as an autonomic motor reflex in response to a nocturnal arousal [1]. Prevalence of sleep bruxism is reported in several studies in children between 6.4 and 20.5% [3], [4], [5]. Sleep bruxism is related to arousal episodes and obstructive sleep apnea (OSA) is also accompanied by high amount of short arousal [2]. Ohayon et al. found that among the associated sleep symptoms and disorders OSA was the highest risk factor for tooth grinding during sleep and suggested that relationship between sleep bruxism and OSA syndrome has been related to an arousal response [6]. On the other hand adenotonsillar hypertrophy (ATH) is the most common cause of obstructive sleep apnea syndrome (OSAS) in children [7], [8]. Valera et al. showed that bruxism has a significantly higher incidence in children with tonsil hypertrophy [9]. Although adenotonsillectomy is considered as the most common surgical treatment of childhood OSAS [8] there are limited investigations for its effect on improvement of the bruxism [10].
The purpose of this study was assessment of the effects of adenotonsillectomy in improving bruxism.
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Patients and methods
In a prospective study, 140 patients aged from 4 to 12 years old who were selected for adenotonsillectomy due to obstructive symptoms such as snoring and mouth breathing and who met our inclusion and exclusion criteria selected (Table 1).
In this study we assessed existence of bruxism in these children. The patients whom their parents did not have attention about their tooth grinding and could not tell us about its existence were excluded. In our study we have excluded the patients with former
Results
In this study 75 (53.6%) persons were male and 65 (46.4%) were female. Among these 140 patients, 36 (25.7%) ones had evidence of bruxism as they mentioned in their questionnaire. Ninety patients (64.2%) had adenoid hypertrophy of grade 3 and 50 (35.7%) had grade 4 of it. Fifty-two patients (37.1%) had grade 2 palatal tonsils hypertrophy, 63 (45%) grade 3 and 25 ones (17.9%) had grade 4 of it.
Among 90 patients with grade 3 adenoid hypertrophy, 23 ones (or 25.5%) had bruxism before the operation
Discussion
One of the main causes of upper airway obstruction (especially in children) and obstructive sleep apnea is adenotonsillar hypertrophy [7], [8] and it seems that adenotonsillectomy is the treatment of choice [8]. Among the associated sleep symptoms and disorders obstructive sleep apnea has the highest risk factor for tooth grinding during sleep and relationship between sleep bruxism and obstructive sleep apnea syndrome has been suggested to be related to an arousal response [6].
The results of
Conclusion
We conclude that adenotonsillectomy can improve bruxism in patients with obstructive symptoms. Physicians should take special attention to the children with bruxism and assess them for upper airway obstruction.
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