Abstract：
Sleep bruxism, characterized by involuntary grinding or clenching of the teeth and/or by bracing or thrusting of the mandible during sleep, is common in children. Sleep bruxism occurs while the patient is asleep. As such, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. This article aims to familiarize physicians with the diagnosis and management of sleep bruxism in children. A search was conducted in May 2023 in PubMed Clinical Queries using the key terms \"Bruxism\" OR \"Teeth grinding\" AND \"sleep\". The search strategy included all observational studies, clinical trials, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. According to the International classification of sleep disorders, the minimum criteria for the diagnosis of sleep bruxism are (1) the presence of frequent or regular (at least three nights per week for at least three months) tooth grinding sounds during sleep and (2) at least one or more of the following (a) abnormal tooth wear; (b) transient morning jaw muscle fatigue or pain; (c) temporary headache; or (d) jaw locking on awaking. According to the International Consensus on the assessment of bruxism, \"possible\" sleep bruxism can be diagnosed based on self-report or report from family members of tooth-grinding sounds during sleep; \"probable\" sleep bruxism based on self-report or report from family members of tooth-grinding sounds during sleep plus clinical findings suggestive of bruxism (e.g., abnormal tooth wear, hypertrophy and/or tenderness of masseter muscles, or tongue/lip indentation); \"definite\" sleep bruxism based on the history and clinical findings and confirmation by polysomnography, preferably combined with video and audio recording. Although polysomnography is the gold standard for the diagnosis of sleep bruxism, because of the high cost, lengthy time involvement, and the need for high levels of technical competence, polysomnography is not available for use in most clinical settings. On the other hand, since sleep bruxism occurs while the patient is asleep, diagnosis can be difficult as the affected child is usually unaware of the tooth grinding sounds. In clinical practice, the diagnosis of sleep bruxism is often based on the history (e.g., reports of grinding noises during sleep) and clinical findings (e.g., tooth wear, hypertrophy and/or tenderness of masseter muscles). In childhood, sleep-bruxism is typically self-limited and does not require specific treatment. Causative or triggering factors should be eliminated if possible. The importance of sleep hygiene cannot be over-emphasized. Bedtime should be relaxed and enjoyable. Mental stimulation and physical activity should be limited before going to bed. For adults with frequent and severe sleep bruxism who do not respond to the above measures, oral devices can be considered to protect teeth from further damage during bruxism episodes. As the orofacial structures are still developing in the pediatric age group, the benefits and risks of using oral devices should be taken into consideration. Pharmacotherapy is not a favorable option and is rarely used in children. Current evidence on the effective interventions for the management of sleep bruxism in children is inconclusive. There is insufficient evidence to make recommendations for specific treatment at this time.
摘要：
睡眠磨牙症,其特征是在睡眠期间不自主地磨牙或咬牙和/或支撑或推进下颌骨，在儿童中很常见。睡眠磨牙症发生在患者睡着时。因此，诊断可能很困难，因为受影响的孩子通常不知道牙齿研磨的声音。本文旨在使医生熟悉儿童睡眠磨牙症的诊断和管理。2023年5月，在PubMed临床查询中使用关键术语“磨牙”或“磨牙”和“睡眠”进行了搜索。搜索策略包括所有观察性研究，临床试验,以及在过去十年内发表的评论。本评论仅包括在英语文献中发表的论文。根据国际睡眠障碍分类，诊断睡眠磨牙症的最低标准是:(1)睡眠期间经常或有规律地(每周至少3晚,至少3个月)出现磨牙声;(2)以下至少一种或多种情况:(a)牙齿磨损异常;(b)短暂性晨颌肌肉疲劳或疼痛;(c)暂时性头痛;或(d)下颌在清醒时锁定.根据磨牙症评估的国际共识,“可能的”睡眠磨牙症可以根据睡眠期间磨牙声音的自我报告或家庭成员的报告来诊断；“可能的”睡眠磨牙症根据睡眠期间磨牙声音的自我报告或家庭成员的报告加上提示磨牙症的临床发现（例如，异常牙齿磨损，咬肌肥大和/或压痛，或舌/唇压痕）；根据病史和临床发现以及多导睡眠图的确认，最好与视频和音频记录相结合。尽管多导睡眠图是诊断睡眠磨牙症的金标准，因为成本高,长时间参与，以及对高水平技术能力的需求，多导睡眠描记术不适用于大多数临床设置。另一方面,因为睡眠磨牙症发生在病人睡着的时候，诊断可能很困难，因为受影响的孩子通常不知道牙齿研磨的声音。在临床实践中,睡眠磨牙症的诊断通常基于病史(例如，睡眠期间的磨砂噪音报告)和临床发现(例如，牙齿磨损,咬肌肥大和/或压痛)。在童年,睡眠磨牙症通常是自限性的,不需要特殊治疗.如有可能，应消除因果或触发因素。睡眠卫生的重要性怎么强调都不为过。睡觉时间应该是轻松愉快的。睡前应限制精神刺激和身体活动。对于经常和严重的睡眠磨牙症的成年人，对上述措施没有反应，在磨牙症发作期间，口腔设备可以被认为可以保护牙齿免受进一步损害。由于儿科年龄组的口面结构仍在发展，应考虑使用口腔器械的益处和风险.药物治疗不是一个有利的选择，很少在儿童中使用。目前关于儿童睡眠磨牙症管理的有效干预措施的证据尚无定论。目前没有足够的证据提出具体治疗建议。
