Mouth Breathing and Prevalence of Sleep Bruxism among Brazilian Preschoolers aged 2 to 5 years

Josiane Pezzini Soares, Daniele Klein, Marcos Ximenes, Carla Silva Pereira, Elis Cristina Antunes, Loraine Dias, Adriano Borgatto, Mariane Cardoso, Michele Bolan


Objective: To determine the prevalence of bruxism, associating it with mouth breathing in preschool children in Florianopolis, Brazil. Material and Methods: Clinical examination and questions to parents/guardians of 429 children aged 2-5 were conducted. The clinical examination was performed by three calibrated examiners to register the presence of tooth wear on incisors and molars. The questions were related to sleep bruxism (teeth grinding) and mouth breathing. For determinate diagnosis, were “possible” bruxism by the American Academy of Sleep Medicine and “probable” bruxism, whereas the Item Response Theory was employed for mouth breathing. To determine the associations, a Chi-square test and Fisher exact test with a standard error of 5% and 95% interval confidence were applied. Results: The clinical examination revealed bruxism in 8.2%, whereas the parental report revealed bruxism in 17.2%. When clinical examination was associated with the parent’s report, bruxism was present in 2.1%. Among the non-clinical variables, the most prevalent changes included: child presenting a regular stuffy nose (19.6%), followed by child is always open-mouthed (16.1%). A significant statistical association between bruxism and age was obtained (p<0.05), the age group with prevalence of 4 and 5 years old with 68.9%. There was no mouth breathing association with the presence of bruxism (p>0.05). Conclusion: Bruxism was prevalent for children aged 4-5 and bruxism had no association with mouth breathing.


Epidemiology; Bruxism; Child; Mouth Breathing

Full Text:



Van Selms MKA, Visscher CM, Naeje M, Lobbezzo F. Bruxism and associated factors among dutch adolescents. Community Dent Oral Epidemiol 2013; 41(4):353-63. doi: 10.1111/cdoe.12017.

Serra-Negra JM, Ribeiro MB, Prado IV, Paiva SM, Pordeus IA. Association between possible sleep bruxism and sleep characteristics in children. Cranio 2016; 35(5):315-20. doi: 10. 1080/08869634.2016.1239894.

Serra-Negra JM, Paiva SM, Auad SM, Ramos-Jorge ML, Pordeus IA. Signs, symptoms, parafunctions and associated factors of parent-reported sleep bruxism in children: A case-control study. Braz Dent J 2012; 23(6):746-52. doi: 10.1590/S0103-64402012000600020.

Vieira-Andrade RG, Drumond CL, Martins-Junior PA, Correa-Faria P, Gonzaga GC, Marques LS et al. Prevalence of sleep bruxism and associated factors in preschool children. Pediatr Dent 2014; 36(1):46-50.

Castroflorio T, Bargellini A, Rossini G, Cugliari G, Rainoldi A, Deregibus A. Risk factors related to sleep bruxism in children: A systematic literature review. Arch Oral Biol 2015; 60(11):1618-24. doi: 10.1016/j.archoralbio.2015.08.014.

Tachibana M, Kato T, Kato-Nishimura K, Matsuzawa S, Mohri I, Taniike M. Associations of sleep bruxism with age, sleep apnea, and daytime problematic behaviors in children. Oral Dis 2016; 22(6):557-65. doi: 10.1111/odi.12492.

Motta LJ, Bortoletto CC, Marques AJ, Ferrari RAM, Fernandes KPS, Bussadori SK. Association between respiratory problems and dental caries in children with bruxism. Indian J Dent Res 2014; 25(1):9-13. doi: 10.4103/0970-9290.131047.

Pacheco MC, Casagrande CF, Teixeira LP, Finck NS, de Araújo MT. Guidelines proposal for clinical recognition of mouth breathing children. Dental Press J Orthod 2015; 20(4):39-44. doi: 10.1590/2176-9451.20.4039-044.oar.

Guo H, Wang T, Li X, Ma Q, Niu X, Qiu J. What sleep behavior are associated with bruxism in children? A systematic review and meta-analyses. Sleep Breath 2017; 21(4):1013-23. doi: 10.1007/s11325-017-1496-3.

Castilho LS, Abreu MHNG, Oliveira RB, Silva MES, Resende VLS. Factors associated with mouth breathing in children with developmental disabilities. Spec Care Dentist 2016; 36(2):75-9. doi: 10.1111/scd.12157.

Serra-Negra JM, Tirsa-Costa D, Guimarães FH, Paiva SM, Pordeus IA. Evaluation of parents/guardian knowledge about the bruxism f their children: Family knowledge of bruxism. J Indian Soc Pedod Prev Dent 2013; 31(3):153-8. doi: 10.4103/0970-4388.117965.

Drumond CL, Souza, DS, Serra-Negra JM, Marques LS, Ramos-Jorge ML, Ramos-Jorge J. Respiratory disorders and the prevalence of sleep bruxism among schoolchildren aged 8 to 11 years. Sleep Breath 2017; 21(1):203-8. doi: 10.1007/s11325-017-1466-9.

Instituto Brasileiro de Geografia e Estatística (IBGE). Florianópolis: ensino – matrículas, docentes e rede escolar – 2015. Available at:, 2017. [Accessed 20 June 2017].

Serra-Negra JM, Paiva SM, Seabra AP, Dorella C, Lemos BF, Pordeus IA. Prevalence of sleep bruxism in a group of Brazilian schoolchildren. Eur Arch Paediatr Dent 2010; 11(4):192-5.

World Health Organization (WHO). Oral health surveys: Basic methods. 5. ed. Geneva: ORH/EPID, 2013.

Palinkas M, de Luca Canto G, Rodrigues LA, Bataglion C, Siéssere S, Semprini M et al. Comparative capabilities of clinical assessment, diagnostic criteria, and polysomnography in detecting sleep bruxism. J Clin Sleep Med 2015; 11(11):1319-25. doi: 10.5664/jcsm.5196.

Abreu RR, Rocha RL, Lamounier JA, Guerra AF. Etiology, clinical manifestations and concurrent findings in mouth-breathing children. J Pediatr 2008; 84(6):529-35. doi: 10.2223/JPED.1844.

Hays RD, Lipscomb J. Next steps for use of item response theory in the assessment of health outcomes. Qual Life Res 2007; 16(1):195-9. doi: 10.1007/s11136-007-9175-7.

Iber CAIS, Chesson AL, Quan SF. The AASM manual for the scoring of sleep and associated events: Rules, terminology, and technical specification. Westchester: American Academy of Sleep Medicine; 2007.

Lobbezoo F, Ahlberg J, Glaros A, Kato T, Koyano K, Lavigne GJ et al. Bruxism defined and graded: An international consensus. J Oral Rehabil 2013; 40(1):2-4. doi: 10/1111/joor.12011.

Ferreira NM, dos Santos JF, dos Santos MB, Marchini L. Sleep bruxism associated with obstructive sleep apnea syndrome in children. Cranio 2015; 33(4):251-5. doi: 10.1080/08869634.2015.1097299.

Souza VA, Abreu MH, Resende VL, Castilho LS. Factors associated with bruxism in children with developmental disabilities. Braz Oral Res 2015; 29(1):1-5. doi: 10.1590/1807-3107BOR-2015.vol29.0009.

Raphael KG, Janal MN, Sirois DA, Dubrovsky B, Klausnerr JJ, Krieger AC, Lavigne GJ. Validity of self-reported sleep bruxism among myofascial temporomandibular disorder patients and controls. J Oral Rehabil 2015; 42(10):751-8. doi: 10.1111/joor.12310.

Simões-Zenari M, Bitar ML. Factors associated to bruxism in children from 4-6 years. Pro Fono 2010; 22(4):465-72. doi: 10.1590/S0104-56872010000400018.

Alencar NA, Fernandes AB, Souza MM, Luiz RR, Fonseca-Gonçalves A, Maia LC. Lifestyle and oral facial disorders associated with sleep bruxism in children. Cranio 2016; 35(3):168-74. doi: 10.1080/08869634.2016.1196865.