172

https://doi.org/10.54589/aol.37/2/172 36/3/156

Primary tooth wear in children from different social environments

Silvina G Cortese , Lucia Babino , Ana M Biondi

Universidad de Buenos Aires, Facultad de Odontología, Cátedra Odontología Integral Niños, Argentina

ABSTRACT
Bilingual schools have more hours and high levels of academic demands. Aims: To compare the degree
of dental wear and frequency of severe wear facets between children from public rural schools (RG) and
children from private bilingual schools in Buenos Aires City (PG). To compare the presence of facets
to parents’ reports on bruxism and their opinion on the importance to health of bruxism and snoring.
Materials and Method: The sample (n=90) consisted of 5- and 10-year-old children. Their parents/
guardians were asked to complete a structured questionnaire on bruxism and snoring. Children’s
degrees of dental wear on primary incisors, canines and molars were identified and recorded. The data
were analyzed statistically. Results: The relative risk of wear between PG and RG was 1.82. Bruxism
and snoring were reported by 22.9% of the parents/guardians of 5-year-olds and 8.8% of the parents/
guardians of 10-year-olds. In 10-year-olds, significant differences were found between RG and PG for
canine wear degree 3 (p=0.01). Conclusions: Children from highly demanding schools presented more
dental wear. Higher frequency of severe dental wear was observed in primary canines and molars late
in the tooth replacement period regardless of whether sleep bruxism was reported. Parents/guardians
from different social conditions considered that bruxism and snoring are important to health to similar
degrees.
Keywords: bruxism - children - dental wear

Desgaste de piezas dentarias primarias en niños de

diferente ámbito social

RESUMEN
Las escuelas bilingües tienen mayor carga horaria y altos niveles de exigencia académica. Objetivos:
Comparar en niños preescolares y escolares de escuela pública rural (GR) y de colegios privados
bilingües de la Ciudad Autónoma de Buenos Aires (GP) el grado de desgaste dentario y la frecuencia
de facetas de desgaste severo. Comparar la presencia de facetas con el reporte de los padres sobre el
To cite: bruxismo y su opinión sobre la importancia de bruxar y roncar. Materiales y Método: Muestra (n=90)
Cortese SG, Babino L, Biondi AM. conformada con niños de 5 y 10 años, cuyos responsables completaron un cuestionario estructurado.
Primary tooth wear in children Fueron registrados y analizados estadísticamente los grados de desgaste dentario en incisivos, caninos
from different social environments. y molares primarios. Resultados: El riesgo relativo de desgaste entre GP y GR fue 1,82. El 22,9% de
Acta Odontol Latinoam. 2024 los responsables de los niños de 5 años y el 8,8% de los de 10 años reportaron que bruxan y roncan.
Aug 30;37(2):172-179. https://doi. En relación a la muestra de 10 años, se hallaron diferencias significativas para caninos desgaste grado
org/10.54589/aol.37/2/172 3 entre GR y GP (p=0.01). Conclusiones: Los niños de escuelas con alta exigencia presentaron más
desgaste. Se observó mayor frecuencia de desgaste dentario severo en caninos y molares primarios al
Corresponding Author: final del recambio dentario independiente al reporte de bruxismo nocturno. Los cuidadores de diferente
Silvina G Cortese condición social revelaron valoración semejante sobre la importancia en la salud del bruxismo y el
[email protected] ronquido.
Palabras clave: bruxismo - niños - desgaste dental

Received: April 2024.

Accepted: June 2024.

This work is licensed under a Creative

Commons Attribution-NonCommercial
4.0 International License

Acta Odontol. Latinoam. 2024 ISSN 1852-4834 Vol. 37 Nº 2 / 172-179

Dental wear in children 173

INTRODUCTION
At different times over the years, and according to distorted perception of negative situations, causing
different specialties, bruxism has been considered a changes in neurotransmitters such as dopamine and
habit, a parafunction, and a parasomnia (according serotonin, which are the main causes of bruxism6-7.
to sleep medicine). In 2013, an international group Esparza and Rodríguez studied a sample of 6- to
of experts published a consensus with the aim of 11-year-old children by applying the Reynolds &
proposing a definition and diagnostic classification Kamphaus Multidimensional Behavior Assessment
system for bruxism which could be adopted by re- Scale, concluding that academic demand is a fac-
searchers and clinical professionals. They defined tor associated to the presence of states of anxiety.
bruxism as a repetitive jaw-muscle activity charac- Serra Negra et al. found higher prevalence of sleep
terized by clenching or grinding teeth and/or thrust- bruxism in children from better socioeconomic con-
ing the mandible. They distinguished two different ditions7-8.
circadian manifestations: sleep and awake bruxism. With regard to wear, our findings in a previous study
With regard to diagnostic criteria, they established showed that primary tooth wear should be consid-
the terms “possible” bruxism when it is self-re- ered according to age and series. The presence of
ported, “probable” when complemented by clinical exposed dentin at early ages could be considered as
findings, and “definitive” when confirmed by stud- an indicator of parafunction9. In a recent study on
ies such as polysomnography and/or electromyog- 48 children, Martins et al. concluded that those with
raphy1. However, polysomnography and electromy- more severe facets have possible sleep and awake
ography are expensive and invasive, and Berrozpe bruxism10.
et al. consider them excessive for diagnosing para- The aims of this study were (a) to compare degree
somnias, which can usually be detected clinically2. and frequency of severe wear facets in preschool-
In the same document, Lobbezoo et al. distinguish ers and schoolchildren from a half-day public rural
primary or idiopathic bruxism as being that which school to those in children from a full-day private
is not associated to medical comorbidities, and sec- bilingual school who visit private pediatric dentistry
ondary bruxism when it is related to psychosocial or practices in Buenos Aires City, and (b) to compare
medical conditions such as breathing-related sleep the presence of facets with parent/guardian-reported
disorders, neurological problems, psychiatric condi- bruxism and opinion on the importance to health of
tions and drug or medication use1. bruxism and snoring.
The multifactorial etiology of bruxism involves fac-
tors related to the central nervous system and possi- MATERIALS AND METHOD
ble influence of socioenvironmental factors. This was a cross-sectional study. It was approved by
Sleep and awake bruxism are currently considered to the FOUBA Ethics Committee (009/2022-CETICA
be different muscular activities. Sleep bruxism may FOUBA).
be rhythmic or non-rhythmic. It should be noted that A structured questionnaire was answered on a volun-
in healthy individuals it should not be considered tary basis by parents/guardians of patients from pri-
disorder, although in some situations, bruxism may vate bilingual schools seeking care at two practices
be a risk behavior, and in other situations a protec- in Buenos Aires City (PG), and parents/guardians of
tive factor, mainly against sleep apneas. Individual children enrolled at a public rural school in Buenos
diagnosis is therefore necessary3. Aires Province (RG). The questionnaire consisted
Most studies on children report prevalence of sleep of 3 items: reporting on bruxism, reporting on snor-
bruxism (SB) as 14 to 36.8%. However, and given ing, and providing an opinion on whether bruxism
the difficulties in diagnosing awake bruxism (AB), and snoring are important to the child’s health. The
its prevalence has been estimated only among adults questionnaire had been used previously Fridman et
as 5 to 31%4. al. in a study on degree of wear in children´s teeth
In a previous study on children of mean age 11 years, before and after completing the tooth replacement
we found reports of 35.3% SB, 35.3% SB + AB, and period11 (Fig. 1).
29.4% AB. Subjects with both types of bruxism had The sample consisted of 5-year-olds whose first
high emotional instability5, which is a personality permanent molars had not yet erupted and 10-year-
trait involving anxiety, a high degree of worry, and olds with mixed dentition, whose parents/guardians

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174 Cortese SG et al.

Fig. 1: Form used for recording

Fig. 2: Degrees of wear according to Smith and Knight’s Index

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Dental wear in children 175

provided consent. Data were collected from May to Table 2. Percentages of different degrees of
July 2023. canine wear in both groups at ages 5 and 10
Three pediatric dentists, with Kappa concordance years.
coefficient 0.92 for determining the Smith and Canine wear
Knight index, recorded degrees of wear for incisors, G0 G1 G2 G3
Age Group N
canines and primary molars in both groups for both % % % %
5-year-olds (PG-5 and RG-5) and 10-year-olds (PG- 5 years PG 26 7.69 34.6 57.7 0
10 and RG-10) (Fig. 2). Any children with multiple (p < 0.001) RG 20 50 50 0 0
caries that interfered with the evaluation of wear in PG 24 0 8.70 60.9 30.4
10 years
any of the tooth groups, children medicated with (p < 0.001) RG 20 50 10 40 0
neuroleptics, or medically compromised children
were excluded. – For molars, no significant difference was
Data were analyzed using R software (https://ww- found in degree of wear between RG-5 and
w.R-project.org/) and VGAM package. PG-5 (p = 0.1863). In both groups, there was
Relative risk (RR) was used to compare the presence predominance of unworn teeth, followed by
of wear between PG and RG. The degree of wear for teeth with wear degree 1. At age 10 years, the
each tooth group (incisors, canines and molars) was differences were significant (p = 0.004), with
compared between PG and RG for each age using predominance of teeth with wear degree 1 in
ordinal logistic regression with proportional odds. PG-10, and unworn teeth in RG-10 (Table 3).
Categorical variables were compared using the chi • Among parents/guardians, 22.9% reported that
square test when at least 80% of the cells had an 5-year-olds presented bruxism and snoring, 8.8%
expected value greater than 5 and all of them had an reported that 10-year-olds did so, and 10.4% said
expected value of at least 1. they did not know.
• There was no difference in reported grinding be-
RESULTS tween groups with or without tooth wear in RG
Samples PG-5 and PG-10 consisted of 26 and 24 at both ages (RG-5 p = 0.068, RG-10 p = 0.582).
children, respectively, while RG-5 and RG-10 com- It was not possible to analyze this in PG because
prised 20 children each. all the children presented facets. Fig. 3, 4, 5 and
• The RR for presence of wear between PG and 6 show the association between wear recorded
RG was 1.82. by dentists and tooth grinding reported by par-
– For incisors, there were significant differ- ents/guardians in the four subgroups.
ences in degree of wear between PG-5 and • There was no difference between PG and RG
RG-5 (p = 0.002). In PG-5, all teeth had wear regarding the importance assigned by parents/
degree 1 or 2, while in RG-5, there was pre- guardians to bruxism (p = 0.58) or snoring (p =
dominance of teeth without wear or teeth with 0.68).
worn enamel only (Table 1). • The frequencies of degree 3 facets were: 30.4%

Table 1. Percentages of different degrees of

incisor wear in both groups. Table 3. Percentages of different degrees of mo-
lar wear in both groups at ages 5 and 10 years.
Incisor wear
G0 G1 G2 G3 Molar wear
Age Group N
% % % % G0 G1 G2 G3
Age Group N
PG 26 0 65.4 34.6 0 % % % %
5 years
(p= 0.02) RG 20 45 50 0 5 5 years PG 26 50 42.3 7.69 0
(p =
0.1863) RG 20 70 25 5 0
– For canines, there were significant differenc-
PG 24 9.09 54.5 27.3 9.09
es at both ages (p < 0.001), with lower de- 10 years
(p = 0.004) RG 20 52.9 35.3 11.8 0
grees of wear in RG (Table 2).

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176 Cortese SG et al.

Fig. 3: Comparison of tooth grinding reported by parents/ Fig. 5: Comparison of tooth grinding reported by parents/
guardians of rural school 5-year-olds with and without wear guardians of rural school 10-year-olds with and without wear

Fig. 4: Tooth grinding reported by parents of bilingual school Fig. 6: Tooth grinding reported by parents of bilingual school
5-year-olds with wear. In this group, all the children presented 10-year-olds with wear. In this group, all the children present-
wear. ed wear.

for canines and 9.1% for molars in PG-10, and DISCUSSION

5% for incisors in RG-5. No severe wear was re- The ages included in the sample were selected be-
corded in the other groups. Fisher’s test showed cause preschoolers (5-year-olds) are frequently re-
significant differences between RG-10 and PG- ported on, and 10-year-olds have mixed dentition, so
10 for canines (p=0.01), and non-significant dif- it is still possible to evaluate present primary teeth.
ferences between RG-5 and PG-5 for incisors The decision to compare children according to
(p=0.43), and between RG-10 and PG-10 for schooling type arose from the marked socioenviron-
molars (p=0.50). mental differences observed between sites located
less than 100 kilometers away from each other. The
rural schoolchildren live in the district Exaltación

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Dental wear in children 177

de la Cruz, Buenos Aires Province, where over 95% study observed significant differences in primary
of the population consists of rural workers. In con- tooth wear between PG and RG. In PG, all children
trast, the children from private bilingual schools presented at least one facet at age 5 years. Our re-
have long days at highly academically demanding sults found that the major difference was in canines,
schools, urban family habits and health insurance. in agreement with Soares et al., who report canines
Bulanda et al. emphasize that socioeconomic and as being the teeth most highly affected14.
cultural features may be associated with the onset Adult self-reporting is considered to differ from pa-
of sleep bruxism, which occurs more frequently in rental reporting on sleep bruxism, and parents’ re-
children from families with higher socioeconomic ports may not always be accurate since they often
level. This might be related to the greater number of sleep at a distance from the children and do not hear
duties and demands these children have compared them. Nevertheless, in the current study, the number
to children from poor environments. It is consis- of “don’t know” answers were low, although reports
tent with the findings on dental wear in the current were not consistent with presence of facets3.
study12. The use of a questionnaire plus clinical examination
Different authors consider that SB is related to is consistent with current recommendations. Re-
stress, anxiety, and behavioral and personality disor- search thus has a multifactorial approach, providing
ders, among others, as a result of serotonin and do- greater consistency, thereby identifying useful in-
pamine release which increases brain activity, heart formation for preventing consequences15.
rate and muscle tone, thereby affecting sleep quali- In the sample used in the current study, children
ty. There is also an association between obstructive from academically demanding schools had high-
sleep apnea and bruxism, and it is currently believed er degrees of wear and greater frequency of severe
that bruxism may be a protective factor that main- wear in primary canines and molars late in the tooth
tains airway patency, which is why snoring has been replacement period. These values were independent
investigated12. of reported sleep bruxism. Parents/guardians from
Awake bruxism is associated to the inability to ex- different social conditions evaluated the importance
press emotions and to states of anxiety13. The current of bruxism and snoring to health similarly.

ACKNOWLEDGMENTS
The authors thank Dr. Gladys Banegas for collecting data from
the rural school.

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