Lakhasly

Bruxism is a behavior characterized by clenching and/or grinding of teeth, and/or by bracing or thrusting of the jaw muscles [1,2].Une clarification de ces
el
ements per-
mettra a l'odontologiste de mieux savoir comment depister ces
patients a risques, comment les surveiller et prevenir l'aggra-
vation des troubles, etablir le pronostic d'un risque
eventuel
par rapport a la croissance, par rapport a un dysfonctionne- ment de l'appareil manducateur (DAM) ?Ce protocole peut ne pas s'averer facile, en particulier chez les jeunes enfants,
et dans ce cas, les therapeutiques cognitivocomportemen-
tales et techniques de biofeedback peuvent egalement
etre ^ utilisees dans le cas de bruxisme de l'
eveil.L'objet de cet article n'est pas de presenter les diff
erentes
formes d'usure rencontrees ; il est sp
ecialement consacr
e
aux differentes formes de bruxisme chez l'enfant et l'adoles-
cent.Nous en preciserons d'abord la d
efinition et la physio-
pathologie a` la lumiere des publications r  ecentes,
l'epid
emiologie, les signes et les facteurs
etiologiques, ainsi
que leurs comorbidites.Therefore, this clinical study aimed to evaluate AB frequency in college preparatory students andits correlation with levels of anxiety, depression, stress, and oral health- related quality of life (OHRQoL)

The dental occlusion of young patients is the everyday busi- ness of dental professionals.Mais si l'occlusion est notre souci tant au niveau fonctionnel qu'esthetique, nous devons
egalement en surveiller l'
evolution physiologique.Clearer knowledge of these features will enable den- tal professionals to better screen those patients at risk and monitor them in order to prevent any worsening of their con- dition, whatever the prognosis, and to ask the relevant ques- tions concerning potential risks for further growth in relation to temporomandibular dysfunction (TMD).Mais une meilleure comprehension du BS est souhaitable, notamment a
cause de son association potentielle avec des troubles psychologiques chez l'enfant.Cette
evolution peut dans certains cas s'accompagner de l
esions
d'usure exager
ee
[1], notamment d'origine parafonctionnelle (fig. 1).Although previous studies [15-17] have tried to associ- ate the presence of oral parafunctions with the academic stage (high school, undergraduate, graduate), the correla- tion between AB frequency and psychological factors has not been described.La litterature internationale formule des propositions th
era-
peutiques adaptees qui seront discut
ees en fin d'article.La therapeutique
de premiere intention passe par la sensibilisation du patient  a surveiller son comportement parafonctionnel et del
et
ere, et  par consequent a
` le changer et le stopper.We will first clarify the definition and physiopathology of bruxism in the light of recent publica- tions in addition to outlining the epidemiology with the various signs and etiological factors, as well as the different comor- bidities.Genetics, environment, and lifestyle factors have been associated with increased susceptibility of AB occurrence in dif- ferent age groups [4].Some authors [9] demonstrated high prevalence of TMD signs and symptoms in college preparatory stu- dents, which were associated with emotional tension, anxiety, and oral parafunctions.Emotional factors may induce AB, and higher fre- quencies of this behavior could lead to orofacial pain, which would, cyclically, worsen psychological symp- toms.Introduction L'occlusion dentaire des jeunes patients est un sujet d'atten- tion quotidien pour l'odontologiste.envisageable d'adopter des strategies d'observation et de
non-intervention chez les jeunes enfants.Le bruxisme de l'eveil se manifeste par des
serrements de dents (tooth clenching [TC]).A recent study has introduced the concept of smartphone-based ecological momentary assessment (EMA) to quantify AB frequency [12]..Usure occlusale. 1).

Bruxism is a behavior characterized by clenching and/or
grinding of teeth, and/or by bracing or thrusting of the jaw
muscles [1,2]. According to the most recent international
expert consensus [1], bruxism may have two circadian
manifestations: sleep and awake bruxism (AB).
AB has a multifactorial etiology, with an interaction
of biological and psychosocial factors [3]. Genetics,
environment, and lifestyle factors have been associated
with increased susceptibility of AB occurrence in dif-
ferent age groups [4]. Literature shows that reports of
this behavior may occur in approximately 22–36% of
the population [5,6], with higher prevalence in
younger individuals [7]. Moreover, it is associated
with increased presence of painful TMD, which
might reduce quality of life [8].
Some authors [9] demonstrated high prevalence of
TMD signs and symptoms in college preparatory stu-
dents, which were associated with emotional tension,
anxiety, and oral parafunctions. For instance, around
53% of subjects aged between 16 and 19 years have
shown at least one sign and/or symptoms of TMDs
[10,11]. The college entrance exam is a highly
competitive environment and is usually accompanied
by social and/or family pressure, being considered an
extremely stressful period. Consequently, anxiety,
stress, and other emotional disorders are commonly
found in this group.
Emotional factors may induce AB, and higher fre-
quencies of this behavior could lead to orofacial pain,
which would, cyclically, worsen psychological symp-
toms. Thus, it is relevant to assess such factors in this
young population. A recent study has introduced the
concept of smartphone-based ecological momentary
assessment (EMA) to quantify AB frequency [12].
This method has been used in several clinical fields
[13,14], providing relevant real-time data collection
during the day, based on the natural environment of
each individual. Thus, such an approach has been
successfully proposed for AB assessment.
Although previous studies [15–17] have tried to associ-
ate the presence of oral parafunctions with the academic
stage (high school, undergraduate, graduate), the correla-
tion between AB frequency and psychological factors has
not been described. Therefore, this clinical study aimed to
evaluate AB frequency in college preparatory students andits correlation with levels of anxiety, depression, stress, and oral health-
related quality of life (OHRQoL)

The dental occlusion of young patients is the everyday busi-
ness of dental professionals. However, while we are concerned
with the occlusion from the functional and esthetic viewpoint,
we should also take care to monitor its physiological develop-
ment. In some cases, this evolution can be associated with
lesions due to excessive wear [1], notably of parafunctional
origin (fig. 1).
envisageable d’adopter des strategies d’observation et de

non-intervention chez les jeunes enfants. Mais une meilleure
comprehension du BS est souhaitable, notamment a
cause de son association potentielle avec des troubles psychologiques chez l’enfant. Le bruxisme de l’eveil se manifeste par des
serrements de dents (tooth clenching [TC]). La therapeutique
de premiere intention passe par la sensibilisation du patient  a surveiller son comportement parafonctionnel et del
et
ere, et 
par consequent a
le changer et le stopper. Ce protocole peut ne pas s’averer facile, en particulier chez les jeunes enfants,
et dans ce cas, les therapeutiques cognitivocomportemen-
tales et techniques de biofeedback peuvent egalement
etre ^ utilisees dans le cas de bruxisme de l’
eveil.

2015 CEO. E´dite´ par Elsevier Masson SAS. Tous droits re´serve´s Mots cles
·Bruxisme. ·Bruxisme du sommeil. ·Usure occlusale. ·Bruxisme du sommeil chez l’enfant. Introduction L’occlusion dentaire des jeunes patients est un sujet d’atten- tion quotidien pour l’odontologiste. Mais si l’occlusion est notre souci tant au niveau fonctionnel qu’esthetique, nous devons
egalement en surveiller l’
evolution physiologique. Cette
evolution peut dans certains cas s’accompagner de l
esions
d’usure exager
ee
[1], notamment d’origine parafonctionnelle (fig. 1). The aim of this paper is not to present the different types of wear encountered but to describe the various forms of bruxism in infants and adolescents. We will first clarify the definition and physiopathology of bruxism in the light of recent publica- tions in addition to outlining the epidemiology with the various signs and etiological factors, as well as the different comor- bidities. Clearer knowledge of these features will enable den- tal professionals to better screen those patients at risk and monitor them in order to prevent any worsening of their con- dition, whatever the prognosis, and to ask the relevant ques- tions concerning potential risks for further growth in relation to temporomandibular dysfunction (TMD). The international literature contains suggestions for appropri- ate treatment which we will discuss at the end of our paper. L’objet de cet article n’est pas de presenter les diff
erentes
formes d’usure rencontrees ; il est sp
ecialement consacr
e
aux differentes formes de bruxisme chez l’enfant et l’adoles-
cent. Nous en preciserons d’abord la d
efinition et la physio-
pathologie a la lumiere des publications r  ecentes,

l’epid
emiologie, les signes et les facteurs
etiologiques, ainsi

que leurs comorbidites. Une clarification de ces
el
ements per-

mettra a l’odontologiste de mieux savoir comment depister ces
patients a risques, comment les surveiller et prevenir l’aggra-

vation des troubles, etablir le pronostic d’un risque
eventuel

par rapport a la croissance, par rapport a un dysfonctionne-
ment de l’appareil manducateur (DAM) ?
La litterature internationale formule des propositions th
era-

peutiques adaptees qui seront discut
ees en fin d’article.

Bruxism is defined as a “repetitive masticatory
muscle activity characterized by clenching or grinding
of the teeth and/or by bracing or thrusting of the
mandible”.1 Although bruxism is not considered a
disorder, it should be seen as a risk factor if the levels of
muscular activity increase the negative consequences
for oral health, such as attrition, dental fractures,
dentin hypersensitivity, headaches, myofascial pain,
temporomandibular joint pain, among others. This
behavior can be classified according to its circadian
manifestation into awake or sleep bruxism.2
Various studies carried out in Europe on university
students show that the prevalence rate of awake
and sleep bruxism in Italy was 37.9% and 31.8%
respectively in 2016.3 In 2019, a prevalence of 57.9%
and 44.7% was reported in a Lithuanian population.4
In Latin America, the rate of awake and sleep bruxism
in Brazilian students corresponded to 31.5% and
21.5% in 2014.5 In 2016, in a population of the
same locality, the prevalence was 63% and 60.8%,
respectively.6 These data suggest that bruxism has
increased progressively over the years, so it should
not be considered an infrequent behavior and needs
to be evaluated in greater depth.
Researchers report that there is a high prevalence
of clinical consequences related to bruxism in
university students. About 91.7% of students with
chewing muscle pain suffer from bruxism. In addition,
84.8% of students with temporomandibular joint pain
and 81.6% with dental attrition exhibit such behavior. Bruxism is known to be of multifactorial origin,
which is why multiple studies have been carried out
to determine the possible associated risk factors
and their relationship with other medical or dental
disorders. Some of the factors evaluated have been
temporomandibular disorders, consumption of ni-
cotine or alcohol, and psycho-emotional factors such
as stress and anxiety, among others.8,9
Several scientific reports confirm the association
between bruxism and psycho-emotional factors. A
study that evaluated stress by measuring salivary
chromogranin A (CgA) levels reports that there is a
relationship between sleep bruxism and sensitivity to
psychological stress.10 It also states that participants
who reported bruxism showed higher scores in the
PSS-10 questionnaire.11
Academic performance is a measure that allows
students to determine their own academic progress
and can be a predictor of their future professional
peformance.12 Many studies have found an association
between anxiety and perceived stress and academic
performance, where the higher the stress and anxiety,
the lower the performance of university students. This
is possibly influenced by poor ability to concentrate,
difficulty in retaining information, and psychological
changes.13,14 In addition, academic performance would
be also affected by various psychosocial factors such
as anxiety, temperament, and motivation.15,16
However, despite the demonstrated association
between bruxism and stress, there are not enough
studies including academic performance,
Attention Deficit and Hyperactivity Disorder (ADHD) and specific learning
difficulties (dyslexia) are the most frequently diagnosed developmental disor-
ders in school-age children. Data concerning the frequency of prevalence of
the two disturbances indicate that over 10% of school age children suffer
from at least one of these. The occurrence of developmental dyslexia in Po -
land is estimated at 10%, of pure dysgraphia, at 4%(Bogdanowicz, 2003b);
European data fluctuate around 10-15% of the population. It is emphasized,
however, that deeper symptoms can be found in approximately 4% of chil-
dren with specific learning difficulties (WHO, 1992). Similarly as in the case
of dyslexia, there is no unambiguous information concerning the occurrence
of ADHD. Moreover, it would appear that the discrepancies between the data
obtained from different countries are even more conspicuous. In the United
States, 3-7% of children are believed to have ADHD (APA, 2000), while in
England less than 1%, in China from 2% to 13% (Mann et al., 1992), in Po -
land 6,6% (Kołakowski et al., 2007).
It was in the 1990s – when researchers first began to realize that the co-
existence of developmental dyslexia and ADHD is so frequent that it cannot
be purely accidental. As early as 1991, Dykman and Ackerman indicated that
25-40% of persons with ADHD also have symptoms of dyslexia, while 15-
40% of persons with developmental dyslexia manifest behaviors diagnostic
for ADHD. The frequency of the co-existence of both disorders and the cog-
nitive deficits characteristic of them induced researchers to seek their genet-
ic basis. Population studies and DNA analysis, using the mapping method,
provided data suggesting that both dyslexia and ADHD are conditioned poly-
genetically (Pennington & Olson, 2004). The genetic basis of complex dis-
turbances, such as dyslexia and ADHD, is associated with atypical brain
development. This is the result of the influence of numerous genes, which
slightly modify the development of the brain, including also its functioning as
far as reading skills are concerned – from normal reading to intensified diffi-
culties, and also intensified excitability and attention deficit. The locus con-
nected with vulnerability to the occurrence of a continuous trait is called the
Quantitative Trait Locus (QTL). The search for a common basis of dyslexia
and ADHD revealed such a QTL on chromosome 6p21, characterized by spe-
cific reading disturbances, and also by the probability of the occurrence of
hyperactivity disorder (Willcutt et al., 2000). What is more, recent studies indi-
cate that the regions on chromosome 16p and 17q may include genes that
aggravate the risk of occurrence of both disorders (Del'Homme et al., 2007).
The co-existence of both these disturbances is an interesting phenome-
non, due, for instance, to the fact that they belong to separate groups of
developmental deficits. Developmental dyslexia is included in a broader diag-
nostic category of specific difficulties in learning or acquiring school-related
skills (ICD-10). According to a definition widely used in Poland, dyslexia is:a syndrome of disturbances of higher mental activities, manifesting them-
selves in the form of specific learning difficulties in reading and writing. They
are conditioned by partial disturbances of the psychomotor development of
the functions involved in reading and writing and their integration. Among the
developmental deficits of cognitive functions, linguistic function disturbances
are of paramount importance. These disturbances include the phonological
aspect of language and are prerequisite for the possibility of linguistic com-
munication (Bogdanowicz, 2003b:495). A significantly lower level of reading,
which usually appears in connection with spelling difficulties, is a essential
condition for the diagnosis of dyslexia. These difficulties take place despite
additional exercises, while simultaneously a conspicuous discrepancy can be
observed between the level of reading achieved by the child and the level
expected at the given level of intellectual development and schooling, with no
history of educational negligence. The European Classification ICD-10
(WHO, 1992) places dyslexia within the category disorders of psychological
development (F80-F89) under the name of specific developmental disorders
of scholastic skills. Simultaneously, it is emphasized that these difficulties do
not constitute a homogenous symptom, but rather refer to a group of distur-
bances related to diverse, significant problems in speech, writing and arith-
metic. Attention-Deficit Hyperactivity Disorder is described, by contrast, as
a hyperkinetic disorder (HKD) and is not included in the group of broadly con-
ceived learning difficulties, but is treated as a behavioral and emotional dis-
order with onset usually occurring in childhood and adolescence (F90-F98).
A more popular term, however, is ADHD, taken from the American Psychiatric
Association classification – DSM-IV-TR (APA, 2000). Despite some differ-
ences in the two medical classification schemes, the terms HKD and ADHD
will be used interchangeably in this paper.
ADHD manifests itself in attention and concentration difficulties, hyperac-
tivity and impulsivity to a degree that impairs the child's functioning, or to a
degree unexpected in relation to the child's development (WHO, 1992; APA,
2000). Behaviors characteristic of ADHD, however, may be a basis for non-
specific learning difficulties. Especially inattention may affect negatively the
process of learning (Borkowska & Tomaszewski, 2008). Moreover, it is not
rare for impulsive reactions and incautious utterances to result in children
with ADHD becoming socially isolated and feeling lonely in the peer group,
as well as having problems finding a place for themselves in their class.
Regrettably, motor restlessness often evokes the reactions of disapproval
and impatience in parents, teachers and peers, clearly influencing the effec-
tiveness of learning (Lipowska, 2003).
Large-scale research on the cognitive functioning of children with Attention-
Deficit Hyperactivity Disorder from around the world (Willcutt et al., 2005) and
Poland (Borkowska, 2008) has described their specific ways of functioning.
In the neuropsychological diagnosis of ADHD it is vital to assess executive
functions, memory and, of course, attention. In the case of developmental dyslexia, research has focused on the analysis of linguistic competencies,
mostly phonological (Bishop & Snowling, 2004; Bogdanowicz, 2003a). For
dyslexic children, however, problems with memory (Ram-Tsur et al., 2008),
attention (Facoetti et al., 2004) and visual functions (Wilmer et al., 2004) are
also characteristic.
Although linguistic deficit is not an axial symptom of ADHD, there is much
evidence to indicate its occurrence in children with ADHD. The analysis of the
path of development in a group of children with ADHD in comparison with
their peers without ADHD symptoms indicates a more frequent occurrence of
abnormal development, or even intellectual impairment in early childhood
(Cohen et al., 2000). A child with ADHD may display not only articulation
problems (Barkley, 2006), but also difficulties in organizing the utterance,
mainly errors of a morphological-syntactical nature, e. g. agramatisms,
incomprehensible compound or complex sentences of improper structure
(Kim & Kaiser, 2000). In addition to vocabulary difficulties, there is a signifi-
cant connection between impulsivity and problems with pragmatics
(Camarata & Gibson, 1999). Due to planning, editing and self-control deficits,
children with ADHD have difficulties in planning their utterances, in both a lex-
ical and semantic aspect. The decrease in tempo of this process decelerates
substantially the course of linguistic communication, and makes it more
prone to disruptions. A majority of scholars have emphasized that the diffi-
culties of children with ADHD in the linguistic sphere concern the expression,
not the perception of speech, and the problems seem to be connected to inat-
tention or impulsivity (Barkley, 2006). Much research on linguistic functioning
concerns children with ADHD in whom there may co-appear other distur-
bances that may intensify or even cause difficulties of linguistic nature. In our
research, then, we wished to provide an answer to the question as to whether
or not children diagnosed with ADHD and developmental dyslexia differ in the
level of linguistic functions from peers who are only hyperactive or have iso-
lated developmental dyslexia. We also wanted to find out what constitutes the
core of these differences.