Attrition

Bruxing and grinding of the teeth are very common in individuals with developmental disabilities including autism. Possible causes include grinding or bruxing from anxiety, airway obstruction or simply because it provides a lot of sensory information to the individual.

Anxiety The parent/caregivers may not have even considered the grinding is triggered by an event or a place or simply a way of communicating the individual with ASD is uncomfortable or unhappy or anxious. Recommend keeping a journal when the individual grinds, how long it lasts, and what events are taking place around the activity. Understanding the trigger will help to prevent the action.

Airway obstruction If upon oral examination it is apparent the individual with ASD grinds their teeth, take a few minutes to assess the airway. Are the tonsils present? If so, are they enlarged or inflamed? Does the individual also snore? Have chronic allergies? Is the patient a mouth breather? Grinding, especially at night may be a symptom of sleep apnea or an obstructed airway. If insufficient oxygen is getting to the brain, the body will try to arouse the individual to take in more air - this is the cause of nocturnal grinding in some individuals.

The Mallampati Score is a score used by anesthesiologists to determine the ease of intubation in patients. This score also relates to the possibility of obstructive sleep apnea or airway obstruction and is easily completed in the dental office. With the patient sitting up in the chair, simply have them open wide and stick their tongue down out and down toward the chin. Class I is healthy, Class IV is indicative of possible obstruction (Figure 6).

Figure 6. The Mallampati Score.
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It is not recommended that dental professionals complete this examination and inform the patient that sleep apnea/airway obstruction is present and the cause of grinding or other associated conditions. This is simply a tool that can be used to identify potential problems that will require a referral to a physician or dentist specifically trained in sleep apnea.

Self-injurous Behavior – Many individuals with autism participate in self-injurious behaviors. They may hit their heads on the wall or the floor on purpose. There is not a scientific explanation for this other than it may be related to frustration in not being able to communicate, being overwhelmed by their environment or simply being uncomfortable i.e., headache, toothache, stomach pain, etc. Some individuals with autism have stated activities like the head banging or teeth grinding are a way “to stop the input” (Figure 7). Meaning the sensory information being taken in is too much, and the best way to stop that or control those feelings is to use a lot of output. At the end of the course is a link to a video that discusses this further.

Figure 7. Teeth damaged by grinding.
grinding teeth