Bruxismo do sono na infância: uma proposta de guia para a prática clínica baseada em evidências

Abstract

The International Classification of Sleep Disorders defines Sleep Bruxism as stereotyped and periodic movements, with teeth grinding and/or clenching, resulting from rhythmic masticatory muscular activity (RMMA) during sleep. The RMMA during sleep bruxism occurs due to the coactivation of the opening and closing muscles of the mouth, as opposed to the alternation between them, commonly observed during mastication. The persistence of this multifactorial habit can lead to dental and orofacial complications. The prevalence in children is still controversial, but it is known that early diagnosis and immediate treatment may minimize the above-mentioned effects. To date, there is still no consensus on the best diagnostic tool and the most effective treatment of sleep bruxism in children. Thus, the present study aimed to develop an Evidence-Based Clinical Practice Guideline for the Diagnosis and Treatment of Sleep Bruxism in Childhood, based on a systematic review of the literature in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) followed by elaboration based on the AGREE (Appraisal of Guidelines for Research & Evaluation) criteria. The keywords "sleep bruxism" and "children" were used to literature search in three databases: "Pubmed", "Scielo" and "Lilacs", resulting in 54 articles of which 18 were included. From these, another 27 were included based on the check of the lists of bibliographical references, totaling 45 articles included and used in the literature review. Of the results found for diagnostic methods, the most used were the questionnaire (37.78%) and the combination between parent / self report and clinical examination (35.55%). The following criteria were included in the Guideline for Diagnosis and Treatment of Sleep Bruxism in Childhood: (1) parent report or self report; (2) clinical examination; (3) Brazilian version of the Children's Sleep Habits Questionnaire (CSHQ) questionnaire; (4) ambulatory type II polysomnography as a complementary exam, (5) occlusal splint for treatment. The Guideline for Diagnosis and Treatment of Sleep Bruxism in ivChildhood is a possible tool for clinical practice based on evidence, however future studies are needed to verify the validity and reliability of the instrument.