Daytime Teeth Grinding Means More Dental Work

People with Rett syndrome who grind their teeth during the day had a higher incidence of dental treatment, particularly restorations, than those who did not, an international database study reported. 

The findings also showed that patients fed orally had more dental treatment than those fed through a stomach tube. 

Regardless, families of Rett patients generally valued the importance of oral health despite reporting difficulties in daily mouth care, the scientists said. 

The study, “Oral health care and service utilisation in individuals with Rett syndrome: an international cross‐sectional study,” was published in the Journal of Intellectual Disability Research. 

Grinding or clenching teeth (bruxism) when awake is a symptom of Rett syndrome, a condition caused mostly by mutations in the MECP2 gene, and characterized by other symptoms including growth defects and problems with movement and communication, as well as cognitive disabilities, seizures, and acid reflux. 

Some studies suggest teeth grinding occurs in up to 90% of Rett patients, but most of the evidence is found in individual case reports. Others have found that those with Rett have fewer cavities than healthy people, but poorer gum health and higher tooth extraction rates. 

Still, given the dental involvement in Rett, information on oral health is scarce. Notably, dental care problems in this patient population also may be due to a lack of access to dental services. 

To investigate further, researchers in Australia administered a questionnaire to Rett families to examine the use of dental services by patients and identify potential barriers with accessing services, as well as investigate patterns of dental problems (including bruxism) and dental management.

“The primary goal of this … study was to explore the at-home and professional dental care experienced by individuals with [Rett],” the team wrote. 

Questionnaires were sent to 232 families enrolled in the International Rett Syndrome Phenotype database (InterRett), of which 216 were returned. All Rett patients were female ages 7 and older with a confirmed MECP2 mutation.

The analysis found that almost half (47.7%) reported difficulty in daily teeth cleaning, primarily due to antagonistic behavior (irritability, challenging behavior), biting, refusal to open, or difficult mouth access. Most families (92.1%) said opening the mouth for cleaning was challenging, with almost two-thirds reporting biting. Dental health was considered important or very important to more than 90% of respondents. 

The overall rate for all dental visits was 1.44 visits per person-year, equivalent to once every eight months on average. Most visits were for dental examinations (nearly once every nine months) rather than tooth extractions — once every 20 years — or to restore teeth (once every 14 years).

Over three years, there were 846 dental examinations, with 768 being performed with no sedation, 34 with relative analgesia (a form of sedation), 22 had intravenous (IV, into-the-vein) sedation, and 22 under general anesthesia. A similar distribution was seen for teeth cleaning. 

Also, across three years, the team found 34 tooth extractions. Of these, 13 were performed under general anesthesia, eight under IV sedation, six using relative analgesia, and seven with no sedation. Of the 41 visits for one or more restorations, more than half had no sedation, while seven used general anesthesia, four IV sedation, and one relative analgesia. 

Most mothers of Rett patients who had completed only secondary school attended visits at private dental clinics less often, but attended hospitals more frequently than mothers with a higher education level. In contrast, mothers who were full-time homemakers or listed “other” employment status were more likely to attend private hospital facilities than mothers in full-time employment. 

Although Rett patients from 7 to 12 years old had similar incidence of dental treatments compared to those older than 19, patients from 13 to 19 years of age had fewer. Still, older patients had a higher incidence of restorations and fewer extractions than the 7-to-12 group. Rett mothers with secondary school qualifications attended fewer dental appointments than mothers with university qualifications.

Rett patients who could walk unassisted had more dental restorations compared to those unable to walk. Over the previous year, compared to those with uncontrolled seizures, the rate of dental restorations increased with more seizure control for either occasional, completely controlled, or no seizure history. 

Results also showed that although they had fewer dental extractions, those who reported acid reflux had similar incidence rates of check-ups and all treatments than those who did not.

Rett patients who ground their teeth, especially during the day, had a higher incidence of dental treatment — particularly restorations followed by extractions — than those who never ground their teeth. 

“This is not surprising given the permanent damage due to tooth wear, particularly in those with special needs,” the researchers wrote, “although it is also possible that parents who are more worried about bruxism were more likely to take their child to the dentist.”

Patients who snored underwent more restorations than those who did not, and participants who were fed orally underwent more treatments, particularly restorations, compared to patients fed by tube. 

Finally, estimating the overall dental cavity progression rate revealed that it might be similar to the average population. However, the scientists said the “present results likely underestimate the true caries [cavities] progression rates as they do not account for early pre-cavitation forms of dental caries.” 

The team concluded: “Most individuals with [Rett] attended for routine dental examinations, and some could tolerate more invasive dental treatments including restorations and extractions in the dental chair without the need for sedation. Pleasingly, the majority of parents believed in the importance of maintaining oral health, despite some challenges during daily toothbrushing.”