Effects of group counseling on height dissatisfaction and attentional bias in adolescence.

Sleep bruxism (SB) is defined as involuntary, episodic, and repetitive jaw muscle activity, accompanied by teeth clenching or grinding and mandible's bracing or thrusting (). This multifactorial condition affecting adults and children is influenced by central factors, such as emotional stress, or morphologic factors such as occlusal interferences (). Prevalence ranges between 1% and 15% in adults and between 3% and 49% () in children and adolescents. This variability may be ascribed to two main reasons: different sleep bruxism definitions and different age groups () in previous studies. Lobbezoo et al. () graded SB as follows: possible SB, for which diagnosis relies upon one of the guardians/parents reporting some noise or sounds of tooth grinding during the patient's sleep; probable SB, diagnosed besides the above-cited report by clinical features of bruxism noted during the functional examination, such as increased tooth wear, masticatory muscle pain or fatigue and muscle hypertrophy; and definite SB, where final diagnosis is based on the gold standard tool, polysomnography (PSG), in adjunction to tooth grinding sounds’ report and SB's clinical features' depiction (). PSG use in pediatric patients is complex and time-consuming, thus difficult (). Therefore probable sleep bruxism (PSB) is currently considered the most appropriate way to assess pediatric SB, relying on detected wear on primary and permanent teeth, in addition to parents recounting SB sounds or symptoms reportedly experienced by their children (). PSB prevalence is higher in the mixed than in the primary dentition (), with SB risk factors for the former discussed in previous studies, including occlusal factors, psychological factors, socio-demographic factors and pathophysiological factors such as Gastro-esophageal reflux disorder (GERD) and sleep-related breathing disorders (SRBDs) (, ). SRBDs are a range of conditions during sleep, ranging from a habitual snoring through upper airway resistance to obstructive sleep apnea (OSA) syndrome, a multifactorial disease with significant heterogeneity in presentation and co-morbidities. Its prevalence in children ranges approximately between 1% and 4% using objective measures (). Children diagnosed with OSA may suffer from attention deficit, learning delay, memory consolidation impairment, aggressive behaviors, metabolic disorders, and cardiovascular diseases, which can worsen in adulthood (). Attempts made to establish an association between SB and high OSA risk in adults and children were inconclusive (, ). There is renewed interest towards pediatric SB and its possible association to sleep breathing disorders (), however such investigations lack in Lebanon as far as the present article's authors know. Therefore, the present study's primary objective was to assess the PSB's prevalence in a sample of Lebanese children in the mixed dentition. A secondary objective aimed to evaluate the association between OSA risk and PSB in the study population. Such assessment may be useful to the future establishment of applicable diagnostic guidelines for dental clinicians to depict sleep apnea's intra-oral signs.