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Full Dent. Sci. 2012; 3(10):217-220.

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Allergic rhinitis and bruxism in children association and

occurrence
Rinite alrgica e bruxismo em crianas - associao e incidncia
Juliana Broch1
Hllen de Lacerda Oliveira1
Fabiana Vargas Ferreira2
Juliana Rodrigues Praetzel3
Fernanda Gomez Corra4

Abstract
Purpose: The study assessed the occurrence of
allergic rhinitis and bruxism, and the association
between these variables from a sample of children ranging from 1 to 12 years of age in the
city of Santa Maria, RS, Brazil. Study design:
This was a retrospective study and data were
analyzed from 465 records belonging to the Pediatric Dentistry Clinic at the Federal University
of Santa Maria from January 1997 to December
2008. In a questionnaire applied to the childrens
parents, questions about bruxism and allergic

rhinitis occurrence were included. The chi-square

test was used to assess data. Girls made up 51%
of the sample and boys 49%. Results: The results showed a 53.1% allergic rhinitis occurrence
and a 23.9% bruxism occurrence. Of the children showing bruxism, 63% also showed allergic
rhinitis. Conclusion: Therefore, the association
between bruxism and allergic rhinitis was significant. It was concluded that bruxism-bearing children are likely to develop allergic rhinitis.
Descriptors: Rhinitis, Bruxism, Child.

M.S. Dental Science Post Graduate Program Students, Federal University of Santa Maria (UFSM), RS, Brazil;
PhD Epidemiology Graduate Program Student, Federal University of Pelotas (UFPEL), RS, Brazil;
3
Dentistry School Associate Professor at the Federal University of Santa Maria (UFSM), RS, Brazil
4
Especial Student of Dental Science Post Graduate Program Students, Federal University of Santa Maria (UFSM), RS, Brazil;
1
2

Correspondncia com o autor:ju_broch@hotmail.com

Recebido para publicao: 25/03/11
Aceito para publicao: 11/10/2011

Artigo original / Original article

Full Dent. Sci. 2012; 3(10):217-220.

218

Artigo original / Original article

Introduction
Bruxism can be defined as the closing or the
grinding of the teeth during non-functional movements of the stomatognatic system (SGS)8. It
can occur either consciously or unconsciously15.
The expression bruxomania was introduced in dental literature in 1907 by Marie & Pietkewkz and Pinto et al.16 (2000) to refer to this
dental wearing habit. Due to its high occurrence
in the population and its harmful effect not only
to the SGS, but to the patient in general, bruxism arouses great interest. It can affect the two
dentitions, though it causes a more severe wearing to deciduous teeth, as these are less resistant to friction as a consequence of the smaller
amount of enamel and dentin16.
Bruxism is a multifactor etiological condition which involves local, as well as systemic,
psychological, occupational, and hereditary
factors2,6,14.
It has also been associated to allergic processes and / or respiratory abnormalities10,13,18,
but mainly to allergic rhinitis (AR)9. However,
there has not been enough scientific evidence
so far to explain such association.
Among oral health risks, allergic diseases
are thought to be the chronic disturbances that
are most often associated with infant morbidity,
affecting roughly 25% of the pediatric population19. Authors consider AR to be a global public
health problem which affects at least 10 to 25%
of the general population and can produce harmful effects on the patients quality of life1,19,20.
According to Bousquet et al.4 (2005), AR is
clinically defined as a symptomatic condition
induced by IgE, or inflammatory mediators,
following exposure to allergens in nose-lining
membranes. In AR, this inflammation5,19 causes
vasodilation, mucosal edema and mucus hypersecretion, which together can cause congestion
and nasal obstruction, symptoms which are largely accountable for the condition morbidity19.
Literature often reports that AR and oral respiratory symptoms directly affect the patients
physical and psychological well-being. These
conditions can harm sleep, which results in fatigue and daytime drowsiness, contributing to a
learning capacity, work efficiency and life quality reduction12.

Study design
This was a retrospective study performed

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by means of data analysis of clinical cards from

1997 until 2008 and it was available 1 to 12
year-old children at the Pediatric Dentistry Clinic
of the Federal University of Santa Maria, Santa
Maria city, RS, Brazil.
Data collection was done by the authors
of this research, and the predictor variables
sex and allergic rhinitis occurrence, as well as
the outcome variable bruxism were analyzed.
Four hundred and sixty-five forms which
had been correctly filled in by patients who
answered the questions, Is the child used to
grinding his teeth during sleep? ( ) yes ( )
no and Does he/she have any allergies?
( ) yes ( ) no. If yes, which?. It was only considered rhinitis when parents specified it.
Data were stored in a database and analyzed
by means of the chi square test at a 5% significance level through the SPSS (Statistical Package of the Social Science) software.
This research was approved of by the ethics
Committee in Research Involving Human Beings
of the Federal University of Santa Maria (UFSM)
under the number 0239.0.243.000-08.

Results
Out of a total of 800 files analyzed, 465
were used in the research. Of these, 51% of the
patients were female and 49% were male. Most
of the sample (82.5%) consisted of children between 1 and 6 years of age (Table 1).
Out of 465 reports analyzed, 247 of the children had AR and 111 of them had bruxism. In
the bruxism group, 70 (63.1%) of the children
had allergic rhinitis (Table 2).
The Chi square test showed an association
between AR and bruxism (p=0.02), once children who had bruxism showed a higher allergic
rhinitis occurrence.

Table 1 - Children of sample (n=465) Santa Maria, RS, Brazil, 2008.

Questions

Male

227

49.00

Female

238

51.00

1-6

335

72.04

7-12

130

27.96

Gender

Years

Full Dent. Sci. 2012; 3(10):217-220.

Table 2 - Children with bruxism and rhinitis (n=465), Santa Maria, RS, Brazil.
2008.

With bruxism

Value of p

Rhinitis

Yes (n)

No (n)

With

70

Without

41

177
177

Total

111

354

p=0.02

*p<0.05

Discussion
Allergic rhinitis occurrence in the pediatric
population has increased over the last few decades and it has a deep impact on the physical,
psychological and social well-being of children.
This study has found a 53.1% occurrence
of AR-bearing children (Table 2), which exceeds
the range reported in literature between 22.6%
and 47.2%9,11,20. The explanation for the AR occurrence variation in literature may be connected
with distinct epidemiological designs. The majorities of the studies have been cross-sectional3,11,20
in which a relationship between the predictor and
outcome variables cannot be established. Crosssectional studies are, however, useful in the identification of risk indicators that can be confirmed
by longitudinal investigations.
In this study, an association between gender
and AR occurrence was not found and that can
be attributed to similar exposure patterns to risk
factors in the study sample (children living in Santa
Maria or surrounding counties).
In this study, the bruxism occurrence percentage found was 23.9% within the range reported
in literature from 5.1% to 41%10,13,16,17,18. This
variation can be explained by the different methodologies used, types of samples evaluated, age
groups selected and diagnosis criteria used by the
authors, once standardized diagnosis criteria have
not yet been established for the two conditions
under study.
Bruxism diagnosis can be obtained by the patients or the parents report as well as the evaluation of signs and symptoms that are suggestive
of the condition, such as wear facets, sensitivity, headache, noises, muscular fatigue, and joint
discomfort2,6,9,16,17,18.
In this study, a statistically significant association between bruxism and allergic rhinitis was
found. Out of 465 records analyzed, 247 of them

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(53.1%) showed AR and 111 (23.9%) showed bruxism. Of the bruxism-bearing group, 70 (63.0%)
of the children had allergic rhinitis (Table 2).
Branco et al.5 (2007) showed that nasal obstruction usually occurs in patients that present
allergic conditions in the upper airways, such as
rhinitis. Following this paradigm, Gregorio et al.13
(2008) evaluated 38 children averaging 7.8 years
of age in order to observe which signs and symptoms could be associated to the apnea-hypopnea
obstructive sleep syndrome. The results revealed
that all children that had a severe obstruction showed an associated bruxism. Following the same
reasoning, Eftekharian et al.10 (2008) observed
140 (4 to 12-year-old) children that showed obstructive signs and symptoms in order to evaluate
the before and after adeno-tonsillectomy effect
on bruxism occurrence. The results showed that,
prior to surgery, bruxism occurred in 25.7% of the
children and, following it, the percentage dropped
to 7.1%.
Cintra7 (2003) analyzed 76 children between 7
and 14 years of age to evaluate how AR may be a
complicating factor in buco-facial alterations. The
result showed that 82% of the children presented
nasal obstruction, while 58% of them presented
bruxism. According to this study, AR also increases
the chances of the child developing bruxism. The
author justifies this association by explaining that
the child masticates, yawns, sneezes and swallows
along the day with an open Eustachian tube.
In agreement with the studies above mentioned, Marks14 (1980) mentions allergy as being an
important factor in bruxism occurrence due to the
embryological, anatomical and neurological relation between the eardrum cavity, the Eustachian
tube and the mandible; thus, middle ear disorders
can ensue an ATM reflex action and stimulate the
nucleus of the trigeminal nerve in the brain. For
Cintra7 (2003) and Marks14 (1980), the allergic
edema ends up closing the Eustachian tube (negative pressure increase). Another hypothesis is
that a respiratory obstruction would lead to histamine release in itching, cough and sneeze attacks,
acting as a stimulating agent that would trigger
bruxism14.
It is worthy to mention that bruxism has to be
diagnosed in its early stage due to the magnitude
of the damages it causes, mainly in the primary
and mixed dentitions. Its etiology is not well-understood, as it is a complex multifactor disorder,
often difficult to be identified. The dentist must
be aware of the patients expressions, evaluate his

Broch J, Oliveira HL, Ferreira FV, Praetzel JR, Corra FG.

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medical and dental history, as well as emotional

aspects10,13,18.
We agree with Barbosa et al.2 (2008) in that
bruxism is becoming a health problem in the infant population on account of the habits and
stress of modern society. The AR impact can directly affect the individuals quality of life, not only
because of respiratory alterations, but also because of the behavioral, functional and physical harm
it causes.

Conclusions
Through the methodology used, it can be concluded that:
Allergic rhinitis had a 53,1% occurrence
rate and bruxism 23,9%.
Sixty-three percent of the group of bruxismbearing children also had an allergic rhinitis
picture.
An association between bruxism and allergic rhinitis was found.

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