Parents' knowledge about childhood bruxism: a systematic review and meta-analysisABSTRACT
Statement of Problem Childhood bruxism is a public health concern, and parents/caregivers are the sources of information about children's habits. Purpose: this systematic review aimed to determine the proportion of knowledge of parents and caregivers about sleep and awake bruxism in children.
Material and Methods cross-sectional studies were included, sourced from Embase, PubMed, LILACS, Scopus, Web of Science, Google Scholar, and ProQuest. Meta-analyses were conducted using Jamovi 2.3.21 Software. Risk of bias was evaluated using the Joanna Briggs Institute critical appraisal checklist.
Results Initially, 580 records were identified of which 20 were selected for full reading and 16 were included in the analysis. For sleep bruxism, 10 were used in the meta-analysis on caregivers’ knowledge about childhood and six for the correct definition. One study reported awake bruxism, making it impossible to draw definitive conclusions. Meta-analysis showed that 52% (CI: 0.36 to 0.68; I2=99.43%; p<0.001) of the caregivers declared knowing bruxism (population = 4585), while 69% (CI: 0.49 to 0.88; I2= 99.62%; p<0.01) defined it correctly (population = 3650). Studies showed risk of bias, mainly due to confounding factors, questionnaire types, and statistical analyses.
Conclusion While half of caregivers knew about sleep bruxism, approximately seven in ten accurately defined it. Awake bruxism had no conclusive results. Registration: CRD42023389357.
KEYWORDS:
Bruxism; Caregiver; Child; Knowledge; Systematic review
RESUMO
Justificativa do Problema bruxismo infantil é uma preocupação de saúde pública, e os pais/cuidadores são as principais fontes de informação sobre os hábitos das crianças. Objetivo: Esta revisão sistemática objetivou determinar a proporção de conhecimento dos pais e cuidadores sobre o bruxismo do sono e o bruxismo em vigília em crianças.
Materiais e Métodos Foram incluídos estudos transversais, obtidos nas bases de dados Embase, PubMed, LILACS, Scopus, Web of Science, Google Scholar e ProQuest. Meta-análises foram realizadas utilizando o software Jamovi 2.3.21. Risco de viés foi avaliado por meio do checklist de avaliação crítica do Instituto Joanna Briggs.
Resultados 580 estudos foram identificados, desses 20 foram selecionados para leitura completa e 16 foram incluídos. Para o bruxismo do sono, 10 estudos foram utilizados na meta-análise sobre o conhecimento dos cuidadores a respeito do bruxismo infantil e seis para a definição correta do termo. Um estudo abordou o bruxismo em vigília, não sendo possível tirar conclusões. A meta-análise mostrou que 52% (IC: 0,36 a 0,68; I2 = 99,43%; p < 0,001) dos cuidadores declararam conhecer o bruxismo (população = 4585), enquanto 69% (IC: 0,49 a 0,88; I2 = 99,62%; p < 0,01) o definiram corretamente (população = 3650). Os estudos apresentaram risco de viés, principalmente devido a fatores de confusão, tipos de questionários e análises estatísticas.
Conclusão Enquanto metade dos cuidadores relatou conhecer o bruxismo do sono, aproximadamente sete em cada dez o definiram corretamente. Para o bruxismo em vigília, os resultados não foram conclusivos. Registro: CRD42023389357
PALAVRAS-CHAVE:
Bruxismo; Cuidadores; Criança; Conhecimento; Revisão sistemática
INTRODUCTION
The definition of bruxism has varied over the years and many authors have proposed different classifications. Following a consensus in 2025, bruxism was classified into three distinct manifestations: unspecified bruxism, sleep bruxism, and awake bruxism. Sleep bruxism is defined as masticatory muscle activity during sleep, characterized by rhythmic (phasic) or non-rhythmic (tonic) episodes, and is not considered a movement disorder or a sleep disorder. Awake bruxism refers to masticatory muscle activity characterized by repetitive or sustained tooth contact and/or by bracing or thrusting of the mandible during wakefulness [1].
The prevalence of possible sleep bruxism reported in children ranges from 25.2% to 34.5% [2] while possible awake bruxism prevalence ranges from 16% to 32% [3]. Some factors reported in consensus and studies may be related to bruxism, for example, awake bruxism may be related to psychosocial and psychopathological factors [4,5]. Sleep bruxism has been associated with personality traits and psychosocial factors, such as stress and anxiety [6]. Recent studies have demonstrated that an increase in screen time and sugar consumption is associated with a higher frequency of sleep bruxism in children [7]. In many cases, it may be a temporary response with potential benefits, like helping to regulate cortisol levels during periods of positive stress. However, in some situations, it can serve as a warning sign of more serious conditions, including obstructive sleep apnea, which may pose risks to the patient’s health [8].
A systematic review of risk factors related to bruxism showed that passive smoking, loud snoring, restless sleep, sleeping with the light on, and sleeping less than eight hours may be factors also associated with sleep bruxism [4,9]. In addition, socioeconomic and cultural characteristics may also be associated with bruxism in children, those of better financial conditions more susceptible than those of low income due to the greater number of daily tasks and demands that these children are submitted to [10].
Bruxism is associated with various conditions, including tooth decay, malocclusion, tooth wear, headaches, facial muscle pain, chewing discomfort, limited mouth opening, temporomandibular joint tenderness, reduced salivary flow, lip or cheek biting, and associated oral habits [10-12]. Studies of bruxism in children and adolescents have increased over the past 20 years and have contributed to the understanding that both sleep and awake bruxism are multidisciplinary and involve multiple techniques [13].
Bruxism was previously classified, according to the 2018 consensus, as "possible sleep/awake bruxism" when based solely on a positive self-report. When is based on a positive clinical examination, with or without self-report, it is classified as "probable sleep/awake bruxism". For "definite sleep/awake bruxism": confirmation is established through instrumental assessment with or without a positive self-report or clinical examination [14]. However, the 2025 consensus proposed a significant shift by abandoning this hierarchical structure. Experts agreed that self-report, clinical examination, and device-based assessments each provide complementary but potentially distinct information about bruxism. The updated approach recommends referring to the assessment method used: subject-based (self-report), clinically based, or device-based [1].
Since self-report is often not feasible in pediatric populations, the identification of bruxism in children relies primarily on observations provided by parents or caregivers. These individuals play a critical role in subject-based assessment, particularly in cases of sleep bruxism, as they are typically the main source of information regarding the child’s sleep-related behaviors [15,16]. Their observations are essential for ensuring timely intervention and preventing the progression of the condition [15]. Identifying and addressing contributing factors, particularly those linked to sleep bruxism, are essential for effective clinical management and may help mitigate its impact [6]. They often notice key signs such as teeth grinding, tense facial expressions, and associated symptoms, including pain, discomfort, or hypersensitivity to hot or cold foods [14,17].
However, level of caregiver knowledge about its identification and effects has not been thoroughly studied. Filling this gap by assessing and quantifying caregivers' understanding of bruxism is essential for improving its recognition and assessment. This may provide valuable insights to inform public health strategies, early interventions, and educational programs aimed at reducing the prevalence of undiagnosed bruxism in children. Therefore, the objective of this systematic review is to determine the proportion of knowledge of caregivers about sleep and awake bruxism in children. Secondary outcomes include the association between childhood bruxism and parental education, as well as factors related to the child's sleep characteristics.
MATERIAL AND METHODS
This systematic review was reported following the Preferred reporting items for systematic reviews and meta-analyses (PRISMA) [18]. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO; University of York CRD42023389357).
Eligibility criteria
The inclusion criteria were based on the PEOS (participants, exposure, outcomes, and study design) question: What is the proportion of knowledge of parents/caregivers about sleep and awake bruxism in children? Where p corresponds to parents/caregivers; e corresponds to knowledge about childhood bruxism; o corresponds to proportion of participants demonstrating knowledge about bruxism (e.g., awareness, self-reported knowledge, or correct identification of its definition or characteristics, as assessed by questionnaires); and s are cross-sectional studies.
All cross-sectional studies showing parental knowledge of childhood bruxism obtained through questionnaires were included, with no restriction on language or year of publication. Letters, systematic reviews, editorials, case reports, case series, in vitro studies, studies without information about the knowledge of parents/caregivers, pragmatic randomized clinical trials, and studies where it was not possible to have access to the full text (even after requesting the authors) were excluded.
Information sources, search strategy and selection process
A librarian helped to build the search strategy with controlled and free vocabulary. Experts were found through the platform "expert escape" by searching for the term "bruxism" and sending an email to the first five names with the most published works in the field.
On January 27th, 2025, the search was applied to the following databases: Embase, PubMed, Lilacs, Scopus, and Web of Science, considering the specifications of each of them. The search was updated on April 6th, 2026 and covered articles from the inception of each database up to the search date. The gray literature was searched in Google Scholar, and ProQuest dissertations and thesis (Supplementary Table 1). References were managed with EndNote desktop where duplicates were removed.
A two-phase selection process was done. Firstly, two independent and trained reviewers (PAAK; TNNP) read the abstracts in the software Rayyan, subsequently, the full text of the potentially eligible studies were read and selected based on the inclusion and exclusion criteria. A third reviewer (CM) helped in any stage of the selection process when a disagreement arose. The reference lists of included studies were also searched.
Data collection process and data items
Two reviewers (PAAK, TNNP) were trained and independently collected the data in a spreadsheet collection form developed and tested for the present review. A third reviewer (CM) helped in case of disagreements. When necessary, the corresponding author was contacted via email to acquire further information. The data collected were studies characteristics’ (author, year, country, study design, setting, and author’s conflict of interests), population characteristics (number of participants in each group, sex, and age in years), studies objectives, outcome characteristics (measures of caregivers’ knowledge and child’s habits, kind of sleep, hours of sleep and if the child sleeps alone), findings and main conclusion.
Risk of bias
The risk of bias in the included studies was assessed using the “Joanna briggs institute (JBI)” critical appraisal checklist for analytical cross-sectional studies [19], which consists of eight questions. The answers to each question can be: yes, no, unclear, or not applicable. The same two reviewers (PAAK; TNNP) independently assessed the risk of bias of each included study and any inconsistencies in the ratings were resolved by consensus, or a third reviewer (CM) made the final decision. The JBI classification determined by the authors is available in Supplementary Table 2.
Effect measures and synthesis methods
The proportion of caregivers’ knowledge was the primary outcome of this systematic review. Quantitative synthesis was applied and during data extraction, it was observed that the studies had two different ways of collecting knowledge about bruxism. In 13 of them, parents/caregivers were asked if they knew what bruxism was [15,16,20-30]. In seven studies, it was also asked about the correct concept of bruxism [15,22,25,30-33]. To ensure a more consistent analysis, the concept that the authors of each primary study judged as correct at the time of their research was considered.
A proportion meta-analysis was performed to assess caregivers' knowledge about childhood bruxism, including sleep and awake bruxism, as well as their ability to correctly define it. Since some studies did not explicitly report the type of bruxism assessed, the meta-analysis was first performed globally and then stratified into two groups: studies that explicitly specified the type of bruxism and those in which sleep bruxism was inferred based on sleep-related data from the questionnaires used. This approach allowed for an assessment of whether differences existed between these proportions.
Meta-analyses were conducted using Jamovi software 2.3.21 (Sydney, Australia), with a significance level of 5%. Given the expected variability among studies, a random-effects model was applied [34,35]. To assess true variation due to heterogeneity, the I2 statistic was used. A high I2 value is common in proportion meta-analyses, which may result from low variance as well as true heterogeneity arising from differences in the time and location of the included studies.
Secondary outcomes, when reported in the studies, included questions assessing the association between childhood sleep and awake bruxism and variables such as parental education level, as well as childhood sleep bruxism and child sleep characteristics.
RESULTS
Study selection
Figure 1 provides a summary of the study selection process. Initially, 580 abstracts were identified in total, 369 from electronic databases, and 211 studies through complementary search (gray literature and experts). Of the five experts contacted, only one responded and indicated five studies. Of these, four were already in the search and one was not about the caregivers’ knowledge about childhood bruxism. After automation removing the duplicates using EndNote, 469 hits remained (265 of electronic databases and 204 of gray literature) and 253 were excluded after reading the abstracts. Twenty-one studies were identified from sources and from reading the references of the selected manuscripts. However, although two of them had different authors, it was noted, after reading that referred to the same thesis. In this way, a decision to combine both was made [21], resulting in the 16 studies.
PRISMA 2020 flow diagram which included searches of databases, registers and other sources.
Study characteristics
Table I summarizes the main findings of the sixteen selected studies included [15,16,20-33]. The types of questionnaires used by each study and who responded to them are described in Table II. Detailed information about the characteristics of the included studies can be observed in Supplementary Table 3. All studies were in English, except for two [23,29], that were in Turkish, and were translated via Google Translater (Google, USA) for data extraction.
All studies that reported caregivers' knowledge about sleep bruxism [16,24,25,27,28,31,33] and awake bruxism [31] were included. Some studies did not report the type of bruxism [15,20-23,26,30,32] that was being investigated, although it could be inferred, by extracting data about the type of sleep, whether the child slept alone and the duration of sleep, that the focus was sleep bruxism [15,20-22,30,32]. One study divided sleep and awake bruxism throughout the study, but did not specify the type of bruxism when asking parents [29].
The children's age was fully presented in nine studies. The mean age of the participants was 7.76 years (± 0.83) [15,22,24,25,28-31,33]. Regarding parents/caregiver mean age, only five studies had this information, and the mean age was 35.37 years (±1.64) [15,25,26,30,33]
The studies mostly took place in colleges and university hospitals, except for Hafiz et al. [22] and Gurunathan, Varadarajan and Balaji [32], which made a questionnaire available electronically, and Alouda et al. [20] and Lagana et al. [24] which made the questionnaire available both online and on paper. Of the included studies, twelve used a validated questionnaire about childhood bruxism and childhood sleep habits [15,16,21,22,24,25,27-31,33]. Prasanna and Ravindran [26], Kasimoglu et al. [23], Lagana et al. [24], and Gurunathan, Varadarajan and Balaji [32] developed their own questionnaire in which two of them report the validation done through one of the investigators with experience in bruxism [24,32] and logical reason [26].
Risk of bias
The risk of bias of each study is detailed in Table III. Three studies scored "no" on all questions, which demonstrates that the studies completed the risk of bias criteria [25,28,30]. About question 1 (were the criteria for inclusion in the sample clearly defined?) all studies had well-described information except Alouda et al. [20] in which the information was unclear. All studies (100%) presented a well-described information for question 2 (were the study subjects and the setting described in detail?).
Risk of Bias assessed by the Joanna Briggs Institute Critical Appraisal tools - Checklist for Analytical Cross-Sectional Studies. The studies that presented “yes” for all questions were rated as having low risk of bias, those that presented at least one answer “unclear” was rated as fair, and at least one answer “no” was rated as high risk of bias.
The concern about risk of bias was related to questions 5 (were confounding factors identified?) and 6 (were strategies to deal with confounding factors stated?), only 25% of the studies presented this information. Questions 7 (were the outcomes measured in a valid and reliable way?) and 8 (was appropriate statistical analysis used?) were well described and detailed in most studies (87.5% and 93.75% respectively) except in Kasimogğlu et al. [23] and Prasanna and Ravindran [26] in which the information was unclear. Overall, among all studies, Kasimogğlu et al. [23] and Prasanna and Ravindran [26] were the ones with the most negative or unclear criteria, mainly regarding confounding factors, the type of questionnaire and statistical analysis used for the research.
Synthesis of results
The proportion of knowledge and correct definition were identified by two ways: in 13 studies [15,16,20-30], a direct question was performed with the possibility of answering “yes or no” and two studies reported this information in the text [23,28]. In other four studies [15,22,25,30] the information was gathered through a question about the caregiver’ self-declaration and the concept. In two, only the concept was questioned, and the possible answers were "correct" or "incorrect" [31,33]. Three of them included multiple-choice questions, allowing participants to select the correct option as an alternative to define the concept of bruxism [22,25,32]
Primary outcomes
Self-declaration of sleep bruxism
Ten studies asked parents whether they were aware of their child’s sleep bruxism, and the parents self-reported their knowledge. Of these, five explicitly stated in their text that they assessed sleep bruxism [16,24,25,27,28]. Another five did not specify the type of bruxism, however, based on questionnaire data and sleep-related information, it was inferred that they addressed sleep bruxism [15,20-22,30]. The data were analyzed together, as shown in Figure 2, revealing a proportion of 52% (CI: 0.36–0.68; I2=99.43%; p<0.001). In Figure 3, when considering only studies that explicitly identified the condition as sleep bruxism, the proportion was 48% (CI: 0.24–0.73; I2=99.41%; p<0.001). Meanwhile, studies that did not explicitly report the condition as sleep bruxism but collected all relevant data showed a prevalence of 55% (CI: 0.32–0.78; I2=99.38%; p<0.001), as presented in Figure 4.
Proportion meta-analysis forest plot of caregivers’ self-declared knowledge of childhood sleep bruxism. The analysis includes studies that explicitly reported sleep bruxism as well as those inferred to assess sleep bruxism based on questionnaire data.
Proportion meta-analysis forest plot of caregivers’ self-declared knowledge of childhood sleep bruxism, including only studies that explicitly reported sleep bruxism.
Proportion meta-analysis forest plot of caregivers’ self-declared knowledge of childhood sleep bruxism, including studies in which sleep bruxism was inferred based on questionnaire data.
The studies by Yildirim et al. [29], Kasimoglu et al. [23], and Prasanna and Ravindran [26] collected data on knowledge but did not report sufficient information to determine the type of bruxism.
Concept of sleep bruxism
Six studies questioned parents about the concept of childhood bruxism [15,22,25,30,32,33]. Of these, two explicitly identified the condition as sleep bruxism [25,33] while four were classified as sleep bruxism based on questionnaire data [15,22,30,32]. The meta-analysis, considering all studies together, found a proportion of 69% (CI: 0.49–0.88; I2=99.62%; p<0.001) (Figure 5).
Proportion meta-analysis forest plot of caregivers’ correct definition of childhood sleep bruxism, including studies that explicitly reported sleep bruxism as well as those inferred based on questionnaire data.
Among the studies that explicitly defined bruxism, Prado et al. [25] reported a proportion of 83.9% correct responses regarding its definition, while Tavares Silva et al. [33] found 38.1%. For studies inferred to be assessing sleep bruxism, the proportion of correct responses was 72% (CI: 0.48–0.97; I2=99.67%; p<0.001), as shown in Figure 6.
Proportion meta-analysis forest plot of caregivers’ correct definition of childhood sleep bruxism, including only studies in which sleep bruxism was inferred based on questionnaire data.
Knowledge and right concept of awake bruxism
Only the study by Caliskan et al. [31] differentiated between sleep and awake bruxism. In this study, parents were asked about the concept of bruxism, and only 8.3% provided a correct definition. However, the study did not specify the definition considered correct and did not present separate data for sleep and awake bruxism.
Secondary outcomes
Parental educational level
Caregiver/parental education level was reported in only four studies. Caliskan et al. [31] and Gurunathan, Varadarajan and Balaji [32] categorized education as completed primary, middle, or high school, and university. On the other hand, Làgana et al. [24] categorized education as completed high school, university, or postgraduate degree. Finally, Us and Us [28] presented education in terms of years of schooling. Due to the heterogeneity in how caregiver/parental education was reported across these studies, a meta-analysis of its association with sleep and awake bruxism was not feasible.
Characteristics of child sleep, child sleeping place and child sleep duration
Data about hours of sleep, kind of sleep, and whether the child sleeps alone were collected to assess whether childhood sleep bruxism is associated with children's sleep [15,16,21,22,25,30-33]. The studies by Hafiz et al. [22] and Serra-Negra et al. [30] found an association between restless sleep and bruxism (p < 0.001), as did Clemetino et al. [16] (p=0.002). Alves et al. [15] found an association between sleep (whether the child sleeps well or not) and bruxism (p=0.013). However, after a complete reading of the primary studies, it was noted that the sleep data were collected through questionnaires and were not presented in a way that would allow the meta-analysis of association with sleep bruxism to be made as expected.
Subject-based prevalence
Data from the included studies allowed for the calculation of the prevalence of sleep bruxism in children based on subject-based assessments (primarily caregiver reports), across 11 studies (total number of children = 5607) [15,16,20-22,24,25,30-33]. Overall, the prevalence was 33% (CI: 0.27–0.40; I2=95.89%; p<0.01), considering both studies that explicitly identified sleep bruxism and those in which it was inferred (Figure S1). When analyzed separately, the prevalence was 28% (CI: 0.21–0.36; I2=90.84%; p<0.01) in studies that explicitly addressed sleep bruxism and 37% (CI: 0.28–0.46; I2=96.34%; p<0.01) in inferred cases (Figure S2 and S3).
Among caregivers in ten studies (total caregivers = 4947) [15,16,21,22,24,25,30-33], the prevalence of bruxism based on subject-based assessments, including both studies that explicitly reported sleep bruxism and those in which it was inferred, was 28% (CI: 0.12–0.43; I2=99.43%; p<0.01) (Figure S4). When considering only studies that explicitly identified sleep bruxism, the prevalence was 15% (CI: 0.14–0.17; I2=0%; p<0.01) (Figure S5). Finally, in studies where sleep bruxism was inferred, the prevalence was 42% (CI: 0.16–0.67; I2=99.6%; p<0.01) (Figure S6).
The study by Caliskan et al. [31] reported data on possible parental bruxism without distinguishing between awake and sleep bruxism. Yildirim et al. [29] did not specify the type of bruxism in their study but reported a prevalence of 8.3%.
DISCUSSION
This systematic review and meta-analysis explored the extent of caregivers' knowledge about childhood bruxism. The findings revealed that approximately half of the caregivers self-reported being aware of sleep bruxism concept. Notably, most of them were able to accurately define the condition when questioned. Regarding awake bruxism, only one study reported its proportion, making it impossible to draw definitive conclusions. These results underscore the importance of evaluating how and when information regarding caregivers' knowledge was gathered, providing critical context for interpreting the data.
In 2013, bruxism was defined as repetitive masticatory muscle activity involving clenching or teeth grinding, classified as sleep or awake bruxism [36, 39]. The 2018 consensus expanded this to include possible and probable sleep/awake bruxism, [14] reinforcing self-report as a key assessment method. More recently, the 2025 consensus recognized that self-report, clinical examination, and instrumental assessments capture complementary dimensions of bruxism, and terminology now emphasizes the assessment method used: subject-based, clinically based, or device-based [1]. The definition used in each study was considered correct or incorrect based on knowledge available at the time, and this evolution should be considered when interpreting findings [16,20,30,33]. Most studies did not separate awake and sleep bruxism when asking this question, and two that did not distinguish them and lacked sleep data were conducted after consensus [23,26]. Concepts considered correct in the included studies were: "when a person clenches the teeth so hard that it makes an audible sound that can be heard by others" [22] and the definition “clenching or grinding of teeth” [15,25,30,32,33], while one study did not describe what was considered correct [31].
The predominance of sleep bruxism studies may introduce bias by reinforcing the more familiar concept of the condition. The term "teeth grinding" is widely associated with bruxism. Asking about "bruxism" [15,16,21–23,25–31,33] differs from asking about "information on teeth grinding" [20,24,32], indicating a questionnaire design issue. Terminology differences can affect response clarity and interpretation, influencing outcomes. One study reported replacing "bruxism" with "teeth grinding" to improve understanding among mothers [20], suggesting caregivers may recognize teeth grinding but not link it to scientific terminology. Such gaps in understanding may lead to underestimation of bruxism prevalence and delay caregivers seeking professional evaluation and early management.
The use of a validated questionnaire reduces the risk of bias in caregiver-reported data. The “Standardized tool for the assessment of bruxism” (STAB) [40] is a validated instrument available for bruxism assessment in adults and more recently, the Awake Bruxism Identification Tool (ABIT) [41] was developed for children and adolescents to facilitate the identification of awake bruxism. This represents an important advancement, as children often have difficulty accurately reporting their own symptoms. However, there remains a need for specific tools designed to assess parental knowledge regarding the different types of bruxism.
Studies assessing the concept of bruxism have provided noteworthy insights. Evidence indicates that while most caregivers recognized that bruxism could be linked to dental problems and emotional factors, only 8.3% were able to accurately define the condition [31]. The studies by Prado et al. [25] and Tavares Silva et al. [33] showed notable differences in the proportion of correct responses regarding the definition of sleep bruxism, with 83.9% and 38.1%, respectively. This discrepancy may be attributed to two key factors. First, Prado et al. [25] collected responses from 1,325 parents, whereas Tavares Silva et al. [33] had a much smaller sample of 134 participants, which could influence the representativeness of the findings. Additionally, Prado et al. [25] conducted their study across seven university clinics in the country and presented the definition of bruxism as multiple-choice options. This format may have facilitated parents' ability to identify the correct answer rather than relying solely on an open-ended judgment of correctness, as done in the study by Tavares Silva et al. [33].
Two studies performed clinical examinations to assess bruxism [28,29], while others relied on caregiver reports of its presence or absence. Data from Yildirim et al. [29] showed that clinically, 48.6% of children had bruxism, but only 15.3% of parents thought their child had the condition. Us and Us [28] assessed sleep bruxism in 160 (32%) of 500 children. These findings indicate that caregiver reports alone are insufficient to assess childhood bruxism, although they remain important. Educating caregivers about the signs and effects of bruxism helps prevent misconceptions. Dentists play a key role by clearly explaining the condition and its potential impacts. Informed caregivers are more likely to recognize bruxism early and seek timely intervention.
The prevalence in this review aligns with an umbrella review reporting sleep bruxism in children and adolescents ranging from 3% to 49%, and the same study also described that most systematic reviews did not specify whether sleep or awake bruxism was analyzed separately [39,42]. In one study with 265 parents, sleep bruxism was reported at 21.5% and awake bruxism at 7.2% [31]. Suguna et al. [27] had an experimental and control group, preventing prevalence calculation, while Kasimogğlu et al. [23] did not specify the type of bruxism or total sample size.
It was not possible to determine how many parents both understood the concept and had bruxism, as these data were unavailable in the studies except in Prado et al. [25], in which 42.7% of caregivers reported knowing what sleep bruxism is, while 57.3% did not. Notably, 27.5% of those who correctly identified the definition had a child with the condition. This may be relevant because parents with bruxism who know this information may more easily recognize the condition in their children. Parental education was a secondary outcome, but data were reported in only four studies and in different ways. Due to methodological differences and data presentation, no association could be established. Regarding children's sleep characteristics, although most studies used questionnaires based on the American association of sleep medicine (AASM) criteria, only Us and Us [28] used the Children’s sleep habits questionnaire (CSHQ). Association was also not possible due to differences in the presented data.
An improved understanding of childhood bruxism extends beyond parental awareness to include its associations, risk factors, and broader clinical implications. Identifying what caregivers need to know, such as early signs and when to seek professional care, is essential to support timely management and reduce potential long-term consequences. These findings highlight the clinical importance of improving caregiver education. Future research should prioritize the development of standardized, validated instruments to assess caregiver knowledge, as well as the use of consistent terminology and clear distinction between sleep and awake bruxism.
This review faced limitations due to the small number of studies, and their limited geographic distribution restricts the generalizability of the findings. Although a comprehensive search, including gray literature, was conducted, many studies relied solely on caregiver reports without clinical confirmation, which may reduce accuracy, particularly given that a substantial proportion of caregivers lacked knowledge of bruxism. Additionally, two full texts could not be retrieved, and two studies were translated via Google Translate, potentially affecting interpretation. Most studies relied on self-reported questionnaires, with only three allowing caregivers to select the correct definition [22,25,32]. Moreover, just 18.75% of the studies met all risk of bias criteria, and most did not account for or analyze potential confounding factors. These limitations highlight the need for more robust and geographically diverse research.
CONCLUSION
While half of caregivers reported knowing about childhood sleep bruxism, approximately seven in ten can correctly define it. Regarding awake bruxism, only one study reported its prevalence, making it impossible to draw definitive conclusions. Although caregiver reports alone may not be sufficient for a comprehensive assessment, they play a crucial role in identifying the condition. Future studies should evaluate caregiver knowledge of both awake and sleep bruxism by integrating concept-based questions, clinical examinations, and targeted educational efforts to enhance early assessment and understanding.
REGISTRATION AND PROTOCOL
The protocol of this systematic review was published and registered in the international “Prospective register of systematic reviews (PROSPERO)” under registration number: CRD42023389357.
Differences between protocol and review
There were some differences in the protocol and the review. For the planned secondary outcomes of child sleep characteristics, sleep type, sleep duration, and parental education, an association meta-analysis was planned but could not be performed due to differences in the reported data.
In addition, the secondary outcome of prevalence of bruxism in parents and children was not planned, but based on the data presented, it was possible to perform meta-analyses. Therefore, forest plots were added to this review to better understand the prevalence and need for parental/caregiver knowledge about childhood bruxism.
Data availability
The supplementary materials cited in the article can be accessed through the following links: https://bds.ict.unesp.br/index.php/cob/libraryFiles/downloadPublic/111 (Supplementary Tables 1-3) and https://bds.ict.unesp.br/index.php/cob/libraryFiles/downloadPublic/112 (Figures S1-S6).
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REFERENCES
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Conflict of Interest
Correspondence
Carla Massignan (Corresponding address) Universidade de Brasília, Departamento de Odontologia, Brasília, DF, Brasil. Email: carmassignan@yahoo.com.brEditor-in-chief:
Editor:
