Relationship Between Malocclusion and Bruxism in Children And

Review Article

Relationship betweenmalocclu.sion and bruxismin children and adolescents: a rewew

Apostole P. Vanderas, DDS, JD, MPH,MDS Konstanfinos J. Manetas, DDS

Abstract Literature review A review of the literature on the relationship between Definition of bruxism malocclusionand bruxismis presented. Statistically sig- In all reviewed studies bruxism was defined as non- nificant correlations werefound betweendifferent types of functional movementsof the mandible with or without morphologicmalocclusion such as Class II and III molar audible sound occurring during the day or night. relationship, deep bite, overjet, and dental wearor grind- Indicators of bruxism ing. The types of functional malocclusioncorrelated with In diagnosing bruxism, the reviewed studies used dental wear or bruxofacets were mediotrusion interfer- either a clinical examination, an interview/question- ences, anterior-posterior and vertical distance between retrudedposition and intercuspal position, lateral shift of naire, or both. Theclinical indicators of diagnosingthis the mandibletogether with nonfunctional side interfer- parafunction were the presence of dental wear/attri- ences. However,all studies that reportedsignificant corre- tion and bruxofacets. The historical indicator of bruxism lations were cross-sectional, which implies that the rela- was grinding or clenching reported by the subject or tionship between malocclusion and bruxism was investi- parent during the interview or on the questionnaire. gated at a certain point of time. The results werenot con- Studiesto link bruxismand malocclusion firmed by the two longitudinal studies. Besides, the corre- Twotypes of epidemiologic studies -- cross-sec- lations were found in different age groups. Finally, the tional and longitudinal -- have been conducted to in- reported correlations cannot have biological significance vestigate the relationship between bruxism and maloc- since the biological plausibility of the causal hypothesis clusion. cannotbe inferred. Onthe basis of this study, malocclusion 1. Cross-sectional studies does not increase the probability of bruxism, and therefore The majority of the reviewed studies is cross-sec- early treatment of occlusal conditions to prevent bruxism tional.10-12,17-22In general, a cross-sectional study inves- is not scientifically justified. (Pediatr Dent17:7-12,1995) tigates the relationship betweenthe characteristic and the disease for a certain period of time, which depends he etiology of bruxism has been attributed to on the nature and the pathogenesis of the disease under investigation. Thus, the information obtained by systemic factors such as intestinal parasites, the reviewed studies regarding bruxism occurred at T subclinical nutritional deficiencies, allergies, and endocrinedisorders; 1, 2 to local factors, especially mal- the time the study was conductedor at sometime in the past. Besides, it should be pointed out that bruxism occlusion;B,4and to psychologicalfactors, s-7 It has been 23 reported that bruxism is an initiating factor of varies with age. On the other hand, it has been re- 8 ported that malocclusion changes during growth and craniomandibular dysfunction in adults. Also, stud- 24 ies9-16 conducted on children and adolescents reported development and that occlusal interferences are not consistent over time.25 Therefore, the major limitation significant correlations between this parafunction and signs and symptomsof craniomandibular dysfunction. of this type of study is that the derivation of inferences It would be useful, therefore, to know whether the depends upon a temporal sequence between malocclusion and bruxism. relationship between malocclusion and bruxism is strong enough to prevent bruxism development by 2. Longitudinal studies early treatment of occlusal conditions. The purpose of Twoof the reviewedstudies are longitudinal.26, 27 A this paper was to review the literature on the relation- major source of difficulty in carrying out a longitudinal ship between malocclusion and bruxism and to discuss study is to maintain a follow-up of the selected group. their causal relationship. In both studies 238 of 402 subjects (59%)were traced.

PediatricDentistry - 17:1,1995 AmericanAcademy of PediatricDentistry 7 Factors related to bruxism thickening of the buccal mucosanear the occlusal sur- Morphologic and functional malocclusion were the faces of the posterior teeth, and impressions of teeth on factors considered to be related to bruxism and inves- the tongue or lips. Statistically significant differences tigated in the reviewed studies. These studies are pre- were found in the prevalence of bruxism between children with and without malocclusion. sented separately for each type of malocclusionas fol- 19 lows: Egermark-Eriksson investigated the relationship between bruxism and morphologic malocclusion on 1. Morphologic malocclusion 402 children aged 7, 11, and 15 years. Bruxism was Lindqvist17 conducted a study on 196 children aged recorded in the presence of dental wear or attrition in 10-13 years to investigate existing differences in the both primary and permanent teeth and as clenching or prevalence of morphologic malocclusion between chil- grinding reported at an interview. The following types dren with and without bruxism. The recorded types of of morphologic malocclusion were reported at the morphologicmalocclusion were Class I, II, and III molar mandible in intercuspal position: Class I, II, and III relationship, overjet, and overbite. Bruxismwas diag- relationship at the canine and molar regions, inversion nosed by the presence of atypical facets on the perma- of incisors, crossbite, scissors bite, lateral open bite, nent teeth. The results showedno statistically signifi- extreme maxillary overjet, frontal open bite, and deep cant differences in any type of malocclusion between bite. The results showedsignificant negative correla- children with and without recorded facets. tion between dental wear and deep bite. No other cor- Wigdorowicz-Makowerowaet al. is examined 2,100 relation was reported. school children 10 to 15 years old to study the relation- Nilner 11 studied the relationship between ship between malocclusion and bruxism. The type of morphologic malocclusion and bruxism on 440 chil- malocclusion was not defined in the study. Bruxism dren aged 7-14 years. The types of morphologicmaloc- was diagnosed by wear facets or pathologic abrasion of clusion recorded in this study were Class I, II, and III the teeth, tension of the masticatory muscles, cicatricial molar relationship, anterior and posterior crossbites,

TABLE 1. STUDIES ON THE RELATIONSHIP BETWEENMORPHOLOGIC MALOCCLUSION AND BRUXISM

Samplesize Correlations Age Investigator M F (Yrs) Typeof malocclusion Bruxism P-value

Lindqvist 1971 89 107 10-13 Nostatistically significant difference in the type of > 0.05 malocclusion betweenchildren with and without facets

Wigdorowicz- 2,100 10-15 Malocclusion A group of < 0.05 Makowerowaet al. symptoms 1979

Egermark-Eriksson 136 7 Deepbite Dental wear > 0.05 1982 131 11 135 15

Nilner 1983a 222 218 7-14 Class II and III molarrelationship Severe < 0.05 dental wear

Nilner 1983b 147 162 15-18 Deepbite Frontal < 0.01 dental wear

Brandt 1985 673 669 6-17 Overjet / overbite Grinding 0.01 < P < 0.05 Right molar relationship

Gunnet al. 1988 67 84 6-18 Overjet, overbite Grinding > 0.05 Class II and 11I molarrelationship

Egermark-Efiksson 66 11 Scissors bite Grinding 0.06" etal. 1990 53 15 Anterior openbite Clenching 119 20 Post normal occlusion

¯ Indicatesthe value of R2.

8 AmericanAcademy of PediatricDentistry PediatricDentistry - 17:1,1995 anterior and lateral open bite, overjet, and deep bite. nosing bruxism as well as the recorded types of Bruxism was diagnosed by an interview and by the morphologic malocclusion were the same as those used presence of dental wear classified in a scale according in their cross-sectional study.19 The results showedno to its severity. Statistically significant correlations were statistically significant correlations betweenany type found between Class II and III molar relationship and of morphologic malocclusion and bruxism. Most of the severe dental wear. Using the same methodology, the relevant information of the reviewed studies related to previous investigator 12 examined the relationship be- morphologic malocclusion is summarized in Table 1. tween morphologic malocclusion and bruxism on 309 adolescents. Significant correlation was reported be- 2. Functional malocclusion tween deep bite and frontal dental wear. In an attempt to investigate differences in the preva- Brandt2° examined 1,342 children and adolescents lence of occlusal interferences between subjects with aged 6-17 years to study the association between and without bruxism, Lindqvist~2 examined 7814-year- morphologic malocclusion and bruxism. The recorded old children. Bruxism was diagnosed by the presence types of malocclusionwere overjet, overbite, open bite, of bruxofacets and a positive answer on a parental Class I, II, and III molar relationship, and posterior questionnaire. The 34 children who had bruxofacets crossbite, while bruxism was identified as tooth grind- and reported tooth grinding constituted the experi- ing reported at an interview. The results showedstatis- mental group. The control group consisted of 45 chil- tically significant association betweenright molar rela- dren without bruxofacets whoreported no tooth grind- tionship, overjet, overbite, and tooth grinding. ing. The types of functional malocclusion recorded in Gunnet al. 21 investigated the relationship between this study were lateral shift of the mandible and non- morphologic malocclusion and tooth grinding using functional side interferences. The results showedsig- Brandt’s methodologyon 151 migrant children aged 6- nificantly higher frequency of occlusal interferences in 18 years. Nostatistically significant correlations were subjects with bruxism than in those without it. found between any type of morphologic malocclusion The same investigator conducted a study ~° on 117 and tooth grinding. pairs of twins 12 years of age to investigate existing Finally, Egermark-Erikssonet al. 27 conducteda lon- differences in the prevalence of occlusal interferences gitudinal study to investigate the relationship between between individuals with and without bruxism. morphologic malocclusion and bruxism. Twohundred Bruxism was diagnosed by recording bruxofacets on thirty-eight of 402 individuals of the original sample permanent teeth clinically and on plaster models made participated in the second examination, performed 4 to from alginate impressions. Lateral shift of the man- 5 years after the first examination.The criteria of diag- dible and nonfunctional side contacts were recorded as

TABLE2. STUDIES ON THE RELATIONSHIP BETWEENFUNCTIONAL MALOCCLUSIONAND BRUXISM

Samplesize Correlations Age Investigator M F (Yrs) Typeof malocclusion Bruxism P-value

Lindqvist 1973 78 14 Statistically significant differencein the occlusal < 0.05 interferences betweenchildren with and without facets

Lindqvist 1974 117 12 Nostatistically significant difference in the occlusal > 0.05 twin pairs interferences betweenchildren with and without facets

Egermark-Eriksson 136 7 Anterior-posterior and vertical Dental wear < 0.05 1982 131 11 distance between retruded 135 15 and intercuspal position

Nilner 1983a 222 218 7-14 Mediotrusioninterferences Dental wear < 0.05

Nilner 1983b 147 162 15-18 Mediotrusion interferences Dental wear < 0.01

Egermark-Eriksson 66 11 Occlusal interferences Dental wear > 0.05 et al. 1987 53 15 119 20

Gunnetal. 1988 67 84 6-18 Functional shift Grinding > 0,05

PediatricDentistry - 17:1,1995 AmericanAcademy of PediatricDentistry 9 occlusal interferences. He found no statistically signifi- bruxism. The different types of malocclusion were re- cant difference in the frequency of occlusal interfer- corded by a clinical examination. It has been reported ences between facet and nonfacet groups. that this methodis highly reproducible if it is done by Egermark-Eriksson’s19 study examinedthe relation- the same investigator. 2~ Of the reviewedstudies, five ship between bruxism and functional malocclusion on 17,19, ~1, 2~ were carried out by one investigator and the 402 children aged 7, 11, and 15 years. Bruxism was majority of the rest of the studies showed acceptable recorded in the presence of dental wear or attrition in interexaminer variability. Therefore, the reliability of both primary and permanent teeth and as clenching or the occlusal variables recorded in these studies should grinding reported on a questionnaire. The following be considered high. types of functional malocclusion were recorded: uni- The diagnosis of bruxism was performed by a ques- lateral contact in retruded position (RP), lateral devia- tionnaire or an interview and by a clinical examination tion between retruded and intercuspal position (IP), using the presence or absence of bruxofacets or dental large anterior-posterior distance between RP and IP, wear as criteria. The errors that are expected using a functional nonworking side interference (on lateral questionnaire or an interview to collect information movement< 3 mm), and nonworking side interference are under-reporting or over-reporting of this (anywhereduring the course of full lateral excrusion). parafunction. 29 Although bruxofacets or dental wear The results showedstatistically significant correlation can be measuredobjectively, they maynot indicate the between retruded and intercuspal positions. subject’s current level of bruxism.3° In other words, Nilner’s 11 examination of 440 children aged 7-14 subjects who bruxed in the past may exhibit facets, years investigated the relationship between functional while subjects who recently began bruxing may not malocclusion and bruxism. The types of functional show signs of dental wear. Also, dental wear can be malocclusion recorded in this study were interferences caused by manyfactors other than bruxism.31 Never- in the terminal hinge movement, mediotrusion inter- theless, the reliability tests of the reviewed studies ferences, and cuspid rise. Bruxism was diagnosed by showedacceptable variability. an interview and by the presence of dental wear classi- The hypothesis tested by the reviewed studies is fied in a scale according to its severity. It was found that malocclusion, especially occlusal interferences, can that dental wear in the lateral sections was more pro- initiate and maintain forceful clenching or grinding of nounced in bites with mediotrusion interferences than the teeth. Statistically significant correlations were in bites without them. found between different types of morphologic maloc- Nilner, using the methodology mentioned in the clusion such as Class II and III molar relationship, deep previous study, investigated the relationship between bite, overjet, and dental wear or grinding (Table 1). functional malocclusion and bruxism on 309 adoles- Mediotrusion interferences, anterior-posterior and ver- cents22 Significant correlation was reported between tical distance between retruded and intercuspal posi- dental wear in the lateral sections and mediotrusion tions, and lateral shift of the mandible together with interferences. nonfunctional side interferences were the types of func- Egermark-Eriksson et al. 26 followed up 238 of 402 tional malocclusion correlated with dental wear or children of the initial sample to investigate the rela- bruxofacets (Table 2). To ascertain the meaningof these tionship between functional malocclusion and bruxism. correlations regarding the causal relationship between Their second examination, performed 4 to 5 years after malocclusion and bruxism, the following factors should the first, studied the children at 11,15, and 20 years old. be taken into consideration. The criteria to diagnose bruxism as well as to record First, significant correlations were found in differ- functional malocclusion were the same as those used in ent age groups, and the type of malocclusion corre- their cross-sectional study. 19 The results showedno lated with bruxism was not the same in all studies. statistically significant correlations betweenany type Therefore, the results of the reviewed studies are in- of occlusal interferences and dental wear or attrition. consistent. Finally, Gunnet alo~1 studied the relationship be- Second, a causal hypothesis is substantiated if a tween functional malocclusion and bruxism on 151 pathogenetic mechanismcan be elucidated. The patho- migrant children aged 6-18 years. Functional shift of genetic mechanismstated for the hypothesis tested in the mandible was the only recorded type of functional these studies is that a sensory input derived from the malocclusion. Bruxism was identified as tooth grind- periodontal mechanoreceptors by stimulation from ing by an interview. Nostatistically significant correla- occlusals discrepancies is capable of causing bruxism, tion was reported betweenfunctional shift of the man- This mechanism,however, implies an activation of the dible and tooth grinding. Most of the relevant jaw closing muscles. The question that comes up then information of the reviewed studies related to func- is whether a sensory input, arising from the periodon- tional malocclusion is summarizedin Table 2. tal mechanoreceptors, can activate the jaw closing muscles to produce a prolonged period of forceful teeth Discussion denching or grinding. Evidence from neurophysiologic The reviewed studies investigated the causal rela- studies5 suggests that the effect of a mechanicalstimu- tionship between different types of malocclusion and lation of the teeth is to reduce or inhibit jaw-closing 10 AmericanAcademy o.f PediatricDentistry PediatricDentistry - 17:1,1995 muscle activity. Also, Anderson and Picton 32 showed Dr. Vanderasand Dr. Manetasare currently in the private practice that the force applied to a tooth in artificially prema- of pediatric dentistry in Athens,Greece. ture occlusion during chewing was less than the force 1. Nadler SC: Bruxism,a classification: critical review. J Am taken prior to the creation of the prematurity. Dent Assoc 54:615-22, 1957. 2. Nadler SC: Detection and recognition of bruxism. J Am Christensen 3~ reported that an interocclusal clearance Dent Assoc 61:472-79, 1960. was created between maxilla and mandible after an 3. Ramfjord SP: Bruxism, a clinical and electromyographic induced increase in occlusal height. Both studies failed study. J AmDent Assoc 62:21-44, 1961. to demonstrate increased jaw muscle activity. Further- 4. Posselt U: The temporomandibularjoint syndromeand oc- more, it has been reported that nocturnal bruxism can clusion. J Prosthet Dent25:432-38, 1971. 34 5. YemmR: Neurophysiologic studies of temporomandibular cause periodontal ligament trauma. This implies that joint dysfunction. Oral Sci Rev1:31-53, 1976. the protective function of mechanoreceptors is can- 6. Rugh JD: Electromyographic analysis of bruxism in the celed in sleep during the forceful grinding or clenching natural environment. In: Advancesin Behavioral Research of the teeth. In contrast, the pathogenetic mechanismof in Dentistry. WeinsteinP, Ed. Seattle: University of Wash- the causal hypothesis of the reviewed studies suggests ington Press, 1978, pp 67-83. 7. Clarke NG,Townsend GC: Distribution of nocturnal bruxing that awareness of occlusal discrepancies during sleep patterns in man. J Oral Rehab11:529-34, 1984. is retained. This phenomenon, however cannot be ex- 8. American Academy of Craniomandibular Disorders: plained physiologically. 7 Based on the above evidence, Craniomandibular Disorders. Guidelines for evaluation, it seems unlikely that the activity of jaw closing muscles diagnosis, and management.Chicago: Quintessence Pub- can be initiated reflexly by specific tooth contact and lishing Co, 1990,p 22. 9. Egermark-ErikssonI, Carlsson GE, Ingervall B: Prevalence the resulting sensory feedback. Therefore, the patho- of mandibulardysfunction and orofacial parafunction in 7- genetic mechanism of the tested causal hypothesis in ,11- and 15-year-old Swedishchildren. Eur J Orthod3:163- the reviewed studies is not supported scientifically. As 72, 1981. a result, the causal hypothesis cannot have a biological 10. Lindqvist B: Bruxismin twins. Acta OdontolScand 32:177- plausibility. 87, 1974. 11. Nilner M: Relationships between oral parafunctions and The causal hypothesis has been supported in the functional disturbances and disease of the stomatognathic reviewed studies 11,12,19, 26, 27 by the commonclinical as- system amongchildren 7-14 years. Acta Odontol Scand sumption that bruxism is diminished or ceases follow- 41:167-72,1983a. ing occlusal adjustment. This assumption is based on 12. Nilner M: Relationships between oral parafunctions and information provided by Ramfjord~ and Posselt. 4 How- functional disturbances in the stomatognathicsystem among children 15- to 18-year-olds. Acta Odontol Scand 41:197- ever, bruxism was not investigated directly in these 201, 1983b. studies. On the other hand, well-controlled experimen- 13. Gazit E, LiebermanM, Eini R, Hirsch N, Serfaty V, FuchsC, tal studies in adult835-37 have shown that occlusal dis- Lilos P: Prevalenceof mandibulardysfunction in 10- to 18- crepancies are not etiologic factors of bruxism. Studies year-old Israeli school children. J Oral Rehabil 11:307-17, 1983. on children and adolescents to investigate the effect of 14. MagnussonT, Egermark-Eriksson I, Carlsson GE: Four- occlusal adjustment on bruxism have not been pub- year longitudinal study of mandibulardysfunction in chil- lished yet. dren. CommunityDent Oral Epidemiol 13:117-20, 1985. As mentioned earlier, the correlations between mal- 15. KampeT, HannerzH: Five-year longitudinal study of ado- occlusion and bruxism are not consistent. If malocclu- lescents with intact and restored dentitions: signs and symptoms of temporomandibular dysfunction and functional sion were a primary etiologic factor of bruxism one recordings. J Oral Rehabil 18:387-98,1991. would expect to see consistently reported significant 16. Kritsineli M, Shim YS: Malocclusion, body posture, and correlations. Also, the statistically significant correla- temporomandibulardisorders in children with primary and tions reported in the reviewed studies cannot have mixeddentition. J Clin Pediatr Dent16:86-93, 1992. biological significance since the biological plausibility 17. Lindqvist B: Bruxismin children. OdontolRevy 22:413-24, 1971. of the causal hypothesis cannot be inferred. Further- 18. Wigdorowicz-Makowerowa N, Grodzki C, Panek H, more, extrapolating from the results of the experimen- MaslankaT, Plonka K, Palacha A: Epidemiologicstudies on tal studies in adults, it is unlikely that occlusal condi- prevalence and etiology of functional disturbances of the tions are an etiologic factor of bruxism in children and masticatory system. J Prosthet Dent 41:76-82, 1979. 19. Egermark-ErikssonI: Mandibular dysfunction in children adolescents. Therefore, it seems safe to assume that and individuals with dual bite. SwedDent J Supp110:1-45, malocclusion cannot increase the probability of the 1982. occurrence of bruxism. 20. Brandt D: Temporomandibulardisorders and their association with morphologicmalocclusion in children. In: Devel- Conclusion opmental Aspects of TemporomandibularJoint Disorders. Early treatment of occlusal conditions to prevent Carlsson DS, McNamaraJA, Ribbens KA, Eds. Ann Arbor, MI: University of MichiganPress, 1985, pp 279-98. bruxism is not supported scientifically since the 21. Gunn SM, Woolfolk MW,Faja BW:Malocclusion and TMJ statistically significant correlations reported by the symptomsin migrant children. J Craniomandib Disord reviewed studies are inconsistent and without bio- 2:196-200,1988. logical significance. 22. Lindqvist B: Occlusalinterferences in children with bruxism. Odontol Revy 24:141-48, 1973.

PediatricDentistry - 17:1, 1995 AmericanAcademy of Pediatric Dentistry 11 23. HeikinheimoK, Salmi K, Myll~irniemiS, Kirveskari P: Symp- 30. Allen JD, Rivera-Morales WC,Zwemer JD: The occurrence toms of craniomandibular disorder in a sample of Finnish of temporomandibulardisorder symptomsin healthy young adolescents at the ages of 12 and 15 years. Eur J Orthod adults with and without evidence of bruxism. Cranio 8:312- 11:325-31,1989. 18, 1990. 24. HeikinheimoK, Salmi K, Myll~irniemi S: Long-termevalu- 31. Carlsson GE, Johansson A, Lindqvist S: Occlusal wear: a ation of orthodontic diagnosesmade at the ages of 7 and 10 follow-up study of 18 subjects with extensively worndenti- years. Eur J Orthod9:151-59, 1987. tions. Acta OdontolScand 43:83-90, 1985. 25. HeikinheimoK, Salmi K, Myll/irniemi S, Kirneskari P: A 32. AndersonDJ, Picton DCA:Masticatory stresses in normal longitudinal study of occlusal interferences and signs of and modified occlusion. J Dent Res 37:312-17, 1958. craniomandibulardisorder at the ages of 12 and 15 years. 33. ChristensenJ: Effect of occlusion-raising procedureson the Eur J Orthod 12:190-97, 1990. chewingsystem. Dent Pract (Bristol) 20:233-38,1970. 26. Egermark-Eriksson I, Carlsson GE, MagnusonT: A long- 34. Okeson PJ: Signs and symptoms of temporomandibular term epidemiologic study of the relationship between disorders. In: Managementof TemporomandibularDisor- occlusal factors and mandibular dysfunction in children ders and Occlusion, 3rd Ed. St Louis: CVMosby Co, 1993, and adolescents. J Dent Res 66:67-71, 1987. pp 178-227. 27. Egermark-ErikssonI, Carlsson GE, MagnusonT, Thilander 35. Kardachi BJ, Bailey JO, Ash MMJr: A comparison of bio- B: A longitudinal study on malocclusionin relation to signs feedbackand occlusal adjustment on bruxism. J Periodontol and symptomsof craniomandibular disorders in children 19:367-72,1978. and adolescents. Eur J Orthod 12:399407, 1990. 36. Bailey JO Jr, RughJD: Effect of occlusal adjustment on 28. Janson M: Reproducibility of occlusal findings, a compari- bruxism as monitored by nocturnal EMGrecordings. J Dent son betweenclinical and articulator analyses. Acta Odontol Res (Abstr #199) 59:317, 1980. Scand 44:95-99, 1986. 37. Rugh JD, Barghi N, Drago CJ: Experimental occlusal dis- 29. Reding GR, Rubright WC, ZimmermanSO: Incidence of crepancies and nocturnal bruxism. J Prosthet Dent 51:548- bruxism. J Dent Res 4:1198-204, 1966. 53, 1984.

Most child illnesses treated with over-the-counter medications

Despite frequent ineffectiveness and risks, "Evidence that these (cold) medications are in- use of over-the-counter medication high efficacious and may, in some circumstances, have amongpreschool-age children adverse effects has apparently done little to dampen enthusiasm for their use," the authors write. Over-the-counter (OTC) medications continue "Although the vast majority of OTC medica- be an important component of health care in the tions are used in accordance with the manufacturer’s United States for treating illness in preschool-age chil- directions, the use of OTC medications may be dren, despite associated risks and frequent ineffec- harmful in some cases; adverse reactions and over- tiveness, according to an article in a recent Journal of doses can occur. During the five-year period from the American Medical Association. 1985 through 1989, about 670,000 reports were Michael D. Kogan, PhD, National Center for received by poison control centers for children Health Statistics, Hyattsville, Maryland, and col- younger than 6 years involving either analgesic leagues, analyzed data from a nationally representa- agents, cough]cold preparations, or gastrointesti- tive sample to estimate the prevalence of recent OTC nal preparations." medication use of preschool-age children. The sample "After adjustment for recent child illness, women consisted of 8,145 3-year-old children whose moth- who were white, more educated and had higher ers were interviewed in person or by telephone. incomes were more likely to have given their child The researchers found that 53.7% of the children OTC medications. Womenwithout health insur- in the sample were given some OTC medications ance were also more likely to have given OTC during the 30 days prior to the survey. Seventy per- medications. Provider visits, but not telephone calls, cent of recent child illnesses were treated with OTC were associated with a reduction in OTCmedica- medications. Among OTCmedication users, the most tion usage," the researchers write. common medications were cough or cold medicine (66.7%) and Tylenol (66.7%).

12 AmericanAcademy of Pediatric Dentistry PediatricDentistry - 17:1, 1995