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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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Year : 2021  |  Volume : 39  |  Issue : 1  |  Page : 42-46

Comparative evaluation of body mass index among school children with and without Bruxism of age group of 6–12 years in Kanchipuram district: A cross-sectional study

1 Department of Paediatric and Preventive Dentistry, Rajah Muthaiah Dental College and Hospital, Chidambaram, Tamil Nadu, India
2 Department of Pedodontics and Preventive Dentistry, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
3 Department of Paediatric and preventive dentistry, Rajah Muthaiah Dental College and Hospital, Chidambaram, Tamil Nadu, India

Date of Submission12-Dec-2020
Date of Decision17-Feb-2021
Date of Acceptance02-Mar-2021
Date of Web Publication22-Apr-2021

Correspondence Address:
Dr. Lokesh Siva
227, Main Road, Mel Bhuvanagiri, Chidambaram, Cuddalore - 608 601, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jisppd.jisppd_523_20

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Aim: To evaluate and compare the body mass index (BMI) of school-going children with bruxism and without bruxism of age between 6 and 12 years. Settings and Design: To find the correlation between BMI and oral habit bruxism among school children and compare with those children without bruxism. Materials and Methods: A total of 6122 children were screened from 28 government and 12 private schools, in which 1854 (30.28%) had various types of oral habits. Among this 280 children had the stressful habit bruxism. The BMI of those children was calculated by measuring the height and weight. The values were compared with the BMI of same number of students of same age group, who does not have any oral habits, with the WHO standard. The values were calculated and tabulated for the statistical analysis, using the SPSS software version 19 (IBM company) with the P < 0.05 as statistically significant. Results: Its shows that children with bruxism has high BMI range, was in the order of overweight > Normal > Underweight, but the BMI of children without any habit was in the order of normal > Underweight > Overweight. On comparison, it was statistically significant. Conclusion: The habit bruxism had a positive correlation with the BMI of children. The children are more stressed from both indoor and outdoor. Hence, kindly educate all the parents, teachers, and public to identify the cause for the habit, because each oral habit is strongly deep rooted with some emotional and/or psychological problem and to make the children stress free in future.

Keywords: Body mass index, bruxism, cortisol, oral habit, prevalence, school children, stress

How to cite this article:
Siva L, Krishnamoorthy V, Durai K S, Shaheed Ahamed S S, Rajakumari S, Catherine N C. Comparative evaluation of body mass index among school children with and without Bruxism of age group of 6–12 years in Kanchipuram district: A cross-sectional study. J Indian Soc Pedod Prev Dent 2021;39:42-6

How to cite this URL:
Siva L, Krishnamoorthy V, Durai K S, Shaheed Ahamed S S, Rajakumari S, Catherine N C. Comparative evaluation of body mass index among school children with and without Bruxism of age group of 6–12 years in Kanchipuram district: A cross-sectional study. J Indian Soc Pedod Prev Dent [serial online] 2021 [cited 2022 Dec 2];39:42-6. Available from: http://www.jisppd.com/text.asp?2021/39/1/42/314368

   Introduction Top

The childhood habits are the learned pattern of muscular contractions.[1] The habit bruxism is an involuntary rhythmic processing or spasmodic nonfunctional gnashing, clenching, and grinding of the teeth when performing movements that are not the part of masticatory function that leads to occlusal trauma.[2]

Bruxism can occur during sleep (nocturnal bruxism) and wakefulness (diurnal bruxism). The psychological factors associated with bruxism are anxiety traits, stress sensitivity and personality characteristics, and a feeling of frustration. Anxiety and fear can stimulate the teeth grinding activity in both children/adolescents and in adults.[3],[4]

Waking up in the morning, exercising, and acute stress are the circumstances which can increases the cortisol production from the adrenal gland. This cortisol plays an important role in human nutrition. It regulates energy by selecting the right type and amount of substrate the body needs to meet the physiological demands. When it is chronically elevated, cortisol can have deleterious effects on weight, immune function, and chronic disease risk.[5]

Developing countries like India, its like a “double ended sword “– at one end overweight and obesity, and on other end, we have malnutrition and underweight is seen in children and adolescents. In 2019, worldwide 38 million children under the age group of 5 were obese. The prevalence of overweight and obesity among Indian children is significantly increasing from 16.3% to 19.3%.[6] It was predicted that by 2025, there will be 340 million obese children and adolescent worldwide.

The oral habit, bruxism is mainly associated with anxiety traits and stress sensitivity in children. Those children with bruxism have the symptoms of altered eating pattern, which can change the body mass index (BMI) of children.[2]

Hence, the aim of the present study is to compare the BMI of school children with bruxism and children without bruxism of age 6–12 years.

   Materials and Methods Top

The present cross-sectional study was conducted as medical and dental camp at schools in and around Melmaruvathur in Kanchipuram district, covered about 28 government schools and 12 private schools, after getting approval from the Institutional Ethical Committee (IRB no: 2018 BRVIII-VAS-04) and permission from the (District Educational Officer) for government schools and school authorities for private schools. An informed parental consent form along with screening form is distributed to children 2 days before the day of screening, physical presence of parents/guardian is must on the day of screening.

A total of 6122 children was screened of age between 6 and 12 years, 3 days in a week, covering 20–40 children/day. The detail history was obtained from both child and parents/guardian, clinical examination was carried out using dental mouth mirror and ice stick, probe. Later school-based medical and dental health preventive program was done, also provided tooth brush and paste to all children. This was conducted in the academic year 2018–2019.

The height was measured using the Prestige Height Measuring Scale in centimeters (cm's) and converted to meters (m's) and weight by digital weighing machine in kilograms (kgs) (RTB Electronic LCD display digital machine). Among the total number of children screened, we found that 1854 (30.28%) have various types of oral habits. In that 280 (4.57%) of the total children had bruxism. [Table 1] shows the distribution of children with bruxism based on their study age and same number of children of the same age group, those who does not have any oral habits (normal children) were included for the comparison of BMI and children with known history of any systemic disease were excluded.
Table 1: Demographic distribution of study participants with and without oral habit bruxism

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The body mass index of those children was calculated using the following formula:

And compared with WHO standard range, and later, the values were tabulated for the statistical analysis, which was done using the Statistical package for the social science version 19 for windows (IBM company Armonk, New York, U.S) with the P < 0.05 as statistically significant.

   Results Top

The distribution of children with and without oral habit bruxism according to the age and the BMI was calculated. The children with bruxism [Table 2] shows 70.71% were overweight, followed by 28.21% were in the normal range and only 1.07% were underweight. However, the children without bruxism [Table 3] shows that 51.79% were in normal range, 47.50% were underweight, and only 0.71% were overweight, which is statistically significant.
Table 2: Comparison of body mass index among children with bruxism

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Table 3: Comparison of body mass index among children without bruxism

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It shows that children with and without bruxism the order of BMI range shows [Graph 1] that overweight > normal range > underweight and normal > underweight > overweight, respectively.

However, on intergroup comparison, the BMI of children with and without bruxism [Table 4] all age group children shows statistically significant with the value of P < 0.05, except the age 6 years shows statistically not significant.
Table 4: Comparison of body mass index among children with and without bruxism

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   Discussion Top

The prevalence of oral habits in the present study is about 30.28%, which is similar to the prevalence reported 29.1% by Ana Flavia Granville – Garcia done in Brazil[7] and 34.1% by Quashie Williams in Nigeria (Lagos)[8] and 38% by Bhavya DP in India (Gulbarga).[9] However, in contrast to this study, only 11.7% had oral habit in India (Chandigarh).[10]

Oral habit bruxism is an unconscious habit mainly seen in children. The children who are more exposed to emotional problems, such as strong emotional tension, family problems, existential crisis, anxiety state, depression, fear of school tests or even the practice of sports competitive action are the factors of psychological and occupational origin to trigger this condition.[1],[11]

The frequency of psychosomatic symptoms among children and adolescents is increasing over the decades as reported by Osika et al.[12]

When the person is being stressed the part of the brain which controls the stress “Emotional brain” located in the limbic system is triggered.[2] This flow chart shows one of the sequence of events that takes place in the body to neutralize the stressful condition.[5]

When the person is stressed, it causes the release of cortisol. On repeated elevation of cortisol can lead to weight gain in two ways. One way by cortisol can mobilize triglycerides from storage and relocate them to visceral fat cells (those under the muscle, deep in the abdomen). Cortisol also aids adipocytes' development into mature fat cells.

The biochemical process at the cellular level has to do with enzyme control (11-hydroxysteroid dehydrogenase), which converts cortisone to cortisol in adipose tissue.

A second way in which cortisol may be involved in weight gain goes back to the blood sugar-insulin problem. Consistently, high blood glucose levels along with insulin suppression lead to cells that are starved of glucose. However, those cells are crying out for energy, and one way to regulate is to send hunger signals to the brain. This can lead to overeating and of course, unused glucose is eventually stored as body fat.[5]

This theoretical evidence shown to be true from the present study, by the percentage of overweight is more for the children with bruxism 70.71%, when compared to the children without any habit 0.71%, and at the same time, underweight is more in children without bruxism, when compared to children with bruxism.

All children knowingly or unknowingly being stressed from home like the family problems – financial, single parent, divorce of parents, and the school problems such as class tests, study grades, sports, and others. This affects child sleeping pattern (insufficient sleep), restless sleep and also sleeping in separate room, which is followed in developed countries was also be the reason.[13]

Even parental/mothers stress condition can tends to generate emotional and/or psychological problems,[14],[15] all this stressful conditions makes the child to adopt more harmful oral habits as a compensatory mechanism to relieve this pressure.[16],[17]

If this continues, children with younger age group are more prone to develop, not only harmful oral habits but also health issues such as chronic diseases and immune problems, with is associated with increased intake of junk foods, decreased physical activities and outdoor games, by online games through cell-phones.[5],[18]

Each oral habit is strongly deep rooted by some emotional or psychological problems. Hence, kindly educate the parents and teachers and the public, to identify the root cause for the habit and to solve it, to make the younger generation stress free and with the favorable environment for the child to grow on one hand, which prevents overweight and obesity and on the other hand by providing adequate nutrition to prevent malnutrition, to prevent the complications arising from the noncommunicable disease.

From the past to the present study, it shows the relationship between bruxism and psychosocial factors such as stress, anxiety, depression, and emotional disturbances has positive influence on the BMI in children. Hence, further studies are needed to confirm these finding, because stress is not the only reason behind in increasing the BMI of children, but also there are many other factors associated for the increase of BMI.

Limitations of the present study include we have only considered the oral habit bruxism associated with BMI, other oral habits developed due to stress is not considered. The study was conducted in a small population, which cannot be taken for the whole population. Stress is the only factor considered for increases in BMI, other factors are not considered. The gender preference is not considered.

   Conclusion Top

“Today's stress is tomorrow's disease.” Hence, please consider stress is a serious issue, which is unknowingly presented to younger generations. Only method to solve this problem is by educating the parents, teachers, and the public regarding the problem and the methods to solve it, as early as possible, to make the future generation stress free.


I would like to thank Adhiparasakthi dental college and the Educational trust for providing the transport and paste, brush to all children.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Shobha Tandon. Commonly occurring oral habits in children and their management. Textbook of Pedodontics. 2nd ed. Hyderabad: Paras Publishing; 2009. Pp. 492-525.  Back to cited text no. 1
Wieckiewicz M, Paradowska-Stolarz A, Wieckiewicz W. Psychosocial aspects of bruxism: The most paramount factor influencing teeth grinding. Biomed Res Int 2014;2014:1-7.  Back to cited text no. 2
Serra-Negra JM, Lobbezoo F, Martins CC, Stellini E, Manfredini D. Prevalence of sleep bruxism and awake bruxism in different chronotype profiles: Hypothesis of an association. Med Hypothesis 2017;101:55-8.  Back to cited text no. 3
Ramdhini DM, Budiardjo SB, Suharsini M. Relationship between stress and bruxism in children aged 9 – 11 years. J Int Dent Med Res 2018;11:997-1001.  Back to cited text no. 4
Aronson D. Cortisol – Its role in stress, inflammation and indications for diet therapy. Todays Diet 2009;11:38-43.  Back to cited text no. 5
Sidhu S, Marwah G, Prabhjot. Prevalence of overweight and obesity among the affluent adolescent school children of Amritsar, Punjab. Coll Antropol 2005;29:53-5.  Back to cited text no. 6
Gomes MC, Neves ÉT, Perazzo MF, Souza EGC, Serra-Negra JM, Paiva SM, et al. Evaluation of the association of bruxism, psychosocial and sociodemographic factors in preschoolers. Braz Oral Res 2018;32:1-9.  Back to cited text no. 7
Quashie-Williams R, Dacosta OO, Isiekwe MC. The prevalence of oral habits among 4 to 15 year old school children in Lagos Niger. J Health Biomed Sci 2007;6:78-82.  Back to cited text no. 8
Bhavya DP, Shyagali TR. Prevalence of Oral Habits in 11–13 year-old School Children in Gulbarga city, India. Virtual J Ortho 2009;8:1-4.  Back to cited text no. 9
Verma L, Gupta J, Passi S. Assessment of the prevalence of oral habits in 3-6 year old school going children in Chandigarh area. Dent J Adv Stud 2016;4:117-21.  Back to cited text no. 10
Mayorquim MV, Zotarelli Filho IJ, Berlanga De Araujo TS, Scriboni AB, Tempest LM, Rudnik Gomes MA. Pediatric bruxism: From etiology to treatment. A review. Acta Sci Dent Sci 2018;2:17-20.  Back to cited text no. 11
Osika W, Friberg P, Wahrborg P. A new short self-rating questionnaire to assess stress in children. Int J Behav Med 2007;14:108-17.  Back to cited text no. 12
Ahlberg K, Jahkola A, Savolainen A, Könönen M, Partinen M, Hublin C, et al. Associations of reported bruxism with insomnia and insufficient sleep symptoms among media personnel with or without irregular shift work. Head Face Med 2008;4:4.  Back to cited text no. 13
Drumond CL, Souza DS, Serra-Negra JM, Marques LS, Ramos-Jorge ML, Ramos-Jorge J. Respiratory disorders and the prevalence of sleep bruxism among schoolchildren aged 8 to 11 years. Sleep Breath 2017;21:203-8.  Back to cited text no. 14
Dickstein S. The family couch: Considerations for infant/early childhood mental health. Child Adolesc Psychiatr Clin N Am 2015;24:487-500.  Back to cited text no. 15
Leme M, Barbosa T, Castelo P, Gavião MB. Associations between psychological factors and the presence of deleterious oral habits in children and adolescents. J Clin Pediatr Dent 2014;38:313-7.  Back to cited text no. 16
Morley DS. Psychophysiological reactivity to stress in nail biters. Int J Neurosci 2000;103:139-54.  Back to cited text no. 17
Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep bruxism in the general population. Chest 2001;119:53-61.  Back to cited text no. 18


  [Table 1], [Table 2], [Table 3], [Table 4]


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