Ask a Therapist bite blocks bite tube hierarchy bite tube set bite tubes Down Syndrome jaw book jaw grading bite blocks jaw instability jaw stimulation jaw strength jaw weakness Sara Rosenfeld-Johnson teeth grinding temporomandibular joint TMJ TMJ stimulation

Ask a Therapist: Teeth Grinding

2 comments

Hi,

 

My 7 year old son with Down Syndrome used to grind his teeth and had grown out of it (we thought). He recently had surgery and the grinding has returned with ferocity. It’s only during the day and is worse than before. His teeth have been ground down to next to nothing. I’m at a loss as to what to do and try, but I would really like to nip this in the bud before his permanent teeth come in – he as 2 bottom ones so far.

 

Do you have any suggestions of strategies I could try?

Hi,

It is not uncommon for children with jaw weakness or jaw instability to teeth grind, stop and then renew the habit when they are under stress.  Surgery can certainly be considered a stressful situation.  As I had mentioned above and reiterate in my book, Assessment and Treatment of the Jaw: Sensory, Feeding and Speech, the TMJ (temporomandibular joint) is the site of organization within the human body.  What your son is telling you, without using the words, is that he wants stimulation in that joint to calm himself down (to satisfy a need).  Once teeth grinding begins and the dentition becomes uneven the habit may continue after the stress has left.  The grinding continues to even out the biting surface of the teeth for chewing or may continue just because the child learns the grinding "feels good."  In either case, we know the grinding is detrimental to your son's teeth and we need to find a way to help him to stop doing it.

tmj
 

You asked for specific suggestions and here is what I would like you to do.  Since your son has the diagnosis of Down syndrome it is likely that he also has jaw weakness.  The activities taught in the book Assessment and Treatment of the Jaw: Sensory, Feeding and Speech are used as an alternative to the teeth grinding while addressing the root cause.  The activities will improve jaw symmetry, stability and grading.  Each of these jaw goals will also improve his feeding skills and his speech clarity.  If possible I would ask you to find a Speech-Language Pathologist in your area who has been trained in the TalkTools approach to muscle-based feeding and speech deficits.  She or he would be able to direct you through the two primary activities: "Jaw Grading Bite Blocks" and the "Bite Tube Hierarchy."  Used together these should reduce and hopefully eliminate the teeth grinding.  Additional activities in the book include: teaching him to chew gum without swallowing the gum, chewing on his back molars and a variety of other activities to address the identified jaw muscle needs.  

As in all cases it is best to read the entire book first to identify your son's specific needs and then to choose the activities that he enjoys.  An ideal time to practice each activity would be when he is teeth grinding.  In this way you will give him an alternative that will help him while acknowledging the fact that he needs stimulation to the TMJ. 

I hope this helps.

Sara Rosenfeld-Johnson, MS, CCC-SLP

2 comments

  • Shereen

    Hi Moriah. Just saw your comment about the difficulty your son faces in accepting the tool. Have you tried dipping the tool into a liquid/food item he likes? Acceptance is always needed before we can start working on the motor skills. So if he is sensitive or resistant to the chewy tube, my suggestion is to first use it like a spoon when he eats his favourite food items (semi solid/purees) so that he accepts the tool. Once he starts accepting it more, you can dip it in other purees and slowly work your way to back of the molars. As he accepts it there, you can try and press down on his molars 2-3 times before taking it out. Gradually as the acceptance becomes more, you can start working on the motor skills.
    Hope this helps!

  • Moriah

    Hi Sara,

    I wrote you this question last month about my 7-year old with Downs. I have since gotten your book from the library and gotten one of the ARK grabbers. There are no therapists in my are who have been trained in your method, so I am doing my best on my own. What do you suggest for a child who is very resistant to having the tool put into his mouth? I believe his problem is symmetrical jaw weakness – he doesn’t seem to have any instability and eats very well without gagging or sensory issues due to different textures. However, I’m unsure if he eats on his back molars and I can’t get him to accept the Grabber to even begin this process of strengthening his jaw. Any suggestions?

    Thanks again for your help.
    - Moriah Davis

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