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Dental Grinding and Sliming

I am presently working with an 18-year-old boy who has CdLS. His mother has told me that he has not cut his 12-year molars yet. Recently he has been grinding his teeth frequently and "sliming." By "sliming" I mean this that he puts a finger into his mouth until he gets enough saliva to spread all around his face. He does this when he seems calm and happy and never when he is unhappy or agitated. The grinding of the teeth happens at different times throughout the day. What would prompt my student to grind his teeth and "slime?" The sliming occurs out in public as well as in school. I feel sorry for my student as it is difficult for him to make friends as it is. Could you please let me know what your thoughts are regarding the grinding and the "sliming" and what I can try to do about the two problems?

The behavioral aberrations that you have described are common within CdLS. The grinding, or bruxism, that you have noticed is quite common. Many children who have no medical abnormalities grind their teeth at various stages in their growth and development. At three years of age, when the second baby molars are coming in, and at age six years, grinding returns as the first permanent molars start to erupt. It is considered as part of the eruptive process. Sometimes we see this with the eruption of the second permanent molars at age twelve, but not as often. Children with neurological problems have a high tendency to grind and will do it at any time, day or night. It sounds like your student falls within the norm for his medical issues. The grinding problem can be addressed by his dentist. An appliance, or retainer, can be fabricated to help prevent damage to the teeth and the temporomandibular joint, the location of the hinges of the jaw. Sometimes the wearing of the appliance takes away the "fun" of grinding and the child stops the habit. The only problem is that the child might not cooperate enough to wear the appliance. A consultation with the child's dentist will help determine what can be done.

It is common for children with CdLS to have a delay in the eruption of their permanent dentition. Being eighteen, and getting the 12 year molars, is the norm for CdLS. Late loss of baby teeth and late eruption of permanent teeth is what we have observed.

The "sliming" activity is difficult to explain. Certainly there can be an increase in salivary flow when one is "teething" but not typically to the extent that one would "pull" it out of one's mouth and rub it all over one's face. This activity being performed at a time when he is happy and calm would indicate that it is not a reaction to discomfort or a difficulty in swallowing or handling oral secretions. I believe this is a form of a habit that he has discovered and somehow enjoys. I am very sorry that I do not have any suggestions that might help with this problem.  Behavioral modification in which "good" behavior is rewarded may be helpful.

RM/TK 7-13-10



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