The prevalence of bruxism and oral parafunction activities among Israeli juveniles with autism spectrum disorder: A preliminary study during the COVID-19 pandemic

Figures & data

Table 1. Severity levels for autism spectrum disorder * [1].

Severity level	Social communication	Restricted, repetitive behaviors
Level 3- “Requiring very substantial support”	Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others	Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Level 2- “Requiring substantial support”	Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or abnormal responses to social overtures from others.	Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/or difficulty changing focus or action.
Level 1 “Requiring support”	Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions.	Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

*Adopted from DSM-5 [1].

Table 2. Participants according to age group.

Group	n	Age Range (years)	Mean (±SD)	Median	M/F
Younger	86	12–6	9.28 (1.58)	9	1/4.73
Older	79	21–13	16.1 (2.43)	16	1/3.16
Total	165	21–6	12.55 (4)	12	1/3.85

SD, standard deviation; M/F, male/female.

Table 3. Medication consumption according to age group.

Group	n	No Medication	Medication Associated with Bruxism	Other Medication	Medical Cannabis*
Younger	86	37 (43%)	40(46.5%)	9(10.5%)	10(2)
Older	79	30 (38%)	43(54.4%)	6(7.6%)	15(1)
Total	165	68(41.2%)	83(50.3%)	14(8.5%)	25(3)

Younger, 6–12 years; Older, 13–21 years *Cannabis with other medication (cannabis as sole treatment)

Table 4. Prevalence of sleep and awake bruxism.

Group	n	SB	Unknown SB	AB	Unknown AB	AB & SB
Younger	86	23(26.7%)	9(10.5%)	19(22%)	8(9.3%)	13(15.1%)
Older	79	4(5%)	21(26.6%)	14(17.7%)	10(12.6%)	3(3.8%)
Total	165	27(16.3%)	30(18.2%)	33(20%)	1810.9%)	16(9.7%)

SB, sleep bruxism; AB, awake bruxism; Younger, 6–12 years; Older, 13–21 years.

Table 5. Prevalence of oral habits according to age group.

Group	n	No Oral Habits	At Least One Oral Habit	More Than One Oral habit
Younger	86	48(55.8%)	38(44.2%)	17(19.8%)
Older	79	46(58.2%)	33(41.8%)	14(17.7%)
Total	165	94(57%)	71(43%)	31(18.8%)

Younger, 6–12 years; Older, 13–21 years. The oral habits are listed in the Methods section.

Only habits that were performed often or daily were taken as being positive.

Table 6. Prevalence of the various oral habits (n = 165).

Oral Habit	Never	Occasional	Often	Daily
Chewing gum	120(72.7%)	38 (23%)	5 (3%)	2 (1.2%)
Nail biting	118(71.5%)	18(10.9%)	13(7.9%)	16(9.7%)
Object biting	97(58.8%)	32(19.4%)	16(9.7%)	20(12.1%)
Cheek/lip biting	141(85.5%)	20(12.1%)	3(1.8%)	1(0.6%)
Food pouching	137(83%)	16(9.7%)	6(3.6%)	6(3.6%)
Thumb sucking	150(90.1%)	7(4.2%)	1(0.6%)	7(4.2%)
Pica	124(75.1%)	28(17%)	10(6%)	3(1.8%)

Table 7. Symptoms related to TMD* according to age group.

Group	Pain in the facial Area	Difficulties in Mouth Opening	Difficulties in Chewing	Reported Jaw Noises
Younger	6(7%)	9(10.6%)	8(9.4%)	11(12.8%)
Older	5(6.3%)	12(15.2%)	11(13.9%)	5(6.3%)
Total	11(6.7%)	21(12.7%)	19(11.5%)	16(9.7%)

*TMD, temporomandibular disorder; Younger, 6–12 years; Older, 13–21 years.

Table 8. Parent/Caregivers reported influence of COVID-19 on the study subjects.

	Extent of Influence	Younger Group (n = 86)	Older Group (n = 79)	Total (n = 165)
Anxiety level	None	30	30	60(34.6%)
	Mild	18	27	45(27.3%)
	Moderate	21	10	31(18.8%)
	Strong	17	12	29(17.6%)
Obsessive behavior	None	32	32	64(38.8%)
	Mild	23	22	45(27.3%)
	Moderate	11	12	23(13.9%)
	Strong	20	13	33(20%)
General behavior	None	18	16	34(20.6%)
	Mild	20	21	41(24.8%)
	Moderate	21	23	44(25.6%)
	Strong/very strong	27	19	46(27.9%)

Younger, 6–12 years; Older, 13–21 years.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013. 74–88.

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Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.