Certain questions posed to the parents and even to the teachers can define the anxiety status of the children49 not better than the children��s own opinion of their anxious state. The CPRS have been shown to measure anxiety as defined by the DSM IV.50 Indeed, the CPRS has been used as a gold standard when comparing other scales to measure anxiety in children51 and has been used before to evaluate anxiety-associated to bruxism in children.45 Other instruments, such as questionnaires for parents including the Child Stress Scale and scales assessing neuroticism and responsibility from the pre-validated Big Five Questionnaire for Children, have been used to evaluate the emotional state of the bruxing child.52 Unfortunately, the results of these instruments only can be interpreted by psychologists.

The rigid occlusal splint is a common treatment for bruxism in adults; it is economical, light and easy to use, among other characteristics. This treatment aims to reduce the parafunctional activity of the muscles, inducing their relaxation, and to raise the vertical occlusal dimension, reduce the pressure over the TMJ, protect the teeth from attrition and wear, allow the centric position of the condyle, give diagnostic information and cause a placebo effect.44,53,54 However, it is difficult to compare the present findings to reports in the literature because there is not enough scientific evidence to support or refute the use of rigid hard plates during the primary dentition stage. Only one previous study evaluated the use of the rigid occlusal plate in bruxist children with complete temporal dentition.

44 However, that investigation did not standardize the selection criteria of the patients, and the children only used the occlusal splint for a two-month period time, which is not enough to change the muscular reflex. It is necessary to use and follow any oral device affecting the muscle��s reflexes for at least two years;55 the muscular reflexes altered during bruxism do not change permanently before that time. If those reflexes continue to be present, then other signs and symptoms of TMD could not be avoided, as every single part of the craniofacial complex belongs to a system in which any alteration in any structure could affect the others. Additionally, the previously mentioned study44 did not present tables or graphics to adequately compare their results to ours or to follow their methodology.

The number of subjects in each group considered in this investigation was not enough to establish comparisons regarding sex. Other studies56�C58 have presented homogeneous gender distributions in the study groups so that this variable was controlled for when tooth wear was studied, and no differences were reported between the males and females. When early treatment Dacomitinib of any kind of habit is established, it is vital to have the collaboration of both the patients and their parents.