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The Incidence of Bruxism in Individuals with Down Syndrome and its Correlating Factors

This is a voluntary, confidential survey used solely for the purpose of research. The focus of this study is to determine the effect of specific variables on the prevalence of bruxism in individuals with Down Syndrome (DS). Bruxism is defined as involuntary grinding of the teeth; excessive teeth grinding or jaw clenching.

Please answer the following questionnaire for your family member with Down syndrome.

Age

Gender

Male Female

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Ethnicity

Hispanic or Latino

Not Hispanic or Latino

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Race

Asian

America Indian or Alaska Native

Hispanic or Latino

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

Prefer not to answer

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How would you classify your family member's degree of intellectual disability?

Mild to Moderate Intellectual Disability (able to take care of themselves, travel to familiar places, learn basic skills related to safety and health)

Severe Intellectual Disability (understands speech but has limited communication skills otherwise, needs to live in a supervised setting)

Profound Intellectual Disability (cannot live independently, very limited ability to communicate and also may have physical limitations)

Prefer not to answer

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Is your family member with DS missing any of his/her teeth

Yes

Unsure

Does your family member with DS clench his/her teeth?

Yes

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Does the clenching occur more frequently:

at night

during the day

both

other

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Describe what other time of day he/she clenches his/her teeth.

At what age did you first notice clenching?

Does your family member with DS grind his/her teeth?

Yes

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Does the grinding occur more frequently:

at night

during the day

both

other

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Describe what other time of day he/she grind his/her teeth.

At what age did you first notice grinding?

Are there any factors that increase the incidence of clenching and/or grinding? Please select all that apply.

Stress

Anger

Concentration

Physical activities (sports, working out, etc)

Technology usage (TV, video games, etc)

Reading

Social involvement

Other

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Please specify what other factors increase clenching and/or grinding.

Are there any factors that decrease the incidence of clenching and/or grinding? Please select all that apply.

Stress

Anger

Concentration

Physical activities (sports, working out, etc)

Technology usage (TV, video games, etc)

Reading

Social involvement

Other

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Please specify what other factors decrease clenching and/or grinding.

Does your child with DS have any other physical, intellectual or mental health conditions? If yes, please list.

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Is your family member with DS taking any prescription or over the counter medications? If yes, please list:

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Has your family member with DS been diagnosed with sleep apnea?

Yes

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Does your family member use a CPAP or other device for sleep apnea?

Yes

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Would you like to receive the aggregate data of this survey?

Yes

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Please provide an email address so we can send you aggregate data.

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.