© 2022 BSPD, IAPD and John Wiley & Sons Ltd.Objective: To evaluate the trabecular bone density in the mandible of paediatric patients diagnosed with sleep bruxism (SB) using the fractal analysis method on panoramic radiographs. Methods: A total of 37 patients whose anamnesis and clinical signs were compatible with SB were diagnosed with SB using BiteStrip®. Three areas were identified on the panoramic radiographs of the patients: the geometric center of the condyle, the angulus region under the mandibular canal, and the distal region of the mental foramen. Regions of interest (ROIs) of 60 × 60 pixels were selected in these three locations, and fractal dimensions (FDs) were calculated. Results were compared with the control group. Results: There was no statistically significant difference between the right and left FD values, and male and female FD values in all regions and both groups (p >.05). In the angulus (p =.03) and condyle (p =.03) regions, the SB group had a significantly higher FD value than the control group. There was no statistically significant difference between the SB and control groups in the corpus region (p =.98). A moderate negative correlation arose between age and condyle FD values among controls (r = −0.38, p =.02). Conclusion: Fractal dimension values evaluating trabeculation of the mandibular bone are affected by SB in the angulus and condyle regions.