7/9/13
Bruxism
Bruxism is one of the most common sleep disorders and occurs in most people at some time in their lives. It is characterized by the grinding of the teeth and is typically accompanied by the clenching of the jaw. In most people, bruxism is mild enough to not be a health problem. While bruxism may be a diurnal or nocturnal activity, it is bruxism during sleep that causes the majority of health issues.
Signs and Symptoms
Most are not aware of their bruxism, and only 5% go on to develop symptoms, such as jaw pain and headaches, which will require treatment. In many cases, a sleeping partner or parent will notice the bruxism before the person experiencing the problem becomes aware of it. Bruxism can result in abnormal wear patterns and fractures in the teeth. Over time, dental damage will usually occur. Bruxism is the leading cause of occlusal trauma and a significant cause of tooth loss and gum recession.
Patients may present with a variety of symptoms including the following: anxiety, stress, depression, earache, eating disorders, headache, insomnia, chewed tissue on the inside of their cheek, and sore or painful jaw.
Diagnoses
Bruxism can sometimes be difficult to diagnose by visual evidence alone, as it is not the only cause of tooth wear. Vigorous brushing, abrasive toothpaste and foods, and acidic soft drinks can also be contributing factors.
The most reliable way to diagnose bruxism is through EMG (electromyographic) measurements. These measurements pick up electrical signals from the chewing muscles. This is the method used in sleep labs. EMG units pick up signals from facial muscles through wires connecting the unit to electrodes that are adhesively attached to the user's faces.
Treatment
There is no single accepted cure for bruxism. Bruxism may be reduced or eliminated when the associated factors, such as sleep disorders, are treated successfully. Other options include mouthguards and splints, nociceptive trigeminal inhibitors, biofeedback, botox, and dietary supplements.
Sleep Apnea and Bruxism
It was found that obstructive sleep apnea (OSA) was the highest risk factor for teeth grinding during sleep. One report evaluated the effect of continuous positive airway pressure (CPAP) on sleep bruxism in a patient with both severe OSA and bruxism. Two polysomnographic (PSG) recordings were carried out. The first showed 67 events of sounded tooth grinding, most of them appearing as an arousal response at the end of apnea/hypopnea events in both the supine and lateral postures. During the CPAP titration night, most breathing abnormalities were eliminated and a complete eradication of teeth grinding events was observed. The results of this study suggest that when sleep bruxism is related to apnea/hypopnea events, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep.
Signs and Symptoms
Most are not aware of their bruxism, and only 5% go on to develop symptoms, such as jaw pain and headaches, which will require treatment. In many cases, a sleeping partner or parent will notice the bruxism before the person experiencing the problem becomes aware of it. Bruxism can result in abnormal wear patterns and fractures in the teeth. Over time, dental damage will usually occur. Bruxism is the leading cause of occlusal trauma and a significant cause of tooth loss and gum recession.
Patients may present with a variety of symptoms including the following: anxiety, stress, depression, earache, eating disorders, headache, insomnia, chewed tissue on the inside of their cheek, and sore or painful jaw.
Diagnoses
Bruxism can sometimes be difficult to diagnose by visual evidence alone, as it is not the only cause of tooth wear. Vigorous brushing, abrasive toothpaste and foods, and acidic soft drinks can also be contributing factors.
The most reliable way to diagnose bruxism is through EMG (electromyographic) measurements. These measurements pick up electrical signals from the chewing muscles. This is the method used in sleep labs. EMG units pick up signals from facial muscles through wires connecting the unit to electrodes that are adhesively attached to the user's faces.
Treatment
There is no single accepted cure for bruxism. Bruxism may be reduced or eliminated when the associated factors, such as sleep disorders, are treated successfully. Other options include mouthguards and splints, nociceptive trigeminal inhibitors, biofeedback, botox, and dietary supplements.
Sleep Apnea and Bruxism
It was found that obstructive sleep apnea (OSA) was the highest risk factor for teeth grinding during sleep. One report evaluated the effect of continuous positive airway pressure (CPAP) on sleep bruxism in a patient with both severe OSA and bruxism. Two polysomnographic (PSG) recordings were carried out. The first showed 67 events of sounded tooth grinding, most of them appearing as an arousal response at the end of apnea/hypopnea events in both the supine and lateral postures. During the CPAP titration night, most breathing abnormalities were eliminated and a complete eradication of teeth grinding events was observed. The results of this study suggest that when sleep bruxism is related to apnea/hypopnea events, the successful treatment of these breathing abnormalities may eliminate bruxism during sleep.
6/27/13
Bruxism - Fast Facts
- Bruxism (grinding of the teeth) is common in young children, but generally goes away by age 9.
- Increased stress, anger, frustration, and anxiety can lead to increased teeth grinding.
- The condition is common with adults in their 40s. It tends to decrease with older age.
- Avoid chewing gum as it allows the muscles to get used to clenching and makes you more likely to grind your teeth.
- According to the American Dental Association, 30-40 million Americans grind their teeth while sleeping.
6/24/13
Indications for Tonsillectomy
These indications for adenotonsillectomy should only be used as a guideline. Please consult your medical doctor for further information.
- Patients with 3 or more infections of tonsils and/or adenoids per year
- Hypertrophy (enlargement) causing dental malocclusion or adversely affecting orofacial growth.
- Hypertrophy causing upper airway obstruction (sleep apnea), severe dysphagia (trouble swallowing), sleep disorders, or cardiopulmonary complications.
- Peritonsillar abscess unresponsive to medical management and drainage
- Persistent foul taste or breath due to chronic tonsillitis
- Chronic or recurrent tonsillitis associated with the streptococcal carrier state
- Unilateral tonsil hypertrophy presumed euplastic
- Recurrent acute otitis media or chronic serous otitis media
6/12/13
More Information on Obstructive Sleep Apnea (OSA)
Diagnosis Guidelines:
Adult
Obstructive sleep apnea (OSA) is very common and typically increases with age. However, children are not immune. They too can suffer from sleep apnea.
Children
- Apnea Hypopnea Index (AHI):
- 0-4 Normal
- 5-14 Mild Apnea
- 15-29 Moderate Apnea
- >30 Severe Apnea
Adult
- CPAP
- Pro: very effective; "gold standard"
- Con: low compliance, difficult to travel with, can cause tooth movement or orthognathic changes
- Surgery - Uvulopalatopharyngoplasty, etc.
- Pro: best for snoring and/or mild cases; once completed, no compliance issues
- Con: about 40% success rate, pain, possible complications, may need re-treatment
- Maxillomandibular Advancement
- Pro: very effective; once completed, no compliance issues
- Con: very invasive, difficult patient acceptance
- Oral Appliance
- Pro: effective for most mild, moderate, and CPAP intolerant apneas, high compliance
- Con: must have healthy mandibular teeth, minor jaw soreness and tooth movement possible
- Co-therapy - Use of CPAP and Oral appliance therapy simultaneously
- Pro: very effective
- Con: not acceptable for many patients
Obstructive sleep apnea (OSA) is very common and typically increases with age. However, children are not immune. They too can suffer from sleep apnea.
Children
- CPAP
- Pro: effective if tolerated
- Con: not often tolerated
- Tonsillectomy/Adenoidectomy
- Pro: often very effective
- Con: pain; not 100% effective
- Orthodontics
- Pro: can be effective in selected cases
- Con: none, when used when indicated
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