Considering Parafunctional EMG Activity, Bruxism and Airway
In May of 2017 I was asked to author an article by Dental Sleep Solution in on managing the airway while considering parafunctional EMG activity. In subsequent conversations with dentists snoring and body position were brought to the forefront in managing these cases. The key in our view is how easily can this data be captured and distinguishing between the dental and medical components in managing these patients. I also heard from several prosthodontists asking about how airway related parafunction can create unanticipated headwinds in implant cases. Because of this article as it relates to sleep apnea and implant overloading, I was invited by Glidewell Dental Laboratory to be a panelist in their upcoming Webinar scheduled on August 8th on Dental Sleep Medicine including measuring for bruxism hosted by Dr. Suzanne Haley. CLICK HERE TO REGISTER
Triaging the Bruxism Triad: Advancements in Dental Sleep Medicine
By Jeff Wyscarver, RPSGT.
Tooth wear causes are numerous requiring more information than just its presence to manage. Significant progress is being made treating patients with the signs and symptoms associated with bruxism. Most notably, the Bruxism Triad originally described by Jeff Rouse, DDS talks about airway dysfunction along with other types of EEG arousals triggering a cascade of events including parafunctional EMG activity and bruxism.
Historically speaking, managing any type of sleep issue is difficult because we find ourselves asking patients about behavior that occurs while asleep. For example, how many times have you heard a patient say, “I DO NOT grind my teeth” yet the patient has 8 teeth with exposed dentin. Triaging the triggers causing tooth wear is the challenge when managing the Bruxism Triad. In many cases, managing the bruxism\tooth wear can be surprisingly simple when the triggers are identified.
For example, if a subtle airway issue is triggering bruxism, something as simple as changing the sleep position can dramatically reduce parafunction, as seen in the diagram below. This example demonstrates the alleviation of oxygen desaturations, snoring and parafunctional activity while sleeping on their side.
In some cases the patient is suffering from Obstructive Sleep Apnea, (OSA). OSA should be managed by a physician. Yet in other patients, subtle respiratory abnormalities can trigger Bruxism as seen below which is an example of Respiratory Effort Related Arousals. (RERA).
There is a relationship between parafunctional activity\bruxism and airway function. Based on the image below it would be difficult to help this patient with severe tooth wear without addressing the underlying airway issue.
Airway issues such as Upper Airway Resistance Syndrome, (UARS) and Respiratory Effort Related Arousals, (RERA) are primary triggers of bruxism leading to tooth wear. Knowing the triggers improves the clinical outcome and precisely directs the treatment most likely to succeed. The key component for treatment success is identifying those triggers and managing them from the dental chair when appropriate, and bringing in your medical team when indicated.
The primary objective of this article is to imbue on the reader the confidence these issues can be effectively managed with an efficient diagnostic protocol and effective training. Bruxism and Parafunction are NOT hopeless and when properly managed can lead to improved care of your patients and a sense of satisfaction you are contributing their overall health and wellbeing.