Bruxism and the Airway – PDP149

Occlusal appliances are commonly prescribed for the management of Bruxism - but they might be doing more harm than good if you have not screened for an airway issue. Dr. Aditi Desai discussed the link between airway and bruxism- could an airway problem cause bruxism? Why is it advised NOT to have a standard occlusal appliance if there is an airway issue? Did you know there are three levels of diagnosis for Sleep Bruxism? The 'Possible' Bruxist, the 'Probable' Bruxist and the 'Definite' Bruxist - in this episode Dr. Aditi Desai who also featured in PDP 139 on sleep disordered breathing and sleep apnea, will explain this and when it may be relevant to sleep apnoea. https://youtu.be/DozqYGEPNxY Watch PDP149 on Youtube The Protrusive Dental Pearl: Parafunctional Screening Sheet - A simple PDF that you can look for in terms of your extra-oral examination, intra-oral examination and the history - to give a clue that a patient might be a bruxist in just 2 minutes - download below: Parafunctional-ScreenDownload Download and Sign in to the Protrusive App on iOS and Android and head over to the freemium version of this episode and on The Protrusive Vault for those Protrusive Premium members (where you can get full CE or CPD Certificate by answering a few questions) Need to Read it? Check out the Full Episode Transcript below! Highlights of this episode 5:21 The Protrusive Dental Pearl6:28 Dr. Aditi Desai’s Introduction9:17 Airway in Dentistry12:49 Lack of studies with regards to diagnosing sleep bruxism16:32 Signs to look for to a possible bruxist and how to communicate with them27:01 Nomenclature of sleep bruxism30:51 Learning points to assess airway35:43 Cases that caused the patient to become apnoeic Get in touch for different Board of Sleep Medicine: UK: British Academy of Dental Sleep Medicine (BADSM)USA: American Academy of Dental Sleep Medicine (AADSM)Australia: Australian Academy of Dental Sleep Medicine If you enjoyed this episode, you may also like Airway – Dentistry’s Elephant in the Room with Prof Ama Johal Click below for full episode transcript: Jaz's Introduction: Bruxism is a really funny thing because it's like really underdiagnosed by dentists, but also at the same time, very over diagnosed. Now, let me explain what I mean by that. Jaz's Introduction: It's underdiagnosed because every time I see a patient, right, and I say to them, 'Hey, did you know that you've got the signs of teeth grinding and clenching? Look at this wear, look at this crack or whatever.' And they all turn around and say to me, 'wow, no dentist has ever told me that before.' So in that regard, we can argue that bruxism is underdiagnosed because dentists are often sharing cases online and suggesting that the etiology of the wear that we see was bruxism. Whereas when I look at it, I see erosion and I see a restricted envelope or an envelope of function issue and perhaps there's a little bit of bruxism, but I don't think that's the primary reason of the failure. Or even sometimes people say that, 'oh, this patient keeps chipping away their class four composite or this crown has broken. I think the patients are bruxist, but really the crown fracture because the patients are bruxist or perhaps there wasn't enough occlusal reduction, right? So it's both underdiagnosed as also overdiagnosed, and it's an area that I love to read about. So I am a bruxist. Okay, confirmed bruxist. And there's three levels of diagnoses you can make in bruxism, and we cover that in this episode today called Bruxism and the Airway were Dr. Aditi Desai. She also featured, if you remember, on PDP139 on Sleep Disordered Breathing and Sleep Apnea and that kind of stuff. So talking about that, it's relevance to bruxism and for you, welcome. I just want to share with you my story and how I got into splints and TMD. It was through bruxism, like I am a massive bruxist and I rely very heavily on my occlusal appliance. Now get this, my occlusal appliance doesn't stop my bruxism. I still brux. How do I know that? Because I color in my occlusal appliance with a black Sharpie marker time to time again, and the next morning I've got a pattern on it, and not only me, but hundreds of patients. Every time I give a patient an appliance, they'll always be a mark on it. And I'm going to show you some photos. If you're watching right now, I'll show some photos on the screen of all the different types of marks that you see. So does that mean every single patient has been a bruxist? Now it's all about definitions again, because if you go by the definition that bruxism is any sort of movement of the jaw, any oro-motor movement, for example, if I just wiggle my jaw side to side without my teeth touching, that's technically bruxism. Did you know that? Whereas other people claim that bruxism is when you have to have a series of physiological events, your heart rate has to elevate, you have to be in a certain stage of sleep, and then teeth come together and you grind left and right. And so that is a type of bruxism. And so my favorite way to classify bruxism is normal bruxist and patho bruxist. So one thing I'm going to do is I'm going to put in the show notes. So protrusive.co.ukshownotes for this episode /149. I'm going to put this paper by G Levine, okay, Levine is fantastic and all the literature he posts about bruxism, and I've learned a lot from G Levine's literature and his studies. So his suggestion of a classification and let's classify patients as either Norma Bruxist or Patho Bruxist. So what that means is that most of us, all of us, do something called 'rhythmic masticatory muscle activity' at nighttime, meaning every night we do a little bit of bruxism, right? A jaw wiggle side side. Sometimes a teeth are touching, sometimes they're not, and that's completely okay. The difference between a Norma Bruxist and a Patho Bruxist, It's a Patho Bruxist will be doing it at much higher forces, much more muscle recruitment, and they are the ones that are more destructive. So we'll be talking more about that with Aditi on the show. The theme of this episode is very much bruxism and the airway. So could the airway be the cause of your patient's bruxism and why perhaps a bruxist is not best managed with any older occlusal appliance if they have an airway issue. So we'll talk about screening the airway before you give an occlusal appliance. Now, if you're looking for restorative management of bruxist and how to make your dentistry survive in these hostile environments, then this episode doesn't really cover that. For that, I'd love to welcome you to OBAB, Occlusion Basics and Beyond. We cover this theme. We show you how we did some full mouth rehabs on some bruxist, but as you know, it's called Occlusion Basics and Beyond. 80% of this course is very much the basics of occlusion, and it's to make you no longer confused about this big grand topic of occlusion. We break it down, we make it tangible. So if you're ready to learn occlusion online, head to occlusion.online, and then we talk about, yes, we talk about occlusal appliances, we talk about the restorative management of bruxist, how to identify that and how to build that into your restorations so that your restorations become unchippable. Hello Protruserati. I'm Jaz Gulati and welcome back to the Protrusive Dental Podcast. Slightly longish intro there, and if you're watching the video, I'm in a different place. Yet again, I'm in a funny phase of my life at the moment. If you are looking carefully, you can see on my hoodie over here, I've got milk, breast milk vomit on my hoodie, right? So this is the kind of stage I'm in. I'm the most commonly said phrase in my household right now is, 'Did he burp? Has he burped yet?' So, as you know, we welcome the baby boy recently. And yeah, things are a bit funny at the moment. I'm not in my usual home. I'm going between Redding and West London, and so things are a little bit crazy and you see the bags under my eyes. But hey ho, this is the beauty, the magic of parenting. But I will always make time for Protrusive Dental podcasts, don't you worry. And team Protrusive always hard at work to make content ready for you few week by week. Protrusive Dental PearlAnd of course, The Protrusive Dental Pearl. The Protrusive Dental Pearl is my Bruxism Screening Sheet, so this is a simple little PDF I made. It's actually for my splint course online delegates. I'm happy to share it with you, is that one of the things that you can look for in terms of your extra-oral examination and your intra oral examination and the history to give you a clue that this patient might be a bruxist as well as some communication strategies that we're going to discuss in the main episode today. The way you can download that, if you head to protrusive.app, make a free account, and then in the episode 149 freemium version, you'll see it's there in the pdf. If you're a Protrusive Premium member, it'll be there in the Protrusive Vault and in the premium version of the episode, we can get the full CE or CPD certificate by answering a few questions. So I'll remind you again at the end of the episode. So download the Protrusive Dental Pearl, which is my Bruxism Screening Sheet. I wrote it myself inspired by all the literature I read about bruxism and the diagnosis of bruxism. And I'll catch you in the outro. Let's join the main interview. Main Episode:Dr. Aditi Desai, welcome back to Protrusive Dental Podcast. Great to have you after that brilliant episode on Airway, everything Airway, and now a close cousin of Airway. It is Bruxism. So for those who haven't listened to that episode yet, and they must go back and listen to it, please, Dr. Desai, introduce yourself. What are you doing at the moment? What is your mission statement? And how did you fall into place with Airway? And then bruxism as well.