110 AUSTRALASIAN DENTIST LABS At least one in three1 Australian adults suffer frombruxism. Perthbased Oral Medicine Specialist, Dr Amanda Phoon Nguyen, shares a four-step guide to diagnosing and treating bruxism. 1. Rule out sleep apnoea Treating bruxism with splints if sleep apnoea is present can make the patient’s sleep apnoea worse. So dentists may need to make sure sleep apnoea is not present in the patient before proceeding with a splint treatment. Dr Phoon Nguyen recommends dentists consider following a simple sleep apnoea screening process: Medical history: Check for conditions that may be associated with sleep apnoea such as loud snoring, excessive daytime sleepiness, and obesity. Physical examination: Look for signs of narrow airways or other abnormalities that may contribute to sleep apnoea. Questionnaires: Consider using validated questionnaires to screen for sleep apnoea, such as the Berlin Questionnaire or the Epworth Sleepiness Scale. “If you suspect the patient may have sleep apnoea after the screening process, then I’d recommend suspending any splint treatments and referring them to an oral health or sleep specialist for further investigation,” says Dr Phoon Nguyen. 2. Assess bruxism severity Dentistsmayneed toconsider referring excessivebruxismcases toan oral health specialist. However, Dr Phoon Nguyen says determining the level of tooth damage or wear that suggests excessive bruxism is present can be problematic. “That’s the million dollar question,” she says. “Assessing tooth wear by age can be helpful. For example, heavy tooth wear in a 20 year old could indicate excessive bruxism. Or if you’ve been seeing the patient over time, assessing their oral photos can show if tooth wear has significantly increased.” There may also be lifestyle factors at play that can mimic bruxism, such as tooth wear caused by an overly acidic diet, digestive conditions like acid reflux, and recreational drug use. Dr Phoon Nguyen emphasises that patients who develop jaw pain or locking should be referred to a specialist for additional investigation. 3. Choose the right splint type Dr Phoon Nguyen points out that bruxism studies haven’t shown strong evidence for the effectiveness of one split type over the other. So splint treatment comes down to the individual dentist’s preferences and experience. How to diagnose and treat bruxism in four steps “But my personal advice is to use full coverage flat splints, and I usually suggest using hard splints. I have seen some studies that suggest a soft splint or a hard splint with a soft liner may actually increase muscle activity. So if you use a soft splint on a patient who’s a clencher, they may end up clenching or grinding more.” Unless mitigating circumstances are present, such as tooth sensitivity, an underlying condition or the patient simply can’t tolerate a hard splint, Dr Phoon Nguyen recommends choosing a more durable nylon material over traditional acrylic. “The nylons we have these days are a lot harder and tend to break a lot less than the acrylic splints,” she says. “But if you’re using a hard nylon splint, the accuracy of the fit is critical. If the splint fits poorly and there’s a chance that it will dislodge during the night, that’s not a safe splint. The patient shouldn’t be able to remove it easily with their tongue.” 4. Ensure a precise splint fit Dr Phoon Nguyen favours intraoral scanning over impressions for superior accuracy, and says dentists must work closely with their dental lab to get the best results. “It is vital to get good scans and take a bite registration. Taking photographs is also helpful as an additional reference,” she explains. “You need to gather as much information as you can, because sometimes the lab will come back to you and say the scan looks really off. “In that case, we can look at the bite registration and look at the photographs and determine whether the patient may have been biting differently during the scan, or if the scan is actually showing the patient’s bite accurately.” u Avant Dental’s expert technicians can help you treat bruxism with highquality splints. Call 1800 287 336 or visit www.avantdental.com.au References 1 https://pubmed.ncbi.nlm.nih.gov/23630682/ Dr Amanda Phoon Nguyen
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