can exacerbate an existing
airway issue of a patient
with recognized airway
dysfunction. Of the 14 pa-
tients evaluated wearing
single arch occlusal guards
for protecting against tooth
wear, 6 had significant
increases in AHI by either
going from below diagnos-
tic AHI of 5\hr. to diagnostic
level above 5\hr. (causing
OSA) or worsening existing
OSA. In all 6 cases, the pa-
tient demonstrated airway
related bruxism as indicated
by temporal association be-
tween an airway event and
subsequent parafunctional
EMG event, clench or grind.
The definition of temporal
association is any parafunc-
tional EMG burst, clench or
grind which occurs during
the second half of an airway
event to 5 seconds past the
airway resolution.
One of the popular explana-
tions as to the airway asso-
ciation is the parafunctional
EMG activity is an effort to
normalize the airway. Obvi-
ously the consequence on
tooth structure regardless
of cause is profound.
So, how is managing Over-
load Risk related to Dental
Sleep Medicine? There is
a very basic answer and
the answer is, “Why are we
performing a rehab in the
first place?” Although not
widely studied it would not
be surprising to learn a high
percentage of implants are
a result of unmanaged air-
way related parafunctional
bruxism. In these cases, if
we addressed the CAUSE of
tooth wear, mobility and
tooth loss as part of the
rehab, doesn’t it make sense
the rehab in these patients
stand a much better chance
of success?