Dental Sleep Medicine Insider May 2017 | Page 27

JEFF WYSCARVER TRIAGING THE Tooth wear causes are numer- ous requiring more informa- tion than just its presence to manage. Significant prog- ress is being made treating patients with the signs and symptoms associated with bruxism. Most notably, the Bruxism Triad originally de- scribed by Jeff Rouse, DDS talks about airway dysfunc- tion along with other types of EEG arousals triggering a cascade of events including parafunctional EMG activity and bruxism. Historically speaking, manag- ing any type of sleep issue is difficult because we find our- selves 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, manag- ing the bruxism\tooth wear can be surprisingly simple when the triggers are identi- fied. For example, if a subtle air- way issue is triggering brux- ism, 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, snor- ing and parafunctional activi- ty while sleeping on their side.