Tooth Wear and Bruxism Triad Flashcards
What is tribology and what are three sources in sleep bruxism?
Study of interacting surfaces in motion and associated issues of lubrication, friction, and wear
- Reduced lubrication (saliva lower at night)
- Erosive friction (tooth on tooth contact)
- Contact time (clenching and at swallowing)
What are the three categories of respiratory disturbances during sleep?
- Snoring
- Upper airway resistance syndrome (UARS)
- Sleep apnea-hypopnea syndrome
What are the STOP BANG items?
What’s the score breakdown?
Ask patient:
Snoring
Tired often?
Observed apnea?
Pressure (high blood pressure)
Objective findings:
BMI (35 kg/m2)
Age (50 years)
Neck circumference (40 cm)
Gender
2 or less is low, 3-4 moderate, and 5+ is high risk for moderate or severe OSA.
A sleep burner has how many episodes of bruxing per hour, bruxing bursts/hour, and how many episodes must make noise?
- 4+ bruxing episodes/hour
- 25+ Bruxing bursts/hour
- 1 episode must make noise
Apnea is the repeated absence of ___ with cessation of breathing for ___ seconds and oxygen desaturation exceeding __%.
Upper airway resistance syndrome is an increased inspiratory effort creating increased __ and narrowing of the ___ without oxygen desaturation below __%.
- Ventilation
- 10 seconds
- 4%
- Microarousals
- Pharynx
- 4%
What are the three components to the Bruxism Triad?
- Sleep bruxism
- Sleep disturbance
- Sleep-related GERD
The bruxism triad coupled with nocturnal ___ appreciably increase the risk of __ and __ toothwear.
- Hypo salivation/xerostomia
- Erosive
- Frictional
Niswonger stated how many mm is present for closest speaking space?
3
Turner/Missirlian Classification
Category 1?
Excessive wear with loss of VDO (with room to restore)
Turner/Missirlian Classification
Category 2?
Excessive wear without loss of OVD (with room to restore)
Turner/Missirlian Classification
Category 3?
Excessive wear without loss of OVD and without room to restore
Turner/Missirlian Classification Cat 2 patients seemingly have insufficient interocclusal restorative space. But why is this not the case?
Manipulation into CR reveals a significant anterior slide from CR to MI. Equilibration or restoration at CR should provide enough restorative room.
Turner/Missirlian Classification Cat 3 patients do not have sufficient restorative space. How can space be gained? (4)
- Orthodontics
- Restorative repositioning
- Surgical repositioning of segments
- Programmed VDO modification
Verrett’s 2001: Four types of tooth structure loss
- Attrition
- Abrasion
- Erosion
- Abfraction
Verrett’s 2001: What are the four patterns of mechanical wear?
- Anterior wear greater than posterior
- Anterior wear progressively greater than posterior
- Wear on facial surfaces of cuspids and premolars
- Variable location and distribution of wear
Verrett’s 2001: M1: Anterior wear greater than posterior - Etiology (3)
- Inadequate posterior wear
- Posterior occlusal prematurity
- Loss of posterior teeth (overuse of anteriors)
Verrett’s 2001: M2: Progressively greater wear on anteriors - Etiology (1)
Chronic bruxism
Verrett’s 2001: M3: Wear on facial surfaces of cuspids and premolars - Etiology?
Toothbrushing
Verrett’s 2001: M4: Wear in variable locations, primarily occlusal and incisal - Etiology?
Parafunctional habit
Verrett’s 2001: Chemical erosion - 3 types?
- Anterior surface loss greater than posterior surface loss
- Posterior surface loss greater than anterior
- Variable location and distribution of wear
Verrett’s 2001: Chem 1: Anterior tooth wear etiology
A. Lingual surface?
B. Facial surface?
A. Chronic regurgitation (vomit, GERD, alcoholism)
B. Fruit sucking
Verrett’s 2001: Chem 2: Posterior tooth surface loss
A. Occl surface of all posteriors
B. Occl surface of mand first molar
A. Fruit mulling
B. Soda swishing
Verrett’s 2001: Chem 3: Variable location and distribution of wear
A. Environmental
B. Medication, drugs (vitamin C, illicit drugs, saliva)
What’s estimated “normal” enamel wear for an adult?
If enamel thickness for an adult is 2 mm, how many years would it take to wear through to dentin?
20-40 microns/year
Therefore, if enamel thickness is 2 mm, it takes 66 years to wear through to dentin (age 72 for the permanent first molar that erupts at age 6)
How long are teeth actual in contact during mastication? In total during the entire day?
- 100 milliseconds
- 17.5 minutes of contact/day
In addition to the three Turner/Missirlian wear classifications, what is the fourth Wiens/Priebe occlusal wear classification?
What is the etiology?
- Excessive posterior wear with excessive OVD
5a. Iatrogenic dental treatment
5b. Result of malocclusion (VME, eruption of posterior teeth associated with chronic respiratory obstruction or apertognathia)
What are four ways to measure GERD? Which is the gold standard?
- Esophagram (pt swallows barium and fluoroscopy)
- Upper endoscopy (direct visualization)
- Esophageal manometry (small diameter tube to measure pressure during swallowing)
- Ambulatory 24-hour pH probe (gold standard) (tube for 24 hours to measure pH levels)
How many apnea events for OSA normal, mild, moderate, severe per the Apnea Hypopnea Index?
0 to 4: Normal
5 to 14: Mild
15 to 29 Moderate
30+ Severe
How does Epworth Sleepiness Scale work? What are the point breakouts?
Answer how likely to nod off to categories like: Sitting and reading, watching tv, sitting/inactive, as a passenger in a car, lying down to rest, sitting and talking with someone, sitting quietly after a meal, in a car while stopped.
0-7: Unlikely to be abnormally sleepy
8-9: Average daytime sleepiness
10-15: May. be excessively sleepy
16-24: Excessively sleepy and should consider medical attention
What Turner Category is your patient? How did you determine this?
What did Goldstein say in his Best Evidence Consensus Statement about Turner?
Turner Category 1.
Interocclusal distance from rest to closure was about 5 mm, closest speaking space about 3 mm. Both slightly larger than normal. You could argue that she doesn’t have excessive amount of wear yet, but given another decade or so without an occlusal device I believe she would continue to progress.
- Without knowing what OVD/RVD was before Bruxism, you can’t make a determination. Not evidence based.
1-2. Difference between awake and sleep bruxism?
- Sleep bruxism is secondary to what:
- Awake bruxism: Semi-voluntary. Associated with anxiety/stress. Common in 20% of adult population and 18% of children. More common in females.
- Sleep bruxism: Involuntary. 8-10% of population. Occurs during REM sleep (Stage 3-4) when micro-arousals occur (Stage 3).
- Secondary to micro-arousals during stage 3, when there are 3-10 second rises in brain activity, heart rate and muscle tone. Micro-arousals occur 8-15 times an hour.
Anything in her medical history increase her risk of bruxism?
Alcoholism (doubles risk), ADHD, depression (SSRI’s)
What are examples of SSRI’s?
Bupropion (Wellbutrin), Fluoxetine (Prozac), Sertraline (Zoloft)
