ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Nocturnal Bruxism Managed With A Sleep Apnea Appliance
Clinical Question In an adult with severe nocturnal bruxism, can a sleep apnea appliance double as an appliance to manage bruxism?
Clinical Bottom Line Reinforced sleep apnea appliances can be used to control nocturnal bruxism without significant breakage of the appliance.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19548407 Landry-Schönbeck/200912 patientsRandomized crossover study
Key results“The mean number of sleep bruxism (SB) episodes per hour was reduced by 39% and 47% from baseline with the mandibular advancement appliance (MAA) at a protrusion of 25% and 75%, respectively (P < .04). No difference between the two MAA positions was noted. The MAA slightly reduced the number of SB episodes per hour without reaching statistical significance (34%, P = .07). None of the SB subjects experienced any MAA breakage.”
#2) 20552084 Saueressig/201013 female and 15 male patientsUncontrolled clinical study
Key results“There was a statistically significant improvement in both SB and sleep scores based on the bite strip and the SAQ (Wilcoxon signed rank and Student paired t test, P < .05). In the signs and symptoms of TMD, there was a significant reduction in temporomandibular joint sounds as well as in masseter and temporalis tenderness to palpation. None of the SB subjects experienced any breakage of the Mandibular Advancement Device.”
Evidence Search Search "dental appliance" AND "sleep apnea" AND "bruxism"
Comments on
The Evidence
The mean number of sleep bruxism episodes per hour was reduced by using a mandibular apnea appliance. None of the sleep bruxism subjects experienced any Mandibular Advancement Appliance breakage.
Applicability Subjects in the study are representative of general population patients. The treatments performed are feasible in any dental clinical setting that has access to a laboratory. The benefits outweigh the risks.
Specialty/Discipline (General Dentistry) (Prosthodontics)
Keywords Bruxism, Dental appliance, Sleep apnea
ID# 2067
Date of submission: 07/07/2011spacer
E-mail Shir@livemail.uthscsa.edu
Author Solmaz Shir
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Mark LittleStar, DDS
Faculty mentor/Co-author e-mail littlestarm@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Nghia Nguyen, Sabrina Chavez (San Antonio, TX) on 11/28/2017
The PubMed database was searched for the efficacy of sleep apnea appliances for treatment of nocturnal bruxism on 11/20/17. The articles discussed in CAT 2067 were confirmed as the highest level of evidence published on this topic, and additional support for the conclusion is provided in a comprehensive review published in 2012 (PMID 22480810). The Carra narrative review reported that mandibular advancement appliances (MAAs) have demonstrated up to a 70% in reduction of sleep bruxism (SB) and could thus serve as an effective treatment for severe sleep SB, especially for patients with sleep-disordered breathing. Although MAA treatment for SB has demonstrated notable effectiveness, all studies in the review assessed the effect after short-term use only (2 weeks on average); more investigation should be done to assess the effectiveness and side effects in long-term treatment.
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