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 |
|
PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
19548407 | Landry-Schönbeck/2009 | 12 patients | Randomized 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.” | 20552084 | Saueressig/2010 | 13 female and 15 male patients | Uncontrolled 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 |
(General Dentistry) (Prosthodontics) |
Keywords |
Bruxism, Dental appliance, Sleep apnea
|
ID# |
2067 |
Date of submission |
07/07/2011 |
E-mail |
Shir@livemail.uthscsa.edu |
Author |
Solmaz Shir |
Co-author(s) |
|
Co-author(s) e-mail |
|
Faculty mentor |
Mark LittleStar, DDS |
Faculty mentor 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?) |
None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
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. | |