January 3, 2019
by Dr. Nabil Tabbara – London, Ontario
RE: The Severely Worn Dentition
by Dr. Oliver Pin-Henry – November 2018 Oral Health
My thanks go to Dr. Pin-Henry for the timely article: The Severely Worn Dentition. As practicing dentists, we do see cases of worn-down dentitions very frequently. These are not always easy cases to treat mainly because unless we address the possible root causes, the results are either unpredictable or short-lived. Literature provides abundant links between nocturnal bruxism and oxygen desaturation. By examining bruxism patients for oral signs of sleep-disordered breathing (SDB) associated with desaturation we can get closer to a possible root cause. It is understood that when oxygen levels go below what the brain is comfortable with, it triggers bruxism to increase the tongue muscles tone and to protrude the mandible. This is evident in cases in which the wear is predominantly in the anterior areas. By screening for SDB dentists are in a unique position to improve the patients’ quality of life by referring to treating physicians while managing tooth wear as a symptom of the above. Signs of SDB can include: high Mallampati index, dorsal surface of tongue above occlusal surfaces of lower molars, linea alba at buccal mucosa, anterior teeth wear, tongue scalloping and tori. Symptoms are often positive to Epworth scale.
The second possible root cause of nocturnal bruxism is TMD. As we all know, since there is no blood nor lymphatic circulation inside the TMJ capsule, the only way to bring nutrients to and drain waste products out of the TMJ capsule is the synovial fluid. Sick joints need more of the above and bruxism is the brain’s way to do just that. Therefore, instead of relying exclusively on flat night guards to protect our restorations it is essential to manage the TMD first.
I’m glad that this article brought up many points and demonstrated beautiful restorations and am pleased to contribute to this exciting field. OH