Sleep Bruxism Related Tooth Wear as a Clinical Marker for Obstructive Sleep Apnea/Hypopnea Syndrome in Children.
Abstract: The etiology of sleep bruxism has been debated and researched extensively for several decades. While still controversial, dento-occlusal and psychological (anxiety) factors do not enjoy scientific support in the etiology of sleep bruxism. Current research has suggested that sleep- disordered breathing, including obstructive sleep apnea-hypopnea syndrome (OSAHS) and upper airway resistance ... read moresyndrome (UARS), may be involved in the genesis of sleep bruxism. Children are at greater risk of having sleep-disordered breathing than adults due to having a narrower upper airway. If untreated or not diagnosed early, pediatric sleep-disordered breathing, including OSAHS, can result in partial irreversibility of the neurocognitive, neurobehavioural, and cardiovascular damage seen with this condition. The problem lies with early diagnosis of pediatric sleep-disordered breathing. This study primarily aimed to investigate whether sleep bruxism-related tooth wear could be a clinical marker for pediatric OSAHS. Analyses were carried out using two comparison groups, those who had OSAHS and those who didn't (controls). Additional measurements were also made to show associations between other dental and medical variables, and sleep bruxism, as well as, OSAHS. All statistical analyses were carried out using SPSS statistical software (Version 17). Fifty (50) pediatric subjects were recruited for this study from a pediatric sleep disorder center and a private dental practice. All subjects had undertaken either an attended or unattended overnight sleep study (polysomnogram) to diagnose the presence of OSAHS. OSAHS was measured utilizing the apnea-hypopnea index (AHI) and the respiratory disturbance index (RDI), as reported from the polysomnogram. The AHI scored the OSAHS events, and was used to classify the subjects into those with OSAHS and those with no OSAHS (controls; AHI<1). The RDI included the AHI score, as well as, measurement of increased respiratory effort due to upper airway resistance called respiratory effort-related arousals (RERAs). Additionally, dental impressions were taken of the subjects and sleep bruxism-related dental wear, as well as other dento-occlusal variables (palatal height, posterior and anterior crossbite, and Angles classification of occlusion) were measured from the orthodontic plaster study models. The dental wear was scored utilizing a modified, previously validated, dental wear index (named dental wear score for the current study). A modified, validated, sleep medical questionnaire was also filled in by the parents of all of the subjects, and statistical measurements were made between the medical variables of anxiety, middle ear infections and dental wear, as well as , between diet variables of erosive beverage and citrus fruit intake, and dental wear. The results revealed no statistically significant association between both the presence and severity of OSAHS (as measured by the AHI) and the presence and severity of sleep bruxism-related dental wear (measured by the dental wear score). Hence, significant dental wear was also found in the control (no OSAHS) group. Additionally, the presence of OSAHS had no association with gender or palatal vault height. Dental wear also showed no association with gender, medically diagnosed anxiety, middle ear infection, dento-occlusal variables (palatal vault height, anterior crossbite, posterior crossbite, and Angles classification of occlusion), and the consumption of erosive beverages and citrus fruits. There was a strong statistically significant association between the validated RDI severity grade utilized in this study, and the presence of dental wear. Additionally, there was a strong statistically significant association between the RDI grade and the dental wear score, and between the actual polysomnogram RDI score (including RERAs) and the dental wear score. Based on the results of the current study, sleep bruxism-related dental wear is not a clinical indicator of pediatric OSAHS (as measured using the AHI). Sleep bruxism-related tooth wear is, however, a clinical indicator for pediatric sleep disordered breathing, as measured by the RDI. The RDI is a more thorough measurement index for pediatric sleep-disordered breathing, as it includes measurement of airway occlusive events (AHI) and events associated with increased upper airway resistance (RERAs). Pediatric sleep bruxism-related tooth wear can be utilized as a clinical marker for underlying pediatric sleep-disordered breathing, allowing the dental practitioner to make prompt referral of the child to appropriate medical specialists concerned with the early diagnosis and management of this condition.
Thesis (M.S.)--Tufts University, 2011.
Submitted to the School of Dental Medicine.
Advisor: Noshir Mehta.
Committee: Brijesh Chandwani, Matthew Finkelman, and Ron Ku;ich.
Keyword: Dentistry.read less
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