Bruxism and OSA

Plus: A Closer Look for Medicare Beneficiaries

November 13, 2023

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In Today’s Edition:

Sleep Bruxism in OSA Patients
Expert Opinion: Sleep Bruxism and OSA
Bruxism on the Rise Post-Pandemic
A Closer Look for Medicare Beneficiaries

6-minute read👇

Clinical Corner

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High SB Prevalence in OSA: Up to 49.7% of OSA patients also exhibit sleep bruxism, especially males with lower BMI. Regular SB screening is advised.

Diverse SB Roles: SB may protect against or contribute to OSA, depending on individual cases, highlighting the importance of personalized treatment.

Bruxism Spike Post-Pandemic: Bruxism rates have almost quadrupled since the pandemic, distinguishing between involuntary sleep bruxism and controllable awake bruxism.

Stress-Related Awake Bruxism: Managing stress is key in controlling awake bruxism, with biofeedback and relaxation techniques as effective interventions.

1/ Sleep Bruxism in OSA Patients

What Happened? A prospective study involving 914 adults diagnosed with obstructive sleep apnea (OSA) sought to uncover the prevalence of sleep bruxism (SB) and its associated risk factors. By using a full polysomnographic recording, researchers identified SB through the rhythmic masticatory muscle activity (RMMA) index, with a threshold set at a minimum of 2 episodes per hour of sleep.

Why It Matters Sleep bruxism is a significant concern for dental sleep professionals as it not only impacts oral health but can also affect the management of OSA. Understanding the prevalence of SB in OSA patients can guide clinicians in comprehensive treatment planning. The study’s findings revealed that a substantial 49.7% of adults with OSA also experienced SB. Notably, being male, having a lower body mass index, and spending a higher percentage of sleep in the N1 (light sleep) stage were factors that increased the likelihood of SB.

Practical Takeaways

For patients with OSA, especially males with a lower BMI, clinicians should be vigilant for signs of SB.
Despite no direct association between RMMA and the severity of OSA or sleep arousals, an intriguing 85.7% of RMMA episodes were temporally linked to arousals, suggesting a nuanced interaction that warrants further clinical attention.
The management of SB in OSA patients may require a multidisciplinary approach, considering the potential for complex interactions between bruxism episodes and sleep patterns.

The intersection of SB and OSA presents a clear call to action for dental sleep professionals: to consider SB screening as an integral part of OSA management and to remain abreast of the evolving research to optimize patient outcomes.

2/ Expert Opinion: Sleep Bruxism and OSA

What Happened? A recent expert opinion piece has delved into the intricate temporal relationship between sleep bruxism (SB) and obstructive sleep apnea (OSA). It outlined four hypothetical scenarios to describe how SB and OSA events could be related: they might be entirely unrelated, SB could precede or follow OSA events suggesting a protective or inducing role, or both phenomena could occur simultaneously.

Why It Matters The relationship between SB and OSA has significant clinical relevance, particularly regarding SB's potential role in either protecting against or inducing OSA. The current literature does not provide a conclusive stance on this temporal relationship, suggesting that multiple scenarios could be possible within different individuals. Understanding these dynamics is crucial for clinicians in tailoring personalized treatment strategies.

Practical Takeaways

Dental sleep professionals should be aware that SB might play a protective role against OSA in some patients by maintaining airway patency, akin to the effects of mandibular advancement strategies.
Conversely, there's a possibility that SB could induce OSA by causing mucosal swelling through a trigeminal cardiac reflex.
The anatomical site of obstruction in OSA might significantly influence the relationship between SB and OSA, emphasizing the need for individualized assessments.

Given these complexities, it's essential for practitioners to approach each case of SB and OSA with a nuanced understanding, recognizing that the interplay between these conditions can vary widely among patients. This calls for a keen eye for detail and a flexible, informed approach to treatment.

3/ Bruxism on the Rise Post-Pandemic

What Happened? The Council of Dentists of Spain has reported a significant rise in bruxism diagnoses since the onset of the pandemic, with incidence rates increasing from 6% to 23%. This escalation has highlighted the distinction between two forms of bruxism: sleep bruxism, an involuntary nocturnal activity, and awake bruxism, which occurs during the day and can be consciously controlled.

Why It Matters The sharp increase in bruxism cases presents a challenge for dental health professionals, as both forms of bruxism, while potentially related, have different origins and implications for treatment. Understanding the distinction is crucial, as bruxism is associated with various health issues, including headaches, migraines, and temporomandibular disorders. Furthermore, bruxism is being reconsidered in current research, not just as a pathological condition but also as a natural motor activity with potential protective benefits against disorders like gastric reflux and obstructive sleep apnoea.

Practical Takeaways

Clinicians should be aware of the rising bruxism rates and the nuances between its sleep and awake forms.
Bruxism, particularly awake bruxism, is often triggered by emotional stress, suggesting a link between stress management and the mitigation of bruxism.
Biofeedback therapy represents an effective treatment avenue, teaching patients to recognize and reduce muscle tension for a more relaxed jaw posture.
Simple behavioral reminders, such as Post-it notes, and regular relaxation practices can help manage bruxism in daily life.
The recent upsurge in bruxism cases requires dental professionals to stay informed on both the evolving definitions and innovative treatments for managing this condition.

The pandemic has not only changed the landscape of public health but also the way we approach dental conditions like bruxism. With the rising tide of cases, dental sleep professionals are called upon to adapt and refine their strategies to address this multifaceted condition effectively.

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A Closer Look for Medicare Beneficiaries

For older adults utilizing Medicare, the journey to treat obstructive sleep apnea (OSA) with oral appliances can present unique challenges. From initial consultations to navigating complex reimbursement processes, here's what dental sleep professionals should consider to aid their patients effectively.

Adjustment and Usage

The learning curve for Medicare beneficiaries prescribed oral appliance therapy (OAT) is steep, with hurdles ranging from physical adjustment difficulties to remembering follow-up appointments. However, dental sleep practitioners play a pivotal role in simplifying this journey, offering a potentially more successful and quicker alternative to CPAP therapy, especially amidst supply chain delays.

Research Insights

Studies highlight that Medicare beneficiaries often face a more complex health picture, including multiple sleep disorders. This complexity underscores the value of specialist care in their treatment. Additionally, untreated OSA in this demographic can lead to increased healthcare service utilization, stressing the importance of proactive management.

Appliance Selection Challenges

Medicare's criteria for oral appliance selection are stringent, limiting patients to a specific set of devices. This can constrain patient choice, potentially affecting the suitability and comfort of the therapy. Dental sleep professionals must navigate these limitations, sometimes discussing non-Medicare-covered options with patients when necessary.

Overcoming Barriers to OAT

Medicare patients may face specific obstacles such as missing or damaged teeth, which can impede the initiation of OAT. Dental practitioners need to ensure that all pre-treatment dental health requirements are met, which may involve coordinating additional dental work before starting OAT.

Titrating Oral Appliances

Titrating devices for Medicare patients requires consideration of their manual dexterity and vision capabilities. Innovative solutions, like video instructions or in-office adjustments, can enhance patient comprehension and comfort with the process. Educating a patient's family member can also be beneficial in ensuring proper device use.

Importance of Follow-Up Care

Effective OSA management for Medicare beneficiaries involves regular follow-ups to discuss product efficacy and address health changes. Adjusting the frequency of these check-ins to meet the specific needs of older patients can improve treatment outcomes.

Navigating Medicare Reimbursement

Dental sleep medicine providers must be meticulous in meeting Medicare's documentation and reimbursement criteria. Utilizing appropriate modifiers, verifying documentation, and understanding the nuances of Medicare's policies are crucial for ensuring that patients receive the benefits they are entitled to.

The Impact of OAT for Medicare Patients

The shift from CPAP to oral appliance therapy has the potential to transform the quality of life for Medicare patients, potentially leading to more restful sleep, reduced medication dependency, and an overall improvement in well-being.

For dental sleep professionals, understanding the Medicare landscape is not just about compliance and paperwork. It’s about facilitating a smoother, more accessible path to OSA management for older adults, ensuring they receive the care they need to enjoy a healthier, more vibrant life.