Dr. Fernando Loscos Morato is a dentist and belongs to Top Doctors, the select circle of top doctors in Spain. He will talk about the splints used for bruxism and apnea.
What is nocturnal bruxism?
Nocturnal bruxism, also known as tooth clenching or teeth grinding, consists of the patient clenching and rubbing the teeth of the jaw on the teeth of the upper jaw. Pathologically speaking, it acts at 3 levels; first at the dental level generating lesions in the tooth, wear, sensitivities, fissures and fractures. On the other hand, it overloads the temporomandibular joint which has a meniscus that can also dislocate, capsulitis, blockages and various joint pathologies can occur at the level of overload. And lastly, it also acts by greatly enhancing the musculature, which can generate headache-type pain and for which it is necessary to establish a correct differential diagnosis with other types of headaches and headaches. It has a lot to do with stress and with the patient’s nervous situation.
How can it be avoided?
The patient, as we mentioned before, does it unconsciously, so it is difficult for him/her to treat and solve the problem by him/herself. It is necessary to differentiate between if there has already been any pathology such as headache or dysfunctions or problems in the temporomandibular joint and if there has not been any pathology. What I recommend to the bruxomaniac patient is the use of an unloading splint that will keep the mouth a little more open during sleep, relax the musculature and avoid the rubbing of the teeth which avoids sensitivities, lets the temporomandibular joint rest and relaxes the musculature which will eliminate tension and muscular headaches. If a pathology has already occurred in the temporomandibular joint we must treat it, sometimes also with a splint, and make a subsequent follow-up to see if the lesions disappear. It must be taken into account that it is a multifactorial injury and in many occasions it is necessary that different specialists intervene such as the neurologist, the ENT specialist, the maxillofacial surgeon and in its recovery the figure of the physiotherapist is also very important.
What happens if it is not treated?
This question is practically already answered. It will cause lesions in the teeth with a subsequent complex treatment. It will generate lesions and premature arthrosis in the temporomandibular joint with all the problems that this entails. And it will generate headaches, often in the morning, which greatly disrupt the patient’s life.
What is an unloading splint, are there different types?
In these cases I believe that a correct diagnosis and an adequate treatment plan must be made. It is not always necessary to use a splint, although on many occasions it is indicated and the correct splint must be used for each case and pathology. Among the many types of splints there is a splint that is now in the forefront is the splint for the treatment of snoring and sleep apnea.
What does this last splint consist of and what is it for?
Snoring and sleep apnea is a pathology of great importance and social relevance at this time. The treatments with other methods are already known, but we have a splint that we call mandibular advancement device (MAD) that has very good results at the level of simple snoring, that is to say, in patients who snore or who have mild apneas. In fact, it is the treatment of indication number 1 in Central European countries or Nordic countries. This splint consists of a device that forces the jaw forward, opens the airways and thus clears them, the snoring disappears and we manage to solve cases of mild apneas. It is important because it is considered a sleep disorder that it is well studied by a sleep unit, by a pulmonologist, a pneumophysiologist, a sleep study and that the best method of treatment is determined because in more severe cases other treatments will be used such as CPAP or surgery to solve the case.