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Hot Topic Blog - Oral/Pharyngeal Sensory-Motor, Orofacial Myofunctional, & Airway Information


By David McIntosh; MBBS, FRACS, PhD; Paediatric ENT Specialist; Associate Professor, James Cook University in Australia

June 2018


Teeth grinding in adults is a topic that comes up frequently. So, here is a summary of what we know about it. 


First things first, we need to differentiate between day time and night time grinding. Day time grinding is overwhelmingly driven by psychological thought processes that sit on the anxiety side of the fence.


Night time bruxism though is far more interesting. The theories about nocturnal bruxism in adults include anxiety, malocclusion, jaw joint problems, reflux, and I’m sure there are others. But, what if there was a condition that was independently linked to bruxism, anxiety, malocclusion, and reflux? Well it turns out there is. That condition is obstructive sleep apnoea. 


Obstructive sleep apnoea, or OSA for short, should be at the forefront of the list of potential underlying problems when patients present with bruxism at night. The research in the paediatric population is growing rapidly and adult-based research is catching up (i.e., poor breathing means low oxygen levels which leads to bruxism in those susceptible to do so). 


But guess what? Adults don’t even need to have sleep apnoea. They just need to have a blocked nose. That could be from a deviated septum or allergy swelling from hay fever. Now, many patients with nasal findings indicative of obstruction will say their nose feels fine. This is of course relative to what they are accustomed. And, if they are used to the nose being in a blocked state, then that is their normal. 


Having trouble breathing affects sleep quality. If you have chronic deprivation of good sleep, with a brain sent into panic mode by low oxygen levels, then the problems of night time agitation overflow into the daytime, with an increased propensity for being anxious can be a result. So, the next time you find signs of bruxism, make enquiries about breathing problems, snoring, allergies, day time fatigue, sleep apnoea, and so forth. Rather than saving the teeth, you could end up saving a life. 


Note: Feel free to share this post on your work pages so patients understand the link and why looking for sleep and breathing problems is now an important part of the professional scope of dentistry.


About the Author


Associate Professor Dr. David McIntosh of ENT Specialists Australia is a Paediatric ENT Specialist with a particular interest in airway obstruction, facial, and dental development and its relationship to ENT airway problems and middle ear disease. He also specialises in sinus disease and provides opinions on the benefit of revision of previous sinus operations. He is passionate about Indigenous Health. And, he has undertaken advanced surgical training in ENT and Head and Neck Surgery and Paediatric training at Starship Children’s Hospital in Auckland, New Zealand. He is the author of Snored to Death: Are You Dying in Your Sleep?


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