Measuring patient compliance with occlusal device wear in the management of bruxism

Abstract

Background: Sleep Bruxism (SB) is a complex oral condition that is characterised by repetitive jaw-muscle activity, by clenching or grinding of the teeth and/or by the bracing or thrusting of the mandible. Sleep bruxism has been associated with a multitude of clinical problems such as temporomandibular joint and muscle pain, tooth wear and is a major cause of dental prosthesis failure or fracture. The wearing of protective occlusal devices is an essential component of the management of tooth grinding (bruxism). In the absence of definitive treatment for sleep bruxism, occlusal devices are the most commonly prescribed method for its management in dentistry, acting to reduce bruxism activity or prevent its deleterious effects on the teeth, restorations and the masticatory system. Compliance with occlusal device wear is essential to prevent further tooth wear and protect any restorations that have been placed. To obtain the maximum preventive and therapeutic effects of occlusal devices, patients should demonstrate acceptable levels of compliance with occlusal device wear. To date, there has been no objective data available concerning compliance for patients using occlusal devices for the management of sleep bruxism. The aim of this study was to measure occlusal device wear time using an inbuilt microsensor objectively Materials and Methods: This study was a longitudinal prospective clinical cohort trial of two groups of possible sleep bruxer participants who were either using the maxillary occlusal hard device for the first time (new wearers) or participants who worn the device for at least three months following prosthodontic treatment (experienced wearers). Possible sleep bruxism patients were identified and recruited based upon their bruxism questionnaire responses, which acted as inclusion criteria. If the current appliances were deemed suitable for experienced wearers, microsensors were retrofitted into existing appliances. For new wearer participants who were to have their first occlusal devices fabricated, and experienced wearers who presented with unsatisfactory devices the microsensors were incorporated at the time of device fabrication. Recall appointments were timed for one week, four weeks and 12 weeks post-placement. The recorded wear times were documented graphically using dedicated TheraMon? Software. The readout data was then demonstrated, and the daily wear times were determined as wear-time graphs. Results: Out of the 46 recruited participants, only 23 wore the occlusal device for the 90 night period of the study. Fourteen participants (12 new users and 2 experienced users) were excluded from the study as they were not compliant with device wear instructions. A further 9 patients (5 new users and 4 experienced users) withdrew for reasons including being lost to follow up due to relocation, delays to device manufacture as they were undertaking additional dental treatment, losing the device, or having a defective senor which they did not want replaced. The overall 90 night median occlusal appliance wear time for all participants was 5.50 h/night. There was a small, statistically insignificant, drop in compliance over time across the three 30-day periods. For the overall study period, there was a significant difference in median occlusal appliance wear time between new patients (N=10; 4.04 h/night) and experienced patients (N=13; 6.79 h/night) with approximately 2.5 hours difference. No significant differences in wear time were found with respect to age and gender. Conclusions: This study exhibited the effectiveness of using a thermo-sensitive microsensor in monitoring sleep bruxism patient compliance and, for the first time, reported the objective wear times of occlusal devices for bruxer patients. Only half of the participants wore the appliances for the duration of the study period. The overall 90 nights median occlusal appliance wear time for all participants (N=23) was 5.50 h/night. Significant differences in median occlusal appliance wear time between new and experienced users were identified. Gender and age had no influence on occlusal device wear patterns.