Most dentists will tell you that 30%-40% of their patients would benefit from wearing a nightguard, but less than 5% actually do. What’s the reason for this significant difference in need and treatment? In my practice I find it boils down to two things: education and treatment options.
Patient education is the key for patients to accept treatment of bruxism. I find the primary reason patients avoid treating bruxism is they are not adequately educated on the true etiology of bruxism, how it presents in their case and that it is typically a slowly degenerative process.
The common misconception my patients have is that they do not feel they are suffering from bruxism unless they are clenching or grinding aggressively. I often tell patients that bruxism most commonly presents itself as very light touching of their teeth. Just holding their teeth together at all, over long periods of time, can cause a lot of damage. Bruxism is a degenerative process that needs to be treated early to avoid long-term problems.
I also find that giving patients multiple treatment options for their bruxism achieves a much higher level of treatment acceptance. There isn’t one appliance that works for everybody. For my practice, the Dreamgard appliance has been a great first line treatment due to its comfort, cost and effectiveness. Dreamgard’s full occlusal, flat plane design works in the majority of cases. I also use full arch acrylic splints that have been equilibrated to the patient’s bite and NTI, in cases where the patient cannot tolerate a full arch appliance.
Since I’ve started using Dreamgard, I’ve been very impressed with the comfort level for patients and therefore patient compliance. In particular, I’ve been pleasantly surprised with the in-mouth self-equilibration of the appliance. It has required virtually none of my time. I’ve not had anyone come back for adjustments, so it truly has been a self-adjusting appliance that is much less hassle for me and more comfortable for the patient.
One other benefit I see is that you can send in cases using digital scans. Ordering digitally is even easier and more cost effective, and creates a more accurate fitting nightguard. Personally, I’ve tried Dreamgards that have been made from both a physical impression and a CEREC digital impression, and I was really impressed with the fit of the digital impression version. I think a big key for patient comfort is to have the accuracy that a digital impression provides.
I encourage dental professionals to embrace the treatment of bruxism in their practices and by doing so, receive the many personal, clinical and economic benefits that this successful treatment provides them and their patients.
