The GEMPro Bruxism Monitor
DDME’s GEMPro Dentist’s Dilemma Sleep apnea is a medical disease and cannot be diagnosed by a dentist. However, tooth wear may be a result of sleep apnea. Dentists concerned about excessive tooth wear cannot ignore airway disturbances much like dentists should not ignore a suspicious lesion under the tongue. The GEMPro was developed to quantify the severity of parafunctional activity and give dentists enough information about airway disturbances to refer/resolve the patient correctly, minimizing potential tooth wear. “Dentists are encouraged to screen for airway issues” 2017 Major Dental Companies recognize the contribution of the GEMPro and have elected to distribute: Glidewell, Great Lakes, Whip Mix, Sleep Group Solutions
The Unmet Clinical Need in Dentistry Bruxism – Presence and severity are NOT being diagnosed – (GEMPro does) 1. Occlusal Guards, based on published data, create unintended medical issues (GEMPro detects) 2. In many cases, bruxism causes can be identified leading to a differentiated treatment protocol (GEMPro does) 3. Restoration’s longevity can be improved by managing Bruxism related overloading (GEMPro helps) 4. 20-30% of all dental office adult patients have untreated airway issues which likely will result in excessive tooth wear 5. (GEMPro can detect)
1. Bruxism – Presence and severity are NOT currently being diagnosed GEMPro’s Unique EMG Calibration Establishes 2 Vectors of Evaluation Frequency – How many and what type of parafunction Magnitude – How strong is the parafunction Calibration Graph: Documents Strongest Waking Bite Force
Bruxism Analysis (Acquisition Graph) Sleeping Maximum Force Waking Maximum Force
Bruxism Analysis (Process Graph) Waking Maximum Force Sleeping Maximum Force Clenches and Grinds Bursts
2. Occlusal Guards, Based on Published data, Create Unintended Medical Issues Any appliance placed in the oral cavity may change tongue and tissue locations Independent research has validated changes in Sleep Apnea with Occlusal guards Occlusal guards will help one of these patients and potentially hurt the other The GEMPro answers these issues Distinguish Between Airway Triggered Parafunction and Bruxism
Occlusal Splints may cause Significant Apnea
3. In many cases, bruxism causes can be identified leading to a differentiated treatment protocol 1. Distinguish between Airway Triggered Parafunction and Idiopathic Bruxism 2. Protect the dentition with maintaining the performance of the airway 3. Do NOT harm the patient with an inappropriate protective strategy Parafunction in 4 minutes, note the correlation to Apnea Events
Airway Parafunction or True Bruxism True Bruxism Airway Triggered Parafunction
Airway Parafunction or True Bruxism True Bruxism Airway Triggered Parafunction
4. Restorations longevity can be improved by managing Bruxism related overloading 1. Avoid Overloading Risks 2. Identify the presence of Parafunction and manage your restoration risks 3. Distinguish between airway triggered parafunction and idiopathic Bruxism 4. Refer to sleep lab after your restoration when Airway issues are present Which Appliance Will Protect Your Restoration? The one they will wear instead of sitting on the night stand
Which Appliance Will Protect Your Restoration? The One They Will Wear 1. Airway related parafunction can be exacerbated by single arch guards 2. If a patient will not wear a guard, it may be because of their airway discomfort 3. Single Arch Splints are associated with increased airway complications (2) . 4. Distinguish between airway triggered parafunction and TRUE Bruxism The #1 Complication for Restoration Protection is Lack of Compliance 1. 2 .
Overloading Articles
Codes Associated with Guards and Appliances Description Code Occlusal Guard (bruxism-grinding) D9951 Limited (equilibration) Occlusal Guard (bruxism-grinding) D9952 Complete (equilibration) Occlusal Guard Adjustment D9943 Occlusal Orthotic – Reduce Bruxism D7880 Reduction\Dislocation Occlusal Orthotic Device Adjustment D7881 Sleep Apnea Appliance E0486 DME-Medical Diagnostic Cast (impression) D0470
Patient’s with Oxygen Desaturations Oxygen desaturations alone do not diagnose OSA However, OSA cannot exist without oxygen desaturations Dental patients testing positive for oxygen desaturations with the GEMPro need to have follow up DDME’s solutions for diagnosing OSA Purchase a Home Sleep Monitor + DDME Sleep Physician GEMPro owners can refer their patients to DDME DDME provides the Home Sleep Monitor DDME’s Physicians provide a patient diagnosis for the dentist This service is part of DDME’s Customer Service package Refer to a sleep lab
Selling the Patient from the Dental Chair - Script Does the patient show signs of excessive Tooth Wear or Bruxism? Yes – We have a new test that is performed at your home through the night. This test will give me information as to the cause of this tooth wear and allow me to give you the appropriate treatment protocol to protect your teeth. (approximately 50% of adult patients will test positive for potential airway disfunction and the dentist may intervene and positively improved the patients overall health and dentition) No – Although you have no signs of excessive tooth wear at this time, we would like to screen you for the onset of abnormal parafunctional activity at night. Our office performs this test as a precautionary screen to insure your teeth stay healthy (approximately 20% of adult patients will test positive for potential excessive tooth wear and the dentist may intervene and positively improve the patients overall health and dentition before damage begins to occur) Benefits to the patient: Patient’s dentist can differentiate between dental issues and potential medical issues Medical issues have large potential consequences if undetected and treated; cardiac disease, diabetes, depression, weight gain, cancer. The dentist may positively impact the overall health of their patient. Patients gain information about their own sleep wellness, a subject that is in the news and generates significant interest. Devices such as Fitbit etc. are increasing the public’s willingness to test for themselves. Method of discussing with patient Mr. Patient. Dentists have been unable to diagnose night time grinding of the teeth until recently. At night, your jaw muscles can fire at several times the magnitude you can make them fire when you are awake. This can be very destructive to your teeth. I would like to do a simple test on you to see if you are having this problem. With this test you and I will learn if your teeth are in danger of excessive wear or damage and if so, is it because of you snoring or stopping breathing at night, or is it caused by stress or other factors in your life. With this information, I can do the appropriate treatment protocol to protect your beautiful smile. (Show report) This is a sample report we will get from the test. This first graph will show us if your blood oxygen levels are compromised. If so this is a serious medical problem we will discuss, This graph tells me if your are clenching or grinding your teeth at night and how often and how hard. We have therapies that can protect your teeth if necessary. This graph tells me if you snore at night and how much and how loud. If you do we can address that condition also. The test is (FREE OR $50 OR $89) and very easy to do. Would it be ok if my staff shows what you need to do and sets you up with a night study?
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