bitestrip ™ introduction
DESCRIPTION
BiteStrip ™ introduction. Main Sleep Disorders Overview. Sleep apnea Stops in respiration during sleep PLMS Involuntary limb movements during sleep Insomnia Problem in initiating and/or maintaining sleep Bruxism Nigh time teeth grinding and clenching Narcolepsy - PowerPoint PPT PresentationTRANSCRIPT
BiteStrip™ introduction
Main Sleep Disorders Overview • Sleep apneaStops in respiration during sleep
• PLMSInvoluntary limb movements during
sleep
• InsomniaProblem in initiating and/or maintaining
sleep
• BruxismNigh time teeth grinding and clenching
• Narcolepsy Sudden uncontrolled sleep spells
The Sleep lab
• EEG• EOG• EMG (Bruxism)• ECG• Effort• Snore • Flow• Pulse oximetry• Leg movement• Esophageal
pressure• Others (NPT, Video)
What is Bruxism• Bruxism is the forceful clenching or grinding
together of the teeth
• Bruxism is subconscious behavior. The patient is usually unaware of this habit
• Prevalence is high (10-25%*), and decreases with age
• Patients sometimes grind much harder while asleep than they can while awake
• Often referred by bed-partner
* Cranio. 2003 Apr;21(2):144-51. Melis M, Abou-Atme YS. Prevalence of bruxism awareness in a Sardinian population. and other sources.
Bruxism Damage• Enamel erosion of teeth chewing surfaces. • May result in fractured teeth and fillings • Damage to tempomandibular joints, leading
to TMJ syndrome • Damage to gums and other oral structures • Sore facial muscles, headaches, and
migraines• Damage to reconstructive dental work like
crowns, veneers and bridges. • Low sleep efficiency, day time sleepiness
Some horrible pictures
Bruxism is usually “diagnosed” by dentists, based on tooth attrition status. New studies show little correlation between current tooth attrition and actual Bruxism, demonstrated by EMG recordings.
Sleep lab Bruxism monitoring
• Monitor EMG activity of jaw muscles• Count events stronger than 20-30% MVC*, longer
than 0.5sec
Jaw muscles
EMG trace
Bruxism =>5 events/hour
*(Maximal Voluntary Clench)
Jaw muscles
contraction
The BiteStrip 2 EMG electrodes (on back)
Miniature 3V lithium battery
CPU and electronics
Indicator light
Permanent electro-chemical display
Operating principle
* The BiteStrip: A Novel Screener for Sleep BruxismHadas N, Shochat T, Molotzky A, Lavie PPresented at the Chicago APSS meeting, 2001
BiteStrip is a complete EMG recorder.
Comprising two EMG electrodes, an amplifier, real-time data acquisition hardware and analysis software and a permanent display.
Each bruxism episode is counted in real time. This count is used to calculate a bruxism severity index, which is presented on the digital display in the morning.
BiteStrip tells me
you need a
nightguar
d!
How BiteStrip scores an event
Event = EMG > 30% of MVC for more than 0.5 sec.
Long events – Additional events are added for every 1.5 second in clench.
Only EMG bursts stronger than threshold are counted*
Threshold is updated to 30% of MVC* in awake
*Voluntary Maximal Clench
BiteStrip operation• Must clean display before study for good readability• Activated by attaching green sticker on display, light
blinks to mark proper activation• During first 20 minutes, light blinks with each clench.
Perform two MVC to calibrate the threshold.• After 20 minutes flashing stops and actual study begins
(assume patient is already asleep)
• Must be on face at least 5 hours for a valid study• When removed, light will turn ON to indicate end of
study• After 60 minutes display can be read after removing the
green sticker, do not remove sticker sooner
BiteStrip Operating instructions
BiteStrip study timeline
First 20‘ Perform two MVC to calibrate threshold. Light flashes with each clench.
After 20’, Automatically begin study
5-6 hours, but not more than 12count clenches and grinds stronger than 30% of MVC
Last 30’ Calculate score and activate display
Remove green sticker
Read score
Remove from face
Attach green sticker
Activation
Light flashes until placed on face
Light turns ON when removed off face
BiteStrip readout
Healthy subject – less than 40 events
Mild Bruxism – 41 to 74 events
Moderate Bruxism – 75 to 124 events
Severe Bruxism –more than 125 events
Error – too short study or other problems.
BiteStrip performance
LeftRightMann Whitn
ey
Spearman’s rho
EMG156.9 (158.7
)
146.2 (157.8)nsr=0.93, p<0.001
BiteStrip144.2 (114.8
)
130.6 (110.3)nsr=0.83, p<0.01
BiteStrip highlights
• Only EMG recorder designed specifically for Bruxism studies.
• At home study – natural sleeping environment• Good correlation with gold-standard results• Low cost – may be repeated as necessary• Easy to use, disposable• No additional equipment necessary• Instant results, small, low weight• Permanent result – save as hard copy of study
BiteStrip Competition
• Questionnaires/Physical examination• Bruxguard reusable biofeedback device• Ambulatory sleep studies• In-lab sleep study
BiteStrip applications (1)
• Dentists: • Check/confirm need for night-guard• Help plan/price reconstructive work• Convince patient of need for dental protection• Dental-sleep: help decide on best oral appliance for
sleep apnea therapy.
• Sleep labs: rule-out Bruxism due to CPAP therapy
• GP: Differential diagnosis for non-specific orofacial pain/ headaches/ migraines
• Dental surgeons: Screening for bruxism before implants
BiteStrip markets (2)
• Research: epidemiological studies• Psychologists: screening for Bruxism as part of
anti-stress therapy• TMJ experts: Differential diagnosis in TMJ
patients
• CPAP users: rule-out Bruxism due to CPAP therapy
• Pain clinics: Differential diagnosis in migraine/non-specific orofacial pain patients.
Thank you
For your time and consideration