Expert Q&A with: Dr. Amanda Phoon Nguyen
Amanda is an Oral Medicine Specialist in Perth, Western Australia. She is also a PhD candidate and adjunct senior lecturer at the University of Western Australia. Her clinical and research interests include orofacial pain, temporomandibular joint disorders, oral mucosal disease, dental sleep medicine and paediatric oral medicine. She is Treasurer of the Australian Dental Association (WA), the Editor, and an examiner for the Royal Australasian College of Dental Surgeons (RACDS), reviews and publishes in multiple journals, and has been on the WA Dental CPD committee for many years. Amanda believes in interdisciplinary teamwork and represents her specialty at multidisciplinary groups. She is heavily involved with various professional committees, and also dedicates her energy to supporting various community and volunteer causes. In particular, she loves making children smile by volunteering as a mascot of the local children’s hospital. Dr. Nguyen has served in the Royal Australian Navy as a Dental Officer for 3 years. She is also passionate about her speciality, regularly lecturing, running oral medicine interest pages and dental forums, and teaching at the University of Western Australia.
With stress increasing worldwide due to this pandemic, there is a correlated increase in bruxism. What advice do you offer patients to manage their teeth grinding?
From the 2018 International Consensus by Lobbezoo et al., in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences. Not all cases will need management.
In order to manage cases of bruxism, I encourage dentists to review the current evidence-based literature, attend quality CPD and to base their practices on good scientific literature. There are many unsolved issues concerning the etiology of bruxism itself, for example, contrary to popular belief, night-time bruxism is actually not as well-correlated with psychosocial factors and stress. Bruxers with jaw muscle pain also have been shown to have LESS bruxing episodes than bruxers with pain. With my patients, taking into account their age, I explore the type of bruxism they may have, determine the predominant behaviour in their type of bruxism, for example (clenching, bracing or grinding), look at possible associations (with differentiation between associations and causation!), and then assess the behaviour of a continuum before discussing any management. With proper patient discussion, most patients then understand why management has been recommended and the potential sequelae of non-management. I think my best tip there is to think of it as education rather than “convincing” them to have a night guard. If your patients understand the “why”, they are invested in their own health outcome and are empowered to take ownership of their diagnosis. I find clinical photographs to be a really useful aid!
Unfortunately, I do not believe management of this is as simple as providing one type of occlusal splint for all cases of suspected bruxism. Management is not always innocuous either, there is some literature on how provision of a maxillary occlusal splint can worsen sleep disordered breathing, and it is clear from the literature that occlusal adjustments to treat bruxism and temporomandibular joint disorders are very outdated and should not be done for this reason.
With routine dental check-ups coming to a halt due to this pandemic, many dentists began examining patients virtually. Do you see a future for tele-dentistry? Do you think it is possible to effectively diagnose oral diseases through pictures and videos, or do you think problems can easily go unnoticed?
Yes, I do think Teledentistry will become more of a reality at some point in the future. I think it has been in the works, simmering for some time, but the COVID-19 impetus really gave people the drive to make it accessible. I think it will be good for reducing one of the barriers to care. I was lucky enough to give a TEDx talk on this topic, which is available here: https://www.youtube.com/watch?v=jZBPPBgD_MI
Our medical colleagues use it well, and I know some dentists who implement its use in their practice, both pre and post COVID. Among some of our dental specialist colleagues, it has been used successfully for a while, for example in dentomaxillofacial radiology. There are limitations, but if we recognize these and work within them, Teledentistry has the power to change lives for some of our patients, especially those in remote or regional areas.
How was your experience serving as a dental officer in the Royal Australian Navy?
One of the things I loved best about serving in the Navy were the close relationships I formed with many of my team-mates, and some of us maintain our friendships to this day. It was a really bonding experience. The Australian Defence Force was really supportive, with providing great access to additional training and dental CPD, which I appreciated. The whole 6 months of officer training in HMAS Creswell was an experience for me, to this day I detest ironing and will trade much for the condensed milk in the ration packs!