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Fig. 3. SDA, up to and including the second premolars [after ref. 12]. Tooth Loss, Occlusal Instability and Bruxism Occlusal disharmony was believed to precipitate bruxism [29], which, in turn, could be relieved by occlusal modification [30]. Since occlusal instability arising from tooth loss was at one time considered a likely cause of occlusal disharmony [26], missing teeth were replaced in order to treat, or indeed prevent, bruxism. However, nocturnal bruxism is an innate activity of central origin [31], which may be classified as a stress-related sleeping disorder [32, 33].

If the patient is willing to make an attempt to quit, dentists should assist the patient. If a patient is not at all interested in stopping it is, in my view, rarely beneficial to push the patient. Instead, the dentist should accept the patient’s decision and make a note in the record for future reference. Dentists should ensure that the patient is aware of the staff’s willingness to help, for instance by providing the patient with written information or/and asking the patient in a subsequent visit to reconsider his or her decision.

In many ways, the growing number of older, partially dentate individuals presents a mounting challenge for prosthodontic management. On the one hand, fewer of 38 Med Princ Pract 2003;12(suppl 1):33–42 Omar sion up to the first molars, or 8 occlusal units (molars counting as 2 units), is then recommended [25]. In complex treatment plans, the SDA approach offers the alternative of less treatment, which is also less complicated, less time-consuming and less expensive. Whether or not the results are inferior to that of the full-scale reconstructive approach has not been demonstrated.