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Evidence-based care, using principles of clinical epidemiology, promises to alter the treatment of chronic musculoskeletal facial pain. With use of a set of "rules of evidence," research studies may be rigorously evaluated. Clinicians can master this methodology, which may usher in a paradigm shift in clinical care.
OBJECTIVE: Evaluation of the characteristics and dental treatments in a Brazilian series of idiopathic trigeminal neuralgia (ITN) patients. STUDY DESIGN: Forty-eight subjects with ITN were interviewed and evaluated according to a systematized approach. RESULTS FINDINGS: (a) location of the trigger zone, intraoral in 64.58%; (b) comorbidities, 18 patients (hypertension in 9); (c) treatment with dental procedures for ITN according to duration of pain (31), 44.44% (during the first year), 50.00% (1-5 years), 80.00% (5-10 years), and 100.00% (>10 years). There was no correlation between trigger zone location and the frequency of previous dental procedures (P=.667). There was significant statistical correlation between the number of patients who underwent dental treatments and the duration of ITN (P=.004). CONCLUSION: (a) Demographic characteristics of this sample are similar to those described in the literature, (b) the dental procedures were not correlated with location of trigger zone, and (c) patients with long-lasting ITN had more number of previous dental procedures.
The aims of this retrospective study were to assess the effect of a Karwetzky mandibular protrusion appliance for treating patients with mild, moderate, and severe obstructive sleep apnea. Eighty-one of 116 patients (69.8%) suffering from obstructive sleep apnea were treated with an activator model according to Karwetzky. After 4 months (SD 4.0 months) treatment outcome was controlled by polysomnography. Therapeutic outcome depended on the severity of obstructive sleep apnea. The median apnea-hypopnea index decreased from 10.6 events/h (range 2.0-14.9) to 5.8 events/h (range 0.2-17.3, P<0.01) in the mild group, from 21.7 events/h (range 17.3-28.4) to 7.7 events/h (range 1.0-30.1, P<0.001) in the moderate group, and from 42.1 events/h (range 33.2-64.9) to 18.1 events/h (range 2.4-48.8, P<0.001) in the severe group. Sleep variables did not show consistent improvement except for a trend towards more REM sleep and slow-wave sleep. The numbers of retentive teeth did not statistically influence treatment efficacy. Comparing the pre- and post-treatment polysomnographic variables, it was found that the respiratory events rather than sleep stages were significantly reduced by the Karwetzky appliance investigated.
Masticatory function can be impaired by craniomandibular disorders. The aim of this study was to assess masticatory performance in patients with an anterior disc displacement (ADD) without reduction. In the experiments, 29 patients and 33 age- and gender-matched volunteers chewed artificial test food for 60 chewing strokes. The collected remains of the test food were filtered, dried, fractionated by a sieving procedure, and weighed. The particle size distribution was then described using a cumulative distribution function. Patients and controls were clinically examined, and patients were asked to complete a pain questionnaire. Comparison with controls, patients showed significantly reduced masticatory performance. Patients that had had a disorder longer than 3 yr tended to display less reduction of their masticatory performance. Neither the treatment methods used, nor restriction of daily life activities or pain intensity were significantly correlated with masticatory performance. Jaw mobility was significantly reduced in patients. More than half of the patients and none of the controls had joint noises and trigger points in the masticatory muscles. Pain was present, in particular, during chewing and maximal opening of the mouth. It was concluded that patients with ADD without reduction have a significantly reduced masticatory performance.
The sleep apnoea/hypopnoea syndrome (SAHS) is characterized by repeated upper airway narrowing or collapse during sleep. The obstruction is caused by the soft palate and/or base of tongue collapsing against the pharyngeal walls because of decreased muscle tone. These episodes are accompanied by hypoxaemia, surges in blood pressure, brief arousal from sleep and pronounced snoring. Individuals with occult disease are at heightened risk of motorway accidents because of excessive sleepiness, sustained hypertension, myocardial infarction, and stroke. The signs and symptoms of SAHS may be recognisable in the dental practice. Common findings in the medical history include daytime sleepiness, snoring, hypertension, and type 2 diabetes mellitus. Common clinical findings include male gender, obesity, increased neck circumference, excessive fat deposition in the palate, tongue (macroglossia) and pharynx, a long soft palate, a small recessive mandible and maxilla, and calcified carotid artery atheromas on panoramic and lateral cephalometric radiographs. Dentists who recognise these signs and symptoms have an opportunity to diagnose patients with occult SAHS. After confirmation of the diagnosis by a physician, dentists can participate in the management of the disorder by fabricating mandibular advancement appliances that enlarge the retroglossal space by anterior displacement of the tongue and performing corrective upper airway surgery that prevents recurrent airway obstruction.
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This study aimed to evaluate the relationship between the nocturnal wearing of an acrylic appliance of 2 mm thickness covering all occlusal surfaces of the teeth and the frequency of attacks of migraine. Nineteen patients were studied and all fulfilled accepted criteria for migraine with or without aura. Two appliance designs were employed, one covering the maxillary occlusal surfaces of the dentition and another which contacted the palatal mucosa only and was free of the occlusion. Treatment outcome was expressed as the number of attacks of migraine per week per patient. The occlusal cover appliance reduced the number of attacks on average to about 40% of that normally experienced. The improvement was most marked in those who had frequent attacks of migraine ie two attacks per week on a regular basis. In summary, acrylic appliance therapy is of value in migraineurs who have attacks on waking but the appliance design has to involve covering of the occlusal surfaces of all of the teeth.
OBJECTIVE: To determine the effectiveness and acceptability of an intra-oral appliance in the reduction of snoring, with construction and fitting as a 1-visit process. DESIGN AND SETTING: This was a prospective study. Patients were attending a hospital sleep breathing disorders clinic and appliances were made at a dental hospital. This work was carried out in the UK during 1996 and 1997. SUBJECTS AND METHODS: Patients were selected from those referred to a sleep breathing disorders clinic with socially disruptive snoring. MAIN OUTCOME MEASURES: Patients were assessed by means of limited sleep studies and by questionnaires before and after fitting of the appliances. The sleep studies consisted of monitoring respiratory variables (principally oronasal airflow and nocturnal oxygen saturation). A respiratory disturbance index was assigned. Questionnaires were completed by both patients and sleep partners, with many of the responses being marked on visual analogue scales. RESULTS: 16 male patients, mean age 49 years, were included in the trial. 14 were able to wear the appliance and their level of snoring, as assessed by their sleep partners, reduced from a mean of 8.8 out of 10 to 4.2 out of 10 (P = 0.0003, paired t-test). CONCLUSION: It is concluded that the semi-flexible intra-oral appliance is effective in the control of snoring.
Obstructive sleep apnoea (OSA) is a potentially fatal breathing disorder, yet is widely under-diagnosed. It is a multi-factorial condition associated with high morbidity, a degree of mortality and is associated with an increase risk of car crashes. A case is presented which demonstrates the inter-disciplinary approach to this condition and the successful treatment through mandibular advancement by orthodontic means followed by orthognathic surgery. The experience of this patient illustrates the importance of the disciplines of orthodontics and oral and maxillofacial surgery in the multi-disciplinary management of these patients.
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The term 'phantom bite' is used to describe an uncommon condition in which patients are preoccupied with their dental occlusion, believing that it is abnormal. The condition is remarkable for the nature of the involved explanations and interpretations that the patients give and for their persistence in trying to find a solution to what appears to be a relatively minor problem. Three clinical cases that illustrate the nature of this condition are presented and problems associated with the management of affected patients are discussed. Phantom bite can be a disabling disorder which is difficult to treat. Available evidence suggests that the symptoms cannot be improved by occlusal treatments. It is therefore essential to avoid extensive irreversible restorative treatment. General dental practitioners should refer patients for specialist opinion and management. Psychiatric assessment with recommendations for management should be obtained if possible. The prognosis is poor for symptom elimination but need not necessarily be poor for patients' overall functioning and well-being. It is suggested that emphasis should be placed on building adaptive coping skills. Further research is needed to elucidate the nature of the condition to improve treatment.
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