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PubMed2004

Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea.

OBJECTIVE: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. SUBJECTS: Twenty-five patients aged 66 +/- 8 years (mean +/- SD) met the inclusion criteria and were included in the study. DESIGN: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months, and 1 year after intervention. RESULTS: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 +/- 12.1 to 11.8 +/- 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by 10 patients. Dental complications were observed in two patients. Sixty-four per cent of the patients were still using the MAD at the 1-year follow-up. CONCLUSIONS: Both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.

Adult↗
PubMed2004

Role of occlusion in endodontic management: report of two cases.

The two clinical cases reported demonstrate that traumatic occlusion can play a role in the initiation and progression of pulp and periradicular inflammation. The symptom of persistent pain did not subside after the commencement of endodontic treatment. Traumatic occlusion was identified in both cases to be the main cause and hence occlusal adjustment was performed. This resulted in the gradual resolution of the symptoms. The findings suggest that occlusal trauma is often overlooked in the diagnosis and management of endodontic diseases.

Adult↗
PubMedDate not supplied

Self-inflicted oral trauma: report of case.

Self-inflicted oral trauma is often encountered in patients who lack cerebral control over the masticatory cycle. Many factors must be considered in treatment, and a variety of appliances may be fabricated to prevent injury to oral structures. This case report documents the use of a soft acrylic appliance in treatment of a comatose patient who showed ruminatory reflex chewing.

Adult↗
PubMedDate not supplied

General and oral characteristics in Rett syndrome.

Rett syndrome (RS) is a neurodegenerative disorder characterized by developmental arrest of parts of the brain. It is an X chromosome-linked condition which affects females almost exclusively. Recent reports have been generated concerning the multidisciplinary management of individuals exhibiting Rett syndrome. The aim of the present report was to provide an update on the oral manifestations of the disorder. We evaluated the general and oral characteristics of RS in 13 female patients. The most frequent manifestations were stereotyped hand movements and bruxism. The treatment we carried out included the use of biteplanes and acupuncture.

Acupuncture Therapy↗
PubMed1996

Dentistry's role in obstructive sleep apnoea. Review and case report.

Obstructive sleep apnoea (OSA) has been associated with many life-threatening conditions but has only recently appeared in the dental literature. Dental appliances and orthognathic surgery are two strategies which are currently used in the treatment of sleep apnoea. This article provides a background on OSA and these treatment approaches, and discusses the potential risks and benefits of each. A case is reported to illustrate the use of a dental appliance in the treatment of OSA.

Adult↗
PubMed1996

Efficacy of arthroscopic surgery and midlaser treatments for chronic temporomandibular joint articular disc derangement following motor vehicle accident.

As a result of motor vehicle accident soft-tissue injury, temporomandibular joint articular disc derangement may develop and persist despite symptomatic treatment and medication. This study reports the effectiveness of management directed at controlling the TMJ and masticatory neuromuscular pain dysfunction with a TMJ/interocclusal stabilization appliance, specific biofeedback and ultrasound therapy. Following these conservative measures residual articular disc derangement was present in some subjects who were offered arthroscopic surgery and infrared midlaser with TMJ/occlusal stabilization. Twenty subjects with residual disc derangement were randomly selected into two groups with and without arthroscopic surgery, and analyses of variance made before treatment, 12 months after conservative procedures, 3 months following arthroscopic surgery and midlaser therapy and 3 years since commencement of management. Dependent variables compared were pain-discomfort, Clinical Dysfunction Index, articular disc derangement and maximal voluntary jaw opening. Conservative management alone provided significant reduction of pain-discomfort and clinical dysfunction, while arthroscopic surgery resulted in significant reduction in articular disc derangement. The midlaser with TMJ/occlusal stabilization maintained significant improvement in the variables (p < 0.01) for both groups. The common articular deviations in form found at arthroscopy were soft tissue alteration with hyperaemia, synovitis, synovial membrane and posterior attachment folding with connective tissue hyperplasia, and disc displacement with fibrous adhesions. The Global Status Score of pain behaviour compared with residual function, confirmed the presence of greater pain before treatment commenced.

Accidents, Traffic↗
PubMed2001

The effect of interocclusal appliances on temporomandibular joints as assessed by 3D reconstruction of MRI scans.

Magnetic resonance imaging (MRI) enables simultaneous visualization of hard and soft tissues. The aims of the present study were to computer generate three-dimensional (3D) images, reconstructed from MRI scans of normal temporomandibular joints (TMJ), to assess the relative positions of the disc, condyle and articular surface of the temporal bone and to study the effect of two mandibular group function interocclusal appliances (IOAs). Bilateral MRI scans of 2 mm slice thickness were generated for the TMJs of 12 asymptomatic subjects with the image acquisition coils orientated in a corrected oblique sagittal plane. MRI scans were generated for all subjects with 3 mm interincisal distance IOAs, while a subgroup (n = 4) was also scanned with a 5 mm interincisal IOA in situ. An average of 10 slices through each TMJ were generated for the closed mouth and IOA positions. Three-dimensional reconstruction was performed on a 486 IBM compatible computer using a suite of nine programs not commercially available. Three-dimensional images allowed visualization of composite images of joint relationships. Subjective assessment indicated that joint relations in 3D were more informative than multiple separate 2D MRI scans. With the 3 mm IOA in situ, the disc was positioned posteriorly and superiorly to the condyle in three of 12 cases. In four of 12 cases the condyle, and in two of 12 cases both the disc and condyle, were positioned anteriorly and inferiorly. With the 5 mm IOA changes in condyle/disc and condyle/fossa relationships were more variable. It was concluded that 3D images of TMJs enabled the assessment of the positional changes of the condyle/disc and condyle/fossa relationships as altered by IOAs. However, the role of IOAs on the internal arrangements within the TMJ remains variable and is deserving of further study.

Adult↗
PubMed2002

Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion.

To evaluate the clinical usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children, we studied 32 patients (mean age, 7.1 +/- 2.6 yr; 20 males) with symptoms of obstructive sleep apnea, malocclusion, and a baseline apnea index > 1 event/h. A group of 19 subjects was randomly assigned to a 6-mo trial of an oral appliance; the remainder acted as control subjects. At baseline and after the trial all patients underwent physical examination, a standard polysomnography, and orthodontic assessment. A modified version of the Brouillette questionnaire related to obstructive sleep apnea symptoms was administered to parents before and after the trial and a clinical score was calculated. Of the 32 subjects enrolled, 4 treated subjects and 5 control subjects were lost to follow-up. Polysomnography after the trial showed that treated subjects all had significantly lower apnea index (p < 0.001) and hypopnea index values (p < 0.001) than before the trial, whereas in untreated control subjects these values remained almost unchanged. Clinical assessment before and after treatment showed that in 7 of the 14 subjects (50%) the oral appliance had reduced (a fall of at least 2 points in the respiratory score) and in 7 had resolved the main respiratory symptoms, whereas untreated patients continued to have symptoms. In conclusion, treatment of obstructive sleep apnea syndrome with an oral appliance in children with malocclusion is effective and well tolerated.

Anthropometry↗
PubMed2002

One-night mandibular advancement titration for obstructive sleep apnea syndrome: a pilot study.

The effect of a dental appliance (DA) is usually evaluated in a single mandibular position reached after several weeks and corresponding to either improvement of symptoms or intolerance to any further advancement. The purpose of this study was to test the feasibility of one-night evaluation of the efficacy of a DA. The study population consisted of seven patients (six men) with obstructive sleep apnea syndrome (66.9 +/- 32.4 apneas and/or hypopneas per hour). Patients underwent two consecutive polysomnographies; first with a temporary DA (two arches connected by a hydraulic system) progressively adjusted during the night to correct sleep disordered breathing and second with a permanent DA (two arches connected by Herbst attachments) set to the effective degree of advancement during the titration night. All patients completed the protocol. The mean mandibular advancement reached during the titration night was 12.6 +/- 2.7 mm. Arousal was never observed during or for 60 seconds following advancement. The apnea-hypopnea index (AHI) was significantly reduced from 66.9 +/- 32.4 to 26.1 +/- 20.7 per hour during the titration night from the diagnostic night (p < 0.01). During the second night, the AHI was 19.6 +/- 20.2 per hour and was less than 20 per hour in 71.4% of patients and less than 10 per hour in 42.9% of patients. The efficacy of a DA can be evaluated during a single night of polysomnography.

Adult↗
PubMed2001

Randomized controlled evaluation of non-surgical treatments for temporomandibular joint anterior disk displacement without reduction.

The common methods for treating anterior disk displacement without reduction (ADDwor) are not based on randomized controlled clinical trials. Our study evaluated non-surgical treatments in 69 MRI-confirmed ADDwor subjects (m/f = 6/63). Subjects were randomly assigned to a control group and one of two treatment groups. Outcomes included maximum mouth opening, visual analogue scale of pain, and daily activity limitation. Calibrated examiners collected data at the initial interview and at 0, 2, 4, and 8 weeks of treatment. At the eight-week point, within-group improvements were present for all variables, for all groups. Between-group differences were not highly evident, with only mean daily activity limitation for the self-care/NSAID group being significantly lower than that of the occlusal appliance/jaw mobilization + self-care/NSAID group at the two- and four-week time-points. These results suggest that ADDwor subjects will improve with only minimal treatment intervention, and no significant difference was evident for the treatments tested and the control condition.

Activities of Daily Living↗
PubMed2003

Occlusal and TMJ loads in subjects with experimentally shortened dental arches.

To determine whether shortened dental arches (SDAs) cause functional overloading of the teeth and the temporomandibular joints, which has been implicated in periodontal diseases and temporomandibular disorders, we investigated the influences of SDA on occlusal and joint loads. Bite force and masticatory muscle electromyograms were recorded in five dentate subjects who clenched maximally on intra-oral appliances, creating symmetrical SDAs experimentally. Muscular forces estimated from the recorded electromyograms were fed into a finite element jaw model for calculating bite forces and joint loads. Comparison between the measured and the calculated bite forces ensured that the joint loads were representative. The bite force on each tooth increased with missing molar occlusions, while joint loads decreased. The bite force per root surface area was always greatest on the most posterior tooth, and these values were most constant. The findings provide no evidence that SDA causes overloading of the joints and the teeth, which suggests that neuromuscular regulatory systems are controlling maximum clenching strength under various occlusal conditions.

Adaptation, Physiological↗
PubMed2003

An involvement of trigeminal mesencephalic neurons in regulation of occlusal vertical dimension in the guinea pig.

Although the occlusal vertical dimension (OVD) is strictly controlled, the neuronal mechanism of its regulation is still unclear. We hypothesize that neurons in the trigeminal mesencephalic nucleus (MesV) play an important role in the regulation of the OVD, because the MesV receives the projection from jaw-closing muscle spindles and periodontal mechanoreceptors. We measured the temporal OVD change in the guinea pig to study the effects of MesV lesions on the OVD. OVD-raised animals without MesV lesions showed a rapid OVD decrease to the same level as that in naïve controls, followed by an OVD increase after the OVD-raising appliance was removed. In contrast, OVD-raised animals with MesV lesions showed only a slight decrease in the OVD for 15 days after removal of the appliance, and then the OVD increased. The time-course of OVD development in normal-bite animals with MesV lesions was similar to that of naïve controls. These results suggest that MesV neurons are involved in OVD regulation.

Animals↗
PubMed2007

Randomized effectiveness study of four therapeutic strategies for TMJ closed lock.

For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p > or = 0.33) or SSI (p > or = 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.

Adolescent↗
PubMed2004

Efficacy and co-morbidity of oral appliances in the treatment of obstructive sleep apnea-hypopnea: a systematic review.

The Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) is a common sleep-related breathing disorder characterized by repetitive obstructions of the upper airway during sleep. Modification of pharyngeal patency by Oral Appliance (OA) therapy has been suggested as an alternative to various treatment modalities for OSAHS. To determine the evidence base with respect to the efficacy and co-morbidity of OA therapy in OSAHS, we conducted a systematic review of the available literature. Primary outcome measures were the reduction in number of upper-airway obstructions and co-morbidity related to the craniomandibular or craniofacial complex, respectively. Eligible studies regarding efficacy were independently assessed by two assessors using a quality assessment scale. Effect sizes of methodologically sound studies were calculated. In identical interventions, effect sizes were pooled with the use of a random-effects model. Given the scarcity of controlled studies related to co-morbidity, appraisal was confined to a description of eligible studies. Sixteen controlled trials related to efficacy were identified. With respect to the primary outcome measure, OA therapy was clearly more effective than control therapy (pooled effect size, -0.96; 95% confidence interval [CI], -1.49 to -0.42) and possibly more effective than uvulopalatopharyngoplasty. Although patients generally preferred OA therapy, improvement of respiratory variables, such as the number of upper-airway obstructions, was usually better in Continuous Positive Airway Pressure (CPAP) therapy (pooled effect size, 0.83; 95% CI, 0.59 to 1.06). Moreover, specific aspects related to OA design may influence patient-perceived efficacy and preference. Twelve patient-series and one controlled trial related to co-morbidity were identified. Analysis of the data suggests that OA therapy may have adverse effects on the craniomandibular and craniofacial complex. Although CPAP is apparently more effective and adverse effects of OA treatment have been described, it can be concluded that OA therapy is a viable treatment for, especially, mild to moderate OSAHS. Controlled studies addressing the specific indication and co-morbidity of OA therapy are warranted.

Comorbidity↗
PubMed1996

Obstructive sleep apnoea: fact not fiction.

Obstructive sleep apnoea (OSA) is a recognized clinical disorder in which periods of cessation of breathing occur in the presence of inspiratory effort. Because this may have serious cardio-vascular and pulmonary consequences, diagnosis, and adequate treatment are important. Apart from its medical repercussions, OSA adversely affects the quality of life of both the sufferer and his family. This paper aims to give an overview of the complaint, defining and describing the disorder, reporting its signs and symptoms, and discussing its diagnosis and treatment. Particular attention will be given to those areas in which the orthodontist may play an active role.

Circadian Rhythm↗
PubMed2004

A longitudinal study of magnetic resonance (MR) evidence of temporomandibular joint (TMJ) fluid in patients with TMJ disorders.

It has been reported that joint effusion, the excessive accumulation of joint fluid in and around the joint, is related to temporomandibular joint (TMJ) disorders such as pain and disk displacement. However, there have been no longitudinal studies of this phenomenon. We performed a longitudinal study on the relationship between joint fluid and various pathological disk conditions. The subjects were 17 patients who visited our facility for orthodontic treatment and were diagnosed using MRI as having internal derangement of one or both TMJs (three males and 14 females; age 12-31 years; mean age 20.5 years). MRI was performed before, during, or after treatment for their disorders. We evaluated the relationship between changes in joint fluid in the joint space and the state of the disk, as well as the presence or absence of pain. Joint fluid was evaluated by classifying the extent of high-signal areas in the upper and lower articular cavities on T2-weighted images. The extent of high-signal areas was classified into five levels. Disk displacement and the extent of displacement were evaluated using proton density-weighted images. Statistical analysis was performed using the chi-square test, and differences in the distribution among the groups were examined. Effusion was noted on the first MRI in nine of the eleven joints (81.8%) in which joint fluid decreased on the second MRI (p<0.01). Displacement remained unchanged or worsened in 18 of the 21 joints (85.7%) that showed joint fluid on the first MRI (p<0.01). Pain was alleviated or absent in all joints in which the fluid decreased. These results suggest that joint fluid may be a factor in the outcome of disk recapture treatment as well as in the evaluation of pain.

Adolescent↗
PubMed2004

The effect of orthotic devices on freeway space.

After any orthotic device placement, there are three possible outcomes to the freeway space. The freeway space is either decreased, unchanged, or increased. The objective of this study was to determine what effect the placement of an orthotic device has on freeway space. Freeway space was measured in a group of 26 subjects immediately after placement of an orthotic device. In a second group of 26 subjects, freeway space was measured at least one week after placement of their orthotic devices. The freeway space was measured along the closing trajectory path during function. The number recorded was based on the actual measurement of the freeway space using a computer measuring device. Both sets of data were analyzed without taking into account other factors which may have influenced the freeway space. A Mann Whitney U test showed no significant differences between the two groups (Z = 0.027, P = 0.978 ). This study concluded that the thickness of an orthotic device does not necessarily increase or decrease freeway space.

Follow-Up Studies↗
PubMed2005

Relationship between habitual occlusal position and flat bite plane induced occlusal position in volunteers with and without temporomandibular joint sounds.

The aim of this study was to assess whether temporomandibular joint (TMJ) sounds are associated with the difference between the habitual occlusal position (HOP) and the bite plane induced occlusal position (BPOP). Fifteen dental technician school students who had complete natural dentition, normal occlusion and who exhibited TMJ sounds were compared with fifteen healthy control subjects. HOP was recorded by voluntary jaw closing while in an upright position, and BPOP was recorded after wearing an anterior bite plane for a short period of time. Three interocclusal records were obtained in both positions with a vinyl polysiloxane material, and the recorded maxillomandibular relations were analyzed three-dimensionally and compared. Subjects with TMJ sounds had statistically larger differences between HOP and BPOP than controls (p<.05). Within this study population, an association was found between TMJ sounds and the difference between HOP and BPOP.

Adolescent↗