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PubMed2005

The effect of bilateral lingual nerve anesthesia and increased occlusal vertical dimension on the onset of swallowing in adult males.

The present study attempts to determine whether the onset of swallowing is affected by bilateral lingual and inferior alveolar nerve anesthesia and by raising the occlusal vertical dimension by wearing an occlusal bite plate. Twenty young male volunteers were selected and asked to chew and swallow corned beef and a corned beef and liquid mixture in their usual manner before and after modifications were made. Oral and pharyngeal swallowing was investigated using videofluoroscopic examination in the lateral plane. Eight objective indicators, including oral containment time, swallowing threshold, and pharynx-to-swallow intervals were estimated. Oral containment time, total sequence duration, total number of chews, and total number of swallows of the two test foods were significantly different before and after the modifications. Individual pharynx-to-swallow intervals also varied. The results indicate that modification of the masticatory condition affects the onset of swallowing and that changes in the onset varied among the participants.

Adult↗
PubMed2005

Anterior repositioning appliance therapy for TMJ disorders: specific symptoms relieved and relationship to disk status on MRI.

Forty-eight (48) consecutive patients seeking treatment in a referral based practice for complex chronic painful temporomandibular joint (TMJ) disease were enrolled in a prospective study to assess specific symptom relief from anterior repositioning appliance (ARA) therapy and the relationship between specific symptom relief and the status of the TMJ disk. Each patient was assessed on 86 symptoms based upon whether each symptom was present before treatment and absent, better, unchanged or worse after Maximum Medical Improvement (MMI). The most common symptom was occipital cephalalgia (94%). The least common symptom was pain and burning of tongue (8%). A profile of a temporomandibular disorder (TMD) patient was developed. The typical TMD patient has cephalalgia, mainly in the occipital, temporal and frontal region, pain upon chewing food, pain upon opening and closing the mouth, TMJ pain, pain in the back of the neck and difficulty chewing food. Before treatment, patients with bilateral displaced disks had more symptoms than those with unilateral displaced disks and the opposite side normal. After MMI, the maximum benefit (percent of pretreatment symptoms relieved) was found in patients with normal or recaptured disks. The minimum occurred in patients whose disks did not recapture with therapy. ARA therapy improved or eliminated symptoms in all patients in the study.

Adolescent↗
PubMed2005

An electromyographic study of masseter and anterior temporalis muscles in extra-articular myogenous TMJ pain patients compared to an asymptomatic and normal population.

The purpose of this study was to evaluate the effectiveness of the therapy with a centric relation stabilization appliance (CRSA) in patients with temporomandibular disorders of myogenous origin by electromyography and compare the results with two asymptomatic control groups. Three groups of 20 patients each were selected for the study. Electromyography (EMG) of masseter and anterior temporalis muscles was performed during mandibular rest position. In the treated group, the occlusal appliance reduced the electrical activity of the analyzed muscles at right and left sides (p<0.0001), and equilibrated muscular activity between right and left sides (p<0.0001), reaching values close to the control groups. Although there was not a statistically significant difference, the normal control group presented lower EMG values than control group II and presented the lowest asymmetry index of all subjects. More than 85% of all subjects, including the controls, demonstrated a statistically significant temporal anterior activity prevalence (p<0.0001). Treatment with the CRSA reduced the activity index, although the prevalence of the temporal muscle over the masseter was maintained. The significant laterodeviating (torque) effect found in the temporomandibular disorder patients was reduced after treatment. No side prevalence was found in the control groups.

Adult↗
PubMed2005

Effect of interocclusal appliance on masticatory performance of patients with bruxism.

This study was designed to evaluate masticatory performance in bruxist patients. The experimental group was composed of 16 dentate volunteers presenting with bruxism and treated by interocclusal appliances and a control group, consisting of 16 dentate volunteers with no symptoms of bruxism. To evaluate masticatory performance, the volunteers chewed .03 grams of peanuts contained in polyvinyl wrapper for four and twelve masticatory cycles. The number of chewed particles was counted using an optical scanning method by Image-Pro Plus 1.4 software (Media Cybernetics, Inc., Silverspring, MD). The score was expressed as the mean of the number of chewed particles for each wrapper. Masticatory performance evaluations were carried out in a single period for the control group and for the experimental group, before interocclusal appliance insertion, and after seven, 15, 30, and 60 days. Comparison between groups, as well as between before and after interocclusal appliance insertion, showed no significant differences (P>.05), irrespective of the number of masticatory cycles.

Adult↗
PubMed2005

Effect of short-term use of a centric occlusion stabilization oral appliance on sensory and pain perception thresholds in the cervically innervated area: a pilot study.

This preliminary study was done to determine the effect of short-term use of a centric occlusion stabilization oral appliance with regard to noxious and sensory perception in the upper extremities. The subjects consisted of 22 asymptomatic females, and the experiments were performed on two separate days within the same week, with the days randomly assigned as either appliance-wearing or nonappliance-wearing days. For each experimental day, cool sensation, warm sensation, cold-induced pain and heat-induced pain were measured using a computer-based quantitative testing device, and these thresholds were compared between the experimental days with or without the oral appliance. We found that during the experimental day wearing an oral appliance, subjects had significantly higher thresholds for warm sensation and heat-induced pain. There was no statistical difference between the testing days in cool sensation or cold-induced pain thresholds. These findings indicate that short-term wearing of a centric occlusion stabilization oral appliance may inhibit some noxious and sensory inputs from cervically innervated structures, which are primarily served by unmyelinated C fibers, and that oral appliances may be appropriate for the treatment of painful cervical disorders.

Adolescent↗
PubMed2005

Full-mouth rehabilitation following treatment of temporomandibular disorders and teeth-related signs and symptoms.

The literature is replete with theories regarding temporomandibular disorders (TMD). However, there is a paucity of information concerning perceived malocclusion and other teeth-related signs and symptoms after full-mouth rehabilitation. This clinical study was designed to evaluate the perception of TMD patients concerning perceived malocclusion and other teeth-related signs and symptoms after full-mouth rehabilitation guided by the Mental Analog Scale (MAS). Among 38 patients referred for full-mouth rehabilitation, 20 were diagnosed as having TMD after reviewing a questionnaire, recording the major complaints and symptoms, in addition to performing comprehensive clinical examination. Nonsurgical therapy was performed, including fabricating an anterior programming device, a centric relation occlusal device and finally full-mouth rehabilitation by means of placing crowns on all upper and/or lower teeth. All full-mouth rehabilitation procedures were performed using a fully adjustable articulator and mandibular movements were recorded following pantographic tracings. After full-mouth rehabilitation, the patients were followed up at 1, 2, 4, 6, 9, and 12-month intervals, and the major signs and symptoms were recorded along with adjunctive teeth-related signs and symptoms. Fisher exact probability tests were applied to analyze the results (P<.05). Statistical comparisons of the MAS responses before and after treatment (at 1-month recall) showed significant improvement (P<.05) for all teeth-related signs and symptoms except for bruxism (P=.0699). Further improvement was noted at the 4-month recall period. However, these improvements were not statistically significant for all teeth-related signs and symptoms. No further change was noted after the 4-month recall period. There was a marked reduction in perceived malocclusion and adjunctive teeth-related signs and symptoms during function, only after performing occlusal equilibration of the final restorations.

Adult↗
PubMed2000

Extensive temporal bone pneumatization: incidental finding in a patient with TMJ dysfunction.

An 18-year-old male presented with symptoms of temporomandibular joint dysfunction. A panoramic radiograph revealed slight erosion of the condylar heads, and an incidental finding of multilocular radiolucencies in the zygomatic processes of the right and left temporal bones. CT scans were undertaken to exclude any sinister cause. The radiolucencies were shown to be extensive bilateral pneumatization of the temporal bones. Conservative management relieved the symptoms of TMJ dysfunction.

Adolescent↗
PubMed2001

Lip-biting in patients with profound neuro-disability.

Profound neuro-disability due to severe brain damage affects approximately 1200 people per year in the UK. Approximately half of these patients exhibit exaggerated or abnormal oral reflexes. Biting, bruxism and ruminating movements may result in dental or soft tissue trauma, with severe lip or tongue lacerations. This paper describes 10 patients referred to the dental department at the Royal Hospital for Neuro-disability with lip bites and/or severe bruxism, during a 12-month period. Management options include: monitoring the lesion; smoothing teeth; providing a bite raising appliance; or extracting teeth. This paper discusses the difficulty in management of lip trauma in this group of patients and emphasizes the importance of an interdisciplinary approach.

Adult↗
PubMed2001

A question of space: options for the restorative management of worn teeth.

The prevalence of tooth surface loss has increased in recent years. The essence of management is an effective preventive regime; however, in many instances restoration may also be necessary. A number of strategies is available for creating sufficient space to enable restoration and several techniques for restoration known. This article reviews the significance of the vertical dimension of occlusion and describes the restorative management of a patient affected by severe tooth wear.

Adult↗
PubMed2001

Snoring, sleep apnoea and the role of dental appliances.

This article describes the problems of snoring and obstructive sleep apnoea, together with an outline of treatment options. The Glasgow approach, whereby patients are investigated at a sleep clinic and a custom-made mandibular advancement device is made in semi-soft material, is also described. We have demonstrated the acceptability and effectiveness of a simple appliance in patients with varying dental states, some with simple snoring and some with mild to moderate sleep apnoea. Our experience relates to around 260 patients, extending over a period of 4 years with good success. The simple intraoral device is recommended as a first line of approach for patients with problem snoring.

Equipment Design↗
PubMed2002

Restorative management of the worn dentition: I. Aetiology and diagnosis.

In this, the first of a four-part series on the restorative management of the worn dentition, the aetiological factors, diagnosis of toothwear and preventive measures are summarized. Later papers will deal with the management of localized anterior and posterior toothwear, the use of 'Dahl type' appliances as an effective means for the restorations and the various treatment options for the management of the dentition showing generalized wear. The series will discuss the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition.

Acids↗
PubMed2002

Restorative management of the worn dentition: 4. Generalized toothwear.

This is the final paper of a four part series on the management of worn dentition. The factors affecting the selection of restorative techniques for generalized toothwear, such as pulpal vitality, jaw relationship and occlusal guidance are discussed. The practical steps of oral rehabilitation using fixed prostheses are illustrated with two clinical cases.

Aged↗
PubMedDate not supplied

Dental appliances for snoring and obstructive sleep apnoea: construction aspects for general dental practitioners.

The medical and dental aspects of management for patients diagnosed with snoring and obstructive sleep apnoea are well documented. However, guidance for treatment by the general dental practitioner is lacking. This article reviews aspects of appliance provision and presents the use of a silicone material in an attempt to improve the longevity of a recognized prosthesis.

Acrylic Resins↗
PubMed1996

OA for OSA.

Explore the source record for details and available documents.

Humans↗
PubMed1996

A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea.

STUDY OBJECTIVE: To compare efficacy, side effects, patient compliance, and preference between oral appliance (OA) therapy and nasal-continuous positive airway pressure (N-CPAP) therapy. DESIGN: Randomized, prospective, crossover study. SETTING: University hospital and tertiary sleep referral center. PATIENTS: Twenty-seven unselected patients with mild-moderate obstructive sleep apnea (OSA). INTERVENTIONS: There was a 2-week wash-in and a 2-week wash-out period, and 2 x 4-month treatment periods (OA and N-CPAP). Efficacy, side effects, compliance, and preference were evaluated by a questionnaire and home sleep monitoring. MEASUREMENTS AND RESULTS: Two patients dropped out early in the study and treatment results are presented on the remaining 25 patients. The apnea/hypopnea index was lower with N-CPAP (3.5 +/- 1.6) (mean +/- SD) than with the OA (9.7 +/- 7.3) (p < 0.05). Twelve of the 25 patients who used the OA (48%) were treatment successes (reduction of apnea/hypopnea to <10/h and relief of symptoms), 6 (24%) were compliance failures (unable or unwilling to use the treatment), and 7 (28%) were treatment failures (failure to reduce apnea/hypopnea index to <10/h and/or failure to relieve symptoms). Four people refused to use N-CPAP after using the OA. Thirteen of the 21 patients who used N-CPAP were overall treatment successes (62%), 8 were compliance failures (38%), and there were no treatment failures. Side effects were more common and the patients were less satisfied with N-CPAP (p < 0.005). Seven patients were treatment successes with both treatments, six of these patients preferred OA, and one preferred N-CPAP as a long-term treatment. CONCLUSIONS: We conclude that OA is an effective treatment in some patients with mild-moderate OSA and is associated with fewer side effects and greater patient satisfaction than N-CPAP.

Adult↗
PubMed2006

Autonomic cardiac modulation in obstructive sleep apnea: effect of an oral jaw-positioning appliance.

BACKGROUND: Patients with obstructive sleep apnea (OSA) are characterized by deranged cardiovascular variability, a well-established marker of cardiovascular risk. While long-term treatment with continuous positive airway pressure leads to a significant improvement of cardiovascular variability, little is known of the possibility of achieving the same results with other therapeutic approaches. The aim of our study was to investigate the responses of autonomic indexes of neural cardiac control to another type of OSA treatment based on an oral jaw-positioning appliance. METHODS: In 10 otherwise healthy subjects with OSA (OSA+) and in 10 subjects without OSA (OSA-) we measured heart rate, BP, and indices of autonomic cardiac regulation derived from time-domain and spectral analysis of R-R interval (RRI), before and after 3 months of treatment with the oral device. High-frequency (HF) power of RRI was taken as an index of parasympathetic cardiac modulation, and the ratio between low-frequency (LF) and HF RRI powers as an indirect marker of the balance between sympathetic and parasympathetic cardiac modulation. RESULTS: At baseline, in comparison with OSA- subjects, OSA+ subjects displayed a significantly lower RRI variance (p < 0.02) and reduced HF RRI powers (p < 0.001). After 3 months of treatment with the oral device, the OSA+ group showed a marked reduction in apnea-hypopnea index (p < 0.001), a lengthening in RRI and a significant increase in its variance (p < 0,02), an increased HF RRI power (from 134 +/- 26 to 502 +/- 48 ms2, p < 0.001), and a reduction in LF/HF RRI power ratio (from 3.11 +/- 0.8 to 1.5 +/- 0.5). As a result of these changes, after the 3-month treatment there were no more significant differences between the two groups in these parameters. In both OSA+ and OSA- groups, body weight, heart rate, and BP did not change over time. CONCLUSIONS: Three months of treatment with a specific oral jaw-positioning appliance improves cardiac autonomic modulation in otherwise healthy patients with OSA of mild degree.

Adult↗
PubMed1993

Managing obstructive sleep apnea.

Obstructive sleep apnea, cessation of breathing during sleep, is potentially life threatening and requires prompt intervention. A prosthesis can reposition the mandible during sleep and minimize or prevent the tongue from collapsing against the pharynx. Two case reports discuss the effectiveness of prosthetic devices.

Aged↗