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Yu M, Ma Y, Gong XU, Gao X. DENTAL AND SKELETAL CHANGES OF LONG-TERM USE OF MANDIBULAR ADVANCEMENT DEVICES FOR THE TREATMENT OF ADULT OBSTRUCTIVE SLEEP APNEA: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2024; 24:101991. [PMID: 39174171 DOI: 10.1016/j.jebdp.2024.101991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Mandibular advancement devices (MADs) are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA). Long-term use of MADs has been found to be associated with dental and skeletal changes. This study aims to conduct a systematic review and meta-analysis to improve knowledge about the dental and skeletal changes of long-term (>1 year) use of MADs for the treatment of OSA. MATERIAL AND METHODS Electronic databases were systematically searched. Two reviewers conducted screening, quality assessment, and data extraction independently. Thirty-four studies were included in the systematic review and 23 in the meta-analysis. RESULTS The mean change of overjet and overbite was -0.77mm (95%CI -1.01 to -0.53, P < .00001) and -0.64mm (95%CI -0.85 to -0.43, P < .00001), with progressive change over the treatment duration. The inclination of the upper incisor (U1/SN) and the lower incisor (L1/MP) showed a mean change of retroclined -2.10° (95%CI -3.93 to -0.28, P = .02) and proclined 1.78° (95%CI 0.63 to 2.92, P = .002), respectively. The mean change of the anteroposterior position of the mandible (SNB) was -0.33° posteriorly (95%CI -0.65 to -0.02, P = .04). CONCLUSIONS The meta-analysis showed a gradual decrease in overjet and overbite with treatment duration with long-term use of MADs for the treatment of OSA. Upper and lower incisors retroclined and proclined, respectively. The skeletal changes might include the mandibular position. Patients treated with MADs need to be continuously monitored over time.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, Haidian District, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, PR China; National Center for Stomatology, Beijing, Haidian District, PR China
| | - Yanyan Ma
- Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, Chaoyang District, PR China
| | - X U Gong
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, Haidian District, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, PR China; National Center for Stomatology, Beijing, Haidian District, PR China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, Haidian District, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, PR China; National Center for Stomatology, Beijing, Haidian District, PR China.
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Mansour N, Saade Y, Mora F, Bouchard P, Kerner S, Carra MC. Effect of mandibular advancement appliance use on oral and periodontal health in patients with OSA: a systematic review. Sleep Breath 2024; 28:1005-1017. [PMID: 38123720 DOI: 10.1007/s11325-023-02971-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
STUDY OBJECTIVES Use of a mandibular advancement appliance (MAA) is an effective treatment option for mild-to-moderate obstructive sleep apnea (OSA). MAA is well-tolerated but undesirable effects may be observed over time. The present systematic review aimed to assess the effect of MAA use on oral and periodontal health in patients with OSA. METHODS MEDLINE (PubMed), Cochrane, and Scopus were searched for randomized and non-randomized controlled trials (RCTs, NRCTs), cohorts, and case-control studies reporting on side effects of MAA treatment in OSA patients during a follow-up of at least 6 months. RESULTS From a total of 169 articles screened, 28 were selected. The most frequently reported MAA-related effects on oral health were: hypersalivation (weighted mean prevalence, 33.3%), occlusal changes (30.2%), muscle pain (22.9%), tooth discomfort or pain (20.2%), and xerostomia (18.3%). No MAA-related periodontal effect was reported. The periodontal status prior to MAA treatment was rarely assessed and described, but 5 studies (17.8%) stated that periodontitis was an exclusion criterion for MAA. Only one retrospective study specifically evaluated periodontal parameters and reported no significant changes in periodontally healthy patients with OSA using MAA for over 7 years. CONCLUSION MAA use is associated with a number of clinical consequences on oral health, but there is no evidence to conclude whether or not MAA affects periodontal health in patients with OSA. This aspect appears to be under-evaluated and should be further investigated in relation to the type of MAA, the duration of treatment, and prior history of periodontitis.
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Affiliation(s)
- Nathalie Mansour
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), UFR of Odontology, Université Paris Cité, Paris, France
| | - Yara Saade
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), UFR of Odontology, Université Paris Cité, Paris, France
| | - Francis Mora
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), UFR of Odontology, Université Paris Cité, Paris, France
| | - Philippe Bouchard
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), UFR of Odontology, Université Paris Cité, Paris, France
- URP, 2496, Montrouge, France
| | - Stephane Kerner
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), UFR of Odontology, Université Paris Cité, Paris, France
- Laboratory of Molecular Oral Physiopathology, Cordeliers Research Centre, Paris, France
- Department of Periodontology, Loma Linda University School of Dentistry, Loma Linda, CA, USA
| | - Maria Clotilde Carra
- Department of Periodontology, Service of Odontology, Rothschild Hospital (AP-HP), UFR of Odontology, Université Paris Cité, Paris, France.
- Centre for Research in Epidemiology and Statistics (CRESS) - INSERM, Paris, France.
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Pahkala R. Objectively measured adherence may affect side effects of mandibular advancement therapy in subjects with obstructive sleep apnea. Sleep Breath 2024; 28:813-821. [PMID: 38114783 PMCID: PMC11136794 DOI: 10.1007/s11325-023-02959-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/16/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE The purpose of this study was to determine if objectively measured adherence to oral appliance (OA) treatment may affect dental changes and temporomandibular disorders (TMD) in patients with obstructive sleep apnea (OSA). METHODS The original study group consisted of adults with OSA who were referred for OA therapy. Eight indicators of subjective side effects of using OA (temporomandibular joint (TMJ) and muscle pain, pain in teeth, jaw stiffness in the morning, clicking, dry mouth, hypersalivation, gingival irritation) were evaluated by a questionnaire. Three occlusal indicators (overjet, overbite, molar occlusion) and clinical TMD signs (TMJ pain, muscle pain, clicking, jaw deviation on opening) were evaluated at baseline and at the 3-, 6-, and 12-month follow-up. In addition, objective adherence monitoring for OA was registered. Statistical analyses included the chi-square test, Fisher's exact test, paired sample t-test, and linear regression analyses. RESULTS A total of 58 adults with OSA were referred for OA therapy. Mean (SD) age was 50.7 (11.7) and mean apnea-hypopnea index (AHI) was 19.5 (10.0). At 1-year follow-up, the study group consisted of 28 men and 12 women. Overjet but not overbite reduced significantly after 1-year OA therapy. The average nightly wear of OA was related to overjet and overbite reduction, and to TMD signs. Hypersalivation, dry mouth, and tooth discomfort were the most common subjective side effects of OA therapy. CONCLUSION There was a time-dependent relationship with the nightly wear of OA and reduction in overjet and overbite, and clinical TMD signs. With 60% of mandibular advancement, dental changes and TM-disorders were considered mild/minor in the 1-year study period.
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Affiliation(s)
- Riitta Pahkala
- Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, P. O. Box 100, 70029, Kuopio, Finland.
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Alessandri-Bonetti A, Lobbezoo F, Mangino G, Aarab G, Gallenzi P. Obstructive sleep apnea treatment improves temporomandibular disorder pain. Sleep Breath 2024; 28:203-209. [PMID: 37491568 PMCID: PMC10954861 DOI: 10.1007/s11325-023-02883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/26/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
PURPOSE The existence of a bidirectional relationship between poor sleep and pain intensity has been studied, and good sleep quality has been found to be a key factor underlying pain control. The purpose of this prospective cohort study was to observe if OSA treatment provides a reduction in temporo-mandibular disorder (TMD) pain and headache attributed to TMD in patients with obstructive sleep apnea (OSA) after 18 months of OSA treatment. METHODS A prospective cohort study was conducted on consecutive patients suffering from OSA. Patients underwent polysomnography and TMD examination according to the DC/TMD protocol at baseline and after 18 months. Intensity of TMD pain and headache attributed to TMD were analyzed. RESULTS Of 40 patients (31 men, mean age 51.3 ± 10.3 years), 33 underwent OSA treatment. At the follow-up examination after 18 months, significant improvements in the intensity of pain-related TMD and headache attributed to TMD were observed (p < 0.05). Seven patients did not start treatment for OSA or discontinued treatment. These patients did not show any significant difference in intensity of TMD-pain or headache attributed to TMD after 18 months (p > 0.05). CONCLUSIONS Significant reductions in intensity of pain-related TMD and headache attributed to TMD were observed in patients with OSA after 18 months of OSA treatment onset, while no difference was observed in subjects not undergoing or discontinuing OSA treatment. TRIAL REGISTRATION The protocol was registered on ClinicalTrials.gov database with number NCT04948541.
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Affiliation(s)
- Anna Alessandri-Bonetti
- Department of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Largo Agostino Gemelli 1, 00168, Rome, Italy.
- Department of Oral Health Practice, College of Dentistry, University of Kentucky, Lexington, KY, USA.
| | - Frank Lobbezoo
- Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gilda Mangino
- Department of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Ghizlane Aarab
- Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Patrizia Gallenzi
- Department of Dental Clinic and Maxillofacial Surgery, A. Gemelli University Policlinic IRCCS, Catholic University of Sacred Heart, Largo Agostino Gemelli 1, 00168, Rome, Italy
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Langaliya A, Alam MK, Hegde U, Panakaje MS, Cervino G, Minervini G. Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions. J Oral Rehabil 2023; 50:1554-1563. [PMID: 37644889 DOI: 10.1111/joor.13574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Patients undergoing mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA) may experience changes in jaw position and altered occlusion. This could potentially contribute to the development or exacerbation of TMD symptoms. The literature on the long-term impact of MAD treated for OSA on TMD is scarce. Hence, this review was undertaken to ascertain the occurrence of TMD in MAD users. METHODS A comprehensive search protocol was implemented across several online databases using MeSH keywords and Boolean operators. A standardised data extraction form was developed specifically for this review. Two reviewers independently extracted the data. RoB-2 was used to evaluate the methodological quality of the included studies. RESULTS A total of 13 clinical studies were selected for this review. Some studies reported a significant reduction in the severity and frequency of TMD symptoms following MAD treatment. However, other studies did not observe significant changes in TMD symptoms or TMJ-related parameters from baseline to follow-up intervals. Temporary increases in TMJ-related pain or symptoms at the beginning of the follow-up period, which later subsided, were reported in some studies. Overall, MAD was not discontinued in any OSA patient due to TMDs. CONCLUSION The findings reveal that different outcomes associated with TMD are affected differently by MAD treatment for OSAS. According to a few studies, MAD therapy significantly reduced the severity and frequency of TMD symptoms. Other research, however, found no appreciable modifications in TMD symptoms or TMJ-related indicators. Although the overall results point to no significant effect of MAD treatment on TMD symptoms, the disparity in results between studies highlights the need for additional studies using standardised approaches.
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Affiliation(s)
- Akshayraj Langaliya
- Department of Conservative Dentistry and Endodontics AMC Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Mohammad Khursheed Alam
- Orthodontic Division, Preventive Dentistry Department, Orthodontic Division, College of Dentistry, Jouf University, Sakakah, Saudi Arabia
| | - Usha Hegde
- Department of Oral Pathology and Microbiology JSS Dental College & Hospital Mysore JSS Academy of Higher Education & Research, Mysore, India
| | - Mangesh Shenoy Panakaje
- Department of Oral & Maxillofacial Pathology and Oral Microbiology, Affiliated College, A B Shetty Memorial Institute of Dental Sciences (A Constituent College of Nitte Deemed to be University) Karnataka, Mangalore, India
| | - Gabriele Cervino
- School of Dentistry, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, Italy
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Tegelberg Å, Nohlert E, List T, Isacsson G. Oral appliance influence on jaw function in obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2023; 164:682-689. [PMID: 37318425 DOI: 10.1016/j.ajodo.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/01/2023] [Accepted: 04/01/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Oral appliance (OA) therapy in obstructive sleep apnea (OSA) could be a risk factor for normal jaw function, given the prolonged effect of an OA in keeping the mandible in a protruded position away from a normal position. This study aimed to assess changes in symptoms and clinical findings related to jaw function after 1 year of treating OSA with an OA. METHODS In this follow-up clinical trial, 302 patients with OSA were assigned to treatment with either monobloc or bibloc OA. Baseline and 1-year follow-up assessment included using the Jaw Functional Limitation Scale, self-reported symptoms and signs related to jaw function. The clinical examination of jaw function included mandibular mobility, dental occlusion, and tenderness in the temporomandibular joints and masticatory muscles. Descriptive analyses of variables are presented for the per-protocol population. To evaluate differences between the baseline and the 1-year follow-up, paired Student t tests and the McNemar change test was used. RESULTS One-hundred and ninety-two patients completed the 1-year follow-up (male 73%, mean aged 55 ± 11 years). There was no change in the Jaw Functional Limitation Scale score at the follow-up (nonsignificant). The patients described no change in symptoms at the follow-up, except for improvements in morning headache (P <0.001) and increased frequency of difficulties in opening the mouth or chewing on awakening (P = 0.002). Subjectively reported changes in dental occlusion during biting/chewing increased significantly at the follow-up (P = 0.009). CONCLUSIONS No changes in measurements of jaw mobility, dental occlusion, or pain on palpation of the temporomandibular joints or masticatory muscles were seen at the follow-up. Thus, using an OA in treating OSA had limited influence on jaw functions and related symptoms. Moreover, the risk of developing pain and functional impairment in the masticatory system was infrequent, indicating that this treatment is safe and can be recommended.
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Affiliation(s)
- Åke Tegelberg
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden; Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden.
| | - Eva Nohlert
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
| | - Göran Isacsson
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital, Västerås, Sweden; Orofacial pain and jaw function Clinic, Department of Specialist Dental Care, Västmanland Hospital, Västerås, Sweden
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Verghese RS, Jose R, Ramachandran A, Shanmugham AM, Nair PK, Kumar KS, Varma BR. Comparison of Pre- and Posttreatment Airway Volume in Patients with Temporomandibular Joint Disorders Treated with Ultra-Low Frequency Transcutaneous Electrical Nerve Stimulation Using Cone Beam Computed Tomography. Int Arch Otorhinolaryngol 2023; 27:e593-e601. [PMID: 37876693 PMCID: PMC10593537 DOI: 10.1055/s-0042-1758207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 07/19/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Temporomandibular joint disorders (TMD) present with a multitude of symptoms that can range from headaches to shoulder pain. Patients frequently present with pain in the ear, dizziness, and vertigo. It is noted that some patients who report TMDs also have a history of sleep disturbances, which is noted in cone beam computed tomography (CBCT) as a reduction in the oropharyngeal airway volume. Objective To evaluate the airway volume in pre- and posttreatment of TMD with the use of neuromuscular orthotics made with ultra-low frequency transcutaneous electrical nerve stimulation (ULF-TENS). Methods A total of 15 patients were evaluated for TMDs using the related criteria. Those included were treated with ULF-TENS with evaluation of the airway volume both pre- and posttreatment using CBCT and the Dolphin 3D volume analysis software. Results While the symptoms were shown to be significantly reduced in patients who were treated with this particular modality, the airway volume varied in those who reported a reduction after a period of 3 months and those that reported after a period of 6 months. Conclusion Posttreatment evaluation of the airway should be done after a period of 6 months for a more objective evaluation. A multidisciplinary evaluation of the patient is required in such cases.
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Affiliation(s)
- Rhea Susan Verghese
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Renju Jose
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Anu Ramachandran
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Aravind M. Shanmugham
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Priya K. Nair
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Krishna S. Kumar
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - Beena R. Varma
- Department of Oral Medicine and Radiology, Amrita School of Dentistry, Amrita Vishwa Vidyapeetham, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
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Manfredini D, Thomas DC, Lobbezoo F. Temporomandibular Disorders Within the Context of Sleep Disorders. Dent Clin North Am 2023; 67:323-334. [PMID: 36965934 DOI: 10.1016/j.cden.2022.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This paper provided an overview of the knowledge on the relationship between temporomandibular disorders (TMDs) and the main sleep conditions and disorders of dental interest, namely, sleep bruxism (SB), sleep apnea, and gastroesophageal reflux disease (GERD). It emerged that although the topic of SB as a possible detrimental factor for the stomatognathic structures has been the most studied, evidence is growing that SB, obstructive sleep apnea, and GERD, all belong to a circle of mutually interacting sleep disorders and conditions that, in turn, may be associated with TMDs. The pathophysiology of the cause-and-effect relationships, if existing, has to be elucidated yet.
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Affiliation(s)
- Daniele Manfredini
- Facial Pain Unit, Department of Biomedical Technologies, School of Dentistry, University of Siena, Viale Bracci c/o Policlinico Le Scotte, Siena 53100, Italy.
| | - Davis C Thomas
- Rutgers School of Dental Medicine, 110 Bergen St, Newark, NJ 07103, USA; Eastman Institute of Oral Health, Rochester, NY, USA
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, the Netherlands
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Belkhode V, Godbole S, Nimonkar S, Pisulkar S, Nimonkar P. Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-a randomized controlled trial. Trials 2023; 24:73. [PMID: 36726182 PMCID: PMC9890424 DOI: 10.1186/s13063-022-07054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/27/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is quite common among the adult population, according to recent epidemiological studies. The most frequently suggested alternate treatment for mild to moderate OSA is oral appliances (OA). The purpose of the present study was to assess as well as compare the effectiveness of custom-made maxillary oral appliances against mandibular advancement appliances in the care of individuals suffering from moderate obstructive sleep apnea. METHODS A prospective interventional research was carried out with 40 participants. Polysomnography (PSG) was done and the participants with an apnea-hypopnea index (AHI) >15-30 were involved in the research. Study participants were randomly split up into two test groups: group I was the "Control Group" (group treated with a mandibular advancement device (MAD), n=20), while group II was exposed to a "customized maxillary oral appliance" (CMOA, n=20). Both groups had reference measures for AHI, blood oxygen saturation (SpO2), oro-nasal airflow via respiratory disturbance index (RDI), and the Epworth Sleepiness Scale (ESS). Appliances were fabricated and delivered to the respective study group participants. PSG was again conducted after a period of 1 and 3 months of appliance delivery and re-evaluation was done for all the parameters and was compared with reference measurements. The facts were analyzed using descriptive and analytical statistical methods. The statistical program utilized in the study was "SPSS (Statistical Package for Social Sciences) Version 20.1." After 1 and 3 months, the statistical significance between the two study groups was assessed at P<0.05. RESULTS The analysis of mean AHI, SPO2, RDI, and ESS for both test groups manifested statistically significant measures (P<0.001). The study results revealed a statistically significant depletion in mean AHI scores, improvement in mean SPO2 scores, and reduction in mean RDI scores and ESS scores when compared with reference measurements to 1 month, 1 to 3 months, and between reference measurements and 3 months. CONCLUSION The CMOA was effective in managing moderate OSA and has great therapeutic potential. It can be an option for the MAD for treating patients suffering from moderate obstructive sleep apnea. TRIAL REGISTRATION The study was registered under Clinical Trials Registry-India and the registration number is CTRI/2020/07/026936 . Registered on 31 July 2020.
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Affiliation(s)
- Vikram Belkhode
- grid.413489.30000 0004 1793 8759Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences, Deemed to be University, Sawangi, Wardha, Maharashtra India ,Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India ,grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, Wardha, India ,grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India ,New SBI Colony NisargNagri, Nagpur Road, Wardha, 442001 India
| | - Sweta Pisulkar
- grid.413489.30000 0004 1793 8759Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra India ,grid.413213.60000 0004 1793 9671Trauma Care Centre, Government Medical College, Nagpur, Maharashtra India
| | - Pranali Nimonkar
- grid.413213.60000 0004 1793 9671Trauma Care Centre, Government Medical College, Nagpur, Maharashtra India
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Kang JH, Lee JK. Associations between obstructive sleep apnea and painful temporomandibular disorder: a systematic review. J Korean Assoc Oral Maxillofac Surg 2022; 48:259-266. [PMID: 36316183 PMCID: PMC9639245 DOI: 10.5125/jkaoms.2022.48.5.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 11/29/2022] Open
Abstract
The relationship between obstructive sleep apnea (OSA) and diverse types of pain conditions have been proposed. However, no consensus on the relationship between OSA and painful temporomandibular disorders (TMDs) has been established. Therefore, this systematic review has been conducted to review the existing literatures and provide comprehensive synthesis of such literatures about OSA and painful TMDs using the evidence-based methodology. A literature search was conducted using two electronic databases, Scopus, and PubMed. Risk of bias was assessed using the risk-ofbias assessment tool for non-randomized study version 2.0. A total of 158 articles were screened from the initial search and eventually, 5 articles were included in this systematic review. One study adopted both the longitudinal prospective cohort and case-control designs and other 4 articles adopted the cross-sectional design. Two studies employed polysomnography (PSG) for the diagnosis of OSA and mentioned the results from the PSG. All crosssectional studies demonstrated higher OSA prevalence among patients with TMD, and one cohort study suggested OSA as a risk factor for TMD. OSA appears to have potential influences on the development of TMD; however, the role of TMD in the development of OSA remains to be unknown owing to the lack of high-quality evidences.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
| | - Jeong Keun Lee
- Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea,Jeong Keun Lee, Department of Oral and Maxillofacial Surgery, Institute of Oral Health Science, Ajou University School of Medicine, 164 WorldCup-ro, Yeongtong-gu, Suwon 16499, Korea, TEL: +82-31-219-5333, E-mail: , ORCID: https://orcid.org/0000-0002-5561-6297
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11
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Belkhode V, Godbole S, Nimonkar S, Nimonkar P, Pisulkar S. Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-protocol for a randomized controlled trial. Trials 2022; 23:159. [PMID: 35172870 PMCID: PMC8848661 DOI: 10.1186/s13063-022-06070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option, i.e., mandibular advancement device (MAD), which is an oral appliance (OA), are the most preferred ones. This study aims to evaluate the efficacy of customized maxillary oral appliances with mandibular advancement devices in moderate OSA patients. Methods A prospective interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) > 15–30, recorded on polysomnography (PSG). Study participants will be randomly divided into the following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of the appliance, all the parameters, i.e., AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be re-evaluated and compared with the baseline measurements. Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p< 0.05. Discussion We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a “gold standard” for managing moderate OSA. Trial registration CTRI/2020/07/026936 Registered 31 July 2020.
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Affiliation(s)
- Vikram Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India.
| | - Pranali Nimonkar
- Trauma Care Centre, Government Medical College, Nagpur, Maharashtra, India
| | - Sweta Pisulkar
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
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12
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Gogou ES, Psarras V, Giannakopoulos NN, Koutsourelakis I, Halazonetis DJ, Tzakis MG. Drug-induced sleep endoscopy improves intervention efficacy among patients treated for obstructive sleep apnea with a mandibular advancement device. Sleep Breath 2022; 26:1747-1758. [DOI: 10.1007/s11325-021-02561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/12/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022]
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13
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Randerath W, Verbraecken J, de Raaff CAL, Hedner J, Herkenrath S, Hohenhorst W, Jakob T, Marrone O, Marklund M, McNicholas WT, Morgan RL, Pepin JL, Schiza S, Skoetz N, Smyth D, Steier J, Tonia T, Trzepizur W, van Mechelen PH, Wijkstra P. European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. Eur Respir Rev 2021; 30:30/162/210200. [PMID: 34853097 PMCID: PMC9489103 DOI: 10.1183/16000617.0200-2021] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/01/2021] [Indexed: 12/12/2022] Open
Abstract
Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear–nose–throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes. OSA-patients who refuse/don't adhere to CPAP can profit from established/emerging treatment options. High scientific evidence is lacking. Patients’ values/preference may weigh heavy in the decision for non-CPAP options, while health inequity is a concern.https://bit.ly/3o0tJeP
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Affiliation(s)
- Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany .,Co-shared first authorship
| | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium.,Co-shared first authorship
| | | | - Jan Hedner
- Dept of Sleep Medicine, Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Simon Herkenrath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
| | | | - Tina Jakob
- Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Oreste Marrone
- National Research Council of Italy, Institute for Biomedical Research and Innovation, Palermo, Italy
| | - Marie Marklund
- Dept of Odontology, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Walter T McNicholas
- School of Medicine, University College Dublin, Dublin, Ireland.,Dept of Respiratory and Sleep Medicine, St Vincent's Hospital Group, Dublin, Ireland
| | - Rebecca L Morgan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Sofia Schiza
- Sleep Disorders Unit, Dept of Respiratory Medicine, Medical School, University of Crete, Greece
| | - Nicole Skoetz
- Evidence-based Oncology, Dept I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dan Smyth
- European Lung Foundation, Sheffield, UK.,Sleep Disorder Support Foundation, Dublin, Ireland
| | - Jörg Steier
- Lane Fox Unit and Sleep Disorders Centre at Guy's & St Thomas' NHS Foundation Trust, Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Wojciech Trzepizur
- Dept of Respiratory and Sleep Medicine, Angers University hospital, Angers, France
| | | | - Peter Wijkstra
- Dept of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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14
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Banu F, Jeyapalan K, V AK. Custom-Made Dual-Functional Oral Appliance for Management of Obstructive Sleep Apneic Completely Edentulous Patient. Cureus 2021; 13:e16656. [PMID: 34462687 PMCID: PMC8388235 DOI: 10.7759/cureus.16656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/12/2022] Open
Abstract
Continuous positive airway pressure (CPAP) being a gold standard treatment to open the upper airway by application of controlled compressed air is still not a widely accepted mode of treatment among obstructive sleep apnea (OSA) individuals. To improve patency of upper airway space and reduce the risk of sleep apnoea, it is essential to provide mandibular advancement devices (MADs) that could provide non-continuous positive airway pressure (non-CPAP) for patients with OSA. Availability of prefabricated oral appliances (OAs) like MADs, tongue holding devices reduced the chair-side fabrication time but has poor adaptation, excessive salivation, and deprivation of sleep. Customized OAs can overcome these challenges, but their fabrication for an edentulous individual is challenging due to the absence of teeth and the encroachment of tongue space by the device. This clinical report gives an insight into the clinical and technical aspect of fabrication of MAD with tongue retaining space for an edentulous individual with OSA.
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Affiliation(s)
- Fathima Banu
- Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Karthigeyan Jeyapalan
- Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Anand Kumar V
- Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
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15
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Baldini N, Gagnadoux F, Trzepizur W, Meslier N, Dugas J, Gerves-Pinquie C, Chouet-Girard F, Kün-Darbois JD. Long-term dentoskeletal side effects of mandibular advancement therapy in patients with obstructive sleep apnea: data from the Pays de la Loire sleep cohort. Clin Oral Investig 2021; 26:863-874. [PMID: 34263409 DOI: 10.1007/s00784-021-04064-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Mandibular advancement devices (MADs) are the main therapeutic alternative to continuous positive airway pressure for obstructive sleep apnea. Our aim was to evaluate the long-term dentoskeletal side effects of MADs and to identify the predictive factors for these side effects. MATERIALS AND METHODS Patients from the Pays de la Loire cohort treated with a custom-made MAD for at least 1 year were included in this retrospective study. Digital cephalometric analyses were performed at baseline and at follow-up. RESULTS We included a total of 117 patients, treated with a MAD for a median [interquartile range] of 4.6 [2.6-6.6] years. The main significant side effects were a decrease in overbite (- 0.5 ± 1 mm), overjet (- 0.7 ± 1 mm) and maxillary incisor inclination (- 2.5 ± 2.8°) and an increase in mandibular incisor inclination (+ 2.2 ± 2.7°). Subjective side effects were not linked to the observed dentoskeletal changes. Current smokers were at higher risk of overjet modifications. A pre-existing anterior open-bite was associated with a greater decrease in overbite. Treatment duration was associated with a more pronounced mandibular incisor proclination. Propulsion was negatively associated with maxillary incisor retroclination. CONCLUSIONS Long-term dentoskeletal side effects were mainly moderate dental side effects. Some predictive factors were shown to be associated with more pronounced changes. Subjective side effects did not appear to be reliable tools to detect dentoskeletal side effects. CLINICAL RELEVANCE Regular follow-up with clinical examination and regular radiographs is mandatory. The predictive factors could be of interest for a better selection of patients and to individualize follow-up.
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Affiliation(s)
- Nicolas Baldini
- Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.
| | - Frédéric Gagnadoux
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Wojciech Trzepizur
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Nicole Meslier
- Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France.,Department of Respiratory and Sleep Medicine, Angers University Hospital, 4 rue Larrey, 49933, Angers Cedex, France
| | - Julien Dugas
- Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France
| | - Chloé Gerves-Pinquie
- Research Institute of Respiratory Health, Pays de La Loire, 9 rue du Landreau, BP 77132, 49071, Beaucouze Cedex, France
| | - Frédérique Chouet-Girard
- Department of Maxillofacial Surgery, Le Mans Hospital, 194 avenue Rubillard, 72037, Le Mans Cedex, France
| | - Jean-Daniel Kün-Darbois
- Department of Oral and Maxillofacial Surgery, Angers University Hospital Center, 4 rue Larrey, 49933, Angers Cedex, France.,Faculty of Medicine, Angers University, 28 rue Roger-Amsler, 49045, Angers Cedex 01, France
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16
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Goodacre CJ, Roberts WE, Goldstein G, Wiens JP. Does the Stomatognathic System Adapt to Changes in Occlusion? Best Evidence Consensus Statement. J Prosthodont 2020; 30:5-11. [PMID: 33350537 DOI: 10.1111/jopr.13310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this Best Evidence Consensus Statement was to evaluate the existing literature on the stomatognathic system's ability to adapt to occlusal changes. MATERIALS AND METHODS The search term stomatognathic system was not useful as it resulted in over 400,000 results nor was the search term temporomandibular joint adaptation with 738 results due to the large number of references not related to the topic. The terms stomatognathic system adaptation to occlusal changes (186 results), teeth flexion (139 results), muscle adaptation to dental occlusion (278 results), and occlusal changes and neuroplasticity (11 results) provided the best selection of articles related to the topic. Limiting the above searches to systematic reviews and randomized controlled clinical trials resulted in multiple publications that were related to the question.9-13 Other literature reviews, data-based publications, and expert opinion resources have been included due to their relationship to the question. RESULTS From the extensive list of search results, 242 articles were determined to be potentially related to the focus question and were evaluated with 56 being included in this paper. It was determined that the stomatognathic system adapts to occlusal changes through the temporomandibular joint, muscles, teeth and bone. The dynamically modified periosteum on the articulator surfaces of the condyle and fossa has a unique load-bearing morphology with 3 subarticular layers of fibrocartilage that absorb and dissipate both peak (impact) and sustained loads. Adaptability of the TMJs and muscles can be documented through studies where artificially produced occlusal interferences were placed in patients and those study participants with normal temporomandibular joints (TMJs) adapted fairly well whereas those with a previous history of temporomandibular disorders (TMD) did not adapt as well. CONCLUSIONS Available evidence indicates patients generally adapt to the occlusal change inherent in orthodontic treatment, mandibular advancement surgery, and the use of mandibular advancement devices. The head and neck muscles also adapt to occlusal changes in patients without a history of TMD. The dentition adapts to changes through the bone and periodontal ligaments as well as the ability of teeth to undergo slight flexion under masticatory loading. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Charles J Goodacre
- Distinguished Professor, Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, CA
| | - W Eugene Roberts
- Professor Emeritus of Orthodontics, Adjunct Professor, Mechanical Engineering, Indiana University & Purdue University, Indianapolis, IN
| | | | - Jonathan P Wiens
- Adjunct Clinical Professor, Department of Restorative Dentistry, University of Detroit Mercy School of Dentistry, Detroit, Michigan
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17
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Abstract
Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effectiveness, particularly for longer-term health outcomes and allowing comparison to PAP.
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18
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Abstract
There is a serious need to consider all potential side effects thoughtfully before commencing individual treatment with oral appliance therapy. Although many of these side effects are self-limiting, easily corrected, or innocuous, others are difficult or impossible to correct and can affect the patient in serious ways. As this field evolves, new information is discovered, and new products are introduced at a rather rapid pace, continuing education and prudent practice are critical to ethical care in the practice of dental sleep medicine.
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Affiliation(s)
- Thomas G Schell
- Dr Thomas G Schell and Dr. Patrick C Noble PLLC, 31 Old Etna Road, N1 Lebanon, NH 03770, USA; Department of Surgery, Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755-1404, USA.
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19
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Obstructive sleep Apnea's association with the cervical spine abnormalities, posture, and pain: a systematic review. Sleep Med 2020; 75:468-476. [PMID: 33007717 DOI: 10.1016/j.sleep.2020.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES While obstructive sleep apnea (OSA) is associated with several chronic health conditions such as hypertension, obesity, and chronic hypoxia, there is limited information on its association with neuromuscular and spinal pathologies that may be of interest to a musculoskeletal (MSK) medicine or pain management clinician. The objective of this study was to perform a systematic literature review to examine the association between OSA and cervical spine pathologies, postural changes, and pain. DESIGN We systematically reviewed PubMed and Embase databases up to 4/15/2019. We included studies that explored associations between OSA and a) pain, b) postural characteristics or changes, or c) cervical spine morphology. Systematic reviews, meta-analysis, randomized control trials, cohort studies, and case-control studies were included. Case reports, narrative reviews or expert opinion papers were excluded. From the articles that met selection criteria, information regarding type, direction and magnitude of such associations was extracted. The OSA-pain association studies were further divided into 3 subgroups: neuropathic, temporomandibular, and chronic pain. RESULTS 21 articles that met our study criteria were selected for this review. Two studies were on cervical spine pathologies, eight on postural changes, and eleven on pain associated with OSA. Exploring the association between OSA and cervical spine pathologies, postural changes, and pain in this systematic review we found: (1) Cervical spine lesions, fusions, and abnormalities that reduce retropharyngeal space are associated with OSA, likely by way of worsening posture and decreasing range of motion. (2) Head extension and anteriorization are associated with OSA likely as a compensatory mechanism. Extension may improve airway function, while anteriorization helps to maintain visual sense. (3) Head-of-bed-elevation may improve OSA symptoms and can possibly supplement other conservative treatment measures. (4) Neuropathic pain is associated with OSA, likely by way of inflammatory pathways. (5) Oral appliance use (eg mandibular advancement/protruding device) in OSA likely contributes to transient temporomandibular pain. (6) There is little association between OSA and chronic pain prevalence. (7) Increased pain intensity and decreased pain tolerance are somewhat associated with OSA, likely by way of hypoxemia and sleep fragmentation. CONCLUSIONS Clinicians in MSK and pain medicine need to consider these associations and consider obtaining imaging studies and/or making referrals for management of their OSA to better provide appropriate care to these patients.
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20
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The Association between Temporomandibular Disorder and Sleep Apnea-A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176311. [PMID: 32872653 PMCID: PMC7504469 DOI: 10.3390/ijerph17176311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/24/2020] [Accepted: 08/28/2020] [Indexed: 12/19/2022]
Abstract
An increased incidence of temporomandibular disorders (TMD) among patients with sleep apnea (SA) has been reported. However, the association between TMD and SA has not been demonstrated in a large-scale study. This population-based cohort study with the Taiwan National Health Insurance (NHI) Research Database aimed to understand the association between SA and TMD. We identified adult patients with suspected SA (identified with diagnostic codes) and excluded those diagnosed with TMD prior to SA. Patients with SA diagnosis after polysomnography were also identified as probable SA patients. The index dates were the dates of their initial SA diagnosis. Ten control subjects were matched, by age and sex, to each SA patient, and were assigned the same index dates as the SA patients. In total, 10,408 suspected SA patients (including 4105 probable SA patients) matched to 104,080 control subjects (including 41,050 subjects matched to the probable SA patients) in this study. The TMD incidence rate was significantly higher in the SA patients than in the control subjects (2.8 vs. 1.0 per thousand-patient-year in probable SA patients vs. the corresponding control subjects, with an adjusted incidence rate ratio [95% confidence interval] = 2.5 [2.3–2.7], p < 0.0001). SA patients significantly showed a higher cumulative incidence of TMD than the corresponding control subjects (p < 0.0001). Multivariable Cox regression analysis revealed SA as an independent risk factor for the development of TMD (adjusted hazard ratio = 2.5 [1.7–3.7], p < 0.0001). In summary, this study confirmed an increased TMD incidence in the SA patients. While treating TMD patients, dentists should pay careful attention to the potential underlying SA.
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21
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Lobbezoo F, Lavigne GJ, Kato T, de Almeida FR, Aarab G. The face of Dental Sleep Medicine in the 21st century. J Oral Rehabil 2020; 47:1579-1589. [PMID: 32799330 PMCID: PMC7754359 DOI: 10.1111/joor.13075] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/31/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
It becomes increasingly clear that some sleep disorders have important diagnostic and/or management links to the dental domain, hence the emergence of the discipline ‘Dental Sleep Medicine’. In this review, the following topics are discussed: 1. the reciprocal associations between oro‐facial pain and sleep; 2. the associations between sleep bruxism and other sleep‐related disorders; 3. the role of the dentist in the assessment and management of sleep bruxism; and 4. the dental management of obstructive sleep apnoea. From these topics' descriptions, it becomes clear that the role of the dentist in the recognition and management of sleep‐related oro‐facial pain, sleep bruxism and obstructive sleep apnoea is large and important. Since many dental sleep disorders can have severe consequences for the individual's general health and well‐being, it is imperative that dentists are not only willing to take on that role, but are also able to do so. This requires more attention for Dental Sleep Medicine in the dental curricula worldwide, as well as better postgraduate training of dentists who are interested in specialising in this intriguing domain. This review contributes to increasing the dental researcher's, teacher's and care professional's insight into the discipline ‘Dental Sleep Medicine’ as it has taken shape in the 21st century, to the benefit of all patients suffering from dental sleep disorders.
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Affiliation(s)
- Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gilles J Lavigne
- Faculty of Dental Medicine, Centre d'étude du sommeil, Université de Montréal and Hôpital du Sacré Coeur, Montréal, QC, Canada
| | - Takafumi Kato
- Department of Oral Physiology, Sleep Medicine Center, Osaka University Hospital, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Fernanda R de Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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22
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Jepsen S, Suvan J, Deschner J. The association of periodontal diseases with metabolic syndrome and obesity. Periodontol 2000 2020; 83:125-153. [PMID: 32385882 DOI: 10.1111/prd.12326] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Periodontitis is a multifactorial chronic inflammatory disease associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth-supporting apparatus. Globally, it is estimated that 740 million people are affected by its severe form. Periodontitis has been suggested to be linked to obesity and metabolic syndrome. Obesity, defined as excessive fat accumulation, is a complex multifactorial chronic inflammatory disease, with a high and increasing prevalence. Metabolic syndrome is defined as a cluster of obesity, dyslipidemia, hypertension, and dysglycemia. Obesity, metabolic syndrome and periodontitis are among the most common non-communicable diseases and a large body of evidence from epidemiologic studies supports the association between these conditions. Extensive research has established plausible mechanisms to explain how these conditions can negatively impact each other, pointing to a bidirectional adverse relationship. At present there is only limited evidence available from a few intervention studies. Nevertheless, the global burden of periodontitis combined with the obesity epidemic has important clinical and public health implications for the dental team. In accordance with the common risk factor approach for tackling non-communicable diseases, it has been proposed that oral healthcare professionals have an important role in the promotion of periodontal health and general well-being through facilitation of healthy lifestyle behaviours.
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Affiliation(s)
- Søren Jepsen
- Department of Periodontology, Operative and Preventive Dentistry, University of Bonn, Bonn, Germany
| | - Jean Suvan
- Department of Periodontology, UCL Eastman Dental Institute, London, UK
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University of Mainz, Mainz, Germany
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Zhou J, Li DH, Zhu PF, Yi CY, Chang L, Zhang Y, Yang XH. Effect of mandibular advancement device on the stomatognathic system in patients with mild-to-moderate obstructive sleep apnoea-hypopnoea syndrome. J Oral Rehabil 2020; 47:889-901. [PMID: 32306424 PMCID: PMC7318685 DOI: 10.1111/joor.12982] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 03/13/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
Objective This study was conducted to evaluate the changes of temporomandibular joints (TMJs) through magnetic resonance imaging (MRI) scanning and the electrical changes in mandibular movement and masticatory muscle surface of mild‐to‐moderate obstructive sleep apnoea‐hypopnoea syndrome (OSAHS) patients before and after treatment with mandibular advancement device (MAD). Methods This was a single‐centre, prospective study recruiting OSAHS patients undergoing treatment with MAD in Department of Stomatology, Yannan Hospital, Kunming, China. Patients were recruited from February 2015 to October 2015, and TMJ changes were observed in MRI scanning before and after 18 months of treatment with MAD in cohort 1. The second cohort of the patients were recruited from January 2014 to September 2015 and electrical changes in mandibular movement and masticatory muscle surface of patients before and after 6 months of treatment with MAD. Results In the cohort 1, TMJ changes analysed through MRI scanning, before and after 18‐month treatment with MAD, there was no significant deviation in the angle of joint disc position. A minor change in the position relationship between condylar process, articular disc and articular fossa but not significant was observed. There was no significant difference in the shape and magnitude of mandibular incision edge movement, percussion movement, masticatory movement and condylar central trajectory among the recruited OSAHS patients, before and after 6 months of MAD treatment as analysed through electromyography. Conclusion In this study, from the results it was evident that the effect of MAD on the stomatognathic system of OSAHS patients is minimal.
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Affiliation(s)
- Jing Zhou
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - De-Hong Li
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Peng-Fei Zhu
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Chun-Yan Yi
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Lin Chang
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Yanan Zhang
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
| | - Xiang-Hong Yang
- Department of Stomatology, Kunming Yan'an Hospital, Kunming City, China
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Nikolopoulou M, Aarab G, Ahlberg J, Hamburger HL, de Lange J, Lobbezoo F. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: A randomized, placebo-controlled trial on temporomandibular side-effects. Clin Exp Dent Res 2020; 6:400-406. [PMID: 32246748 PMCID: PMC7453778 DOI: 10.1002/cre2.288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To assess the differences in the frequency of clinical signs of temporomandibular disorder (TMD) pain and mandibular function impairment between mandibular advancement device (MAD) and nasal continuous positive airway pressure (nCPAP) therapies in obstructive sleep apnea (OSA) patients at baseline and after 6 month of treatment. Methods This study concerns a secondary analysis of a randomized placebo‐controlled trial in which different treatment effects of an objectively titrated MAD were compared with those of nCPAP and an intra‐oral placebo appliance in a parallel design. Sixty‐four mild to severe OSA patients (52.0 ± 9.6 years) were randomly assigned to these three groups. All patients underwent a shortened functional examination of their masticatory system at baseline and after 6 months to establish the presence of clinical signs of TMD pain. Mandibular function impairment was assessed with a questionnaire. Results Clinical signs of TMD pain were only rarely present at baseline and therapy evaluation. No significant differences were found between the three groups in the (low) frequency of clinical signs of TMD pain at both time points (p = .401–.176). In addition, the (low) scores of mandibular function impairment did not differ between the three groups either, neither at baseline (p = .744) nor after 6 months (p = .359). Conclusions A low frequency of clinical signs of TMD pain in mild to severe OSA patients was found after 6 months, regardless of treatment with MAD or nCPAP. In addition, no difference in mandibular function impairment was observed between the different treatment modalities.
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Affiliation(s)
- Maria Nikolopoulou
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Hans L Hamburger
- Amsterdam Sleep Centre, Boerhaave Medical Centre, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centre and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre of Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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25
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A stepwise titration protocol for oral appliance therapy in positional obstructive sleep apnea patients: proof of concept. Sleep Breath 2020; 24:1229-1236. [PMID: 32162278 PMCID: PMC7426292 DOI: 10.1007/s11325-020-02045-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/12/2020] [Accepted: 02/28/2020] [Indexed: 11/21/2022]
Abstract
Purpose In patients with positional obstructive sleep apnea (POSA), oral appliance therapy (OAT) is among the first-line treatments. The aim of this study was to evaluate the effects of a new standardized stepwise titration protocol for OAT in a group of patients with POSA. Methods This was an observational intervention trial. Patients who were previously randomized to the OAT intervention arm of a comparison study comprised the subjects for this study. These patients, who had mild to moderate POSA, were assessed after 3 and 12 months for treatment efficacy, objective adherence by temperature microsensor, and side effects. The titration of OAT was performed using a standardized stepwise titration protocol including advancement levels of 60%, 75%, and 90% of the maximum mandibular protrusion. The optimal advancement level per individual was based on a weighted compromise between efficacy and side effects. Results In total, 36 patients were included and all completed the titration protocol after 3 months. At baseline, the OAT was set at 60% of the maximal mandibular protrusion position. At a 3-month evaluation, the advancement remained at 60% in 16 patients (44%) and reached 75% advancement in 20 patients (56%). Mean apnea-hypopnea index decreased from 12.9 events per hour (9.1–16.7) to 6.9 (3.7–10.3) (P < 0.001), and median objective adherence was 97.4 (61.4–100.00) after 3 months. The 12-month analysis showed consistent results and good OAT tolerance. Six patients (16.7%) terminated OAT and one patient (2.8%) was lost to follow-up. Conclusions This standardized stepwise titration protocol for OAT showed good efficacy, good OAT tolerance, and good objective adherence in patients with mild to moderate POSA. Therefore, the protocol is recommended in research projects to improve standardization of methods between studies and in clinical practice for its practical feasibility. Electronic supplementary material The online version of this article (10.1007/s11325-020-02045-w) contains supplementary material, which is available to authorized users.
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Fransson AMC, Benavente-Lundahl C, Isacsson G. A prospective 10-year cephalometric follow-up study of patients with obstructive sleep apnea and snoring who used a mandibular protruding device. Am J Orthod Dentofacial Orthop 2020; 157:91-97. [PMID: 31901287 DOI: 10.1016/j.ajodo.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This 10-year prospective cephalometric study evaluates the influence of a mandibular protruding device (MPD) in people with obstructive sleep apnea and snoring. METHODS A baseline study population of 77 people was followed biennially. After 10 years, 65 people (45 MPD users and 20 stopped-MPD users) were reexamined. At baseline and after 10 years, a lateral cephalogram was taken in the upright position. RESULTS MPD users showed significant changes in all cephalometric variables except for maxillary protrusion. The maxillary incisors were retroclined by a mean -4.2° (standard deviation [SD] 3.95; P <0.001), mandibular incisors were proclined by a mean 3.2° (SD, 5.02; P <0.001), and SNB was reduced by a mean -0.6° (SD 1.41; P = 0.01). In those who had stopped MPD use, these initial cephalometric values were retained. Significant changes in decreased overjet and overbite were seen in the MPD group but not in the MPD-stopped group. The length of the mandible (Cd-Pg) increased by a mean of 5.1 mm (SD 6.78; P <0.001) and 6.1 mm (SD 5.99; P <0.001) in MPD and MPD-stopped groups, respectively. The hyoid bone-mandibular plane distance (hy-ML) increased by a mean of 3.3 mm (SD, 2.90; P <0.001) and 3.8 mm (SD 3.67; P = 0.001) in MPD and MPD-stopped groups, respectively. CONCLUSIONS Long-term nocturnal MPD use causes retroclination of the maxillary incisors and proclination of the mandibular incisors with consequent decreased overjet and overbite. Both MPD and MPD-stopped users obtained increased mandibular length and lower position of the hyoid bone, which can be a normal physiological change with age.
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Affiliation(s)
- Anette M C Fransson
- Department of Dental Research, Public Dental Service, Region Örebro County, and Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
| | | | - Göran Isacsson
- Department of Orofacial Pain and Jaw Function, Västmanland Hospital, Västerås, Sweden
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Uniken Venema JAM, Doff MHJ, Joffe-Sokolova DS, Wijkstra PJ, van der Hoeven JH, Stegenga B, Hoekema A. Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study. Clin Oral Investig 2019; 24:3069-3076. [PMID: 31863188 DOI: 10.1007/s00784-019-03175-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with obstructive sleep apnea (OSA) are usually treated with either mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) therapy. The objective of this study is to evaluate changes in dental occlusion associated with long-term MAD and CPAP therapy. MATERIALS AND METHODS Data from 14 OSA patients using MAD and 17 OSA patients using CPAP therapy were evaluated at baseline, 2-year and 10-year follow-up. Changes in dental occlusion were analyzed from dental plaster casts with a digital sliding caliper. RESULTS At 2-year follow-up, MAD therapy resulted in significant dental changes when compared with baseline values. In MAD therapy, overjet and overbite decreased with 1.1 ± 1.8 mm and 1.1 ± 1.2 mm respectively. With CPAP therapy overjet and overbite decreased significantly with 0.2 ± 0.5 mm and 0.3 ± 0.5 mm, respectively. Both groups also showed significant changes in molar occlusion. After a 10-year follow-up, significant and more pronounced changes were seen in overjet and overbite. In MAD therapy, overjet and overbite decreased with 3.5 ± 1.5 mm and 2.9 ± 1.5 mm respectively when compared with baseline values. In CPAP therapy, overjet and overbite decreased with 0.7 ± 1.5 mm and 0.8 ± 1.4 mm respectively when compared with baseline values. CONCLUSIONS This study demonstrates that MAD and CPAP therapy result in significant changes in dental occlusion. These changes appear progressive and more pronounced with MAD compared to CPAP therapy. CLINICAL RELEVANCE Long-term OSA treatment results in significant dental side effects that may progress over time. Informed consent is fundamental before starting MAD treatment and individualized long-term follow-up is of eminent importance.
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Affiliation(s)
- Julia Anne Margarethe Uniken Venema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
| | - Michiel H J Doff
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Dilyana S Joffe-Sokolova
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Department of Home Mechanical Ventilation, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Johannes H van der Hoeven
- Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Boudewijn Stegenga
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aarnoud Hoekema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
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Alessandri-Bonetti A, Bortolotti F, Moreno-Hay I, Michelotti A, Cordaro M, Alessandri-Bonetti G, Okeson JP. Effects of mandibular advancement device for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis. Sleep Med Rev 2019; 48:101211. [DOI: 10.1016/j.smrv.2019.101211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
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Dupuy-Bonafe I, Francois C, Lachiche V, Castel M, Duminil G. [OSA in adults: Role of the mandibular advancement device (MAD)]. Orthod Fr 2019; 90:389-399. [PMID: 34643524 DOI: 10.1051/orthodfr/2019024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/ hypopnea syndrome (OSA). Oral appliances advance the mandible and tongue, enlarge and stabilize the upper airways during sleep. Clinical examination is used to select candidates for oral appliances and a particular appliance for a given patient. Titration of the advancement will optimize its effectiveness by resolving subjective clinical symptoms. Polygraphic or ventilatory polysomnography controls the effectiveness of the treatment (IAH reduction, increase of oxygen saturation and improvement of the main symptoms). Clinical follow-up is required to assess longterm outcomes, side effects and treatment adherence. Oral appliances are effective in the short-term provided they achieved a 50% reduction in IAH and complete symptom resolution.
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Affiliation(s)
- Isabelle Dupuy-Bonafe
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Cindy Francois
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Virginie Lachiche
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Manon Castel
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
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Viviano J, Klauer D, Olmos S, Viviano JD. Retrospective comparison of the George Gauge™ registration and the sibilant phoneme registration for constructing OSA oral appliances. Cranio 2019; 40:5-13. [PMID: 31770076 DOI: 10.1080/08869634.2019.1694776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To compare outcomes for appliances manufactured utilizing the George Gauge™ Registration (GGR) and the Sibilant Phoneme Registration (SPR). It was hypothesized that there would be no difference in outcomes.Methods: This study is a retrospective analysis of two groups. Each group consisted of 20 oral appliances manufactured utilizing the GGR and 20 utilizing the SPR.Results: For the two-site data, no difference in outcomes was demonstrated (p = .24). The SPR method required fewer calibrations (p = 5.6 × 10-3) and less jaw movement (p = 3.33 × 10-4). Both bite methods resulted in similarly variable post-AHI scores (p = .52). For the eight-site data, no difference in outcomes was demonstrated (p = .76). The SPR required less movement of the jaw (p = 4.52 × 10-5); however, outcome variance was larger for the SPR (p = .036).Conclusion: The study null hypothesis of no difference in outcomes was supported.Abbreviations: AHI: Apnea-Hypopnea Index; GGR: George Gauge Registration; SPR: Sibilant Phoneme Registration; OSA: Obstructive Sleep Apnea; OA: Oral Appliance; OAT: Oral Appliance Therapy; MA: Mandibular Advancement; VDO: Vertical Dimensional Opening; AADSM: American Academy of Dental Sleep Medicine; ABDSM: American Board of Dental Sleep Medicine; BMI: Body Mass Index.
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Affiliation(s)
- John Viviano
- Private Practice, Sleep Disorders Dentistry RLC, Mississauga, ON, Canada
| | | | | | - Joseph D Viviano
- Private Practice, Sleep Disorders Dentistry RLC, Mississauga, ON, Canada
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Suga H, Iwasaki T, Mishima K, Nakano H, Ueyama Y, Yamasaki Y. Evaluation of the effect of oral appliance treatment on upper-airway ventilation conditions in obstructive sleep apnea using computational fluid dynamics. Cranio 2019; 39:209-217. [DOI: 10.1080/08869634.2019.1596554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Hokuto Suga
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tomonori Iwasaki
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Katsuaki Mishima
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hiroyuki Nakano
- Department of Dentistry and Oral Surgery, Division of Medicine for Function and Morphology of Sensory Organs, Faculty of Medicine, Osaka Medical College, Osaka, JAPAN
| | - Yoshiya Ueyama
- Department of Oral and Maxillofacial Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Youichi Yamasaki
- Department of Pediatric Dentistry, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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Abstract
There is a serious need to consider all potential side effects thoughtfully before commencing individual treatment with oral appliance therapy. Although many of these side effects are self-limiting, easily corrected, or innocuous, others are difficult or impossible to correct and can affect the patient in serious ways. As this field evolves, new information is discovered, and new products are introduced at a rather rapid pace, continuing education and prudent practice are critical to ethical care in the practice of dental sleep medicine.
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Affiliation(s)
- Thomas G Schell
- Dr Thomas G Schell and Dr. Patrick C Noble PLLC, 31 Old Etna Road, N1 Lebanon, NH 03770, USA; Department of Surgery, Dartmouth Geisel School of Medicine, 1 Rope Ferry Road, Hanover, NH 03755-1404, USA.
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34
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Martins ODFM, Chaves Junior CM, Rossi RRP, Cunali PA, Dal-Fabbro C, Bittencourt L. Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea: a systematic review. Dental Press J Orthod 2018; 23:45-54. [PMID: 30304153 PMCID: PMC6150709 DOI: 10.1590/2177-6709.23.4.045-054.oar] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/26/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Occlusal side effects or development of pain and/or functional impairment of the temporomandibular complex are potential reasons for poor compliance or abandonment of mandibular advancement splints treatment for snoring and obstructive sleep apnea. OBJECTIVE This study aimed at providing a comprehensive review evaluating the craniofacial side effects of oral appliance therapy for snoring and obstructive sleep apnea. METHODS An electronic search was systematically conducted in PubMed and Virtual Health Library from their inception until October 2016. Only Randomized Controlled Trials whose primary aim was to measure objectively identified side effects on craniofacial complex of a custom-made oral appliance for treating primary snoring or obstructive sleep apnea were included. Studied patients should be aged 20 or older. The risk of bias in the trials was assessed in accordance with the recommendations of The Cochrane Risk of Bias criteria. RESULTS A total of 62 full-text articles were assessed for eligibility. After the review process, only 6 met all the inclusion criteria. All studies were rated as having a high risk of bias. The most uniformly reported mandibular advancement splint side effects were predominantly of dental nature and included a decrease in overjet and overbite. The risk of developing pain and function impairment of the temporomandibular complex appeared limited with long-term mandibular advancement splint use. CONCLUSION The limited available evidence suggests that mandibular advancement splint therapy for snoring and obstructive sleep apnea results in changes in craniofacial morphology that are predominantly dental in nature, specially on a long-term basis. Considering the chronic nature of obstructive sleep apnea and that oral appliance use might be a lifelong treatment, a thorough customized follow-up should therefore be undertaken to detect possible side effects on craniofacial complex. It is also important to provide adequate information to the patients regarding these possible changes, especially to those in whom larger occlusal changes are to be expected or in whom they are unfavorable. Long-term assessments of adverse effects of oral appliance therapy, with larger study samples and recruitment of homogenous patient population are still required.
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Affiliation(s)
- Olivia de Freitas Mendes Martins
- Universidade Federal do Piauí, Curso de Especialização em Ortodontia (Teresina/PI, Brazil).,Centro Universitário UNINOVAFAPI, Curso de Especialização em Ortodontia (Teresina/PI, Brazil)
| | | | | | - Paulo Afonso Cunali
- Universidade Federal do Paraná, Departamento de Odontologia (Curitiba/PR, Brazil)
| | - Cibele Dal-Fabbro
- Instituto do Sono de São Paulo, Curso de Odontologia do Sono (São Paulo/SP, Brazil)
| | - Lia Bittencourt
- Universidade Federal de São Paulo, Departamento de Psicobiologia (São Paulo/SP, Brazil)
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Zhang M, Liu Y, Liu Y, Yu F, Yan S, Chen L, Lv C, Lu H. Effectiveness of oral appliances versus continuous positive airway pressure in treatment of OSA patients: An updated meta-analysis. Cranio 2018; 37:347-364. [PMID: 29793390 DOI: 10.1080/08869634.2018.1475278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: To update the meta-analysis comparing the effectiveness of oral appliance (OA) with continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea (OSA). Methods: PubMed, ISI Web of Knowledge, Ovid, EBSCO Dentistry & Oral Science Source, The Cochrane Library, and Embase database were searched for RCTs until 23 May 2017. Meta-analyses were performed using RevMan 5.3. Results: Sixteen RCTs were included. Compared with OA, CPAP significantly decreased AHI, min SaO2, ARI, ESS (p < 0.05), with no significant difference in REM%, FOSQ, BP (p ≥ 0.05). OA significantly improved REM% in the severe groups and ESS in the adjustable OA group (p < 0.05). OA shared greater preference. Conclusion: Even though CPAP can better decrease the severity of OSA, more patients opted for OA, which showed better results in severe patients, especially adjustable OA.
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Affiliation(s)
- Menghan Zhang
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China
| | - Yuehua Liu
- Shanghai Stomatological Hospital, Fudan University , Shanghai , China
| | - Yuanshun Liu
- The Second Clinical Medical College, Zhejiang Chinese Medical University , Hangzhou , China
| | - Fengyang Yu
- Orthodontic Center, Perfect Dental Care, Golden Mansion , Hangzhou , China
| | - Shaowen Yan
- Zhejiang Provincial People's Hospital , Hangzhou , China
| | - Lulu Chen
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China
| | - Chenxing Lv
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China
| | - Haiping Lu
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China.,Orthodontic Center, Perfect Dental Care, Golden Mansion , Hangzhou , China
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de Ruiter MHT, Benoist LBL, de Vries N, de Lange J. Durability of treatment effects of the Sleep Position Trainer versus oral appliance therapy in positional OSA: 12-month follow-up of a randomized controlled trial. Sleep Breath 2018; 22:441-450. [PMID: 28913630 PMCID: PMC5918490 DOI: 10.1007/s11325-017-1568-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The Sleep Position Trainer (SPT) is a new option for treating patients with positional obstructive sleep apnea (POSA). This study investigated long-term efficacy, adherence, and quality of life during use of the SPT device compared with oral appliance therapy (OAT) in patients with POSA. METHODS This prospective, multicenter trial randomized patients with mild to moderate POSA (apnea-hypopnea index [AHI] 5-30/h) to SPT or OAT. Polysomnography was performed at baseline and after 3 and 12 months' follow-up. The primary endpoint was OSA severity; adherence, quality of life, and adverse events were also assessed. RESULTS Ninety-nine patients were randomized and 58 completed the study (29 in each group). Median AHI in the SPT group decreased from 13.2/h at baseline to 7.1/h after 12 months (P < 0.001); corresponding values in the OAT group were 13.4/h and 5.0/h (P < 0.001), with no significant between-group difference (P = 1.000). Improvements throughout the study were maintained at 12 months. Long-term median adherence was also similar in the two treatment groups; the proportion of patients who used their device for ≥ 4 h for 5 days in a week was 100% in the SPT group and 97.0% in the OAT group (P = 0.598). CONCLUSIONS The efficacy of SPT therapy was maintained over 12 months and was comparable to that of OAT in patients with mild to moderate POSA. Adherence was relatively high, and similar in the two groups. TRIAL REGISTRATION www.clinicaltrials.gov (NCT02045576).
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Affiliation(s)
- Maurits H T de Ruiter
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Linda B L Benoist
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Jan Tooropstraat 164 1061 AE, Amsterdam, The Netherlands.
- Departments of Otorhinolaryngology and Head and Neck Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Nico de Vries
- Department of Otorhinolaryngology Head and Neck Surgery, OLVG West, Jan Tooropstraat 164 1061 AE, Amsterdam, The Netherlands
- Department of Oral Kinesiology of the Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Departments of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Oral Kinesiology of the Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Lorenzi-Filho G, Almeida FR, Strollo PJ. Treating OSA: Current and emerging therapies beyond CPAP. Respirology 2017; 22:1500-1507. [PMID: 28901030 DOI: 10.1111/resp.13144] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 12/20/2022]
Abstract
Continuous positive airway pressure (CPAP) is the standard treatment for moderate-to-severe obstructive sleep apnoea (OSA). However, adherence to CPAP is limited and non-CPAP therapies are frequently explored. Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA. The most commonly used and studied OA consists of a maxillary and mandibular splint which hold the lower jaw forward during sleep. The efficacy of OA is inferior to CPAP; however, the effectiveness as measured by sleepiness, quality of life, endothelial function and blood pressure is similar likely due to higher acceptance and subjective adherence. Upper airway stimulation augments neural drive by unilaterally stimulating the hypoglossal nerve. The Stimulation Therapy for Apnea Reduction (STAR) study enrolled 126 patients and demonstrated a 68% reduction in OSA severity. A high upfront cost and variable response are the main limitations. Oropharyngeal exercises consist of a set of isometric and isotonic exercises involving the tongue, soft palate and lateral pharyngeal wall. The collective reported trials (n = 120) showed that oropharyngeal exercises can ameliorate OSA and snoring (~30-40%). Nasal EPAP devices consist of disposable one-way resister valve. A systematic review (n = 345) showed that nasal EPAP reduced OSA severity by 53%. The Winx device consists of a mouthpiece placed inside the oral cavity that is connected by tubing to a console that generates negative pressure. Winx may provide successful therapy for ~30-40% of OSA patients. In conclusion, several non-CPAP therapies to treat OSA are currently available.
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Affiliation(s)
- Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fernanda R Almeida
- Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Patrick J Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine and Veterans Administration Pittsburgh Health System, Pittsburgh, PA, USA
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Gagnadoux F, Nguyen XL, Le Vaillant M, Priou P, Meslier N, Eberlein A, Kun-Darbois JD, Chaufton C, Villiers B, Levy M, Trzépizur W, Launois S. Comparison of titrable thermoplastic versus custom-made mandibular advancement device for the treatment of obstructive sleep apnoea. Respir Med 2017; 131:35-42. [PMID: 28947040 DOI: 10.1016/j.rmed.2017.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/02/2017] [Accepted: 08/03/2017] [Indexed: 01/21/2023]
Abstract
BACKGOUND AND OBJECTIVES The disadvantages of custom-made mandibular advancement devices (MAD) for obstructive sleep apnoea (OSA) therapy are the cost and delay required to manufacture the device. This study aimed to evaluate the efficacy of a titrable, thermoplastic MAD compared to a custom-made MAD for OSA therapy. METHODS In this prospective nonrandomized study, 158 patients with OSA from two French sleep centers were treated for 6 months with a titrable thermoplastic MAD (n = 86) or a custom-made MAD (n = 72). The primary outcome was the change in sleep-disordered breathing (SDB) severity. RESULTS After adjustment for baseline values, age, body mass index and study site, no significant intergroup differences were observed between thermoplastic and custom-made MAD for the outcome of apnoea, hypopnoea and oxygen desaturation indices. No between treatment differences were observed for the outcome of subjective sleepiness, symptoms of snoring and fatigue, depressive symptoms, and quality of life. Thermoplastic MAD therapy was associated with higher side effects scores for tooth pain (p < 0.0001) and self-reported occlusal changes (p = 0.0069). Mean (SD) reported compliance was lower in the thermoplastic MAD group than in the custom-made MAD group (6.4 [0.2] vs 7.1 [0.1] h/night; p = 0.035). CONCLUSIONS This study demonstrates the efficacy of a titrable thermoplastic MAD in reducing SDB and related symptoms in patients with mild to severe OSA. Reported compliance at 6 months was high despite more dental discomfort than with custom-made MAD.
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Affiliation(s)
- Frédéric Gagnadoux
- Université Bretagne Loire, Département de Pneumologie, CHU, Angers, France; Université Bretagne Loire, INSERM UMR 1063, SOPAM, Angers, France.
| | - Xuan-Lan Nguyen
- Unité de Somnologie et Fonction Respiratoire, Hôpital Saint-Antoine, Paris, France
| | - Marc Le Vaillant
- Centre de Recherche Médecine, Sciences, Santé, Santé mentale, Société, CNRS UMR 8211, INSERM UMR U988-EHESS, Villejuif, France
| | - Pascaline Priou
- Université Bretagne Loire, Département de Pneumologie, CHU, Angers, France; Université Bretagne Loire, INSERM UMR 1063, SOPAM, Angers, France
| | - Nicole Meslier
- Université Bretagne Loire, Département de Pneumologie, CHU, Angers, France; Université Bretagne Loire, INSERM UMR 1063, SOPAM, Angers, France
| | - Audrey Eberlein
- Université Bretagne Loire, Département de Pneumologie, CHU, Angers, France
| | - Jean-Daniel Kun-Darbois
- Université Bretagne Loire, Service de Stomatologie et Chirurgie Maxillo-Faciale, CHU, Angers, France
| | - Cyril Chaufton
- Unité de Somnologie et Fonction Respiratoire, Hôpital Saint-Antoine, Paris, France
| | - Bruno Villiers
- Service de Stomatologie, Hôpital Saint-Antoine, Paris, France
| | - Maguy Levy
- Service de Stomatologie, Hôpital Saint-Antoine, Paris, France
| | - Wojciech Trzépizur
- Université Bretagne Loire, Département de Pneumologie, CHU, Angers, France; Université Bretagne Loire, INSERM UMR 1063, SOPAM, Angers, France
| | - Sandrine Launois
- Unité de Somnologie et Fonction Respiratoire, Hôpital Saint-Antoine, Paris, France; Sorbonne Universités, UPMC Université Paris 06, INSERM UMR_S 1158, Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Sanchez-Ariza CA. Tratamiento con dispositivos orales para síndrome de apnea-hipopnea obstructiva del sueño (SAHOS). REVISTA DE LA FACULTAD DE MEDICINA 2017. [DOI: 10.15446/revfacmed.v65n1sup.59642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El objetivo de este artículo es mejorar la práctica con dispositivos orales (DO) por parte del odontólogo tratante, al alcanzar una adecuada selección del DO y brindar seguridad y efectividad al paciente. Con el uso de estos, se intenta disminuir la frecuencia o duración de los eventos respiratorios. Los DO están indicados en pacientes con ronquido primario, síndrome de apnea-hipopnea obstructiva del sueño (SAHOS) leve-moderado y SAHOS severo que no quieran o no toleren tratamiento con presión positiva. Además, se clasifican en aparatos de retención de lengua, aparatos no ajustables y ajustables, siendo estos últimos los más recomendados por ser dispositivos de avance mandibular (DAM), pues son hechos a la medida, ajustables y de arco dual. Su mecanismo de acción consiste en protruisión del maxilar inferior, adelantamiento del hueso hioides y apertura mandibular.Los DAM son más eficaces en pacientes jóvenes, con menor índice de masa corporal (IMC), circunferencia de cuello reducida, SAHOS posicional y mandíbula retrognática. Se pueden presentar efectos adversos como salivación excesiva, cambios oclusales y trastornos temporomandibulares. Se ha demostrado que los DAM tienen un impacto en la disminución del índice de apnea-hipopnea (IAH) y somnolencia diurna, mejoría en la oxigenación nocturna, función cardiovascular, calidad de vida y comportamiento neurocognitivo. Asimismo, los DAM son superiores al tratamiento con presión positiva de vía aérea (PAP) en adherencia. Se sugiere que la terapia combinada de DAM con PAP y otros tratamientos es promisoria para aquellos pacientes que responden de manera insuficiente a la monoterapia.
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Güneri P, İlhan B, Çal E, Epstein JB, Klasser GD. Obstructive sleep apnoea and the need for its introduction into dental curricula. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2017; 21:121-129. [PMID: 26895614 DOI: 10.1111/eje.12190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
Abstract
Obstructive sleep apnoea (OSA) is a major health problem which causes blood oxygen desaturation that may initiate a cascade of events via inflammatory cytokines and adrenocorticotrophic hormone that may have impact upon quality of life and lead to potential life-threatening events. Even though OSA affects an increasing number of individuals, the role of dental practitioners in recognition, screening and management has not developed accordingly. The goal of this article was to provide updated information to dental practitioners on pathophysiology, consequences and treatment options of OSA with a focused discussion on oral appliance (OA) therapy, as this topic is not routinely included in current dental curricula of many dental schools. Additionally, we present a template dental curriculum for predoctoral and/or postdoctoral students in education regarding sleep disordered breathing.
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Affiliation(s)
- P Güneri
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, Turkey
| | - B İlhan
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, Turkey
| | - E Çal
- Department of Prosthetic Dentistry, Ege University School of Dentistry, Izmir, Turkey
| | - J B Epstein
- Division of Otolaryngology and Head and Neck Surgery City of Hope National Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - G D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University, New Orleans, LA, USA
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41
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Shelgikar AV, Aronovich S, Stanley JJ. Multidisciplinary Alternatives to CPAP Program for CPAP-Intolerant Patients. J Clin Sleep Med 2017; 13:505-510. [PMID: 28095977 DOI: 10.5664/jcsm.6508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 11/30/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT Continuous positive airway pressure (CPAP) intolerance remains a persistent problem for many obstructive sleep apnea patients. Clinicians and researchers continue to search for other effective treatment modalities given the well-documented sequelae associated with untreated obstructive sleep apnea. A multidisciplinary "Alternatives to CPAP program" (ALT) can facilitate systematic evaluation of non-CPAP therapies appropriate for an individual patient. We review successful strategies and barriers encountered during implementation of an ALT at our institution. Creation of similar programs in private practice and academic settings can help medical, dental, and surgical sleep medicine specialists coordinate evaluation and treatment of CPAP-intolerant patients.
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Affiliation(s)
| | - Sharon Aronovich
- Oral and Maxillofacial Surgery, University of Michigan, Ann Arbor, MI
| | - Jeffrey J Stanley
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI.,Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI
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Effect of jaw-opening exercise on prevention of temporomandibular disorders pain associated with oral appliance therapy in obstructive sleep apnea patients: A randomized, double-blind, placebo-controlled trial. J Prosthodont Res 2017; 61:259-267. [PMID: 28063976 DOI: 10.1016/j.jpor.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE There are no studies on the prevention of temporomandibular joint and/or masticatory muscle pain (TMD pain) associated with oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA). The aim of this study was to determine the effect of jaw-opening exercise on TMD pain associated with OA therapy in OSA patients. METHODS Twenty-five OSA patients without pain-related TMD were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise (JE, n=13), and the other group performed placebo exercise (PE, n=12) for 1-month, and had started 2-weeks prior to insertion of an adjustable OA. TMD sign using the Research Diagnostic Criteria for Temporomandibular Disorders and TMD pain intensity using a visual analog scale (VAS) in the morning and daytime were evaluated at baseline (pre-exercise) and at 2-weeks, 1-month, and 3-months after OA insertion. RESULTS Pain-related TMD was not observed in the JE-group at all evaluation periods, although one subject in the PE-group was diagnosed with arthralgia at the 1-month evaluation. The JE-group showed lower morning and daytime VAS scores than the those of the PE-group at all evaluation periods, and significant group differences were found in terms of chewing pain and jaw-opening pain in the morning at the 1-month evaluation, and of jaw-opening pain during daytime at the 3-month evaluation (P<0.05). CONCLUSIONS Within the limitations of the study, jaw-opening exercise prior to OA therapy reduced the risk of TMD pain associated with OA use. Therefore, jaw-opening exercise may contribute to the prevention of TMD pain.
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Svensson P, Kumar A. Assessment of risk factors for oro-facial pain and recent developments in classification: implications for management. J Oral Rehabil 2016; 43:977-989. [PMID: 27690281 DOI: 10.1111/joor.12447] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 02/06/2023]
Abstract
Oro-facial pain research has during the last decades provided important novel insights into the basic underlying mechanisms, the need for standardised diagnostic procedures and classification systems, and multiple treatment options for successful rehabilitation of the patient in pain. Notwithstanding the significant progress in our knowledge spanning from molecules to chair, there may also be limitations in our ability to integrate and interpret the tremendous amount of new data and information, in particular in terms of the clinical implications and overriding conceptual models for oro-facial pain. The aim of the present narrative review is to briefly summarise some of the current thoughts on oro-facial pain mechanisms and recent attempts to identify biomarkers and risk factors leading to the proposal of a new risk assessment diagram for oro-facial pain (RADOP) and a provocative new concept based on stochastic variation between multiple risk factors. Finally, the implications for novel management strategies will briefly be discussed.
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Affiliation(s)
- P Svensson
- Section of Orofacial Pain and Jaw Function, Institute of Odontology and Oral Health, Aarhus University, Aarhus, Denmark.,Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University, Aarhus, Denmark
| | - A Kumar
- Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden.,Scandinavian Center for Orofacial Neurosciences (SCON), Aarhus University, Aarhus, Denmark
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González M, Macias-Escalada E, Cobo J, Fernández Mondragón MP, Gómez-Moreno G, Martínez-Martínez M, de Carlos F. Can treatment with statins have a negative influence on the tolerance of mandibular advancement devices? Sleep Breath 2016; 20:1363-1366. [PMID: 27562773 DOI: 10.1007/s11325-016-1399-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/01/2016] [Accepted: 08/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Statins are considered the most effective drugs used in the treatment of dyslipidemias. Some of their adverse effects are related to muscle problems. Myalgias produced by statins appear more often during exercise. Mandibular advancement devices (MAD) force the propulsory and elevatory musculature of the mandible to exercise by making the jaw move forward. The aim of this study is to evaluate the incidence of muscular side effects (referred, spontaneous, or under palpation pain, myofascial pain, mandibular rigidity and fatigue, tension and sensitivity of the masticatory muscles) in a group of patients with a diagnosis of obstructive sleep apnea being treated with MAD. METHODS This was a prospective study, involving consecutively 104 patients with a diagnosis of OSAS, and who had begun treatment with a custom made oral device. Muscular side effects were collected by anamnesis (verbal request and questionnaires), psychological status and clinical assessment (manual muscle palpation in the masticatory and cervical muscle groups), before and during MAD treatment. RESULTS Of the total sample, 22.1 % presented muscular side effects with the oral device. However, in patients taking statins, this percentage was 57.1 %, as opposed to 16.7 % of the non-statins patients (p < 0.001). The risk of suffering muscular alterations during oral device treatment is higher in statin patients (odds ratio 6.67, p = 0.002). CONCLUSION Treatment with statins can give rise to the appearance of undesirable side effects among patients being treated with oral devices.
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Affiliation(s)
- Mónica González
- Sleep and Ventilation Unit, Respiratory Division, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Emilio Macias-Escalada
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Catedrático Serrano s/n, 33006, Oviedo, Spain
| | - Juan Cobo
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Catedrático Serrano s/n, 33006, Oviedo, Spain
| | | | - Gerardo Gómez-Moreno
- Department of Special Care in Dentistry, Pharmacological Research in Dentistry, Faculty of Dentistry, University of Granada, Granada, Spain
| | - Marian Martínez-Martínez
- Sleep and Ventilation Unit, Respiratory Division, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Felix de Carlos
- Department of Surgery and Medical-Surgical Specialties, Area of Orthodontics, Faculty of Medicine, University of Oviedo, Catedrático Serrano s/n, 33006, Oviedo, Spain.
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Bettega G, Breton P, Goudot P, Saint-Pierre F. Place de l’orthèse d’avancée mandibulaire (OAM) dans le traitement du syndrome d’apnées hypopnées obstructives du sommeil de l’adulte (SAHOS). Juillet 2014. Rev Mal Respir 2016; 33:526-54. [DOI: 10.1016/j.rmr.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bartolucci ML, Bortolotti F, Raffaelli E, D'Antò V, Michelotti A, Alessandri Bonetti G. The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis. Sleep Breath 2016; 20:911-9. [PMID: 26779903 DOI: 10.1007/s11325-015-1307-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/20/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The therapy with mandibular advancement devices (MADs) represents a treatment option for patients with obstructive sleep apnea (OSA). The literature does not provide evidence regarding the most effective mandibular advancement; therefore, the aim of this systematic review with meta-regression was to investigate the effectiveness of different mandibular advancement amounts in reducing apnea-hypopnea index (AHI) in OSA patients. METHODS An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, ISI Web of Knowledge, Scopus, and LILACS to select randomized controlled trials (RCTs) investigating the efficacy of MADs in reducing AHI in adult OSA patients. Inclusion criteria were the diagnosis of OSA and success evaluation performed with a polysomnography, follow-up of maximum 12 months, and protrusion amount reported as a percentage of the maximum mandibular advancement. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The success rate of each study was computed: [(mean AHI at baseline-mean AHI after treatment)/mean AHI at baseline]. RESULTS Thirteen RCTs performing advancements from 50 to 89 % of maximum mandibular protrusion were included. The meta-regression analysis showed that advancement amounts higher than 50 % do not significantly influence the success rate (Q = 0.373, p = 0.541). According to the GRADE score system, the quality of evidence resulted to be moderate. CONCLUSION The AHI improvement resulted to be not proportional to the mandibular advancement increase. It is plausible that the success of the therapy is influenced by a combination of variables that need closer study.
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Affiliation(s)
- Maria Lavinia Bartolucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy.
| | - Francesco Bortolotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy
| | - Eugenia Raffaelli
- Department of Biomedical Sciences, Section of Orthodontics, University of Bologna, via san Vitale, 59, 40125, Bologna, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy
| | - Giulio Alessandri Bonetti
- Department of Biomedical Sciences, Section of Orthodontics, University of Bologna, via san Vitale, 59, 40125, Bologna, Italy
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Odontoiatria e disturbi del sonno. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Correction physiologique de la dysfonction linguale avec le « Tongue Right Positioner » : effets bénéfiques sur les voies aériennes supérieures. Int Orthod 2015. [DOI: 10.1016/j.ortho.2015.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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50
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Mauclaire C, Vanpoulle F, Saint-Georges-Chaumet Y. Physiological correction of lingual dysfunction with the "Tongue Right Positioner": Beneficial effects on the upper airways. Int Orthod 2015; 13:370-89. [PMID: 26282520 DOI: 10.1016/j.ortho.2015.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several studies have demonstrated the beneficial role of functional tongue therapy in stabilizing treatments for dental malocclusion and treating sleep-disordered breathing (SDB). The aim of this retrospective study was to evaluate the effect on the upper airways of the Tongue Right Positioner device (TRP) used for the correction of atypical swallowing. We analyzed lateral headfilms of 94 orthodontic patients aged between 11 and 17, before the start of treatment and after establishment of mature swallowing, treated with the TRP (TRP group) or by reeducation exercises (control group). In the TRP group, the establishment of mature swallowing occurs twice as fast as in the control group. This led to thinning of the floor of the mouth (-8.38%, P<0.001) linked to anteroposterior enlargement of the pharynx (+10.48%, P<0.01), both probably due to an increase in genioglossal and styloglossal muscle tone and correction of cranio-cervical posture (+2.52%, P<0.01). These results are not dependent on the type of orthodontic treatment. They suggest that the TRP could be used in the treatment of SDB.
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