1
|
Rengasamy Venugopalan S, Allareddy V, Yadav S. Interdisciplinary Role of Orthodontist in Screening and Managing Obstructive Sleep Apnea in Children and Adults. Dent Clin North Am 2024; 68:475-483. [PMID: 38879281 DOI: 10.1016/j.cden.2024.03.005] [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] [Indexed: 06/26/2024]
Abstract
Obstructive sleep apnea (OSA) can affect children and adults, and, if left untreated, could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have an interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by a sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. Currently the evidence in the literature for prophylactic growth modification in children to prevent OSA is weak. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective.
Collapse
Affiliation(s)
| | - Veerasathpurush Allareddy
- Department of Orthodontics, University of Illinois College of Dentistry, 801 S. Paulina Street, IL 60612, USA
| | - Sumit Yadav
- Department of Growth and Development, University of Nebraska Medical Center, UNMC College of Dentistry, Room 2432, 4000 East Campus Loop South, Lincoln, NE 68583-0740, USA
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Jafarimehrabady N, Scribante A, Defabianis P, Merlati G, Vitale MC. A Systematic Review of Oral Modifications Caused by the Prolonged Application of Continuous Positive Airway Pressure (CPAP) and Intraoral Appliances in Patients with Obstructive Sleep Apnea (OSA). BIOMED RESEARCH INTERNATIONAL 2024; 2024:9361528. [PMID: 38435538 PMCID: PMC10907106 DOI: 10.1155/2024/9361528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Objective Prolonged use of oral devices as a substitute for traditional treatments has been studied in relation to the dental and skeletal changes associated with obstructive sleep apnea syndrome (OSA), which is a sleep-breathing disorder. Materials and Methods A review of articles indexed in PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, and CINHAL databases in September 2022 based on MeSH-based keywords with "dental and skeletal" and "oral appliance" and "obstructive sleep apnea" was examined to ensure that the keywords alone or cross-linked, depending on which base of the searched data, were used. 16 articles out of 289 articles were included in the research, and 273 articles were excluded due to lack of study. Conclusions CPAP treatment has limited dental or skeletal effects in short-term or long-term use. OAs and MADs show significant dental changes with prolonged use. MAS and TSD are more effective in short-term goals than CPAP. OAs' increase may cause dental and skeletal changes. MPD shows notable cephalometric alterations.
Collapse
Affiliation(s)
- Niloofar Jafarimehrabady
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Andrea Scribante
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Patrizia Defabianis
- Department of Surgical Sciences, C.I.R. Dental School-Section of Pediatric Dentistry, University of Turin, Turin, Italy
| | - Giuseppe Merlati
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Marina Consuelo Vitale
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| |
Collapse
|
4
|
Huynh N, Fabbro CD. Sleep bruxism in children and adolescents-A scoping review. J Oral Rehabil 2024; 51:103-109. [PMID: 37743603 DOI: 10.1111/joor.13603] [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: 11/08/2022] [Revised: 08/21/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND AND OBJECTIVE This review paper focuses on sleep bruxism (SB) in children and adolescents. It aims to assess the landscape of knowledge published in the last 20 years. METHODS A total of 144 relevant publications from 386 previously identified through Medline were included, of which 83 were on possible SB, 37 on probable SB, 20 on definite SB and 4 were non-applicable. The review places emphasis on the recent evidence on prevalence, pathophysiology, diagnosis and management of SB in children and adolescents, with special focus on probable and definitive SB. RESULTS The prevalence ranges from 5% to 50% depending on the age range and on the SB diagnosis (possible, probable or definitive). The pathophysiology is multifactorial, arousal associated and with behavioural problems and sleep disorders (obstructive sleep apnoea, snoring, nightmares) as risk factors, as well as respiratory conditions (allergies, oral breathing). Screening should include questionnaires and dental assessment. Instrumental recording is helpful to confirm diagnosis although more studies are needed to validate this approach in children. SB management includes controlling orofacial and dental consequences and assessing for any other comorbidity. Management options include occlusal splints, oral appliances (advancement mandibular), rapid maxillary expansion and some medications, although this last option is supported by limited evidences in children. CONCLUSION Suggestions of future topics in research are delivered to better understand comorbidities, diagnosis and management with improved outcomes compared to what is currently available.
Collapse
Affiliation(s)
- Nelly Huynh
- Faculty of dental medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Cibele Dal Fabbro
- CIUSSS Nord Ile Montreal, CEAMS and research centre, Montreal, Quebec, Canada
- Instituto do Sono, Sao Paulo, Brazil
| |
Collapse
|
5
|
Johal A, Hamoda MM, Almeida FR, Marklund M, Tallamraju H. The role of oral appliance therapy in obstructive sleep apnoea. Eur Respir Rev 2023; 32:220257. [PMID: 37343962 DOI: 10.1183/16000617.0257-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 06/23/2023] Open
Abstract
There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made versus noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.
Collapse
Affiliation(s)
- Ama Johal
- Oral Bioengineering, Institute of Dentistry, Queen Mary, University of London, London, UK
| | - Mona M Hamoda
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Marie Marklund
- Department of Otontology, Medical Faculty, Umea University, Umea, Sweden
| | - Harishri Tallamraju
- Oral Bioengineering, Institute of Dentistry, Queen Mary, University of London, London, UK
| |
Collapse
|
6
|
Liu Y, Zhou JR, Xie SQ, Yang X, Chen JL. The Effects of Orofacial Myofunctional Therapy on Children with OSAHS’s Craniomaxillofacial Growth: A Systematic Review. CHILDREN 2023; 10:children10040670. [PMID: 37189919 DOI: 10.3390/children10040670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Orofacial myofunctional therapy (OMT) is one of the therapeutic methods for neuromuscular re-education and has been considered as one of the auxiliary methods for obstructive sleep apnea hypopnea syndrome (OSAHS) and orthodontic treatment. There is a dearth of comprehensive analysis of OMT’s effects on muscle morphology and function. This systematic review examines the literature on the craniomaxillofacial effects of OMT in children with OSAHS. This systematic analysis was carried out using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards, and the research was scanned using PICO principles. A total of 1776 articles were retrieved within a limited time, with 146 papers accepted for full-text perusing following preliminary inspection and 9 of those ultimately included in the qualitative analysis. Three studies were rated as having a severe bias risk, and five studies were rated as having a moderate bias risk. Improvement in craniofacial function or morphology was observed in most of the 693 children. OMT can improve the function or morphology of the craniofacial surface of children with OSAHS, and its effect becomes more significant as the duration of the intervention increases and compliance improves. In the majority of the 693 infants, improvements in craniofacial function or morphology were seen. The function or morphology of a kid’s craniofacial surface can be improved with OMT, and as the duration of the intervention lengthens and compliance rises, the impact becomes more pronounced.
Collapse
|
7
|
Tsolakis IA, Palomo JM, Matthaios S, Tsolakis AI. Dental and Skeletal Side Effects of Oral Appliances Used for the Treatment of Obstructive Sleep Apnea and Snoring in Adult Patients—A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12030483. [PMID: 35330482 PMCID: PMC8949347 DOI: 10.3390/jpm12030483] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Mandibular advancement devices for obstructive sleep apnea treatment are becoming increasingly popular among patients who do not prefer CPAP devices or surgery. Our study aims to evaluate the literature regarding potential dental and skeletal side effects caused by mandibular advancement appliances used for adult OSA treatment. Methods: Electronic databases were searched for published and unpublished literature along with the reference lists of the eligible studies. Randomized clinical trials and non-randomized trials assessing dental and skeletal changes by comparing cephalometric radiographs were selected. Study selection, data extraction, and risk of bias assessment were performed individually and in duplicate. Fourteen articles were finally selected (two randomized clinical trials and 12 non-randomized trials). Results: The results suggest that mandibular advancement devices used for OSA treatment increase the lower incisor proclination by 1.54 ± 0.16°, decrease overjet by 0.89 ± 0.04 mm and overbite by 0.68 ± 0.04 mm, rotate the mandible downward and forward, and increase the SNA angle by to 0.06 ± 0.03°. The meta-analysis revealed high statistical heterogeneity. Conclusions: The MADs affect the lower incisor proclination, overjet, overbite, the rotation of the mandible and the SNA angle. More randomized clinical trials providing high-quality evidence are needed to support those findings.
Collapse
Affiliation(s)
- Ioannis A. Tsolakis
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
- Correspondence:
| | - Juan Martin Palomo
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106, USA; (J.M.P.); (S.M.)
| | - Stefanos Matthaios
- Department of Orthodontics, Case Western Reserve University School of Dental Medicine, Cleveland, OH 44106, USA; (J.M.P.); (S.M.)
| | - Apostolos I. Tsolakis
- Department of Orthodontics, School of Dentistry, National and Kapodistrian, University of Athens, 157 72 Athens, Greece;
| |
Collapse
|
8
|
Karadeniz C, Lee KWC, Lindsay D, Karadeniz EI, Flores-Mir C. Oral appliance-generated malocclusion traits during the long-term management of obstructive sleep apnea in adults. Angle Orthod 2021; 92:255-264. [PMID: 34929027 DOI: 10.2319/041921-316.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To identify malocclusion characteristics generated after using oral appliances (OAs) for at least 5 years for the management of snoring and obstructive sleep apnea (OSA) in adults. MATERIALS AND METHODS PubMed, MEDLINE (Ovid), Scopus, CINAHL, and Informit were searched without language restrictions through January 20, 2021. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and the Pro-Quest Dissertation Abstracts and Thesis database. Authors were contacted when necessary, and reference lists of the included studies were screened. Risk of bias was assessed through the revised Cochrane Risk of Bias tool for randomized controlled trials (RoB2) and Non-Randomized Studies of Interventions for non-RCTs and uncontrolled before-after studies (ROBINS-I). A random-effects meta-analysis was conducted only on studies that used the same OAs to exclude biomechanical differences. Risk of bias across studies was assessed with the Grading of Recommendations, Assessment, Development and Evaluation tool. RESULTS A total of 12 studies were included in the final qualitative synthesis. Eight included studies had high, one had moderate, and three had low risks of bias. Significant progressive decreases of overjet (OJ; -1.43 mm; 95% confidence interval [CI], -1.66 to -1.20) and overbite (OB; -1.94 mm; 95% CI, -2.14 to -1.74) associated with maxillary incisor retroclination and mandibular incisor proclination were reported long term. Although most studies showed no sagittal skeletal changes, some degree of vertical skeletal changes were noted. CONCLUSIONS Based on a very low evidence level, inevitable anterior teeth positional changes seem to be a common long-term adverse effect of OAs. The magnitude of those changes could be considered clinically irrelevant for most pretreatment occlusions, but in occlusions with limited OJ and OB, it may be worth clinical consideration.
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Heda P, Alalola B, Almeida FR, Kim H, Peres BU, Pliska BT. Long-term periodontal changes associated with oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med 2021; 17:2067-2074. [PMID: 33985648 DOI: 10.5664/jcsm.9358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To characterize the mandibular anterior teeth crown height as a marker of periodontal changes and bone loss as a side effect of an oral appliance (OA) worn for a minimum of 4.5 years. METHODS This retrospective study conducted on patients with healthy baseline periodontiu m recruited participants from consecutive sleep apnea patients treated with an OA between 2004 to 2014. Eligible participants were recalled for a follow-up visit where a periodontal exam was performed, a lateral cephalogram and dental impressions were obtained. Clinical crown height for mandibular anterior teeth and cephalometric variables were measured and compared before and after treatment. A full periodontal evaluation was performed at the follow-up visit. RESULTS 21 patients enrolled with a mean treatment length of 7.9±3.3 years. For the mandibular anterior teeth, clinical crown height did not change over the evaluated period. At follow-up, all the periodontal assessed variables were within normal limits, with the mean probing depth of 1.4±0.5 mm, recession 0.6±1.1 mm and Clinical Attachment Loss (CAL) 0.8±1.0 mm. Compared to baseline, there was a significant proclination of mandibular incisors (mean increase of 5.1°) with the continued use of OA. Gingival levels were maintained with clinically insignificant changes during the observation period. CONCLUSIONS Inclination of the mandibular incisors increases significantly with the use of an OA in patients with obstructive sleep apnea (OSA). Positional changes in these teeth were not associated with any measured evidence of increase in clinical crown height or gingival recession.
Collapse
Affiliation(s)
- Piyush Heda
- Private practice, Vancouver, British Columbia, Canada
| | - Bassam Alalola
- Assistant Professor, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Fernanda R Almeida
- Associate Professor, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hugh Kim
- Associate Professor, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernardo U Peres
- Graduate Orthodontic Resident, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin T Pliska
- Associate Professor, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
11
|
Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2020; 124:274-349. [PMID: 32811666 DOI: 10.1016/j.prosdent.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.
Collapse
|
12
|
Lobbezoo F, Li J, Koutris M, Warnsinck CJ, Wetselaar P, Visscher CM, Aarab G. Nasal CPAP therapy associated with masticatory muscle myalgia. J Clin Sleep Med 2020; 16:455-457. [DOI: 10.5664/jcsm.8230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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
| | - Jiayu Li
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. Jan Warnsinck
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter Wetselaar
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine M. Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Sutherland K, Cistulli PA. Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art. J Clin Med 2019; 8:jcm8122121. [PMID: 31810332 PMCID: PMC6947472 DOI: 10.3390/jcm8122121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/17/2022] Open
Abstract
Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances (OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for OSA therapy, they are often considered only as second-line therapy following positive airway pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep study night, have been proposed, although none has been widely validated for clinical use. Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not be necessary to produce the same health benefits of PAP. This may be related to the more favourable adherence to OA therapy, which can now be objectively verified. Data on longer term health outcomes are needed, and there are additional opportunities for device improvement and combination therapy approaches. OAs have an important role in precision care of OSA as a chronic disorder through a multi-disciplinary care team. Future studies on real-world health outcomes following OA therapy are needed.
Collapse
Affiliation(s)
- Kate Sutherland
- Sleep Research Group, Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW 2065, Australia
- Correspondence:
| | - Peter A. Cistulli
- Sleep Research Group, Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| |
Collapse
|
14
|
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]
|
15
|
Dieltjens M, Vanderveken OM. Oral Appliances in Obstructive Sleep Apnea. Healthcare (Basel) 2019; 7:healthcare7040141. [PMID: 31717429 PMCID: PMC6956298 DOI: 10.3390/healthcare7040141] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/29/2019] [Accepted: 11/01/2019] [Indexed: 12/25/2022] Open
Abstract
Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.
Collapse
Affiliation(s)
- Marijke Dieltjens
- Department of Translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium;
- Special Dentistry Care, Antwerp University Hospital, 2650 Edegem, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Olivier M. Vanderveken
- Department of Translational neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, 2610 Wilrijk, Belgium;
- ENT, Head and Neck Surgery, Antwerp University Hospital, 2650 Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, 2650 Edegem, Belgium
- Correspondence:
| |
Collapse
|
16
|
Lavigne G, Herrero Babiloni A, Beetz G, Dal Fabbro C, Sutherland K, Huynh N, Cistulli P. Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea. J Dent Res 2019; 99:26-35. [DOI: 10.1177/0022034519885644] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with a drop in oxygen and/or rise in carbon dioxide. It can be associated with sleepiness and fatigue, impaired mood and cognition, cardiometabolic complications, and risk for transportation and work accidents. Although sleep apnea is diagnosed by a sleep physician, its management is interdisciplinary. The dentist’s role includes 1) screening patients for OSA risk factors (e.g., retrognathia, high arched palate, enlarged tonsils or tongue, enlarged tori, high Mallampati score, poor sleep, supine sleep position, obesity, hypertension, morning headache or orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; and 3) providing oral appliance therapy followed by regular dental and sleep medical follow-up. In addition to the device features and provider expertise, anatomic, behavioral, demographic, and neurophysiologic characteristics can influence oral appliance effectiveness in managing OSA. Therefore, OSA treatment should be tailored to each patient individually. This review highlights some of the putative action mechanisms related to oral appliance effectiveness and proposes future research directions.
Collapse
Affiliation(s)
- G.J. Lavigne
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
- Division of Experimental Medicine, McGill University, Montréal, Canada
| | - A. Herrero Babiloni
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
- Division of Experimental Medicine, McGill University, Montréal, Canada
| | - G. Beetz
- Research Center, CIUSSS du Nord-de-l’Île-de-Montréal, Montréal, Canada
| | | | - K. Sutherland
- Charles Perkins Centre and Sydney Medical School, University of Sydney, and Royal North Shore Hospital, Sydney, Australia
| | - N. Huynh
- Faculté de médicine dentaire, Université de Montréal, Montréal, Canada
| | - P.A. Cistulli
- Charles Perkins Centre and Sydney Medical School, University of Sydney, and Royal North Shore Hospital, Sydney, Australia
| |
Collapse
|
17
|
Chan ASL, Sutherland K, Cistulli PA. Mandibular advancement splints for the treatment of obstructive sleep apnea. Expert Rev Respir Med 2019; 14:81-88. [PMID: 31663416 DOI: 10.1080/17476348.2020.1686978] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Introduction: Obstructive sleep apnea (OSA) is a chronic condition which requires a comprehensive chronic disease management model, rather than a device-focused approach, so as to achieve the best possible health outcomes. Oral appliances are the main alternative to continuous positive airway pressure (CPAP) for the treatment of OSA. There has been an expansion of the research evidence to support the use of oral appliances in clinical practice and the clinical use of oral appliances for the treatment of OSA has become a mainstream practice.Areas covered: This review summarizes the evidence base for the use of oral appliances for the treatment of OSA. The types of oral appliances; their mechanism of action and clinical efficacy for the treatment of OSA; adverse effects, and the impact on patient acceptability and treatment adherence; and clinical effectiveness and health outcomes are discussed.Expert opinion: Personalization of treatment is vitally important in OSA and is a pre-requisite for optimizing adherence with treatment which, in turn, is a key determinant of clinical effectiveness. Treatment of OSA with mandibular advancement splints could provide an equivalent health benefit to CPAP despite not achieving a complete normalization of polysomnographic indices, mediated by differences in adherence profiles.
Collapse
Affiliation(s)
- Andrew S L Chan
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Australia.,Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Kate Sutherland
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Australia.,Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Peter A Cistulli
- Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, Australia.,Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia.,Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| |
Collapse
|