Use of a modified mandibular splint to reduce nocturnal symptoms in persons with post-traumatic stress disorder

Traumatic brain injury and sleep in military and veteran populations: A literature review

BACKGROUND

Traumatic brain injury (TBI) is a hallmark of wartime injury and is related to numerous sleep wake disorders (SWD), which persist long term in veterans. Current knowledge gaps in pathophysiology have hindered advances in diagnosis and treatment.

OBJECTIVE

We reviewed TBI SWD pathophysiology, comorbidities, diagnosis and treatment that have emerged over the past two decades.

METHODS

We conducted a literature review of English language publications evaluating sleep disorders (obstructive sleep apnea, insomnia, hypersomnia, parasomnias, restless legs syndrome and periodic limb movement disorder) and TBI published since 2000. We excluded studies that were not specifically evaluating TBI populations.

RESULTS

Highlighted areas of interest and knowledge gaps were identified in TBI pathophysiology and mechanisms of sleep disruption, a comparison of TBI SWD and post-traumatic stress disorder SWD. The role of TBI and glymphatic biomarkers and management strategies for TBI SWD will also be discussed.

CONCLUSION

Our understanding of the pathophysiologic underpinnings of TBI and sleep health, particularly at the basic science level, is limited. Developing an understanding of biomarkers, neuroimaging, and mixed-methods research in comorbid TBI SWD holds the greatest promise to advance our ability to diagnose and monitor response to therapy in this vulnerable population.

The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review

The purpose of this systematic study was to discover a connection between temporomandibular joint disorders and post-traumatic stress disorder. A systematic review of observational studies on post-traumatic stress disorder and the incidence of temporomandibular joint disorders (TMD) was conducted. Electronic searches of PubMed, the Saudi Digital Library, Science Direct, the Virtual Health Library (VHL), Scopus, Web of Science, Sage, EBSCO Information Services, and Ovid were performed. There was a consensus among the reviewing examiners. Only studies with the following Medical Subject Headings (MeSH) terms were included: "Posttraumatic stress disorder" combined with "temporomandibular joint disorder," "myofascial pain," "orofacial pain," "internal derangement," "disc displacement with reduction," or "disc displacement without reduction." Only full-text studies in the English language published between 2010 and June 2020 were considered. Of a total of 381 articles meeting the initial screening criteria, only eight were included in the qualitative analysis. Overall, pain is exacerbated in patients with PTSD; that is, their TMD is heightened in all aspects of pain, chronicity, decreased response to conventional therapies, and the need for more potent treatment options as compared with patients with just TMD. The evidence, albeit weak, obtained from the studies included in this review suggests a relationship between PTSD and TMDs.

Pilot trial of a mouthpiece as treatment for signs and symptoms of Parkinson disease

PURPOSE

Several case studies and anecdotal reports have shown assorted motor and quality of life benefits from use of a dental mouthpiece among people with Parkinson disease (PD). A larger exploratory study is necessary to assess potential efficacy and feasibility of this treatment strategy. If shown to be effective and feasible in a larger sample of people with PD, mechanistic studies may be warranted to examine a potential relationship between orofacial sensory input and motor function in people with PD.

MATERIALS AND METHODS

This study was registered on clinicaltrials.gov (NCT: 04082663). Twenty people with PD, Hoehn and Yahr stages I-III, participated in this study. Each participant completed various baseline motor and quality of life assessments before being fitted with a custom mouthpiece. Motor assessments were completed a second time after 25 min of mouthpiece wear. Participants were asked to wear the mouthpiece for 1 month before completing follow-up quality of life assessments and providing feedback about the mouthpiece. Wilcoxon signed-rank tests were used to compare results across conditions.

RESULTS

Gait velocity and cadence showed significant (p < .05) improvement while wearing the mouthpiece. However, these changes were not significant after correcting for multiple comparisons. Thirteen participants indicated they would be unlikely to continue wearing the mouthpiece.

CONCLUSIONS

These results do not provide adequate evidence to pursue further this type of mouthpiece as a treatment strategy for motor signs and symptoms or quality of life in people with PD.