Sleep and Dentistry / 수면정신생리

Dental sleep medicine is an up-and-coming discipline of dentistry, more specifically an offshoot of oral medicine. It traditionally focuses on sleep-related breathing disorders, such as snoring and obstructive sleep apnea. However, everyday practice shows that also other sleep disorders touch on dentistry, including orofacial pain, xerostomia, and bruxism. Therefore, a new definition has been formulated for dental sleep medicine as following; ‘Dental sleep medicine is the discipline concerned with the study of the oral and maxillofacial causes and consequences of sleep-related problems’. It is this article’s aim to further introduce the emerging discipline of dental sleep medicine to all professionals working in sleep medicine. This article briefly describes the different dental sleep disorders with special focus on the more remarkable associations between orofacial pain and sleep.

Sleep Apnea Headache in Korean Patients with Obstructive Sleep Apnea

BACKGROUND: The prevalence of sleep apnea headache has not been established and its possible mechanism is unclear. This study evaluated the frequency of sleep apnea headache in Korean patients with obstructive sleep apnea (OSA) with the aim of identifying their clinical characteristics as well as the sleep parameters that are correlated with headache intensity. METHODS: Between January 2005 and December 2014, 2000 patients who were referred to our sleep clinic underwent overnight polysomnography and were interviewed by a neurologist. The neurologist also reviewed the medical records and headache questionnaires of 1659 patients with OSA. We selected patients with sleep apnea headache based on diagnostic criteria of the International Classification of Headache Disorders (III beta version). Descriptive statistics were applied to analyze clinical characteristics and various sleep parameters. Pearson's correlation coefficient and single/multivariate linear regression analysis were used to identify predictors of headache intensity. RESULTS: Sleep apnea headache was diagnosed in 139 (8.4%) of the patients in this single-center study. The diagnosed patients had male dominancy (87.8%), severe sleep apnea (mean apnea-hypopnea index [AHI]>30), and were middle-aged (mean of 43.5 years old). The ratio of the apnea-hypopnea time to the total sleep time, AHI, the oxygen desaturation index, and the arousal index were positively correlated with headache intensity. AHI was the best predictor of headache intensity in the patients with sleep apnea headache. CONCLUSIONS: The frequency of sleep apnea headache among the Korean patients in this study was lower than in previous studies. We found that there was a strong positive correlation between OSA severity (mostly, AHI) and headache intensity in patients with sleep apnea headache.

Dynamic Upper Airway Study in Snoring Subjects Using Electron Beam Tomography / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The upper airway caliber shows rhythmic changes according to the respiratory cycle. The dynamic imaging technique is needed to demonstrate nonfixed oropharyngeal obstruction in patients with snoring and/or obstructive sleep apnea. This study was designed with the purpose to determine the level, extent, and dynamics of the oropharyngeal closure from the dynamic view of the oropharynx and to estimate the usefulness of electron beam tomography (EBT) in the snoring and/or obstructive sleep apnea patients. MATERIALS AND METHOD: The upper airway was scanned in 18 patients with snoring by using EBT while awake, asleep, pre and post UPPP (six patients), and pre and post oral appliance (seven patients) during at least two full respiratory cycles. RESULTS: The oropharyngeal stenosis and collapsibility were increased during sleep, especially in the minimum cross sectional area level. In most cases, the sites of stenosis of wakefulness and sleep did not coincide. The degree of stenosis as well as collapsibility of the oropharynx were reduced after UPPP and oral appliance. CONCLUSION: The dynamic study during sleep is needed to evaluate sleep induced airway disease. EBT has the potential to provide information quickly and non-invasively on upper airway dynamics and has certain definite advantages over conventional studies.

Possibility in Unification of Oriental and Western Medicine Education by Combination of Educational Curricula / 의사학

The authors attempted a pdssibility of unifcation in the educational curricula of both Oriental and Western medical schools for the unification of two medicines . Historically the two medicines were originated from the most primitive state like intinctive method and we can say two medicines were entirely same. However after abrupt and current development of science in 19 century by discovery of microscope and bacteria as well as cells changed medicine into recent unbelievable current medicine from old ancient style medicine like Chinese Medicine which was just the remnant old medicine. The unification of educational curricular is thought to be possible to combine each other by technical adjustment from mutual understanding and cooperations for the most high quality of people's lives. There were good equality to partial corrrespondances between two educational curricular around 90 % at two pre- and schools from the study to analyse. The combined medicine is thought to be more efficient to the diagnosis and treatment of patients because of the effectiveness of Oriental medicine in a certain disease conditions like chronic illness by acupuncture as a alternative medicine or herbs.

Prediction of Soft Tissue Profile Changes after Mandibular Set-back Surgery

We usually accept 1 : 1 ratio soft tissue change in mandibular set-back surgery. But we cannot sure whether we can use this ratio as a long term predictor after surgery. We investigated the change of hard tissue and its effects to soft tissue and examined the predictability of cephalometric analysis in short term and long term follow-up periods in mandibular set-back surgery. Subjects were 15 patients (5 male, 10 female) performed mandibular set-back procedure only by BSSRO with rigid fixation. Cephalometric data were obtained before orthodontic treatment, immediate before surgery and immediate after surgery, 6 months, and 18 months after surgery consecutively. Differences in soft and hard tissue changes among the time intervals were examined using analysis of variance (ANOVA) ; the association between immediate surgical change in chin landmarks and subsequent short and long term soft and hard tissue changes were examined using linear regression analysis 1. Soft tissue mandibular structures were positioned posteriorly and superiorly after surgery. Average mandibular set-back were 8.17mm at Pog. The horizontal and vertical hard tissue mandibular changes were stable for 18 months after surgery. Although there was a small degree of change, soft tissue and hard tissue remain relatively stable after surgery and there was no clinically discernable changes between 6 months and 18 months post-operatively. 2. Some part of upper lip (Ls & stms)and most part of mandibular soft tissue moves postero-superiorly after mandibular set-back. The ratio of horizontal changes of hard tissue to soft tissue at Inf. labial sulcus(B'), Pogonion(Pog') were 84.7%, 74.7% after 18 months. respectively. 3. Predictability of the soft tissue change is less certain than hard tissue and this predictability is decreased over time. These result suggests that we cannot predict the surgical outcomes exactly. It is recommendable that the oral surgeon should be careful in using the computerized surgical prediction software program as a predictor of long term soft tissue change.

A Relationship Between Amount of Joint Effusion, Disk Displacement and Presence of Pain in theTemporomandibular Joint: MR Imaging

PURPOSE: To correlate MR findings of amount of temporomandibular joint effusion with joint pain and disk displacement. MATERIALS AND METHODS: In 57 patients, 114 temporomandibular joints with symptoms of disorder(presence of clinical pain) were imaged. Closed and open mouth sagittal spin echo (SE) T1-weighted images (WI) and fast spin echo (FSE) T2-WI were obtained. We classified the amount of joint effusion into grades. Joint effusion was classified as either Grade I, II or III, as follours : in sagittal FSE T2-WI, a long diameter of joint effusion shorter than 1/3 of the diameter of the convex margin of temporal eminence was grade I; longer than 2/3 was grade III; between grade I and III was grade II. Disk displacement was classified as either with or without reduction in the open mouth position. These findings were correlated with one another and statistically analyzed. RESULTS: In 29 cases with joint pain (37%) and in 34 cases without pain (63%) there was no evidence of joint effusion; there were, however, more grade I joint effusion cases with pain (14 ; 60.9%) than without pain (9 : 39.1%). Cases of joint pain increased in proportion to grade of joint effusion, which was statistically significant (p<0.05). In joints without disk displacement, the largest grouping was that which showed no effusion (39 ; 72.2%) ; no joints showed grade III effusion. Cases of joint effusion decreased in proportion to grade of effusion. In joints with disk displacement, cases of joint effusion tended to increase in proportion to the grade of effusion. CONCLUSION: MR findings of amount of temporomandibular joint effusion correlate with joint pain and anterior disk displacement.