ABSTRACT
OBJECTIVE: This study uses polysomnography and the Epworth sleepiness scale to assess the efficiency of the Ocluch©MAD in patients with Obstructive sleep apnea-hypopnea syndrome (OSAS), on overall respiratory disturbance indices (RDI), supine respiratory disturbance index (SRDI), minimum oxygen saturation, microarousals, CT90 (or ID90), sleep efficacy and snoring. These data are associated with skeletal class and facial biotype in order to establish predictive parameters for its effectiveness according to craniofacial morphology. METHODS: 22 adult patients (between 38 and 60 years of age) of both sexes (7 women, 15 men) diagnosed with OSAS in the Hospital de Carabineros de Chile (HOSCAR) Neurology Unit were recruited and given the Ocluch© MAD in the hospital's dental clinic, for its use during a three-month period. Patients were assess at the beginning and in the end of this period. RESULTS: 87.5% of patients with mild OSAS achieved the success criterion and normalization; 71.5% of patients with moderate OSAS achieved the success criterion and 33.3% achieved normalization; 85.7% of patients with severe OSAS achieved the success criterion and 57.1% achieved normalization. All class I and mesofacial patients achieved normalization, but class II patients had the greatest proportional improvement. CONCLUSIONS: The Ocluch MAD is an efficient low-cost alternative that should be considered among the therapeutic arsenal for a multidisciplinary approach to treating this disease.
ABSTRACT
Objetivo Para el manejo de los trastornos temporomandibulares y del bruxismo de sueño (BS) se ha recurrido durante años a los dispositivos oclusales rígidos superiores (DORS). Estos dispositivos podrían modificar la posición de la mandíbula induciendo una posición más posterior de la lengua y del hueso hioides, comprometiendo la permeabilidad de la vía aérea superior y agravando los trastornos respiratorios del sueño. Este trabajo tiene como objetivo evaluar el cambio de las dimensiones lineales y de área de la luz de la vía aérea faríngea en pacientes diagnosticados con BS que estén usando un DORS, mediante una telerradiografía lateral. Metodología Se reclutaron 20 pacientes del Hospital de Carabineros, de ambos sexos, diagnosticados con BS probable manejados con un DORS, a los cuales se les tomó una telerradiografía lateral sin DORS y otra con DORS sin modificar la postura para evitar distorsiones por posición craneocervical. Se analizó el área y profundidad faríngea por medio de cefalometría para medir el espacio faríngeo. Resultados Se observaron diferencias estadísticamente significativas en la disminución del área de la orofaringe (promedio: 41,2 mm2, p = 0,035) y la profundidad al nivel del gonion (promedio: 0,38 mm, p = 0,019) y la úvula (promedio: 1,38 mm, p = 0,009). No se encontró correlación entre el aumento de la dimensión vertical y las diferencias dimensionales. Conclusión Bajo las condiciones de este estudio el uso de un DORS produce una tendencia a la disminución del área y profundidad orofaríngea.
Objective The use of the superior rigid occlusal splint (SROS) has been used to management temporomandibular disorders and sleep bruxism for many years. These SROS could change the mandibular position leading to a more posterior position of the tongue and hyoids bone, and compromising the upper airway flow permeability and make sleep-breathing disorders worse. The aim of this study is to evaluate the linear and area changes of lumen in patients with sleep bruxism who are using a SROS, measured by lateral teleradiograph. Methodology The study included 20 patients, of both sexes, from the Hospital de Carabineros, Chile, who were diagnosed with probable sleep bruxism due to using and SROS. The cephalometric analysis was performed of the area and pharyngeal depth in order to measure the pharyngeal space, by obtaining a lateral teleradiograph without SROS and a second teleradiograph using SROS, at the same time, to avoid dimensional variation due to possible craniocervical positional changes. Results A statistical significance was found for oropharynx reduction (mean: 41.2 mm2, P = .035), for the gonion linear depth (mean: 0.38 mm, P = .019), and at uvula level (mean: 1.83 mm, P = .009). No correlations were found between the increasing vertical dimensions using SROS and pharyngeal spaces. Conclusion The using of a superior occlusal splint (SROS) could reduce the oropharyngeal depth and space.
Subject(s)
Humans , Male , Female , Adult , Respiratory System/anatomy & histology , Temporomandibular Joint Disorders/etiology , Occlusal Splints/adverse effects , Teleradiology , Sleep Bruxism/therapy , Respiratory System/diagnostic imaging , Vertical Dimension , Temporomandibular Joint Disorders/diagnostic imaging , Cephalometry , Double-Blind Method , Cross-Sectional StudiesABSTRACT
Bruxism is a rhythmic masticatory muscle activity, characterized by teeth grinding and clenching. This is a phenomenon mainly regulated by the central nervous system and peripherally influenced. It has two circadian manifestations, during sleep (sleep bruxism) and awake states (awake bruxism). Bruxism is much more than just tooth wearing. It is currently linked to orofacial pain; headaches; sleep disorders; sleep breathing disorders, such as apnea and hypopnea sleep syndrome; behavior disorders, or those associated with the use of medications. It is also influenced by psycho-social and behavior factors, which means that oromandibular parafunctional activities, temporomandibular disorders, malocclusion, high levels of anxiety and stress, among others, may precipitate the occurrence of bruxism. Nowadays, its etiology is multifactorial. The dentist and the pediatrician are responsible for its early detection, diagnosis, management, and prevention of its possible consequences on the patients. The aim of this review is to update the concepts of this disease and to make health professionals aware of its early detection and its timely management.
Subject(s)
Facial Pain/etiology , Sleep Bruxism/therapy , Tooth Wear/etiology , Adolescent , Anxiety/etiology , Child , Early Diagnosis , Headache/etiology , Humans , Sleep Bruxism/complications , Sleep Bruxism/diagnosis , Sleep Wake Disorders/etiology , Temporomandibular Joint Disorders/etiology , Tooth Wear/prevention & controlABSTRACT
El bruxismo es una actividad muscular mandibular repetitiva, caracterizada por apriete y rechinamiento dentario. Se considera un fenómeno regulado por el sistema nervioso central, principalmente, e influido por factores periféricos. Tiene 2 manifestaciones circadianas distintas: puede ocurrir durante el sueño -indicado como bruxismo de sueño- o durante la vigilia -indicado como bruxismo despierto-. El bruxismo es mucho más que solo el desgaste que podemos observar en los dientes: de hecho, se asocia con dolor orofacial, cefaleas, trastornos del sueño, trastornos respiratorios durante el sueño como el síndrome de apnea e hipoapnea del sueño, trastornos del comportamiento o asociados al uso de fármacos. Además, se ve influido por factores psicosociales y posturales, lo que indica que parafunciones oromandibulares, los trastornos temporomandibulares, la maloclusión, los altos niveles de ansiedad y de estrés, entre otros, podrían influir en la ocurrencia de bruxismo. Su etiología es considerada hoy como multifactorial. Su detección temprana, diagnóstico, tratamiento y la prevención de sus posibles consecuencias en los pacientes es responsabilidad del pediatra y del odontólogo. El objetivo de esta revisión es actualizar los conceptos sobre esta patología y alertar a los profesionales de la salud sobre su detección precoz y su manejo oportuno.
Bruxism is a rhythmic masticatory muscle activity, characterized by teeth grinding and clenching. This is a phenomenon mainly regulated by the central nervous system and peripherally influenced. It has two circadian manifestations, during sleep (sleep bruxism) and awake states (awake bruxism). Bruxism is much more than just tooth wearing. It is currently linked to orofacial pain; headaches; sleep disorders; sleep breathing disorders, such as apnea and hypopnea sleep syndrome; behavior disorders, or those associated with the use of medications. It is also influenced by psycho-social and behavior factors, which means that oromandibular parafunctional activities, temporomandibular disorders, malocclusion, high levels of anxiety and stress, among others, may precipitate the occurrence of bruxism. Nowadays, its etiology is multifactorial. The dentist and the pediatrician are responsible for its early detection, diagnosis, management, and prevention of its possible consequences on the patients. The aim of this review is to update the concepts of this disease and to make health professionals aware of its early detection and its timely management.
Subject(s)
Humans , Child , Adolescent , Facial Pain/etiology , Sleep Bruxism/therapy , Tooth Wear/etiology , Anxiety/etiology , Sleep Wake Disorders/etiology , Temporomandibular Joint Disorders/etiology , Sleep Bruxism/complications , Sleep Bruxism/diagnosis , Early Diagnosis , Tooth Wear/prevention & control , Headache/etiologyABSTRACT
OBJECTIVE: To compare the effects of 5% lidocaine patches and placebo patches on pain intensity and electromyographic (EMG) activity of an active myofascial trigger point (MTrP) of the upper trapezius muscle. MATERIALS AND METHODS: Thirty-six patients with a MTrP in the upper trapezius muscle were randomly divided into two groups: 20 patients received lidocaine patches (lidocaine group) and 16 patients received placebo patches (placebo group). They used the patches for 12 h each day, for 2 weeks. The patch was applied to the skin over the upper trapezius MTrP. Spontaneous pain, pressure pain thresholds, pain provoked by a 4-kg pressure applied to the MTrP and trapezius EMG activity were measured before and after treatment. RESULTS: Baseline spontaneous pain values were similar in both groups and significantly lower in the lidocaine group than the placebo group after treatment. The baseline pressure pain threshold was significantly lower in the lidocaine group, but after treatment it was significantly higher in this group. Baseline and final values of the pain provoked by a 4-kg pressure showed no significant difference between the groups. Baseline EMG activity at rest and during swallowing of saliva was significantly higher in the lidocaine group, but no significant difference was observed after treatment. Baseline EMG activity during maximum voluntary clenching was similar in both groups, but significantly higher in the lidocaine group after treatment. CONCLUSIONS: These clinical and EMG results support the use of 5% lidocaine patches for treating patients with MTrP of the upper trapezius muscle.
