The Evolving Field of Dental Sleep Medicine.

Dental sleep medicine is a dynamic field focused on the relationship between oral health and sleep disorders, particularly sleep apnea. Dentists play a crucial role in diagnosing and treating sleep-related breathing issues. As awareness of the impact of sleep on overall health grows, the field is evolving rapidly with advancements in technology, diagnostic tools, and treatment modalities. Interdisciplinary collaboration between dentists, sleep physicians, and other health care professionals is becoming increasingly important. The integration of innovative approaches and a patient-centric focus make dental sleep medicine a pivotal player in addressing the complex interplay between oral health and sleep quality.

Effect of sitting posture with and without sole-ground contact on chewing stability and masticatory performance.

PURPOSE: To verify the effect of sitting posture with and without sole-ground contact on chewing stability and masticatory performance. METHODS: Thirty healthy subjects were evaluated. The Conformat was used to analyze the center of sitting pressure (COSP), and the three-dimensional motion analysis system was used to analyze changes in head and trunk postures while subjects remained in a sitting position with and without sole-ground contact. The parameters of masticatory performance and movement were calculated as follows. For evaluating masticatory performance, the amount of glucose extraction (AGE) during chewing of a gummy jelly was measured. For evaluating masticatory movements, the movement of the mandibular incisal point was recorded using the Motion Visi-Trainer V1, and parameters of the stabilities of movement path and rhythm were calculated. RESULTS: Head and trunk sway values and the displacement of COSP were significantly smaller with sole-ground contact than those without sole-ground contact. The masticatory movement path with sole-ground contact showed less variation in the opening distance and more stable movement path compared to those without sole-ground contact. The AGE was significantly greater with sole-ground contact than that without sole-ground contact. CONCLUSION: Sitting posture with and without sole-ground contact affects chewing stability and masticatory performance.

Effect of masticatory movements on head and trunk sways, and sitting and foot pressure distributions during sitting position.

BACKGROUND: The head plays an important role in the postural control. Chewing co-activates jaw and neck muscles leading to coordinated jaw and head-neck movements. Therefore, to examine effect of masticatory movements on head and trunk sways, and sitting and foot pressure distributions during mastication is helpful in the attempt to understand the interrelationship between stomatognathic function and posture control system in the sitting position. OBJECTIVES: The purpose of this study was to test the hypothesis in healthy subjects that masticatory movements affect head and trunk sways and sitting and foot pressure distributions during sitting position. METHODS: A total of 30 healthy male subjects with an average age of 25.3 years (range, 22-32 years) were evaluated. The CONFORMat™ and MatScan™ system were used to analyse changes in sitting pressure distribution center of sitting pressure (COSP) and changes in foot pressure distribution center of foot pressure (COFP), respectively, and the three-dimensional motion analysis system was used to analyse changes in head and trunk postures while subjects remained sitting position with rest position, centric occlusion and chewing. The total trajectory length of COSP/COFP, COSP/COFP area, and head and trunk sway values were compared between the three conditions to evaluate whether masticatory movement affected the stability of head and trunk sways and sitting and foot pressure distributions. RESULTS: Total trajectory length of COSP and COSP area during chewing were significantly shorter and smaller respectively than it was in rest position and centric occlusion (p ⟨ .016). Head sway value during chewing was significantly larger than it was in rest position and centric occlusion (p ⟨ .016). CONCLUSION: Masticatory movements affect sitting pressure distribution and head movements during sitting position.

Evaluating a dental sleep apnea mini-residency program using the Kirkpatrick model.

OBJECTIVE: The aim of this retrospective study was to evaluate a Dental Sleep Medicine Mini-Residency (DSMMR) continuing education (CE) program using the Kirkpatrick model. METHODS: After receiving ethical approval, data from participants in the 2019-2020 DSMMR CE course were included for the Kirkpatrick evaluation. The analysis was stratified and all the Kirkpatrick levels were integrated: level 1 (satisfaction) was assessed via Likert scale and open-ended questions; level 2 (learning) was evaluated using pretest and posttest knowledge data following Module 1 (M1) and an assessment of multiple-choice questions (MCQs) developed by participants; level 3 (behavior) was evaluated using Likert scale questions; and level 4 (results) was assessed via the percentage of participants who passed the American Board of Dental Sleep Medicine (ABDSM) examination on their first attempt. RESULTS: A total of 90 participants were included in the study. At least 83.1% of participants agreed/strongly agreed with positively worded statements about satisfaction. Knowledge scores significantly increased from pre-M1 to post-M1 (p < 0.001); however, only 15.2% of MCQs were evaluated as well-formulated. At least 88.6% of participants agreed/strongly agreed with positively worded statements about transfer of knowledge/skills to their practice. 91.1% passed the ABDSM examination on their first attempt. CONCLUSION: The evaluation of the 2019-2020 DSMMR using the Kirkpatrick model suggests its overall positive impact as a training program. The Kirkpatrick model provided information that can be used to improve the quality of a program. Future studies should assess other dental CE programs using the Kirkpatrick model or another evaluation model.

Recommendations for remaining agile in the face of a dental faculty workforce shortage.

PURPOSE: Dental education is facing a faculty workforce shortage. Lack of preparation risks faculty, student, and staff morale and is an impediment to institutional growth and innovation. Administrators and faculty must consider strategies to better prepare for, and be successful within, a faculty shortage environment. METHODS: We review strategies utilized by health professional institutions that have confronted faculty workforce shortages. RESULTS: These strategies were grouped into four domains reflecting the organizational units that typically direct and initiate change within dental education institutions: budget and finance, human resources, organizational structure, and curricular structure. Recommendations using a four-pronged approach based on these domains have been developed for remaining agile in the face of a faculty workforce shortage. CONCLUSIONS: Local needs assessments and strategic planning are the first steps in highlighting institutional strengths and identifying gaps within each of the domains. Faculty development and retention efforts, as well as increasing curricular efficiencies, are essential for success across all domains.

Effect of body posture on stability and balance of occlusal contacts.

OBJECTIVE: To evaluate the effect of body posture on occlusal contact. METHODS: A total of 30 healthy subjects were evaluated. T-Scan™ III was used to analyze the center of occlusal force (COF) and occlusal force distribution while subjects remained supine (SP), upright sitting with the head fixed (UP-HFI), upright sitting with the head free (UP-HFR), and natural standing (NS). RESULTS: The total trajectory length of COF was significantly longer in NS than in SP, UP-HFI, and UP-HFR. The COF area was significantly larger in UP-HFR than in SP and UP-HFI and also significantly larger in NS than in SP, UP-HFI, and UP-HFR. The anteroposterior occlusal force distribution (AOD) in NS shifted significantly forward, compared to SP, UP-HFI, and UP-HFR. AOD in UP-HFI and UP-HFR shifted significantly forward, compared to the SP position. CONCLUSION: Changes in body posture affect the stability and anteroposterior balance of occlusal contacts.

Oral Appliance Therapy and Temporomandibular Disorders.

This article focuses on clinical examination to assist in maintaining stable function between jaw posture, muscle function, and temporomandibular joint stability. It describes a simple and understandable approach for assessment and management of common temporomandibular symptoms arising as side effects from use of mandibular advancement device therapy for obstructive sleep apnea. Follow-up visits are necessary to assess efficacy of sleep oral devices. An interdisciplinary approach is necessary for better treatment outcome. Qualified dentists offering this therapy should be educated and gain knowledge about diagnosis, prevention, and management of common side effects, and adhere to current standards of dental sleep medicine practice.

Utilizing the concept of geste antagoniste for conservative management of oro-mandibular tardive dyskinesia: a case report and mini-review.

OBJECTIVE: This case report highlights the implication of the concept of "geste antagoniste" in conservatively managing oromotor dysfunction and its complications. CLINICAL PRESENTATION: A 66-year-old female with a 1-year history of tardive dyskinesia (TD) was referred to the Craniofacial Pain Department (CPC) at Tufts University School of Dental Medicine for management of sore labial/lingual mucosa secondary to excessive daytime involuntary activity of the tongue, lips, and mandible. A detailed head/neck examination revealed excessive involuntary movements of the tongue, lips, and mandible with generalized tenderness of her masticatory muscles. No TMJ or bone pathology was evident in a panoramic radiograph. INTERVENTION: A lower daytime appliance with bilateral posterior contacts was fabricated to protect her oral mucosa. On reevaluation, excessive movement of the jaw/tongue was significantly reduced with the presence of the appliance in her mouth. Face/neck muscle tenderness was also greatly reduced. CONCLUSION: The use of oral appliance therapy in TD patients plays an important role in protecting the teeth/oral mucosa. The subsequent inhibition of excessive motor activity is proposed and should be further investigated.