Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study.

OBJECTIVES: Literature presents conflicting results regarding malocclusions, Obstructive Sleep Apnea (OSA) and sleep bruxism in children with ADHD. Aim of this study was to evaluate the prevalence of these parameters. METHODS: A prospective study was conducted on 40 consecutive ADHD children referred to the Paediatric Dentistry Unit of Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome. All subjects underwent an orthodontic examination and were screened for OSA and sleep bruxism. Data were compared to a sex- and aged-matched control group. RESULTS: Prevalence of high risk of OSA in children with ADHD was 62.5% compared to 10% in the control group (p < .00001). No differences were found in any of the occlusal variables examined between children with ADHD and controls (p > .05). An increased prevalence of sleep bruxism was observed in ADHD children (40%) compared to controls (7.5%) (p < .001). CONCLUSIONS: A higher prevalence of OSA risk and probable sleep bruxism were observed in ADHD patients compared with controls. No significant differences were observed in malocclusions d.

Impact of Concurrent Use of N95 and Surgical Masks on Peripheral Oxygen Saturation and Heart Rate Frequency-A Prospective Study during the COVID-19 Outbreak.

Background and Objectives: The COVID-19 outbreak has necessitated the prolonged use of N95 facemasks in addition to traditional surgical facemasks by healthcare workers. The aim of this study was to investigate the effect of wearing N95 facemasks in addition to surgical facemasks on peripheral oxygen saturation (SpO2) and heart rate (HR) among dental professionals during routine care. Materials and Methods: This prospective study compared SpO2 and HR between dental providers wearing N95 + surgical facemasks vs. wearing a surgical facemask only. SpO2 and HR were recorded using a portable pulse oximeter before wearing the facemask (T0); at 30 min (T1); at 1 h (T2); and at the end of clinical activity (T3). Inter-group and intra-group differences were assessed with independent t tests and repeated measures ANOVA, respectively. Results: A total of 88 participants (57 wearing N95 + surgical facemasks, and 31 wearing a surgical facemask only) completed the study. The two groups did not statistically differ in SpO2 at different timepoints nor showed any intra-group differences. The participants wearing N95 + surgical facemasks exhibited a statistically higher HR at T0 (p = 0.007), T2 (p = 0.010), and T3 (p = 0.014) compared to those wearing a surgical facemask only. A statistically significant decrease was observed in HR between T0 and T3 in those wearing N95 + surgical facemasks (p = 0.012). No intra-group differences were seen in HR over time in those wearing a surgical facemask only. Conclusions: The continuous use of an N95 in addition to a surgical facemask did not show any significant effects in SpO2 during routine care; however, the concurrent use of an N95 and a surgical facemask seemed to be accompanied by a decrease in HR, although the values remained within the normal range.

Relationship between insomnia and pain in patients with chronic orofacial pain.

OBJECTIVE: Few studies have investigated specific associations between insomnia and orofacial pain (OFP). The aim of this cross-sectional study was to examine relationships of insomnia with pain, mental health, and physical health variables among treatment-seeking patients with chronic OFP. METHODS: OFP diagnosis, demographics, insomnia symptoms, pain intensity, interference, and duration, mental health measures, and number of medical comorbidities were extracted from the medical records of 450 patients receiving an initial appointment at a university-affiliated tertiary OFP clinic. T-tests compared differences between patients with and without insomnia symptomatology, and between patients with different insomnia subtypes (delayed onset/early wakening). RESULTS: Compared to patients without insomnia, those with elevated insomnia symptomatology (45.1%) reported higher pain intensity (60.70 ± 20.61 vs 44.15 ± 21.69; P < .001) and interference (43.81 ± 29.84 vs 18.40 ± 23.43; P < 0.001), depression/anxiety symptomatology (5.53 ± 3.32 vs 2.72 ± 2.66; P < 0.001), dissatisfaction with life (21.63 ± 6.95 vs 26.50 ± 6.21; P < .001), and number of medical comorbidities (6.72 ± 5.37 vs 4.37 ± 4.60; P < .001). Patients with Sleep Onset Latency insomnia (SOL-insomnia) (N = 76) reported higher pain intensity (t = 3.57; P < 0.001), and pain interference (t = 4.46; P < .001) compared to those without SOL-insomnia. Those with Early Morning Awakening insomnia (EMA-insomnia) (N = 71) did not significantly differ from those without EMA-insomnia on any of the variables. Differences remained significant after adjusting for age, sex, primary OFP diagnosis, and pain intensity. CONCLUSIONS: Insomnia is associated with pain outcomes and should be appropriately managed when treating patients with chronic OFP.

Effectiveness of dental monitoring system in orthodontics: A systematic review.

BACKGROUND: Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful. OBJECTIVES: To assess the effectiveness of DM in orthodontic care. ELIGIBILITY: Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orthodontic emergencies and improvement of oral health status. INFORMATION SOURCES: PubMed, Web of Science and Scopus were searched for publications until November 2022. RISK OF BIAS: Quality assessment was performed with the STROBE Checklist. DATA EXTRACTION: Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer. INCLUDED STUDIES: Out of 6887 records screened, 11 studies were included. SYNTHESIS OF RESULTS: DM implemented to the standard orthodontic care was found to significantly decrease the number of in-office visits by 1.68-3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis. CONCLUSIONS: This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investigation team and rigorous methodology are advocated.

Obstructive sleep apnea treatment improves temporomandibular disorder pain.

PURPOSE: The existence of a bidirectional relationship between poor sleep and pain intensity has been studied, and good sleep quality has been found to be a key factor underlying pain control. The purpose of this prospective cohort study was to observe if OSA treatment provides a reduction in temporo-mandibular disorder (TMD) pain and headache attributed to TMD in patients with obstructive sleep apnea (OSA) after 18 months of OSA treatment. METHODS: A prospective cohort study was conducted on consecutive patients suffering from OSA. Patients underwent polysomnography and TMD examination according to the DC/TMD protocol at baseline and after 18 months. Intensity of TMD pain and headache attributed to TMD were analyzed. RESULTS: Of 40 patients (31 men, mean age 51.3 ± 10.3 years), 33 underwent OSA treatment. At the follow-up examination after 18 months, significant improvements in the intensity of pain-related TMD and headache attributed to TMD were observed (p < 0.05). Seven patients did not start treatment for OSA or discontinued treatment. These patients did not show any significant difference in intensity of TMD-pain or headache attributed to TMD after 18 months (p > 0.05). CONCLUSIONS: Significant reductions in intensity of pain-related TMD and headache attributed to TMD were observed in patients with OSA after 18 months of OSA treatment onset, while no difference was observed in subjects not undergoing or discontinuing OSA treatment. TRIAL REGISTRATION: The protocol was registered on ClinicalTrials.gov database with number NCT04948541.

Occupations associated with treatment seeking and biopsychosocial functioning at a tertiary orofacial pain clinic: A cross-sectional study.

BACKGROUND: The aim of this study was to describe whether certain occupations were over- or underrepresented and to compare biopsychosocial functioning by types of occupation and employment status among adults seeking orofacial pain (OFP) treatment. METHODS: The authors extracted self-reported employment status, occupation, and biopsychosocial functioning from initial appointment records of 444 treatment-seeking adults at a university-affiliated OFP clinic. The authors categorized occupations in major and minor occupational groups according to the 2018 Standard Occupational Classification. The authors compared proportions between their sample and the corresponding state level, using a ratio and 95% CI (1.00 = equal representation in sample vs state, < 1.00 = underrepresentation, > 1.00 = overrepresentation). RESULTS: Among major occupational categories, health care practitioners and technical occupations were the most common in the study sample (22.4%) and the second most overrepresented (ratio, 3.20; 95% CI, 2.59 to 3.97) after the arts, design, entertainment, sports, and media occupations (ratio, 3.95; 95% CI, 2.15 to 7.26). Among minor occupational categories, teachers and instructors were the most common in the study sample (11.2%) and the most overrepresented (ratio, 90.71; 95% CI, 65.67 to 125.30), followed by managers (ratio, 43.87; 95% CI, 29.61 to 64.99) and photographers (ratio, 40.89; 95% CI, 10.23 to 163.4). No differences were observed in biopsychosocial functioning between major occupational categories. However, those not working due to health reasons or disability had worse biopsychosocial functioning (insomnia, anxiety and depression, life satisfaction, sleep health, pain intensity, pain-related interference; all P < .034) than those who were employed. CONCLUSIONS: Several occupations are strongly over- and underrepresented among adults seeking OFP treatment. Differences were not explained by biopsychosocial functioning. PRACTICAL IMPLICATIONS: Future research should attempt to identify and address the underlying mechanisms of association between occupation and seeking care for OFP.

Prevalence of Malocclusions in Down Syndrome Population: A Cross-Sectional Study.

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10-18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

Assessment of dental ergonomics among dental students: A retrospective study.

INTRODUCTION: Musculoskeletal (MSK) disorders account for 11%-98% of occupational health issues for dental professionals, with an onset as early as in dental school. Dental ergonomics is among the risk factors; thus, a prompt assessment is crucial in preventing future MSK pain. The aim of this study was to retrospectively assess dental ergonomics of second-year dental students after dedicated lectures were introduced in the predoctoral curriculum. METHODS: Three cohorts of second-year dental students were evaluated during preclinical activity in July 2019, January 2022, and December 2022 by an Occupational Therapy (OT) faculty and calibrated OT students. Dental ergonomics was assessed with the Rapid Upper Limb Assessment (RULA). Dental student cohorts were compared with one-way analysis of variance (ANOVA). RESULTS: The average RULA final score of 409 participants was 5.1 ± 0.9, with no difference between the three cohorts (p = 0.676). The January 2022 cohort scored significantly lower in wrist-arm score than that of 2019 (p = 0.001) and December 2022 (p = 0.046). Neck and lower limb posture were significantly higher in January 2022 cohort than in 2019 (p = 0.001 and 0.013) and December 2022 (p = 0.001 and 0.005) cohorts. The December 2022 cohort revealed a medium, high and extremely high risk of developing MSK of 40.2%, 37.1%, and 21.6%, respectively, with no difference between sexes. CONCLUSION: The risk of developing MSK pain was medium-high in predoctoral dental students and was not related to sex. The overall dental ergonomics required attention and rapid change. Further implementation of varied forms of teaching and monitoring of dental ergonomics from the early years of education is recommended to prevent development of MSK pain at young age and foster better postural habits.

Is there an association between EMG activity and temporomandibular disorders during orthotic mandibular advancement in sleep apnea patients undergoing DISE?

OBJECTIVE: To detect whether myotatic reflex activation of masticatory muscles during drug-induced sleep endoscopy (DISE) can be an indirect marker for temporomandibular disorder (TMD) in patients suffering from obstructive sleep apnea (OSA). METHODS: OSA patients were prospectively recruited and underwent a complete TMD examination prior to undergoing DISE with the addition of electrodes applied over masticatory muscles. A positive activation of myotatic reflex was considered in case of an increase in muscle tone of at least 50%. RESULTS: Of the 41 patients included, 48.8% presented activation of myotatic reflex. Of these patients, 45% presented a TMD diagnosis, 40% presented pain at masticatory muscles palpation, and 15% did not report pain during clinical examination. CONCLUSION: An increase in EMG activity during mandibular advancement is not associated with TMD presence, but it can be an indirect marker of pain in the orofacial area in OSA patients.

Prevalence of signs and symptoms of temporo-mandibular disorder in patients with sleep apnea.

PURPOSE: The aim of the present study was to detect the prevalence of temporomandibular disorders (TMD) in patients with untreated obstructive sleep apnea (OSA) and to compare the results with healthy controls, matched for sex and age. METHODS: Forty-one consecutive patients with OSA were prospectively recruited from the Department of Otorhinolaryngology at the A. Gemelli Hospital prior to undergoing any treatment for OSA and independently of OSA severity. All patients underwent a complete TMD examination according to the diagnostic criteria for temporomandibular disorders (DC/TMD) protocol. The same examination was performed on 41 healthy controls matched for sex and age. Chi-squared test was used to compare results between the two groups. RESULTS: Of the 41 patients with OSA, 21 (51%) presented signs and/or symptoms of TMD compared to 13 of 41 subjects (32%) from the control group. Headache attributed to TMD and disc displacement with reduction were the most common diagnoses, with a statistically significant difference between the two groups (p<0.05). CONCLUSIONS: The prevalence of TMD signs and symptoms is significantly higher in untreated patients with OSA compared to healthy controls.

Effects of mandibular advancement device for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis.

The clinical practice guidelines do not give precise indications on the use of mandibular advancement devices (MAD) for obstructive sleep apnea (OSA) patients when they suffer from temporomandibular disorders (TMD). The aim of this systematic review was to evaluate the effects of MADs on prevalence of TMD signs and symptoms in adult OSA patients. The study protocol was registered under the PROSPERO register and an electronic search was performed in several databases. All types of studies evaluating TMD prevalence on adult patients wearing MAD for OSA were included and independently evaluated by two investigators. The quality of evidence was evaluated using the grading of recommendations assessment, development and evaluation and the risk of bias by the risk of bias in non-randomized studies of interventions tool or the Cochrane collaboration's tool. For each study included, the difference in means and 95% CI was calculated between baseline and follow-up. Twelve studies were included. The meta-regression analysis showed that patients with pre-existing signs and symptoms of TMD do not experience significant exacerbation of symptoms using the MAD. The presence of TMD does not appear to be routine contraindication for the use of MAD used for the management of OSA.