Attitude of Italian dental practitioners toward bruxism assessment and management: A survey-based study.

INTRODUCTION: Bruxism is a spectrum of masticatory muscles activities. According to the recent evidence and international consensus, there is no indication to treat bruxism unless clinical consequences are present. The aim of the present study was to investigate the approach of Italian dentists to bruxism in their clinical practice. METHODS: An anonymous online survey was developed, composed by 26 items grouped into five sections: (1) Characteristics of the respondent (Q1-Q6); (2) Bruxism frequencies (Q7-Q11); (3) Bruxism assessment (Q12-Q15); (4) Bruxism management (Q16-Q20); (5) Occlusal splints therapy (Q21-Q26). RESULTS: A total of 384 practitioners, including specialists and non-specialists, participated in this survey. The majority of the respondents reported that 1-3 out of ten patients presented with bruxism. The diagnosis is mainly performed with non-instrumental methods, and facial pain and dental wear are the major clinical consequence associated with bruxism. Almost the entire sample of respondents report to offer occlusal splints to bruxism patients, and 41% refer to perform occlusal adjustments. Almost half of the respondents have never proposed any form of cognitive-behavioural therapy. CONCLUSION: The results of the current survey highlighted several inconsistencies in Italian dentists' approaches to bruxism, suggesting the need for better education of practitioners and for the development of a standardized protocol to assess and manage bruxism in dental practices.

Response to letter to the Editor: Look at the elephant! Commentary on 'Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study'.

Obstructive sleep apnoea and temporomandibular disorders are complex pathologies. Considering dento-skeletal occlusion as their main predisposing factor could be detrimental for optimal patient care.

Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study.

BACKGROUND: Obstructive sleep apnoea (OSA) is characterised by partial or complete obstruction of the upper airways during sleep and it has been associated with temporomandibular disorders (TMDs) on the basis of several pathophysiological hypotheses. OBJECTIVES: To assess the prevalence of TMDs in a population of patients affected by OSA compared to a control group of subjects not affected by OSA. METHODS: A cross-sectional controlled study was conducted on a group subjects studied by polygraphy (PG) at the snoring section of the ENT department, Sant'Orsola-Malpighi Hospital - University of Bologna. Patients who received a diagnosis of OSA were included in the study group and subjects with a negative PG diagnosis for Sleep Disordered Breathing and PG respiratory pattern that did not suggest the occurrence of sleep disorders were enrolled in the control group. Both the subjects included in the study group and the control group underwent an examination following the Diagnostic Criteria for Temporomandibular Disorders Axis I and II. RESULTS: Forty-three OSA patients (29 M, 16 F, mean age 52.26 ± 11.40) and 43 healthy controls (25 M, 18 F, mean age 49.95 ± 7.59) were included in the study. No significant differences were found between groups in demographic data. TMD prevalence and Axis II results did not differ between groups. CONCLUSIONS: This paper does not highlight a higher prevalence of TMDs in adults with OSA compared to healthy controls. Further high-quality studies are needed to confirm the results and to give possible pathophysiological explanations, providing reliable evidence.

Dropout and adherence of obstructive sleep apnoea patients to mandibular advancement device therapy: A systematic review of randomised controlled trials with meta-analysis and meta-regression.

BACKGROUND: Mandibular advancement devices (MADs) are used as an alternative to continuous positive airways pressure to treat obstructive sleep apnoea (OSA) patients, but to date, specific data on the adherence to MAD therapy are lacking. OBJECTIVES: The aim of the present systematic review was to investigate the dropout rate and adherence of OSA patients to different custom-made (CM) and non-custom-made (NCM) MAD therapies. SEARCH METHODS: An electronic search was performed in MEDLINE, Cochrane Database of Systematic Reviews, Scopus, LILACS and Web of Science. SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing the compliance to customised and not customised MADs in the treatment of adult OSA patients were included. DATA COLLECTION AND ANALYSIS: The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in RCT. The dropout rate of each study was computed and the adherence to MAD therapy in terms of hours per night and nights per week was extracted from each study. RESULTS: Thirty-two RCTs were included. The risk of bias resulted low in most of the studies. The GRADE scores indicated that the quality of evidence was from very low to moderate. The meta-analyses showed that the mean dropout rate did not significantly differ between CM and NCM MADs: The overall mean dropout rate was 0.171 [0.128-0.213] with a mean follow-up of 4.1 months. The hours per night adherence was significantly higher for CM MADs (6.418 [6.033-6.803]) compared to NCM MADs (5.107 [4.324-5.890]. The meta-regression showed that the dropout rate increases significantly during time (p < .05). CONCLUSIONS: There is a very low to moderate quality of evidence that the dropout rate of MAD therapy is similar among CM and NCM MADs, that the dropout rate increases significantly during time and that CM MADs have higher hours per night adherence compared with NCM MAD. REGISTRATION: The study protocol was registered on PROSPERO (n. CRD42020199866).

Obstructive sleep apneas naturally occur in mice during REM sleep and are highly prevalent in a mouse model of Down syndrome.

STUDY OBJECTIVES: The use of mouse models in sleep apnea study is limited by the belief that central (CSA) but not obstructive sleep apneas (OSA) occur in rodents. We aimed to develop a protocol to investigate the presence of OSAs in wild-type mice and, then, to apply it to a validated model of Down syndrome (Ts65Dn), a human pathology characterized by a high incidence of OSAs. METHODS: In a pilot study, nine C57BL/6J wild-type mice were implanted with electrodes for electroencephalography (EEG), neck electromyography (nEMG), and diaphragmatic activity (DIA), and then placed in a whole-body-plethysmographic (WBP) chamber for 8 h during the rest (light) phase to simultaneously record sleep and breathing activity. CSA and OSA were discriminated on the basis of WBP and DIA signals recorded simultaneously. The same protocol was then applied to 12 Ts65Dn mice and 14 euploid controls. RESULTS: OSAs represented about half of the apneic events recorded during rapid-eye-movement-sleep (REMS) in each experimental group, while the majority of CSAs were found during non-rapid eye movement sleep. Compared with euploid controls, Ts65Dn mice had a similar total occurrence rate of apneic events during sleep, but a significantly higher occurrence rate of OSAs during REMS, and a significantly lower occurrence rate of CSAs during NREMS. CONCLUSIONS: Mice physiologically exhibit both CSAs and OSAs. The latter appear almost exclusively during REMS, and are highly prevalent in Ts65Dn. Mice may, thus, represent a useful model to accelerate the understanding of the pathophysiology and genetics of sleep-disordered breathing and to help the development of new therapies.

Effectiveness of different mandibular advancement device designs in obstructive sleep apnoea therapy: A systematic review of randomised controlled trials with meta-analysis.

Mandibular advancement devices (MADs) are used to treat patients with obstructive sleep apnoea (OSA). To date, there are no data that identify the most effective MAD design for apnoea-hypopnea index (AHI) reduction. The purpose of this systematic review is to investigate the effectiveness of different MAD designs in AHI reduction and oxygen saturation improvement in OSA patients. An electronic search was performed in MEDLINE, Cochrane Database, Scopus, Web of Knowledge and LILACS. Randomised controlled trials (RCTs) investigating the reduction of AHI on adult patients wearing MAD for OSA were included. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration's tool for assessing risk of bias in randomised controlled trial. The success rate of each study was computed: [(mean baseline AHI - mean AHI after treatment)/mean baseline AHI]. Fifty RCTs were included. The risk of bias resulted with some concerns in most of the studies. The GRADE scores indicated that the quality of evidence was very low. The meta-analysis showed a success rate with mono-bloc and duo-bloc MADs respectively of 0.821 [0.722-0.887] and 0.547 [0.443-0.637]. The mono-bloc compared with duo-bloc better improved the minimum oxygen saturation (10.048 [7.733-12.363] and 3.357 [2.290-4.423], respectively). There is a very low quality body of evidence that mono-bloc MADs are more effective in reducing AHI and improving minimum oxygen saturation compared with duo-bloc MADs. The study protocol was registered on PROSPERO (n. CRD42019118084).

Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials.

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) is a surgical technique developed to correct transverse discrepancies in skeletally mature patients. However, there is limited evidence concerning the immediate skeletal and dental changes obtained only due to SARME. OBJECTIVE: The aim of the present systematic review is to investigate the immediate skeletal and dental effects of SARME in adult patients with transverse maxillary hypoplasia. SEARCH METHODS: An electronic search of the literature in MEDLINE, The Cochrane Library, Lilacs and Scopus databases was performed. SELECTION CRITERIA: Only randomized controlled trials (RCTs) studies investigating the skeletal and dental effects of SARME procedures in adult patients were included. DATA COLLECTION AND ANALYSIS: The included studies received a methodological quality scoring according to the revised Cochrane risk-of-bias tool for randomized trials. The quality of evidence was assessed by means of the Grading Recommendation Assessment, Development and Evaluation (GRADE) system. For each included study and for each analysed parameter, the difference in means and 95 per cent confidence interval was calculated between baseline and immediate post-expansion. A meta-analysis of original outcome data, if possible, was conducted. RESULTS: Nine articles were selected. The methodological quality ratings indicated that one study was at low risk of bias, seven presented some concerns and only one was at high risk of bias. In all the included studies, the SARME procedure resulted in a significant expansion of the maxillary transverse dimension. The meta-analysis compared skeletal and dental inter-molar width before and after treatment: the mean difference was of 3.3 mm (2.8-3.9) and 7.0 mm (6.1-7.8), respectively (P-value less than 0.001). The quality of evidence was low-moderate. CONCLUSIONS: SARME is effective in obtaining a significant expansion of the maxillary transverse dimension. However, the immediate SARME effect is mainly a molar expansion rather than a pure bone transverse widening of the maxilla. REGISTRATION: The review protocol was registered at PROSPERO database with the registration number CRD42018117967.

Dental and skeletal long-term side effects of mandibular advancement devices in obstructive sleep apnea patients: a systematic review with meta-regression analysis.

Background: Mandibular advancement devices (MAD) are effective in reducing apnea episodes and they are frequently used as first-line therapy in obstructive sleep apnea (OSA) patients. Objectives: The MAD must be used every night for a lifetime and since it performs its function discharging the forces on dental elements the aim of this systematic review was to identify the dental and skeletal long-term side effects of MAD therapy and to evaluate the influence of time on them in OSA or snoring patients. Search Methods: An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, Scopus, and LILACS. Studies until 4 April 2018 were analysed, without language restrictions. Selection Criteria: Randomized controlled trials and cohort studies investigating dental and/or skeletal side effects on adult patients wearing MAD for OSA or snoring treatment with at least 2 years follow-up were included and independently evaluated by two investigators. Data Collection and Analysis: The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by means of Cochrane's tools. For each study included and for each dental and/or skeletal parameter, the difference in means and 95% CI was calculated between baseline and follow-up. Results: Twenty-one studies with follow-up between 2 and 11 years were included. The side effects reported were a reduction in overjet, overbite, and in the upper incisor inclination, and an increase in lower incisor inclination, A point-Nasion-B point, and anterior facial height. The meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). The quality of evidence was low/moderate. Conclusions: MAD therapy produces time-related dental and skeletal side effects. After a long period of treatment, the dental side effects are clinically relevant and therefore the clinician should inform the patients about this issue. Since the side effects are progressive, patients need to be continuously monitored over time. Registration: The study protocol was not registered.

Micronized palmitoylethanolamide reduces joint pain and glial cell activation.

OBJECTIVE AND DESIGN: Temporomandibular disorder (TMD) is a common painful condition in the temporomandibular joint (TMJ). Joint inflammation is believed to be a chief cause of pain in patients with TMD, through the release of pro-inflammatory cytokines that induce peripheral sensitization of nerve terminals followed by microglial stimulation. MATERIALS AND SUBJECT: TMJ was induced in rats with the injection of complete Freund's adjuvant (CFA) emulsion into the left TMJ capsule. TREATMENT: The present study would assess the effects of micronized palmitoylethanolamide (m-PEA) on glial activation and trigeminal hypersensitivity. METHODS: Ten mg/kg m-PEA or corresponding vehicle was administered 1 h after CFA and mechanical allodynia and edema were evaluated at 24 and 72 h after CFA injection. RESULTS: CFA-injected animals showed TMJ edema and ipsilateral mechanical allodynia accompanied by a robust growth in GFAP protein-positive satellite glial cells and activation of resident macrophages in the TG. Moreover, m-PEA administration significantly reduced the degree of TMJ damage and pain, macrophage activation in TG and up-regulation of Iba1. CONCLUSIONS: The results confirm that m-PEA could represent a novel approach for monitoring pain during trigeminal nerve sensitization.

The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis.

PURPOSE: The therapy with mandibular advancement devices (MADs) represents a treatment option for patients with obstructive sleep apnea (OSA). The literature does not provide evidence regarding the most effective mandibular advancement; therefore, the aim of this systematic review with meta-regression was to investigate the effectiveness of different mandibular advancement amounts in reducing apnea-hypopnea index (AHI) in OSA patients. METHODS: An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, ISI Web of Knowledge, Scopus, and LILACS to select randomized controlled trials (RCTs) investigating the efficacy of MADs in reducing AHI in adult OSA patients. Inclusion criteria were the diagnosis of OSA and success evaluation performed with a polysomnography, follow-up of maximum 12 months, and protrusion amount reported as a percentage of the maximum mandibular advancement. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The success rate of each study was computed: [(mean AHI at baseline-mean AHI after treatment)/mean AHI at baseline]. RESULTS: Thirteen RCTs performing advancements from 50 to 89 % of maximum mandibular protrusion were included. The meta-regression analysis showed that advancement amounts higher than 50 % do not significantly influence the success rate (Q = 0.373, p = 0.541). According to the GRADE score system, the quality of evidence resulted to be moderate. CONCLUSION: The AHI improvement resulted to be not proportional to the mandibular advancement increase. It is plausible that the success of the therapy is influenced by a combination of variables that need closer study.

The effect of diode superpulsed low-level laser therapy on experimental orthodontic pain caused by elastomeric separators: a randomized controlled clinical trial.

The aim of this study was to evaluate the efficacy of diode superpulsed low-level laser therapy (SLLLT) in reducing experimentally induced orthodontic pain. Overall, 120 subjects (23.01 ± 1.39 years) were enrolled for a clinical trial. Subjects were randomly assigned to upper (U, N = 60) or lower (L, N = 60) jaw groups. All subjects received 4 elastomeric separators mesial and distal to the upper (U group) or lower (L group) right first molar and bicuspids. Each subject of the U and L groups was randomly assigned to laser (Ul, N = 20 and Ll, N = 20), placebo (Up, N = 20 and Lp, N = 20) or control (Uc, N = 20 and Lc, N = 20) sub-groups. Subjects in laser groups received a single GaAs diode SLLLT application (910 nm, 160 mW, beam diameter of 8 mm, applied for 340 s) immediately after placing orthodontic separators. Placebo groups received a simulated SLLLT and controls did not receive any therapy. All participants compiled a survey on pain duration and a 100-mm visual analogue scale immediately after the separators placement and after 12, 24, 36, 48, 72, and 96 h. Pain intensity of laser groups was significantly lower compared to placebo and control groups (p = 0.0001). In the laser group, 70% of subjects felt pain, while in the placebo and control groups all subjects felt pain (p = 0.0001). The end of pain occurred earlier in laser compared to placebo and control groups (p = 0.021). A single-diode SLLLT application appeared to be effective in reducing the intensity and duration of experimentally induced orthodontic pain and could be used in daily orthodontic practice.

Pressure pain threshold of the cervico-facial muscles in healthy elderly people: the role of gender, age and dominance.

OBJECTIVE: The aim of this study was to assess the impact of age on pressure pain threshold (PPT) of cervico-facial muscles in healthy geriatric subjects and to investigate the role of gender and dominance on nociception. BACKGROUND: Musculo-skeletal pain is common in the elderly, but being subjective, it risks to be underdiagnosed and undertreated. A useful method for assessment of local pain is determining PPT through pressure algometry. Ageing process seems to increase PPTs, but reference values for the assessment of pain in geriatric subjects are lacking. METHODS: In this study, PPTs in temporal muscle, masseter, sternocleidomastoid, occipital and splenius capitis of 97 healthy elderly subjects were measured using Fischer algometer. Participants were divided by age in four classes (years 65-69; 70-74; 75-79; ≥80). RESULTS: Women had lower PPTs in all muscles compared with men. Comparing PPTs obtained from the right and the left side, no significant differences were recorded neither in men nor in women. When dividing subjects by age class and education, in both genders no significant differences were observed in PPTs among the groups, neither in the right nor in the left sides. CONCLUSION: In conclusion, the present study reports reference PPT values for the cervico-facial muscles that can be applied to a population of healthy elderly subjects. After 65 years of age, further ageing does not influence PPTs in cervico-facial muscles whereas female gender has lower PPTs.

Correlation between Malocclusions, Tonsillar Grading and Mallampati Modified Scale: A Retrospective Observational Study.

AIM: to investigate the correlation between growth tendency and different patient malocclusion, tonsillar grading, and tongue size (Mallampati index). MATERIALS AND METHODS: The sample is composed of 64 males and 40 females; patients aged between 6 and 16 years (median age 11 years, IQR 9-13) were included. The final sample is therefore 104 patients. After the first orthodontic visit, all the children underwent a collection of documentation (photographs, digital arch models, and X-rays). Patients were classified according to their malocclusion, palatal conformation, tonsillar grading, and Mallampati index. Group comparisons were performed using Fisher's test. A p-value less than 0.05 was considered statistically significant. RESULTS: The narrow palate was more frequent in those with Angle class III (p = 0.04), while the other variables considered (tonsillar grading, Mallampati, and lingual frenulum) were not significantly associated with dental class (p > 0.05). Furthermore, a different distribution of tonsillar grading was observed between subjects with normal palate and subjects with narrow palate, while no statistically significant association was found between the palatal shape and Mallampati index (p = 0.88). CONCLUSIONS: This study found that children with higher tonsillar grading had a higher prevalence of crossbite or narrow palate compared to other children at the same developmental stage. However, we did not observe any association between tonsil hyperplasia and the prevalence of class II malocclusion, anterior open bite, or patient divergence in this sample. Furthermore, no correlation was found between the Mallampati index and patients' dental class, narrow palate, or divergence in this study.

Awareness and Sources of Knowledge about Obstructive Sleep Apnea: A Cross Sectional Survey Study.

Obstructive sleep apnea (OSA) is a multifactorial sleep breathing disorder, seriously impacting quality of life and involving approximately 1 billion of the world's population. It is characterized by episodes of total cessation of breathing or decreases in airflow during sleep. Available data suggest that most cases of OSA remain undiagnosed even in developed countries. This is due to a lack of widespread knowledge about this pathology and the medical morbidities and mortality it brings about, among both laypeople and physicians. Moreover, despite receiving indications about the need to undergo specific evaluations for OSA signs and symptoms, sometimes patients do not pay sufficient attention to the problem. This is probably due to a lack of correct information on these issues. The present investigation analyzed the level of knowledge about OSA pathology and the sources through which a group of OSA patients gained information on their condition. A survey of 92 patients diagnosed with OSA (mean age 60.55 ± 10.10) and referred to the Unit of Orthodontics and Dental Sleep Medicine of the University of Bologna was conducted by means of a questionnaire investigating sociodemographic characteristics, the level of general knowledge on OSA pathology and its possible medical consequences. Despite about two third (67.38%) of the population demonstrating extensive knowledge, remarkably, a group of subjects (20.65%) had poor awareness of the OSA condition. A statistically significant correlation emerged between the level of knowledge about OSA and the level of education (p = 0.002). A great effort should be made to improve the quality of information and the communication modalities for OSA to enable a fully appropriate awareness of the condition among patients.

Sleep Bruxism and Orofacial Pain in Patients with Sleep Disorders: A Controlled Cohort Study.

BACKGROUND: The gold standard for the diagnosis of sleep bruxism (SB) is laboratory polysomnography (L-PSG) recording. However, many clinicians still define SB using patients' self-assessment and/or clinical tooth wear (TW). The purpose of this cross-sectional controlled study was to compare the prevalence of TW, head-neck muscles sensitivity and Temporomandibular Disorders (TMD) between SB and non-SB patients diagnosed with L-PSG in a cohort of patient with sleep disorders (SD). METHODS: 102 adult subjects with suspected SD underwent L-PSG recording to assess the presence of sleep disorder and SB. TW was clinically analyzed using TWES 2.0. The pressure pain threshold (PPT) of masticatory muscles were assessed using a Fisher algometer. Diagnostic criteria for TMD (DC/TMD) were used to evaluate the presence of TMD. SB self-assessment questionnaires were administered. TWES score, PPT, TMD prevalence and questionnaire results were compared between SB and non-SB patients. RESULTS: 22 SB patients and 66 non-SB patients with SD were included. No significant differences emerged between groups in regards to TW, the PPT values, or SB's self-assessment questionnaires as well the prevalence of TMD. CONCLUSION: in a SD population, TW is not pathognomonic of active SB and SB self-assessment is not reliable. There seems to be no correlation between SB, TMD and head/neck muscle sensitivity.

The Effect of Bite Raise on AHI Values in Adult Patients Affected by OSA: A Systematic Review with Meta-Regression.

Obstructive sleep apnea (OSA) is a highly prevalent sleep breathing disorder characterized by the collapse of the pharyngeal walls that entails recurrent episodes of cessation of breathing or decrease in airflow while sleeping. This results in sleep fragmentation, decreased oxygen saturation and an increase in the partial pressure of carbon dioxide, causing excessive daytime sleepiness, hypertension and increased prevalence of cardiovascular morbidity and mortality. Mandibular advancement devices (MAD) represent a valid alternative therapy to Continuous Positive Airway Pressure, thrusting the mandible forward, increasing the lateral diameter of the pharynx and reducing the collapsibility of the airway. Several investigations have focused on the detection of the best mandibular advancement amount in terms of effectiveness and tolerance, but few and contrasting data are available on the role of occlusal bite raise in reducing the apnea/hypopnea index (AHI). The aim of this systematic review with meta-regression analysis was to investigate the effect of the bite raise of MAD on AHI values in adult patients affected by OSA. An electronic search was performed in MEDLINE, the Cochrane Database, Scopus, Web of Science and LILACS. Randomized controlled trials (RCT) investigating the effectiveness of MAD in OSA patients were included. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias with the Cochrane risk-of-bias tool for randomized trials (RoB2). Six RCT were included. The success rate of each study was computed: (mean baseline AHI - mean post treatment AHI)/mean baseline AHI. The GRADE scores indicated that the quality of evidence was very low. The meta-regression analysis showed that there was no correlation between the occlusal bite raise and the AHI improvement.

Palmitoylethanolamide versus a nonsteroidal anti-inflammatory drug in the treatment of temporomandibular joint inflammatory pain.

AIMS: To carry out a randomized clinical trial to compare the effect of palmitoylethanolamide (PEA) versus ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), for pain relief in temporomandibular joint (TMJ) osteoarthritis or arthralgia. PEA acts as an endogenous agent with an autacoid local inflammation antagonism and modulates mast cell behavior controlling both acute and chronic inflammation. METHODS: A triple-blind randomized clinical trial was conducted on 24 patients (16 women and 8 men) aged 24 to 54 years and suffering from TMJ osteoarthritis or arthralgia. The patients were enrolled from a group of 120 consecutive patients referred to the University of Bologna's Department of Orthodontics. Patients were randomly divided into two groups: group A (12 subjects) received PEA 300 mg in the morning and 600 mg in the evening for 7 days and then 300 mg twice a day for 7 more days. Group B (12 subjects) received ibuprofen 600 mg three times a day for 2 weeks. Every patient recorded the intensity of spontaneous pain on a visual analog scale twice a day. Maximum mouth opening was recorded by a blind operator during the first visit and again after the 14th day of drug treatment. A t test was used for data comparisons. RESULTS: Pain decrease after 2 weeks of treatment was significantly higher in group A than in group B (P = .0001); maximum mouth opening improved more in group A than in group B (P = .022). CONCLUSION: These data suggest that PEA is effective in treating TMJ inflammatory pain.

Aging effect on pressure pain thresholds of head and neck muscles.

BACKGROUND AND AIMS: Aging implies a physiological decline in skeletal muscle mass and strength, pain perception, transmission and processing, causing pain thresholds to increase (presbyalgesia). This study compares the pressure pain thresholds (PPTs) of 18 head and neck muscles in groups of young and elderly subjects. METHODS: A cross-sectional study was conducted on 40 subjects, selected from a group of 97, referred for dental consultation. The inclusion criterion was subjects' age (from 20 to 30, and over 65 years). Exclusion criteria were all conditions which may alter PPTs. In two groups, A (young subjects; 10 men, 10 women) and B (elderly subjects; 11 men, 9 women) PPTs were evaluated by one calibrated examiner with a Fischer algometer. Data are described with mean values ± standard error and the 95% confidence interval. The Mann-Whitney test was used to compare PPT values between the two groups (α=0.05). RESULTS: There was a significant difference between the PPTs of group A and B, which were higher in the elderly group in all muscles except five. CONCLUSIONS: These preliminary data demonstrate that PPTs increase with aging in the muscles examined. Other confirmatory studies with a larger sample size are necessary.

The Effects of Mandibular Advancement Device on Pressure Pain Threshold of Masticatory Muscles: A Prospective Controlled Cohort Study.

AIMS: To determine if pressure pain thresholds (PPTs) of masticatory and neck muscles change after the application of a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA). METHODS: A prospective study was conducted in a sample of 27 OSA patients (24 males and 3 females; mean age ± standard deviation [SD]: 54.8 ± 11.8, mean apnea-hypopnea index ± SD: 23.5 ± 13.3) and 27 age- and sex-matched healthy controls. Exclusion criteria were signs and symptoms of temporomandibular disorders (TMD), metabolic diseases, and use of antidepressants, analgesics, or anti-inflammatory drugs. A calibrated examiner evaluated PPTs of seven head and neck muscles bilaterally by using a Fischer algometer. In the OSA group, PPTs were recorded immediately before the MAD application (T0), after 15 days (T1), and after 6 months (T2) of therapy; in the control group, PPTs were recorded at the same time intervals. PPT differences at baseline and over time within each group and between OSA and control groups were analyzed by Friedman and Mann-Whitney tests. RESULTS: There were no PPT differences between groups at baseline. In the OSA group, PPTs of temporalis and masseter muscles decreased significantly at T1 compared with T0 (P < .05), but no differences were found at T2. No significant PPT differences were found in the neck muscles or over time in the control group. CONCLUSION: MAD application induces a decrease of PPTs of masticatory muscles at the beginning of the therapy, but a physiologic adaptation occurs by 6 months.

Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review.

OBJECTIVE: The efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnea (OSA) ranges between 42% and 65%. However, it is still unclear which predictive factors can be used to select suitable patients for MAD treatment. This study aimed to systematically review the literature on the predictive value of cephalometric analysis for MAD treatment outcomes in adult OSA patients. METHODS: The MEDLINE, Google Scholar, Scopus, and Cochrane Library databases were searched through December 2014. Reference lists from the retrieved publications were also examined. English language studies published in international peer-reviewed journals concerning the predictive value of cephalometric analysis for MAD treatment outcome were considered for inclusion. Two review authors independently assessed eligibility, extracted data, and ascertained the quality of the studies. RESULTS: Fifteen eligible studies were identified. Most of the skeletal, dental, and soft tissue cephalometric measurements examined were widely recognized as not prognostic for MAD treatment outcome; however, controversial and limited data were found on the predictive role of certain cephalometric measurements including cranial base angle, mandibular plane angle, hyoid to mandibular plane distance, posterior nasal spine to soft-palate tip distance, anterior nasal spine to epiglottis base distance, and tongue/oral cross sectional area ratio thus justifying additional studies on these parameters. CONCLUSIONS: Currently available evidence is inadequate for identification of cephalometric parameters capable of reliably discriminating between poor and good responders to MAD treatment. To guide further research, methodological weaknesses of the currently available studies were highlighted and possible reasons for their discordant results were analyzed.