Multidisciplinary Treatment in Patients with Craniofacial, Neurocognitive, and Neuromuscular Disorders with Obstructive Sleep Apnea: A Systematic Review of the Literature.

Obstructive sleep apnea (OSA) is a respiratory disorder that has a high prevalence in patients with craniofacial, neurocognitive, and neuromuscular disorders. Currently, the treatments for this population are diverse and depend on the individual conditions of the patient and the severity of the case. However, there are no multidisciplinary dental treatment guidelines. The aim of the present study was to determine the multidisciplinary dental treatment alternatives in patients with craniofacial, neurocognitive, and neuromuscular disorders with a diagnosis of OSA through evidence-based medicine. A systematic review of the literature has been performed by searching scientific articles in the PubMed, Cochrane, Ovid, ScienceDirect and Scopus databases, through controlled and uncontrolled language. Articles were classified according to the level of evidence and grades of recommendation through the Scottish Intercollegiate Guidelines Network. A total of 19,439 references were identified, of which 15 articles met the predetermined requirements to be included in the investigation. The articles included for this systematic review showed that mandibular distraction osteogenesis and adenotonsilectomy are the first-choice therapies for craniofacial and neurocognitive disorders. However, for neuromuscular disorders, the findings reported were not enough to provide information about surgical or nonsurgical alternatives. Despite the reported high frequency of OSA in those children with craniofacial, neurocognitive, and neuromuscular disorders, the evidence on the surgical and nonsurgical therapeutic success for OSA in these patients is scarce. It is necessary to perform future studies to investigate successful therapies for OSA in children. [Pediatr Ann. 2024;53(2):e62-e69.].

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography

ABSTRACT BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Biomarkers for the severity of periodontal disease in patients with obstructive sleep apnea:IL-1 ß, IL-6, IL-17A, and IL-33.

Objective: This study aims to compare the salivary and gingival crevicular fluid (GCF) concentrations of five cytokines: IL-1ß, IL-6, IL-17A, IL-33, and Tumor Necrosis Factor-alpha (TNF-α) in patients with OSA and their association with periodontitis. Methods: Samples of saliva and GCF were obtained from 84 patients classified into four groups according to periodontal and OSA diagnosis: G1(H) healthy patients, G2(P) periodontitis and non-OSA patients, G3(OSA) OSA and non-periodontitis patients, and G4(P-OSA) periodontitis and OSA patients. The cytokines in the samples were quantified using multiplexed bead immunoassays. Data were analyzed with the Kruskal-Wallis test, Dunn's multiple comparisons test, and the Spearman correlation test. Results: Stage III periodontitis was the highest in patients with severe OSA (69%; p=0.0142). Similar levels of IL-1ß and IL-6 in saliva were noted in G2(P) and G4(P-OSA). The IL-6, IL-17A and IL-33 levels were higher in the GCF of G4(P-OSA). There was a significant positive correlation between IL-33 in saliva and stage IV periodontitis in G4(P-OSA) (r s  = 0.531). The cytokine profile of the patients in G4(P-OSA) with Candida spp. had an increase of the cytokine's levels compared to patients who did not have the yeast. Conclusions: OSA may increase the risk of developing periodontitis due to increase of IL-1ß and IL-6 in saliva and IL-6, IL-17A and IL-33 in GCF that share the activation of the osteoclastogenesis. Those cytokines may be considered as biomarkers of OSA and periodontitis.

Dental Anomalies in Permanent Teeth Associated With Nonsyndromic Cleft Lip and Palate in a Group of Colombian Children.

OBJECTIVES: To assess the risk of dental anomaly presentation in permanent teeth in a group of Colombian children with nonsyndromic cleft lip and palate (NSCLP) and to determine the frequency of the anomalies according to the cleft type. METHODS: An analytical matched case-control study was conducted with 210 controls and 210 patients with NSCLP. The patients were classified into 3 groups: complete right unilateral cleft lip and palate (RCLP), complete left unilateral cleft lip and palate (LCLP), and complete bilateral cleft lip and palate (BCLP). Univariate and multivariate Poisson regression models were used to analyze paired samples (Bonferroni adjustment, P ≤ .002). RESULTS: A high risk of finding agenesis of the maxillary lateral incisors, supernumerary teeth, microdontia of the maxillary lateral incisors, and rotation of the maxillary central incisors adjacent to the cleft (P < .0001) was observed in the patients with NSCLP. One or more dental anomalies were found in 98% of patients with BCLP, in 96% of those with LCLP, and in 87% of those with RCLP. Most of the anomalies were located on the cleft area. The incidence relative risk (IRR) of anomalies was highest in patients with BCLP (IRR: 10.5; 95% confidence interval [CI]: 6.76-16.3), followed by in those with LCLP (IRR: 8.51; 95% CI: 5.64-12.8). CONCLUSIONS: Most dental anomalies were found in the cleft area; this was expected because the cleft area was the most affected in the patients included in this study.

Temporary restorative treatment in children and adolescents with amelogenesis imperfecta: scoping review

Background: amelogenesis imperfecta (AI) is a group of disorders that affect the enamel of the teeth, either in quality or quantity. this alteration causes sensitivity and is associated with factors that could affect the strength of the adhesive bond of the restorative material. aim: to review the literature regarding the most used temporary restorative treatment in children and adolescents with AI. methods: this scoping review aimed to include case reports, literature reviews and original studies that evaluated restorative materials for the teeth of children and adolescents with AI. editorials, meeting abstracts and letters to the editor were excluded. the following electronic databases were used: Medline (Ovid), PubMed, Ebsco, Scopus (Elsevier) and Web of Science (Thomson Reuters). manual searches in the reference lists of the included articles were also carried out. finally, a search in Google Scholar restricted to the first 100 hits was performed. duplicates were eliminated upon identification. the search covered a period between the years of 2011 and 2016. PRISMA guidelines were used for reporting the review. the evidence ranking was carried out by means of the Oxford criteria. results: six articles met the eligibility criteria and were included in this scoping review. three articles were case reports, one was a review and two were original studies. tor the treatment of AI, direct or indirect composite resins were the most commonly used material of choice in the retrieved studies because they demonstrate greater longevity, aesthetics and function compared to the other materials used. conclusions: among children and adolescents with AI, the temporary restorative treatment that demonstrated better long-term results in permanent teeth was the direct and indirect composite resins. however, high quality studies should be conducted to confirm the results presented herein.

A comparative study of facial asymmetry in philippine, colombian, and ethiopian families with nonsyndromic cleft lip palate.

Objective. To compare the asymmetry displayed by Philippine, Colombian, and Ethiopian unaffected parents of patients with nonsyndromic cleft palate (NSCLP) and a control population. Methods. Facial measurements were compared between unaffected parents of NSCLP patients and those in the control group for three populations from South America, Asia, and Africa by anthropometric and photographic measurements. Fluctuating and directional asymmetries, height and width proportions, were analyzed and compared. Results. Fluctuating asymmetries (ear length, middle line to Zigion perpendicular for left and right sides) and variations in the facial thirds demonstrated statistical significance in the study group of unaffected parents from Colombia and Philippines, while increased interorbital distance was evident in the unaffected Ethiopian parents of NSCLP patients. Conclusions. The facial differences in unaffected parents could indicate an underlying genetic liability. Identification of these differences has relevance in the understanding of the etiology of NSCLP.

Proporción de tenascina y fibronectina en el ligamento periodontal de dientes sometidos a fuerzas ortodónticas / Tenascin and fibronectin proportions in human periodontal ligament of teeth undergoing orthodontic forces

El presente estudio tuvo como objetivo comprobar los cambios en la proporción de tenascina (T) y fibronectina (F) en la zona de tensión del ligamento periodontal humano (LPH) de dientes sometidos a fuerzas ortodónticas. Se tomaron muestras de LPH en 20 pacientes entre 18 y 25 años. A los dientes del grupo experimental se les aplicó una fuerza con intervalos de 1, 21 y 40 días. Las muestras fueron congeladas en nitrógeno líquido y posteriormente sometidas a tinción inmunohistoquímica. Para el grupo de F, el primer día se observó que los dientes del grupo control presentaban una tinción leve. En el grupo experimental se observó que las siete muestras presentaban una tinción leve. En el día 21, cinco de las siete muestras presentaban una tinción moderada y las dos restantes, una tinción intensa. En el día 40, en todas se observó una tinción intensa. En el grupo control de T, las muestras presentaron una tinción leve. En el primer día se observó una tinción moderada. En el día 21, cuatro presentaron una tinción intensa y las tres restantes, una tinción moderada. En el día 40 fue leve. Los resultados sugieren la posible relación de la F y la T en los procesos de neoformación en la zona de tensión, contribuyendo a la mejor comprensión de los procesos moleculares involucrados al aplicar fuerzas ortodónticas en los dientes

Quimiotaxis del polimorfo nuclear en pacientes con diferentes grados de enfermedad periodontal / Periodontal disease and quimiotaxis of neutrophils

La quimiotaxis del PMN en pacientes con diabetes mellitus (DM) se caracteriza por la disfunción del PMN ante un antígeno. En éste estudio se tomaron 10 pacientes DM y 10 pacientes control; con la técnica de boca dividida se seleccionaron 3 sitios de acuerdo al índice de Sillness y Loe; se tomaron muestras en cada surco seleccionado de acuerdo a la técnica de Spasky y Lehner, para medir la quimiotaxis del PMN se utilizó la técnica de Boyden modificada. Después de tomar las muestras iniciales se les realizó terapia higiénica y controles semanales durante 2 meses. En los pacientes DM y en los del grupo control, con periodonto sano y con gingivitis, no se encontraron diferencias significativas en la quimiotaxis del PMNs, entre los grupos. Entre el grupo con diferentes grados enfermedad periodontal la respuesta si fue significatica (p<.056), pero entre los grupos 1 y 2 hubo diferencias en el primer día al estímulo de la quimiotaxis de los PMNs (p<000) y a los 60 días no mostraron diferencias entre los 2 grupos (p<.025) y al estímulo la diferencia si fué significativa entre cada grupo con diferentes grados de enfermedad periodontal (p<.000), pero no entre los grupos 1 y 2 (p<0.25). Se comprueba que la quimiotaxis de los PMNs no se altera en los pacientes diabéticos con periodonto sano o con gingivitis, pero en pacientes con periodonto severamente afectado por enfermedad periodontal, la quimiotaxis si esta alterada