A Nonsurgical Treatment Strategy for Longstanding, Nonreducible, Bilateral Temporomandibular Joint Dislocation: A Case Report.

Temporomandibular joint (TMJ) dislocation is a condition in which the mandibular condyle is displaced from the glenoid fossa and must be manipulated to return it to its normal position. Among several diagnostic subtypes, long-standing or chronically protracted TMJ dislocation is rare and challenging to manage. Treatment options include various nonsurgical and surgical approaches. This case report describes the successful nonsurgical management of a longstanding bilateral TMJ dislocation using elastic traction with a removable appliance and posterior bite planes. This technique should be attempted before performing additional surgical interventions.

Effective Fluoride Mouthwash Delivery Methods as an Alternative to Rinsing.

BACKGROUND: Special-needs patients with high caries risk cannot benefit from the proven caries-reducing effect of fluoride mouthrinse because of poor rinsing compliance and a lack of home-use fluoride application recommendations. OBJECTIVES: This study aimed to evaluate whether two modified delivery methods-spray or swab application-could raise the salivary fluoride to levels similar to that of rinsing. METHODS: Five healthy men and 16 healthy women, ages 18-22 years, participated in this crossover study. The subjects performed a standardized brushing routine twice a day with 1,000-ppm fluoride dentifrice 1 week before and during the experimental period. The three fluoride mouthwash (0.05% NaF; 226-ppm fluoride) administration methods consisted of rinsing, spray, and cotton swab application. Each application was separated by at least 1 week. Unstimulated whole saliva was sampled for 2 minutes at baseline and at 0, 5, 10, 20, 30, 60, and 120 minutes after each fluoride mouthwash application. Salivary fluoride level (ppm) was measured by a blinded investigator using an ion-specific electrode (ORION EA940). The differences in salivary fluoride concentration for each application method were analyzed by repeated measures ANOVA at a nominal significance level of .05. RESULTS: The newly designed fluoride mouthwash delivery methods yielded a similar fluoride level in whole saliva compared to that of rinsing at all time points (p > .05). The t half-life of fluoride concentration ranged from 1.62 minutes (SD = 0.53) in the spray group to 2.08 minutes (SD = 0.87) in the cotton swab group; the values were not significantly different. DISCUSSION: Our results indicate that the spray and cotton swab fluoride delivery methods were effective alternatives to conventional mouth rinsing. Caregivers of individuals with acute and chronic illness, including developmental disabilities affecting cognitive or physical abilities, may consider using these alternative fluoride delivery methods to help promote dental hygiene.

Efficacy of oropharyngeal exercises as an adjuvant therapy for obstructive sleep apnea: A randomized controlled trial.

PURPOSE: Some patients with mild-to-moderate obstructive sleep apnea (OSA) undergoing mandibular advancement device (MAD) therapy may exhibit residual sleep-breathing abnormalities. These cases require adjunctive treatment to further reduce the remaining airway inadequacy, which may affect the health and quality of life. This clinical trial was conducted since the oropharyngeal exercise, which aims to enhance the muscular function of the upper airway, combined with MAD, is unknown. We assessed the possible improvements in respiratory event parameters and lip and tongue physiological properties in patients with OSA who received oropharyngeal exercises for 2 months as an adjunct to MAD therapy. METHODS: Twenty-three participants with OSA who had been using MAD but still had residual apnea-hypopnea were randomly allocated to either the oropharyngeal exercise (OE group; N=12) or the sham exercise group (N=11). Lip and tongue strength, endurance, daytime sleepiness, respiratory event index (REI), and the lowest oxygen saturation (SpO2 nadir) were determined. RESULTS: Within and between the treatment groups, no significant improvement in the REI or SpO2 nadir was found. In both groups, there was a significant reduction in the Epworth Sleepiness Scale at 2 months (OE, P = 0.02; control, P = 0.02). In the OE group, lip endurance (P = 0.03), anterior tongue strength (P = 0.02), and endurance (P = 0.02) increased after 2-month of exercise, but only anterior tongue endurance increased significantly compared with the sham control (P = 0.01). CONCLUSIONS: This study found that adjunctive OE to MAD showed no additive effect in treating patients with moderate OSA who had a mild residual apnea-hypopnea index following MAD treatment. However, the exercises successfully enhanced lip and anterior tongue endurance, as well as anterior tongue strength.

Cross-Cultural Validation of the Thai Oral Health Impact Profile for Temporomandibular Disorders.

OBJECTIVES: The Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMDs) is a validated condition-specific outcome measure to help guide decision-making in the management of the condition. There is no Thai version of OHIP-TMDs, and therefore the original English version needs cross-cultural adaptation translation, and validation with a Thai population to reduce the anomalies due to language and cultural differences. This study aimed to develop the Thai-language version of OHIP-TMDs, perform a cross-cultural adaptation to Thailand, and assess its content validity, internal consistency, reliability, and construct validity. METHODS: The original English version of OHIP-TMDs was forward and backward translated into Thai language using the International Network for Orofacial Pain and Related Disorders methodology (INfORM) protocol for cross-cultural adaptation. The Content Validity Index (CVI) was performed by 5 orofacial pain (OFP) specialists to establish content validity. The OHIP-TMDs-T was then tested in 2 groups of Thai dental patients including 110 TMD patients and 110 control participants. The internal reliability and test-retest reliability (n = 30) were investigated in the TMD group using Cronbach alpha coefficient and intraclass correlation coefficient (2-way mixed effect model), respectively. The difference in OHIP-TMDs-T score between the TMD group and control group was investigated for known group validity. RESULTS: Cronbach alpha and intraclass correlation coefficients were 0.942 and 0.797, respectively. The CVI collected from the OFP specialists was 0.92. There was a statistical difference in the OHIP-TMDs-T overall score between the TMD group (95% CI, 40-46) and control group (95% CI, 2.0-3.4) (Z = 9.060, r = 1, P < .001). CONCLUSIONS: The OHIP-TMDs-T is a valid and reliable tool for evaluating the quality of life and the impact on oral health in Thai patients with TMD.