Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper.

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.

Pain-related worry in patients with chronic orofacial pain.

BACKGROUND: Pain-related worry is distinct from, but related to, pain catastrophizing (PC) and anxiety. Worry and its relationship with other variables have been studied in people with chronic pain but not in people with chronic orofacial pain. The authors explored the prevalence of trait, general and pain-related worry and the association of worry with higher pain levels and other variables. METHODS: The authors assessed people who had a diagnosis of chronic orofacial pain by using nonpain-related trait worry, state anxiety, trait anxiety, PC and pain measures. The participants' answers to an open-ended question about what they were most worried about led to the identification of worry domains, including worry about pain. RESULTS: The authors found that worrying about pain was related significantly to worst and least pain levels, pain interference and pain duration, as well as moderated trait worry in predicting pain interference. Although trait worry was not correlated directly with pain, when moderated by PC, it made substantial contributions in predicting pain interference. CONCLUSIONS: Participants with chronic orofacial pain reported experiencing substantial levels of trait worry, anxiety, PC and worry about pain that related to pain ratings directly and indirectly. PRACTICAL IMPLICATIONS: Clinicians should assess pain-related worry in patients with chronic orofacial pain to understand the effects of worry on pain and functioning. Clinicians could treat these patients more effectively by helping them reduce their levels of pain-related worry and focusing on improved coping.

Orthodontics and temporomandibular disorders: a curriculum proposal for postgraduate programs.

In a previous article, we reported the results of a survey of American and Canadian orthodontic postgraduate programs to determine how the topics of occlusion, temporomandibular joint, and temporomandibular disorders were currently being taught. Based on the finding of considerable diversity among those programs, we decided to write a curriculum proposal for temporomandibular disorders that would be compatible with and satisfy the current curriculum guidelines for postgraduate orthodontic programs. These guidelines arose from a combination of the requirements published by the American Dental Association's Commission on Dental Accreditation and the written guide (July 2010) of the American Board of Orthodontics for the its clinical examination. The proposed curriculum, based on the latest scientific evidence in the temporomandibular disorder field, gives program directors a template for covering these subjects thoroughly. At the same time, they can focus on related orthodontic issues, so that their future graduates will be prepared to deal with patients who either have or later develop temporomandibular disorder problems.

Survey of orthodontic residency programs: teaching about occlusion, temporomandibular joints, and temporomandibular disorders in postgraduate curricula.

INTRODUCTION: Teaching orthodontic postgraduate students about occlusion and the temporomandibular joint is a fundamental component of their education, but faculty members are confronted with disputes and controversies about these topics. The purpose of this study was to ascertain where the orthodontic teaching community currently stands on the topics of occlusion, temporomandibular joint, and temporomandibular disorder. METHODS: A 46-question survey was sent to every orthodontic program director in the United States and Canada (n = 69). Responses were submitted by 46, and the results were tabulated. RESULTS: Three interrelated topics (normal or ideal temporomandibular joint, normal or ideal occlusion, and management of temporomandibular disorder) are being taught in diverse ways in these postgraduate orthodontic programs. CONCLUSIONS: The results of this survey will help us to understand and improve how these topics are being taught at accredited orthodontic programs in the United States and Canada. Perhaps a standardized curriculum can be developed.

Complications and solutions in presurgical nasoalveolar molding therapy.

OBJECTIVE: To outline three main categories of nasoalveolar molding complications, describe their etiologies and manifestations, and prescribe preventive and palliative therapy for their proper management. Estimates of the incidence of each complication also are provided. MATERIALS AND METHODS: Data were collected retrospectively from the charts of 27 patients with complete unilateral cleft lip and palate treated by the first author (D.L.-B.) at the University of Puerto Rico (n = 12) and the Medical College of Georgia (n = 15). Confidence intervals for the true incidence of each complication were calculated using exact methods based on the binomial distribution. A significance level of .05 was used for all statistical tests. RESULTS: Of the soft and hard tissue complications considered, only one (tissue irritation) had an estimated incidence greater than 10%. Compliance issues were of greater concern, with an estimated incidence of 30% for broken appointments and an estimated incidence of 26% for removal of the nasoalveolar molding appliance by the tongue. CONCLUSIONS: Although benefits outnumber the complications, it is important to address all complications in order to prevent any deleterious outcomes.

Sleep disordered breathing in infants and children: a review of the literature.

The objective of this report was to review the etiology, diagnosis, and treatment of sleep disordered breathing (SDB) in children and infants. English peer-reviewed SDB literature identified by MEDLINE and a manual search conducted between 1999 and 2006 was selected. The keywords used for the search included: (1) children; (2) sleep disorder; (3) snoring; and (4) obstructive sleep apnea. A total of 153 manuscripts was identified. A delay in treatment of SDB children may be caused by several factors and may result in serious but generally reversible problems, including: (1) impaired growth; (2) neurocognitive and behavioral dysfunction; and (3) cardiorespiratory failure. Adenotonsillectomy is the treatment of choice, and continuous positive airway pressure may be an option for patients who are not candidates for surgery or who do not respond to surgery. Minimal information is available concerning the dental treatment of these disorders. With the devastating effects sleep disorders can have on children and their families, dentists must recognize obvious symptoms and refer these patients for management by physicians.