Corrigendum to "Health-Related Quality of Life and Sleep Quality after 12 Months of Treatment in Nonsevere Obstructive Sleep Apnea: A Randomized Clinical Trial with Continuous Positive Airway Pressure and Mandibular Advancement Splints".

[This corrects the article DOI: 10.1155/2020/2856460.].

Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group.

BACKGROUND: To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. PURPOSE: To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. MATERIAL AND METHODS: Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. RESULTS: The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. CONCLUSION: This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.

Health-Related Quality of Life and Sleep Quality after 12 Months of Treatment in Nonsevere Obstructive Sleep Apnea: A Randomized Clinical Trial with Continuous Positive Airway Pressure and Mandibular Advancement Splints.

In this randomized controlled trial, patients with nonsevere obstructive sleep apnea (OSA) were treated with continuous positive airway pressure (CPAP) or a twin block mandibular advancement splint (MAS). The primary objective was to compare how CPAP and MAS treatments change the health-related quality of life (HRQoL) and self-reported sleep quality of patients after 12 months of treatment. In total, 104 patients were recruited: 55 were allocated to the CPAP treatment group and 49 to the MAS treatment group. We used the SF36 questionnaire to evaluate HRQoL and the Pittsburgh Sleep Quality Index (PSQI) to evaluate sleep quality. All patients were included in the intention-to-treat analyses. These analyses showed improvements in the SF36 physical component score (from 48.8 ± 7.6 at baseline to 50.5 ± 8.0 at follow-up, p=0.03) in the CPAP treatment group and in the mental component score (from 44.9 ± 12.1 to 49.3 ± 9.2, p=0.009) in the MAS treatment group. The PSQI global score improved in both the CPAP (from 7.7 ± 3.5 to 6.6 ± 2.9, p=0.006) and the MAS (8.0 ± 3.1 to 6.1 ± 2.6, p < 0.001) treatment groups. No difference was found between the treatment groups in any of the SF36 scores or PSQI global score at the final follow-up (p > 0.05) in any analysis. The improvement in the SF36 vitality domain moderately correlated to the improvement in the PSQI global score in both groups (CPAP: |r|=0.47, p < 0.001; MAS: |r|=0.36, p=0.01). In the MAS treatment group, we also found a weak correlation between improvements in the SF36 mental component score and PSQI global score (|r|=0.28, p=0.05). In conclusion, CPAP and MAS treatments lead to similar improvements in the HRQoL and self-reported sleep quality in nonsevere OSA. Improvements in aspects of HRQoL seem to be moderately correlated to the self-reported sleep quality in both CPAP and MAS treatments.

Friedman Score in Relation to Compliance and Treatment Response in Nonsevere Obstructive Sleep Apnea.

Nonsevere obstructive sleep apnea (OSA) is most often treated with a continuous positive airway pressure (CPAP) device or a mandibular advancement splint (MAS). However, patient compliance with these treatments is difficult to predict. Improvement in apnea-hypopnea index (AHI) is also somewhat unpredictable in MAS treatment. In this study, we investigated the association between Friedman tongue position score (Friedman score) and both treatment compliance and AHI improvement in patients with nonsevere OSA receiving CPAP or MAS treatment. 104 patients with nonsevere OSA were randomly allocated to CPAP or MAS treatment and followed for 12 months. Data were collected through a medical examination, questionnaires, sleep recordings from ambulatory type 3 polygraphic sleep recording devices, and CPAP recordings. Associations between Friedman score, treatment compliance, and AHI improvement were analysed with logistic regression analyses. Friedman score was not associated with treatment compliance (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.59-1.23), or AHI improvement (OR: 1.05, 95% CI: 0.62-1.76) in the overall study sample, the CPAP treatment group, or the MAS treatment group. Adjustment for socioeconomic factors, body mass index, and tonsil size did not significantly impact the results. Although Friedman score may predict OSA severity and contribute to the prediction of success in uvulopalatopharyngoplasty, we found no association between Friedman score and treatment compliance in patients with nonsevere OSA receiving CPAP or MAS treatment, nor did we find any association between Friedman score and AHI improvement. Factors other than Friedman score should be considered when deciding whether a patient with nonsevere OSA should be treated with CPAP or MAS.

Apnea-Hypopnea Index in Healthy Class III Patients Treated With Intraoral Vertical Ramus Osteotomy: A Prospective Cohort Study.

PURPOSE: The study purpose was to assess whether mandibular setback surgery by intraoral vertical ramus osteotomy (IVRO) induces obstructive apnea and hypopnea in healthy Class III patients without a history of respiratory dysfunction. We hypothesized that the apnea-hypopnea index (AHI) would not exceed 5 events per hour after surgery. PATIENTS AND METHODS: A prospective cohort study was conducted. The sample was composed of healthy Class III patients without a history of obstructive sleep apnea treated with isolated mandibular setback surgery by the IVRO procedure at a university hospital. In-home respiratory sleep recordings (Nox T3; Nox Medical, Reykjavik, Iceland) and self-administered questionnaires were obtained before and at least 3 months after surgery. The AHI was the primary outcome variable. Other study variables were as follows: peripheral capillary oxygen saturation, oxygen desaturation index, snore index, body mass index, Epworth Sleepiness Scale, and Oral Impact on Daily Performance index. Descriptive and bivariate statistics were computed, and the significance level was set at .05. RESULTS: The sample was composed of 8 patients. The mean age at surgery was 23.2 years (range, 18.2 to 33.4 years). The mean amount of surgical setback was 4.3 mm (range, 2.5 to 7.4 mm). The mean body mass index was 24.2 kg/m2 (standard error [SE], 1.3 kg/m2) and 23.9 kg/m2 (SE, 1.4 kg/m2) at the presurgical and postsurgical sleep recordings, respectively. The mean AHI was 1.3 events per hour (SE, 0.3; range, 0.1 to 2.5) before surgery and 1.8 events per hour (SE, 0.4; range, 0.3 to 3.3) after surgery. No statistically significant changes in AHI (P = .412), peripheral capillary oxygen saturation (P = .443), oxygen desaturation index (P = .194), snore index (P = .363), or Epworth Sleepiness Scale (P = .812) were observed. The patients' self-reported oral health-related quality of life was statistically significantly improved after surgery (P = .034). CONCLUSIONS: Mandibular setback surgery with the IVRO procedure in the range of 2.5 to 7.4 mm did not induce obstructive sleep apnea, measured as an AHI above 5 events per hour, in the 8 healthy, young adult Class III patients presented in this study. More studies including larger patient samples are needed.

Prevalence of Painful Temporomandibular Disorders and Correlation to Lifestyle Factors among Adolescents in Norway.

AIM: To estimate the prevalence of painful temporomandibular disorders (TMD-P) among adolescents and to investigate correlations with health, environment, and lifestyle factors. METHODS: For this cross-sectional case-control study, 562 patients were consecutively recruited at their yearly revision control from four dental clinics in Rogaland County, Norway. Patients completed a questionnaire on general health, socioeconomics, demographics, and lifestyle factors. Responses to two screening questions identified patients with TMD-P, who then underwent clinical examination to verify the TMD diagnosis. Pain intensity was assessed on a visual analogue scale. Patients without TMD-P constituted the control group and were not clinically examined. RESULTS: 7% experienced TMD-P. The female-to-male ratio is 3:1; median age is 17 years. Patients at urban clinics had higher prevalence compared with those at rural clinics. TMD-P patients had headache and severe menstrual pain compared to controls. They were more likely to live with divorced/single parents and less likely to have regular physical activity. Myalgia was present in 21 patients with TMD-P, arthralgia in nine, and myalgia and arthralgia in nine. Females had higher pain intensity than males. CONCLUSIONS: A low prevalence of TMD-P was shown but was comparable to other studies. Sex, health, lifestyle, and environment factors were associated with TMD-P.

Relapse and stability after mandibular setback surgery one year postoperatively: a retrospective study.

PURPOSE: A retrospective evaluation was performed of dentoalveolar and skeletal stability 1 year after mandibular setback surgery using intraoral vertical subcondylar osteotomy (IVSO) combined with intermaxillary fixation. PATIENTS AND METHODS: Twenty-eight patients (16 men, 12 women) with skeletal Angle Class III malocclusions were included. Mean age at start of treatment was 23.9 years. All patients underwent combined surgical and orthodontic treatment. Dental casts and cephalometric measurements were performed for each patient before orthodontic treatment and at 8 weeks and 1 year after surgery. RESULTS: Treatment changes from 8 weeks to 1 year after surgery were small but significant for the angular relationship between the maxilla and the mandible in the sagittal plane (ANB) (mean difference, -0.5 mm; P = .021), Wits appraisal (mean difference, -0.7 mm; P = .044), the inclination of the mandible in relation to the nasion-sella line (ML-NSL) (mean difference, -0.8 mm; P = .010), and the inclination of the lower incisors in relation to the nasion-point B line (Li-NB) (mean difference, -0.6 mm; P < .001). These findings for cephalometric values indicated a small skeletal relapse in sagittal and vertical relations. No significant dentoalveolar relapse occurred according to the dental cast evaluations. CONCLUSION: The results clearly show that orthodontic treatment combined with IVSO provides a stable dental and skeletal result 1 year after treatment.

Minor changes in serum levels of cytokines after removal of amalgam restorations.

Dental amalgam restorations release mercury and silver which is absorbed and distributed in the body. Animal studies have shown that both elements may interfere with the host by activation of the immune system in genetically susceptible strains at exposure levels relevant to those from dental amalgam restorations. The aim of this study was to test the hypothesis of no change over time in concentrations of a number of immune mediators in serum after removal of all dental amalgam restorations in patients with health complaints attributed to their amalgam restorations and compare with a healthy reference group. Twenty patients previously examined at a specialty unit for health complaints attributed to dental materials were included in a clinical trial and had all amalgam restorations replaced with other dental restorative materials. Serum samples were collected before amalgam removal and 3 and 12 months after the removal was finished. Twenty blood donors matched for age and gender were used as comparison group. A fluorescent bead-based (Luminex) immunoassay kit was used to measure cytokines, chemokines and growth factors in serum. At baseline, the patient group had slightly higher values for GM-CSF, IL-6, IL-2R, IFN-alpha, IL-7, and IL-12p40/p70 compared with the reference group. After amalgam removal a decrease towards the median value of the reference group was found for GM-CSF, IL-8, and IL-7. In conclusion, removal of all dental amalgam restorations and replacement with other dental restorative materials was associated with decreased concentrations of Th1-type proinflammatory markers in serum.

Patients' perceptions of improvements after bilateral sagittal split osteotomy advancement surgery: 10 to 14 years of follow-up.

INTRODUCTION: The aims of this study were to determine reasons for orthodontic-surgical treatment, to quantify the perceptions of possible improvement 10 to 14 years after treatment, and to assess factors that affect treatment satisfaction and socio-dental impacts on quality of life. METHODS: The participation rate was 36 of 78 patients; their mean age was 45.7 years (SD, 10.7 years; range, 29-62 years). The presurgical anatomic occlusions were measured on dental casts. Visual analog scales allowed the participants to rate their perceived treatment outcome on 7 oral health-related items. A 3-point scale rated satisfaction with orthodontic-surgical treatment. The oral impact of daily performances index was included to assess socio-dental impacts on quality of life. RESULTS: Most responders reported improvements on the 7 items. The most significant change was reported for chewing. "Very satisfied" with the treatment was reported by 13 responders; 19 of 36 persons were "reasonably satisfied." Reporting "very satisfied with treatment" was 8 times more likely when peers had noticed a changed in the participant's appearance after surgery. Sex was significantly associated with quality of life. CONCLUSIONS: The most frequently reported reason for treatment was to improve chewing, and the item that showed the most pronounced improvement was also chewing. Most responders were only reasonably satisfied with the treatment. Whether peers noticed a change in appearance after treatment was a significant factor affecting both treatment satisfaction and reporting a good quality of life.

Dental or skeletal relapse after sagittal split osteotomy advancement surgery? Long-term follow-up.

PURPOSE: To evaluate the short- and long-term stability of mandibular advancement surgery with sagittal split osteotomy (SSO), and to investigate when relapse occurs and identify variables contributing to relapse. PATIENTS AND METHODS: Thirty-six patients with Class II anomalies were included; the mean age at surgery was 33.0 years. All underwent SSO surgery and clinical and radiologic follow-up at 8 weeks, 1 year, and 13 years. Model analysis, cephalometric analysis, and clinical examinations were performed at each control. RESULTS: Mean overjet relapse from 8 weeks to 13 years was 2.3 mm (range, 0 to 7.0 mm). Between 8 weeks and 1 year, mean overjet relapse was 0.6 mm (range, -1.0 to 4.0 mm), and it was 1.7 mm (range, -1.0 to 6.0 mm) between 1 year and 13 years. Overjet relapse greater than 4 mm was found in 13.9% of the patients. Mean overjet 1 year after surgery was 2.6 mm and was significantly increased compared with 8 weeks (P = .006). Mean overjet 13 years after surgery was 4.3 mm and was significantly increased compared with 1 year (P < .001). Inferior incisor line to nasion-B-point was 29.0° at 8 weeks after surgery and 25.4° at 13 years (P = .001). Insignificant changes in the other cephalometric variables were found at follow-up. CONCLUSION: SSO advancement surgery is a relatively stable technique over time. Mean overjet relapse was found to be 2.3 mm after 13 years, following a continuous pattern over time. The cephalometric variables showed insignificant changes during follow-up, indicating that relapses are mainly of dental and not skeletal origin.

A practical approach to interpretation of MRI of the temporomandibular joint.

BACKGROUND: Temporomandibular disorders (TMDs) such as pain, joint sounds, and impaired movement are common, and magnetic resonance imaging (MRI) is now the method of choice for diagnostic assessment. PURPOSE: To describe MR criteria chosen and the amount of temporomandibular joint (TMJ) pathology registered when examining MR images from patients referred to a university hospital for imaging of their TMJs. MATERIAL AND METHODS: The TMJs of 152 consecutive patients, 102 women and 40 men, referred for MRI during an 18 month period were imaged with a 1.5 T imaging system. Twelve asymptomatic students, seven women and five men, gave informed consent and acted as a control group. RESULTS: Moderate to extensive disk displacement was registered in 53% of the patients' TMJs, and 38% of the disks were deformed. Degenerative changes registered were flattening of the condyle heads in 50% of the TMJs and erosion of their cortical surfaces in 30%. Osteophytes were present in 31% of the condyles and bone marrow edema in 30%. Marked to extensive effusion in synovial compartments was registered in 39% of the studied TMJs. In the control group, none of the TMJs showed anterior disk displacement, deformed disks or degenerative changes, but 8 of the 24 joints showed marked effusion. A tendency for a higher amount of disk displacement and deformation was seen among young age groups and more degenerative changes in older age groups, but differences among groups were not significant when tested with chi-square analysis. CONCLUSION: Defined MR criteria that allow for comparative assessment are presented. According to these criteria, a large proportion of the patients referred for MR examination showed morphologic changes indicating TMJ pathology.

The long-term effect of anti TNF-alpha treatment on temporomandibular joints, oral mucosa, and salivary flow in patients with active rheumatoid arthritis: a pilot study.

OBJECTIVE: The objective of this study was to evaluate the long-term effects of anti-TNF-alpha treatment on temporomandibular joints (TMJs), oral mucosa, and salivary flow in RA. STUDY DESIGN: Seventeen patients received infusions of TNF-alpha blocking agents after 0, 2, and 6 weeks, and then every 8 weeks until week 54 (follow-up). Clinical dysfunction index (Di) for the TMJ system, salivary flow, disease activity score (DAS28), and other medical assessments were calculated at weeks 0 and 54. RESULTS: Median Di was 5.0 (range 0-21) at baseline and 1.0 (range 0-6) (P = .001) at follow-up. Mean salivary flow was 3.2 mL/15 minutes at baseline and 4.6 at follow-up (P = .055). Two (11.7%) of the patients developed oral candidiasis during the period of treatment. The median DAS28 was 6.2 (range, 4.7-7.7) at baseline and 4.1 (range, 1.6-6.8) at follow-up (P = .001). CONCLUSION: We conclude that anti-TNF-alpha blocking treatments have beneficial effects on oral as well as general manifestations of RA.

Immunoglobulin G and A antibody responses to Bacteroides forsythus and Prevotella intermedia in sera and synovial fluids of arthritis patients.

The objective of the present study was to investigate immunoglobulin G (IgG) and IgA antibody immune responses to Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, and Candida albicans in the sera of patients with rheumatoid arthritis (RA), the synovial fluid (SF) of patients with RA (RA-SF samples), and the SF of patients without RA (non-RA-SF samples). An enzyme-linked immunosorbent assay was used to determine IgG and IgA antibody levels in 116 serum samples from patients with RA, 52 RA-SF samples, and 43 non-RA-SF samples; and these were compared with those in SF samples from 9 patients with osteoarthritis (OA-SF samples) and the blood from 100 donors (the control [CTR] group). Higher levels of IgG antibodies against B. forsythus (P < 0.0001) and P. intermedia (P < 0.0001) were found in non-RA-SF samples than in OA-SF samples, and higher levels of IgG antibodies against B. forsythus (P = 0.003) and P. intermedia (P = 0.024) were found in RA-SF samples than in OA-SF samples. Significantly higher levels of IgA antibodies against B. forsythus were demonstrated in both RA-SF and non-RA-SF samples than in OA-SF samples. When corrected for total Ig levels, levels of IgG antibody against B. forsythus were elevated in RA-SF and non-RA-SF samples compared to those in OA-SF samples. Lower levels of Ig antibodies against B. forsythus were found in the sera of patients with RA than in the plasma of the CTR group for both IgG (P = 0.003) and IgA (P < 0.0001). When corrected for total Ig levels, the levels of IgG and IgA antibodies against B. forsythus were still found to be lower in the sera from patients with RA than in the plasma of the CTR group (P < 0.0001). The levels of antibodies against P. gingivalis and C. albicans in the sera and SF of RA and non-RA patients were comparable to those found in the respective controls. The levels of IgG and IgA antibodies against B. forsythus were elevated in SF from patients with RA and non-RA-SF samples compared to those in OA-SF samples. Significantly lower levels of IgG and IgA antibodies against B. forsythus were found in the sera of patients with RA than in the plasma of the CTR group. This indicates the presence of an active antibody response in synovial tissue and illustrates a potential connection between periodontal and joint diseases.

Current issues in Sjögren's syndrome.

Sjögren's syndrome is a chronic autoimmune and rheumatic disorder with prominent sicca complaints from the mucous membranes because of lack of proper exocrine secretions. There is no straightforward and simple diagnostic test for Sjögren's syndrome, although several classification criteria have been designed including several oral diagnostic tests. A new set of classification criteria in a joint effort by research groups in Europe and USA has recently been presented. A large number of autoantibodies have been reported in Sjögren's syndrome where, in some cases, the antibodies are correlated with the extent and severity of disease. The finding of serum autoantibodies directed against the muscarinic M3 receptor is an important advance in understanding the pathogenesis of not only the impaired glandular function but also associated features of autonomic dysfunction in some patients. The treatment of primary Sjögren's syndrome is still mainly symptomatic.