The impact of oral appliance therapy with moderate mandibular advancement on obstructive sleep apnea and upper airway volume.

PURPOSE: To find out if a moderate protrusion with a mandibular advancement device (MAD) can significantly increase the upper airway volume and, further, what signs and symptoms of obstructive sleep apnea (OSA) can be improved by this maneuver. METHODS: There were 58 adults diagnosed with OSA who were referred for MAD therapy. The mean apnea-hypopnea index (AHI) was 19.2 (SD 8.6). Five indicators of signs and symptoms of OSA (AHI, oxygen saturation, snoring, daytime sleepiness, and health-related quality of life) were evaluated at the baseline and after 6 months of MAD therapy. Nasal resistance and airway volume and cross-sectional areas with and without the MAD in situ were recorded. Based on AHI reduction, the treatment response was classified as complete, partial, or non-complete. Statistical analyses included the chi-square, t tests, Mann-Whitney U tests, and regression analyses (linear and logistic). RESULTS: Twenty-three patients attained a complete response (residual AHI < 5 events/h) to MAD therapy. In 13 subjects, the response was partial, and in 9 patients, it was non-complete. The complete responders were significantly younger, and they had a deeper overbite than partial/non-complete responders. A convex profile associated positively, but a vertically restricted throat and increased lower facial height associated negatively with the increase in airway volume. CONCLUSIONS: Excellent MAD therapy outcomes were achieved in most patients. Only age and deep bite had some influence on AHI reduction, indicating multifactorial nature in the response to MAD therapy.

Efficacy of stabilisation splint treatment on the oral health-related quality of life-A randomised controlled one-year follow-up trial.

The aim of this randomised controlled trial was to assess the efficacy of stabilisation splint treatment on the oral health-related quality of life OHRQoL during a 1-year follow-up. Originally, the sample consisted of 80 patients (18 men, 62 women) with temporomandibular disorders (TMD) who had been referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, for treatment. Patients were randomly designated into splint (n = 39) and control group (n = 41). Patients in the splint group were treated with a stabilisation splint. Additionally, patients in both groups received counselling and instructions on masticatory muscle exercises. The patients filled in the Oral Health Impact Profile-14 (OHIP-14) questionnaire before treatment and at 3 months, 6 months and 1 year. At total, 67 patients (35 in the splint group vs. 32 in the control group) completed the questionnaire at baseline. The outcome variables were OHIP prevalence, OHIP severity and OHIP extent. Linear mixed-effect regression model was used to analyse factors associated with change in OHIP severity during the 1-year follow-up, taking into account treatment time, age, gender and group status. OHIP prevalence, severity and extent decreased in both groups during the follow-up. According to linear mixed-effect regression, decrease in OHIP severity did not associate significantly with group status. Compared to masticatory muscle exercises and counselling alone, stabilisation splint treatment was not more beneficial on self-perceived OHRQoL among TMD patients over a 1-year follow-up.

Diagnostic criteria for temporomandibular disorders (DC/TMD): interexaminer reliability of the Finnish version of Axis I clinical diagnoses.

Recently, updated diagnostic criteria for temporomandibular disorders (DC/TMD) were published to assess TMD in a standardised way in clinical and research settings. The DC/TMD protocol has been translated into Finnish using specific cultural equivalency procedures. To assess the interexaminer reliability using the Finnish translations of the DC/TMD-FIN Axis I clinical diagnostic assessment instruments. Reliability assessment data were collected during a 1-day DC/TMD Examiner Training Course at the University of Turku, Finland, in collaboration with the International DC/TMD Training and Calibration Center in Malmö University. Clinical TMD examinations according to the Finnish pre-final version of the DC/TMD Axis I assessment protocol were performed by four experienced TMD specialists on altogether 16 models. Kappa coefficient, overall percentage agreement (%A) as well as positive (PA) and negative (NA) agreements were used to define the reliability. Myofascial pain with referral, headache attributed to TMD and disc displacement (DD) without reduction without limited opening showed excellent kappa values (range 0·87-1·00). Fair-to-good reliability was observed for diagnoses of myalgia (k = 0·67), arthralgia (k = 0·71) and DD with reduction (k = 0·64). The PA was high for all pain-related diagnoses and DD without reduction without limited opening (medians ≥83%), and acceptable for DD with reduction (median 67%). The NA was high (medians ≥87%) for all DC/TMD diagnoses, except for myalgia which showed acceptable NA (median 75%). The %A was high for all assessed diagnoses (medians >85%). The findings of this study showed DC/TMD-FIN Axis I to demonstrate sufficiently high reliability for pain-related TMD diagnoses.

Palatal training appliances in children with mild to moderate oral dysfunctions.

OBJECTIVE: The objective of the study was to evaluate the efficacy of palatal training appliances on speech articulation and orofacial functions in children undergoing speech therapy. STUDY DESIGN: The material consisted of 134 boys and 34 girls who were referred by speech and language therapists to the Public Dental Health Service in Vantaa due to mild to moderate problems with speech articulation or in oral motor skills. The mean age of the children at the start of the palatal plate therapy was 6.4 years (SD 1.9). The articulation assessment was performed by five speech and language therapist while the palatal plate therapy was carried out by an experienced dentist. The mean treatment time with the oral plates was 4.4 months (SD 2.3). RESULTS: An improvement in speech articulation was observed by the speech and language therapists in 51% of the children. Tongue movements improved in 47%, and lip closure in 38% of the participants. Drooling decreased in 54% of the cases. A multiple logistic regression model revealed that with respect to speech articulation the best improvement was found in children with /r/-disorder and in those with a crossbite. CONCLUSIONS: Palatal training appliances during speech therapy seemed to be an efficient way to improve speech articulation and tongue movements in children with mild to moderate problems in orofacial functions.