Clinical Management of Interproximal and Occlusal Caries in Children and Adolescents by Canadian Dentists: A Survey.

PURPOSE: Early restorative interventions may have important implications in young patients, and the International Caries Classification and Management System strongly recommends non-surgical strategies in the management of dental caries. We aimed to assess management of interproximal and occlusal caries in children and adolescents (≤18 years of age) by Canadian dentists. METHODS: An electronic survey was created and sent to members of Canadian provincial regulatory dental bodies. The survey included 11 questions on demographic factors and 3 clinical situations on dental caries management. RESULTS: The response rate was 4.6% (n = 702). To treat interproximal carious lesions limited to enamel, 442 dentists (63.0%) reported using surgical caries removal on a permanent molar and 502 dentists (71.5%) did the same for a primary tooth. For occlusal carious lesions, the corresponding numbers were 300 dentists (42.7%) for a permanent molar and 269 (38.3%) for a primary molar. Age, year of graduation and province of practice appear to have a significant impact on the restorative threshold. CONCLUSIONS: According to the latest evidence-based recommendations for caries management, the presence of cavitated enamel should be the main indication to restore, and non-surgical interventions for non-cavitated lesions confined to enamel should be prioritized. Results show that a good proportion of respondents have a lower restorative threshold, particularly for interproximal lesions.

Oral appliances reduce masticatory muscle activity-sleep bruxism metrics independently of changes in heart rate variability.

OBJECTIVES: Sleep bruxism (SB) is associated with physiological activities including sympathetic autonomic system dominance and sleep micro-arousal. While oral appliances (OA) are used to prevent SB harmful effects, the influence of OAs physiological mechanisms during sleep is unknown. The aim of this study is to assess whether heart rate variability (HRV) changes, as a marker of autonomic nervous system activity, would be associated with the OA mechanism of action on SB using occlusal splint (OS) and mandibular advancement splint (MAS). MATERIALS AND METHODS: A retrospective analysis, from data previously collected in 21 participants with SB (25.6 ± 4.5 years) with polysomnographic recordings, was done. HRV data were compared between a reference night (no-device) and ones during which OS or MAS was used in a crossover study design. Rhythmic masticatory muscle activity (RMMA) index was compared between nights. HRV was evaluated using autoregressive model analysis for three sections: baseline (distance from RMMA), immediately before, and after RMMA period. RESULTS: A significant reduction in RMMA index, when wearing OA during sleep, was observed (P < 0.01), but was not associated with HRV parameters change. HRV significantly changed after RMMA onset for nights with OA during non-REM sleep in comparison with baseline (P < 0.02). CONCLUSIONS: The usage of OAs for SB participants reduced RMMA, but most likely independently of changes in HRV linked to the mechanism associated with SB genesis. CLINICAL RELEVANCE: Wearing OA seems to reduce grinding noise and protect from dental injuries but does not seem to influence SB genesis.

Do postoperative antibiotics influence one-year peri-implant crestal bone remodelling and morbidity? A double-blinded randomized clinical trial.

OBJECTIVES: The primary objective of this study was to assess whether giving postoperative antibiotics to healthy patients after straightforward platform-switched implant placement would influence peri-implant crestal bone levels and postoperative morbidity after 1 year. METHODS: Thirty-eight healthy individuals were recruited in this pilot, randomized, double-blinded, placebo-controlled clinical trial. The intervention group (n = 18) received two grams of amoxicillin one hour before implant placement followed by a 7 days postoperative regimen (500 mg tid). The control group (n = 20) took the same preoperative dose of amoxicillin and an identical placebo postoperatively. Mesial and distal peri-implant crestal bone levels were measured at baseline, four months and one year later with standardized periapical radiographs. Postoperative pain severity was assessed through self-administered questionnaires for 7 days. Surgery-associated morbidities were evaluated after one, three, 16 weeks and 1 year. Descriptive and bivariate analyses were used. RESULTS: Thirty-seven participants completed the trial. At the one-year follow-up, the mean combined peri-implant crestal bone changes for the intervention (n = 18) and control (n = 19) groups were - 0.44 ± 0.41 mm and - 0.27 ± 0.56 mm, respectively. The difference between the groups (intervention-control) for mean combined crestal bone level changes was not statistically significant. There were no significant differences in surgery-associated morbidities between the intervention and control groups. The one-year implant survival rate was 100% in both groups. CONCLUSIONS: Study results suggest that a routine postoperative antibiotic regimen for healthy patients undergoing straightforward platform-switched implant placement might not be necessary to prevent postoperative peri-implant bone loss and complications.

Effects of nocturnal wearing of dentures on the quality of sleep and oral-health-related quality in edentate elders with untreated sleep apnea: a randomized cross-over trial.

STUDY OBJECTIVES: This study aims to assess whether the nocturnal wear of dentures has an effect on the quality of sleep and oral-health-related quality of life of the edentulous elderly with untreated sleep apnea. METHODS: A single-blind randomized cross-over design with two sequences and two periods was used. Participants (n = 77) were randomly assigned either to sequence 1 (nocturnal wear followed by nocturnal nonwear of the denture for 30-30 days) or sequence 2 (nocturnal nonwear followed by nocturnal wear of denture for 30-30 days). The primary sleep outcome was the quality of sleep, assessed through sleep fragmentation measured as Apnea-Hypopnea Index (AHI) and respiratory arousal from portable polysomnography. Secondary outcomes were daytime sleepiness, sleep quality (Pittsburgh Sleep Quality Index, PSQI) and oral-health-related quality of life measured by validated questionnaires. RESULTS: The mean paired difference in AHI scores for the period of wearing versus not wearing dentures at night was small 1.0 event per hour (p = 0.50; 95% confidence interval (CI) = -2.0 to 4.1). The mean respiratory arousal index was higher when wearing dentures at night than when not wearing dentures at night, with a mean paired difference of 2.3 events per hour (p = 0.05; 95% CI = 0.0 to 4.6). No difference in sleepiness and PSQI were noted. Wearing dentures at night resulted in a statistically significantly higher mean score of psychological discomfort when compared to not wearing dentures at night. CONCLUSIONS: The results provide some support to usual practice guidelines to remove dentures at night in edentulous elders suffering from sleep apnea. CLINICAL TRIAL REGISTRATION: NCT01868295.

Prospective randomized clinical trial evaluating the effects of two different implant collar designs on peri-implant healing and functional osseointegration after 25 years.

OBJECTIVES: Evaluate the effects of two different machined-collar lengths and designs on peri-implant healing. MATERIAL AND METHODS: An implant with a microtextured surface and 3.6mm-long internal-connection machined collar was compared to two implants that had an identical 1.2mm-long external-connection machined collar, but one had the microtextured surface while the other's was machined. Participants received the three implants, with microgap at the crest, alternately at five sites between mental foramen, and a full-arch prosthesis. Peri-implant bone levels were measured after 23 to 26 years of function. Keratinized tissue height, plaque, probing depth, bleeding, and purulence were also evaluated. Descriptive and mixed models for repeated\measures analyses were used, with Bonferroni correction for pairwise comparisons. RESULTS: Twenty-two participants (110 implants) were evaluated at the 25-year examination. Microtextured implants with the longer machined collar had significantly greater mean marginal bone loss (-1.77mm ± 0.18, mean ± SE) than machined (-0.85mm ± 0.18, p < .001) and microtextured (-1.00 ± 0.18mm, p < .001) implants with the shorter machined collar. Keratinized tissue height was greater for internal-connection (0.74mm ± 0.10) versus external-connection (0.51 ± 0.08, p =  0.01) microtextured implants. No differences were observed for plaque (p = 0.78), probing depth (p = 0.42), bleeding (p  = 0.07), and purulence (p = 1.00). Implant survival rate was 99%. CONCLUSIONS: Implants with the 1.2mm machined collar limited bone loss to 1mm, while those with the longer machined collar showed > 1.5mm loss after 25 years of function with microgap at the crest. Internal-connection design and fixture surface microtexturing did not result in greater bone preservation. ClinicalTrials.gov Identifier: NCT03862482.

The Evaluation of Autonomic Arousals in Scoring Sleep Respiratory Disturbances with Polysomnography and Portable Monitor Devices: A Proof of Concept Study.

BACKGROUND: Autonomic arousals can be considered as surrogates of electroencephalography (EEG) arousals when calculating respiratory disturbance index (RDI). The main objective of this proof of concept study was to evaluate the use of heart rate acceleration (HRa) arousals associated with sleep respiratory events in a population undergoing full polysomnography (type 1) and in another undergoing portable monitor study (type 3). Our hypothesis is that when compared to other commonly used indexes, RDI based on HRa will capture more events in both types of recording. MATERIALS AND METHODS: A retrospective analysis was performed in two different populations of patients with suspected OSA: a) 72 patients undergoing one night of type 1 recording and b) 79 patients undergoing one night of type 3 recording. Variables for type 1 were 4% oxygen desaturation index (ODI), apnea/hypopnea index (AHI), RDI based on EEG arousals (RDIe), and RDI based on HRa with threshold of 5bpm (RDIa5). For type 3, variables were 4% ODI, AHI, and RDIa5 (it is not possible to calculate RDIe due to the absence of EEG). Calculated data were 1) Mean values for each sleep disturbance index in type 1 and 3 recordings; 2) Frequency of migration from lower to higher OSA severity categories using RDIa5 in comparison to AHI (thresholds: ≥5/h mild, ≥15/h moderate, ≥30/h severe); and 3) Bland-Altman plots to assess agreement between AHI vs RDIe and RDIa5 in type 1 population, and AHI vs RDIa5 in type 3 populations. RESULTS: More respiratory disturbance events were captured with RDIa5 index in both type 1 and type 3 recordings when compared to the other indexes. In type 1 recording, when using RDIa5 37% of patients classified as not having OSA with AHI were now identified as having OSA, and a total of 59% migrated to higher severity categories. In type 3 recording, similar results were obtained, as 37% of patients classified as not having OSA with AHI were now identified as having OSA using RDIa5, and a total of 55% patients migrated to higher severity categories. Mean differences for RDIa5 and AHI in type 1 and 3 populations were similar. CONCLUSION: The use of autonomic arousals such as HRa can help to detect more respiratory disturbance events when compared to other indexes, being a variable that may help to capture borderline mild cases. This becomes especially relevant in type 3 recordings. Future research is needed to determine its validity, optimization, and its clinical significance.

Association of Circulating YKL-40 Levels and CHI3L1 Variants with the Risk of Spinal Deformity Progression in Adolescent Idiopathic Scoliosis.

The cellular and molecular mechanisms underlying spinal deformity progression in adolescent idiopathic scoliosis (AIS) remain poorly understood. In this study, 804 French-Canadian patients and 278 age- and sex-matched controls were enrolled and genotyped for 12 single nucleotide polymorphisms (SNPs) in the chitinase 3-like 1 (CHI3L1) gene or its promoter. The plasma YKL-40 levels were determined by ELISA. We showed that elevation of circulating YKL-40 levels was correlated with a reduction of spinal deformity progression risk. We further identified significant associations of multiple CHI3L1 SNPs and their haplotypes with plasma YKL-40 levels and scoliosis severity as a function of their classification in a specific endophenotype. In the endophenotype FG3 group, we found that patients harboring the haplotype G-G-A-G-G-A (rs880633|rs1538372|rs4950881|rs10399805|rs6691378|rs946261), which presented in 48% of the cases, showed a positive correlation with the plasma YKL-40 levels (P = 7.6 × 10-6 and coefficient = 36). Conversely, the haplotype A-A-G-G-G-G, which presented in 15% of the analyzed subjects, showed a strong negative association with the plasma YKL-40 levels (P = 2 × 10-9 and coefficient = -9.56). We found that this haplotype showed the strongest association with AIS patients in endophenotype FG2 (P = 9.9 × 10-6 and coefficient = -13.53), who more often develop severe scoliosis compared to those classified in the other two endophenotypes. Of note, it showed stronger association in females (P = 1.6 × 10-7 and coefficient = -10.08) than males (P = 0.0021 and coefficient = -9.01). At the functional level, we showed that YKL-40 treatments rescued Gi-coupled receptor signalling dysfunction occurring in primary AIS osteoblasts. Collectively, our findings reveal a novel role for YKL-40 in AIS pathogenesis and a new molecular mechanism interfering with spinal deformity progression.

Dental caries are positively associated with periodontal disease severity.

OBJECTIVES: To examine associations between periodontal disease severity and clinical and microbiological measures of caries in adults. MATERIALS AND METHODS: A cross-sectional study of 94 healthy adults ((mean ± SD) 55.4 ± 13.0 years) was conducted. Data were collected by means of questionnaire and a clinical examination that included the Decayed, Missing, Filled teeth Surfaces (DMFS) index, probing depth (PD), clinical attachment level (CAL), and gingival bleeding and plaque scores. Supra- and subgingival plaque samples were collected to assess the presence of Streptococcus mutans and six periodontal pathogens. Participants were subsequently categorized using Center for Disease Control and Prevention/American Academy of Periodontology (CDC-AAP) definitions and tertiles of percentage of sites with CAL ≥ 3mm. RESULTS: Significant positive associations were found between the periodontal disease severity (CDC-AAP) and the DMFS (aOR = 1.03; 95% CI 1.01-1.05) and DS indices (aOR = 1.18; 95% CI 1.05-1.32) as well as between the tertiles of percentage of sites with CAL ≥ 3 mm and DMFS (aOR = 1.03; 95% CI 1.00-1.05) and DS indices (aOR = 1.12; 95% CI 1.00-1.25). A significant positive association was also found between oral levels of F. nucleatum and S. mutans (aOR = 6.03; 95% CI 1.55-23.45). CONCLUSIONS: A small but positive association was found between clinical measures of caries and periodontal disease severity. Further research is warranted to examine the association between these two common oral diseases. CLINICAL RELEVANCE: Periodontal diseases and caries are the two most common oral diseases. There was a positive association between clinical and microbiological markers of both diseases. Therefore, strategies in oral health education should involve both caries and periodontitis prevention.

Autonomic Arousals as Surrogates for Cortical Arousals Caused by Respiratory Events: A Methodological Optimization Study in the Diagnosis of Sleep Breathing Disorders.

INTRODUCTION: Portable monitoring (PM) is an alternative to laboratory polysomnography (PSG) for diagnosing obstructive sleep apnea (OSA). However, PM tends to underestimate the apnea-hypopnea index (AHI), as it does not identify non-desaturating events associated with electroencephalographic (EEG) arousal. The objectives were to explore heart rate acceleration (HRa) and decrease in pulse transit time (PTT) as surrogates to EEG arousal for non-desaturating hypopnea and respiratory effort-related arousal (RERA), and to estimate cut-off values for their use with both total sleep time (TST), the standard method for PSG, and total recording time (TRT), the usual method for PM. METHODS: Twenty-four consecutive individuals with suspected OSA were studied with PSG. Calculated outcomes were: AHI, respiratory disturbance index with EEG arousal (RDIe) and autonomic arousal by HRa (RDI-HRa) and PTT decreases (RDI-PTT) at different time cut-offs. Using RDIe as reference, Bland Altman and intraclass coefficient of correlation (ICC) were used to calculate agreement between indexes, and receiver operating curves (ROC) for sensitivity/specificity of the different cut-offs. RESULTS: Autonomic arousals, limited to respiratory events, were present in 36% of non-desaturating hypopneas and 29% of RERAs. Using TST, RDI-HRa of 10 bpm (ICC= 0.89) and RDI-PTT with a decrease of -15 msec (ICC=0.90) agreed better with RDIe. With TRT, the RDI-HRa of 5 bpm agreed better with the RDIe (ICC=0.89). Bland-Altman plots showed mean differences of 1.53 between RDI-HRa10-TST and RDIe and 0.89 between RDI-HRa5-TRT and RDIe. CONCLUSION: Autonomic arousals (HRa and PTT) may be a suitable proxy of EEG arousals associated with respiratory events, using both TST and TRT. Therefore, they could potentially help to capture borderline symptomatic patients and to monitor treatment outcomes.

Long-term randomized clinical trial evaluating the effects of fixture surface acid-etching and machined collar design on bone healing.

OBJECTIVES: An implant with an acid-etched fixture surface and internal-hex collar may achieve greater osseointegration. The goal of this research was to study the effects on long-term bone healing of fixture surface acid-etching and machined collar design. METHOD AND MATERIALS: Three two-part implant types were compared: standard Brånemark (with an external-hex 1.2 mm long machined flat collar), Swede-Vent (a copy of the Brånemark design, with an identical collar but a fixture surface acid-etched to 1 to 3 µm), and Screw-Vent (with a fixture surface acid-etched identically to that of Swede-Vent, but a longer internal-hex machined flat collar that did not require countersinking). Fifty-eight subjects each received the three types in alternate fashion at five sites between mental foramen, and a fixed full-arch prosthesis. Abutment-implant interface/microgap (MG) was placed at the crest, and first bone-to-implant contact point-to microgap (fBIC-MG) was measured at mesial and distal sides of each implant. Mean fBIC-MG values were compared after 15 to 20 years of function. Statistical analysis was based on the mixed linear model with the level of significance set at P < .05 and Bonferroni correction for pairwise comparisons. RESULTS: Brånemark had less mean marginal bone loss (-1.08 mm, standard error [SE] 0.20) compared with Swede-Vent (-1.28 mm, SE 0.20), but pairwise comparisons showed that the difference was not statistically significant (mean difference of 0.20 mm, P = .662). Screw-Vent had the greatest loss (-1.92 mm, SE 0.20), and pairwise comparisons showed that the difference was statistically significant compared with Brånemark and Swede-Vent (difference ≥ 0.64 mm, P < .001). CONCLUSION: According to accepted standards for osseointegration, all three implant types achieved very acceptable long-term results. However, while Brånemark had the least bone loss, the implant with the acid-etched fixture surface and longer internal-hex collar design had the greatest loss. Within the confines of this study, shorter collar length of 1.2 mm may be more important to limit long-term bone loss with microgap placed at the crest.

Characterization of Burning Mouth Syndrome in Patients with Parkinson's Disease.

AIMS: To determine the prevalence and characteristics of burning mouth syndrome (BMS) in a Parkinson's disease (PD) population through a self-administered, custom-made survey. METHODS: A total of 218 surveys were collected during regular outpatient visits at two Movement Disorders Clinics in Montreal (Canada) and Toulouse (France) to gather information about pain experience, PD-related symptoms, and oral and general health. A neurologist confirmed the diagnosis of PD, drug treatment, Hoehn-Yahr stage, and Schwab & England Activity of Daily Living score. Data between groups were compared using the independent samples Mann-Whitney U test and two-sided exact Fisher test. RESULTS: Data from 203 surveys were analyzed. BMS was reported by eight subjects (seven females and one male), resulting in a prevalence of 4.0% (95% confidence interval [CI] = 2.1-7.8). Five participants with chronic nonburning oral pain were excluded. PD severity and levodopa equivalent daily dose did not differ between non-BMS and BMS participants. Mean poor oral health index was higher in BMS compared to non-BMS subjects (49.0 vs 32.2 points, P < .05). BMS manifested after PD onset in seven patients, did not occur on a daily basis in four, and always coexisted with restless legs syndrome. CONCLUSION: This survey yielded a low prevalence of BMS in PD patients, indicating no strong link between the two conditions. An augmenting effect such as that resulting from drug treatment in restless legs syndrome or sensory neuropathy cannot be excluded.

Mapping the Quebec dental workforce: ranking rural oral health disparities.

INTRODUCTION: Ensuring access to oral health services is crucial for improving the oral health of rural and remote populations. A logical step towards addressing oral health disparities and underutilization of services in rural areas is to ensure the availability of the dental workforce. Geographical information systems are valuable in examining workforce dispersion patterns and identifying priority areas requiring administrative and policy attention. The objective of this study was to examine and map the distribution patterns of the dental workforce in Quebec, Canada. METHODS: Utilizing the membership directory of Quebec Professional Orders (2009-2010), data on practice locations, practice types and license issue date for all active members of the Quebec dental workforce were obtained. This was followed by reverse geocoding of the geographic coordinates using a global positioning system visualizer to reveal textual locations. These locations were classified according to various degrees of rurality as defined by the 2006 Census Metropolitan Area and Census Agglomeration Influenced Zone typology, developed by Statistics Canada. Cartography layers were extracted from a geospatial database provided by Canada Natural Resources using ArcGIS 9.3. Descriptive and bivariate analyses were performed using SPSS v17 for Windows. RESULTS: Data analysis revealed statistically significant differences in the distribution of dental professionals in rural and urban areas (urban 59.4±19.4/100 000 vs rural 39.9±17.6/100 000; p<0.001). Approximately 90.3% of the dental workforce was located in urban zones, 1.3% in the zones strongly influenced by metropolitan area, 4.9% in the moderately influenced zones, while only 0.3% of the dental workforce was located in non-metropolitan-influenced zones. Urban zones such as Montreal, Quebec and Sherbrooke had the highest workforce availability (4-6 dentists for every 5000 inhabitants). Of a total of 447 specialist dentists in Quebec, only five were located in rural areas. CONCLUSIONS: This study concludes that there is a strong relationship between the degree of urbanization and the highest concentration of dental professionals. In addition, there is a lack of dental workforce availability, particularly specialists in rural Quebec. Further research is needed to examine and evaluate to what degree these distribution patterns might contribute to oral health outcomes of the rural population.

Linking evidence to treatment for denture stomatitis: a meta-analysis of randomized controlled trials.

OBJECTIVES: The aim of this meta-analysis was to compare the efficacy of antifungal therapy with any other alternative methods used for the treatment of denture stomatitis. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews were searched, complemented by hand searching, until the first week of January 2013. STUDY SELECTION: Included studies consisted of randomized clinical trials published in English or French, which compared antifungals with any other alternative or placebo, used for the treatment of denture stomatitis. The remission of clinical signs of denture stomatitis, and the reduction in Candida colony counts were considered as the clinical and microbiological outcomes, respectively. Random effects models were used to conduct the statistical analyses. RESULTS: From 233 identified articles, a total of 15 manuscripts on 14 randomized controlled trials were included in systematic review and 8 in the meta-analysis. No statistically significant difference between antifungal treatment and disinfection methods was found for both clinical (OR=0.7; 95% CI: 0.32-1.36; Z=-1.14; p=0.256) and microbiological (OR=0.8; 95% CI: 0.26-2.5; Z=-0.35; p=0.724) outcomes. The meta-analysis showed a statistically significant difference between an antifungal and a placebo for the microbiological outcome (OR=0.32; 95% CI: 0.12-0.89; Z=-2.2; p=0.028), favouring the antifungals. However, there was no statistically significant difference between antifungal and placebo for the clinical outcome (OR=0.2; 95% CI: 0.04-1.04; Z=-1.9; p=0.056). CONCLUSIONS: Disinfection agents, antiseptic mouthwashes, natural substances with antimicrobial properties, microwave disinfection and photodynamic therapy could be suggested as an adjunct or alternative to antifungal medications in the treatment of denture stomatitis.

Clinimetric evaluation of the Simpson-Angus Scale in older adults with schizophrenia.

OBJECTIVE: Parkinsonism (or Parkinson's syndrome [PS]) remains common in patients exposed to antipsychotic drugs. One clinical tool used in its detection and follow-up, the Simpson-Angus Scale (SAS), has been under revision lately. We further examined the discriminative power of the SAS to detect PS and its efficacy as a measure of PS intensity in chronic schizophrenia. METHODS: Fifty-six outpatients between 50 and 75 years of age, under stable antipsychotic drug therapy, provided consent to undergo an evaluation along the SAS and Unified Parkinson's Disease Rating Scale III motor subsection, split according to the presence or absence of PS defined in the UK Parkinson's Disease Society Brain Bank (UKPDSBB) criteria or Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. RESULTS: The identification rate for PS was 39.3% based on UKPDSBB criteria applied to the Unified Parkinson's Disease Rating Scale III, compared with 62.5% and 87.5% according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and SAS cutoff value greater than 0.3, respectively. Median SAS scores for PS and PS-free participants were comparable. The SAS yielded high sensitivity (90.9%) but low specificity (17.7%). κ Values generally revealed only slight agreement between the group allocation provided by the SAS and the UKPDSBB criteria. Receiver operating characteristic curve for screening performance of the SAS provided poor prediction of subject status. CONCLUSIONS: The SAS lacks specificity and constitutes an imperfect detection and measurement tool for PS in older adults. Raising the cutoff score would avoid inflation in PS identification. The scale is probably best used as a measure of change relative to baseline score following an intervention, but results should be interpreted with caution.

Sleep bruxism and oromandibular myoclonus in rapid eye movement sleep behavior disorder: a preliminary report.

OBJECTIVE: We aimed to compare rhythmic masticatory muscle activity typical of sleep bruxism and oromandibular myoclonus (OMM) during rapid eye movement (REM) sleep in patients with idiopathic REM sleep behavior disorder (iRBD) and in Parkinson disease (PD) patients with RBD (PD-RBD). METHODS: Sleep polygraphic data were collected from 9 age-matched controls and 28 patients (mean±standard error of the mean, 66.0±1.7 y) with a clinical and sleep laboratory diagnosis of RBD. Patients were divided into two groups: 13 patients with iRBD and 15 patients with PD-RBD. Rhythmic masticatory muscle activity, a marker of sleep bruxism, and OMM were scored blind to subject's diagnosis from jaw electromyographic recordings during sleep. RESULTS: The rhythmic masticatory muscle activity index was significantly higher during REM sleep in iRBD subjects compared to controls (P<.01) and was significantly higher during non-REM (NREM) sleep in both subject groups compared to controls (P < or = .03). A positive sleep laboratory diagnosis of sleep bruxism was made in 25% of all patients. In iRBD, patients had more OMM during REM sleep than controls (2.4 times higher; P=.01). CONCLUSION: In the presence of a high frequency of rhythmic masticatory muscle activity during REM sleep, RBD may be suspected and further neurologic assessment is recommended.

Females with sleep bruxism show lower theta and alpha electroencephalographic activity irrespective of transient morning masticatory muscle pain.

AIMS: To investigate the hypothesis that the presence of transient morning masticatory muscle pain in young, healthy sleep bruxers (SBr) is associated with sex-related differences in sleep electroencephalographic (EEG) activity. METHODS: Data on morning masticatory muscle pain and sleep variables were obtained from visual analog scales and a second night of polysomnographic recordings. Nineteen normal control (CTRL) subjects were age- and sex-matched to 62 tooth-grinding SBr. Differences in sleep macrostructure (stage distribution and duration, number of sleep-stage shifts), number of rhythmic masticatory muscle activity (RMMA) events÷ hour, and EEG activity were analyzed blind to subject status. The influence of pain and gender in SBr and CTRL subjects was assessed with the Fisher's exact test, Mann-Whitney U test, two-sample t test, and analysis of variance (ANOVA). RESULTS: Low-intensity morning transient orofacial pain was reported by 71% of SBr, with no sex difference. RMMA event frequency was higher in SB than CTRL subjects (4.5÷hour vs 1.3÷hour; P < .001). SBr had fewer sleep-stage shifts, irrespective of sex or pain status. Female SBr had significantly lower theta and alpha EEG activity compared to female CTRL subjects (P = .03), irrespective of pain. CONCLUSION: Female SBr had lower theta and alpha EEG activity irrespective of transient morning pain.

Relevance of animal models to human tardive dyskinesia.

Tardive dyskinesia remains an elusive and significant clinical entity that can possibly be understood via experimentation with animal models. We conducted a literature review on tardive dyskinesia modeling. Subchronic antipsychotic drug exposure is a standard approach to model tardive dyskinesia in rodents. Vacuous chewing movements constitute the most common pattern of expression of purposeless oral movements and represent an impermanent response, with individual and strain susceptibility differences. Transgenic mice are also used to address the contribution of adaptive and maladaptive signals induced during antipsychotic drug exposure. An emphasis on non-human primate modeling is proposed, and past experimental observations reviewed in various monkey species. Rodent and primate models are complementary, but the non-human primate model appears more convincingly similar to the human condition and better suited to address therapeutic issues against tardive dyskinesia.

Contribution of orodental status to the intensity of orofacial tardive dyskinesia: an interdisciplinary and video-based assessment.

BACKGROUND: Tardive dyskinesia (TD) is a neurological motor complication eventually arising in one-third of patients chronically exposed to antipsychotic drugs. Some orodental peripheral factors have been reported to influence TD. OBJECTIVE: To measure orodental factors such as temporomandibular joint function, static occlusal contacts, and denture condition, and attempt correlations with orofacial TD intensity. METHODS: In this exploratory cross-sectional pilot study, 31 subjects between 30 and 75 years of age were divided in two groups displaying minimal to mild, or moderate to severe orofacial TD, respectively, and underwent a detailed oral, dental, and prosthetic evaluation to capture various aspects of oral health compared between the two groups. Blinded video-based TD ratings along a validated scale were obtained to compare dentulous and edentulous subjects, and contrast TD intensity in complete denture wearers with and without their own prostheses. RESULTS: None of the factors examined tightly correlated with orofacial TD intensity. However, edentulism was associated with a higher median orofacial TD rating compared to the dentulous group (p = 0.001). Further, a significant intra-subject difference was observed in the edentulous subjects rated with their own complete dentures in place or not (p = 0.028), the dentures attenuating the mean orofacial ratings by 21.8 ± 7.3%. CONCLUSION: Of all orodental factors considered, only edentulism and complete denture wearing influenced oral TD expression, calling for the close monitoring of the dental status in antipsychotic drug-exposed patients to prevent tooth loss. Further studies to measure the impact of an adequate prosthodontic rehabilitation in edentulous subjects with orofacial TD seem warranted.

Comparing three screening tools for drug-induced parkinsonism in patients with advanced schizophrenia: a pilot study.

BACKGROUND: Drug-induced parkinsonism (DIP) is seen in one third of patients exposed to antipsychotic drugs and may lead to complications related to dysphagia and falls. Aside from skilled neurological examination, no tool has been validated to facilitate detection and follow-up. OBJECTIVE: In this pilot study, three validated screening instruments were tested in an age-biased cohort of schizophrenia patients, including four items of the Liverpool University Neuroleptic Side-Effects Rating Scale (LUNSERS) and two brief questionnaires designed for community survey of parkinsonism. METHOD: Fifty-six subjects living with chronic schizophrenia between 50 and 75 years of age underwent a motor evaluation along the original Unified Parkinson's Disease Rating Scale-section III and answered questions along the selected screening instruments, and results compared to those of 16 patients with Parkinson's disease (PD) and 15 neurologically unimpaired volunteers. Odds ratios, sensitivity, specificity, and their 95% confidence intervals, were calculated. RESULTS: All three screening instruments correctly identified the PD state and distinguished PD from healthy participants. Eighteen (32%) schizophrenic patients displayed objective motor signs of parkinsonism. A single item of the LUNSERS (shakiness) significantly distinguished DIP from DIP-free patients, with a sensitivity of 61.1% and a specificity of 83.3%. The positive predictive value was 63.5% and the negative predictive value was 81.9%. The two other screening methods showed insufficient predictive value. CONCLUSION: Apart from a single query on shakiness, none of the tools examined were adequate to screen for DIP in patients treated for schizophrenia. A different instrument is necessary to monitor this important adverse effect in schizophrenia.