Nasal patency and mandibular movement: clinical application in prosthodontics.

This case report describes a patient with a primary concern of persistent mandibular deviation during speech who experienced clinically significant improvement (mandibular movement without deviation) after improvements to nasal resistance. At the initial consultation, temporary placement of a nasal valve dilator immediately eliminated the patient's mandibular deviation during speech, indicating the need for referral to an otolaryngologist. The patient was also provided with a dental appliance to address secondary concerns of temporomandibular joint noises and cervicofacial pain. Although the dental treatment provided some relief, resolution of the patient's mandibular deviation during speech did not occur until after nasal surgery was completed. This case illustrates the importance and effects of nasal resistance and nasal patency to obtaining a reproducible mandibular position.

Dental Appliance Therapy in the Treatment of Snoring and Obstructive Sleep Apnea.

People who snore have an increased risk of obstructive sleep apnea (OSA). Both of these conditions have a strong association with the potential development of cardiovascular disease. The use of oral appliances for OSA has been found to be equivalent to continuous positive airway pressure (CPAP) at reducing blood pressure in adults, and oral appliance therapy (OAT) has higher compliance than CPAP. Oral appliances give tonus to the muscles of the throat, specifically the velopharynx and oropharynx, via mandibular positioning. Used to treat both snoring and OSA, oral appliances are designed to maintain and/or advance the mandible while the user is in the supine position. An effective oral appliance is titratable, durable, retentive, adjustable, comfortable, and minimally invasive, providing marginal tooth movement and reducing the risk of temporomandibular disorder or joint pain. This article discusses the function and design of and materials used for optimal OAT to treat snoring and OSA.

Nasal airway obstruction and orofacial pain: a multicenter retrospective analysis.

The aim of this study was to investigate the relationship between nasal airway obstruction (NAO) and symptoms of orofacial pain, including temporomandibular joint pathology and primary headaches. This study was a retrospective analysis of consecutive patients seeking care for chronic orofacial pain at 14 North American treatment centers. The standardized evaluation protocol followed for all patients included cone beam computed tomography (CBCT), a comprehensive clinical examination, and a thorough review of the patient's subjective complaints and health history, including pain and sleep pathology. The primary conditions of interest in this study were the following 5 types of NAO: nasal valve compromise (NVC), deviated septum, septal swell body, concha bullosa, and inferior turbinate soft tissue hypertrophy. Descriptive statistics and regression analysis were performed to determine comorbidities between orofacial pain symptoms and NAO observed on CBCT images. The study population consisted of 1393 patients, 253 men (18.2%) and 1140 women (81.8%). The mean age of the patients was 43.3 (SD 18.1) years. NVC was the most prevalent type of NAO found in the study population (n = 1006; 72.2%). NVC showed a statistically significant comorbidity with capsulitis (odds ratio, 3.73) as well as facial and cervical myositis (odds ratio, 6.97). To the author's knowledge, this is first time that these comorbidities have been identified. NAO had a high comorbidity with orofacial pain. Specifically, NVC was a major contributor to NAO. An understanding of the mechanisms of orofacial pain as well as the effects of improper (mouth) breathing, adaptive forward head posture, muscular fatigue, parafunction, and temporomandibular joint pathology will help the clinician to evaluate the role a patient's nose may be playing in orofacial pain.

Comorbidities of chronic facial pain and obstructive sleep apnea.

PURPOSE OF REVIEW: This article explains the high comorbidity of craniofacial pain (chronic face pain, temporomandibular disorders, and primary headaches) with obstructive sleep breathing disorders and obstructive sleep apnea (OSA). It is recommended that physicians treating OSA should be aware of the concurrent chronic pain that affects the quality of sleep, and also dentists treating chronic pain be aware of a sleep breathing origin so that proper reciprocal referrals be made for optimal patient treatment outcome. RECENT FINDINGS: These comorbid relationships are not limited to adults. The most recent literature demonstrates that children diagnosed with primary headaches are highly comorbid with OSA and frequently have chronic facial pain complaints. SUMMARY: It is recommended that patients who seek care for the symptoms of sleep-related breathing disorders (OSA), or patients seeking care for chronic head and face pain be screened with intake forms that include questions of both to insure optimal treatment outcomes for either chief complaint.

Headache and jaw locking comorbidity with daytime sleepiness.

PURPOSE: To investigate the relationship between craniofacial pain symptoms (painful conditions present in the cranium and face, including jaw joint-related pathology and primary headache conditions) and daytime sleepiness, determined by the Epworth sleepiness scale (ESS), to correlate comorbidity as well as potential predictive factors. METHODS: 1,171 patients seeking care for chronic pain and/or sleep-related breathing disorders (SRBDs) at 11 international treatment centers were included in the study. Patients completed the ESS and identified their primary craniofacial pain and sleep pathology symptoms. Descriptive statistics and regression analysis were performed to determine comorbidities between craniofacial pain symptoms and daytime sleepiness, and factors predictive of higher ESS scores. RESULTS: There was high comorbidity of some craniofacial pain symptoms and high ESS scores, including headaches. In addition, for the first time to our knowledge, orthopedic craniofacial dysfunction (i.e., jaw locking) was correlated with, and predictive of, high ESS scores.

The effect of condyle fossa relationships on head posture.

Although it is commonly accepted that there is an interrelationship between the temporomandibular joint (TMJ) and head posture, few, if any, previous studies have quantified this effect. The purpose of this study is to quantify the effect of a change in the condyle fossa relationship of symptomatic temporomandibular joints on head posture. Charts of 51 patients (N=10 men and N=41 women) with symptomatic TMJ pathology were reviewed. The condyle fossa relationships were measured pre- and posttreatment using sagittal corrected hypocycloidal tomography. The amount of slant between the shoulder and external auditory meatus (EAM) was measured in pre- and posttreatment photographs as an indicator of forward head posture; less slant indicates better posture. Subjects ranged in age from 13-74 years (mean=43.1) and had been treated for an average of 5 months. Comparisons with pre-treatment measures showed that after treatment, the amount of retrodiskal space was significantly increased by an average of 1.67 mm on the left side (t=-10.11, p<0.0001) and 1.92 mm on the right (t=-9.62, p<0.0001). Comparisons also showed that after treatment, the amount of slant between the shoulder and EAM decreased by 4.43 inches on average which was also significant (t=13.08, p<0.0001). Improvement in the condyle fossa relationship was related to decreased forward head posture. This suggests that optimizing mandibular condyle position should be considered in the management of forward head posture (adaptive posture).