Morphological changes in temporomandibular joint architecture in patients with temporomandibular disorders: systematic review protocol.

OBJECTIVE: The review involves the assessment of morphological variations in the temporomandibular joint (TMJ) and its associated structures in patients with temporomandibular disorder. INTRODUCTION: Temporomandibular disorders (TMD) are debilitating conditions that affect the TMJ complex, surrounding musculature and osseous components. Studies have reported that TMD result from morphological alterations in TMJ. These alterations can be efficiently studied using three-dimensional imaging. This review will summarise the morphological changes in TMJ and associated structures based on studies with three-dimensional imaging in patients with TMD. INCLUSION CRITERIA: The systematic review will include studies with adult subjects with any one symptom of TMD and those studies that assessed TMJ morphology using three-dimensional imaging like CT, cone beam CT, MRI or arthrography. METHODS: Systematic searches for relevant studies will be carried out in multiple databases. Sources will include MEDLINE, Scopus, Dentistry and Oral Sciences Source, Cochrane CENTRAL, CINAHL, Web of Science, ProQuest Dissertation and Thesis and Google Scholar. The databases will be searched from inception to November 2023. Analytical observational studies comprising retrospective and prospective cohort studies, case-control studies and analytical cross-sectional studies will be selected and critical appraisal will be performed. No restrictions will be imposed on the date and country of publication. Joanna Briggs Institute (JBI) guidelines for systematic effectiveness reviews will be followed for data appraisal, extraction and synthesis. The strength of evidence will be graded using the Grading of Recommendations, Assessment, Development and Evaluation method and the summary of findings will be created using GRADEpro software. ETHICS AND DISSEMINATION: Ethical approval is not applicable for this study since this involves analysis of secondary data. Results will be disseminated through peer-reviewed publications and cnference presentations. A comprehensive summary of morphological alterations in TMJ is essential for assessing risk factors, accurate diagnosis, treatment planning and will collectively contribute to enhanced clinical care and overall patient well-being. PROSPERO REGISTRATION NUMBER: The protocol is registered in PROSPERO: CRD42023448882.

Reliability of Friedman Staging System and Modified Mallampati Scoring as clinical assessment methods for Obstructive Sleep Apnea - A cross sectional study.

OBJECTIVE: To assess the utility of oropharyngeal crowding indicators as predictors of Obstructive Sleep Apnea (OSA). METHODS: STOP-BANG Questionnaire was administered to 145 adults. Of the 95 with high OSA risk, 42 underwent polysomnography. Intraoral space was assessed using modified Mallampati (MMP) and Friedman Scoring (FS) System. RESULTS: Twenty-four were found to have OSA by polysomnography. Most with low risk (86%) had only Class I MMP. Whereas Class III and IV were seen in 37.9% and 17.9% patients with high risk (p < .001) and 50% and 20.8% patients with OSA (p < .831), respectively. All with low risk had Stage 1 FS. Stages 3 and 4 were observed in 27.4% and 1.1% in the high-risk group (p < .001) and in 29.2% and 4.2% with OSA (p < .092), respectively. CONCLUSION: In limited settings, either MMP or FS scores along with the STOP-BANG questionnaire can be used to diagnose OSA.

Oral appliance therapy for the management of obstructive sleep apnea in adults: an umbrella review protocol.

OBJECTIVE: The objective of this review is to summarize the evidence on the effectiveness of oral appliance therapy compared with other therapeutic approaches (continuous positive airway pressure, maxillomandibular and upper airway surgeries, behavioral techniques) for the management of obstructive sleep apnea in adults. INTRODUCTION: For primary snoring, mild to moderate obstructive sleep apnea, and patients with a severe condition who are intolerant of continuous positive airway pressure therapy, an oral appliance is the treatment of choice among conservative procedures. The effectiveness of these appliances is largely determined by a variety of parameters, including the severity of sleep apnea (mild, moderate, severe), materials and methods used to fabricate the appliance, and the degree of mandibular protrusion. Thus, it is important to evaluate the effectiveness of oral appliances in the reduction of sleep apnea. INCLUSION CRITERIA: This review will include systematic reviews of quantitative studies reporting on the effectiveness of oral appliances for the treatment of obstructive sleep apnea of any severity, confirmed using polysomnography. The primary outcome will be measured by reduction in the apnea-hypopnea index. METHODS: A search will be conducted of MEDLINE, Cochrane Database of Systematic Reviews, Scopus, Web of Science, CINAHL, Epistemonikos, Embase, ProQuest Dissertations and Theses, and Shodhganga Dissertations and Theses from database inception until the present, with no language restrictions. Google Scholar will be searched manually. Two independent reviewers will screen titles, abstracts, and full-text articles and perform data extraction. Quality assessment will be conducted using the standard JBI critical appraisal tool. Data will be extracted from systematic reviews and a synthesis of the findings will be presented. The certainty will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). REVIEW REGISTRATION: PROSPERO CRD42021258515.

Epidemiological study on prevalent risk factors and craniofacial skeletal patterns in obstructive sleep apnea among South Indian population.

CONTEXT: Obstructive sleep apnea (OSA) is a condition affecting the upper airway among a vast number of people around the world. AIMS: To determine the prevalent risk factors of OSA and its association with craniofacial skeletal pattern. SETTINGS AND DESIGN: Cross-sectional, community-based study. MATERIALS AND METHODS: In the first stage, questionnaire and physical examination were done for 1000 subjects between 20 and 70 years of age. Subjects were categorized as snorers and non-snorers. Snorers were further grouped as high-risk and low-risk snorers. In the second stage, polysomnography (PSG) was done for randomly selected high-risk subjects. Craniofacial skeletal pattern of OSA-diagnosed subjects were compared with non-OSA subjects using lateral cephalograms. STATISTICAL ANALYSIS: Analysis was performed using IBM SPSS 20. Independent sample t-test was used. A P value < 0.05 was considered as statistically significant. RESULTS: The study population represented the following: high-risk snorers: 22.4%, low-risk snorers: 13.9%, and non-snorers: 63.7%. Excessive daytime sleepiness was present in 7.7%. Among high-risk, 80 underwent PSG, and 75 were diagnosed as OSA (94%) and 5 non-OSA subjects. Increased body mass index and neck circumference were statistically significant. Cephalometric evaluation showed difference in maxillomandibular relationship, narrowing of airway space, and inferiorly displaced hyoid. CONCLUSION: OSA is a major public health problem. Obesity is a strong predictor for OSA. Thus, high-risk subjects for sleep apnea could be identified using routine clinical examination, investigations, and anthropometric parameters.