The correlation between craniofacial morphology and sleep-disordered breathing in children in an undergraduate orthodontic clinic.

PURPOSE: The aim of this study was to assess children in an orthodontic teaching clinic to determine the relationship between sleep-disordered breathing (SDB) symptoms and craniofacial morphology. METHODS: All parents were asked to complete a SDB questionnaire at the commencement of orthodontic therapy. A cephalometric analysis included face heights, hyoid position, soft palate lengths, mandibular, vertical airway, overjet, and overbite. Study model measurements included dental width, depth, and palatal height. The subjects were divided into two groups according to their dentition stage: early or late mixed. RESULTS: Data from 173 children (male 50.3%, mean age 10.1 ± 1.7 years) that completed the OSA-18 questionnaire and the cephalometric (CA) and model (MA) analyses were evaluated. The questionnaire suggested that only two children in the orthodontic pool had an increased chance of exhibiting SDB. However, loud snoring, mouth breathing, and difficulty awakening were reported in more than 20% of the children. Overall, a higher total score correlated with retroclined upper incisors (CA) and high palatal height (MA, p < 0.05). Although there was no significant score differences between the groups, a higher total score correlated with a long soft palate (CA, p < 0.05) in the early mixed dentition group and a high palatal height (MA) in the late mixed dentition group (p < 0.05). CONCLUSION: Even though few patients were suspected as having SDB, symptoms were related to many cephalometric variables and study model measurements. Since the etiology of SDB is believed to involve multiple factors, such patients may exhibit some risk of developing SDB in the future.

Changes in headache characteristics with oral appliance treatment for obstructive sleep apnea.

Changes in headache characteristics in obstructive sleep apnea (OSA) patients following oral appliance treatment was investigated for the first time. Thirteen OSA patients with headaches treated with a mandibular advancement device were investigated. Level I polysomnography and Migraine Disability Assessment Questionnaire were completed before and after treatment. Various headache characteristics and concomitant conditions were analyzed. The patient was considered a headache responder when ≥ 30% reduction in headache frequency following treatment. Differences in headache and polysomnographic parameters were compared between headache responder groups. Eight patients (62%) were headache responders. Eleven patients (85%) before and 7 (54%) after treatment reported morning headaches. Significantly more patients had bilateral headache in the responder group before treatment (P = 0.035). The severest headache intensity (P = 0.018) at baseline showed a significant decrease in the headache responder group after treatment. The time spent in N2 (r = - 0.663, P = 0.014), REM sleep (r = 0.704, P = 0.007) and mean oxygen saturation (r = 0.566, P = 0.044) showed a significant correlation with post-treatment average headache intensity. Pre-treatment lower PLM index (r = - 0.632, P = 0.027) and higher mean oxygen saturation levels (r = 0.592, P = 0.043) were significantly correlated with higher post-treatment severest headache intensity. Treatment with an oral appliance is beneficial for many OSA patients with headaches. It should be considered as an alternative treatment in headache patients with mild to moderate OSA.

Postburn Microstomia Prevention Using an Appliance Providing Simultaneous Horizontal and Vertical Adjustable Forces.

Microstomia, an abnormally small oral orifice, is a complication of perioral facial burns. In this case, contraction of the circumoral tissues and hypotonia of the musculature is responsible for this microstomia, which can produce aesthetic and functional impairment with eating, swallowing, communication (speech and facial expressions), compromised dental care and maintenance due to limited oral access, social interactions, and psychological well-being. Conservative management involves providing physical resistance to scar contracture, with opposing horizontal and vertical circumoral forces by means of appliances that aim to stretch the commissures and fibrotic muscles. Numerous appliances, either intraoral or extraoral, have been described to prevent or treat microstomia by delivering a static or dynamic stretch horizontally or vertically, with most designed to stretch the mouth horizontally. Finding a comfortable effective way to stretch the mouth vertically has proved to be a challenge. This article describes the fabrication of a dynamic commissural appliance, constructed using acrylic resin and expansion screws, which provide simultaneous horizontal and vertical circumoral forces. This appliance is constructed easily and inexpensively without the need for taking impressions, can be adjusted so that it is almost painlessly inserted, and is progressively activated. It is convenient for use because the patient controls the pressure that is applied by the appliance. Its use in a case is described where the appliance has improved mouth opening and consequently functional outcomes.

Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis.

INTRODUCTION: Side effects observed in the occlusion and dental arches of patients using an oral appliance (OA) to treat snoring or sleep apnea for more than 5 years have not yet been investigated. METHODS: Stone casts trimmed in centric occlusion before appliance placement and after an average of 7.4 +/- 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists. RESULTS: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class II Division 1 and Class II Division 2 malocclusions were more likely to have favorable or no changes. More favorable changes in overbite occurred in subjects with large baseline overbites. A greater baseline overjet and more distal mandibular canine relationship were correlated to favorable changes. A greater initial overjet was correlated to a more favorable change, a decrease in mandibular crowding, a smaller change in anterior crossbite, and a greater change in overjet. CONCLUSIONS: OA wear after a mean of 7.4 years induces clinically relevant changes in the dental arch and the occlusion.

Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome.

STUDY OBJECTIVE: This study, by means of a mail survey, quantified the compliance with and side effects of the use of an oral appliance for more than five years in patients with snoring or obstructive sleep apnea. METHODS: A questionnaire was mailed to 544 patients who used an oral appliance for the treatment of snoring or obstructive sleep apnea. RESULTS: Some 46.1% of the patients returned the questionnaire, 37.8% did not, 15% had an invalid address, and 0.9% were deceased. The mean time period between oral appliance insertion and the return date of these surveys was 5.7 +/- 3.5 years. Of the returned sample, 64.1% were wearing their oral appliance (users). There was no significant difference in the baseline and post-titration respiratory disturbance index between the returned and not-returned groups or between patients who had stopped wearing the oral appliance (nonusers) and users. Within the users group, 93.7% used the oral appliance more than 4 nights per week, 100% wore it more than half of each night, and 95% were satisfied with the treatment. The most frequent reasons why patients discontinued wear were uncomfortable (44.4%), had little or no effect (33.6%), or switched to nasal continuous positive airway pressure (23.3%). Snoring was satisfactorily controlled in 75.6% of users and in 43.2% of nonusers. Side effects, such as dry mouth and tooth and/or jaw discomfort, were more frequent and more severe in the nonusers (P < .05). With oral appliance usage, both users and nonusers reported an increase in temporomandibular joint symptoms, but there was no difference in the degree of change. CONCLUSIONS: Subjects who were compliant with oral appliance therapy reported long periods of use and adequate control of snoring.