COVID-19 and dental sleep medicine: risks, precautions and patient guidance.

COVID-19 is the offcial name for the disease caused by SARS-CoV-2, which has become a pandemic, infecting more than 5 million people worldwide. Transmission occurs by inhaling droplets generated when an infected person coughs, sneezes or exhales, or by touching contaminated surfaces and then rubbing their hands over their eyes, nose or mouth. Some infected people become seriously ill, while others have no symptoms, but even though they are asymptomatic, they can still transmit the virus. As vaccines and effective medications do not yet exist, the only way to handle the devastating consequences of the pandemic is prevention. Quality of sleep is essential for the immune system to be prepared to receive, fight and restore itself after a viral infection. Therefore, patients with obstructive sleep apnea (OSA) should continue treatment, and only suspend or change the therapeutic modality under the guidance of a sleep physician. In the era of COVID-19, due to the high probability of contamination promoted by CPAP, the mandibular repositioning device has been considered as the first choice for patients with OSA. However, as the dental approach is at high risk of contamination, due to the proximity of the dental surgeon to the patient, it is essential that the professional who works in this field knows the risks to which they are exposed. Precautions must be adopted and patients should be guided in order to control and use of their intraoral devices.

Cone beam computed tomography in assessment on pharynx effects of orthopedic-surgical treatment - a review of the literature.

The cone beam computed tomography (CBCT) image provides clear differentiation of soft tissues from empty spaces. This paper presents a literature review to evaluate the effects of orthopedic and surgical treatment on the pharyngeal dimension by CBCT. It was concluded that treatments involving dentofacial orthopedics and orthognathic surgery have been related with an increase in the upper airway volume. Standardized capturing of tomographic images and more controlled and randomized studies are necessary.

Effectiveness of Maxillomandibular advancement (MMA) surgery in sleep apnea treatment: Case report.

Obstructive sleep apnea (OSA) is characterized by episodes of pharyngeal collapse during sleep. Craniofacial alterations such as retrognathia are often found in OSA patients. Maxillomandibular advancement (MMA) surgeries increase the pharyngeal space and are a treatment option for OSA. The aim of this study was to present a successful case of MMA surgery in the treatment of OSA. A patient with moderate OSA (apnea-hypopnea index (AHI)=25.2) and mandibular retrognathism and Maxillomandibular asymmetry underwent MMA surgery. The apnea-hypopnea index (AHI) were considerably improved after six months (IAH =6.7) and one year of treatment (IAH=0.2).

Treatment of obstructive sleep apnea with mandibular advancement appliance over prostheses: A case report.

Treatment with a mandibular advancement device (MAD) is recommended for mild obstructive sleep apnea (OSA), primary snoring and as a secondary option for Continuous Positive Airway Pressure, because it has better adherence and acceptance. However, edentulous patients do not have supports to hold the MAD. This study aimed to present a possible to OSA treatment with MAD in over complete upper and partial lower dentures. The patient, a 38-year-old female with mild OSA, was treated with a MAD. The respiratory parameter, such as apnea-hypopnea index, arousal index and oxyhemoglobin saturation was improved after treatment.

Assessment of interobserver concordance in polysomnography scoring of sleep bruxism.

INTRODUCTION: Objective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring. METHODS: Fifty-six PSG tests were scored from individuals with clinical history and polysomnography criteria of SB. In addition to the protocol of conventional whole-night PSG, electrodes were also placed bilaterally on the masseter and temporal muscles. Visual EMG scoring without audio video monitoring was scored by two independent scorers (Dentist 1 and Dentist 2) according the recommendations formulated in the AASM manual (2007). Kendall Tau correlation was used to assess interobserver concordance relative to variables "total duration of events (seconds), "shortest events", "longest events" and index in each phasic, tonic or mixed event. RESULTS: The correlation was positive and significant relative to all the investigated variables, being T>0.54. CONCLUSION: It was found a good inter-examiner concordance rate in SB scoring in absence of audio video monitoring.

Avaliação tomográfica do tratamento síndrome da apneia obstrutiva do sono (SAOS) com aparelho intra-oral: relato de caso / Tomographic evaluation of treatment of obstructive sleep apnea syndrome (OSAS) with oral appliances: case report

A Síndrome da Apneia Obstrutiva do Sono (SAOS) é caracterizada pelos eventos recorrentes que obstruem total ou parcialmente a via aérea superior (VAS) durante o sono, associados aos sinais e aos sintomas.¹ Apesar do padrão ouro do diagnóstico ser o exame de polissonografia (PSG), a história clínica e o exame físico principalmente da via aérea superior são importantes na complementação do diagnóstico. A avaliação da VAS pela Tomografia Computadorizada de Feixe Cônico (TCFC) é um importante exame na investigação tridimensional dos fatores etiológicos anatômicos da SAOS. O objetivo deste trabalho foi relatar o tratamento da SAOS moderada com aparelho intra-oral de avanço mandibular, com ênfase nas alterações anatômicas transitórias da VAS visualizadas por meio da TCFC. O paciente foi tratado com o aparelho BRD (Brazilian Dental Appliance) e teve redução do índice de apneia e hipapneia (IAH) de 17,5 para 0,2 e aumento da saturação da oxiemoglobina (de 84 para 92%) e melhora dos sintomas clínicos. O volume total da VAS aumentou 54,21% e a área mais constrita aumentou 133,37%. Os resultados demostraram que o AIO de avanço mandibular foi eficaz para o tratamento da SAOS moderada e que a utilização da TCFC foi importante para avaliar as modificações anatômicas transitórias causadas pelo uso de AIO, não negligenciando as alterações transversais da VAS, o que não pode ser observado nas radiografias cefalométricas em norma lateral.

Syndrome of Obstructive Sleep Apnea (OSA) is characterized by recurrent events blocking all or part of the upper airway (UA) during sleep, associated with signs and symptoms.2 Although the gold standard of diagnosis is the polysomnography (PSG) clinical history and physical examination, especially of the upper airway are important to complement the diagnosis. The evaluation of VAS for Cone Beam Computed Tomography (CBCT) is an important examination in the investigation of three-dimensional anatomical etiological factors of OSA.3,4,18 The objective of this study was to report the treatment of mild OSA with intra-oral appliances for mandibular advancement with emphasis on anatomical transient VAS viewed by CBCT. The patient was treated with the device BRD (Brazilian Dental Appliance) and had reduced hipapneia and apnea index (AHI) of 17.5 to 0.2 and increased oxyhemoglobin saturation (92% of 84 pair) and improvement of symptoms clinicians. The total volume increased 54.21% of the VAS and the more constricted increased 133.37%. The results showed that the AIO mandibular advancement was effective for the treatment of moderate OSA and that the use of CBCT was important to evaluate the anatomical changes caused by temporary use of AIO, without neglecting the changes of upper airway cross, which cannot be observed in lateral cephalometric radiographs.

Cirurgia ortognática: avanço maxilomandibular para tratamento da síndrome da apnéia obstrutiva do sono (SAOS) / Ortognthathic surgery: maxillomandibular advancement for the treatment of obstructive sleep apnea syndrome (OSAS)

Síndrome da apneia obstrutiva do sono (SAOS) é uma condição altamente prevalente na população mundial, caracterizada por episódios de colapso da faringe durante o sono. A faringe, órgão muscular que se sustenta nos ossos da face e crânio, é dividido em naso, oro e hipofaringe, sendo um tubo que serve aos sistemas respiratório e digestório, participando das funções de respiração, deglutição e fonação. Um estudo epidemiológico recente realizado na cidade de São Paulo constatou que a prevalência da SAOS é de 32,8% da população analisada. Anormalidades anatômicas são frequentes na SAOS, podendo surgir devido a alterações macroscópicas (micrognatia, retrognatia, hipertrofia tonsilar, macroglossia ou depósito de gordura). A cirurgia concomitante de avanço maxilar e mandibular (AMM) além de preservar as relações maxilomandibulares aumentam o espaço faríngeo pela expansão da estrutura esquelética, nos quais os tecidos moles da faringe e língua estão aderidos, resultando na diminuição de colapso da faringe. Segundo recomendações da American Academy of Sleep Medicine (AASM), a cirurgia de AMM está indicada no tratamento de SAOS moderada e grave em pacientes com falta de adesão ou relutantes ao uso do CPAP e em pacientes com falta de adesão ao uso do AIO na SAOS leve e moderada. O objetivo deste trabalho é realizar através de uma revisão descritiva da literatura, a abordagem das cirurgias de avanço maxilomandibular no tratamento da SAOS.

Obstructive sleep apnea symdrome (OSAS) is a highly prevalent condition in the world population characterized by pharyngeal collapse episodes during sleep. Pharynx, a muscle organ sustained in the facial and cranial bones, is divided in Oro-Naso-Hypopharynx, and is a tube that connects to the respiratory and digestive systems, being part of the respiration, deglutition, and phonation functions. A recent epidemiological study carried out in the city of São Paulo concluded that the prevalence of OSAS is 32.8% of the covered population. Anatomical abnormalities are frequent in OSAS and they can arise from macroscopial alterations (micrognathia, retrognathia, tonsillar hypertrophy, macroglossia, or fat deposit). A concomitant maxillomandibular advancement (MMA) surgery not only preserves the maxillomandibular relationship, but also increases the pharyngeal airspace by expanding the skeletal structure to which the pharynx and tongue soft tissues are adhered, resulting in a reduction of the pharyngeal collapse. According to the American Academy of Sleep Medicine (formerly AASM) recommendations, the maxillomandibular advancement (MMA) surgery is indicated for severe OSAS treatment to patients with lack of adherence or reluctant to use CPAP in moderate and severe OSAS, and to patients with lack of adherence to use of IOA in light and moderate OSAS. The purpose of this essay is to make an approach into the maxillomandibular advancement surgeries for OSAS treatment through a descriptive review of the literature.