COST-EFFECTIVENESS OF TREATMENTS FOR MILD-TO-MODERATE OBSTRUCTIVE SLEEP APNEA IN FRANCE.

OBJECTIVES: Untreated obstructive sleep apnea-hypopnea syndrome (OSAHS) is associated with excessive daytime sleepiness, increased risk of cardiovascular (CV) disease, and road traffic accidents (RTAs), which impact survival and health-related quality of life. This study, funded by the French National Authority for Health (HAS), aimed to assess the cost-effectiveness of different treatments (i.e., continuous positive airway pressure [CPAP], dental devices, lifestyle advice, and no treatment) in patients with mild-to-moderate OSAHS in France. METHODS: A Markov model was developed to simulate the progression of two cohorts, stratified by CV risk, over a lifetime horizon. Daytime sleepiness and RTAs were taken into account for all patients while CV events were only considered for patients with high CV risk. RESULTS: For patients with low CV risk, incremental cost-effectiveness ratio (ICER) of dental devices versus no treatment varied between 32,976 EUR (moderate OSAHS) and 45,579 EUR (mild OSAHS) per quality-adjusted life-year (QALY), and CPAP versus dental devices, above 256,000 EUR/QALY. For patients with high CV risk, CPAP was associated with a gain of 0.62 QALY compared with no treatment, resulting in an ICER of 10,128 EUR/QALY. CONCLUSION: The analysis suggests that it is efficient to treat all OSAHS patients with high CV risk with CPAP and that dental devices are more efficient than CPAP for mild-to-moderate OSAHS with low CV risk. However, out-of-pocket costs are currently much higher for dental devices than for CPAP (i.e., 3,326 EUR versus 2,430 EUR) as orthodontic treatment is mainly non-refundable in France.

Does a free-of-charge distribution of boil-and-bite mouthguards to young adult amateur sportsmen affect oral and facial trauma?

The purpose of this retrospective study was to evaluate the compliance effectiveness of free-of-charge distribution of boil-and-bite mouthguards to amateur sportsmen who exercise and play without a formal team, a coach, or regulations. Several infantry units in the Israel Defense Forces distributed maxillary boil-and-bite mouthguards to their recruits. Target companies from these battalions and from similar battalions (comparison group--mouthguards not supplied), were selected. Soldiers were interviewed using a structured questionnaire. Of the 630 male participants, 272 received a mouthguard and 358 served as the comparison group. No differences were found between groups regarding demographic parameters or overall trauma cases. When compliance to a free-of-charge distributed boil-and-bite mouthguard was assessed, 93 (34.2%) participants reported using the mouthguard during sport activities. Compliance was high for martial arts, but low for other sports. Although the number of self-reported sport-related oral/dental trauma cases was similar between mouthguard users and non-users, the users group showed less severe injuries. However, free distribution to young amateur sportsmen does not affect oral and dental trauma unless accompanied by education and motivation.

Randomised feasibility study to compare the use of Therabite® with wooden spatulas to relieve and prevent trismus in patients with cancer of the head and neck.

Our aim was to compare the efficacy of the Therabite® jaw motion rehabilitation system (Atos Medical) with that of wooden spatulas to relieve and prevent trismus in patients who have had radiotherapy for stage three and four oral and oropharyngeal cancer. Secondary aims were to assess the feasibility and the impact of exercise on health-related quality of life (QoL), and the use of health services after treatment. We designed a randomised, open-label, controlled, three-centre feasibility study to compare the effectiveness and cost of the Therabite® and wooden spatulas. We studied compliance with exercises and health-related QoL, assessed cost using three health economics measures, and conducted semistructured interviews with patients. Patients were randomised into two groups: the Therabite® group (n=37) and the wooden spatula group (n=34). All patients had some sense of jaw tightening before the study started. Mean mouth opening after six months increased in both groups, but the difference between the groups was not significant (p=0.39). Completion rates for the three economic measures were good. There was no significant difference between the two groups in frequency of contact with care services or in QoL. Exercises during and after radiotherapy can ameliorate trismus in patients with stage three and four oral and oropharygeal cancers, but differences between groups in efficacy, compliance, QoL, or use of hospital or community health services, were not significant.

Prevalência e conhecimento do uso de protetores bucais personalizados em praticantes de esportes / Prevalence and knowledge of the use of personalized mouth protectors in sports practitioners

Objetivo: descrever a prevalência e os conhecimentos sobre o uso de protetores bucais personalizados (PBP) por atletas e professores. Métodos: estudo transversal descritivo realizado em 2016 no município de Piratini, RS. Os participantes eram atletas e professores de escolas e centros de treinamento. Foram coletados dados socioeconômicos, sobre conhecimentos, práticas, experiências e uso de PBP. Os dados foram analisados de forma descritiva com o programa EpiData Analysis, V2.2.3.187. Resultados: a amostra foi composta por 40 atletas e 7 professores, com idades entre 17 e 45 anos. A prevalência do uso de PBP entre os atletas foi de 32,5% (13) e 55% (22) não tinham conhecimento sobre PBP. Além disso, 77,5% (31) dos atletas e 100% (7) dos professores não saberiam indicar um profissional para confeccioná-los. Conclusão: o conhecimento sobre o uso de PBP é escasso, mas, contudo, há uma parcela de atletas que faz uso para a prática de esportes. Destaca-se a importância da necessidade de se investir em políticas de educação em saúde sobre protetores bucais em escolas, academias e centros de treinamento esportivo.(AU)

Objective: to describe the prevalence and knowledge about the use of personalized mouth protectors (PMP) by athletes and teachers. Methods: cross-sectional descriptive study carried out in 2016 in the Piratini/RS city. Participants were athletes and teachers from school and training centers. Socioeconomic data, knowledge, practices, experiences and use of PMP were collected. Data were analyzed in a descriptive with the EpiData Analysis program V2.2.3.187. Results: the sample consisted of 40 athletes and 7 teachers, aged between 17 and 45 years. The prevalence of PMP use among athletes was 32.5% (13) and 55% (22) were not knowledge of PMP. In addition, 77.5% (31) of the athletes and 100% (7) of the teachers did not know to indicate a professional to make them. Conclusion: the knowledge about the use of PMP is scarce and on the other hand, there is a portion of athletes that makes use for the practice of sports. It is important to emphasize the need to invest in health education policies on mouth protectors in schools, gyms and sports training centers.(AU)

Management of sports-related concussions.

Mild head injury is a frequent occurrence in a multitude of athletic endeavors across all levels of play. Clinicians should carefully consider all interventions at their disposal to reduce the prevalence and severity of injury to protect those involved. The exploration and evaluation of using properly fitted mouthguards to provide effective, albeit limited, defense against brain injury merits attention. The minimal costs of such an intervention when properly applied would no doubt reap numerous benefits in terms of reducing the medical, financial, cognitive, psychological, and social consequences of mild head injury. The cosmetic salvation would be no small side effect to efficacious, properly fitted mouthguard use.

A review of selected microstomia prevention appliances.

Perioral burns may occur due to electrical, thermal, or chemical agents. The resultant contracture of the facial tissue during healing causes limited oral access, compromised esthetics, and other related problems. This article presents various microstomia prevention appliances used by dentists and hospital burn centers. These appliances reflect different treatment concerns, ease of fabrication, age appropriateness, and cost effectiveness. An understanding of these factors and available appliances will aid the clinician in selecting or developing the best appliance for burn patients.

Project mouthguard: join the team to help our young athletes.

Project Mouthguard is a "win-win" situation for everyone involved. The athlete will be getting the best protection available for their dentition while they participate in school sports. The school will be able to prevent injuries, making sports participation safer and the job of the school's athletic trainer easier. Dentists will have an opportunity to do community service and help patients while also marketing their practice. The community will be aware of mouthguards, and those who participate in athletic activities can make more educated decisions on mouthguard use.

The "Buy-Max" mouthguard: oral, peri-oral and cerebral protection for contact sports.

Protective equipment plays an important role in the reduction of certain sports injuries. Mouthguards have been shown to reduce the number of orafacial and cerebral injuries in a variety of contact sports including rugby, hockey and boxing. The varieties of mouthguards available are discussed. The most effective, but also the most expensive, is the "Bimaxillary" mouthguard popularised by Chapman. It covers both dental arches and as the jaws are held in the position of heavy breathing, air flow is not impeded. The advantages and disadvantages of the various types of mouthguard are discussed.

Cost-effective dental protection during rigid endoscopy.

We describe a simple method to create a reusable and customizable dental guard using readily available materials. Our method does not require an extra patient visit and does not add operative time. Furthermore, our guard is rigid, which allows force to be distributed over adjacent teeth, unlike soft mouth guards.

Introduction to four custom-made mouth protectors constructed of single and double layers for activists in contact sports.

Four mouth protectors are introduced, all manufactured by dentists familiar with small-scale technical work. Mouth protectors made of Erkoflex or Erkoloc sheets are moulded in an Erkopress device under a vacuum, while the TranSheet/Perform and TranSheet/LiteLine mouth protectors are constructed of a hard outer shell (Triad TranSheet, light-cured polyurethane dimethacrylate) and a soft inner part against the labial surface of the front teeth (Perform or LiteLine, both light-cured polyurethane dimethacrylate), thus minimizing the impact on individual teeth and better preventing dental traumas. The technical construction of the mouth protectors is illustrated, as is the need for instrumentation and its costs and the materials required to manufacture these mouth protectors.

Attitudes concerning mouthguard use in 7- to 8-year-old children.

The purpose of this study was to determine the acceptance of 3 types of mouthguards 1) stock, 2) boil and bite, and 3) custom-made by 7-8 year old children playing organized soccer. Three teams volunteered to participate and the type of mouthguard was randomly selected for each team. The children were fitted for the mouthguards and after wearing them, a questionnaire was returned to the investigator. Eighty two percent of the children wearing custom made mouthguards and 87% of the boil and bite ranged from happy to enthusiastic about its use. None of the children provided stock mouthguards reported liking their use. Only 1 child in the custom group failed to wear the appliance during practice and games while the children in the stock group ranged from 20% to all of the time. Ninety five percent of the parents believe that children should wear mouthguards when injuries may occur. However, only 24% of the parents would be willing to pay $25.00 for this protection. It is concluded that mouthguards will be used by children during organized sports activities if they fit.