Objective adherence to dental device versus positive airway pressure treatment in adults with obstructive sleep apnea.

Although mandibular advancement device (MAD) treatment of adults with obstructive sleep apnea (OSA) is generally less efficacious than positive airway pressure (PAP), the two treatments are associated, with similar clinical outcomes. As a sub-analysis of a randomized trial comparing the effect of MAD versus PAP on blood pressure, this study compared objectively measured adherence to MAD versus PAP treatment in adults with OSA. Adults with OSA (age 54.1 ± 11.2 [standard deviation] years, 71.1% male, apnea-hypopnea index 31.6 ± 22.7 events/h) were randomized to MAD (n = 89) or PAP (n = 91) treatment for 3-6 months. Objective adherence was assessed with a thermal sensor embedded in the MAD and a pressure sensor in the PAP unit. In a per protocol analysis, no difference was observed in average daily hours of use over all days in participants on MAD (n = 35, 4.4 ± 2.9 h) versus PAP (n = 51, 4.7 ± 1.6 h, p = .597) treatment when days with missing adherence data were included as no use. MAD was used on a lower percentage of days (62.5 ± 36.4% versus 79.9 ± 19.8%, p = .047), but with greater average daily hours of use on days used (6.4 ± 1.9 h versus 5.7 ± 1.2 h, p = .013). Average daily hours of use in the first week were associated with long-term adherence to MAD (p < .0001) and PAP (p = .0009) treatment. Similar results were obtained when excluding days with missing adherence data. In conclusion, no significant difference was observed in objectively measured average daily hours of MAD and PAP adherence in adults with OSA, despite differences in the patterns of use. MAD adherence in the first week predicted long-term use.

Pseudomonas aeruginosa outcompetes other bacteria in the manifestation and maintenance of a biofilm in polyvinylchloride tubing as used in dental devices.

In a PVC tube as a model system for dental devices, Pseudomonas aeruginosa outcompetes Staphylococcus aureus and Klebsiella pneumoniae for the biofilm formation. P. aeruginosa has advantage over the other strains due to higher tolerance for low-nutrient situations or direct killing by the production of soluble factors like pyocyanin.

Role of nasal positive end expiratory pressure valve as an alternative treatment for obstructive sleep apnoea in Chinese patients.

BACKGROUND AND OBJECTIVE: As compliance of continuous positive airway pressure (CPAP) for treatment of obstructive sleep apnoea (OSA) is often suboptimal, a less cumbersome treatment is desirable. We explored the clinical usefulness of nasal positive end expiratory pressure (nPEEP) valves. METHODS: Symptomatic OSA patients (apnoea hypopnea index (AHI) >5/h by polysomnography (PSG) or >10/h by type III devices), who declined CPAP, were recruited. A nPEEP valve was attached to each nostril before bed. After successful acclimatization for 1 week, treatment was continued for 4 weeks. The nPEEP valves provided expiratory resistance to build up PEEP. PSG was performed at week 4. RESULTS: Among 196 subjects, 46 (23%) failed acclimatization and 14 (7%) withdrew. Among the 120 patients with a valid PSG, 72 (60%) and 75 (63%) had >50% reduction in mean (standard deviation) overall AHI 26 (16)/h to 18 (18)/h and mean supine AHI 31 (19)/h to 11(16)/h, respectively, P < 0.001. Compared with responders, patients with <50% reduction in AHI had a higher mean overall AHI (30/h vs 23/h, P = 0.03), higher mean supine AHI (35/h vs 26/h, P = 0.04), more severe mean oxygen desaturation nadir (76.7% vs 82.7%, P < 0.01) and longer mean period of desaturation <90% SaO2 (7.7 vs 2.4, P = 0.02). Breathing discomfort and dry mouth were the most common side effects. Compared with a dental device, there was a larger mean reduction in supine AHI using nPEEP (29 (14)/h vs 16 (17)/h). CONCLUSION: nPEEP valves were useful in selected patients with mild or positional-related OSA.

A Novel Design of an Oral Appliance for Monitoring Electromyograms of the Genioglossus Muscle in Obstructive Sleep Apnea Syndrome.

Obstructive sleep apnea (OSA) is a prevalent source of sleep-disordered breathing. OSA is most commonly associated with dysfunctions in the genioglossus (GG) muscle. In this study, we present the first version of a medical device that produces an electromyogram (EMG) of the GG. The prototype is composed of a (custom-made) 3D-printed mouthpiece. Impressions were taken for the lower arch and scanned with a lab scanner to be converted into digital impressions. ExoCad software was used to design the appliance. Fusion 360 software was then used to modify the design and create tubes to house the electrodes in a bilateral configuration to secure excellent and continuous contact with the GG muscle. Silver-silver chloride electrodes were incorporated within the appliance through the created tubes to produce a muscle EMG. In this preliminary prototype, an EMG amplifier was placed outside the mouth, and isolated electric wires were connected to the amplifier input. To test the design, we ran experiments to acquire EMG signals from a group of OSA patients and a control group in wakefulness. The GG EMGs were acquired from the participants for 60 s in a resting state whereby they rested their tongues without performing any movement. Then, the subjects pushed their tongues against the fontal teeth with steady force while keeping the mouth closed (active state). Several features were extracted from the acquired EMGs, and statistical tests were applied to evaluate the significant differences in these features between the two groups. The results showed that the mean power and standard deviation were higher in the control group than in the OSA group (p < 0.01). Regarding the wavelength during the active state, the control group had a significantly longer wavelength than the OSA group (p < 0.01). Meanwhile, the mean frequency was higher in the OSA group (p < 0.01) at rest. These findings support research that showed that impairment in GG activity continues in the daytime and does not only occur during sleep. Future research should focus on developing the device to be more user-friendly and easily used at home during wakefulness and sleep.

Oral Microbiota in Children and Adolescents with Type 1 Diabetes Mellitus: Novel Insights into the Pathogenesis of Dental and Periodontal Disease.

The oral microbiota can be influenced by multiple factors, but only a few studies have focused on the role of glycemic control in determining early alterations of oral microbiota and their association with pathogenesis of both periodontitis and caries. The aim of this study is to evaluate the interplay between bacteria composition, oral hygiene, and glycemic control in a cohort of children with T1D. A total of 89 T1D children were enrolled (62% males, mean age: 12.6 ± 2.2 years). Physical and clinical characteristics, glucometabolic parameters, insulin treatment, and oral hygiene habits data were collected. Microbiological analysis was performed from saliva samples. A high prevalence of cariogenic and periodontopathogens bacteria in our cohort was detected. In particular, in all subjects Actinomyces spp., Aggregatibacter actinomycetemcomitans, Prevotella intermedia, and Lactobacillus spp. were isolated. S. mutans was found in about half of the analyzed sample (49.4%), in particular in patients with imbalance values of glycemic control. Moreover, a higher presence of both S. mutans and Veillonella spp. was detected in subjects with poorer glycemic control, in terms of HbA1c, %TIR and %TAR, even adjusting for age, sex, and hygiene habits as covariates. Virtuous oral hygiene habits, such as frequency of toothbrush changes and professional oral hygiene, negatively correlated with the simultaneous presence of Tannerella forsythia, Treponema denticola, and Porphyromonas gingivalis, red complex bacteria. Our study shows it is crucial to pay attention to glycemic control and regular oral hygiene to prevent the establishment of an oral microbiota predisposing to dental and periodontal pathology in subjects with T1D since childhood.

Comparison of Intaglio Surface Trueness of Interim Dental Crowns Fabricated with SLA 3D Printing, DLP 3D Printing, and Milling Technologies.

This study aimed to evaluate the intaglio surface trueness of interim dental crowns fabricated with three 3-dimensional (3D) printing and milling technologies. Dental crown was designated and assigned as a computer-aided design (CAD) reference model (CRM). Interim dental crowns were fabricated based on CRM using two types of 3D printer technologies (stereolithography apparatus and digital light processing) and one type of milling machine (n = 15 per technology). The fabricated interim dental crowns were obtained via 3D modeling of the intaglio surface using a laboratory scanner and designated as CAD test models (CTMs). The alignment and 3D comparison of CRM and CTM were performed based on the intaglio surface using a 3D inspection software program (Geomagic Control X). Statistical analysis was validated using one-way analysis of variance and Tukey HSD test (α = 0.05). There were significant differences in intaglio surface trueness between the three different fabrication technologies, and high trueness values were observed in the milling group (p < 0.05). In the milling group, there was a significant difference in trueness according to the location of the intaglio surface (p < 0.001). In the manufacturing process of interim dental crowns, 3D printing technologies showed superior and uniform manufacturing accuracy than milling technology.

Sensory trick splint as a multimodal therapy for oromandibular dystonia.

PURPOSE: Many patients with oromandibular dystonia, which is characterized by involuntary masticatory, lower facial, and/or tongue muscle contractions, experience relief of symptoms through sensory tricks such as eating chewing gum or candy. The aim of this study was to identify the factors influencing the effects of splints in patients with oromandibular dystonia. METHODS: Occlusal splints were inserted in 128 patients (89 women, 39 men) with oromandibular dystonia (102 with jaw closing dystonia, 20 with lingual dystonia, 5 with jaw deviation dystonia, 4 with jaw opening dystonia, 3 with lip dystonia, and 2 with jaw protrusion dystonia). Patients who showed improvement with the use of splints and continued to wear them for at least 3 months were defined as responders. In contrast, patients who showed little or no effect and/or were unable to insert splints were defined as non-responders. Differences in demographic and clinical data were statistically compared between responders and non-responders. RESULTS: Ninety-eight patients (76.6%) were responders (subjective improvement: 30.5%). Thirty patients (23.4%) were non-responders (subjective improvement: 7.2%). The responders were significantly older than the non-responders (53.8 years vs 47.0 years; p<0.05). Patients with jaw closing dystonia showed the most favorable results. The proportion of patients with sensory tricks was significantly higher in responders than in non-responders (66.3% vs 26.7%; p<0.05). CONCLUSIONS: The sensory trick splint is especially helpful for patients with jaw closing dystonia. It is useful, although partially effective, as an alternative therapy in patients for whom other therapies have been unsatisfactory.

A study on a dental device for the prevention of mucosal dose enhancement caused by backscatter radiation from dental alloy during external beam radiotherapy.

The changes in dose distribution caused by backscatter radiation from a common commercial dental alloy (Au-Ag-Pd dental alloy; DA) were investigated to identify the optimal material and thicknesses of a dental device (DD) for effective prevention of mucositis. To this end, 1 cm3 of DA was irradiated with a 6-MV X-ray beam (100 MU) in a field size of 10 × 10 cm2 using a Novalis TX linear accelerator. Ethylene vinyl acetate copolymer, polyolefin elastomer, and polyethylene terephthalate (PET) were selected as DD materials. The depth dose along the central axis was determined with respect to the presence/absence of DA and DDs at thicknesses of 1-10 mm using a parallel-plate ionization chamber. The dose in the absence of DDs showed the lowest value at a distance of 5 mm from the DA surface and gradually increased with distance between the measurement point and the DA surface for distances of ≥5 mm. Except for PET, no significant difference between the DA dose curves for the presence and absence of DDs was observed. In the dose curve, PET showed a slightly higher dose for DA with DD than for DA without DD for thicknesses of ≥4 mm. The findings herein suggest that the optimal DD material for preventing local dose enhancement of the mucosa caused by DA backscatter radiation should have a relatively low atomic number and physical density and that optimal DD thickness should be chosen considering backscatter radiation and percentage depth dose.

Effectiveness of Oral Appliances in Obstructive Sleep Apnea with Respiratory Arousals.

STUDY OBJECTIVES: To compare adherence and treatment effects with an oral appliance (OA) in patients with different types of obstructive sleep apnea (OSA): those with mainly respiratory arousals ("arousers"), and those with oxygen desaturations ("desaturaters") at polysomnography (PSG). METHODS: A prospective intervention study on 72 "tired snorers" with "normal" home sleep study (HSS), but later diagnosed as OSA with PSG, who accepted OA treatment. They were offered evaluation with a follow-up PSG and questionnaires, including the Epworth Sleepiness Scale (ESS), general health (GH), satisfaction, and side effects. RESULTS: Sixty-six patients, 33 arousers and 33 desaturaters, were adapted to OA. The 1-year adherence rate was significantly higher among arousers (85%) than desaturaters (55%) (p = 0.034). Thirty-six of 66 patients underwent follow-up PSG; the apnea-hypopnea index was significantly reduced in 22 arousers from a median of 14 to 3 (p < 0.001), and in 14 desaturaters from 18 to 7 (p = 0.002; no significant group difference). ESS and GH showed no significant improvements in either group, although sleepy "arousers" (ESS ≥ 10) significantly improved their ESS. In total, 77% reported side effects, while 63% were still satisfied with the OA treatment. Gender analysis showed a significant dominance of females classified as "arousers" (p = 0.025). CONCLUSIONS: OSA patients with mainly arousals at PSG showed higher adherence to OA treatment, compared to patients with desaturations. Both groups responded similarly to treatment: improved nocturnal respiration, but only a small reduction of symptoms. We suggest that "tired snorers" with "normal HSS" should be offered PSG, and if OSA, also OA treatment.

Sexsomnia and REM- predominant obstructive sleep apnea effectively treated with a mandibular advancement device.

Parasomnias with sexual behavior or sexsomnias are considered a subtype of NREM parasomnias. Obstructive sleep apnea/hypopnea (OSAH) has been described as a known triggering factor for parasomnias including sexsomnia. Nasal continuous positive airway pressure (nCPAP) has been the standard of treatment for OSAH but mandibular advancement devices (MAD) are becoming an important treatment alternative. We present the case of a patient with mild OSAH and sexsomnia who had resolution of both conditions with a MAD. This patient had the added uniqueness of having REM-predominant OSAH.