Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.

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Oral appliance treatment for obstructive sleep apnea: An update

Background Oral appliance (OA) therapy is increasingly prescribed as a non-continuous positive airway pressure treatment modality for sleep-disordered breathing (SDB). Although OA therapy is reported to be efficacious for the treatment of SDB, data on compliance remain limited to self-report. Methods In this 3-month prospective clinical trial, the main outcome was to assess the safety and feasibility of an objective measurement of compliance during OA therapy using an embedded microsensor thermometer with on-chip integrated readout electronics in 51 consecutive patients with an established diagnosis of SDB (AHI 18.0±11.9/h; age 47±10 y; BMI 26.6±4.0 kg/m 2 ; men/women: 31/20). Patients were unaware of the purpose of the study. Results No microsensor-related adverse events were recorded. In addition, no problems were encountered during the readout of the compliance data. Out of 51 microsensors, one had a technical defect and was lost to follow-up. In this study, the overall objective mean rate of OA use was 6.6±1.3 h per day with a regular OA users’ rate of 82% at the 3-month follow-up. Statistical analysis revealed no significant differences between objective and self-reported OA compliance data in this study. Measurement of the objective OA compliance allowed us to calculate the mean disease alleviation (MDA) as the product of objective compliance and therapeutic efficacy. MDA serves as a measure of the overall therapeutic effectiveness, and turned out to be 51.1%. Conclusions The results illustrate the safety and feasibility of objective measurement of OA compliance. The objective measurement of OA compliance allows for calculation of the MDA.

https://thorax.bmj.com/content/thoraxjnl/68/1/91.full.pdf

Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing

Sleep bruxism (SB) is a term covering different motor phenomena with various risk and etiological factors and potentially different clinical relevance, especially as far as its possible protective role against obstructive sleep apnea (OSA) is concerned. The present expert opinion discusses the possible temporal relationships between the two phenomena. Four hypothetical scenarios for a temporal relationship may be identified: (1) the two phenomena are unrelated; (2) the onset of the OSA event precedes the onset of the SB event within a limited time span, with SB having a potential OSA-protective role; (3) the onset of the SB event precedes the onset of the OSA event within a limited time span, with SB having an OSA-inducing effect; and (4) the onset of the OSA and SB event occurs at the same moment. Literature findings on the SB-OSA temporal relationship are inconclusive. The most plausible hypothesis is that the above scenarios are all actually possible and that the relative predominance of one specific sequence of events varies at the individual level. SB activity may be protective against OSA by protruding the mandible and restoring airway patency in those subjects who benefit from mandibular advancement strategies or may even be related to OSA induction, as a consequence of airways’ mucosae swelling resulting from a SB-induced trigeminal cardiac reflex. Clinicians should keep in mind that the SB-OSA relationship is complex and that interindividual differences may explain the possible different SB-OSA relationships, with particular regard to the anatomical site of obstruction.

Theories on possible temporal relationships between sleep bruxism and obstructive sleep apnea events. An expert opinion.

Sleep less and bite more: Sleep disorders associated with occlusal loads during sleep

Background: All disciplines of dentistry require that clinicians assess the articulation of the teeth/prosthesis with respect to simultaneous contacts, bite force and timing.Aims: This article intends to describe the advantages and limitations of the data acquired when using a computerized occlusal analysis as a dynamic occlusal indicator.Methodology: A search of the literature was completed (Medline, PubMed) using the keywords occlusion, occlusal registration, computerized occlusal analysis and T-Scan for dental.Results: According to the evidence available, the computerized occlusal analysis system is the only occlusal indicator that demonstrates the ability to provide quantifiable force and time variance in a real-time window from the initial tooth contact into maximum intercuspation.Conclusion: The reported advantages to accurately indicate occlusal contacts make the computerized occlusal analysis system a better occlusal indicator when compared with other non-digital convention indicator mater...

Computerized occlusal analysis as an alternative occlusal indicator

Purpose: This study compared oral dryness measured using an oral moisture checking device and the modified cotton method. Methods: Oral moisture was measured at the lingual mucosa (LM) and the buccal mucosa (BM) using an oral moisture checking device in 13 healthy adults (HA) and 13 patients with oral dryness (OD). The modified cotton method was performed in the same subjects by placing cottons under and over the tongue for 30 seconds and measuring the weight of the saliva absorbed by the cotton. Differences between groups were examined using the Mann-Whitney U-test. Results: The moisture percentage at the LM in the HA and OD groups was 30.0 ± 0.5 % and 28.6 ± 1.1 %, respectively, while the percentage at the BM was 30.3 ± 0.2 % and 29.6 ± 0.7 %, respectively. The amount of hypoglossal salivary secretion in the HA and OD groups was 0.339 ± 0.172 g and 0.036 ± 0.033 g, respectively, while the amount of salivary secretion on the tongue’ s surface was 0.059 ± 0.023 g and 0.011 ± 0.007 g, respectively. Both oral moisture and the amount of saliva at rest were significantly different between the HA and OD groups (P<0.05). Conclusion: Both the oral moisture checking device and the modified cotton method were useful for measuring oral dryness. An oral moisture level of 30 % or less, less than 0.1 g of saliva collected at the hypoglossus within 30 seconds, or less than 0.02 g of saliva collected from the surface of the tongue within 30 seconds may indicate oral dryness.

/pdf/oral-dryness-examinations-use-of-an-oral-moisture-checking-b4cq8xokqv.pdf

Oral Dryness Examinations : Use of an Oral Moisture Checking Device and a Modified Cotton Method

Study on Mouthguard Material : Thickness, Relationship between the Elongation and the Thickness of Mouthguard Sheet after Vacuum Forming Process

Study on the Elongation and Thickness of Mouthguard Sheets after Vacuum Forming Process : The Influence of the Height of the Working Model

PURPOSE Mouthguards are available to provide protection from stomatognathic injury during sports. The aim of this study was to examine the thickness of each part of mouthguard sheet depending on the thickness of mouthguard sheet material. METHODS Cross stripes (10 x 10 mm) were printed in mouthguard sheets. We measured the thickness of each cross stripe area using a measuring-device (R). Two mouthguard sheet materials were compared. The thickness of the mouthguard sheet materials were 2 and 4 mm. The difference in the thickness of the two mouthguard sheet materials was analyzed by Wilcoxon signed-rank test and t-test. Additionally, the relationship between the elongation and the thickness of the mouthguard sheets was investigated by regression analysis. RESULTS All parts of the sheet mounted on the cast decreased the thickness. The changes of the thickness in each part of mouthguard sheet were similar in both the 2-mm sheets and 4-mm sheets. In addition, the ratio of changes of the thickness in the part of the sheet fitted to the anterior teeth and palate on the 2-mm sheets was greater than that of the 4-mm sheets (p < 0.01). There was no statistically significant difference between the thicknesses of the sheet on the posterior teeth. The relationship between the elongation and the thickness of mouthguard sheet was modeled by quadratic equation. CONCLUSIONS This study suggests that the ratio of changes of the thickness of the part of the sheet fitted to the anterior teeth and palate on the 2-mm sheets was greater than that of the 4-mm sheets. Furthermore the ratio of changes of the thickness of the part of the sheet fitted to the posterior teeth did not differ between the 2-mm and the 4-mm sheets.

Thickness of mouthguard sheet material after vacuum forming process depending on the thickness of mouthguard sheet

The purpose of this study was to verify the cytotoxicity of a temperature data logger (Thermochron iButton, DS1921G; Maxim, Dallas, TX, USA) and to show the clinical use of such loggers in measuring compliance with oral appliances (OA). In the first experimental study (in vitro cytotoxicity test), we used Testskin (Toyobo, Osaka, Japan) to examine the influence on cytotoxicity caused by use of a temperature data logger (Thermochron) in a human dermal tissue model. The cytotoxicity of extracted fluid in which Thermochron was immersed was calculated and only minimal cytotoxic effects were observed. In the second study, six patients with obstructive sleep apnea-hypopnea syndrome were studied to determine compliance with OA use. Thermochron was attached to the surface of the appliance on the buccal side and was used by the patients. After 1 month, the Thermochron was extracted from the OA and analyzed. Two patients used the OA every day, but one patient used it on only 20% of the recording days. No negative results associated with the use of the Thermochron were reported. The results indicated that temperature data loggers are effective for measuring compliance with the use of OAs.

Osami Morita

Papers

Oral Dryness Examinations : Use of an Oral Moisture Checking Device and a Modified Cotton Method

Study on Mouthguard Material : Thickness, Relationship between the Elongation and the Thickness of Mouthguard Sheet after Vacuum Forming Process

Study on the Elongation and Thickness of Mouthguard Sheets after Vacuum Forming Process : The Influence of the Height of the Working Model

Thickness of mouthguard sheet material after vacuum forming process depending on the thickness of mouthguard sheet

Efficacy and safety of temperature data loggers in measuring compliance with the use of oral appliances