CPAP compliance can be challenging under ideal conditions. Not surprisingly, the quality of sleep among soldiers can be a shambles during combat deployment. “Research shows that chronic low-level sleep deprivation impairs reasoning, decision-making, and slows reaction time. You don’t want that in a combat-deployed troop.” Beyond the obvious benefits of reduced accidents and convenient placement in a ruck sack, they found that even post traumatic stress disorder (PTSD) may be affected by poor sleep. Even in cases of clearly identified sleep apnea, most troops could not afford to give up pack space for CPAP devices and batteries.
Armed with findings from one of the largest patient populations to date, Army researchers found that adjustable OAs are nearly as effective as CPAP treatment for patients with mild to moderate OSA, and are more effective than fixed oral appliances—particularly in patients with moderate to severe OSA.
The military is interested in the potential of adjustable OAs, also called mandibular advancement devices, as alternatives to CPAP systems since some active duty service members deploy to remote environments where electricity is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service. “Adjustable OAs would eliminate duty assignment limitations associated with CPAP, allowing soldiers to travel to remote areas as needed,” adds Lettieri.
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Treatment of children with increased overjet using functional appliances reduces the probability of needing orthognathic surgery later. The skeletal effect of these appliances appears to result from various phenomena: remodeling and relocation of the glenoid fossa accelerated and enhanced condylar growth and neuromuscular adaptation.
The purpose of this study was to determine the effect of the T4K, a prefabricated functional appliance, on the transverse and anterior-height dimensions of the maxillary and mandibular dental arches. Dimensions before and after treatment were measured on the sample, then, natural growth was subtracted from the treatment effects and compared with twice the error of the method. A clinically sign cant increase of both dimensions was observed in the maxilla and mandible when Class II malocclusion patients were treated with the T4K.
The control group consisted composed of 32 girls and 28 boys. Data from clinical histories of the patients in the treated group were used to determine age at the beginning and at the end of treatment, as well as the duration of treatment. Each patient in the treated group had a matched control from normative data with respect to age, sex and observation period.
To see the results of this study please visit the fowling link:
Orthodontic intervention in the early mixed dentition: A prospective, controlled study on the effects of the eruption guidance appliance
This study was started to investigate the effects of orthodontic treatment in the early mixed dentition with the eruption guidance appliance. Treatment in the early mixed dentition with the eruption guidance appliance is an effective method to restore normal occlusion and eliminate the need for further orthodontic treatment.
The treatment group was derived from the entire 1992 and 1993 age cohorts in Jalasjärvi (population, 9000) and the 1992 age cohort in Kurikka (population, 11,000). All children were screened in the late deciduous dentition, and a full clinical examination was made at the onset of the mixed dentition period of those who were considered to potentially need treatment.
The study started with a total of 315 children. Of them, 33 were treated with other appliances, mainly the quad-helix, and they were excluded from the study sample. In 27 cases, the child or the family refused orthodontic treatment. Treatment with an erup- tion guidance appliance was started in 255 children. During the treatment, 12 children moved to another municipality and could not complete the treatment; their records were excluded from the analysis. Of the remaining 243 children, 167 completed the treatment successfully.
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http://www.myobrace.com/media/pdf/Orthodontic intervention in the early mixed dentition.pdf
A Tanner type stabilization splint, fabricated in the musculoskeletally stable CR position, appears to be an effective and efficient means for the treatment of patients with disc displacement without reduction. The efficacy of this specific splint, fabricated in the musculoskeletally stable CR position, makes it a promising tool to treat TMD patients with disc displacement without reduction.
The objectives for this study is to collect non-controlled, therapy-related observations; in other words, to demonstrate the efficacy of this appliance for the treatment of patients with disc displacement without reduction.
Overall, the study enrolled 55 patients, 5 men, and 50 women, with the clinical diagnosis disc displacement without reduction, 42 with and 13 without limited mouth opening. All patients received a splint in the musculoskeletally stable centric relation (CR) position. Mouth opening, clinical performance, and the timeframe of splint treatment were assessed.
For more information about the stabilization splint and the results of the study please click on the link below:
Mandibular repositioning devices (MRD) have been deployed for the management of mild, moderate and even severe cases of OSA, but there are some concerns regarding unwanted tooth movements, temporo-mandibular joint issues and facial profile changes using that approach. Biomimetic oral appliance therapy (BOAT) differs from conventional MRD therapy as it aims to correct the nasal airway through midfacial redevelopment followed by mandibular correction, which aims to improve the oropharyngeal airway in adults. In this investigation, Dr. Griffin and Singh test the hypothesis that severe OSA can be addressed without primary mandibular advancement using BOAT.
BOAT may be a useful method of managing severe cases of OSA in adults, and may represent an alternative to CPAP and MRD therapy. However, long-term follow up using a larger sample size is needed to reach more definitive conclusions on these initial findings.
To find more information about this study regarding Osturrtucitve Sleep Apnea please click on the link below:
Mouth breathing: Adverse effects on facial growth, health, academics, and behavior- Yosh Jefferson, DMD, MAGD
The vast majority of health care professionals are unaware of the negative impact of upper airway obstruction (mouth breathing) on normal facial growth and physiologic health. Children whose mouth breathing is untreated may develop long, narrow faces, narrow mouths, high palatal vaults, dental malocclusion, gummy smiles, and many other unattractive facial features, such as skeletal Class II or Class III facial profiles.
These children do not sleep well at night due to obstructed airways; this lack of sleep can adversely affect their growth and academic performance. Many of these children are misdiagnosed with attention deficit disorder (ADD) and hyperactivity. It is important for the entire health care community (including general and pediatric dentists) to screen and diagnose for mouth breathing in adults and in children as young as 5 years of age. If mouth breathing is treated early, its negative effect on facial and dental development and the medical and social problems associated with it can be reduced or averted.
Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005
These practice parameters are an update of the previously published recommendations regarding use of oral appliances in the treat- ment of snoring and Obstructive Sleep Apnea (OSA). Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur.
Patients with OSA who are treated with oral appliances should return for follow-up of- fice visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evalu- ate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA. Research to define patient characteristics more clearly for OA acceptance, success, and adherence is needed.
Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate
the health of the oral structures and integrity of the occlusion.
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There is no doubt that Sleep Apnoea exists and is a valid and extremely debilitating condition. The actual statistics on the successful patient compliance with CPAP are difficult to obtain as it is in the interests of the industry to overstate the effectiveness. They ‘fail’ to take into account those machines that have been prescribed, purchased, trialled and then left lying about in a cupboard because the user just cannot tolerate the device. According to our in-house records less than 16% of the people that we see are able to use CPAP effectively.
There are two major factors which trigger the breathing response:
-The pH of the blood, more specifically the movement towards pH7.8 and alkalosis.
-The hypoxic drive to breathe created by reduction of oxygen to the brain.
What appears to be totally ignored, relative to the above, is the fact that both of these mechanisms are controlled and regulated by the levels of CO2 in the body. ANY mechanism that regulates breathing and increases CO2 levels will automatically reduce the incidence of apnoeas using the following well known facts:
- CO2 combines with water to produce Carbonic Acid which is used to buffer the alkaline blood back to the correct pH.
- The return to pH 7.35 then allows the oxy-haemoglobin bond to dissolve and release O2 to the body’s cells.
Thousands of patients have regained normal sleeping patterns, stopped snoring, no longer have sleep apnoea and/or restless leg syndrome or periodic limb movement, by learning this simple way of retraining breathing back to the way it was designed to be.
For more information on Sleep Apnea and Dysfunctional Breathing please visit the following link:
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). OAm are an effective treatment for OSA, not only improving AHI but also a variety of physiologic and behavioral outcomes.
OAm are an effective treatment for OSA, not only improving AHI but also a variety of physiologic and behavioral outcomes. Recent comparative effectiveness trials have shown health outcomes between CPAP and OAm treatments are equivalent, even in severe OSA, despite greater efficacy of CPAP in reducing AHI. This likely reflects greater nightly adherence to OAm compared to CPAP therapy. Recent advances in technologies related to OAm treatment have the potential to further improve their efficacy and effectiveness in clinical practice. Selection of appropriate patients who will respond to OAm treatment is an ongoing barrier to use.
The now commercially available remotely controlled mandibular positioner offers a means to predict response from a single-night mandibular titration study and has shown good positive predictive value in initial testing. The advent of new adherence monitoring technology that can be routinely incorporated into OAm devices to objectively monitor treatment usage represents another advance in OSA treatment, which will be beneficial in practice and research. This will further help clarify the role of OAm in OSA treatment next to CPAP. Establishing best quality devices that are objectively validated in terms of both efficacy and durability in combination with recent advances in patient selection and treatment monitoring, will continue to optimize OAm as an effective and even first-line treatment for OSA.
If you would like more about Oral Appliances please click on the link below:
Current treatments for sleep bruxism include dental nightguards or occlusal splints, which are often provided without upper airway or sleep assessments. In this case report, they used biomimetic oral appliance therapy by redeveloping the maxilla and repositioning the mandible. This particular case report represents a patient who followed all treatment recommendations conscientiously, and her progress and results appear to reflect her pursuit of health. It is thought that preventive therapy cannot effectively cure sleep bruxism but various treatment protocols for its management are available.
This particular case report tracks a patient who followed all treatment recommendations conscientiously, and her progress and results appear to reflect her pursuit of health. However, a major limitation of this case report is the lack of a PSG study to document bruxism and OSA at both the baseline and post-treatment phases. However, psychometric measures, such as an Epworth Sleepiness Scale questionnaire were used to confirm the presence of bruxism, its severity and daytime sleepiness. In addition, the patient admitted to grinding her teeth, had worn holes through her night-guard, and the flattened cusps of her posterior teeth were indicative of sleep bruxism. As a result of biomimetic oral appliance therapy, her upper airway was developed so that mouth breathing was corrected and she could revert back to nasal breathing. This change in function appears to have resolved her chief concern of sleep bruxism. In addition, the nasal mode of breathing allowed her lips to contact gently while at rest.
A multi-disciplinary approach may be appropriate for patients that present to a dental office with issues relating to sleep bruxism. The protocol described in this article may also be applicable to cases of posterior open bite associated with mandibular advancement appliance therapy for the management of OSA. That premise remains as the basis for future studies. We conclude that dentists and orthodontists can help in the recognition and treatment of both sleep bruxism and malocclusion, thereby preventing systemic co-morbidities associated with obstructive sleep apnea.
For more information regarding the case study and sleep bruxism please refer to the following link: