Cranio-The Journal of Craniomandibular & Sleep Practice最新文献

Aim: To assess sleep medicine and obstructive sleep apnea knowledge and management confidence among Greek dentists.

Methods: Postgraduate dental students at the Aristotle University of Thessaloniki completed the Assessment of Sleep Knowledge in Medical Education (ASKME) and the knowledge and attitudes towards obstructive sleep apnea (OSA) questionnaires (OSAKA) via an online survey from May to December 2022.

Results: The response rate was 77.1%, yielding 168 respondents (mean age 30.5 years; 50% female). Master's candidates accounted for 83% (n=140) and PhD candidates for 17% (n=28). The mean ASKME score was 13.9 ± 5.2, with 79.2% answering fewer than 60% of items correctly. The mean OSAKA knowledge score was 10.9 ± 4.2; half scored below 60%. Although all recognized OSA's clinical importance, 70.8% reported low confidence in managing it.

Conclusion: Greek postgraduate dental students exhibit limited sleep medicine knowledge and low OSA management confidence. Incorporating structured sleep medicine education into dental training is essential.

Background: Alternobaric facial palsy (AFP) is a rare peripheral facial nerve palsy resulting from transient neurapraxia when sudden ambient-pressure changes disrupt middle-ear equilibrium. Common precipitants include scuba diving, air travel, and altitude. AFP triggered by routine activities is exceedingly uncommon.

Case report: A healthy 27 year old man developed acute right facial paresis after a prolonged yawn, while in the car. He reported ear fullness, cheek and tongue numbness, and inability to close the right eye, without other neurological sympthoms. Examination revealed a right peripheral facial palsy (House - Brackmann Grade IV), positive Bell's sign, and otherwise normal findings. CT and MRI of the brain and temporal bones showed no lesions. Other causes were ruled-out. Given the abrupt onset, absence of structural pathology, exclusion of other etiologies, AFP was diagnosed.

Management and outcome: Prednisone (50 mg, tapered over 3 weeks), eye care, and close follow-up led to full recovery within three weeks. No recurrence occurred at 3, 6, or 12 months.

Conclusions: This case highlights an atypical AFP trigger - a simple yawn - and underscores the importance of considering alternobaric mechanisms in acute peripheral facial palsy, even in everyday settings.

Objective: The aim of this study was to investigate the impact of rapid maxillary expansion (RME) on sleep bruxism (SB) and respiratory indexes in pediatric patients.

Methods: Twenty-four subjects needing orthodontic treatment and with suspicion of obstructive sleep apnea (OSA) were recruited. Before orthodontics, a clinical and anamnestic evaluation as well as a polygraphic recording was performed. The subjects underwent rapid palatal expansion and, after 6 months, the evaluations were repeated for the participants with an apnea-hypopnea index (AHI) > 1.

Results: Mean AHI was 2.3±1.4 and 2.2±1.2 at T0 and T1, respectively, while sleep bruxism events (SBEs) values were 15.1± 17 and 23.1±14.5. No significant differences between pre and post treatment values could be detected.

Conclusions: At the study population level, no statistically significant differences in the main (i.e., AHI and SBEs) and secondary outcomes with RME treatment were described. Specific phenotypes might be identified with future studies.

Objective: To investigate the prevalence of temporomandibular disorder (TMD) and its association with stress, bruxism, and pain hypervigilance among military personnel in the Amazon region, Brazil.

Material and methods: A cross-sectional study was conducted with 352 active-duty military personnel without health issues. Participants completed the Perceived Stress Scale, Pain Vigilance Awareness Questionnaire, questions on awake and sleep bruxism, and the Diagnostic Criteria for Temporomandibular Disorder (DC/TMD). Logistic regression models were applied, retaining variables with p ≤ .05. Model fit was tested using the Akaike Information Criterion.

Results: TMD symptoms were reported by 53.7% of participants, and 48.0% experienced pain. Significant associations were observed between TMD and longer service duration, awake and sleep bruxism, and higher stress. Women reported more headaches, while men more often experienced jaw-locking.

Conclusion: TMD was highly prevalent and linked to stress, bruxism, and service duration, highlighting the need for interventions to mitigate physical and psychological consequences in military populations.

Objective: This systematic review aimed to evaluate the effectiveness of conservative approaches on otologic signs and symptoms in patients affected by Menière's Disease (MD) and temporomandibular disorders (TMD).

Methods: PubMed, Scopus, and Web of Science were systematically searched to identify studies presenting participants with a diagnosis of MD associated with TMD, conservative approaches as interventions, and modification of the otological signs and symptoms as outcome.

Results: Out of 627 articles assessed for eligibility, two studies were included. Both studies showed a significant reduction of Situational Vertigo Questionnaire after treatment, number of vertigo spells, Functional Level Scale, Dizziness Hearing Inventory, and Tinnitus Handicap Inventory, after occlusal splint therapy. No significant differences were found in terms of pure-tone audiometry average.

Conclusion: Findings of this systematic review suggested that conservative approaches might improve vertigo in patients affected by MD and TMD. However, the low number of included studies makes difficult to draw strong conclusions.

Objective: To assess which improvements and side effects are considered most important by patients with OSA treated with a MAD.

Methods: A specific questionnaire consisting of 20 questions, including 10 questions on improvements and 10 on side effects, was developed and mailed to all subjects (54).

Results: 42 patients, participated in the survey by answering the questionnaire. The results showed that patients placed greater importance on the positive outcomes of treatment, with the most significant being the reduction in snoring and improvement in sleep quality. On the other hand, the side effects of difficulty speaking with the device, tooth mobility, and foreign body sensation were considered important.

Conclusions: The advantages perceived by the patients appear to outweigh the disadvantages, especially the reduction of snoring, increased productivity, and improved social and intellectual life. Most significant side effects are reversible and short-term, while occlusal changes, is not considered important by patients.

Objectives: This study assessed the voice quality in TMD patients compared to healthy individuals using the Dysphonia Severity Index (DSI) and evaluated the correlation between the DSI and TMD severity.

Methods: Patients who had TMD with Fonseca's anamnestic index were subjected to an examination based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). A sample of 35 patients with TMD and 36 healthy subjects were included in the study.

Results: There were significant differences in the DSI score and its components between healthy subjects and TMD patients (p < .001). A significant correlation was found between the DSI scores and TMD severity (Spearman's rho: -0.90, p < .001).

Conclusion: Patients with TMD demonstrated lower DSI scores and lower voice quality compared to healthy subjects.

Objective: This study aimed to assess the effects of aligners on masseter muscle activity by using an electromyographic device in the home environment.

Methods: The study was performed on healthy patients who required orthodontic treatment. Three different 24 h-EMG recording sessions were performed in different conditions: without aligners, with passive aligners, and with active aligners. The non-functional MMA work index (nfMMA-WI) and the non-functional MMA time index (nfMMA-TI) for both awake and sleep hours were assessed. ANOVA test was used to compare the average activity during the three recording conditions.

Results: On average, a total recording time of 204.7 ± 7.9 hours were provided for each patient. For most patients, ANOVA test showed an absence of significant differences between the recording sessions.

Conclusions: The impact of our results is not negligible: clinicians can find remarkable support to the hypothesis that the use of aligners affects the MMA only in a minority of subjects.

Objective: This study aimed to evaluate the relationship between the presence of calcium deposits (CDs) around the dens axis and patients' age, gender, and systemic diseases.

Methods: This retrospective study was carried out by examining CBCT. Basic descriptive statistical analyses and normality tests were performed on all variables. The assumption of normality was checked using the Shapiro-Wilk method. The statistical significance level was accepted as a p-value less than 0.05.

Results: CDs were observed in a total of 99 (21.9%) individuals. The incidence of CDs statistically significantly increased with age (p < .01),while it didn't statistically significantly differ between genders (p = .47). 13% were systemically healthy, while 55% had hypertension. The incidence of CDs was statistically significantly higher in individuals with hypertension.

Conclusions: In the presence of CDs, the patient should be referred to a medical doctor to confirm the diagnosis of CDS and prevent possible complications.

Objective: To assess the association between self-reported symptoms of pediatric OSA and clinical signs in MB children.

Methods: Seventy-three MB children aged 7-14 years answered an interview questionnaire on OSA symptoms in childhood, focusing on chewing, nasal, and sleep disturbances. MB children were checked for changes on the craniofacial, occlusion, TMJ, upper airway, and body posture by a multi-disciplinary team, consisting of medical residents, dental, and psychology postgraduate students. Multiple logistic regression analysis verified the association between clinical signs and self-reported symptoms.

Results: Reported symptoms of chewing disturbance as TMD noise, muscle pain, and morning headache were significantly associated with the presence of lip incompetence and Class II malocclusion. Sleep disturbances as snoring, waking up at night, daytime sleepiness, and sleeping with the mouth open were significantly associated with the presence of hypertrophic tonsils and obstructive Mallampati score.

Conclusion: Symptoms of pediatric OSA were found in mouth-breathing children, which should be carefully investigated in order to prevent OSA in the future.