Australian dental journal最新文献

Community water fluoridation is one of the most important public health interventions. Despite reliable systematically revised evidence supporting the associated health and economic benefits, its implementation to expand community water fluoridation is variable in Australia. Our editorial provides commentary on the existing evidence, and the gaps in adopting Cochrane review methods, and calls for more policy-relevant research to ensure community water fluoridation remains a priority for all levels of government and civil society actors.

Defined as an elevated frequency of obstructive respiratory events in sleep, obstructive sleep apnoea (OSA) is driven by a combination of four pathophysiologic mechanisms: elevated upper airway collapsibility, unstable ventilatory control, impaired upper airway dilator muscle responsiveness and decreased arousal threshold. Established therapies such as continuous positive airway pressure (CPAP) and oral appliance therapy (OAT) work chiefly through targeting elevated collapsibility, which affects the majority of OSA patients. However, many patients respond poorly or do not tolerate these 'anatomic' therapies. The emerging field of 'precision sleep medicine' seeks to determine if novel treatment approaches specifically targeting the other, 'non-anatomic' mechanisms will improve treatment efficacy and acceptance. In this review, we consider the concepts underlying each pathophysiologic mechanism, the predisposing factors, and the potential implications for established and future OSA treatments.

Obstructive sleep apnoea (OSA) is a disorder associated with multiple cardiovascular, metabolic and neurocognitive comorbidities which impact the health and quality of life of patients. Dentists trained in dental sleep medicine have a significant role as part of a collaborative multidisciplinary team led by specialist sleep physicians in the overall management of OSA. Based on the recommendations of the medical team and the patient's preference, dentists have a pertinent role in the provision of oral appliance (OA) therapy for OSA. This narrative review provides a practical guide for OA therapy for snoring and OSA.

Sleep bruxism is a masticatory muscle activity that occurs during sleep and presents as rhythmic or non-rhythmic activities commonly seen in healthy individuals but might also represent movement or sleep disorders. Given that the clinical presentations of sleep bruxism are relevant to dentistry, the early detection of sleep bruxism is of particular interest to dentists. However, the gold standard for sleep bruxism diagnosis involves polysomnography with audio-visual recording - a resource intensive and mostly inaccessible diagnostic method. As such, ambulatory devices to detect sleep bruxism have the potential to address the limitations of polysomnography. This review of the literature was carried out up until December 2024 on commercially available ambulatory devices in detecting sleep bruxism. Select ambulatory devices appear promising as a preliminary screening tool for sleep bruxism both in clinical practice and for domestic use.

Objective: This systematic review and meta-analysis study was carried out to compare the effectiveness of occlusal splint (OS) and Botox (BTX) injections in temporomandibular disorders (TMDs).

Material and methods: Irrespective of the starting year, studies were searched for up to 2024 using PubMed, Web of Science, Scopus databases and the Google Scholar search engine. In the study, graded chronic pain scale and maximum mouth opening amount parameters were analysed with Comprehensive Meta-Analysis programme.

Results: Out of 619 studies, only six were included in the meta-analysis. The effect size was 0.293 in favour of BTX in the studies evaluating the maximum mouth-opening (MMO) range. However, the amount of MMO did not show a statistically significant difference between the OS and BTX groups (95% CI - 0.383 to 0.969, P = 0.395, z = -0.850). In the subgroup analyses carried out based on the follow-up periods, it was found that the MMO was statistically significantly higher in the BTX group at the first week and in the OS group at the third month. However, there was no significant difference observed at the first, second, sixth and twelfth month follow-ups (P > 0.05). No significant difference was found between the groups (P > 0.05) in the publications that evaluated the graded chronic pain scale (GCPS), although an effect size of 0.673 was found in favour of OS (95% CI 0.331 to 1.365, P = 0.272, z = -1.098).

Conclusion: BTX injections and OS applications show significant differences in the MMO of individuals in the early period. In contrast, the MMO of individuals and the GCPS show similar findings in the sixth month and longer follow-up.

Failure of upper airway muscles to develop efficient dilating forces plays a key role in the occurrence of obstructive sleep apnoea in given patients. Thus, myofunctional therapy has been developed to improve the activity/efficacy of the upper airway (UA) dilator muscles, reduce its fatigability and improve mechanical performance. Various programmes, differing in the types of daytime exercises to be completed, as well as in their duration and intensity, have been evaluated. Meta-analysis confirmed the efficacy of myofunctional therapy, with mean apnoea hypopnoea index (AHI) scores decreasing from 28.0 ± 16.2/h to 18.6 ± 13.1/h, and lowest oxygen saturation (LSAT) values improving from 83.2% ± 6.1% to 85.1% ± 7.0%. In children, MT and nasal washing may result in little to no difference in AHI. Integrating oropharyngeal exercises with the use of a smartphone application to complete and record exercise performances represents an innovative turn in the development of ambulatory MT programmes. Since adherence to therapy is a weakness in conventional OSA strategies such as CPAP, this approach to MT is promising, as evidenced by a 90% mean adherence to it after 3 months of using a smart application. There is further need to determine the most effective combination of exercise algorithms and identify the target population most likely to benefit from MT in outpatient training programmes.

Background: Chronic periodontitis is one of the most common inflammatory diseases worldwide. Micronutrients play a significant impact on health and periodontal disease progression. However, there is still a lack of conclusive studies confirming the causal association of micronutrients with chronic periodontitis.

Materials and methods: Genome-wide association study pooled data on chronic periodontitis were collected from the FinnGen consortium, and 14 micronutrients (calcium, copper, zinc, potassium, magnesium, selenium, iron, carotenoids, vitamin B6, B12, C, D, E and folate) were obtained from the OpenGWAS and UK Biobank Study. Instrumental variables were screened by strict criteria. Five Mendelian randomization (MR) methods were used. Finally, the robustness of the findings was verified by sensitivity analyses.

Results: We found that vitamin D reduced the risk of chronic periodontitis (OR: 0.605, 95%CI: 0.398-0.921, P = 0.019). However, we had no evidence of a significant association between other micronutrients and chronic periodontitis. Multiple sensitivity analyses confirmed the robustness of the findings. A variety of sensitivity analysis methods confirmed the reliability of the results.

Conclusion: In this study, we found a potential causal relationship between vitamin D and chronic periodontitis by MR analysis, whereas we did not find an association between 13 other micronutrients and chronic periodontitis. This result might provide new ideas for the prevention and treatment of chronic periodontitis to some extent. However, despite the rigorous analytical methods used in this study, this finding needs to be interpreted with caution. Further randomized controlled studies might provide more in-depth references to the findings of this study.

Background: This study aimed to evaluate the current status of dental sleep medicine education across dental schools in Australia and New Zealand and gain further insights into the educational background of dentists who have sat the Australasian Sleep Association Fellow of Dental Sleep Medicine examination in 2023.

Methods: Online surveys were carried out, and descriptive statistics were used to analyse data.

Results: All dental schools responded to the survey. Seventy per cent of the schools included dental sleep medicine as part of their curriculum, with an average total teaching time of 2.6 h. Dentists who sat the Fellow of dental sleep medicine examination spent on average 87 h preparing for the examination. All dental schools included discussion on pathophysiology of obstructive sleep apnoea and oral appliance therapy, but did not adequately discuss advanced sleep medicine topics, clinical aspects in treatment planning or contemporary dental sleep medicine topics, whereas dentists that completed the Fellow of dental sleep medicine examination gained knowledge in all aspects of the field.

Conclusion: Findings from the study reveal that dental schools across Australia and New Zealand are not delivering adequate levels of education in dental sleep medicine, and hence the current dental sleep medicine curriculum needs to be reviewed and improved.