Occlusal splints for treating sleep bruxism (tooth grinding)

BackgroundSleep bruxism is an oral activity characterised by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental.ObjectivesTo evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo or no treatment.Search strategyWe searched the Cochrane Oral Health Group's Trials Register ( to May 2007); the Cochrane Central Register of Controlled Trials ( CENTRAL) ( the Cochrane Library 2007, Issue 1); MEDLINE ( 1966 to May 2007); EMBASE ( 1980 to May 2007); LILACS ( 1982 to May 2007); Biblioteca Brasileira de Odontologia ( 1982 to May 2007); Dissertation, Theses and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.Selection criteriaWe selected randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism.Data collection and analysisData extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. the author of the primary study was contacted when necessary.Main resultsThirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to: palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome ( arousal index) which was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses.Authors'conclusionsThere is not sufficient evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCTs that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of follow up. the study design must be parallel, in order to eliminate the bias provided by studies of crossover type. A standardisation of the outcomes of the treatment of sleep bruxism should be established in the RCTs.Universidade Federal de São Paulo, Dept Med, BR-04039001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, BR-04039001 São Paulo, BrazilWeb of Scienc

Estudo da mastigação e da deglutição em crianças e adolescentes com Sequência de Möbius Study of chewing and swallowing in children and teenagers with Möbius syndrome

OBJETIVOS: Descrever as alterações morfofuncionais nas funções de mastigação e deglutição, reconhecer as consistências alimentares mais bem aceitas e avaliar a presença de manobras compensatórias durante a deglutição em crianças com Sequência de Möbius. MÉTODOS: A casuística consistiu de oito crianças, sendo três do sexo feminino e cinco do sexo masculino, na faixa etária de cinco a 15 anos, diagnosticadas com Sequência de Möbius. As crianças foram avaliadas em situação de alimentação, nas quais foram oferecidos alimentos de consistência líquida, pastosa e sólida. Os dados coletados foram registrados em protocolo de avaliação adaptado por Guedes, Shintani e Cabello (2003). RESULTADOS: Os resultados obtidos demonstraram significância entre a condição de mobilidade de língua e o tipo de mastigação. As variáveis velocidade de mastigação e contração do masseter, também se mostraram dependentes (p=0,018), uma vez que não houve alteração da velocidade da mastigação quando a contração do masseter estava presente. O pão de queijo mostrou-se como a melhor consistência sólida, pois produziu um bolo mais coeso e menos espalhado na cavidade oral. CONCLUSÕES: As alterações morfofuncionais presentes nos pacientes com Sequência de Möbius contribuíram para a alteração da dinâmica da mastigação e deglutição. Toda a amostra fez uso de manobras compensatórias e, mesmo com a ausência dos sinais clínicos sugestivos de penetração/aspiração, estes pacientes devem ser submetidos à terapia fonoaudiológica, a fim de adequar os órgãos fonoarticulatórios na tentativa de proporcionar uma refeição mais prazerosa.<br>PURPOSE: To describe morphofunctional alterations in the functions of chewing and deglutition, to recognize the most accepted food consistency, and to evaluate the presence of compensatory maneuvers during deglutition, in children and adolescents with Möbius syndrome. METHODS: The subjects were eight children (three female and five male), with ages ranging from five to 15 years, diagnosed with Möbius syndrome. The children were evaluated during a feeding situation, where they were offered food with different consistencies: liquid, pasty and solid. Data were registered in an evaluation protocol adapted by Guedes, Shintani and Cabello (2003). RESULTS: Results showed a significant relation between tongue mobility condition and type of mastication. The variables speed of mastication and contraction of the masseter muscle were also dependents (p=0018), since there was no change in the speed of mastication when the contraction of the masseter was present. The cheese bread was the best solid consistency food for evaluation, because it produced a more cohesive and less widespread mass in the oral cavity. CONCLUSIONS: The morphofunctional alterations found in patients with Möbius syndrome contributed to change the dynamics of chewing and swallowing. All subjects in the sample used compensatory maneuvers. Therefore, even in the absence of clinical signs that suggest penetration/aspiration, patients with such diagnosis should be referred to speech therapy, in order to provide adequate conditions for a more pleasant meal

Práticas baseadas em evidências publicadas no Brasil: identificação e análise de suas vertentes e abordagens metodológicas

Revisão integrativa de estudos brasileiros sobre práticas baseadas em evidências (PBE) em saúde, publicados em periódicos ISI/JCR, nos últimos 10 anos. O objetivo foi identificar as especialidades que mais realizaram estes estudos, seus enfoques e abordagens metodológicas. A partir de critérios de inclusão, foram selecionados 144 trabalhos. Os resultados indicam que a maior quantidade de estudos feitos em PBE foram sobre infância e adolescência, infectologia, psiquiatria/saúde mental e cirurgia. Os enfoques predominantes foram prevenção, tratamento/reabilitação, diagnóstico e avaliação. As metodologias mais empregadas foram revisão sistemática sem ou com metanálise, revisão de protocolos ou síntese de estudos de evidências já disponíveis, e revisão integrativa. Constata-se forte expansão multiprofissional da PBE no Brasil, contribuindo para a busca de práticas mais criteriosas pela reunião, reconhecimento e análise crítica dos conhecimentos produzidos. O estudo contribui também para a própria análise dos modos de fazer pesquisa e novas possibilidades de investigação