スイミンジ ムコキュウ ショウコウグン ニ タイスル シカ ガイライ デノ チリョウ ケイケン

Obstructive sleep apnea, OSA is a syndrome in which nasal and oral airflow ceases in spite of continued diaphragmatic efforts. This syndrome occurs during sleep and is brought about by a collapse or other obstruction in the upper airway. Because OSA prevents air from entering the lungs, it produces a rapid decrease in circulating blood oxygen levels. If the blood oxygen saturation level drops, the cardiovascular system reacts quickly in an effort to increase blood flow. As a result, OSA patients are frequently hypertensive and often exhibit dangerous cardiac arrhythmias. Other complications include the development of severe daytime sleepiness, loud snoring and disturbed nighttime sleep. Oral appliance, OA is a popular non-surgical method for treatment of sleep apnea. The OA, used in our clinic, consisted of separate lower and upper full coverage acrylic appliances, which were connected with two rod and tube devices. This device advanced the mandible and allow for opening, protrusive and some side-to-side movement, but no retrusive movement. The OA was worn during sleep and supposedly increases airway caliber and decrease airway resistance. This report introduces the clinical know-how of OA treatment for OSA patients

Dental Approach for Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is characterized by intermittent upper airway obstruction during sleep. It causes sleep fragmentation from brief arousal and affects social life by excessive daytime sleepiness. Moreover, OSA is considered a risk factor for cardiovascular complications and type 2 diabetes as associated features. The gold standard treatment for OSA is continuous positive airway pressure during sleep. However, if this treatment is frustrating to the patient or the apnea and hypopnea index is low or mild, alternative treatments for OSA must be found. One possible treatment is an oral appliance (OA) to improve the upper airway configuration. Dental clinicians have attempted to improve this respiratory condition caused by OSA by using OA, and at Tokushima University Hospital, OA therapy has been in use since 1993. Nishigawa et al. introduced a method to fabricate an OA and to investigate the effects of this therapy. In the present article, the method of OA fabrication was modified, and its effects were evaluated. Dental clinicians should have some knowledge about the mechanics of sleep and the management of sleep conditions so that they can cooperate closely with medical physicians. Thus, collaboration between the medical and dental fields can help patients attain healthy sleep

Validity of Rubrics for Team-Based Learning in Dental Hygienist Education in Japan

Purpose: This study aimed to determine the validity of rubrics for team-based learning (TBL) classes in dental hygienist education. Rubrics are learning achievement evaluation criteria that provide a learning support system with high equity, equality and objectivity. In this study, we adopted rubrics for grading students in TBL classes instead of peer evaluation, and evaluated its validity and effectiveness. Methods: Subjects were 25 second-year dental hygienist students in a medical ethics course. Eight classes were held during the semester: two classes with a traditional face-to-face teaching style, and five classes with a TBL style. In the last class, the students wrote a term paper about what they learned in the class and evaluated their learning achievement according to the criteria in a rubric table. During the TBL classes, students were graded using an individual readiness assurance test (IRAT), group readiness assurance test (GRAT), and self-evaluation of their level of contribution to group discussion and preparatory study. The term paper was also scored. Correlations of these scores and the results of the rubric evaluation were analyzed. Results: The rubric scores showed a significant positive correlation with all other scores excepts for the GRAT. Multiple regression analysis using the rubric scores as the criterion variable and the other scores as the explanatory variables showed a significant association between the rubric scores and the other scores. Conclusion: These results indicate the effectiveness of the evaluation points and criteria in the rubric table and the validity of the rubric scores for this course

Masticatory performance alters stress relief effect

Purpose: We evaluated the effects of gum chewing on the response to psychological stress induced by a calculation task and investigated the relationship between this response and masticatory performance. Methods: Nineteen healthy adult volunteers without dental problems undertook the Uchida–Kraepelin (UK) test (30 min of reiterating additions of one-digit numbers). Before and immediately after the test, saliva samples were collected from the sublingual area of the participants. Three min after the UK test, the participants were made to chew flavorless gum for 3 min, and the final saliva samples were collected 10 min after the UK test. The experiment was performed without gum chewing on a different day. Masticatory performance was evaluated using color-changing chewing gum. Results: Salivary CgA levels at immediately and 10 min after the UK test were compared with and without gum chewing condition. Two-way repeated measures analysis of variance revealed significant interaction between gum chewing condition and changes in CgA levels during post 10 min UK test period. A significant correlation was found between changes in CgA levels and masticatory performance in all participants. Conclusion: Our results indicate that gum chewing may relieve stress responses; however, high masticatory performance is required to achieve this effect

Complications causing patients to discontinue using oral appliances for treatment of obstructive sleep apnea

Purpose: Oral appliances (OAs) are commonly used as a noninvasive treatment for obstructive sleep apnea syndrome (OSAS). These devices are worn during sleep and create mandibular anterior traction to enlarge the upper airway. Continuous use of the device is essential for the success of OA therapy, but some patients stop using the OA for various reasons. The purpose of this research was to investigate complications in OA therapy that might prevent continuous use of these devices. Methods: The progress of 90 OSAS patients who visited Tokushima University Hospital and underwent OA therapy was investigated with a mailed questionnaire. All patients had been receiving OA therapy for more than 12 months. Results: Forty patients responded to the questionnaire and of these, 22 were not wearing their OA during sleep. The average period before stopping OA therapy was 9.6 months. Answers from 38 patients who were treated with two-piece Herbst®-type oral appliances were analyzed. The main reasons for stopping OA therapy were: (1) it was bothersome to use; and (2) it did not effectively prevent sleep apnea. Comparison of OA complications between current OA users and nonusers revealed significant differences for the items ‘‘difficulty sleeping’’ and ‘‘stifling feeling’’. OA users recorded better scores for sleep quality than nonusers. Conclusions: The results of this study indicate that patients discontinued OA therapy because the appliance was ‘‘bothersome to use’’ and because it had ‘‘little or no effect’’ rather than because they experienced the typical complications of OA therapy

Recurrent TMJ open lock

Patient: This report describes the case of a 51-year-old male patient who initially presented at age 23 with a habitual intermittent open lock (at > 35 mm) in the left temporomandibular joint (TMJ). The patient was able to manage this affliction through rapid-repetition jaw opening and closing. Tomography of the joint showed no irregular morphology, but intraoral examination revealed an occlusal interference at the mandibular left third molar during leftwards excursion. For this patient, alteration of lateral guidance using a palatal plate attached to the maxillary left canine precluded this intermittent open lock, but at 22 years of age, the open lock recurred and could not be relieved by the patient, who was unable to assume an occlusal position. Because conservative treatment was ineffective, a pumping manipulation technique was applied to reduce the open lock, after which the patient has maintained good jaw function. MRI taken before and after repositioning indicated that abrupt reduction of a displaced articular disk was the cause of the open lock, and that this articular disk was restored to its proper position during the manipulation. Discussion: Most TMJ open locks occur as anterior dislocation, where the mandibular head becomes trapped anterior to the articular eminences, causing excessive opening and difficulty closing. Our clinical findings from this patient indicate that open lock can occur through abrupt reduction of a displaced articular disk, particularly in patients with chronic internal derangement of the TMJ. Conclusion: TMJ open lock can occur following abrupt reduction of a displaced articular disk

Dysphagia Screening Questionnaire : Swallow-10

The Seirei dysphagia screening questionnaire (namely, Seirei dsq) has been used to screen for oropharyngeal dysphagia (OD). Some of the questions in the questionnaire are difficult for people with cognitive decline to answer. We selected 10 items from the Seirei dsq that could be assessed by others, such as care workers (named Swallow-10). This study aims to verify the validity of the scoring method used in Swallow-10. The dataset used in this study was the one used in the development of Seirei dsq : 50 patients with cerebrovascular disease who were diagnosed with OD, 145 patients with cerebrovascular disease who did not have OD, and 170 healthy subjects. Among the answer choices, “A” for severe symptom, “B” for mild symptom and “C” for no symptom were scored with 4, 1 and 0 points respectively. Factor analysis extracted two factors : one related to pharyngeal function and another related to oral function. In addition, the Cronbach’s alpha coefficient was 0.84. ROC analysis indicated that optimal cutoff value was 5 points, with a sensitivity of 90.0% and a specificity of 88.5%. These results suggest that Swallow-10 may be useful as an OD screening tool for subjects with cognitive decline

Allergic contact dermatitis caused by titanium screws and dental implants

Patients: Titanium has been considered to be a non-allergenic material. However, several studies have reported cases of metal allergy caused by titanium-containing materials. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. He exhibited allergic symptoms (eczema) after orthopedic surgery. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. After removal of dental implants, the eczema disappeared completely. Discussion: Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. Most of the usage of titanium is in the form of titanium dioxide. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population. Conclusions: In general, allergic risk of titanium material is smaller than that of other metal materials. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions

Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants

Purpose: Studies have reported cases of metal allergy caused by titanium-containing materials. We wished to clarify the relationship between titanium allergy and dental implants by describing patients who suffered allergic symptoms after they had received such implants. Methods: A total of 270 patients who visited a Dental Metal Allergy Clinic at Tokushima University Hospital from April 2010 to March 2014 were the study cohort. Patch testing with 28 types of metal allergens (including four titanium allergens) was undertaken for patients. Results: A total of 217 patients (80.4 %) exhibited allergy-positive reactions to at least one type of metal allergen. Mercury, palladium, chromium and nickel exhibited a higher prevalence of allergy-positive reactions than other metals. Sixteen patients visited our clinic suffering allergic symptoms after receiving dental implants. Eleven of those patients exhibited allergy-positive reactions for any of the metal allergens, and 4 of these patients had allergy-positive reactions against titanium allergens. The total number of allergy-positive reactions for titanium allergens among all 270 patients was 17 (6.3 %). No patient exhibited a positive reaction only for the titanium allergen. Conclusions: The prevalence of allergy-positive reactions for titanium allergens was lower than for other metal allergens. We suggest examination of pre-implant patients who have a history of hypersensitivity reactions to metals