Pilot Study of a New Mandibular Advancement Device

This study was conducted to determine the efficacy of a customized mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). Eight patients (M = 3; F = 5; mean age = 56.3 ± 9.4) with a diagnosis of OSA confirmed by polysomnography (PSG) were recruited on the basis of the following inclusion criteria: apnea-hypopnea index (AHI) > 5, age between 18 and 75 years, body mass index (BMI) < 25, and PSG data available at baseline (T0). All were treated with the new NOA® MAD by OrthoApnea (NOA®) for at least 3 months; PSG with NOA in situ was performed after 3 months of treatment (T1). The following parameters were calculated at T0 and T1: AHI, supine AHI, oxygen desaturation index (ODI), percentage of recording time spent with oxygen saturation <90% (SpO2 < 90%), and mean oxygen desaturation (MeanSpO2%). Data were submitted for statistical analysis. The baseline values were AHI = 21.33 ± 14.79, supine AHI = 35.64 ± 12.80, ODI = 17.51 ± 13.5, SpO2 < 90% = 7.82 ± 17.08, and MeanSpO2% = 93.45 ± 1.86. Four patients had mild OSA (5 > AHI < 15), one moderate OSA (15 > AHI < 30), and three severe OSA (AHI > 30). After treatment with NOA®, statistically significant improvements in AHI (8.6 ± 4.21) and supine AHI (11.21 ± 7.26) were recorded. OrthoApnea NOA® could be an effective alternative in the treatment of OSA: the device improved the PSG parameters assessed

Awareness and attitude among general dentists and orthodontists toward obstructive sleep apnea in children

AimThis study aimed to investigate Italian dentists’ knowledge of and attitudes toward obstructive sleep apnea (OSA) in children.MethodsAn anonymous questionnaire was prepared using Google Forms and sent to dentists in Italy through private social platforms. The first part of the questionnaire contained basic demographic data questions, and the second part included items about pediatric OSA.ResultsA total of 125 responses were collected within 1 month. The interviews revealed gaps in undergraduate and post-graduate training on OSA, and consequently, low self-evaluation of knowledge and self-confidence in managing young patients with OSA. Dentists showed unfavorable attitudes and poor knowledge of the general findings, risk factors, and consequences of pediatric OSA but demonstrated good knowledge of the beneficial effects of rapid maxillary expansion. Orthodontists showed a more favorable attitude and better recognition of the craniofacial features associated with OSA. In addition, a comparison was made between dentists who had graduated more than 5 years ago and new graduates, and differences were found in undergraduate education, which was better for new graduates, and a small number of questions were better answered by experienced dentists.ConclusionThis study showed a lack of knowledge about pediatric OSA and its management among Italian dentists, revealing the need to update the dentistry curriculum and organize educational interventions

The Knowledge of Pediatric Sleep Medicine among Orthodontists in Italy

AIM This study aimed to evaluate knowledge and attitude regarding obstructive sleep apnea (OSA) in children among orthodontists. MATERIALS AND METHODS An anonymous questionnaire was prepared using Google Forms and sent to dentists in Italy via private social platforms. The first part of the questionnaire contained basic demographic data questions, and the second part included items about pediatric OSA. A total of 125 responses were recorded over one month. For this study, we considered only the questionnaires compiled by orthodontists, selected using answer “yes” at the question 5 “have you achieved your orthodontic residency?”. RESULTS AND CONCLUSIONS 40 orthodontists from different regions of North, Center and South Italy, 26 male and 14 female, with a mean age of 48 compiled the questionnaire. The findings reveal the desire for more training about pediatric OSA. About half of the orthodontists surveyed feel that their knowledge is poor and does not enable them to manage young patients with OSA. Gaps are observed in the recognition of some relevant risk factors and conditions associated with OSA and in the awareness of some benefits of orthodontic treatments. Moreover, collaboration in a multidisciplinary team to proper manage OSA is still weak and not recognized by all the physicians. This study shows lack of knowledge about pediatric OSA and its management among orthodontists, revealing the need to update the dentistry curriculum and to organize educational interventions

The Interaction of Craniofacial Morphology and Body Mass Index in Obstructive Sleep Apnea

Abstract: Aim: This study sets out to explore the relationship between craniofacial morphology and obstructive sleep apnea (OSA) severity, assessing the relative contribution of obesity, calculated using BMI. Methods: A sample of 30 adult patients (20 males; 10 females), mean age = 54(±76) years, with a polysomnography-confirmed diagnosis of OSA, i.e., with an apnea-hypopnea index (AHI) of over 5 events/h, was recruited and underwent cephalometric evaluation. Sleep parameters, namely AHI, AHI supine, oxygen desaturation index (ODI), and mean oxygen saturation [Mean SaO2%], were assessed. Correlation analysis between 13 cephalometric features and AHI was performed using a Pearson test. The sample was split into three groups based on AHI score (mild = 10 < AHI < 15; moderate = 15 < AHI < 30; severe = AHI > 30), and ANOVA was performed to compare the means of cephalometric features. In addition, the sample was split into two groups according to BMI (normal weight = BMI < 25; overweight = BMI > 25). Correlation analysis between cephalometric features and AHI was performed for each group using a Pearson test. Results: The average polysomnographic val- ues were AHI = 29.08(±16); AHI supine = 43.45(±21); ODI = 23.98(±21); mean SaO2(%) = 93.12(±2). Posterior facial height (PFH) was significantly lower in the severe OSA group than in patients with moderate OSA (p = 0.05). In the normal-weight group, negative correlations of the PFH and SNA angle with AHI (r = −0.36; r = −0.25, respectively), and positive correlations of the FMA angle and MP-H distance with AHI (r = 0.29; r = 0.20, respectively), were found. In the overweight group, negative correlations of AO-BO distance, SPAS (upper posterior airway space) and PAS (posterior airway space) with AHI (r = −0.30; r = −0.28; r = −0.24, respectively), and positive correlations of AFH (anterior facial height) and the FMA angle with AHI (r = 0.32; r = 0.25, respectively), emerged. Conclusions: PFH seems to be related to the aggravation of OSA. In normal-weight subjects, hard tissue-related factors have a greater impact on OSA severity, whereas in overweight subjects, the impact of fat tissue is greater

The Paediatric Obstructive Sleep Apnea (OSA): A Study on Knowledge and Attitude among Italian Dentists

AIM This study aimed to investigate knowledge and attitude about obstructive sleep apnoea (OSA) in children among Italian dentists. METHODS An anonymous questionnaire was prepared using Google Forms and sent to dentists in Italy via private social platforms. The first part of the questionnaire contained basic demographic data questions, and the second part included items about paediatric OSA. A total of 125 responses were recorded over one month. For this study, we excluded questionnaires compiled by orthodontists using the answer “no” to the question “have you achieved your orthodontic residency?”. RESULTS The general dentists who compiled the questionnaire were in total 85, 35 female e 50 male, with an average age of 46,8 years, from regions of North, Centre and South Italy. About 50% of them reports having never received training about paediatric OSA and about 60% consider their knowledge in that field low. Most of the dentists who participated in this study acknowledge the importance of the multidisciplinary team in the management of OSA in children; despite that, they can’t correctly identify the figures mandatorily involved and the referral to other specialists is infrequent. Moreover, some of the most common risk factors of the disorder remain underestimated and some severe consequence of OSA are not recognized by at least 30% of the interviewed. CONCLUSION This study shows lack of knowledge about paediatric OSA and its management among Italian dentists, revealing the need to update the dentistry curriculum and to organize educational interventions

Obstructive Sleep Apnea Syndrome Analysis Using Stereophotogrammetry: A Sistematic Review

Aim: Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by nocturnal breathing interruptions due to upper airway obstruction. The aim of the review is to verify the existence of any current literature concerning the craniofacial stereophotogrammetric evaluation in order to predict the presence and severity of OSAS. This technology uses a three-dimensional model obtained from multiple frames of the face taken from different angles. Methods: The research was performed on MEDLINE-PUBMED without applying temporal or linguistic restrictions. From 19 studies, 4 were selected. Results: The study of Banabilh et al. 2009 shows how the severity of OSAS depends on the deposition of submandibular fat, neck circumference and body mass index. According to the study of Lin et al. 2018 numerous measurements concerning areas, volumes and anthropometric lines of the head and neck district indicate the presence and severity of the pathology. In the study of Ohmura et al. 2022 it has been demonstrated that mandibular width, length, depth and width-lenght angle are correlated with OSAS severity. In the study of Tyler et al. 2022 emerged that an increasing obtuse angle of facial convexity is found in severe OSAS subject. Conclusions: In this review emerged a correlation between OSAS severity and submandibular fat deposition, neck circumference, body mass index, facial convexity as well as numerous anthropometric parameters from the literature. It should be note the limited amount of scientific material currently available in this regard

Perception of general practitioners towards the role of dentists in obstructive sleep apnea [Percezione dei medici di medicina generale verso il ruolo degli odontoiatri nell’apnea ostruttiva del sonno]

OBJECTIVES The aim of the study was to as-sess the awareness and attitudes of general practitioners (GPs) about the role of dental practitioners in the management of ob-structive sleep apnea (OSAS). MATERIALS AND METHODS Data were collected through Google Forms on a sample of GPs operat-ing in: Piedmont, Lombardy and Emilia-Romagna. Collection was done anonymously without identify-ing data so as to ensure privacy. The questionnaire included three sections: demographic data of physicians, knowledge about OSAS and the role of dentists (14 questions), and knowledge about the existence of the OSAS PDTA (diagnostic therapeutic care plan) and specialized centers in the management of OSAS patients (4 questions). Microsoft Excel was used to eval-uate the results by using descrip-tive statistics, as the different per-centages obtained were analysed by counting the number of marked answers per question against the total sample. Three “categories of knowledge” were then created to classify the per-centages recorded: poor, good and excellent, corresponding to specific ranges of established percentages. RESULTS AND CONCLUSIONS The preparation of the GPs was found to be rather uneven but still good in terms of knowledge on OSAS, while unfortunately on the figure of the dental surgeon, de-spite being rightly recognized as a specialist who can participate in the management of OSAS pa-tients, the knowledge was found to be insufficient, and therefore special courses on the subject were recommended. On mandibular advancement de-vice (MAD), a good general knowledge base was found, but with more specific questions on the success rates of this therapy, inadequate knowledge of the physicians participating in the study emerged. A low number (only 30 percent) of GPs were found to be aware of the exis-tence of the OSAS PDTA, and a marginal role of National Health Service in communicating infor-mation regarding referral centers for the management of OSAS pa-tients. For this reason, it is recommend-ed that, in addition to more train-ing of physicians on these issues, National Health Service should al-so be more involved in the infor-mation process of GPs in their ter-ritories. In any case, it is necessary to con-tinue the study on a larger sample of physicians so that it is more representative of the category of GPs. CLINICAL SIGNIFICANCE From the data analysis, we will thus be able to identify the possi-ble need to improve the training of GPs by raising their awareness of this issue, leading to a more tar-geted and accurate management of patients suffering from OSAS, trying to highlight the possibility of making use of the dentist as a physician who can manage such patients

New protocol of hygiene and motivation in the patient affected by OSAS in therapy with MAD

OBJECTIVES This study aims to evaluate a new oral hygiene protocol and the mandibular advancement device (MAD) in patients with Obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS The study envisaged the recruit-ment of a sample of 40 subjects affected by OSAS and in therapy with MAD. During the first visit with the dental hygienist, the pa-tients informed of the purpose of the study filled in a paper questionnaire relating to oral hygiene habits and MAD. On this occasion, the professional motivated the pa-tients by identifying the V.A.K. (Vi-sual, Auditory, Kineasthetic) learn-ing model of the patients them-selves and issuing them two pro-tocols on the correct home oral hygiene techniques and mainte-nance of the MAD device. The questionnaire was recompiled at three months. RESULTS The answers to the questionnaire made it possible to compare the data regarding oral hygiene and the MAD device at T0 (first visit to the dental hygienist) and at T1 (after 3 months). After months, none of the patients claimed to have ever cleaned the device since the visit; patients who cleaned it twice a day went from 33% to 51%; the percentage of subjects washing the device with a toothbrush and surfactant in-creased to 65%; the majority (n = 33 at visit, n = 37 at follow-up) of patients stated that they kept the device in the appropriate container and the number of subjects who kept the container open increased from 9 to 29. Pa-tients who dried the device after use increased from 13 to 30; the number of patients who rated their home oral hygiene as excel-lent (score of 9 or higher) de-creased from 6 to 1, while the scores just adequate (scores of 5 and 6) doubled from 6 to 12; re-garding the cleaning of the MAD, the scores just sufficient (5 and 6) decreased from 16 to 6; the good scores (7 and 8) increased from 11 to 18, in particular the scores 8 almost tripled (from 4 to 11), the excellent scores in-creased from 9 to 12. CONCLUSIONS The experimental study conduct-ed on forty patients with OSAS confirmed how effective the mo-tivational approach used was. The protocol of home hygiene and the intraoral device has proved to be an excellent tool for implementing oral hygiene, if the patient has been sufficiently stimulated to comply with it. CLINICAL SIGNIFICANCE Demonstrate the importance of the role of the dental hygienist in the correct maintenance of the intraoral device called MAD. © 2023 EDRA SpA. Tutti i diritti riservati