Linguistic adaptation and validation of Italian version of OSA-18, a quality of life questionnaire for evaluation of children with obstructive sleep apnea-hypopnea syndrome (OSAS).

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Standardizing Terminology and Assessment for Orofacial Conditions in Juvenile Idiopathic Arthritis : International, Multidisciplinary Consensus-based Recommendations

Objective. To propose multidisciplinary, consensus-based, standardization of operational terminology and method of assessment for temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA). Methods. Using a sequential expert group–defined terminology and methods-of-assessment approach by (1) establishment of task force, (2) item generation, (3) working group consensus, (4) external expert content validity testing, and (5) multidisciplinary group of experts final Delphi survey consensus. Results. Seven standardized operational terms were defined: TMJ arthritis, TMJ involvement, TMJ arthritis management, dentofacial deformity, TMJ deformity, TMJ symptoms, and TMJ dysfunction. Conclusion. Definition of 7 operational standardized terms provides an optimal platform for communication across healthcare providers involved in JIA-TMJ arthritis management.publishersversionPeer reviewe

Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations

Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA

Pediatric patients’ reasons for visiting dentists in all WHO regions

Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact are the four oral healthrelated quality of life (OHRQoL) dimensions (4D) or areas in which oral disorders impact pediatric patients. Using their dentists’ assessment, the study aimed to evaluate whether pediatric dental patients’ oral health concerns ft into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct.Dentists who treat children from 32 countries and all WHO regions were selected from a web-based survey of 1580 international dentists. Dentists were asked if their pediatric patients with current or future oral health concerns ft into the 4D of the Oral Health-Related Quality of Life (OHRQoL) construct. Proportions of all pediatric patients’ oral health problems and prevention needs were computed

The effectiveness of manual therapy applied to craniomandibular structures in temporomandibular disorders: a systematic review

Within physical therapy, manual therapy is known to be effective for managing temporomandibular disorders (TMDs). However, manual therapy is a broad term including different approaches applied to different body regions. This is the first systematic review that aims to evaluate the effectiveness of manual therapy applied specifically to the craniomandibular structures (Cranio-Mandibular Manual Therapy (CMMT)) on pain and maximum mouth opening in people with TMD. This systematic review was developed based on a pre-determined published protocol which was prospectively registered with PROSPERO (CRD42019160213). A search of MEDLINE, Embase, CINAHL, ZETOC, Web of Science, SCOPUS, PEDro, PubMed, Cochrane Library and Best Evidence, EBM reviews-Cochrane Central Register of Controlled Trials, Index to Chiropractic Literature ChiroAccess and Google Scholar databases was conducted from inception until October 2020. Randomised controlled trials comparing the effect of CMMT on pain and maximum mouth opening versus other types of treatment in TMDs were included. Two reviewers independently screened articles for inclusion, extracted data, assessed risk of bias with the revised Cochrane risk of bias tool for randomised trials and evaluated the overall quality of evidence with the Grading of Recommendations, Assessment, Development and Evaluations. A total of 2720 records were screened, of which only 6 (293 participants) satisfied the inclusion criteria. All studies showed some concerns in risk of bias, except for one, which was high risk of bias. The overall quality of evidence was very low for all outcomes because of high heterogeneity and small sample sizes. All studies showed a significant improvement in pain and maximum mouth opening for CMMT from baseline in the mid-term, but only two showed superiority compared to other interventions. Given the high heterogeneity and small sample sizes of the included studies, a quantitative synthesis was not performed. There is the need for future high methodology research investigating different manual therapy techniques applied to different regions and different populations (e.g., chronic versus acute TMD) to determine what is most effective for pain and maximum mouth opening in patients with TMDs

Cross-cultural differences in types and beliefs about treatment in women with temporomandibular disorder pain

ObjectivesWomen with temporomandibular disorder (TMD) pain from three cultures were assessed for type of treatment received and core illness beliefs. MethodsIn a clinical setting, 122 women patients with chronic TMD pain (39 Saudis, 41 Swedes and 42 Italians) were evaluated for patient characteristics, type of practitioner, type of treatment received and beliefs about TMD prior to consultation in TMD specialist centres. Measures included a survey of treatments received and a belief scale regarding contributing, aggravating and treatment-relevant factors related to the pain. All questionnaires were translated from English and culturally adapted. Comparisons among cultural groups were performed using a linear regression model for continuous variables and logistic regression model for dichotomous variables. A P-value<0.05 was considered statistically significant. ResultsThe study found no significant associations between cultures and the type of practitioners consulted previously. Treatments differed among cultures: Swedes most commonly received behavioural therapy, acupuncture and an occlusal appliance; Saudis most commonly received Islamic medicine; and Italians most commonly received an antidepressant. Swedes were significantly more likely than Saudis and Italians to believe that TMD pain treatment should address behavioural factors. ConclusionsAmong Saudi, Italian and Swedish women with chronic TMD pain, culture does not influence the type of practitioner consulted before visiting a TMD specialist or their beliefs about contributing and aggravating factors for their pain. However, treatment types and beliefs concerning mechanisms underlying the pain differed cross-culturally, with local availability or larger cultural beliefs also probably influencing the types of treatments that TMD patients pursue

Treatment of Palatally Displaced Canines Using Miniscrews for Direct or Indirect Anchorage: A Three-Dimensional Prospective Cohort Study on Tooth Movement Speed

Palatally impacted canines are usually challenging to treat in terms of both biomechanics and possible side effects. Different therapeutic approaches have been reported with or without the use of temporary anchorage devices, including the canine-first approach. Two groups of patients with palatally impacted canines were compared, observing their canine movement measured on consecutive CBCTs after three months of treatment. In the control group, impacted canines were treated with direct anchorage on miniscrews, and in the test group with indirect anchorage using a miniscrew-supported transpalatal arch. The primary outcome was the canine movement speed; the secondary outcome was the change in the root length of adjacent teeth. The median monthly apex speed was 1.05 mm in the control group (IR [0.74, 1.64]) and 0.72 mm in the test group (IR [0.27, 1.30]). The median monthly cusp displacement was 1.89 mm in the control group (IR [1.04, 2.84]) and 1.08 mm in the test group (IR [0.81, 1.91]). Approximately 50% of teeth adjacent to an impacted canine underwent a negative root length change of less than 1 mm in the majority of cases, but no significant differences were found in root length changes between groups. No statistically significant differences in the reported speeds were found, and no miniscrew failures were observed in either group

Treatment of Palatally Displaced Canines Using Miniscrews for Direct or Indirect Anchorage: A Three-Dimensional Prospective Cohort Study on Tooth Movement Speed

Palatally impacted canines are usually challenging to treat in terms of both biomechanics and possible side effects. Different therapeutic approaches have been reported with or without the use of temporary anchorage devices, including the canine-first approach. Two groups of patients with palatally impacted canines were compared, observing their canine movement measured on consecutive CBCTs after three months of treatment. In the control group, impacted canines were treated with direct anchorage on miniscrews, and in the test group with indirect anchorage using a miniscrew-supported transpalatal arch. The primary outcome was the canine movement speed; the secondary outcome was the change in the root length of adjacent teeth. The median monthly apex speed was 1.05 mm in the control group (IR [0.74, 1.64]) and 0.72 mm in the test group (IR [0.27, 1.30]). The median monthly cusp displacement was 1.89 mm in the control group (IR [1.04, 2.84]) and 1.08 mm in the test group (IR [0.81, 1.91]). Approximately 50% of teeth adjacent to an impacted canine underwent a negative root length change of less than 1 mm in the majority of cases, but no significant differences were found in root length changes between groups. No statistically significant differences in the reported speeds were found, and no miniscrew failures were observed in either group

Die Anwendung von Protrusionsschienen zur Behandlung des obstruktiven Schlafapnoe-Syndroms bei erwachsenen Patienten The use of oral appliances in the treatment of obstructive sleep apnea syndrome in adult patients

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial closure of the upper airway during sleep leading to sleep fragmentation and oxygen desaturation. This sleep-related breathing disorder is associated with daytime sleepiness, impaired quality of life, poor work performance, neurocognitive decline, increased risk of motor vehicle accidents and, in the long term, an increased risk of cardio-vascular disease and mortality. Nasal continuous positive airway pressure (nCPAP) maintains a positive pressure in the upper airway through a nose mask worn during sleep and is currently the most effective treatment option for OSA patients. Nevertheless, adherence to this therapy is low. The availability of alternative treatment options is therefore of the utmost importance. Mandibular advancement devices (MADs), which hold the mandible forward with the aim of preventing collapse of the upper airway during sleep provide a less invasive, more comfortable, and less costly treatment alternative for patients with mild to moderate OSA who do not tolerate, do not respond to, or are not appropriate candidates for treatment with nCPAP. Forward repositioning of the mandible increases the upper airway volume, widens the lateral dimension of the velopharynx, it stretches tongue muscles counteracting tongue's retrolapse during sleep, and it moves the hyoid bone anteriorly and stabilizes epiglottis and soft palate preventing the posterior rotation of the jaw. The therapy with a mandibular advancement device (MAD) represents a treatment option to obtain this anterior jaw repositioning. In this article, we will review the indications, the efficacy, the role in the clinical practice and the adverse effects of MADs for the management of OSA

Dentoskeletal long-term side effects of mandibular advancement devices in obstructive sleep apnoea patients: a systematic review with meta-regression.

AIMS: To identify in a systematic review with meta-regression the dental and skeletal long-term side effects of mandibular advancement device (MAD) therapy and to evaluate the influence of time. MATERIALS AND METHOD: An electronic search was performed in Medline, Cochrane Database of Systematic Reviews, Google Scholar Beta, ISI Web of Knowledge, Scopus and Lilacs to select randomized controlled trials and cohort studies investigating dental and/or skeletal side effects in adult patients wearing a MAD for obstructive sleep apnoea or snoring treatment for at least two years. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). For each study included and for each dental and/or skeletal parameter, the mean difference and 95 per cent confidence interval was calculated between baseline and follow-up. RESULTS: Twenty studies with a follow-up between 2 and 11 years were included. The side effects identified were a decrease of overjet, overbite and upper incisor inclination, and an increase of lower incisor inclination, ANB and anterior face height. Meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). According to GRADE, the quality of evidence was moderate for all the outcomes except for lower incisor inclination which was low. CONCLUSION: MAD therapy produced both dental and skeletal side effects which are influenced by the duration of therapy. The dental side effects could be clinically relevant, while the clinical importance of skeletal side effects seems to be questionable. Since the side effects are progressive, patients need to be continuously monitored over time