No abstract

This study, by means of a mail survey, quantified the compliance with and side effects of the use of an oral appliance for more than five years in patients with snoring or obstructive sleep apnea. Methods: A questionnaire was mailed to 544 patients who used an oral appliance for the treatment of snoring or obstructive sleep apnea. Results: Some 46.1% of the patients returned the questionnaire, 37.8% did not, 15% had an invalid address, and 0.9% were deceased. The mean time period between oral appliance insertion and the return date of these surveys was 5.7 ± 3.5 years. Of the returned sample, 64.1% were wearing their oral appliance (users). There was no significant difference in the baseline and posttitration respiratory disturbance index between the returned and not-returned groups or between patients who had stopped wearing the oral appliance (nonusers) and users. Within the users group, 93.7% used the oral appliance more than 4 nights per week, 100% wore it more than half of each night, and 95% were satisfied with the treatment. The most frequent reasons why patients discontinued wear were uncomfortable (44.4%), had little or no effect (33.6%), or switched to nasal continuous positive airway pressure (23.3%). Snoring was satisfactorily controlled in 75.6% of users and in 43.2% of nonusers. Side effects, such as dry mouth and tooth and/or jaw discomfort, were more frequent and more severe in the nonusers (P < .05). With oral appliance usage, both users and nonusers reported an increase in temporomandibular joint symptoms, but there was no difference in the degree of change. Conclusions: Subjects who were compliant with oral appliance therapy reported long periods of use and adequate control of snoring.

Even though few patients were suspected as having SDB, symptoms were related to many cephalometric variables and study model measurements. Since the etiology of SDB is believed to involve multiple factors, such patients may exhibit some risk of developing SDB in the future.

Changes in headache characteristics in obstructive sleep apnea (OSA) patients following oral appliance treatment was investigated for the first time. Thirteen OSA patients with headaches treated with a mandibular advancement device were investigated. Level I polysomnography and Migraine Disability Assessment Questionnaire were completed before and after treatment. Various headache characteristics and concomitant conditions were analyzed. The patient was considered a headache responder when ≥ 30% reduction in headache frequency following treatment. Differences in headache and polysomnographic parameters were compared between headache responder groups. Eight patients (62%) were headache responders. Eleven patients (85%) before and 7 (54%) after treatment reported morning headaches. Significantly more patients had bilateral headache in the responder group before treatment (P = 0.035). The severest headache intensity (P = 0.018) at baseline showed a significant decrease in the headache responder group after treatment. The time spent in N2 (r = − 0.663, P = 0.014), REM sleep (r = 0.704, P = 0.007) and mean oxygen saturation (r = 0.566, P = 0.044) showed a significant correlation with post-treatment average headache intensity. Pre-treatment lower PLM index (r = − 0.632, P = 0.027) and higher mean oxygen saturation levels (r = 0.592, P = 0.043) were significantly correlated with higher post-treatment severest headache intensity. Treatment with an oral appliance is beneficial for many OSA patients with headaches. It should be considered as an alternative treatment in headache patients with mild to moderate OSA.

Microstomia, an abnormally small oral orifice, is a complication of perioral facial burns. In this case, contraction of the circumoral tissues and hypotonia of the musculature is responsible for this microstomia, which can produce aesthetic and functional impairment with eating, swallowing, communication (speech and facial expressions), compromised dental care and maintenance due to limited oral access, social interactions, and psychological well-being. Conservative management involves providing physical resistance to scar contracture, with opposing horizontal and vertical circumoral forces by means of appliances that aim to stretch the commissures and fibrotic muscles. Numerous appliances, either intraoral or extraoral, have been described to prevent or treat microstomia by delivering a static or dynamic stretch horizontally or vertically, with most designed to stretch the mouth horizontally. Finding a comfortable effective way to stretch the mouth vertically has proved to be a challenge. This article describes the fabrication of a dynamic commissural appliance, constructed using acrylic resin and expansion screws, which provide simultaneous horizontal and vertical circumoral forces. This appliance is constructed easily and inexpensively without the need for taking impressions, can be adjusted so that it is almost painlessly inserted, and is progressively activated. It is convenient for use because the patient controls the pressure that is applied by the appliance. Its use in a case is described where the appliance has improved mouth opening and consequently functional outcomes.