Effects of Photobiomodulation in Children with Down Syndrome and Possible Sleep Bruxism: Protocol For A Randomized, Controlled, Blind, Clinical Trial

Abstract

Hypotonia, particularly of the masticatory and oropharyngeal muscles, is 1 of the main characteristics of Down Syndrome (DS), resulting in impaired speech, chewing and swallowing. Moreover, the complete or partial obstruction of the airways during sleep may occur due to hypotonia of the tongue, leading to snoring and sleep disorders, such as obstructive apnea and sleep bruxism. Objective: Analyze salivary levels of dopamine and cortisol and muscle activity before and after treatment with low-level laser therapy administered to acupoints in children with DS. Methods: A randomized, controlled, clinical trial will be conducted. Individuals 4 to 17 years of age with a diagnosis of DS and possible sleep bruxism will be screened at the Integrated Health Clinic of Nove de Julho University. We will evaluate orofacial dysfunction (Nordic Orofacial Test - Screening questionnaire), Masseter muscle activity during sleep will be assessed by BiteStrip and the masticatory muscles will be evaluated by electromyography (BTS TMJOINT) head posture as well as salivary cortisol and dopamine. After the evaluations, the participants will be randomized into 2 groups: Grupo 1 – treatment with low-level laser therapy at a wavelength of 808 nm; Group 2 – sham treatment (simulated laser therapy). Treatment will be conducted twice per week for a total of 12 sessions. The data will be tabulated and treated using GraphPad Prism version 7.0. The Kolmogorov-Smirnov test will be used to determine the normality of the data. Variables that fit the Gaussian curve will be expressed as mean and standard deviation. The ANOVA 2-way will be used for comparisons between the groups, with the significance level set to 5% ( P < .05). ClinicalTrials registration number: NCT04211870.

Sleep Bruxism in Children: Etiology, Diagnosis, and Treatment—A Literature Review

“…Mostafavi et al [35] Oral administration of hydroxyzine A. Ghanizadeh [36] Photobiomodulation M.C.C. Salgueiro et al [37] Orthodontic treatment (rapid palatal expansion) A. Bellerive et al [33] Another therapy proposed for reducing bruxism in children is physiotherapy. The "self-awareness of movement" concept was put forth to improve the organization and coordination of body movements [6].…”

“…In children, acupoint stimulation with laser is recommended because it is painless and requires a shorter exposure time [34]. In addition, photobiomodulation was used in children with Down syndrome in a study by Salgueiro et al which showed that acupuncture point treatment relieved the symptoms of bruxism in these children and reduced the levels of cortisol [37,38].…”

Bruxism in Children and Adolescents with Down Syndrome: A Comprehensive Review

“…A protocol proposal for a randomized, controlled, blind, clinical trial for the treatment of SB in children with DS has been recently published [ 70 ]. Underlying this protocol, there are studies on acupuncture, a technique successfully used for the treatment of bruxism, obtaining a reduction in the activity of the masseter and anterior temporal muscles and an anxiety reduction as well [ 71 ].…”

The Electrical Activity of the Orbicularis Oris Muscle in Children with Down Syndrome—A Preliminary Study

“…Generalized orofacial muscles hypotonia e.g., orbicularis oris, zygomatic, masseter, and temporalis muscles, contributes to poor oral seal, poor suck, weak tongue control, and problems with jaw stability. This may result in impairments to speech, swallowing, and mastication in these individuals [ 5 , 6 ]. Hypotonia, muscle weakness, sluggish motor responses, and sensory changes can reduce their ability to maintain proper muscle balance [ 5 ].…”

“…This may result in impairments to speech, swallowing, and mastication in these individuals [ 5 , 6 ]. Hypotonia, muscle weakness, sluggish motor responses, and sensory changes can reduce their ability to maintain proper muscle balance [ 5 ]. Other general manifestations found in subjects with DS are stunted growth, congenital heart defects, thyroid dysfunction, brachycephaly, upper airway obstruction, respiratory breathing disorders, severely inhibited sagittal development in the midface region, reduced size of maxillary and mandibular bones, breathing through the mouth, risk of aspiration pneumonia, and a weak immune system [ 2 ].…”