Difference in dental arch size between obese and non-obese patients with obstructive sleep apnoea

Summary A large tongue is recognised as a factor that increases the collapsibility of the upper airway in obstructive sleep apnoea (OSA) patients. We hypothesised that the propensity to develop severe OSA could be minimised if the dental arches were enlarged in obese OSA people who are thought to have a large tongue. We therefore compared the size of the dental arches in obese and non‐obese OSA patients. Using a lateral cephalogram and study models, we compared the sizes of the tongue and dental arches in 23 obese and 23 non‐obese Japanese male OSA patients, who were matched for age, apnoea hypopnea index (AHI) and maxillomandibular size. The median age (years) and AHI (events per hour) for the obese and non‐obese groups were 36·5 and 39·0, and 13·4 and 14·3, respectively. The maxillomandibular size was matched with regard to SNA, SNB and lower face cage obtained from cephalometric measurements. The parameters that were measured for the study model included dental arch width, dental arch length, overjet and overbite. Tongue size (P < 0·05) and both upper (P < 0·01) and lower (P < 0·05) dental arch widths were significantly larger in obese than in non‐obese OSA patients, and there was no difference in the severity of OSA between the two groups. These findings suggest that the tongue was larger and dental arches were enlarged in obese patients compared with non‐obese patients under the same disease severity. Wider dental arches in obese OSA patients may help to offset the impact of the enlarged tongue on upper airway patency.     

The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta‐analysis of randomised controlled trials

Oral appliances (OAs) have demonstrated efficacy in treating obstructive sleep apnea (OSA), but many different OA devices are available. The Japanese Academy of Dental Sleep Medicine supported the use of OAs that advanced the mandible forward and limited mouth opening and suggested an evaluation of their effects in comparison with untreated or CPAP. A systematic search was undertaken in 16 April 2012. The outcome measures of interest were as follows: Apnea Hypopnea Index (AHI), lowest SpO₂, arousal index, Epworth Sleepiness Scale (ESS), the SF‐36 Health Survey. We performed this meta‐analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Five studies remained eligible after applying the exclusion criteria. Comparing OA and control appliance, OA significantly reduced the weighted mean difference (WMD) in both AHI and the arousal index (favouring OA, AHI: ?7·05 events h^?1; 95% CI, ?12·07 to ?2·03; P = 0·006, arousal index: ?6·95 events h^?1; 95% CI, ?11·75 to ?2·15; P = 0·005). OAs were significantly less effective at reducing the WMD in AHI and improving lowest SpO₂ and SF‐36 than CPAP, (favouring OA, AHI: 6·11 events h^?1; 95% CI, 3·24 to 8·98; P = 0·0001, lowest SpO₂: ?2·52%; 95% CI, ?4·81 to ?0·23; P = 0·03, SF‐36: ?1·80; 95% CI, ?3·17 to ?042; P = 0·01). Apnea Hypopnea Index and arousal index were significantly improved by OA relative to the untreated disease. Apnea Hypopnea Index, lowest SpO₂ and SF‐36 were significantly better with CPAP than with OA. The results of this study suggested that OAs improve OSA compared with untreated. CPAP appears to be more effective in improving OSA than OAs.     

Differences in biomechanical features of tongue pressure production between articulation and swallow

Summary The purpose of this study was to compare the tongue pressure against the hard palate during the articulation of a monosyllable with that during swallowing. The participants were 20 healthy adults without swallowing or articulation disorder (10 men and 10 women, mean age ± standard deviation: 22·5 ± 0·9 years). Tongue pressure during articulation of [ki] (articulatory pressure) and during dry swallowing (swallowing pressure) was recorded by a 0·1‐mm‐thick sensor sheet with five measuring points attached to the hard palate. Biomechanical parameters such as maximal magnitude, duration, integrated value and slope gradient were compared between articulatory pressure and swallowing pressure at each measuring point. Although swallowing pressure was produced at each measuring point, articulatory pressure was found only in the posterior circumferential parts of the hard palate and was smaller in magnitude (14·9–16·7% of swallowing pressure) and integrated value, which meant the amount of work by tongue pressing (7·0–7·9%), shorter in duration (26·6–31·8%) and shallower in slope gradient, which meant the speed of tongue pressing (26·9–27·4%). Maximal magnitude was closely correlated with duration (R² = 0·386) and slope gradient (R² = 0·843) for articulatory pressure. These results first show the biomechanical differences between articulation and swallowing in terms of tongue contact with the hard palate. The findings suggest that tongue pressure measurement might be a useful investigation for patients with tongue motor disorder.     

Efficacy of low‐level laser therapy in the treatment of TMDs: a meta‐analysis of 14 randomised controlled trials

This study was designed to evaluate the efficacy of low‐level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMDs). We searched electronic databases and references lists of relevant articles, retrieved all of the published randomised controlled trials in regard to these issues and then performed a meta‐analysis. Fourteen highly qualified RCTs reporting on a total of 454 patients, which evaluated the effectiveness of LLLT for patients suffering from TMDs were retrieved. The results indicated that LLLT was not better than placebo in reducing chronic TMD pain (weighted mean difference = ?19·39; 95% confidence interval = ?40·80–2·03; P < 0·00001; I² = 99%). However, the LLLT provided significant better functional outcomes in terms of maximum active vertical opening (MAVO) (weighted mean difference = 4·18; 95% confidence interval = 0·73–7·63; P = 0·006; I² = 73%), maximum passive vertical opening (MPVO) (weighted mean difference = 6·73; 95% confidence interval = 01·34–12·13; P = 0·06; I² = 73%), protrusion excursion (PE) (weighted mean difference = 1·81; 95% confidence interval = 0·79–2·83; P = 0·59; I² = 0%) and right lateral excursion (RLE) (weighted mean difference = 2·86; 95% confidence interval = 1·27–4·45; P = 0·01; I² = 73%). The results of our meta‐analysis have provided the best evidence on the efficacy of LLLT in the treatment of TMDs. This study indicates that using LLLT has limited efficacy in reducing pain in patients with TMDs. However, LLLT can significantly improve the functional outcomes of patients with TMDs.     

Development of the Chinese version of the Oro‐facial Esthetic Scale

The aim of this study was to investigate the psychometric properties of the Oro‐facial Esthetic Scale among Chinese‐speaking patients. The original Oro‐facial Esthetic Scale was cross‐culturally adapted in accordance with the international standards to develop a Chinese version (OES‐C). Unlike the original Oro‐facial Esthetic Scale, the version employed in this study used a 5‐point Likert scale with items rated from unsatisfactory to most satisfactory. Psychometric evaluation included the reliability and validity of the OES‐C. The reliability of the OES‐C was determined through internal consistency and test–retest methods. The validity of OES‐C was analysed by content validity, discriminative validity, construct validity and convergent validity. The corrected item‐total correlation coefficients of the OES‐C ranged from 0·859 to 0·910. The inter‐item correlation coefficients between each two of the eight items of the OES‐C ranged from 0·766 to 0·922. The values of ICC ranged from 0·79 (95% CI = 0·54–0·98) to 0·93 (95% CI = 0·87–0·99), indicating an excellent agreement. Construct validity was proved by the presence of one‐factor structure that accounted for 83·507% of the variance and fitted well into the model. Convergent validity was confirmed by the association between OES‐C scores and self‐reported oral aesthetics and three questions from the Oral Health Impact Profile related to aesthetics (correlation coefficients ranged from ?0·830 to ?0·702, P < 0·001). OES‐C scores discriminated aesthetically impaired patients from healthy controls. This study provides preliminary evidence concerning the reliability and validity of the OES‐C. The results show that the OES‐C may be a useful tool for assessment of oro‐facial esthetics in China.     

The efficacy of non‐narcotic analgesics on post‐operative endodontic pain: A systematic review and meta‐analysis

The objective of this review was to evaluate the efficacy of non‐narcotic analgesics including non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or paracetamol in the treatment of post‐operative endodontic pain. Additionally, we aimed to examine the possible association of study covariates on the pain scores using meta‐regression analysis. An electronic search was performed in 2016. After data extraction and quality assessment of the included studies (n = 27, representing 2188 patients), meta‐analysis was performed using a random‐effect inverse variance method. Meta‐regression analysis was conducted to examine the associations between effect sizes and study‐level covariates (P < 0·05). The results showed that administration of non‐narcotic analgesic was more effective than placebo in the management of post‐operative pain, resulting in a lower pain scores with a standardised mean difference of ?0·50 (95% CI= ?0·70, ?0·30), ?0·76 (95%CI= ?0·95, ?0·56), ?1·15 (95% CI= ?1·52, ?0·78), ?0·65 (95% CI= ?1·05, ?0·26) for immediately after the procedure, 6?, 12? and 24 h post?operative follow‐ups (test for statistical heterogeneity: P = 0·000, P = 0·000, P = 0·000 and P = 0·001), respectively. Our meta‐regression analysis provided the evidence for association between some study covariates with treatment effect, each at different follow‐ups. We concluded that the clinicians can manage post‐operative endodontic pain by administration of NSAIDs and/or paracetamol. However, analgesic regimens should be considered as important determinants when prescribing a pharmacological adjuvant.     

Self‐reported Bruxism ‐ associations with perceived stress,motivation for control,dental anxiety and gagging*

Summary To examine possible associations between self‐reported bruxism, stress, desirability of control, dental anxiety and gagging. Five questionnaires were distributed among a general adult population (402 respondents): the Perceived Stress Scale (PSS), Desirability of Control Scale (DC), Dental Anxiety Scale (DAS), Gagging Assessment Scale (GAS), and Bruxism Assessment Questionnaire. A high positive correlation between DAS and GAS (R = 0·604, P < 0·001) was found. PSS was negatively correlated with DC (R = ?0·292, P < 0·001), and was positively correlated with GAS (R = 0·217, P < 0·001) and DAS (R = 0·214, P < 0·001). Respondents who reported bruxing while awake or asleep showed higher levels of GAS, DAS and PSS than those who did not. There were no differences between the bruxers and the non‐bruxers (sleep and aware) with regard to the DC scores. The best predictors of awake bruxism were sleep bruxism (OR = 4·98, CI 95% 2·54–9·74) and GAS (OR = 1·10, CI 95% 1·04–1·17). The best predictors of sleep bruxism were awake bruxism (OR = 5·0, CI 95% 2·56–9·78) and GAS (OR = 1·19; CI 95% 1·11–1·27). Self‐reported sleep bruxism significantly increases the odds for awake bruxism and vice versa. Tendency for gagging during dental care slightly increases the odds of both types of self‐reported bruxism, but desirability of control is not associated with these phenomena.     

Long‐term side effects on the temporomandibular joints and oro‐facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device

Patients with obstructive sleep apnoea (OSA) in long‐term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro‐facial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long‐term MAD treatment on the TMJs, oro‐facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea–Hypopnoea Index (AHI): 7–57]. They were examined with the Nordic Orofacial Test Screening (NOT‐S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3–6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analysed as long term (T0–T3, n = 14) and short term (T0–T2, n = 24) by t‐test, Fisher's exact test and anova . Both long‐ and short‐term analyses revealed a reduction in AHI (P < 0·002). Significant long term were increased scores in the NOT‐S Interview (P < 0·045), reduced vertical overbite (P < 0·031) and increased jaw protrusive movement (P < 0·027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short term as a decrease and subsequent recurrence (P < 0·053; P < 0·037). No significant radiological changes were found. In conclusion, MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the oro‐facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow‐ups.     

Prophylactic antibiotic regimen and dental implant failure: a meta‐analysis

The aim of this meta‐analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post‐operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I² statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed‐ or random‐effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non‐use of antibiotics) significantly affected the implant failure rates (P = 0·0002), with a RR of 0·55 (95% CI 0·41–0·75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33–100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post‐operative infections in healthy patients receiving implants (P = 0·520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Turned versus anodised dental implants: a meta‐analysis

The aim of this meta‐analysis was to test the null hypothesis of no difference in the implant failure rates, marginal bone loss (MBL)and post‐operative infection for patients being rehabilitated by turned versus anodised‐surface implants, against the alternative hypothesis of a difference. An electronic search without time or language restrictions was undertaken in November 2015. Eligibility criteria included clinical human studies, either randomised or not. Thirty‐eight publications were included. The results suggest a risk ratio of 2·82 (95% CI 1·95–4·06, P < 0·00001) for failure of turned implants, when compared to anodised‐surface implants. Sensitivity analyses showed similar results when only the studies inserting implants in maxillae or mandibles were pooled. There were no statistically significant effects of turned implants on the MBL (mean difference‐MD 0·02, 95%CI ?0·16–0·20; P = 0·82) in comparison to anodised implants. The results of a meta‐regression considering the follow‐up period as a covariate suggested an increase of the MD with the increase in the follow‐up time (MD increase 0·012 mm year^?1), however, without a statistical significance (P = 0·813). Due to lack of satisfactory information, meta‐analysis for the outcome ‘post‐operative infection’ was not performed. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Clinical phenotype of South–East Asian temporomandibular disorder patients with upper airway resistance syndrome

Clinical and radiographic characteristics of a subset of South East Asian temporomandibular disorder (TMD) patients with comorbid upper airway resistance syndrome (UARS) were documented in a multi‐center prospective series of 86 patients (26 men and 60 women / mean age 35.7 years). All had excessive daytime sleepiness, high arousal index and Apnoea‐Hypopnoea Index (AHI) <5. The mean body mass index was 20·1, mean arousal index 16·2, mean respiratory disturbance index 19·6, mean AHI 3·9 while the mean Epworth Sleepiness Scale was 14·8. Many had functional somatic complaints; 66·3% headaches, 41·9% neck aches, 53·5% masticatory muscle myalgia, 68·6% temporomandibular joint (TMJ) arthralgia while 90·7% reported sleep bruxism (SB). Unlike patients with obstructive sleep apnoea (OSA), hypertension was uncommon (4·7%) while depression was prevalent at 68·6% with short REM latency of <90 min and an increased REM composition >25% documented in 79·6% and 57·6% of these depressed patients, respectively. 65·1% displayed a posteriorly displaced condyle at maximum intercuspation with or without TMJ clicking. Most exhibited a forward head posture (FHP) characterised by loss of normal cervical lordosis (80·2%), C0–C1 narrowing (38·4%) or an elevated hyoid position (50%), and 91·9% had nasal congestion. We postulate the TMD‐UARS phenotype may have originally developed as an adaptive response to ‘awake’ disordered breathing during growth. Patients with persistent TMD and/or reporting SB should be screened for UARS and chronic nasal obstruction, especially when they also present with FHP. The lateral cephalogram is a useful tool in the differentiation of UARS from other OSA phenotypes.     

A practice‐based clinical evaluation of the survival and success of metal‐ceramic and zirconia molar crowns: 5‐year results

This practice‐based study evaluates the survival and success of conventionally luted metal‐ceramic and zirconia molar crowns fabricated by using a prolonged cooling period for the veneering porcelain. Fifty‐three patients were treated from 07/2008 to 07/2009 with either metal‐ceramic crowns (MCC) or zirconia crowns (ZC). Forty‐five patients (26 female) with 91 restorations (obser‐vational period: 64·0 ± 4·8 months) participated in a clinical follow‐up examination and were included in the study. Estimated cumulative survival (ECSv), success (ECSc) and veneering ceramic success (ECVCSc) were calculated (Kaplan–Meier) and analysed by the crown fabrication technique and the position of the restoration (Cox regression model) (P < 0·05). Five complete failures (MCC: 2, ZC: 3) were recorded (5‐year ECSv: MCC: 97·6%, (95% confidence interval (95%‐CI): [93%; 100%]/ZC: 94·0%, (95%‐CI): [87%; 100%]). Of the MCCs (n = 41), 85·0%, [95%‐CI: (77%; 96%)] remained event‐free, whereas the ECSc for the ZCs (n = 50) was 74·3% (95%‐CI): [61%; 87%]. No significant differences in ECSv (P = 0·51), ECSc (P = 0·43) and ECVCSc (P = 0·36) were detected between the two fabrication techniques. Restorations placed on terminal abutments (n = 44) demonstrated a significantly lower ECVCSc (P = 0·035), (5‐year VCF‐rate: 14·8%) than crowns placed on tooth‐neighboured abutments (n = 47), (5‐year VCF‐rate: 4·3%). In the present study, zirconia molar crowns demonstrated a 5‐year ECSv, ECSc and ECVCSc comparable to MCCs. Irrespective of the fabrication technique, crowns on terminal abutments bear a significantly increased risk for VCFs. Clinical investigations with an increased number of restorations are needed.     

Mood‐induced variations of mandible and tongue postures

Twelve young adults in a good general health were observed during habitual posture of tongue and jaw in different emotional conditions induced by watching three video sequences. The position of the mandible was tracked by the displacements of an electromagnetic sensor glued to the chin. The tongue‐to‐palate distance was obtained by 2‐D location of three electromagnetic sensors placed on the tongue upper midline surface. Head displacements were evaluated with a sensor fixed to an upper central incisor and were subtracted from corresponding displacements of tongue and chin sensors to obtain the real tongue and mandible positions during continuous recording sequences. Emotional conditioning by a fear movie influenced the vertical position of the mandible: the mean interarch distances during the fear movie (2·34 ± 0·24 mm) were significantly different from those measured during the tender (3·13 ± 0·35) and neutral (3·42 ± 0·80) movies, respectively (anova repeated measure, SNK; P < 0·05). anova repeated measure indicated that the tongue‐to‐palate distance differed significantly when the subjects were watching the conditioning movies (P = 0·003), the tip of the tongue taking a lower position during the fear movie than during the tender and neutral movies.     

Reliability of novel multidirectional lip‐closing force measurement system

Summary This study aimed to quantify the directional specificity of multidirectional lip‐closing force (LCF) and evaluate the reliability of multidirectional LCF measurements made using a novel system. In fourteen healthy subjects (seven females, seven males, median age = 28 years), LCFs in eight directions and electromyograms (EMGs) from four parts of the orbicularis oris muscles (OOM) were recorded during voluntary pursing‐like lip closure tasks. The quantitative reliability was assessed from repeated measurements of the LCFs in the eight directions and from summed values for all eight directions [total lip‐closing force (TLCF)]. The intra‐ and inter‐investigator reliabilities for TLCF were assessed by the interclass correlation of the measurements by the same investigator and two investigators, respectively. Lip‐closing forces showed directional specificity in vertical, horizontal and oblique directions but those in oblique and horizontal directions were symmetrical bilaterally. The quantitative reliability of measurements was between 0·735 and 0·948 in the eight directions and that of TLCF was 0·934. Interclass correlations of intra‐ and inter‐investigator reliabilities were 0·96 [lower limit of 95% confidence interval (95% LL), 0·87] and 0·96 (95% LL, 0·91), respectively. The intra‐ and inter‐investigator differences of measurements were randomly distributed in the whole range of measurements. The 95% confidence intervals of these differences were significantly narrower than those of the limits of agreement (mean ± 1·96 s.d.). In 13 subjects, Pearson’s correlation coefficients between LCF and EMGs from OOM were above 0·95. We conclude that this system has a reasonable quality and reliability for quantitative measurements of multidirectional LCF for evaluating lip functions.     

Tongue‐mandible coupling movements during saliva swallowing

The purpose of this study was to measure the tongue and mandible positions and displacements in relation to the maxilla in the midsagittal plane to characterize the different saliva swallowing patterns by recording their kinematics. A 2D electromagnetic articulograph using four transducer coils, three attached to the upper surface of the tongue midline plus one attached to the chin anterior part allowed continuous evaluation of tongue and chin movements in twelve young adults in good general health. During 170 s sequences recorded at a frequency of 100 Hz, subjects were at rest, silently reading a text they had chosen. The subjects were free to swallow during the sequence. Deglutition of accumulated saliva was analysed after averaging all values obtained during successive 250 ms periods. We identified three elementary swallowing patterns. Mean duration of tongue‐mandible movements were 1·51 ± 0·17 s, 1·63 ± 0·14 s and 2·00 ± 0·08 s for the first, second and third patterns respectively. In the light of other studies based on intra‐oral pressure recordings, our results help to understand the tongue‐mandible coupling behaviours involved in managing an in‐mouth saliva bolus during the three elementary swallowing patterns identified.     

Impact of shortened dental arches on oral health‐related quality of life

This study described the prevalence of adults with shortened dental arches (SDA) in Brazil, specifically assessing the differences of oral health‐related quality of life [the prevalence and severity of oral impacts on daily performance (OIDP)] by dentition status. We analysed data from the 2010 National Survey of Oral Health in Brazil, including home interviews and oral examinations. The assessment of SDA used two alternative definitions: having 3–5 natural occlusal units (OUs) in posterior teeth or having 4 OUs in posterior teeth. Both definitions included having intact anterior region and no dental prosthesis. The analysis was weighted, and a complex sampling design was used. Negative binomial regression models assessed associations as adjusted for socio‐demographic conditions and dental outcomes. A total of 9779 adults (35–44 years old) participated in the study. A non‐negligible proportion had SDA: 9·9% and 3·8% for the first and second definition, respectively. Individuals with SDA (first definition) ranked higher in OIDP prevalence [count ratio (CR) 1·22; 1·09–1·36, 95% confidence interval (CI)] and severity (CR = 1·43; 1·19–1·72, 95% CI) than those with more natural teeth. This difference was not statistically significant when adjusted for socio‐demographic and dental covariates: OIDP prevalence (CR = 1·04; 0·92–1·17, 95% CI) and severity (CR = 1·09; 0·91–1·30, 95% CI). Analogous results were obtained when the second definition of SDA was adopted. These findings suggest that a considerable contingent of adults may function well without dental prostheses, despite having several missing teeth. This conclusion challenges the traditional approach of replacing any missing tooth and instructs the allocation of more dental resources to preventive, diagnostic and restorative services.     

Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non‐adherent to CPAP

The aim of this retrospective study was to evaluate the effect of individually adjusted custom‐made mandibular advancement device/oral appliance (OA) in treatment of patients with moderate and severe obstructive sleep apnoea (OSA), who were non‐adherent to continuous positive airway pressure (CPAP) therapy. During 2007‐2013, 116 patients with moderate (n = 82) and severe (n = 34) OSA non‐adherent to CPAP treatment were referred for dental management with an individually adjusted OA at a specialist sleep clinic. Ten of the participants (8·6%) were lost to follow‐up, leaving the data set to consist of 106 patients (71 men/35 women, mean age 57 year, range 28‐90). Nocturnal respiratory polygraphic recordings were performed at baseline and follow‐up. Average time between baseline polygraphy and follow‐up was 12 months. A successful OA treatment outcome was based on polygraphy at the follow‐up and divided into three groups: 1 = AHI <5; 2 = 5 ≤ AHI <10 and >50% reduction in baseline AHI; and 3. >50% reduction in baseline AHI. If there was a ≤ 50% reduction in baseline AHI at the follow‐up, the treatment was considered as a failure. The overall treatment success rate was 75%. There was no significant difference in success rates between patients in the moderate and severe categories (69% and 77%, respectively). Low oxygen saturation (SpO_{2 nadir)} had a high predictive value for OA treatment failure. OA treatment of patients non‐adherent to CPAP is efficient and especially promising for the severe OSA group who are at greatest risks for developing serious comorbidities, if left untreated.     

Oral health survey of 5-12-year-old children of National Guard employees in Riyadh, Saudi Arabia

Objectives. To assess the oral health status, preventive practices and mutans streptococci (MS) levels among the children of National Guard personnel living in Riyadh, Saudi Arabia. Design. Cross‐sectional study of schoolchildren. Setting. Dental Clinic of the National Guard Hospital in Riyadh, Saudi Arabia. Sample and methods. A sample of 272 5–12‐year‐old children, 154 males and 118 females (95% Bedouin), were selected from approximately 35 National Guard schools in the Riyadh area. An examination was performed in the dental clinic in the National Guard hospital. Oral hygiene was assessed using the Simplified Debris Index (DI‐S); Gingival Index (GI) was used to measure gingival health; dental fluorosis was recorded according to the criteria of Dean. Dental caries (dmft, dmfs, DMFT and DMFS) was recorded according to the recommendations of Haugejorden. Concentration of MS in saline rinse samples was assessed by routine laboratory methods and expressed as colony forming units (CFU) per ml (log₁₀). Results. There was a high level of dental caries (mean dmft = 3·8 ± 3·2; mean dmfs = 21·5 ± 15·7; mean DMFT = 2·0 ± 1·9; mean DMFS = 3·1 ± 3·7). Only 0·7% of the children had no caries experience (dmft + DMFT). MS levels ranged from 0 to 7·5×10⁵ CFU per ml (mean MS = 4·10 ± 0·90 log₁₀ CFU per ml). A significant relationship between MS and caries experience was observed (P = 0·003). Mild fluorosis was observed in 14% of the children. Oral hygiene scores indicated that most of the examined tooth surfaces had detectable plaque (mean DI‐S = 1·78). Gingivitis was present in 100% of the children and was considered moderate to severe in 14% (mean GI = 1·18). Conclusions. The study revealed a high level of oral diseases and poor oral hygiene in the study population and a need for therapeutic and preventive measures.     

Effect of an impaired oral stage on swallowing in patients with Parkinson's disease

We investigated the swallowing function in patients with Parkinson's disease (PD) using deteriorated tongue control because patients with PD frequently exhibit an impaired oral stage of swallowing and the tongue movement affects oral and pharyngeal stage. In total, 201 patients with PD (106 men, 95 women; mean age 70·6 ± 8·0 years; median Hoehn‐Yahr Stage III) were studied. The patients swallowed 10 mL of liquid barium under videofluorography, and their oral transit time (OTT) was measured. Based on 20 healthy controls (mean age 70·3 ± 7·8 years) with an OTT + 2 standard deviation (0·89 + 2 × 0·46) of 1·81 s, the patients with PD were divided into 167 patients with an OTT < 1·81 s and 34 patients with an OTT ≥ 1·81 s. Swallowing function was compared between the groups and assessed using logistic regression analysis. The following factors were significantly associated with oral stage impairment in both groups: tongue‐to‐palate contact, tongue root‐to‐posterior pharyngeal wall contact, premature spillage into the pharynx, aspiration and onset of swallowing reflex. Logistic regression analysis showed that tongue root‐to‐posterior pharyngeal wall contact, onset of swallowing reflex and aspiration were independent factors. PD patients with prolonged OTT displayed poor lingual control and decreased range of motion of the tongue due to bradykinesia and rigidity. Such problems in the oral stage affected the subsequent pharyngeal stage of swallowing with aspiration. Lingual movement in the oral stage thus appears to play an important role in the sequential movement of swallowing in PD.