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Changes in the dynamic Young's modulus under flexure of self-cured and light-cured composite resins during setting were demonstrated to reflect accurately the condition of the curing composite resins. The rate of stiffness increase during setting varied considerably with the product, and the light-cured composite resins generally showed a faster rate of increase of stiffness. In the initial stage, the Young's moduli were very low, especially for the self-cured composite resins. This accounts for the damage (adhesion disruption and cross-linking interruption) that can be inflicted on a freshly placed composite resin filling that is not yet mechanically stabilized. Therefore, such fillings are vulnerable to aggressive distortion for at least 10 to 15 minutes after placement. [ABSTRACT FROM AUTHOR]

Comparisons were made of the Young's moduli obtained with tests that impose static, low-frequency, or high-frequency elastic deformations on dental composite systems. The frequency of the imposed stress was reflected in the absolute value of Young's modulus. However, the values obtained at different test frequencies could be compared and understood by taking into account this frequency dependence. It was thus found that the composite structure largely determined the type of reaction to the imposed stress. The fundamental period test permitted the greatest differentiation in the elastic behavior of the investigated composites. [ABSTRACT FROM AUTHOR]

The non-destructive determination of Young's modulus of dental composites by means of the fundamental period was found to be reliable and accurate. Post-polymerization effects could clearly be detected. Exponential regression analysis showed a correlation coefficient of 0.92, after logarithmic transformation, with volumetric filler content. The high accuracy and reliability of the measurements themselves are reflected in low standard deviations. The results are in excellent agreement with those of other investigations. Furthermore, the ease and speed of operation make this new procedure a powerful laboratory tool for material-testing and practical large-scale investigations. [ABSTRACT FROM AUTHOR]

Thirteen dual cure luting composites were compared in function of film thickness, consistency, and working time by using the American National Standard/American Dental Association (ANS/ADA) specifications for zinc phosphate cement and direct filling resins. The effect of temperature and setting reaction on the film thickness was also evaluated for some representative products. All three clinically related properties varied widely among the products investigated. A strong linear correlation was found between film thickness and consistency. This relation is supported by the temperature dependence of film thickness of dual cure luting composites. Cooling of the material increased the consistency, resulting in a larger film thickness, while heating reduced the film thickness because of the lower consistency. However, one product with a rather short working time at room temperature occasionally exhibited a dramatically enlarged film thickness after heating, probably caused by accelerated chemical polymerization. No correlation emerged between film thickness and maximum filler size or between consistency and filler weight content. Maximum filler size and filler weight content had been measured previously in Part I of this study. Scanning electron microscope (SEM) analysis of the cured film thickness samples revealed that the largest filler particles had been crushed under the heavy load pressure during film thickness measurement. The lack of correlation between consistency and filler weight content can be explained by the multifactorial determination of the consistency. It is concluded that the great diversity in the currently available luting composites makes clear specifications with regard to the optimum composition of luting composites urgently needed. Furthermore, more adequate methods for testing the film thickness of luting composites are also required. [ABSTRACT FROM AUTHOR]

In this study, the attrition wear, also called occlusal-contact-area wear, of human enamel was measured quantitatively with a computerized three-dimensional measuring technique over a period of four years. Tooth replicas from a clinical trial were used. A running-in wear period after restorative treatment, followed by steady-state wear, was suggested. The average steady-wear rate on occlusal contact areas was about 29 pm per year for molars and about 15 pm per year for premolars. [ABSTRACT FROM AUTHOR]

To inventory typical clinical characteristics of patients with somatic tinnitus (ST) and co-existence of temporomandibular disorders (TMD) or oral parafunctions. This pilot study was performed in the start-up phase of a larger clinical trial. Patients with moderate to severe tinnitus (Tinnitus Functional Index (TFI)-score: 25-90) and TMD or oral parafunctions, were recruited. All patients were investigated by means of medical history, ENT examination, audiometry, tinnitus assessment (tinnitus loudness using visual analogue scale (VAS), hyperacusis using Hyperacusis Questionnaire (HQ) and tinnitus annoyance using TFI and Tinnitus Questionnaire (TQ)), pain pressure thresholds (PPT) of masticatory muscles and the presence of TMD or oral parafunctions. 9 adults with ST, averagely 41± 16 years old, were screened. All patients suffered from non-pulsatile tinnitus, with a mean TQ-score of 37±9, TFI-score of 45±8, HQ-score of 18±7 and VAS of 40+24 mm. 8 patients were diagnosed with TMD, mainly myogenic. Clenching was reported in all patients, bruxism in 89%. Neck complaints were found in 78% and 67% suffered from headaches, while this was only 23% and 36%, respectively, in patients with other types of tinnitus. Tinnitus modulation by jaw movement was present in 78%. PPT s tend to be lower in patients with ST in comparison with healthy subjects. In these preliminary results we could confirm the frequent co-existence of TMD, neck symptoms and oral parafunctions in a group of patients with tinnitus. Due to the small sample size, tinnitus modulation by jaw movements should not be overestimated. In patients with tinnitus and co-existence of TMD, more comorbidities, such as neck pain and headaches, are present. Further analysis of the PPT values is necessary. Results from a larger group will be presented at the conference. In a population with tinnitus and co-existence of TMD, neck complaints, clenching, bruxism and headaches appear to be more common than in other types of tinnitus. Modulation of tinnitus by jaw or neck movements is present in more than half of the patients. Masticatory muscles seem to be more sensitive in patients with somatic tinnitus with co-existence of TMD when compared with healthy subjects. Further research is needed to understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Information about the prevalence of somatic tinnitus among patients with tinnitus is currently lacking. By this screening we aim to estimate the prevalence of somatic tinnitus (ST) in a sample of patients with subjective tinnitus and to describe their clinical characteristics. A retrospective cohort was collected by screening all patients that presented themselves at the tinnitus clinic in the past six months. All patients were investigated by means of medical history, ENT examination, pure tone audiometry, tinnitus assessment, the presence of cervical spine dysfunctions, temporomandibular disorders (TMD), oral parafunctions and the levels of anxiety and depression. The diagnosis of ST was made when, after exclusion of other causes, the predominant feature was the temporal coincidence of onset or increase of either neck pain or TMD and tinnitus. The cohort contained 150 adults with tinnitus, (age: 49 years (SD 14)). ST was diagnosed in 34%. The ST-group contained more women (p<0.05) and suffered more frequently from headaches (p<0.05). Sixty-seven percent of the ST-group had neck complaints, 41 % had TMD, 49% reported bruxism and 47% clenching, which was significantly more (p<0.05) than in the non-ST-group (NST). There was no difference in tinnitus modulation by neck or jaw movements between both groups. No significant differences in tinnitus parameters were found between ST and NST patients. Neck complaints, headache, TMD and oral parafunctions were more frequently present in the ST-group. Further research is needed to understand why patients with ST display more comorbidities. Since TMD is 4 times more prevalent in women, this may explain the higher proportion of women in the ST-group. ST is present in 34% of a subjective tinnitus population in a tertiary center setting. These patients show significantly more neck and temporomandibular complaints and oral parafunctions than patients with other types of tinnitus. Contradictory, there are no differences in the ability to modulate the tinnitus by neck or jaw movements. Since one third of our population suffered from ST, we suggest to question every tinnitus patient about the presence of neck or temporomandibular complaints and oral parafunctions during anamnesis. [ABSTRACT FROM AUTHOR]

Sensory processing sensitivity (SPS) is a personality trait described in humans and dogs that mediates how individuals are affected by experiences. It involves being aware of subtle stimuli, high emotional intensity and empathy, and deeper processing of information. Recognizing individuals scoring higher in SPS is likely to help better diagnose, treat, and prevent both psychological (behavioral) and physical problems, leading to increased welfare and quality of life of the animal and its surroundings., Competing Interests: Disclosure The author declares that she has no relevant or material financial interests that relate to the research described in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Purpose: Epiglottic collapse is a specific sleep-endoscopic finding that can prove challenging to treat in patients with obstructive sleep apnea (OSA). Its effect on mandibular advancement devices (MAD) remains largely unknown. Therefore, this study assessed whether or not epiglottic collapse affects treatment outcome with MAD., Methods: Patients with diagnosed OSAD underwent drug-induced sleep endoscopy (DISE) and were treated with a titratable MAD. Two age- and gender-matched controls were selected for every subject with primary epiglottic collapse (i.e., complete closure without involvement of other upper airway structures). Treatment response was defined as a reduction in oxygen desaturation index (ODI) of ≥ 50% following MAD therapy., Results: Of 101 patients who underwent DISE, twenty (20%) showed primary epiglottic collapse (mean [SD]: 17 men; age 49.8 [10.1]; body mass index 28.3 [2.9] kg/m 2 ; apnea-hypopnea index 27.0 [16.9] events/h). There were no significant differences in baseline clinical characteristics between cases and controls. MAD therapy was equally effective in patients with and without epiglottic collapse (mean [SD]; ODI with MAD, 8.7 [7.7] events/h vs. 7.8 [7.5] events/h, P = .62; ΔODI, 53.3 [29.6]% vs. 50.6 [37.7]%, P = .82; responder status, 10/20 vs. 22/40, P = .79). Logistic regression analysis revealed no associations between epiglottic collapse and treatment outcome., Conclusion: The presence of epiglottic collapse during DISE does not impair the effectiveness of MAD. Therefore, MAD therapy should be considered in patients with predominant epiglottic collapse., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Purpose: Tinnitus frequently causes disability as it affects daily living, which is objectified using several tinnitus questionnaires. To what extent they cover domains of the International Classification of Functioning, Disability and Health (ICF) is currently unknown. Therefore, this study aims to investigate which ICF domains are measured by two questionnaires and to describe the health status of somatic tinnitus patients in ICF terms., Materials and Methods: All questions of the Tinnitus Questionnaire (TQ) and Tinnitus Functional Index (TFI) were linked to the ICF using linking rules. A count-based method was used to link all individual answers of 80 tinnitus patients, to the ICF categories., Results: Most of the linked questions concerned "body functions". TFI covered more categories of "activity and participation" than TQ. Patients reported severe impairments in "mental functions", "sensory functions and pain", and "sleep functions". Additionally, severe limitations were scored in "focusing attention"., Conclusions: The TFI and TQ measure distinct domains but can be used complementary or solely, depending on the research question. The TFI identifies a broad spectrum of problems, where the TQ focuses on the psychological impact of tinnitus. Somatic patients in our study reported impairments and disabilities in all covered domains, especially in "onset of sleep" and "sound detection".Implications for RehabilitationThe Tinnitus Functional Index (TFI) and the Tinnitus Questionnaire (TQ) cover different domains of the International Classification of Functioning, Disability and Health.The TFI identifies problems in "body functions" and "activity and participation".The TQ focuses on the psychological impact of tinnitus.

Treatment of obstructive sleep apnoea in adults is evolving, from a "one treatment fits all" to a more individualised approach. The spectrum of treatment options is broad and heterogeneous, including conservative, technological and pharmaceutical modalities. This raises the questions of which patients these modalities might be useful for, and if there are specific criteria for single or combined treatment. The most commonly used non-CPAP treatment is a mandibular advancement device. Furthermore, it appears from the available evidence that upper airway surgery, bariatric surgery, and maxillomandibular advancement can be effective in particular patient groups and should be indicated more readily in clinical practice. Technically, a tracheotomy is the most effective surgical treatment, but is not socially acceptable and is associated with major side-effects. Other treatment options are emerging, like positional therapy, hypoglossal nerve stimulation, and myofunctional exercises. Drug therapy is also promising when pathophysiological traits are considered. The range of currently available treatment options will be discussed in this review, with emphasis on the selection of appropriate patients, therapeutic efficacy and compliance, and reference to recent guidelines. In the selection process, routine application of drug-induced sleep endoscopy to assess the site(s) of collapse during sleep can increase the success rate of both surgical interventions and oral appliance therapy., Educational Aims: To outline recommendations concerning the proper management of obstructive sleep apnoea (OSA) patients that cannot be treated adequately with continuous positive airway pressure (CPAP) due to intolerance, poor adherence or compliance, or CPAP refusal.To provide information about the selection of appropriate patients for alternative non-CPAP treatment options.To better understand the different aspects of OSA treatment with noninvasive approaches, such as oral appliances, positional therapy, drug treatment and myofunctional therapy, including indications, contraindications, and expected short- and long-term results.To discuss the different surgical options for the treatment of OSA and to provide information on the important issue of proper patient selection for surgery, as most OSA surgical outcomes are associated with the pre-operative assessment of the level(s) of upper airway collapse., Competing Interests: Conflict of interest: All authors have seen and approved this manuscript. J. Verbraecken reports institutional fees and educational grants from AirLiquide, AstraZeneca, Bekaert Deslee Academy, Bioprojet, Desitin, Ectosense, Epilog, Fisher & Paykel, Heinen & Löwenstein, Idorsia, Inspire, Jazz Pharmaceutics, Medidis, Mediq Tefa, OSG, Philips, ResMed, Sefam, SomnoMed, Total Care, UCB Pharma, Vivisol, and Westfalen Medical. M. Dieltjens holds a Postdoctoral Fellowship at the Research Foundation Flanders (FWO: 12H4520N). S. Op de Beeck holds a Postdoctoral Fellowship at the Research Foundation Flanders (FWO). A. Vroegop has nothing to disclose. M. Braem reports a research grant from SomnoMed at the Antwerp University Hospital and sits on the advisory board of ResMed and SomnoMed. O. Vanderveken reports research support outside the submitted work from Philips, SomnoMed, Inspire Medical Systems and Nyxoah at the Antwerp University Hospital, consultancy for Galvani and Liva Nova, and is an advisory board member for Zephyr and SomnoMed; he holds a Senior Clinical Investigator Fellowship from the Research Foundation Flanders (FWO: 1833517 N). W. Randerath reports personal fees and travel grants from Weinmann, Heinen & Löwenstein, Resmed, Philips, Inspire and Bioprojet., (Copyright ©ERS 2022.)

Study Objectives: Obstructive sleep apnea has major health consequences but is challenging to treat. For many therapies, efficacy is determined by the severity of underlying pharyngeal collapsibility, yet there is no accepted clinical means to measure it. Here, we provide insight into which polysomnographic surrogate measures of collapsibility are valid, applicable across the population, and predictive of therapeutic outcomes., Methods: Seven promising polysomnography-derived surrogate collapsibility candidates were evaluated: Vpassive (flow at eupneic ventilatory drive), Vmin (ventilation at nadir drive), event depth (depth of the average respiratory event), oxygen desaturation slope and mean oxygen desaturation (events-related averages), Fhypopneas (fraction of events scored as hypopneas), and apnea index. Evaluation included (1) validation by comparison to physiological gold-standard collapsibility values (critical closing pressure, Pcrit), (2) capacity to detect increased collapsibility with older age, male sex, and obesity in a large community-based cohort (Multi-Ethnic Study of Atherosclerosis, MESA), and (3) prediction of treatment efficacy (oral appliances and pharmacological pharyngeal muscle stimulation using atomoxetine-plus-oxybutynin)., Results: Pcrit was significantly correlated with Vmin (r = -0.54), event depth (r = 0.49), Vpassive (r = -0.38), Fhypopneas (r = -0.46), and apnea index (r = -0.46; all p < .01) but not others. All measures detected greater collapsibility with male sex, age, and obesity, except Fhypopneas and apnea index which were not associated with obesity. Fhypopneas and apnea index were associated with oral appliance and atomoxetine-plus-oxybutynin efficacy (both p < .05)., Conclusions: Among several candidates, event depth, Fhypopneas, and apnea index were identified as preferred pharyngeal collapsibility surrogates for use in the clinical arena., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Successful orofacial treatment can reduce tinnitus severity in patients with somatic tinnitus (ST). However, it is still unclear to what extent the degree of reduction in temporomandibular disorders (TMD) actually contributes to the decrease in tinnitus severity after orofacial treatment. Therefore, the aim of this study was to analyze the mediating effect of reduction in TMD pain on the improvement of tinnitus severity after multidisciplinary orofacial treatment., Methods: A total of 80 patients with moderate to severe ST attributed to the temporomandibular region, were recruited from a tertiary tinnitus clinic. At baseline, patients were randomly assigned to the orofacial treatment group or to the control group. Both groups received a minimum of information and advice regarding their tinnitus complaints. The orofacial treatment group received orofacial physical therapy complemented with occlusal splints when needed, while the control group received no other treatment. A mediation analysis was performed according to the steps described by Baron and Kenny and the proportion of the mediating effect was calculated for the potential mediator: "change in TMD pain," measured by a one-point decrease in TMD pain screener score., Results: Our analysis showed that 35% of the observed decrease in tinnitus severity can be attributed to a reduction in TMD pain. A significant total effect of orofacial treatment compared with control on the change in tinnitus functional index (TFI) score was found (B = 0.253 p = 0.025 Cl for B = 1.265-18.576). Orofacial treatment was also significantly related to the change in TMD pain (Exp (B) = 2.800, p = 0.034 Cl for Exp B 1.081-7.251). Additionally, the change in TMD pain screener score was significantly related to the change in TFI score (B = -0.273 p = 0.016 Cl for B = -19.875 to -2.119)., Conclusion: Reduction of TMD pain is a mediating factor in the decrease of tinnitus severity after multidisciplinary orofacial treatment., Practical Implications: Orofacial treatment can be used to decrease tinnitus severity in patients with TMD related somatic tinnitus., Competing Interests: The authors disclose no conflicts of interest., (Copyright © 2022, Otology & Neurotology, Inc.)

Introduction: Subjective tinnitus that is influenced by the somatosensory system is called somatosensory tinnitus (ST). When ST is related to the temporomandibular area, multidisciplinary orofacial treatment can reduce tinnitus severity. It is, however, unknown if we can predict this positive outcome. The aim of this study is to look for prognostic indicators that can predict a positive outcome after multidisciplinary orofacial treatment in patients with ST., Methods: Patients were included when they were diagnosed with temporomandibular-related ST and received a maximum of 18 sessions of orofacial treatment during a 9-week program. Predictors for positive treatment outcome were identified using univariate and multiple logistic regression analyses with the Tinnitus Questionnaire (TQ) and the Tinnitus Functional Index (TFI) as dependent variables., Results: The results of 101 patients were included in the analysis. Immediately after multidisciplinary orofacial treatment, a clinically relevant decrease in TQ score was significantly associated with "shorter duration of tinnitus" [odds ratio (OR) 0.99], "higher initial score on the TQ somatic subscale" (OR 1.52), and "painful palpation of the temporomandibular joint (TMJ)" (OR 2.46). After 9 weeks of follow-up, the "higher initial score on the TQ somatic subscale" remained as the sole predictor (OR 1.44). A clinically relevant decrease on TFI after 9 weeks of follow-up was predicted by "female gender" (OR 2.70), "younger age" (OR 0.96), "shorter duration of the tinnitus" (OR 0.99), "lower pressure pain thresholds (PPT) on TMJ" (OR 0.99), "lower PPT on sternocleidomastoid origin" (OR 0.99), and "better speech in noise perception" (OR 0.88). A multivariate model comprising "shorter duration of tinnitus" and "higher initial score on the somatic subscale of the TQ" correctly predicts the clinically relevant decrease in TQ score after treatment in 68.5%. A second multivariate model comprising "female gender," "younger age," and "shorter duration of the tinnitus" correctly predicts a clinically significant decrease on TFI after follow-up in 68.1%., Conclusion: We were able to identify various prognostic indicators. "Younger female patients" with a "shorter duration of tinnitus" and a "higher initial score on the TQ somatic subscale" appear to have the best prognosis after multimodal orofacial therapy., (Copyright © 2020 van der Wal, Van de Heyning, Gilles, Jacquemin, Topsakal, Van Rompaey, Braem, Visscher, Truijen, Michiels and De Hertogh.)

Study Objectives: Oral appliance therapy is an increasingly common option for treating obstructive sleep apnea (OSA) in patients who are intolerant to continuous positive airway pressure (CPAP). Clinically applicable tools to identify patients who could respond to oral appliance therapy are limited., Methods: Data from three studies (N = 81) were compiled, which included two sleep study nights, on and off oral appliance treatment. Along with clinical variables, airflow features were computed that included the average drop in airflow during respiratory events (event depth) and flow shape features, which, from previous work, indicates the mechanism of pharyngeal collapse. A model was developed to predict oral appliance treatment response (>50% reduction in apnea-hypopnea index [AHI] from baseline plus a treatment AHI <10 events/h). Model performance was quantified using (1) accuracy and (2) the difference in oral appliance treatment efficacy (percent reduction in AHI) and treatment AHI between predicted responders and nonresponders., Results: In addition to age and body mass index (BMI), event depth and expiratory "pinching" (validated to reflect palatal prolapse) were the airflow features selected by the model. Nonresponders had deeper events, "pinched" expiratory flow shape (i.e. associated with palatal collapse), were older, and had a higher BMI. Prediction accuracy was 74% and treatment AHI was lower in predicted responders compared to nonresponders by a clinically meaningful margin (8.0 [5.1 to 11.6] vs. 20.0 [12.2 to 29.5] events/h, p < 0.001)., Conclusions: A model developed with airflow features calculated from routine polysomnography, combined with age and BMI, identified oral appliance treatment responders from nonresponders. This research represents an important application of phenotyping to identify alternative treatments for personalized OSA management., (© Sleep Research Society 2020. Published by Oxford University Press on behalf of the Sleep Research Society. All rights reserved. For permissions, please e-mail journals.permissions@oup.com.)

Background: Tinnitus, or ringing in the ears, is a perception of sound in the absence of overt acoustic stimulation. In some cases, tinnitus can be influenced by temporomandibular somatosensory input, then called temporomandibular somatosensory tinnitus (TST). It is, however, not entirely known if orofacial treatment can decrease tinnitus severity. The purpose of this study was to evaluate the effect of orofacial treatment on tinnitus complaints in patients with TST., Methods: Adult patients with TST were included, and all patients received information and advice about tinnitus and conservative orofacial treatment consisting of physical therapy, and, in case of grinding, occlusal splints were applied. Included patients were randomly assigned to an early start group and a delayed start group according to our delayed treatment design., Results: In total, 40 patients were included in each group. The treatment effect on tinnitus severity was investigated using the tinnitus questionnaire (TQ) and Tinnitus Functional Index (TFI). Regarding the TQ score, no clinically relevant reductions were observed, and no significant differences in the decrease were observed between the early start group and delayed start group. Contrarily, a significantly higher percentage of patients showed a decrease in the TQ degree in the early start group compared to the delayed start group (30.0% versus 2.8%, p = 0.006). The TFI score did show a significantly greater and clinically relevant reduction in the early start group compared to the delayed start group ( p = 0.042)., Conclusion: A multidisciplinary non-invasive orofacial treatment was able to reduce tinnitus severity in patients with temporomandibular related somatosensory tinnitus.

Aims: To investigate whether temporomandibular disorders treatment can positively influence tinnitus complaints., Methods: Four online databases (PubMed, Web of Science, Scopus, and the Cochrane Library) were searched up to August 2018 for relevant studies. Two independent reviewers extracted the data and performed a risk of bias assessment., Results: A total of 11 studies were included. These studies showed an overall positive effect of the combination of splint therapy and exercise treatment on tinnitus severity and intensity (as measured on a visual analog or numeric rating scale), as well as on global perceived effect. One study specified that the treatment effect was only present in patients with severe to very severe tinnitus, while the others found an effect in the overall study group. The risk of bias in the included studies was high, mainly due to lack of statistical analyses between groups and before vs after treatment, incomplete presentation of the data, and selective reporting. Additionally, most included studies showed a lack of information concerning blinding of the subjects, therapists, and investigators. The heterogeneity of the inclusion criteria, outcome measurements, and treatments made data pooling and meta-analysis impossible., Conclusion: There is low-quality evidence for a positive effect of conservative temporomandibular disorders treatment on tinnitus complaints. The combination of splint therapy and exercise treatment is currently the best investigated treatment approach, showing a decrease in tinnitus severity and intensity. Despite the low level of evidence and the methodologic issues in the included studies, it is noteworthy that all included studies show positive treatment effects.

Background: Tinnitus is a highly prevalent symptom affecting 10-15% of the adult population. It often affects patient quality of life and frequently causes distress. When subjective tinnitus can be elicited by the somatosensory system of the cervical spine or temporomandibular area it is termed somatic tinnitus. The first aim of the current study is to investigate the effect of the best evidence conservative temporomandibular disorder (TMD) treatment on tinnitus in patients with co-existence of tinnitus and TMD or oral parafunctions compared to no treatment. The second aim is to identify a subgroup of patients with tinnitus that benefits from the conservative temporomandibular joint treatment., Methods and Design: This study is a randomised controlled trial with a delayed treatment design. Patients with a TMD (TMD pain screener ≥ 3 points) or oral parafunctions (such as clenching and bruxism), who are suffering from moderate to severe subjective tinnitus (Tinnitus Functional Index (TFI) between 25 and 90 points), will be recruited from the tertiary tinnitus clinic of the University Hospital of Antwerp, Edegem, Belgium. Patients will be excluded in case of clear otological or neurological causes of the tinnitus, progressive middle ear pathology, intracranial pathology, traumatic cervical spine or temporomandibular injury in the past 6 months, severe depression as diagnosed by a psychologist, tumours, previous surgery in the orofacial area, substance abuse that may affect the outcome measures, any contra-indication for physical therapy treatment directed to the orofacial area or when they received TMD treatment in the past 2 months. After screening for eligibility, baseline data among which scores on the TFI, tinnitus questionnaire (TQ), mean tinnitus loudness as measured with visual analogue scale (VAS), TMD pain screener, and a set of temporomandibular joint tests will be collected. Patients will be randomised in an early-start group and in a delayed-start group of therapy by 9 weeks. Patients will receive conservative TMD treatment with a maximum of 18 sessions within 9 weeks. At baseline (week 0), at the start of therapy (weeks 0 or 9), 9 weeks after therapy (weeks 9 or 18), and at follow-up (weeks 18 or 27) data from the TFI, TQ, VAS mean tinnitus loudness and the TMD pain screener will be collected., Discussion: Herein, we aim to improve the quality of care for patients with tinnitus attributed to TMD or oral parafunctions. By evaluating the effect of state-of-the-art TMD treatment on tinnitus complaints, we can investigate the usefulness of TMD treatment in patients with somatic tinnitus., Trial Registration: 3 July 2017, version 1 of the protocol, ClinicalTrials.gov NCT03209297 .

In humans, the personality dimension 'sensory processing sensitivity (SPS)', also referred to as "high sensitivity", involves deeper processing of sensory information, which can be associated with physiological and behavioral overarousal. However, it has not been studied up to now whether this dimension also exists in other species. SPS can influence how people perceive the environment and how this affects them, thus a similar dimension in animals would be highly relevant with respect to animal welfare. We therefore explored whether SPS translates to dogs, one of the primary model species in personality research. A 32-item questionnaire to assess the "highly sensitive dog score" (HSD-s) was developed based on the "highly sensitive person" (HSP) questionnaire. A large-scale, international online survey was conducted, including the HSD questionnaire, as well as questions on fearfulness, neuroticism, "demographic" (e.g. dog sex, age, weight; age at adoption, etc.) and "human" factors (e.g. owner age, sex, profession, communication style, etc.), and the HSP questionnaire. Data were analyzed using linear mixed effect models with forward stepwise selection to test prediction of HSD-s by the above-mentioned factors, with country of residence and dog breed treated as random effects. A total of 3647 questionnaires were fully completed. HSD-, fearfulness, neuroticism and HSP-scores showed good internal consistencies, and HSD-s only moderately correlated with fearfulness and neuroticism scores, paralleling previous findings in humans. Intra- (N = 447) and inter-rater (N = 120) reliabilities were good. Demographic and human factors, including HSP score, explained only a small amount of the variance of HSD-s. A PCA analysis identified three subtraits of SPS, comparable to human findings. Overall, the measured personality dimension in dogs showed good internal consistency, partial independence from fearfulness and neuroticism, and good intra- and inter-rater reliability, indicating good construct validity of the HSD questionnaire. Human and demographic factors only marginally affected the HSD-s suggesting that, as hypothesized for human SPS, a genetic basis may underlie this dimension within the dog species.

Background: Tinnitus is a very common symptom that often causes distress and decreases the patient's quality of life. Apart from the well-known causes, tinnitus can in some cases be elicited by dysfunctions of the cervical spine or the temporomandibular joint (TMJ). To date however, it is unclear whether alleviation of these dysfunctions, by physical therapy treatment, also decreases the tinnitus complaints. Such physical therapy could be an interesting treatment option for patients that are now often left without treatment. Objectives: The aim of this review was to investigate the current evidence regarding physical therapy treatment in patients with tinnitus. Data sources: The online databases Pubmed, Web of Science, Cochrane, and Embase were searched up to March 2016. Two independent reviewers conducted the data extraction and methodological quality assessment. Study eligibility criteria: Only randomized controlled trials and quasi-experimental trials were included in the review. Studies had to be written in English, French, Dutch, or German. Participants and interventions: The included studies investigated the effect of physical therapy treatment modalities on tinnitus severity in patients suffering from subjective tinnitus. Results: Six studies were included in this review, four investigating cervical spine treatment and two investigating TMJ treatment. These studies show positive effects of cervical spine treatment (manipulations, exercises, triggerpoint treatment) on tinnitus severity. Additionally, decrease in tinnitus severity and intensity was demonstrated after TMJ treatment, following splints, occlusal adjustments as well as jaw exercises. Limitations: The risk of bias in the included studies was high, mainly due to lack of randomization, lack of blinding of subjects, therapists, and/or investigators. Additionally, risk of bias is present due to incomplete presentation of the data and selective reporting. A major issue of the reviewed papers is the heterogeneity of the included study populations, treatments and outcome measures, which inhibit data pooling and meta-analysis. Conclusions: Despite the methodological issues in the included studies and the consequent low quality evidence, it is noteworthy that all included studies show positive treatment effects. Before recommendations can be made, these results need to be confirmed in larger, high quality studies, using unambiguous inclusion criteria, state-of-the-art treatment, and high quality outcome measures.

Mandibular repositioning devices (MRDs) increase the patency of the upper airway by repositioning the mandible forward, resulting in displacement of the oropharyngeal tissues preventing upper airway collapsibility. Mandibular anterior repositioning is counteracted by muscle force from the temporalis muscle. A 39-year-old man had an osteolytic lesion with fracture of the coronoid process of the mandible secondary to wearing a MRD for sleep apnea. Continuous stress generated on the coronoid process temporalis muscle resulted in osteolysis and fracture of the coronoid process on the patient's right side, resulting in swelling and limited ability to open his mouth. The patient was managed with intravenous antibiotics to control the osteomyelitis and surgical debridement, with removal of the coronoid process of the mandible. It is unclear why the fracture only occurred on the right side. Pathologic fracture of the coronoid process due to chronic stress and secondary osteomyelitis is a rare severe complication of treatment for obstructive sleep apnea syndrome with a MRD.

Purpose: This prospective clinical trial assessed the therapeutic outcomes of patients with obstructive sleep apnea (OSA) treated with a novel duobloc custom-made titratable mandibular advancement device (OAm)., Material and Methods: The modular Somnomed G2® OAm (Somnomed Europe AG, Zurich, Switzerland) with 'click-to-fit' adjustability provides instant feedback on the mandibular advancement. 161 consecutive patients with established diagnoses of OSA. Dental impressions were made and a bite registration in 75% of the maximal protrusion being the starting protrusion. Treatment response was defined as ≥ 50% decrease in apnea-hypopnea index (AHI). Treatment success was defined as 1a) AHI with OAm < 5 events/h sleep or 1b) AHI with OAm < 10 events/h. Treatment success and response were combined to define additional criteria: 2a) reduction in AHI ≥ 50% and AHI < 5 events/h; and 2b) reduction in AHI ≥ 50% and AHI <10 events/h., Results: In 112 patients AHI decreased significantly from 25 ± 18/h sleep at baseline to 12 ± 13/h with the OAm (p < 0.001). The visual analogue scoring for snoring (VAS) decreased significantly from 7 ± 3 to 2 ± 2 (p < 0.001). Treatment response was achieved in 65 of 112 patients (58%); 31% and 57% of patients were treated successfully according to criteria 1a and 1b, respectively. Furthermore, 31% and 50% of patients were treated successfully according to criteria 2a and 2b, respectively., Conclusions: This clinical trial indicates that treatment with a novel custom-made OAm can reduce the severity of sleep-disordered breathing by significantly decreasing the AHI and VAS scores.

Oral appliance (OA) therapy with a mandibular advancement device (OAm) is a non-invasive, alternative approach to maintaining upper airway patency. The main requirement for an OAm to be effective is the adequate retention on the teeth while the patient is asleep. We evaluated the retentive forces of a new low-cost, customizable, titratable, thermoplastic OAm (BluePro (®); BlueSom, France). Dental impressions and casts were made for one patient with complete upper and lower dental arches including the third molars and class II bite proportions. A setup based on Frasaco ANA-4 models was also used. Two protrusive positions of the mandible were investigated: 3 mm and 8 mm, representing respectively 25% and 65% of the maximal protrusion. The forces required to remove the BluePro (®) device from the carriers were recorded continuously over 730 cycles (=365 days, twice a day) to simulate 1 year of clinical use. At 8 mm protrusion the BluePro (®) device showed retentive forces of ~27N. There was a slight but non-significant decrease in retentive forces in the tests on the epoxified carriers which was not found on the ANA-4 carriers. There were no significant differences between the carriers as a function of protrusion. The BluePro (®) device tested in the present study possesses sufficient retention forces to resist initial jaw opening forces and full mouth opening forces estimated to be ~20N. It could therefore broaden the indications for use of thermoplastic OAms. It could provide a temporary OAm while a custom-made OAm is being manufactured or repaired. Patients could be provided with a low-cost try-out device capable of reliable titration, providing an indication of effectiveness and of patient acceptance of an OAm, although the effect of device shape and size on therapeutic outcome is not yet known. Finally it could provide an affordable OAm solution in resource-restricted healthcare settings.

Background: Oral appliance therapy with a mandibular advancement device (OAm) can yield to complete therapeutic response (apnea-hypopnea index [AHI]<5 events/h), though some patients show little or no improvement in daytime sleepiness. The prevalence of residual excessive sleepiness (RES) despite effective treatment with OAm therapy is unknown. We aimed to determine the prevalence of RES in patients treated with a titratable custom-made duobloc OAm., Methods: A prevalence study was performed, collecting data from 185 patients with an established diagnosis of sleep-disordered breathing (SDB) under OAm therapy with a titratable custom-made duobloc device (baseline data were male:female ratio, 129:56; age, 48±9 years; body mass index [BMI], 27±4 kg/m2; Epworth Sleepiness Scale [ESS] score, 10±5; and AHI, 19±12 events/h). A full-night polysomnography was performed at baseline and after 3 months of OAm therapy. Daytime sleepiness was assessed using the ESS with RES defined as an ESS score of 11 or higher out of 24, despite complete therapeutic response., Results: Out of 185 patients, 84 patients (45%) showed a complete therapeutic response with an AHI of <5 events per hour after 3 months of OAm therapy. Despite this normalization of AHI, 27 out of these 84 patients (32%) showed RES and had a significantly higher baseline ESS (15±4 vs. 9±4; P<.001) and were younger (43±9 vs. 47±9; P=.028) compared to patients without RES., Conclusion: RES under OAm therapy showed a prevalence of up to 32% in SDB patients effectively treated with respect to AHI. Patients with RES were younger and had higher baseline daytime sleepiness., (Copyright © 2013 Elsevier B.V. All rights reserved.)