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Aims: To investigate whether any of the pretreatment physical signs, symptoms, and responses on psychological questionnaires would predict treatment outcomes after a standardized temporomandibular disorder (TMD) treatment program. Methods: The care provided to 157 TMD patients was a short course of physical therapy, an occlusal appliance, and over-the-counter nonsteroidal anti-inflammatory drugs (OTC NSAIDs). A multidimensional outcome assessment was performed using six variables. Follow-up data were available on 81.5% of enrolled subjects and elapsed time from initial visit to the two follow-up points was 13 +/- 4.7 and 33.6 +/- 9.8 months, respectively. Multiple regression analyses were conducted to assess the relationship between 18 predictor variables and the six outcome variables. Results: The results showed that the combination of a higher initial visual analog scale (VAS) pain score plus a lower jaw function interference score was significantly associated with a reduction of VAS pain after treatment (P < .05; adjusted R2 = 0.54). Moreover, the combination of a higher initial activity limitation score plus a lower jaw function interference score was associated with a greater reduction of the activity limitation score after treatment (P < .05; adjusted R2 = 0.36). None of the other outcomes were found to relate to any of the pretreatment variables. It must be noted that no single variable was a strong predictor and the odds ratios between the above three variables and the predicted outcomes were not robust. Conclusion: The corollary of these results suggests that if a high degree of jaw function interference is present (eg, clicking, locking), then the prognosis of improvement with brief self-directed physical therapy, an occlusal appliance, and OTC NSAID is lower, at least within the time frame of this study. [ABSTRACT FROM AUTHOR]

PURPOSE: The relationship between sleep bruxism (SB) and temporomandibular disorders (TMD) is unclear. This study aimed to estimate SB prevalence in an adolescent population and to investigate the relationship between SB frequency and prevalence of TMD signs/symptoms. MATERIALS AND METHODS: First-year students at a high school in Okayama, Japan, were recruited in 2005, with 195 subjects responding. The SB detection device was a miniature disposable device (BiteStrip, SLP) that indicated the total SB events per night on a 4-grade score. The subjects were divided into severe and nonsevere SB groups with SB frequency cutoffs. The subjects were examined for temporomandibular joint (TMJ) noise during mouth opening/closing, tenderness of the masticatory/cervical muscles, and range of TMJ condylar movement. The presence/absence of headache and shoulder stiffness was also determined by the interview. The odds ratio (OR) and confidence interval (CI) were calculated to test the relationship between SB frequency, gender difference, and presence of the TMD signs/symptoms by multiple regression analysis. RESULTS: Severe SB (more than 125 events per night) was significantly related to the presence of TMJ clicking (OR: 3.74, CI: 1.22-11.49, P = .02), while gender (male) was not related to the presence of TMJ clicking. Severe SB was not related to headache, though gender (male) was significantly related to headache (OR: 2.52, Cl: 1.04-6.11, P= .04) in these subjects. CONCLUSION: These results suggest that the presence of TMJ clicking was closely related to severe SB in an adolescent population. [ABSTRACT FROM AUTHOR]

AIMS: To examine whether any signs and symptoms of temporomandibular disorders were significantly associated with masseter muscle activity levels during sleep. METHODS: One hundred three healthy adult subjects (age range, 22 to 32 years) participated in the study. They were asked to fill out questionnaires, undergo a calibrated clinical examination of their jaws and teeth, and perform 6 consecutive nightly masseter electromyographic (EMG) recordings with a portable EMG recording system in their home. The EMG data were considered dependent variables, while the questionnaire and examination data were considered independent variables. Multiple stepwise linear regression analysis was utilized to assess possible associations between these variables. RESULTS: Both gender and joint sound scores were significantly related to the duration of EMG activity. None of the other independent variables were found to be related to any of the muscle activity variables. CONCLUSION: The results suggest that both gender and clicking are significantly related to duration of masseter EMG activity during sleep. [ABSTRACT FROM AUTHOR]

PURPOSE: This study investigated whether tooth wear status can predict bruxism level. MATERIALS AND METHODS: Sixteen Japanese subjects (eight bruxers and eight age- and gender-matched controls; mean age 30 years) participated in this study. From dental casts of these subjects, the tooth wear was scored by Murphy's method. Bruxism level in these subjects was also recorded for 5 consecutive nights in the subject's home environment using a force-based bruxism detecting system. The relationship between the tooth wear score and bruxism data was evaluated statistically. RESULTS: Correlation analysis between the Murphy's scores of maxillary and mandibular dental arch and bruxism event duration score revealed no significant relationship between tooth wear and current bruxism. CONCLUSION: Tooth wear status is not predictive of ongoing bruxism level as measured by the force-based bruxism detection system in 30-year-old Japanese subjects. [ABSTRACT FROM AUTHOR]

AIMS: To test whether 3-week duration recordings of sleep bruxism are correlated with daily behaviors. METHODS: Twelve patients with a sleep bruxism disorder were monitored to see if any daily behaviors (stress, physical activity, anger), jaw-pain/headache symptoms, or sleep quality were correlated with their sleep bruxism levels. A telemetric-based system was used for monitoring bruxism levels, which were detected with an intra-appliance piezoelectric film system. Bruxism was defined as a force applied to the occlusal surface of the splint at or above a level of 10% maximum voluntary contraction. Bruxism levels were recorded at night for at least 3 weeks on the 12 subjects in this study (6 females and 6 males). Patients used standard (100 mm) visual analog scaling methods during this period to rate their daily behaviors, sleep quality, and jaw-pain/headache symptoms in a diary. Correlation analysis was performed between these recorded variables. RESULTS: The subjects demonstrated both bruxism and sleep disturbance, and the mean bruxism score for the male subjects was significantly higher than that for the female subjects. Overall, no single diary variable was consistently correlated with the bruxism levels in these subjects. CONCLUSION: These data support the conclusion that bruxism is not strongly related to any of the subject's self-monitored daytime activities or sleep quality. [ABSTRACT FROM AUTHOR]

AIMS: To test the reliability and utility of a force-based bruxism detection system (Intra-Splint Force Detector [ISFD]) for multiple night recordings of forceful tooth-to-splint contacts in sleeping human subjects in their home environment. METHODS: Bruxism-type forces, i.e., forceful tooth-to-splint contacts, during the night were recorded with this system in 12 subjects (6 bruxers and 6 controls) for 5 nights in their home environment; a laboratory-based nocturnal polysomnogram (NPSG) study was also performed on 1 of these subjects. RESULTS: All 12 subjects were able to use the device without substantial difficulty on a nightly basis. The bruxer group exhibited bruxism events of significantly longer duration than the control group (27 seconds/hour versus 7.4 seconds/hour, P < .01). A NPSG study performed on 1 subject revealed that, when the masseter muscle electromyogram (EMG) was used as a 'gold standard,' the ISFD had a sensitivity of 0.89. The correlation coefficient between the duration of events detected by the ISFD and the EMG was also 0.89. CONCLUSION: These results suggest that the ISFD is a system that can be used easily by the subjects and that has a reasonable reliability for bruxism detection as reflected in forceful tooth-to-splint contacts during sleep. [ABSTRACT FROM AUTHOR]

Aims: Stabilization appliances and mandibular anterior repositioning appliances have been used to treat patients with internal derangement of the temporomandibular joint (TMJ) based on the assumption that these appliances work by decompressing the TMJ. The purpose of this study was to indirectly test this assumption. Methods: Bilateral TMJ tomograms of 7 subjects with unilateral anterior disc displacement without reduction (ADDwor) were taken during comfortable closure and during maximum clenching in maximum intercuspation; tomograms were also taken with the 2 types of occlusal appliances in use. Outlines of the condyle and the temporal fossa were automatically determined by an edgedetection protocol, and the minimum joint space dimension of the joints with and without ADDwor was automatically measured for each experimental condition as the outcome variable. Results: Upon comfortable closure and maximum clenching, the minimum joint space dimensions of the ipsilateral and contralateral joints with the use of stabilization appliances and mandibular anterior repositioning appliances were not significantly different from those seen in maximum intercuspation. Conclusion: These findings do not indicate that these appliances induce an increase in joint space during closing and clenching in joints with ADDwor. [ABSTRACT FROM AUTHOR]

AIMS: The pressure pain threshold (PPT) in the superficial masseter muscle was measured with and without cutaneous anesthesia to determine whether there would be a difference in PPT scores. METHODS: In 14 healthy male subjects, cutaneous tissues in the target areas were anesthetized with lidocaine with the help of an iontophoretic device. As a control, physiologic saline solution was applied iontophoretically to the contralateral masseter site. The subject and the PPT examiner did not know which side contained anesthesia, and the selection of which side to anesthetize was done in a random fashion. Multiple PPT measurements were made in the target sites before and immediately after the iontophoretic anesthesia. RESULTS: The PPT level on the lidocaine side was not statistically different from the PPT level recorded on the control side (339.0 +/- 87.6 kPa and 337.5 +/- 77.7 kPa, respectively). CONCLUSION: Pressure pain sensation in the human masseter is not derived predominantly from the cutaneous tissues, but from the muscle itself. [ABSTRACT FROM AUTHOR]

Purpose: Previous research has demonstrated that typically developing children, verbal children with a diagnosis of autism, children with Down syndrome, children with developmental language disorder, and children with dyslexia can all benefit from orthographic support during word learning tasks. This study sought to determine if minimally speaking or nonspeaking children with a diagnosis of autism would also demonstrate an orthographic facilitation effect during a computer-based remote word learning task., Method: Twenty-two school-age children with a diagnosis of autism and little to no spoken language learned four novel words by contrasting the words with known objects. Two novel words were taught with orthographic support present, and two were taught without orthographic support. Participants were exposed to the words a total of 12 times and then given an immediate posttest to assess identification. Parent report measures of receptive vocabulary, expressive vocabulary, autism symptomatology, and reading skills were also collected., Results: During learning tasks, participants performed equally well whether orthographic support was given or not. For the posttest, however, participants performed significantly better for words that were taught with orthographic support. The presence of orthography improved accuracy and supported a greater number of participants to reach the passing criterion compared to the absence of orthography. Orthographic representations aided the word learning of those with lower expressive language significantly more than those with higher expressive language., Conclusions: Minimally speaking or nonspeaking children with a diagnosis of autism benefit from orthographic support when learning new words. Further investigation is warranted to determine if this effect holds during face-to-face interactions using augmentative and alternative communication systems., Supplemental Material: https://doi.org/10.23641/asha.22465492.

Background: Although there is a growing body of literature on cognitive and language processing in bilingual children with developmental language disorder (DLD), there is a major gap in the evidence for language intervention. Critically, speech-language therapists are often required to make clinical decisions for language intervention on specific domains, such as phonology, vocabulary, morphosyntax and literacy., Aims: To examine evidence for language intervention and cross-language transfer effects in bilingual children with DLD. Specifically, the study aimed to review intervention evidence targeting non-linguistic cognitive skills and six areas of language: phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy., Methods & Procedures: We carried out searches in five electronic databases: CINAHL, Scopus, Psychinfo, Proquest and Sciencedirect. Data from selected papers were extracted and organized into the three following categories: study information, participant information and intervention information. Critical appraisal for selected papers was conducted using a quality assessment tool (QAT)., Outcomes & Results: We included 14 papers in the review. The majority indicated evidence for vocabulary intervention. There was limited evidence for intervention targeting phonology or morphosyntax. Cross-language generalization effects were evident for vocabulary, but in some instances also reported for morphosyntax and literacy., Conclusions & Implications: The present review indicates that there is a significant gap in the literature regarding language intervention for several key language areas such as morphosyntax, narrative skills and literacy. There are only limited data for the effects of cross-language generalization indicating that more research is needed in this area specifically for skills beyond vocabulary., What This Paper Adds: What is already known on the subject Previous studies have examined the effects of bi- and monolingual intervention in bilingual children with DLD. Although the results indicated superior effects for bilingual compared with monolingual intervention, language intervention evidence in specific language domains (e.g., vocabulary, literacy) has not been investigated. What this paper adds to existing knowledge This study will add intervention evidence specific to language domains such as phonology, vocabulary, morphosyntax, pragmatics, narrative skills and literacy. Additionally, we have synthesized intervention evidence on non-linguistic cognition given that these skills are often impaired in bilingual children with DLD. The review has also demonstrated evidence for the effects of cross-language transfer beyond vocabulary skills, especially when the intervention was provided in the home language. What are the potential or actual clinical implications of this work? Although there was a lack of intervention evidence in language domains such as pragmatics, the results indicated some evidence for intervention targeting vocabulary. However, positive effects of cross-language generalization were not constrained to vocabulary but were also reported for intervention targeting mean length of utterance and literacy in the home language. This result indicates an interactive nature of the two languages, as well as provides further evidence for supporting home language(s) in intervention. Finally, intervention targeting non-linguistic cognition may yield additional cross-domain generalization to language skills specifically for bilingual children with DLD., (© 2022 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Alzheimer's Disease (AD) is a neuroinflammatory disease characterized partly by the inability to clear, and subsequent build-up, of amyloid-beta (Aβ). AD has a bi-directional relationship with circadian disruption (CD) with sleep disturbances starting years before disease onset. However, the molecular mechanism underlying the relationship of CD and AD has not been elucidated. Myeloid-based phagocytosis, a key component in the metabolism of Aβ, is circadianly-regulated, presenting a potential link between CD and AD. In this work, we revealed that the phagocytosis of Aβ42 undergoes a daily circadian oscillation. We found the circadian timing of global heparan sulfate proteoglycan (HSPG) biosynthesis was the molecular timer for the clock-controlled phagocytosis of Aβ and that both HSPG binding and aggregation may play a role in this oscillation. These data highlight that circadian regulation in immune cells may play a role in the intricate relationship between the circadian clock and AD., Competing Interests: The authors have declared that no competing interests exist.

Background: Contingent vibratory feedback stimuli applied by a specially designed oral appliance (OA) have been reported to be effective in reducing sleep bruxism (SB). However, the inhibitory effects of the OA, which occur immediately after OA delivery, may have confounded this finding., Objective: This study sought to shed light on the effects of vibratory stimuli on SB after the OA adaptation period, when its inhibitory effects are diminished., Methods: Fourteen 'definite' SB patients were enrolled. A force-based bruxism detection system was utilised to trigger a vibrator attached to the OA. Masseter electromyographic activity during sleep was recorded at home using portable polysomnography. After using the OA without vibratory stimulus for 16 nights (adaptation period), intermittent vibratory stimuli were applied every other half-hour for four nights (intervention period). Electromyographic activity over 10% of the maximum voluntary contraction was regarded as a SB episode. The number and the total duration of SB episodes per hour of sleep were calculated for the sessions with and without stimuli separately and averaged for four intervention nights. The effects of stimuli on these two variables were evaluated., Results: The number and the total duration of the sessions without stimuli were 5.2 episodes/h and 35.3 s/h, respectively. These values significantly decreased to 3.9 episodes/h and 15.1 s/h (p < .05) for the sessions with vibratory stimuli., Conclusion: Contingent vibratory stimulus via an OA may be effective for the management of SB even after adaptation to OA., (© 2021 John Wiley & Sons Ltd.)

Purpose A systematic review was performed to determine the extent to which orthographic facilitation, a strategy to improve word learning, has been demonstrated in the literature for children and adolescents from clinical categories such as developmental language disorders (DLD), autism spectrum disorders (ASD), Down syndrome, dyslexia, hearing impairment, intellectual disability, and cerebral palsy. Method Five databases were searched for all studies published through December 2019. Eligible studies included participants from a clinical population (DLD, ASD, dyslexia, cerebral palsy, Down syndrome, hearing impairment, etc.) and compared word learning with and without orthography. Selected studies were extracted for pertinent information. In addition, assessment of the methodological rigor was performed for each study. Results The review yielded five studies that targeted word learning with orthographic facilitation for children from various clinical populations including DLD, verbal children with autism, Down syndrome, and dyslexia. All studied populations showed a benefit for word learning in picture naming posttests when words were trained in the presence of orthography. Conclusions For the studied populations, training words in the presence of orthography will improve word learning accuracy and retention. The review highlights the need for more research in this area across other clinical populations. Supplemental Material https://doi.org/10.23641/asha.14632791.

Physicians collect data in patient encounters that they use to diagnose patients. This process can fail if the needed data is not collected or if physicians fail to interpret the data. Previous work in orofacial pain (OFP) has automated diagnosis from encounter notes and pre-encounter diagnoses questionnaires, however they do not address how variables are selected and how to scale the number of diagnoses. With a domain expert we extract a dataset of 451 cases from patient notes. We examine the performance of various machine learning (ML) approaches and compare with a simplified model that captures the diagnostic process followed by the expert. Our experiments show that the methods are adequate to making data-driven diagnoses predictions for 5 diagnoses and we discuss the lessons learned to scale the number of diagnoses and cases as to allow for an actual implementation in an OFP clinic., (©2020 AMIA - All rights reserved.)

Objective: This study aims to verify the associations among sleep bruxism (SB), sleep arousal (SA) and concurrent body movements., Material and Methods: Subjects underwent a standard overnight polysomnography test and audio-video recordings. Sleep quality was evaluated according to the Rechtschaffen and Kales criteria, while SA was determined as per the American Sleep Disorders Association criteria. Analyses were performed by an external institution after masking of the subjects' information. SB was assessed based on the presence/absence of rhythmic masticatory muscle activity (RMMA) episodes, which were identified by using electromyography of the masseter muscle. The observed simultaneous movements included lower leg movement (LLM), swallowing, face scratching, head movement, body movement, eye blinking, coughing, licking, sighing, body scratching, lip sucking, somniloquy and yawning. The LLM was determined visually, as well as through an increase in the tibialis electromyogram signal. Other movements were visually assessed using audio-video recordings. The incidences of all the simultaneous movements were compared between RMMA with intercurrent SA (SAwRMMA; RMMA episode derived from a masseter electromyogram showing more than 10% of maximum voluntary contraction) and SA without RMMA (SAw/oRMMA)., Results: Fourteen subjects were included in this study (females/males: 4/10, mean age: 31.5 ± 5.7 years). Among these, LLM, swallowing, body movement, licking, body scratching and lip sucking were frequently observed in SAwRMMA episodes than in SAw/oRMMA episodes, significantly. However, the non-specific simultaneous movements were higher observed in SAw/oRMMA episodes than that in SAwRMMA., Conclusion: Our results suggest that SB is concurrently activated with LLM in relation to arousal., (© 2019 John Wiley & Sons Ltd.)

Purpose: Although sleep bruxism (SB) is one of the most important clinical problems in dental practice, there is no definitive method for controlling it. This pilot study evaluated the effects of contingent vibratory feedback stimuli using an occlusal splint for inhibition of sleep bruxism., Methods: Thirteen subjects with clinically diagnosed SB participated after providing an informed consent. Portable polysomnographic recordings were conducted in the subjects' home environment to make a definitive SB diagnosis and to evaluate the effects of the vibratory stimuli on SB. A force-based bruxism detection system, which used a pressure-sensitive piezoelectric film embedded in the occlusal splint, was utilized to trigger vibration feedback stimuli, which was scheduled to be applied intermittently for 30 min, at 30-min intervals., Results: The number of SB episodes (times/hour), the total SB duration (seconds/hour), the mean duration of SB episodes (seconds/episode), and the micro-arousal index (times/hour) were scored for each time period (with and without vibration). The effects of the vibration on these scores were tested (paired t test; p < 0.05). The number of SB episodes tended to decrease with the vibration stimuli, and the decrease in the total SB duration was statistically significant (14.3 ± 9.5 vs. 26.0 ± 20.0, p = 0.03). No substantial change was found in terms of the micro-arousal index., Conclusions: These study results suggested that the SB inhibitory system employing a vibratory stimulus might be able to suppress the total SB duration without disturbing sleep.

Aims: To conduct a systematic review and meta-analysis to determine the efficacy of low-level laser therapy (LLLT) in treating temporomandibular myofascial pain in adults compared to laser placebo., Methods: Randomized, placebo-controlled studies were identified by a search on March 2, 2016 and updated on February 9, 2017 in the PubMed, Web of Science, and Cochrane Library databases. Three of the authors assessed the studies for risk of bias. Outcomes included pain reduction on a visual analog scale (VAS) and interincisal opening., Results: The initial search strategy yielded 142 unduplicated references assessed independently by three review authors. After evaluation, this number was reduced to eight relevant studies for inclusion in this review. Of these eight studies, four were at unclear risk of bias and four were at high risk. In a meta-analysis, pain intensity was significantly reduced after treatment in the group that received LLLT as compared to laser placebo (an average of 2.2 units on a scale of 0 to 10) (P = .005) and an average of 2.4 units 3 to 4 weeks later (P = .022). Pooled results showed a significant increase in interincisal opening at 1 month after treatment (P = .012), but not when the treatment was completed (P = .079)., Conclusion: The findings from this systematic review showed that LLLT seems to be effective in reducing pain in patients with temporomandibular myofascial pain with moderate-quality evidence. However, due to the high heterogeneity, small number, and high risk of bias of the included studies, the results are not definitive, and further well-designed studies are needed.

The dynamics of weakly magnetized collisionless plasmas in the presence of an imposed temperature gradient along an ambient magnetic field is explored with particle-in-cell simulations and modeling. Two thermal reservoirs at different temperatures drive an electron heat flux that destabilizes off-angle whistler-type modes. The whistlers grow to large amplitude, δB/B&#95;{0}≃1, and resonantly scatter the electrons, significantly reducing the heat flux. Surprisingly, the resulting steady-state heat flux is largely independent of the thermal gradient. The rate of thermal conduction is instead controlled by the finite propagation speed of the whistlers, which act as mobile scattering centers that convect the thermal energy of the hot reservoir. The results are relevant to thermal transport in high-β astrophysical plasmas such as hot accretion flows and the intracluster medium of galaxy clusters.

Objective: Management of medication-related osteone-crosis of the jaw (MRONJ) with active infection can be a serious challenge for clinicians. Based on Association of Oral and Maxillofacial Surgeons (AAOMS) recommendations, we have tested a modified treatment protocol using topical minocycline., Study Design: Five patients diagnosed with stage II or III MRONJ lesions were willing to consent to our protocol. In addition to conventional treatment as suggested by the AAOMS, such as, surgical debridement, chlorhexidine irrigation, and systemic antibiotics, we applied 10% minocycline to the lesions once a week for sustained local antibiotic delivery., Results: All five patients reported pain relief after the first minocycline application. Complete healing occurred in three patients; case three healed completely after the third application, one case continues to improve toward resolution and one withdraws due to other non-relevant medical problem., Conclusions: In this study, we are reporting favorable results using a modified protocol with topical minocycline to treat MRONJ lesions., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Orofacial movement disorders (OMDs) include dystonia, dyskinesia, drug-induced extrapyramidal reactions, and bruxism. The definition, epidemiology, pathophysiology, clinical features, and management are detailed. OMDs are often disabling and affect patients' overall quality of life with pain, difficulty chewing food, speech difficulty, drooling, and social embarrassment. Management involves medications, botulinum toxin injections, and peripheral or central surgery. Botulinum toxin injections are the most effective management, often used in conjunction with medications. Surgery is the last resort for patients who fail to respond to medications or develop resistance to botulinum toxin type A., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Although oral appliances (OAs) have become widely used for the management of obstructive sleep apnea (OSA), side effects of OAs are generally related to poor utilization. The purpose of the present study was to evaluate relationship between utilization and treatment efficacy of a boil-and-bite appliance for OSA patients. A total of 135 patients with OSA who had used an OAs were mailed a questionnaire to determine whether they were currently using the OA. If so, they were asked about OA use, improvement of signs and subjective symptoms, and utilization. Otherwise, they were asked to indicate why and when they quit using the OA. Results of overnight polysomnography (PSG) before and after treatment were reviewed. Of the 48 responding patients, 33 patients were currently using the OA. The most common complication was excessive salivation ( n  = 11). All indices from PSG excluding arousal index were significantly improved after treatment ( p  < 0.05). Thirty patients showed improved signs and subjective symptoms. Eight out of 12 subjects (66.7%) were successfully treated, achieving an apnea-hypopnea index (AHI) < 10/h and >50% reduction in apnea-hypopnea index. Of the 15 patients no longer using the OA, the primary reason for quitting was "no treatment effect" ( n  = 5). No indices from PSG recording differed between before and after treatment in the not-using group. These results suggest that both subjective and objective signs and symptoms improved with use of the OA in the using group. However, no signs and subjective symptoms or indices of sleep quality differed between before and after treatment in the not-using group. Device improvements are needed to achieve better treatment efficacy, and thus improve compliance. The present study evaluated relationship between utilization and treatment efficacy of a boil -and bite appliance for OSA patients. Device improvements are needed to achieve better treatment efficacy, thus improve compliance.

Background: The authors of this systematic review and meta-analysis assessed the utility of serum C-telopeptide cross-link of type 1 collagen (sCTX), a biomarker of bone resorption, as a predictor of the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ)., Types of Studies Reviewed: The authors searched for studies involving adult participants, written in English, and published through January 20, 2016, using the following electronic databases: the Cochrane Library, MEDLINE via PubMed, and Web of Science. They also searched Google Scholar and the reference lists of all eligible trials and reviews. They identified 16 articles that met their inclusion criteria (9 controlled studies and 7 case series). They applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews and meta-analyses. They independently extracted data in duplicate, including the characteristics of study participants, risk factors, control groups, and outcomes. They assessed risk of bias, and they resolved any disagreements between review authors through discussion., Results: A meta-analysis with 9 controlled studies revealed no significant difference in mean sCTX values between patients with BRONJ and control participants (difference in means, -31.417; 95% confidence interval [CI], -91.560 to 28.726; P = .306). A second meta-analysis with 4 studies showed no significant difference in risk of having an sCTX value below 150 picograms per milliliter for patients with BRONJ compared with control participants (risk ratio, 1.892; 95% CI, 0.636-5.626; P = .251)., Conclusions and Practical Implications: A systematic review of the literature with meta-analysis does not support the use of sCTX levels as a predictor of the development of BRONJ. Further prospective large sample studies are needed to understand the role of sCTX as a predictor for BRONJ., (Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the efficacy of a botulinum toxin type A (BoTN-A) in treating trigeminal neuralgia (TN) and postherpetic neuralgia (PHN)., Study Design: Three databases were searched: Medline, Web of Science, and Cochrane Library. The search was restricted to English-language randomized, placebo-controlled trials. Three review authors evaluated the cases for risk of bias., Results: Six studies were eligible for inclusion. Pooled results showed a difference in post-treatment pain intensity of -3.009 (95% confidence interval -4.566 to -1.453; P < .001) in favor of BoTN-A compared with placebo in managing TN or PHN. Of the six studies, five had unclear risk of bias, and one showed high risk., Conclusions: Although the studies had unclear or high risk of bias, moderate evidence regarding the efficacy of BoTN-A in treating TN and PHN was found. BoTN-A might be an alternative treatment to those patients who are either unable to manage their pain medically or would like adjunct therapy., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Aims: To conduct a systematic review to determine the efficacy of oral medications for the management of postherpetic neuralgia (PHN)., Methods: Three electronic databases were searched: Cochrane Library (up to 7 July 2015), MEDLINE via PubMed (from 1950 to 7 July 2015), and Web of Science (1864 to 7 July 2015). Studies were limited to double-blind, placebo controlled, randomized controlled trials on oral medications used to treat PHN. Risk of bias was independently assessed in duplicate., Results: A total of 256 abstracts were screened by two independent reviewers and 26 full-text articles were assessed for eligibility. A total of 11 relevant articles were selected for inclusion. These 11 articles were included in a qualitative synthesis and 8 were included in a meta-analysis; however, all the included studies had a high or unclear risk of bias and the interventions were heterogenous. In a subgroup analysis of five studies, anticonvulsants (gabapentin, pregabalin, and divalproex sodium) were found to improve short-term pain intensity (standardized mean difference [SMD] = -0.484, 95% confidence interval [CI] = -0.622 to -0.346, P < .001). In a second subgroup analysis of five studies, it was found that patients taking anticonvulsants were 2.5 times as likely to have a 50% or more reduction in pain after treatment than patients taking placebo., Conclusion: This review has provided favorable but low-quality evidence to support the use of anticonvulsants for PHN. Although statistically significant effects were observed for posttreatment pain and the percent of responders, the number of studies in each subgroup analysis for anticonvulsants was small and the included studies had high or unclear risk of bias. Further high-quality methodologic studies are needed to explore the effects of orally administered anticonvulsants for PHN.

Background: The authors' objective was to determine whether scientific evidence supports the use of oral premedication to increase the efficacy of inferior alveolar nerve block (IANB) and to decrease endodontic treatment pain in patients with diagnosed irreversible pulpitis., Types of Studies Reviewed: The authors included randomized controlled trials that involved enteral premedication and 2% lidocaine IANB for adults with irreversible pulpitis compared with placebo. In particular, the authors reviewed studies comparing nonsteroidal anti-inflammatory drugs (NSAIDs), benzodiazepines, acetaminophen, and corticosteroids with placebo. The authors searched the following electronic databases: the Cochrane Library, MEDLINE, and Web of Science., Results: The authors analyzed 9 randomized controlled clinical trials. Patients who took the NSAIDs under study, including ibuprofen, ketorolac, diclofenac, indomethacin, and lornoxicam, 1 hour before endodontic treatment showed statistically significant improvement in the outcome of having "little or no pain" during endodontic treatment compared with patients who took a placebo 1 hour before endodontic treatment (risk ratio [RR], 1.989; 95% confidence interval [CI], 1.495-2.646; P < .001). Benzodiazepines were not as well represented in the literature, but the 2 included studies did not show a significant improvement in patients' having "little or no pain" during endodontic treatment over placebo (RR, 0.989; 95% CI, 0.677-1.444; P = .954)., Conclusions and Practical Implications: There is moderate evidence to support the use of oral NSAIDs-in particular, ibuprofen (600 milligrams)-1 hour before the administration of IANB local anesthetic (1.8-3.6 milliliters of 2% lidocaine) to provide additional analgesia to the patient., (Copyright © 2016 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate correlations between serotonin transporter (SERT) uptake ability in human peripheral platelets and sleep bruxism (SB) frequency., Methods: Subjects were consecutively recruited from sixth-year students at Okayama University Dental School. Subjects were excluded if they (1) were receiving orthodontic treatment, (2) had a dermatological disease, (3) had taken an antidepressant within 6 months, or (4) had used an oral appliance within 6 months. SB frequency was determined as the summary score of three consecutive night assessments using a self-contained electromyography detector/analyzer in their home. Fasting peripheral venous blood samples were collected in the morning following the final SB assessment. SERT amount and platelet number were quantified via an ELISA assay and flow cytometry, respectively. Functional SERT characterization, 5-hydroxytryptamine (5-HT) uptake, maximum velocity (V max), and an affinity constant (K m ) were assessed with a [(3)H] 5-HT uptake assay. The correlations between these variables and SB level were evaluated., Results: Among 50 eligible subjects (26 males, mean age 25.4 ± 2.41 years), 7 were excluded because of venipuncture failure, smoking, and alcohol intake during the experimental period. A small but significant negative correlation between SB level and [(3)H] 5-HT uptake was observed (Spearman's correlation R (2) = 0.063, p = 0.04). However, there were no significant correlations between SB level and total platelet amount, SERT, V max, and K m values (p = 0.08, 0.12, 0.71, and 0.68, respectively)., Conclusions: Platelet serotonin uptake is significantly associated with SB frequency, yet only explains a small amount of SB variability.

The purpose of this systematic review and meta-analysis was to compare the prognosis of patients with p16 expressing oropharyngeal squamous cell cancers to patients with p16 non-expressing cancers. Clinical outcomes that were evaluated included overall survival, local recurrence, disease-free survival, disease-specific survival, and event-free survival. The following electronic databases were searched: Cochrane Library, MEDLINE (via Pubmed), and Web of Science. Publications were restricted to English language. Studies were limited to controlled clinical trials on the survival rates of patients with oropharyngeal tumors that were p16 expressing, compared to patients with p16 non-expressing tumors, and at least one clinical endpoint reported by trial authors (hazard ratios). Specific ascertainment criteria were applied for inclusion and exclusion of eligible studies. Data was independently extracted in duplicate. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis PRISMA checklist. Risk of bias was assessed for all included studies, and disagreements between review authors were discussed until an agreement was reached. Eighteen studies were included for final review and meta-analysis. The subgroup meta-analyses, which included survival and recurrence data, showed significantly favorable outcomes for patients with p16 expressing tumors. There is strong evidence to support that patients with p16 expressing oropharyngeal squamous cell cancers have favorable clinical outcomes and prognosis., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The previous reports suggest that obstructive sleep apnoea (OSA) is related to metabolic syndrome, mineral metabolism disorders and cardiovascular disease. In addition, a possible relationship between obesity and the calcification of ligaments has been implied. However, the potential link between OSA and the calcification of ligaments has not been directly studied. In this present study, to investigate the potential link between OSA and the calcification of ligaments, we examined the prevalence of the calcification of ligaments in OSA patients and the relationship between these findings and OSA severity. Eighty consecutive patients (60 males, 20 females) diagnosed as OSA or a heavy snorer based on full-night polyso-mnography were retrospectively recruited from May 2006 to July 2008. Each patient underwent cephalometric imaging examination before the arrangement of an oral appliance. One calibrated observer (YS) reviewed the cephalometric images for the presence of calcification of the nuchal ligament and osteophytes of the cervical spine. The prevalence of calcification of the nuchal ligament in OSA patients and snorers was 46.3% (males: 52%, females: 30%) There was a significant positive correlation between the severity of OSA (AHI) and the calcification of the nuchal ligament before and after adjusting for BMI. The prevalence of the calcification of the nuchal ligament in OSA subjects and snorers was higher than in previous studies with non-OSA subjects. In addition, it is suggested that the severity of OSA correlates with the presence of calcification of the nuchal ligament., (© 2015 John Wiley & Sons Ltd.)

Purpose: This review article covers the diagnosis and treatment of obstructive sleep apnea (OSA) from a dental perspective. It addresses the issue of when and how to screen for and then, if indicated, refer the patient for a more comprehensive., Study Selection: Our focus in this article was on identifying current unanswered questions that relevant to OSA problems that dental scientists have to pursue and on providing valuable information on that problems, consequently the previous studies which investigated or reviewed the diagnosis and treatment of OSA were included. In addition, we included studies on jaw movements during sleep and on the use of a lateral cephalometric film related to the diagnosis and treatment of OSA., Results: The role of portable sleep monitoring devices versus full laboratory polysomnography is discussed. This review also describes what is known about the efficacy of mandibular advancement devices and when and how they fit in to a treatment program for a patient with obstructive sleep apnea. Finally some basic research is presented on jaw movements during sleep and how a lateral cephalometric film can be used to assess the changes of the airway with body posture and head posture., Conclusion: This article provides the valuable suggestions for the clinical questions in the diagnosis and treatment of OSA., (Copyright © 2015. Published by Elsevier Ltd.)

Purpose: The aim of this study was to evaluate the correlation between sleep bruxism (SB) frequency and serotonin transporter (SERT)-driven serotonin (5-HT)-uptake in platelets., Methods: Subjects were dental trainee residents and faculty members of Okayama University Hospital who were aware of having severe or no SB. SB frequency was assessed for 3-consecutive nights by a self-contained electromyographic detector/analyzer, which indicated individual SB levels as one of four grades (score 0, 1, 2 and 3). Subjects were classified as normal control (NC) when SB scores indicated only 0 or 1 during the 3 nights, or as severe SB for scores 2 or 3. Those subjects whose scores fluctuated from 0 to 3 during the 3 nights were omitted from further analysis. Fasting peripheral venous blood samples were collected in the morning following the final SB assessment. Amounts of SERTs proteins collected from peripheral platelets were quantified using ELISA, and SERTs transport activity was assessed by uptake assay using [3H]-5-HT., Results: Thirteen severe SB subjects and 7 NC subjects were eligible. Gender distribution, mean age, 5-HT concentration and total amounts of SERT protein in platelets showed no significant differences between NC and severe SB (p=0.85: Chi-squared test; p=0.64, 0.26, 0.46: t-test). However, [3H]-5-HT uptake by platelets was significantly greater in NC compared to severe SB subjects (12.79±1.97, 8.27±1.91 fmol/10(5) platelets/min, p<0.001, t-test)., Conclusion: The results of this pilot study suggest a possible correlation between peripheral platelet serotonin transporter uptake ability and SB severity., (Copyright © 2014 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.)

Cultural competence is considered an important skill in health care delivery; accordingly, it requires an effective and efficient course of training. Web-based teaching has increasingly been used in medical education with a few reports also in the dental field; however, there is a lack of evidence of its full application and usefulness. The objective of this study was to evaluate the efficacy of web-based case scenarios in comparison with seminar-based training to deliver cultural competency material to the health care provider in training. Eighty-one fourth-year dental students attending a mandatory Special Patients' Care clinical rotation were randomly allocated to receive first either a session of seminar or web-based case scenarios on cultural competence, with all students receiving a manual containing information about various cultures and the issues of cultural diversity on the first day of the training. All students underwent pre- and post-training examinations, which were conducted using a multiple-choice questionnaire and a self-analytic evaluation. Both the seminar and the web-based case scenarios resulted in significant improvement (p≤0.001) of scores comparing the pre- and posttest outcomes. Training either as a seminar or a series of web-based case scenarios combined with written material presented in a manual was found to increase students' cultural competence.

Background: The narrowest area of the airway between the posterior nasal opening and the epiglottis is usually located in the retro palatal area. Many consider this the most likely site of airway obstruction during an obstructive sleep apnea (OSA) event. The aim of this study was to investigate the differences in soft palate and airway length between OSA and non-OSA patients., Methods: In this study, we analyzed the ratio of the soft palate and the upper airway length in 45 consecutive patients. Twenty-five had an Apnea-Hypoapnea Index of more than 5 events per hour and were classified in the OSA group (male, 19; female, 6). These patients were compared with 20 normal controls (male, 12; female, 8). Controls who complained of snoring did have sleep studies (n = 5). The other fifteen controls were clinically asymptomatic and did not have sleep studies. Medical computed tomography scans were taken to determine the length of the upper airway and the soft palate length measured in the midsagittal image., Results: Soft palate length was significantly larger in OSA patients compared to controls (p = 0.009), and in men compared to women (p = 0.002). However, there were no differences in airway length. The soft palate length, as a percent of oropharyngeal airway length, was significantly larger in OSA patients compared to controls (p = < 0.0001) and in men compared to women (p = 0.02). Soft palate length increases significantly with age by 0.3 mm per year in males (after adjustment for body mass index (BMI) and OSA). Soft palate length as a percent of airway length is larger in OSA patients and increases significantly with BMI in males only after adjusting for age., Conclusion: In this study, OSA patients had a longer soft palate in proportion to their oropharyngeal airway compared to controls as well as men compared to women. This proportion could be used for identifying patients at risk for OSA in combination with age.

Purpose: Small, self-contained electromyographic (EMG) detector/analyzer (D/A) devices have become available for the detection of jaw muscle activity events above threshold. These devices claim to be less intrusive to the subjects sleep so it is less prone to induce disturbed sleep. The objective of this study was to evaluate for night-to-night variability and examine for a systematic alteration on the first night in EMG levels., Methods: Ten asymptomatic healthy volunteers (mean age, 26.8 ± 3.78) were recorded for six sequential nights in their home environment using EMG D/A system. The device yields a nightly EMG level above threshold score on a 0-4 level. Because the data are categorical and nonparametric, the data of the ten subjects across six nights were submitted to a Friedman repeated measures ANOVA. The significant level was set as alpha equal to 0.05., Results: The median and mode values of the subjects were tabulated and analyzed and we did not find a significant difference in EMG D/A level across the six nights (p = 0.287, Kendall's coefficient of concordance = 0.124, Friedman two-way repeated measures ANOVA). The data did show clear and substantial night-to-night variability., Conclusion: Substantial night-to-night variability in masseter EMG activity levels was clearly observed in our subjects. There was no evidence of a suppressed or elevated first-night effect-like variability on masseter muscle EMG level seen in these subjects using a small portable self-contained EMG detector/analyzer. These data suggest that recordings should be at least 5-6-nights duration to establish a reasonable measure of an individual's average nightly masseter EMG level.

Objective: The objective of this study was to compare the incidental radiographic findings in the maxillofacial structures and the pharyngeal airway between subjects with moderate/severe obstructive sleep apnea (OSA) and mild OSA/healthy subjects using cone-beam computed tomography (CBCT) scans., Study Design: A total of 53 subjects with moderate/severe OSA (with a Respiratory Disturbance Index [RDI] ≥ 15 events/h) and 33 mild OSA/healthy subjects (RDI < 15), based on ambulatory somnographic assessment, were recruited. Supine CBCTs were taken and sent for radiological report. The incidental findings were compared between the 2 groups., Results: Moderate/severe subjects had larger prevalence of conchae bullosa, hypertrophic turbinates, hypertrophic tonsils, elongated or posteriorly placed soft palate, narrower airway, enlarged tongue, and focal calcifications, although no significant differences were found., Conclusions: CBCT is useful in identifying maxillofacial and airway anomalies that could interfere with normal breathing; however, no significant difference was found in prevalence of incidental findings between subjects with moderate/severe OSA and mild OSA/healthy subjects. Further studies are necessary to generalize our results., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Occlusal dysesthesia refers to a persistent complaint of uncomfortable bite sensation with no obvious occlusal discrepancy. This systematic review aimed to draw a picture of such patients, to present an agreement of previously reported diagnostic criteria and to analyse the evidence level of the recommended management approaches. An electronic search for all relevant reports on occlusal dysesthesia was thoroughly performed based on previous nomenclatures (e.g. phantom bite, occlusal hyperawareness) in PubMed and The Cochrane Library in July, 2011. A total of 84 reports were matched, among which only 11 studies were included after a two-step (abstract and detailed full-text revision) screening process. Additionally, a thorough manual review of reference lists of the included reports enabled the inclusion of two additional studies. Data analysis revealed that 37 occlusal dysesthesia patients presented a mean age of 51.7 ± 10.6 years and were predominantly women (male/female: 1/5.1) with symptom duration of more than 6 years (average: 6.3 ± 7.5 years) and with concomitant psychological disturbances (e.g. mood disorders, somatoform disorders, personality disorders). Only four authors presented diagnostic criteria for occlusal dysesthesia, which served as the basis for an agreement in the diagnostic criteria. Treatment approaches included psychotherapy, cognitive/behaviour therapy, splint therapy and prescription of anti-depressants or anti-anxiety drugs. Classification of evidence level of management approaches, however, revealed that most of them were expert opinions with single- or multiple-case report(s). Future studies are necessary for a deeper understanding of the mechanisms behind the occlusal dysesthesia symptoms, and consequently, for improvements in evidence-based management approaches., (© 2012 Blackwell Publishing Ltd.)