Objectives/Hypothesis
Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/hypopnea syndrome (OSAHS). ...The main aim of this review was to assess the effectiveness of different devices in treating OSAHS, based on polysomnographic measurements such as the apnea/hypopnea index (AHI) and oxygen saturation, and on changes in the upper airway and improvements in the most common symptoms: snoring and somnolence. Their adverse effects were also noted.
Study Design
Systematic review.
Methods
Following an exhaustive search in the Medline, Scopus, and Cochrane Library databases, 22 articles published in the past 10 years met the quality and inclusion criteria.
Results
Using mandibular advancement devices during the hours of sleep helps to prevent snoring and excessive daytime sleepiness, reduce the AHI significantly, and bring about beneficial changes in the upper airway. Adjustable and custom‐made mandibular advancement devices give better results than fixed and prefabricated appliances. Monobloc devices give rise to more adverse events, although these are generally mild and transient.
Conclusions
Mandibular advancement devices increase the area of the airway. They bring the soft palate, tongue, and hyoid bone forward and activate the masseter and submental muscles, preventing closure. All these effects reduce the AHI, increase the oxygen saturation, and improve the main symptoms of OSAHS.
Level of Evidence
NA Laryngoscope, 126:507–514, 2016
The purpose of this study was to assess the validity and reliability of the Spanish version of PIDAQ for application in adolescents.
The questionnaire was translated, cross-culturally adapted and ...completed by 627 adolescents (366 12-year-olds and 261 15-year-olds). The adolescents were also examined by 4 examiners who had been calibrated against a gold standard and relative to each other (Kappa >0.85) in determining treatment need with the Dental Aesthetic Index (DAI) and the Index of Orthodontic Treatment Need (IOTN) DHC and AC components.
Cronbach's alpha of the translated PIDAQ was 0.90. The 23 items of the questionnaire were divided into four domains that explained 60% of the variance. The test-retest reliability of the questionnaire was 0.93. Discriminant validity revealed a significant association between the scores for the questionnaire and its subscales or domains and those for the DAI, IOTN-DHC and IOTN-AC treatment need indices. Adolescents with orthodontic treatment need scored higher in the questionnaires.
The results show that the Spanish version of PIDAQ has a very similar internal structure and psychometric properties to those of the original questionnaire and demonstrate its validity for use with Spanish adolescents.
To assess the oral health status of the child population and its evolution over the 2004-2010 period.
A descriptive cross-sectional study of the entire schoolchild population of the Valencia region ...of Spain was conducted using cluster sampling. Seventy schools were selected. The sample size was 1373 pupils, aged 6, 12 and 15 years. The children were examined in November and December 2010, at their schools, by 6 examiners calibrated in the ICDAS II method. The descriptive statistics, comparison of means and comparison of proportions (p<0.05) were recorded.
The caries prevalence (ICDAS 4-6>0) was 30% in primary dentition at 6 years and 37.7% and 43.6% in permanent dentition at 12 and 15 years respectively. At 6, 12 and 15 years, the df.t/DMF. TICDASII 4-6 scores were 0.98, 0.83 and 1.08, the df.s/DMF.SICDASII 4-6 scores were 1.43, 1.27 and 1.64 and the care index results were 14.3%, 59% and 71.3% respectively.
Both the caries indices (df.t at 6 years and DMF.T at 12 and 15) and caries prevalence have improved, as the values obtained were lower than in 2004. Using the comparison at 95% CI, between both years, the improvement was only noticeable in the 15 year-old group. The care index continued to be low at 6 years of age but higher values than in 2004 were found at 12 and 15 years. Social class continued to influence the child caries indicators.
Of the five nerves that innervate the foot, the one in which anesthetic blocking presents the greatest difficulty is the tibial nerve. The aim of this clinical trial was to establish a protocol for ...two tibial nerve block anesthetic techniques to later compare the anesthetic efficiency of retromalleolar blocking and supramalleolar blocking in order to ascertain whether the supramalleolar approach achieved a higher effective blocking rate. A total of 110 tibial nerve blocks were performed. Location of the injection site was based on a prior ultrasound assessment of the tibial nerve. The block administered was 3 mL of 2% mepivacaine. The two anesthetic techniques under study provided very similar clinical results. The tibial nerve success rate was 81.8% for the retromalleolar technique and 78.2% for the supramalleolar technique. No significant differences in absolute latency time (p = 0.287), percentage of effective nerve blocks (p = 0.634), anesthetic block duration (p = 0.895), or pain level during puncture (p = 0.847) were found between the two techniques. The greater ease in locating the tibial nerve at the retromalleolar approach could suggest that this is the technique of choice for tibial nerve blocking, especially in the case of professionals new to the field. The supramalleolar technique could be worth considering for those more experienced professionals.
A cross-sectional study was carried out to determine the prevalence of Streptococcus mutans and Streptococcus sobrinus and the association of the two in a random sample (n=614) of the child ...population of the region of Valencia (Spain). Saliva samples were analyzed by the quantitative polymerase chain reaction (PCR) method to study the relation of these bacteria to caries prevalence and the DMFT index. The prevalence of S. mutans was 35.4% at age 12 and 22.9% at age 15, that of S. sobrinus 18.9% and 8.4% and that of the S. mutans-S. sobrinus association 18.2% and 6.8% respectively. At both 12 and 15 years of age, the caries prevalence rates were lower in the Streptococcus-free group of children (37.6% and 48.5% respectively) and higher in the S.mutans-only group (67.3% and 74.0%). At the age of 12, the DMFT index was significantly higher in the mutans-only carriers (2.1) than in the Streptococcus-free and S. mutans-S. sobrinus association groups (both 0.9). At the age of 15, the DMFT index was significantly higher in the S. mutans-S. sobrinus association (3.71) and mutans-only (3.1) carrier groups than in the Streptococcus-free group (1.4). Determination of S. mutans and S. sobrinus by real-time quantitative PCR can provide valuable information for caries risk assessment in epidemiological studies.
In recent years the Valencia region has undergone mass immigration, mainly of people from eastern Europe, North Africa, and Latin America. The objective of this study was to assess the effect of ...immigration on caries prevalence and experience in 12‐ and 15‐yr‐old children in the Valencia region, and to relate this to other socio‐economic and oral hygiene‐related variables. The data were obtained from the epidemiological study of oral health carried out in the Valencia Region in 2004. The study group comprised 478, 12‐yr‐old children and 401, 15‐yr‐old children. Immigration status, age, toothbrushing frequency, and intake of cariogenic foods between meals showed significant association in a multiple linear regression model using the decayed, missing or filled teeth (DMFT) count as the dependent variable. Of all the predictive variables, the one that made the highest contribution to the model was immigration status. In a multiple logistic regression analysis with caries presence as the dependent variable, immigration status, intake of cariogenic foods, social class, and age were significantly associated with the presence of caries. As immigrant children have significantly higher caries levels than Spanish children, future public health service planning should pay attention to this risk group.
Orthodontic treatment need has often been assessed in child populations, but few studies employing internationally-recognized indices have been conducted in adult or young adult populations. The aim ...of this study was to determine the orthodontic treatment need of a young adult population in Spain by means of the Dental Aesthetic Index (DAI), the Index of Orthodontic Treatment Need (IOTN) and the need perceived by the patients.
A cross-sectional epidemiological study was conducted in a broad, representative sample of 671 adults aged between 35 and 44 years using health centers in the Valencia Region of Spain, following the recommendations of the World Health Organization (WHO).
Orthodontic treatment was required by 31.3% of the sample according to the DAI and 19.2% according to the IOTN (DHC). The orthodontic treatment need perceived by the patients was 21.1%. On relating treatment need to different variables, significant differences in patient perception were encountered by gender, as women perceived a greater need (23.9%) than men (14.4%). Significant differences in previous orthodontic treatment history were found between middle/high (15%) and low (9%) social class and between secondary/tertiary (14%) and primary (3.3%) education.
There was no agreement between the treatment need assessed objectively by the indices and that perceived by the patient, or between the indices themselves. The decision to undergo orthodontic treatment can depend on socioeconomic and psychological factors and on values and principles that do not easily lend themselves to objective measurement.
Cross-sectional study of malocclusion in Spanish children Almerich-Silla, José-Manuel; Montiel-Company, José-María; Bellot-Arcís, Carlos ...
Medicina oral, patología oral y cirugía bucal,
01/2014, Letnik:
19, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This study was conducted to determine the orthodontic treatment need of the child population of the Valencia region of Spain, employing the DAI and the IOTN, to examine the relations between ...treatment need, socio-economic data and gender and to assess the diagnostic agreement between the two indices.
A cross-sectional descriptive study was conducted in a random representative sample of the schoolchild population of the Valencia region of Spain. The sample size was a total of 765 children aged 12 and 15 years at 39 schools.
The orthodontic treatment need assessed by the DAI was 21.7% at 12 years of age and 14.1% at 15 years. The orthodontic treatment need assessed by the IOTN DHC was 20.9% at 12 years of age and 12.7% at 15 years. The diagnostic agreement between the DAI and the modified IOTN was moderate, with Kappa scores of 0.426 at 12 years of age and 0.415 for the 15-year-old group.
Approximately 20% of the children needed orthodontic treatment. Neither gender nor social class appeared to exert a significant influence on orthodontic treatment need.
Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. The aim of this ...systematic review is to identify predictors of the efficacy of oral appliance (OA) therapy for OSA in adult patients. This review focuses on performing the quantitative analysis by subgroups based on the response criteria used in the literature and based on the type of device. PubMed, EMBASE, Scopus, Web of Science and Cochrane databases was conducted to identify potentially relevant studies published until Dec 2021. The search identified 1343 preliminary references. A total of 99 studies met the eligibility criteria and were included in the review, and 60 in the meta-analysis. The quality of studies was assessed using the Newcastle–Ottawa scale and the Cochrane scale. Based on meta-analysis, and considering a low to moderate evidence profile according to the GRADE scale, responders are younger patients, with smaller neck circumference, lower body mass index. Responders have shorter maxillary length, lower anterior and posterior facial height, a shorter distance from the hyoid bone to the third cervical vertebra, a shorter airway length, a smaller minimum airway cross-sectional area and a higher minimum oxygen saturation during sleep. Responders needed a lower optimal continuous positive airway pressure than non-responders. The type of device has not affected the results of the meta-analysis. The criterion “AHI <10 and reduction AHI >50%” is the one that provides the “weight” of significance for several variables. This criterion should be taken into consideration for future studies to predict OSA treatment by OA.
To maintain high treatment quality it is important to evaluate orthodontic treatment results using objective methods. Outcome assessments allow private practitioners and university students to ...evaluate their results and raise the level of treatment outcomes. The aim of this study was to assess the orthodontic treatment outcome in a post-graduate orthodontics program in the University of Valencia (Spain) and to determine whether the treatment outcome is related to several factors as gender, age at start of the treatment, treatment duration, treatment method, extraction-non extraction treatment and cooperation needed.
A sample of 50 patients treated in the post-graduate clinic was randomly selected. Pre-treatment and post-treatment study casts have been assessed by the Peer Assessment Rating (PAR index). The influence of various factors: gender, age at start of the treatment, treatment duration, treatment method, extraction-non extraction treatment, cooperation needed and number of students finishing each case, were statistically analyzed.
According to the PAR index, orthodontic treatment reduced the malocclusion in a mean point reduction of 21.4 (CI 95% 18.7-24.1) and a mean percentage reduction of 80.5% (CI 95% 75.9-85.1). The total of the cases improved, 44% of the patients were in greatly improved category.
None of the variables studied influenced significantly the treatment outcomes regarding the PAR. Based on the general classification criteria of the index, the results showed that the patients received a high standard treatment. Key words:Treatment outcome, orthodontics education, PAR Index.
PDF
