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Πέμπτη 28 Ιανουαρίου 2021

Does the Presence of Spontaneous Components Affect the Reliability of Contralateral Suppression of Evoked Otoacoustic Emissions?

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Objectives: The function of the medial olivocochlear system can be evaluated by measuring the suppression of otoacoustic emissions (OAEs) by contralateral stimulation. One of the obstacles preventing the clinical use of the OAE suppression is that it has considerable variability across subjects. One feature that tends to differentiate subjects is the presence or absence of spontaneous OAEs (SOAEs). The purpose of the present study was to investigate the reliability of contralateral suppression of transiently evoked OAEs (TEOAEs) measured using a commercial device in ears with and without SOAEs. Design: OAEs were recorded in a group of 60 women with normal hearing. TEOAEs were recorded with a linear protocol (identical stimuli), a constant stimulus level of 65 dB peSPL, and contralateral broadband noise (60 dB SPL) as a suppressor. Each recording session consisted of three measurements: the first two were made consecutively without taking out the probe (the "no refit" condition); the third measurement was made after taking out and refitting the probe (a "refit" condition). Global (for the whole signal) and half-octave band values of TEOAE response levels, signal-to-noise ratios (SNRs), raw dB TEOAE suppression, and normalized TEOAE suppression, and latency were investigated. Each subject was tested for the presence of SOAEs using the synchronized SOAE (SSOAE) technique. Reliability was evaluated by calculating the intraclass correlation coefficient, standard error of measurement (SEM) and minimum detectable change. Results: The TEOAE suppression was higher in ears with SSOAEs in terms of normalized percentages. However, when calculated in terms of decibels, the effect was not significant. The reliability of the TEOAE suppression as assessed by SEM was similar for ears with and without SSOAEs. The SEM for the whole dataset (with and without SSOAEs) was 0.08 dB for the no-refit condition and 0.13 dB for the refit condition (equivalent to 1.6% and 2.2%, respectively). SEMs were higher for half-octave bands than for global values. TEOAE SNRs were higher in ears with SSOAEs. Conclusions: The effect of SSOAEs on reliability of the TEOAE suppression remains complicated. On the one hand, we found that higher SNRs generally provide lower variability of calculated suppressions, and that the presence of SSOAEs favors high SNRs. On the other hand, reliability estimates were not much different between ears with and without SSOAEs. Therefore, in a clinical setting, the presence of SOAEs does not seem to have an effect on suppression measures, at least when testing involves measuring global or half-octave band response levels. ACKNOWLEDGMENTS: The authors would like to thank Dr A. Bell and Dr E. Gos for stimulating discussions on earlier versions of the manuscript, and M. Ganc and M. Pastucha for help with data collection. The study was partially supported by grant OPUS 2014/15/B/NZ4/00700 financed by the Polish National Science Centre. Preliminary results of this study were presented at AAS 2016. The authors have no conflicts of interest to declare. Received April 24, 2020; accepted October 22, 2020 Address for correspondence: W. Wiktor Jedrzejczak, World Hearing Center, ul. Mokra 17, Kajetany 05-830 Nadarzyn, Poland. E-mail: w.wiktor.j@gmail.com Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Association between sleep bruxism and stress symptoms in adults: A systematic review and meta‐analysis

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Abstract

Aim

To synthesize and critically review the association between sleep bruxism (SB) and stress symptoms in adults.

Methods

A systematic review was performed. The search was completed using seven primary electronic databases in addition to a grey literature search. Two reviewers blindly selected studies based on pre‐defined eligibility criteria. Risk of bias of the included articles was performed using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross‐Sectional Studies. RevMan 5.4 was used to perform the meta‐analysis. The quality of evidence was evaluated according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results

Ten studies were included for qualitative analysis, of which three were included for quantitative analysis. Three studies were evaluated to have low risk of bias and seven were assessed with moderate risk of bias. Quality of evidence was classified as very low for all outcomes. Individuals with SB were found to have higher levels of some self‐reported stress symptoms as assessed through questionnaires with a mean difference of 4.59 (95% CI 0.26 to 8.92). Biomarkers like epinephrine, norepinephrine, cortisol, adrenaline, dopamine, noradrenaline and prolidase enzyme levels also showed a positive association with SB.

Conclusions

Although some associations were identified between probable SB and self‐ reported stress symptoms and biomarkers of stress in adults, given that the quality of evidence was found to be very low, caution should be exercised in interpreting these results. These findings suggest that additional and better designed studies are warranted in order to clarify the link between SB and stress.

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Catastrophising, pain self‐efficacy and acceptance in patients with Burning Mouth Syndrome

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Abstract

Background

Little is known about pain catastrophising, pain self‐efficacy and chronic pain acceptance in burning mouth syndrome (BMS) and their effect on health‐related quality of life (HRQoL) and symptoms of anxiety and depressive disorders.

Objectives

To describe pain catastrophising, pain self‐efficacy and pain acceptance in BMS patients and explore associations with affective function and HRQoL.

Methods

A cross‐sectional study of 36 BMS patients (31 female) referred to an Orofacial Pain Clinic completed the Pain Catastrophizing Scale, the Pain Self‐Efficacy Questionnaire and the Chronic Pain Acceptance Questionnaire‐8 in addition to standardised self‐reported questionnaires measuring mood and oral and generic HRQoL.

Results

Pain catastrophising levels were markedly higher than (non‐clinical) population norms, with 32.0% of patients reporting clinically relevant levels. Pain self‐efficacy and chronic pain acceptance varied widely; 24.0% evidenced low confidence to cope with pain, and 53.8% reported low activity engagement and/or low pain willingness. Catastrophising showed moderate‐to‐strong associations with measures of anxiety (r = 0.63), depression (r = 0.80), and oral (r = 0.61) and generic HRQoL (rho=−0.84). Self‐efficacy and acceptance were also closely related to levels of depression (r/rho=−0.83 to −0.73) and generic HRQoL (r/rho = 0.74 to 0.75). These associations were stronger than those between pain severity and affective function/HRQoL and persisted after controlling for pain severity.

Conclusions

A substantial proportion of BMS patients evidence maladaptive beliefs about personal effectiveness in managing pain, which is closely related to affective disorders and impaired HRQoL. As such, treatment approaches targeting catastrophising, pain self‐efficacy and acceptance may prove beneficial in improving mood and quality of life in BMS patients.

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Effects of preventing intercuspation on the precision of jaw movements

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ABSTRACT

Background

Closing movements are among the jaw's basic physiological motor actions. During functional movements, the jaw changes position continually, which requires appropriate proprioception. However, the significance of the various proprioceptive receptors involved and how they interact is not yet fully clear.

Objectives

This study's main objective was to test whether preventing intercuspation (IC) for 1 week would affect the precision of jaw‐closing movements into IC and the functional space of habitual chewing movements (HCM). A secondary objective was to compare precision of jaw‐closing movements into IC with the precision of movements into a target position (TP) far from IC.

Methods

Fourteen participants' HCM and jaw‐closing movements into IC were recorded on two sessions (T1 and T2) 1 week apart. Between sessions, participants wore posterior bite plates to prevent IC. They also received a 10‐minute training session at T1 to guide their jaw‐closing movements into TP. The precision of the closing movements into IC and TP was analysed. For HCM, the vertical amplitude, lateral width and area of chewing cycles were evaluated.

Results

The precision of jaw movements into IC increased as the jaw gap decreased, but precision did not differ significantly between T1 and T2. For HCM, the vertical amplitude and area of chewing cycles increased significantly between T1 and T2. The precision of the closing trajectory into TP increased significantly during the training session.

Conclusion

Our results confirm the excellent adaptability of the craniomandibular system, controlled by stringent motor programmes that are supported by continuous peripheral sensory input.

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Relative risk of positional and dynamic temporomandibular disc abnormality for osteoarthritis—magnetic resonance imaging study

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Abstract

Dynamic articular disc abnormality (wR, with reduction; woR, without reduction) is well known as the risk factor for temporomandibular joint osteoarthritis (TMJOA). However, there are few speculations on the potential risk of positional disc abnormalities for TMJOA. The purpose of this study was to investigate the relative risk of positional abnormality and dynamic abnormality of the temporomandibular disc for OA after the three‐dimensional interpretation of all the sagittal and coronal planes of magnetic resonance (MR) data in a large dataset of consecutive subjects. Experimental samples consisted of images of 1356 TMJs of patients. A diagnosis of disc state was established in each TMJ utilising a 1.5T MR imaging scanner. A binary logistic regression analysis was performed to identify the significant associations between the outcome (dependent variable: the presence of OA) and the predictors (covariates: age, sex, dynamic disc state [the presence of woR], and 5 categories of th e positional disc state [NA, no abnormality; SW, sideways; pADD, partial anterior; cADD, complete anterior; PDD, posterior]). Based on the result of the binary logistic regression analysis, the presence of woR showed an odds ratio of 14.1 (P < .05). In addition, compared with the joints NA, those with SW and cADD showed odds ratios of 5.62 and 10.88, respectively (P < .05). Despite the limitations of the study, in the positional disc abnormalities, sideways disc displacement and complete anterior disc displacement could be associated with the occurrence of TMJOA. All the coronal and sagittal MR images should be evaluated to assess intra‐articular joint disorders accurately.

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A comparative evaluation between the reliability of gypsum casts and digital greyscale intra‐oral scans for the scoring of tooth wear using the Tooth Wear Evaluation System (TWES)

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Abstract

Background

The Tooth Wear Evaluation System (TWES) is a type of tooth wear index. To date, there is the lack of data comparing the reliability of the application of this index on gypsum cast records and digital greyscale intra‐oral scan records.

Objectives

A comparative evaluation between the use of gypsum cast records and digital greyscale intra‐oral scan records with the reliability of tooth wear scoring using the TWES amongst a group of patients with tooth wear.

Methods

Records for 10 patients with moderate to severe tooth wear (TWES ≥ 2) were randomly selected from a larger clinical trial. TWES grading of the occlusal/incisal, buccal and palatal/lingual surfaces was performed to determine the levels of intra‐ and interobserver agreement. Intra‐observer reproducibility was based on the findings of one examiner only. For the interobserver reproducibility, the findings of two examiners were considered. One set of models/ records were used per patient. Cohen's weighted kappa (κW) was used to ascertain agreement between and within the observers. Comparison of agreement was performed using t tests (P < .05).

Results

For the scoring of the of the total occlusal/incisal surfaces, the overall levels of intra‐ and interobserver agreement were significantly higher using the gypsum cast records than with the digital greyscale intra‐oral scan records, (P < .001) and (P < .001), respectively. For the overall buccal surfaces, only a significant difference was found in the intra‐observer agreement using gypsum casts, (P = .013). For the palatal/lingual surfaces, a significant difference was only reported in the interobserver agreement using gypsum casts, (P = .043). At the occlusal/incisal surfaces, grading performed using gypsum casts, culminated in significantly higher TWES scores than with the use of the digital greyscale intra‐oral scans (P < .001). At the buccal and palatal/lingual surfaces, significantly higher wear scores were obtained using digital greyscale intra‐oral scan records (P& nbsp;< .009).

Conclusions

The TWES can offer a reliable means for the scoring of wearing occlusal/incisal surfaces using gypsum casts. The reliability offered by digital greyscale intra‐oral scans for consecutive scoring was in general, inferior.

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Effects of surgical mandibular advancement on the upper airways of adult class II patients: A systematic review with meta‐analysis

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Abstract

Aim

To systematically review the effects of surgical mandibular advancement (SMA) regarding changes of the upper airways in adult patients with skeletal Class II malocclusion.

Materials and Methods

Five electronic databases were searched up to April 2020. Human studies focusing on the morphology and dimension of the upper airways after SMA were included. 'Quality assessment for Before‐After (Pre‐Post) Studies' was used to assess the risk of bias of the individual studies. Standard mean differences (SMD) with 95% confidence intervals (CI) were calculated for random effect model meta‐analysis. The certainty of evidence was assessed using the GRADE tool.

Results

Twenty cohort studies of only treated patients without control group were eligible for qualitative synthesis, of which 17 were used for quantitative synthesis. Very low certainty of evidence indicated that SMA resulted in significant increase of the volume and of the smallest cross‐sectional area (SMC) of the nasopharynx (volume SMD: 1.43, CI: 0.62, 2.24, P = .001, I 2 = 87.8%; SMC SMD: 1.53, CI: 0.59, 2.47, P = .001, I 2 = 90.5%) and oropharynx (volume SMD: 1.36, CI: 0.37,2.35, P = .007, I 2 = 92.1%; SMC SMD: 1.21, CI: 0.11,2.32, P = .032, I 2 = 93.1%). Significant augmentation of the distances between the posterior pharynx wall and the uvala (SMD: 0.73, CI: 0.46,0.98, P < .001, I 2 = 72.7%), the posterior border of the tongue (SMD: 0.52, CI: 0.21,0.84, P = .001; I 2: 60.5%), the gonion (SMD: 1.24, CI: 0.56,1.91, P < .001; I 2 = 88.8%) and the epiglottis (SMD: 0.40, CI: 0.06,0.74, P = .033; I 2 = 84.8%) were observed.

Conclusions

Weak evidence suggests enlargement of the upper airways of adult Class II subjects following SMA, with major increases in the oropharynx.

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Sterile water; a novel and promising human experimental craniofacial muscle pain model

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Abstract

Background

The aim of this study was to investigate if intramuscular injection of sterile water can be used as a human experimental pain model that resembles clinical craniofacial muscle pain, and to analyze if the effects differ between sexes.

Methods

This randomized, double‐blind, placebo‐controlled cross‐over study included 30 healthy age‐matched women and men (23.6±2.4 years). At three sessions, with at least one week of wash‐out in between, 0.2mL of either sterile water (test‐substance), hypertonic saline (58.5mg/mL; active‐control) or isotonic saline (0.9mg/mL; passive‐control) were randomly injected into the right masseter muscle. Pain intensity (VAS) was continuously assessed during 5min whereafter pain duration (s) and pain area (au) were calculated pressure pain thresholds (PPT;kPa) were recorded every 5‐min during 30min.

Results

Sterile water evoked pain of similar intensity (74.5±49.9) as hypertonic saline (74.0±50.5), whereas isotonic saline evoked low‐intensity pain (11.4±23.4). The pain induced by sterile water and hypertonic saline had higher intensity (P<0.001), longer duration (P<0.001) and larger pain area (P<0.001) than isotonic saline. There were no significant differences in any pain variable between sterile water and hypertonic saline. The PPT did not change significantly after any substance, except for in women 5 min after sterile water injection (P<0.002). Pain duration was longer in the men for all substances (P<0.006), while the pain area was larger in women after injection of hypertonic saline (P<0.003).

Conclusion

These results indicate that pain evoked by sterile water resembles clinical muscle pain and may offer a novel and simpler alternative to hypertonic saline injections.

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Oral health‐related quality of life and associated factors in patients with burning mouth syndrome

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Abstract

Objective

The purpose of this study was to assess oral health‐related quality of life (OHRQoL) in patients with burning mouth syndrome (BMS) and to identify clinical factors associated with OHRQoL.

Methods

Fifty‐seven patients with BMS (56.4 ± 10.7 years) participated in the study. Patients underwent oral examination, laboratory tests, psychological evaluation, measurement of salivary flow rates and evaluation of clinical characteristics using a BMS questionnaire. The OHRQoL of patients was assessed using the Oral Health Impact Profile‐14 (OHIP‐14).

Results

The OHIP‐14 score for patients with BMS was 38.6 ± 12.8. Patients had higher scores for the psychological discomfort and physical pain dimensions of the OHIP‐14. The intensity of taste disturbance or xerostomia symptoms (β = 0.464, P < .001), worry about symptoms (β = 0.307, P = .020), and results of psychological evaluation (β = 0.311, P = .026) were significantly associated with OHIP‐14 score. Multiple linear regression showed that the intensity of taste disturbance or xerostomia symptoms was significantly associated with decreased OHRQoL (β = 0.637, P = .026).

Conclusions

This study suggests that severity of taste disturbance or xerostomia is an important factor that influences OHRQoL in patients with BMS.

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Changes in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders

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Abstract

Background

Menstrual cycle may contribute to experimental pain measures in healthy women and women with chronic pain.

Objectives

The present study aimed to investigate variation in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders (TMD) and to explore the effect of TMD pain and psychosocial variables on the pulp response.

Methods

This longitudinal study involved 47 regularly menstruating women aged 20‐45, 24 healthy and 23 with diagnosed painful TMD. The electric and cold stimuli were performed by electric pulp tester and refrigerant spray, respectively, on mandibular lateral incisors, in five menstrual phases (menstrual, follicular, periovulatory, luteal and premenstrual). Research Diagnostic Criteria for TMD were used to assess TMD, chronic pain, depression and somatisation. Regression analysis was performed to investigate the effect of the predictor variables on the pulp sensitivity.

Results

Significant phase‐related differences were observed for pain intensity to cold stimuli. Higher pain sensitivity was reported in menstrual in comparison with luteal phase (P = .019) among healthy women, and in menstrual in comparison with follicular (P = .033), periovulatory (P = .003) and luteal (P = .007) phases in TMD women. No significant differences were recorded for electric stimuli. Regression analysis identified depression as the determinant of cold and electric response in menstrual phase, regardless of age and presence of TMD.

Conclusion

Menstrual phase in healthy and TMD women with regular menstrual cycle is characterised with higher pulp sensitivity to cold stimuli. Depressive symptoms independently influence pulp response in this phase.

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Efficacy of oral myofunctional therapy in middle‐aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure

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Efficacy of oral myofunctional therapy in middle‐aged to elderly patients with obstructive sleep apnoea treated with continuous positive airway pressure

Apnoea‐hypopnea index values were significantly reduced after 6 months of MFT. Tongue pressures were significantly increased after 6 months of MFT. Half of the patients with moderate OSA successfully withdrew from CPAP.


Abstract

Background

Oral myofunctional therapy (MFT) is an effective treatment for mild‐to‐moderate obstructive sleep apnoea (OSA) in middle‐aged patients. However, few reports have described its use in elderly patients with moderate and severe OSA. Moreover, no studies have examined the relationship between changes in tongue pressure with MFT and the severity of OSA.

Objective

We conducted an interventional study using MFT to evaluate the effect of MFT on middle‐to‐senior‐aged patients with moderate or severe OSA and compared changes in apnoea‐hypopnea index (AHI) and tongue pressure.

Methods

Thirty‐two OSA patients (≥45 years) treated with continuous positive airway pressure (CPAP) were included. MFT was performed in parallel with CPAP. Three days after CPAP discontinuation, polysomnographies were performed and tongue pressures were measured before and after MFT.

Results

Patients were 69.3 ± 1.5 years old. After 6 months of MFT, AHI decreased significantly from 34.7 to 29.0/h (P = .03), while tongue pressure significantly increased from 35.9 to 45.6 kPa (P < .01). Seven patients (22%), including 6 of the 12 patients with moderate OSA (50%), experienced successful CPAP discontinuation.

Conclusions

MFT can be a useful intervention even among middle‐aged to elderly patients with OSA. Increased tongue pressure may have contributed to the AHI improvement.

Clinical trials: Trial registration at www.umin.ac.jp UMIN000027547.

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