Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation.
OBJECTIVE
The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms.


METHODS
Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 +/- 17.0 months.


CONCLUSIONS
The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 +/- 5.0 to 6.9 +/- 2.6 (p < or = 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients.


CONCLUSIONS
We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.
Institute of Research and Development IP&D, University of Vale do Paraíba, São Paulo, Brazil. odontogiannasi@uol.com.br
Lílian C
LC
Giannasi
Fernanda R
FR
Almeida
Márcio
M
Magini
Maricília S
MS
Costa
Cláudia S
CS
de Oliveira
Júlio César Mendes
JC
de Oliveira
Sandra
S
Kalil Bussadori
Luis Vicente F
LV
de Oliveira
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D016382:Orthodontic Appliance Design; D009968:Orthodontic Appliances, Removable; D017060:Patient Satisfaction; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013704:Temporomandibular Joint / Q000503:physiopathology*; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis / Q000503:physiopathology