title: Analysis of the influence of a mandibular advancement device on sleep and sleep bruxism scores by means of the BiteStrip and the Sleep Assessment Questionnaire.
abstract: OBJECTIVE
  A before-and-after experimental clinical study was carried out with the objective of evaluating the effect of a mandibular advancement device (MAD; 75% advancement), made of a thermoplastic material, on sleep bruxism (SB) and sleep scores.
  
  
  METHODS
  After a habituation period of 1 week, SB scores were taken at baseline and after use of the MAD for 30 days. Scores were compared using the newly developed BiteStrip, which registers the number of contractions of the unilateral masseter muscle after a 5-hour period, giving a severity score from 0 to 3 after the registrations. To assess sleep, the Sleep Assessment Questionnaire (SAQ), a screening tool with scores ranging from 0 to 68, was used before and after use of the MAD. Twenty-eight subjects (13 women, 15 men; mean age: 42.9 +/- 12.0 years) with a clinical history of SB and no spontaneous temporomandibular disorder (TMD) pain were selected. The clinical diagnosis of either moderate or severe SB was further confirmed through use of the BiteStrip (scores 2 or 3) at baseline. A 30-day follow-up period was used for evaluation. Both methods were validated against polysomnography. In addition, common signs and symptoms of TMD based on the Research Diagnostic Criteria for Temporomandibular Disorders were also evaluated before and after use to assess the side effects of the MAD.
  
  
  RESULTS
  There was a statistically significant improvement in both SB and sleep scores based on the BiteStrip and the SAQ (Wilcoxon signed rank and Student paired t test, P < .05). In the signs and symptoms of TMD, there was a significant reduction in temporomandibular joint sounds as well as in masseter and temporalis tenderness to palpation. None of the SB subjects experienced any breakage of the MAD.
  
  
  CONCLUSIONS
  The MAD had a positive effect on SB and sleep scores, measured by the BiteStrip and the SAQ, respectively, and did not increase any traditional signs and symptoms of TMD in a 30-day evaluation period.
authors.affiliation: Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Aline C
authors.initials: AC
authors.lastname: Saueressig
authors.forename: Vivian C
authors.initials: VC
authors.lastname: Mainieri
authors.forename: Patricia K
authors.initials: PK
authors.lastname: Grossi
authors.forename: Simone C
authors.initials: SC
authors.lastname: Fagondes
authors.forename: Rosemary S A
authors.initials: RS
authors.lastname: Shinkai
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Lima
authors.forename: Eduardo R
authors.initials: ER
authors.lastname: Teixeira
authors.forename: Márcio L
authors.initials: ML
authors.lastname: Grossi
mesh_terms: D000328:Adult; D004576:Electromyography / Q000295:instrumentation; D004867:Equipment Design; D005157:Facial Pain / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation*; D008406:Masseter Muscle / Q000503:physiopathology; D055617:Micro-Electrical-Mechanical Systems / Q000295:instrumentation*; D009119:Muscle Contraction / Q000502:physiology; D016382:Orthodontic Appliance Design; D017286:Polysomnography; D015203:Reproducibility of Results; D012890:Sleep / Q000502:physiology*; D020186:Sleep Bruxism / Q000503:physiopathology / Q000628:therapy*; D013016:Sound; D011795:Surveys and Questionnaires; D013703:Temporal Muscle / Q000503:physiopathology; D013705:Temporomandibular Joint Disorders / Q000209:etiology