title: Sleep bruxism, snoring, and headaches in adolescents: short-term effects of a mandibular advancement appliance.
abstract: OBJECTIVE
  Sleep bruxism (SB) frequently is associated with other sleep disorders and pain concerns. Our study assesses the efficacy of a mandibular advancement appliance (MAA) for SB management in adolescents reporting snoring and headache (HA).
  
  
  METHODS
  Sixteen adolescents (mean age, 14.9±0.5) reporting SB, HA (>1d/wk), or snoring underwent four ambulatory polysomnographies for baseline (BSL) and while wearing MAA during sleep. MAA was worn in three positions (free splints [FS], neutral position [NP], and advanced to 50% of maximum protrusion [A50]) for 1 week each in random order (FS-NP-A50 or NP-A50-FS; titration order, NP-A50). Reports of HA were assessed with pain questionnaires.
  
  
  RESULTS
  Overall, sleep variables did not differ across the four nights. SB index decreased up to 60% with MAA in A50 (P=.004; analysis of variance). Snoring was measured as the percentage of sleep time spent snoring. The subgroup of snorers (n=8) showed significant improvement with MAA (-93%; P=.002). Initial HA intensity was reported at 42.7±5/100 mm, showing a decreasing trend with MAA (-21% to -51%; P=.07).
  
  
  CONCLUSIONS
  Short-term use of an MAA appears to reduce SB, snoring, and reports of HA. However, interactions between SB, breathing during sleep, and HA as well as the long-term effectiveness and safety of MAA in adolescents need further investigation.
authors: Faculté de Médecine Dentaire, Université de Montréal, CP 6128, succursale Centre-ville, Montréal, Québec, Canada H3C 3J7. mclotildecarra@gmail.com
authors: Maria Clotilde
authors: MC
authors: Carra
authors: Nelly T
authors: NT
authors: Huynh
authors: Hicham
authors: H
authors: El-Khatib
authors: Claude
authors: C
authors: Remise
authors: Gilles J
authors: GJ
authors: Lavigne
mesh_terms: D000293:Adolescent; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D006261:Headache / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D017090:Occlusal Splints; D017286:Polysomnography; D012890:Sleep; D020186:Sleep Bruxism / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012913:Snoring / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome
keywords: Headache; Mandibular advancement appliance; Pediatrics; Polysomnography; Sleep; Sleep bruxism; Snoring