RESUMEN
Edentulous orodyskinesia (ED) is a neglected source of aimless oral movements that may be confused with tardive dyskinesia (TD). We attempted to clarify the clinical features, significance, and orodental factors in relation to ED. Fourteen ED subjects, 13 TD patients, and 15 age-matched controls self-assessed their oral pain perception, condition, and function using a visual analogue scale. Dyskinesias were classified and rated by a neurologist. Perioral thermal and pressure pain threshold studies, and a standardized orodental examination, were conducted blind to subject group. The perceived oral pain level was low in all groups, and those reporting a significant intensity level of pain (>or=50th percentile) were few. The pain thresholds in both dyskinetic groups were comparable to control values. All ED cases wore a complete set of dentures, considered a current source of problems by 85.7% of them. ED cases commonly displayed inadequate dental occlusal relationship (P = 0.014 vs. controls; P = 0.036 vs. TD) and an overclosed vertical dimension (P = 0.006 vs. controls) as well as unstable and unretentive dentures. ED was limited to the oral region, spared the tongue when the mouth is open, and was never severe in our patients. ED has distinct movement characteristics and is often associated with inadequate dentures and biomechanical sources of denture instability. The contribution of the foregoing findings to the expression of oral dyskinesia warrants further studies.
Asunto(s)
Dentadura Completa/efectos adversos , Boca Edéntula/complicaciones , Trastornos del Movimiento/complicaciones , Umbral del Dolor/fisiología , Dolor/etiología , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor/métodos , AutoimagenRESUMEN
PURPOSE: The objective of this experimental study was to compare the effect on sleep bruxism and tooth-grinding activity of a double-arch temporary custom-fit mandibular advancement device (MAD) and a single maxillary occlusal splint (MOS). MATERIALS AND METHODS: Thirteen intense and frequent bruxors participated in this short-term randomized crossover controlled study. All polygraphic recordings and analyses were made in a sleep laboratory. The MOS was used as the active control condition and the MAD was used as the experimental treatment condition. Designed to temporarily manage snoring and sleep apnea, the MAD was used in 3 different configurations: (1) without the retention pin between the arches (full freedom of movement), (2) with the retention pin in a slightly advanced position (< 40%), and (3) with the retention pin in a more advanced position (> 75%) of the lower arch. Sleep variables, bruxism-related motor activity, and subjective reports (pain, comfort, oral salivation, and quality of sleep) were analyzed with analysis of variance and the Friedman test. RESULTS: A significant reduction in the number of sleep bruxism episodes per hour (decrease of 42%, P < .001) was observed with the MOS. Compared to the MOS, active MADs (with advancement) also revealed a significant reduction in sleep bruxism motor activity. However, 8 of 13 patients reported pain (localized on mandibular gums and/or anterior teeth) with active MADs. CONCLUSIONS: Short-term use of a temporary custom-fit MAD is associated with a remarkable reduction in sleep bruxism motor activity. To a smaller extent, the MOS also reduces sleep bruxism. However, the exact mechanism supporting this reduction remains to be explained. Hypotheses are oriented toward the following: dimension and configuration of the appliance, presence of pain, reduced freedom of movement, or change in the upper airway patency.
Asunto(s)
Avance Mandibular/instrumentación , Bruxismo del Sueño/prevención & control , Adulto , Bruxismo/fisiopatología , Bruxismo/prevención & control , Estudios Cruzados , Dolor Facial/etiología , Femenino , Humanos , Masculino , Actividad Motora/fisiología , Ferulas Oclusales , Diseño de Aparato Ortodóncico , Aparatos Ortodóncicos , Polisomnografía , Salivación/fisiología , Sueño/fisiología , Bruxismo del Sueño/fisiopatología , Propiedades de SuperficieRESUMEN
The literature on sensory perception during sleep suggests that light sleep (Stage 2) is more responsive to external sensory stimulation (e.g. sound, electrical shock) than deep sleep (Stages 3 and 4) and REM sleep. The main objective of this study was to characterize the specificity of nociceptive stimulation to trigger sleep arousal-awakening over all sleep stages. Thirteen healthy adults (e.g. without pain or sleep problems; six female and seven male of a mean age of 24.2+/-1.3 years) were included in the study. The responses to noxious intramuscular 5% hypertonic infusion were compared to innocuous vibrotactile and to respective control stimulations: isotonic infusion and auditory stimulations. These stimulations were applied during wakefulness and were repeated during sleep. Polygraphic signals (e.g. brain activity, heart rate) signals were recorded to score sleep arousal over all sleep stages. A subjective assessment of sleep quality was made on next morning. No overnight sensitization or habituation occurred with any of the experimental stimulations. The vibratory-auditory stimulations and the noxious hypertonic infusions triggered significantly (P < 0.05) more awakenings in sleep Stage 2 and in REM than their respective control stimulations. In sleep Stage 2, both vibratory + auditory stimulations and the noxious hypertonic infusions has the same awakening response frequency (approximately 30%), however, with the noxious infusions the response frequency were similar in sleep Stages 3 and 4 (P < 0.05) and in REM (trend). Compared to the baseline night, sleep quality was lower following the night with noxious stimulation (90.1+/-2.7 and 73.3+/-7.4 mm, respectively; P < 0.03. These data suggest that pain during sleep could trigger a sleep awaking response over all sleep stages and not only in light sleep.