Association between sleep bruxism, use of antidepressants, and obstructive sleep apnea syndrome: a cross-sectional study

BACKGROUND

Sleep bruxism (SB) is a condition regulated centrally, with a multifactorial etiology, which can occur secondary to systemic disorders and use of certain medications.

OBJECTIVE

The aim of this study was to identify associations between sleep bruxism, obstructive sleep apnea and hypopnea syndrome (OSAHS) and the use of antidepressants.

MATERIAL AND METHODS

In this cross-sectional study, 240 individuals underwent a full-night polysomnography, for medical reasons. Anamnesis was performed to collect data about the use of antidepressants and general health conditions. Polysomnography was performed to analyze sleep data and assess respiratory-related events and apnea and hypopnea index (AHI). The polysomnographic assessment of sleep bruxism was performed, from electrodes placed on masseter muscles and chin. SB was defined by the presence of more than two events of rhythmic masticatory muscles activity (RMMA) per hour of sleep. Statistical analyzes were performed to compare the presence of SB and AHI, severity of OSAHS and use of antidepressants.

RESULTS

There were statistically significant differences between bruxers and non-bruxers, when comparing AHI (48.28±25.84; p=0.001) and severity of OSAHS (p=0.015). Regarding the use of antidepressants, comparative analyzes did not shown correlations with bruxism (p=0.072). However, logistic regression suggests that the use of these medications may represent increased odds for SB development (OR=2.387; p=0.005).

CONCLUSION

The relationship between the use of antidepressants and SB remains inconclusive. SB is associated with OSAHS, mainly in its severe form. Therefore, identifying SB can raise the suspicion of the occurrence of other systemic disturbances.

Increased vertical dimension of occlusion: signs, symptoms, diagnosis, treatment and options

During the planning of oral rehabilitation, the vertical dimension of occlusion (VDO) is one of the first parameters to be measured since its improper restoration can lead to the failure of any prosthetic rehabilitation. A decreased VDO can lead to the appearance of lesions, such as angular cheilitis, facial disharmony, and temporomandibular disorders; meanwhile, an increased VDO may lead to the onset of joint and muscle pain, tension in functional speech, difficulty in swallowing, impaired chewing, tooth sensitivity due to traumatogenic forces, pathologic bone resorption, abnormal wearing of teeth, the appearance of an elongated face, and a facial expression of fatigue. Most scientific articles deal with methods and techniques for re-establishing VDO in edentulous patients or those who have lost their tooth reference due to prosthetic preparations. However, patients with increased VDO are also found in everyday practice. One treatment option for these patients is occlusal adjustment by selective tooth wear; it is still possible to perform orthodontic intrusion and/or orthognathic surgery in severe cases. The aim of this study was to discuss signs, symptoms, diagnosis, and treatment, and to report a clinical case of a patient with increased VDO.

Invasive cervical resorption: etiology, diagnosis, classification and treatment

BACKGROUND

Invasive cervical resorption (ICR) is not well understood by the professional, being misdiagnosed, leading to inappropriate treatment and unnecessary loss of tooth.

INTRODUCTION

ICR is defined as a localized process of resorption, which begins in the cervical area of the tooth, just below the epithelial junction and above the ridge crest in the area of the connective tissue insertion. Possible predisposing factors include external trauma, orthodontic movement, surgical procedures, periodontal disease and its treatments, endogenous bleaching, pressure generated by wind instruments and herpes virus infection. Different approaches have been suggested for the treatment of ICR, depending on the extent of the lesion and its location. However, in some cases due to the severity of the injury, there is no alternative but to tooth extraction, followed by restoration of the edentulous area.

AIM AND OBJECTIVE

Discuss etiology, diagnosis and classification of the ICR, as well as different treatment options. Also is presented a case in which extraction was carried out, installation of the implant and ceramic crown, subsequent to a treatment approach that resulted in failure in the short-term period.

CONCLUSION

Early diagnosis of the ICR is critical to proper treatment and favorable prognosis. Interdisciplinary treatment should be instituted as soon as possible, avoiding the loss of the affected tooth. In advanced cases, treatment involving the installation of osseointegrated implants should be considered the first choice of treatment.

CLINICAL SIGNIFICANCE

Early diagnosis of the ICR is critical do prevent unnecessary tooth loss, once the prognosis for advanced cases is doubtful.

The impact of orofacial pain on the quality of life of patients with temporomandibular disorder

AIMS

To evaluate the relationships between gender, diagnosis, and severity of temporomandibular disorders (TMD) with self-reports of the impact of TMD on the quality of life.

METHODS

Eighty-three individuals seeking TMD treatment at the Dental School of Pontifical Catholic University Minas from May to August 2005 were evaluated by a single examiner who was trained and calibrated for diagnosis according to criteria of Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD). The severity of TMD was established by the Temporomandibular Index and the impact on quality of life by the Oral Health Impact Profile (OHIP 14). Complete data were available for 78 of the 83 initial patients and evaluated by the Mann-Whitney test and Spearman correlation analysis.

RESULTS

Except for one patient, all individuals showed some impact related to physical pain. Of the seven aspects evaluated on the OHIP 14, women presented a greater impact than men only for functional limitations (Mann-Whitney, P < .05). Patients presenting with diagnoses of muscular disorders (group I) or osteoarthritis (group III) reported a greater impact than those without (P < .05). The Spearman test demonstrated a significant correlation between impact on quality of life and severity of TMD (P < .05).

CONCLUSION

Orofacial pain had a great impact on the quality of life of individuals with TMD, without group difference between genders. The presence of muscular disorders (group I) and osteoarthritis (group III) was related to greater impact on quality of life, which was not observed for diagnoses of disc displacement (group II). A correlation between severity of TMD and impact on quality of life was clearly observed.