- Email: [email protected]
Selections From the Current Literature
ORIGINAL CONTRIBUTIONS
JOURNALSCAN
SELECTIONS FROM THE CURRENT LITERATURE Compiled by Bruce Lee Pihlstrom, DDS, MS
INCIDENCE OF INFECTIVE ENDOCARDITIS REPORTED TO INCREASE AS PRESCRIPTIONS FOR ANTIBIOTIC PROPHYLAXIS DECREASED IN THE UNITED KINGDOM
Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet. 2015; 385(9974):1219-1228. http://dx.doi.org/10.1016/ S0140-6736(14)62007-9 Background. For many years, antibiotics prophylaxis has been used to prevent infective endocarditis that may be caused by bacteremia resulting from dental procedures. However, there is little evidence that antibiotic prophylaxis is effective in preventing infective endocarditis that may be associated with dental procedures. Moreover, antibiotic use may involve adverse effects, allergic reactions, and cause the emergence of bacteria that are resistant to antibiotics. Guidelines for prevention of infective endocarditis have been modified to recommend complete1,2 or partial cessation3 of antibiotic prophylaxis before invasive dental procedures. The purpose of this retrospective study was to compare the incidence of infective endocarditis before and after the 2008 guidelines were issued in the United Kingdom that recommended complete cessation of antibiotic prophylaxis for infective endocarditis (National Institute for Health and Clinical Excellence [NICE] guidelines1,2). Methods. The authors analyzed National Health Service (NHS) data on the prescription of antibiotic prophylaxis from January 1, 2004, to March 31, 2013, and hospital discharge data for patients from January 1, 2000, to March 31, 2013. They used statistical methods to compare the incidence of infective endocarditis before and after introduction of the NICE guidelines. Results. Dayer and colleagues reported that there was a significant decrease in the number of prescriptions for antibiotic prophylaxis after the NICE guidelines were introduced. They reported that the number fell from 10,900 per month before to 2,236 per month after introduction of the guidelines. During the last 6 months of the study, (October 1, 2012, to March 31, 2013), the mean number decreased further to 1,307 prescriptions for antibiotic prophylaxis per month. The investigators reported that most of the prescriptions were for
702 JADA 146(9) http://jada.ada.org
September 2015
amoxicillin, and approximately 90% were issued by dentists. The investigators also reported that the number of patients having a diagnosis of infective endocarditis increased after the NICE guidelines were introduced. The trend for the incidence of infective endocarditis increased significantly by 0.11 cases per month (95% confidence interval, 0.05-0.16). They estimated that by March 2013, there were approximately 35 more patients per month being diagnosed with infective endocarditis than would have been expected before the NICE guidelines were introduced. The investigators also reported that the inflection point of increased incidence of infective endocarditis occurred 3 months after introduction of the NICE guidelines. Why is this study important? This is an important study because it involved a very large sample of patients in England’s NHS database and because it showed an increase in patients having infective endocarditis following the NICE guidelines that recommended complete cessation of antibiotic prophylaxis. It is important to emphasize that the study does not establish a cause-andeffect relationship between cessation of antibiotic prophylaxis and an increase in infective endocarditis. As stated in an accompanying commentary,4 the increased incidence of infective endocarditis could have been due to an increase in the number of people at high risk for endocarditis because of population aging, more use of implanted cardiac devices, increased diabetes mellitus, or increased chronic dialysis. The commentary also noted that United Kingdom hospital discharge data were based on codes that were not validated and did not include information about the causal microorganism of infective endocarditis. These and other possible factors may have confounded this retrospective study. Nonetheless, the findings are important and provocative. As noted in the commentary,4 randomized clinical trials are needed to determine the efficacy of antibiotic prophylaxis in preventing infective endocarditis. 1. NICE. Prophylaxis against infective endocarditis. National Institute for Health and Clinical Excellence, 2008. Available at: https://www.nice.org.uk/ guidance/cg64. Accessed June 6, 2015. 2. Richey R, Wray D, Stokes T; Guideline Development Group. Prophylaxis against infective endocarditis: summary of NICE guidance. BMJ. 2008;336(7647):770-771. 3. Wilson W, Taubert KA, Gewitz M, et al; American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group; American Dental Association. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group [review]. JADA. 2007;138(6):739-745, 747-760. 4. Duval X, Hoen B. Prophylaxis for infective endocarditis: let’s end the debate. Lancet. 2015;385(9974):1164-1165.
ORIGINAL CONTRIBUTIONS
MOST EARLY CARIES DO NOT PROGRESS IN ADULTS EXPOSED TO FLUORIDES
Brown JP, Amaechi BT, Bader JD, et al. The dynamic behavior of the early dental caries lesion in caries-active adults and implications. Community Dent Oral Epidemiol. 2015;43(3):208-216. http://dx.doi.org/10.1111/ cdoe.12143. Background. As noted by the authors of this study, it has been known for many years that dental caries is not a simple, unrelenting process of enamel dissolution. Rather, it is a dynamic process involving progression, reversal, and quiescence. Despite this knowledge, there has been limited research on the behavior of early caries in large numbers of adults. The purpose of this study was to describe the dynamic nature of dental caries in caries-active adults and discuss its implications for management of dental caries. Methods. The investigators analyzed data from 543 adults (21-80 years old) who participated in the 33-month Xylitol for Adult Caries Trial.1 A total of 8,084 early, noncavitated lesions were identified in the trial and were followed for caries progression, reversal, or quiescence for up to 33 months. Results. Brown and colleagues reported that among the 8,084 early, noncavitated caries lesions that were observed in the study, only 674 (8.3%) progressed to cavitation or were restored by a dental restoration or a crown. One-half of the lesions reversed to a sound tooth surface, approximately 20% were stable, and 15% oscillated between an early noncavitated lesion and a sound tooth surface. Moreover, they reported that xylitol showed no significant and consistent effect on these changes over time. The authors concluded that their study supports that dentists should observe early caries lesions over time using defined lesion thresholds, use risk-based caries prevention, and restore early caries using minimally invasive techniques “only if indicated by definitive, direct visual determination of cavitation, not inference thereof from radiographs.” Why is this study important? This is an important study because it involved a large sample of adults with active caries who were carefully observed over almost 3 years for the occurrence, progression, regression, and quiescence of dental caries. The finding that only 8.3% of early, noncavitated caries lesions progressed to cavitation or a restoration and that most lesions remained stable or reversed to a sound tooth surface is important information that every dentist should consider when making treatment decisions for adults who have early, noncavitated caries lesions. 1. Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). JADA. 2013;144(1):21-30.
PRACTICE-BASED STUDY REPORTS ASSOCIATION BETWEEN CROWN–ROOT RATIO AND SURVIVAL OF PARTIAL DENTURE ABUTMENT TEETH
Tada S, Allen PF, Ikebe K, Zheng H, Shintani A, Maeda Y. The impact of the crown–root ratio on survival of abutment teeth for dentures [published online ahead of print June 8, 2015]. J Dent Res. http:// dx.doi.org/10.1177/0022034515589710. Background. The crown–root ratio (CRR), which is the ratio of tooth length outside of alveolar bone divided by the tooth length within alveolar bone, is often used as a tool for determining the prognosis of abutment teeth for fixed and removable prosthesis. As noted by the authors of this study, abutment teeth having higher CCRs are generally given a poorer prognosis than those with lower CCRs. However, there is no consensus about the specific values of CRRs that are associated with a favorable prognosis for abutment teeth. The purpose of this study was to determine the association between the CRR and survival of removable partial denture (RPD) abutment teeth. Methods. The authors conducted a retrospective study of 147 patients (37% male; mean age, 64 years) who collectively received 236 clasp-retained RPDs involving 856 abutment teeth at Osaka University Dental Hospital in Japan. Patients were excluded if they had received maxillofacial prosthesis, immediate RPDs, and RPDs with “complex” designs, such as those that were retained by attachments or had lingual plate connectors. The authors also excluded patients who did not have at least 1 periodontal maintenance appointment during each year of follow-up. They divided the abutment teeth into 5 CRR categories and used statistical methods to analyze abutment tooth survival together with various explanatory variables such as sex, frequency of periodontal maintenance appointments, occlusal support, endodontic therapy, periodontal pocket depth, and type of abutment (indirect, direct, and location adjacent to an edentulous area). Results. The investigators reported that higher median baseline CRRs (1.4 and 1.97) of RPD abutment teeth were associated with lower 7-year tooth survival (77% and 47%, respectively) than abutment teeth having lower CRRs of 0.60, 0.86, and 1.12 (7-year tooth survival, 89%, 86%, and 86%, respectively). They also reported no differences in survival time among abutment teeth having median CRRs of 0.60, 0.86, and 1.12. Their multivariable analysis indicated that less frequent periodontal maintenance (greater than 6 months versus 6 months or less), less occlusal support area, having root canal therapy, increased periodontal pocket depth, and abutment teeth in contact with direct retainers or adjacent to an edentulous area were significantly (P < .05) associated with an increased hazard for abutment tooth loss.
JADA 146(9) http://jada.ada.org
September 2015 703
ORIGINAL CONTRIBUTIONS
Why is this study important? This is an important study because, according to the authors, it is the first longitudinal cohort study of the relationship of specific CRR values and the survival of RPD abutment teeth. The findings are also important because they should help establish criteria for acceptable abutment tooth CRRs using objective evidence rather than clinical opinion. However, as noted by the authors, further prospective research is needed to confirm the findings of this retrospective study. CLINICAL TRIAL REPORTS THAT ORAL APPLIANCE DECREASES OBSTRUCTIVE SLEEP APNEA AND SNORING
Marklund M, Carlberg B, Forsgren L, Olsson T, Stenlund H, Franklin KA. Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial [published online ahead of print June 1, 2015]. JAMA Intern Med. http://dx.doi.org/10.1001/ jamainternmed.2015.2051. Background. As the authors of this study note, it has been estimated that 24% of middle-aged men and 9% of middle-aged women experience sleep apnea,1 which can be associated with serious consequences such as hypertension, stroke, traffic accidents, and early death. Oral appliances that hold the mandible forward have been shown to reduce sleep apnea, but the use of these devices on daytime sleeplessness and quality of life is unclear. The purpose of this clinical trial was to study the effects of using a custom-made oral appliance on daytime sleepiness and quality of life in patients who have daytime sleepiness, snoring, or mild to moderate sleep apnea. Methods. The investigators conducted a randomized, single-masked parallel-design clinical trial to compare the efficacy of using a placebo oral appliance to use of an oral appliance that positioned the mandible in a forward
704 JADA 146(9) http://jada.ada.org
September 2015
or anterior position. Marklund and colleagues randomly assigned 96 people who met the inclusion criteria to nighttime use of a placebo or an active oral appliance that positioned the mandible in an anterior position. They recorded outcomes after the participants had used the appliances for a mean duration of 175 days. Daytime sleepiness and quality of life were measured using standardized methods, and polysomnographic sleep recordings were made using sensors attached to participants’ bodies while they slept at home. Results. The investigators reported that after 4 months of use, the mandibular repositioning oral appliance was not associated with improvement in daytime sleepiness or quality of life compared with the placebo device. However, they also reported that the repositioning appliance reduced obstructive sleep apnea, snoring, and restless leg symptoms. Why is this study important? This is an important study because it was a randomized clinical trial involving a fairly large number of participants who had mild to moderate sleep apnea. As noted by the authors, patients with mild to moderate sleep apnea are the primary target group for use of mandibular repositioning appliances. It is also important because it included 2 outcomes that have received limited attention in sleep apnea studies: daytime sleepiness and quality of life measures. n 1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-1235.
http://dx.doi.org/10.1016/j.adaj.2015.06.017 Copyright ª 2015 American Dental Association. All rights reserved.
Dr. Pihlstrom is a professor emeritus, Department of Surgical and Developmental Sciences, School of Dentistry, University of Minnesota, Minneapolis. He also is the associate editor, Research, for The Journal of the American Dental Association, as well as an independent oral health research consultant. Disclosure. Dr. Pihlstrom is a paid consultant for the Carolinas Medical Center, Charlotte, North Carolina.
JOURNALSCAN
SELECTIONS FROM THE CURRENT LITERATURE Compiled by Bruce Lee Pihlstrom, DDS, MS
INCIDENCE OF INFECTIVE ENDOCARDITIS REPORTED TO INCREASE AS PRESCRIPTIONS FOR ANTIBIOTIC PROPHYLAXIS DECREASED IN THE UNITED KINGDOM
Dayer MJ, Jones S, Prendergast B, Baddour LM, Lockhart PB, Thornhill MH. Incidence of infective endocarditis in England, 2000-13: a secular trend, interrupted time-series analysis. Lancet. 2015; 385(9974):1219-1228. http://dx.doi.org/10.1016/ S0140-6736(14)62007-9 Background. For many years, antibiotics prophylaxis has been used to prevent infective endocarditis that may be caused by bacteremia resulting from dental procedures. However, there is little evidence that antibiotic prophylaxis is effective in preventing infective endocarditis that may be associated with dental procedures. Moreover, antibiotic use may involve adverse effects, allergic reactions, and cause the emergence of bacteria that are resistant to antibiotics. Guidelines for prevention of infective endocarditis have been modified to recommend complete1,2 or partial cessation3 of antibiotic prophylaxis before invasive dental procedures. The purpose of this retrospective study was to compare the incidence of infective endocarditis before and after the 2008 guidelines were issued in the United Kingdom that recommended complete cessation of antibiotic prophylaxis for infective endocarditis (National Institute for Health and Clinical Excellence [NICE] guidelines1,2). Methods. The authors analyzed National Health Service (NHS) data on the prescription of antibiotic prophylaxis from January 1, 2004, to March 31, 2013, and hospital discharge data for patients from January 1, 2000, to March 31, 2013. They used statistical methods to compare the incidence of infective endocarditis before and after introduction of the NICE guidelines. Results. Dayer and colleagues reported that there was a significant decrease in the number of prescriptions for antibiotic prophylaxis after the NICE guidelines were introduced. They reported that the number fell from 10,900 per month before to 2,236 per month after introduction of the guidelines. During the last 6 months of the study, (October 1, 2012, to March 31, 2013), the mean number decreased further to 1,307 prescriptions for antibiotic prophylaxis per month. The investigators reported that most of the prescriptions were for
702 JADA 146(9) http://jada.ada.org
September 2015
amoxicillin, and approximately 90% were issued by dentists. The investigators also reported that the number of patients having a diagnosis of infective endocarditis increased after the NICE guidelines were introduced. The trend for the incidence of infective endocarditis increased significantly by 0.11 cases per month (95% confidence interval, 0.05-0.16). They estimated that by March 2013, there were approximately 35 more patients per month being diagnosed with infective endocarditis than would have been expected before the NICE guidelines were introduced. The investigators also reported that the inflection point of increased incidence of infective endocarditis occurred 3 months after introduction of the NICE guidelines. Why is this study important? This is an important study because it involved a very large sample of patients in England’s NHS database and because it showed an increase in patients having infective endocarditis following the NICE guidelines that recommended complete cessation of antibiotic prophylaxis. It is important to emphasize that the study does not establish a cause-andeffect relationship between cessation of antibiotic prophylaxis and an increase in infective endocarditis. As stated in an accompanying commentary,4 the increased incidence of infective endocarditis could have been due to an increase in the number of people at high risk for endocarditis because of population aging, more use of implanted cardiac devices, increased diabetes mellitus, or increased chronic dialysis. The commentary also noted that United Kingdom hospital discharge data were based on codes that were not validated and did not include information about the causal microorganism of infective endocarditis. These and other possible factors may have confounded this retrospective study. Nonetheless, the findings are important and provocative. As noted in the commentary,4 randomized clinical trials are needed to determine the efficacy of antibiotic prophylaxis in preventing infective endocarditis. 1. NICE. Prophylaxis against infective endocarditis. National Institute for Health and Clinical Excellence, 2008. Available at: https://www.nice.org.uk/ guidance/cg64. Accessed June 6, 2015. 2. Richey R, Wray D, Stokes T; Guideline Development Group. Prophylaxis against infective endocarditis: summary of NICE guidance. BMJ. 2008;336(7647):770-771. 3. Wilson W, Taubert KA, Gewitz M, et al; American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group; American Dental Association. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group [review]. JADA. 2007;138(6):739-745, 747-760. 4. Duval X, Hoen B. Prophylaxis for infective endocarditis: let’s end the debate. Lancet. 2015;385(9974):1164-1165.
ORIGINAL CONTRIBUTIONS
MOST EARLY CARIES DO NOT PROGRESS IN ADULTS EXPOSED TO FLUORIDES
Brown JP, Amaechi BT, Bader JD, et al. The dynamic behavior of the early dental caries lesion in caries-active adults and implications. Community Dent Oral Epidemiol. 2015;43(3):208-216. http://dx.doi.org/10.1111/ cdoe.12143. Background. As noted by the authors of this study, it has been known for many years that dental caries is not a simple, unrelenting process of enamel dissolution. Rather, it is a dynamic process involving progression, reversal, and quiescence. Despite this knowledge, there has been limited research on the behavior of early caries in large numbers of adults. The purpose of this study was to describe the dynamic nature of dental caries in caries-active adults and discuss its implications for management of dental caries. Methods. The investigators analyzed data from 543 adults (21-80 years old) who participated in the 33-month Xylitol for Adult Caries Trial.1 A total of 8,084 early, noncavitated lesions were identified in the trial and were followed for caries progression, reversal, or quiescence for up to 33 months. Results. Brown and colleagues reported that among the 8,084 early, noncavitated caries lesions that were observed in the study, only 674 (8.3%) progressed to cavitation or were restored by a dental restoration or a crown. One-half of the lesions reversed to a sound tooth surface, approximately 20% were stable, and 15% oscillated between an early noncavitated lesion and a sound tooth surface. Moreover, they reported that xylitol showed no significant and consistent effect on these changes over time. The authors concluded that their study supports that dentists should observe early caries lesions over time using defined lesion thresholds, use risk-based caries prevention, and restore early caries using minimally invasive techniques “only if indicated by definitive, direct visual determination of cavitation, not inference thereof from radiographs.” Why is this study important? This is an important study because it involved a large sample of adults with active caries who were carefully observed over almost 3 years for the occurrence, progression, regression, and quiescence of dental caries. The finding that only 8.3% of early, noncavitated caries lesions progressed to cavitation or a restoration and that most lesions remained stable or reversed to a sound tooth surface is important information that every dentist should consider when making treatment decisions for adults who have early, noncavitated caries lesions. 1. Bader JD, Vollmer WM, Shugars DA, et al. Results from the Xylitol for Adult Caries Trial (X-ACT). JADA. 2013;144(1):21-30.
PRACTICE-BASED STUDY REPORTS ASSOCIATION BETWEEN CROWN–ROOT RATIO AND SURVIVAL OF PARTIAL DENTURE ABUTMENT TEETH
Tada S, Allen PF, Ikebe K, Zheng H, Shintani A, Maeda Y. The impact of the crown–root ratio on survival of abutment teeth for dentures [published online ahead of print June 8, 2015]. J Dent Res. http:// dx.doi.org/10.1177/0022034515589710. Background. The crown–root ratio (CRR), which is the ratio of tooth length outside of alveolar bone divided by the tooth length within alveolar bone, is often used as a tool for determining the prognosis of abutment teeth for fixed and removable prosthesis. As noted by the authors of this study, abutment teeth having higher CCRs are generally given a poorer prognosis than those with lower CCRs. However, there is no consensus about the specific values of CRRs that are associated with a favorable prognosis for abutment teeth. The purpose of this study was to determine the association between the CRR and survival of removable partial denture (RPD) abutment teeth. Methods. The authors conducted a retrospective study of 147 patients (37% male; mean age, 64 years) who collectively received 236 clasp-retained RPDs involving 856 abutment teeth at Osaka University Dental Hospital in Japan. Patients were excluded if they had received maxillofacial prosthesis, immediate RPDs, and RPDs with “complex” designs, such as those that were retained by attachments or had lingual plate connectors. The authors also excluded patients who did not have at least 1 periodontal maintenance appointment during each year of follow-up. They divided the abutment teeth into 5 CRR categories and used statistical methods to analyze abutment tooth survival together with various explanatory variables such as sex, frequency of periodontal maintenance appointments, occlusal support, endodontic therapy, periodontal pocket depth, and type of abutment (indirect, direct, and location adjacent to an edentulous area). Results. The investigators reported that higher median baseline CRRs (1.4 and 1.97) of RPD abutment teeth were associated with lower 7-year tooth survival (77% and 47%, respectively) than abutment teeth having lower CRRs of 0.60, 0.86, and 1.12 (7-year tooth survival, 89%, 86%, and 86%, respectively). They also reported no differences in survival time among abutment teeth having median CRRs of 0.60, 0.86, and 1.12. Their multivariable analysis indicated that less frequent periodontal maintenance (greater than 6 months versus 6 months or less), less occlusal support area, having root canal therapy, increased periodontal pocket depth, and abutment teeth in contact with direct retainers or adjacent to an edentulous area were significantly (P < .05) associated with an increased hazard for abutment tooth loss.
JADA 146(9) http://jada.ada.org
September 2015 703
ORIGINAL CONTRIBUTIONS
Why is this study important? This is an important study because, according to the authors, it is the first longitudinal cohort study of the relationship of specific CRR values and the survival of RPD abutment teeth. The findings are also important because they should help establish criteria for acceptable abutment tooth CRRs using objective evidence rather than clinical opinion. However, as noted by the authors, further prospective research is needed to confirm the findings of this retrospective study. CLINICAL TRIAL REPORTS THAT ORAL APPLIANCE DECREASES OBSTRUCTIVE SLEEP APNEA AND SNORING
Marklund M, Carlberg B, Forsgren L, Olsson T, Stenlund H, Franklin KA. Oral appliance therapy in patients with daytime sleepiness and snoring or mild to moderate sleep apnea: a randomized clinical trial [published online ahead of print June 1, 2015]. JAMA Intern Med. http://dx.doi.org/10.1001/ jamainternmed.2015.2051. Background. As the authors of this study note, it has been estimated that 24% of middle-aged men and 9% of middle-aged women experience sleep apnea,1 which can be associated with serious consequences such as hypertension, stroke, traffic accidents, and early death. Oral appliances that hold the mandible forward have been shown to reduce sleep apnea, but the use of these devices on daytime sleeplessness and quality of life is unclear. The purpose of this clinical trial was to study the effects of using a custom-made oral appliance on daytime sleepiness and quality of life in patients who have daytime sleepiness, snoring, or mild to moderate sleep apnea. Methods. The investigators conducted a randomized, single-masked parallel-design clinical trial to compare the efficacy of using a placebo oral appliance to use of an oral appliance that positioned the mandible in a forward
704 JADA 146(9) http://jada.ada.org
September 2015
or anterior position. Marklund and colleagues randomly assigned 96 people who met the inclusion criteria to nighttime use of a placebo or an active oral appliance that positioned the mandible in an anterior position. They recorded outcomes after the participants had used the appliances for a mean duration of 175 days. Daytime sleepiness and quality of life were measured using standardized methods, and polysomnographic sleep recordings were made using sensors attached to participants’ bodies while they slept at home. Results. The investigators reported that after 4 months of use, the mandibular repositioning oral appliance was not associated with improvement in daytime sleepiness or quality of life compared with the placebo device. However, they also reported that the repositioning appliance reduced obstructive sleep apnea, snoring, and restless leg symptoms. Why is this study important? This is an important study because it was a randomized clinical trial involving a fairly large number of participants who had mild to moderate sleep apnea. As noted by the authors, patients with mild to moderate sleep apnea are the primary target group for use of mandibular repositioning appliances. It is also important because it included 2 outcomes that have received limited attention in sleep apnea studies: daytime sleepiness and quality of life measures. n 1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328(17):1230-1235.
http://dx.doi.org/10.1016/j.adaj.2015.06.017 Copyright ª 2015 American Dental Association. All rights reserved.
Dr. Pihlstrom is a professor emeritus, Department of Surgical and Developmental Sciences, School of Dentistry, University of Minnesota, Minneapolis. He also is the associate editor, Research, for The Journal of the American Dental Association, as well as an independent oral health research consultant. Disclosure. Dr. Pihlstrom is a paid consultant for the Carolinas Medical Center, Charlotte, North Carolina.