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Support terapy efficacy for temporomadibular disfunction in patients with sleep apnea and hypopnea syndrome with oral appliance: a randomized, double blind and placebo-controled treatment


Intra-oral mandibular advancement appliances (IMA) have been useful in treating primary snoring, upper airways resistance syndrome (UARS) and mild and moderate obstructive sleep apnea (OSA). Harmful side effects, discomfort or pain in mastigatory muscles and in the tempromandibular articulation (TMA) could be associated with tempromandibular dysfunction (TMD). Current literature is lacking regarding precise diagnostic criteria for OSA patients with TMD. Articles focusing on low IMA compliance due to suspected TMD have been cited as a basis for rejecting this treatment in patients who have already been diagnosed with TMD. However, other studies argued that this association cannot be confirmed. Thermotherapy or massaging associated with exercises has been viewed as a support therapy in TMD as part of a general treatment for this condition. These techniques could be applied to patients with mild or moderate OSA and with suspected TMD. It has been argued that this would lead to enhanced IMA compliance. Our project will compare IMA efficay and compliance efficiency in a 80 mild or moderate OSA patients with suspected TMD who may have been following or not support therapy for TMD.All patients will undergo a range of evaluative measures at the outset of the project and once again upon completion of 120 days IMA use. Such measures will include: the Fletcher and Lucket Sleep Questionnaire, Epworth Sleep Scale, SF 36 Life Quality Inventory, PSG recordings, Sleep and IMA compliance diaries, clinical evaluation, tooth and bone radiography and TMA examinations using TMD diagnostic criteria (RDC). We will randomly distribute patients into 2 groups of 40 each: GT1 and GT2. GT1 patients will use IMA along with instructions of how to benefit from TMD support therapy (ST). GT2 patients will use IMA along with placebo support therapy (PST). Project researchers and patients will be blind as to treatment modalities which all patients will undergo, be they IMA plus ST or IMA plus PST. (AU)

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(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
CUNALI, PAULO A.; ALMEIDA, FEMANDA R.; SANTOS, CAMILA D.; VALDRIGHI, NATALIA Y.; NASCIMENTO, LILIANE S.; DAL'FABBRO, CIBELE; TUFIK, SERGIO; BITTENCOURT, LIA RITA A.. Prevalence of Temporomandibular Disorders in Obstructive Sleep Apnea Patients Referred for Oral Appliance Therapy. JOURNAL OF OROFACIAL PAIN, v. 23, n. 4, p. 339-344, . (06/04488-4)
CUNALI, PAULO AFONSO; ALMEIDA, FERNANDA R.; SANTOS, CAMILA D.; VALDRICHI, NATALIA Y.; NASCIMENTO, LILIANE S.; DAL-FABBRO, CIBELE; TUFIK, SERGIO; BITTENCOURT, LIA RITA A.. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep and Breathing, v. 15, n. 4, p. 717-727, . (06/04488-4)

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