By John S. Casko, DDS, MS, PhD Based on: Zachrisson BU, Nyogaard L, Mobarak K. Dental Health Assesed More Than 10 Years After Interproximal Enamel Reduction of Mandibular Anterior Teeth. Am J Orthodontics Dentofacial Orhtop 2007; 131 (Feburary): 162-169 

When you have patients with crowded mandibular anterior teeth, do you sometimes use interproximal reduction or enamel stripping to resolve the crowding and avoid extractions? I suspect many orthodontists do. If you do use interproximal stripping or enamel reduction, what are the long term dental and periodontal effects of using this procedure? A recent study addresses this question.

Authors evaluated 61 patients who had undergone interproximal enamel reduction of the mandibular anterior teeth an average of 12.5 years after treatment. The procedure for enamel reduction used at the time these patients were treated consisted of reducing the interproximal enamel with fine- or medium- grit, safe sided diamond disk at mdium speed with the contra- angle handpiece. Air-cooling was usd during the procedure. Polishing after stripping with a diamond disk was done with fine sand disks. Topical fluoride agents were not applied to the ground tooth surfaces, but all patients were routinely instructed to use diluted sodium fluoride mouth rinses once daily. Sixteen dental students were used as a control group to compare the long-term dental and periodontal results of stripping.

Take Home Pearl:

Take Home Pearl: You may be able to help a patient with mild-to-moderate obstructive sleep apnea by using a mandibular advancement splint.

Background: Many patients today suffer from obstructive sleep apnea, which can have a negative effect on their health and quality of life. Would doing something as simple as placing a mandibular advancement splint significantly improve their sleep apnea?

Objective: The purpose of this study was to investigate psychosocial function in patients with obstructive sleep apnea before and after mandibular advancement splint therapy.

Participants: The sample for this study consisted of 85 patients with mild-to-moderate obstructive sleep apnea.

Methods: The participants in this study were separated into 2 groups. One group received conservative treatment consisting of advice on sleeping position, avoidance of alcohol in the evenings, and weight loss. The second group received mandibular advancement splint therapy, which included a modified Herbst appliance. Two standardized tests to evaluate psychosocial health and daytime sleepiness were used to evaluate each participant at baseline and again 3 months later.

Results: 68% of the patients in the mandibular splint therapy group showed an improvement in energy and vitality, and 80% showed improvement in sleepiness. This was a significant improvement compared with the conservatively treated group. The improvements in energy and vitality scores in the mandibular advancement splint therapy group were similar to those seen in continuous positive airway pressure (CPAP) studied.

Conclusions: The use of mandibular advancement splints can result in a significant improvement in energy, vitality, and sleepiness for patients with obstructive sleep apnea.

Reviewer’s Comments: The results of this study were very impressive. I would not have thought that improvements with a mandibular advancement splint could be comparable to CPAP. In interpreting the results of this study, it is important to understand that the participants had mild-to-moderate sleep apnea and were preselected based on the likelihood that they would respond positively to mandibular advancement splint therapy.

Reviewer: John S. Casko, DDs, MS, PhD

Because developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums, the American Dental Association sponsors National Children’s Dental Health Month each February.

Now in its 63rd year, this month-long national health observance brings together thousands of dedicated dental professionals, health care providers and others to promote the benefits of good oral health to children and adults, caregivers, teachers and many others.

Parents and teachers can help kids celebrate and learn more about the importance of a healthy smile. The ADA offers free downloadable information, kid-friendly oral health worksheets and games on MouthHealthy.org, the ADA’s consumer website. Click on the For Kids tab on the left side of the page for a variety of age-appropriate activities, games and videos and presentations. There are also teaching guides that adults can use at home, in the classroom or in other community-based settings.

MouthHealthy.org also offers a variety of tools to help consumers learn more about oral health or address their concerns, including the new ADA Dental Symptom Checker. This new tool is designed to understand what your dental symptoms may mean so that you can make informed decisions about your dental health.

Families who don’t have a regular dentist can use the ADA Find-A-Dentist online feature that uses a zip code search feature to help locate a dentist in their community. Find a Dentist listings include information like office hours, insurance accepted, languages spoken and photos of the dentists.

MouthHealthy.org Dental disease can lead to difficulty eating, sleeping, paying attention in school and smiling. The ADA urges parents to make sure their children brush twice daily with fluoride toothpaste, floss daily, eat a balanced diet and see their dentist regularly to address tooth decay in its earliest stages.

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