Journal of Oral Rehabilitation
Journal of Oral Rehabilitation 2013 40; 810--817
Cervical column posture and airway dimensions in clinical
bruxist adults: a preliminary study

V A R E Z , J . J A I M E S & A . F . G OM
C . C . R E S T R E P O , C . P AL
Universidad CES, Medell
ın, Colombia
SUMMARY The aim of this study was to compare
the cervical column posture and the upper airway
dimensions between sleep bruxist and non-bruxist
young adults. Twenty-three sleep-grinders and 22
asymptomatic subjects, selected according to the
American Academy of Sleep Medicine (AASM)
criteria (report by a sleep partner and the presence
of dental wear, according to Wetselaar et al.), were
evaluated. The mean age was 23
8 years (range
18–30). All the subjects had complete permanent
dentition and skeletal and occlusal class I. A digital
cephalometric radiograph with natural head
posture was performed for each subject. The
craniocervical posture was traced and evaluated
according to Solow and Tallgren, and the airway
Introduction
Bruxism is as a repetitive jaw muscle activity charac-
terised by clenching or grinding of the teeth and/or
by bracing or thrusting of the mandible (1). Different
characteristics have been associated with the occur-
rence of sleep-grinding (2–4).
In previous studies (5,6), forwarded head posture
was found in bruxist children, with both X-rays and
photographs. It might be interesting to verify the exis-
tence of such differences also in adults. The forwarded
position of the head has been correlated before with
hypertrophy of the masticatory muscles (7), which
also has been considered a symptom of bruxism.
The upper airway muscles are innervated by tri-
geminal, glossopharyngeal, vagus and hypoglossal
motor axons (8). Parts of the same innervations are
comprised also with the muscles of neck and tongue,
masticatory muscles and respiration. Thus, cervical
© 2013 John Wiley & Sons Ltd

EZ CES-LPH Research Group,
dimensions of the oropharynx and nasopharynx
were evaluated in agreement with Sayinsu. The
data were analysed with independent-samples
t-tests and Mann–Whitney U-test. Significance was
set at P < 0
05. Sleep bruxist young adults
presented more forwarded cervical column
posture and narrower measures of the oropharynx,
when compared with controls (P < 0
05). As in
children, anterior cervical column posture was
found to be associated with sleep bruxism.
KEYWORDS: Cervical column posture, airway, sleep
bruxism, adults
Accepted for publication 21 August 2013
column posture and airway patency also depend par-
tially on these innervations.
Rhythmic masticatory muscle activity (RMMA) is
frequently observed during sleep in normal subjects
and sleep bruxers (9). However, values are higher in
subjects with bruxism. Khoury et al. (10). stated the
hypothesis that an increase in respiration also cha-
racterises the onset of sleep bruxism (SB) within the
arousal sequence. They found a positive and signifi-
cant correlation between the frequencies of RMMA
episodes and the amplitude of breath.
Considering the emerging associations between
bruxism and breathing disorders during sleep (11)
and the fact that mandibular advancement devices are
helpful to reduce both bruxism episodes and AHI
index (12,13), it might be interesting to assess the cer-
vical column posture of bruxers, with the hypothesis
that it is more forwarded as an attempt to increase
airway patency.
doi: 10.1111/joor.12100
 CERVICAL COLUMN POSTURE AND AIRWAY DIMENSIONS IN BRUXIST
The objective of this investigation was to compare
the cervical column posture and the upper airway
dimensions between sleep-grinders and asymptomatic
young adults.
Materials and methods
A cross-sectional study was carried out to evaluate
the cervical column posture and the airway dimen-
sions, through a digital cephalometric radiograph with
natural head posture.
Subjects
Twenty- to 30-year-old adults who studied or work at
CES University, Medellin, Colombia (N = 272), and
who were seeking for treatment at the dental clinics
or physiotherapy centre of the same university
(n = 122), were evaluated to participate in this pres-
ent study. The patients were evaluated by a dentist
and a physiotherapist. All the patients were required
to be healthy (no altered medical conditions related
by the participants) and to have normal facial mor-
phology (Absence of cleft lip and palate or other syn-
dromes that imply facial alterations); complete
permanent dentition, history of trauma, restorations;
and absence of other type of oral habits, such as nail
biting. The sample size was calculated for the studied
variables with a confidence of 95% and power of
80%, using the data by Restrepo et al. (14) and Velez
et al. (5).
The procedures, possible discomforts or risks, to
which the subjects were going to be exposed, as well
as possible benefits were fully explained to the partici-
pants, and the written informed consent was obtained
prior to the investigation.
The institutional ethics committee of CES Univer-
sity was informed about the whole methods and
approved the study. The inclusion criteria were the
absence of mental problems, syndromes or retarda-
tion; and angle molar and canine class I and adequate
anterior teeth relationship (Overjet between
1–3 mm).
The exclusion criteria were medical or anatomical
alterations (e.g. scoliosis, lordosis, etc.) that could lead
to postural problems evaluated by a physiotherapist:
previous orthopaedic treatment or maxillofacial sur-
gery and the presence of transversal malocclusion
(uni- or bilateral cross-bites).
© 2013 John Wiley & Sons Ltd
811
All the individuals were tested for the minimal cri-
teria for sleep bruxism of the American Academy of
Sleep Medicine (AASM)(15):
1 The sleep partner indicated, in an interview with
one of the examiners, the occurrence of tooth
grinding or tooth clenching during sleep at least
once during the night for at least five nights in a
2-week period.
2 No other medical or mental disorders (e.g. sleep-
related epilepsy, accounts for the abnormal move-
ments during sleep) were present.
3 Other sleep disorders (e.g. obstructive sleep apnoea
syndrome) were absent.
4 The 8-point scale described by Wetselaar et al. (16).
was utilised to determine the occlusal/incisal wear
of the permanent teeth (0 = no wear; 1a = mini-
mal wear within the enamel of cusps or incisal tips;
1b = facets within the enamel parallel to the nor-
mal planes or contour; 1c = noticeable flattening of
cusps or incisal edges within the enamel; 2 = wear
with dentine exposure and loss of clinical crown
high <1/3; 3a = wear with dentine exposure and
loss of clinical crown high of 1/3–½; 3b = wear
with dentine exposure and loss of clinical crown of
½–2/3; and 4 = wear with dentine exposure and
loss of clinical crown of >2/3). The 3-point scale
described by the same authors (16) was employed
to check the non-occlusal/non-incisal wear (0 = no
wear; 1 = wear confined to the enamel; 2 = wear
into the dentine). The dental wear was always eval-
uated by the same investigator ICC = 0
89 in a
dental chair and under the same conditions of light
and dryness.
All subjects were required to sleep with a partner
for a two-week period before starting the study.
Subjects whose sleep partner related sleep-grinding
of the teeth for five days during the last two weeks
and presented dental wear were classified as brux-
ers and the ones who did not relate the presence
of sleep-grinding of the teeth and did not present
dental wear were included in the non-bruxist
group.
From the eligible subjects (n = 74), twenty-three of
thirty-two sleep-grinders (11 women and 12 men)
were randomly selected through the sauteed list
method, and twenty-three of forty two asymptomatic
were included in the control group with the same
method. When the X-rays were going to be taken,
812 C . C . R E S T R E P O et al.
one woman became pregnant and could not partici-
pate in the study. Thus, the control group was com-
posed by 22 young adults (11 women and 11 men).
X-rays
Each X-ray was taken with digital technique with an
Orthophos Plus Ceph* for lateral cephalograms in
‘CERO 70’ (A dental diagnostic centre) in Medell
ın,
Colombia. The machine was vertically adjustable; it
had a standardised focus – film distance of 190 cm
and a distance from the film to the medial plane of
10 cm. Each subject stood up without fixation in
ortho-position after balancing forward and backward
three times, with the teeth together and the lips in
rest, looking to a light in a mirror, located perpendic-
ular to the eyes of the subject. This position made
sure that the head and the neck were in natural posi-
tion. The exposures were taken at 60–80 kv and
32 mAs. A vertical 0
5-mm-wide wire was put parallel
to Nasion to register the perfect vertical line (VV).
The technique used to take the lateral cephalogram
was the natural head posture, described previously by
different authors (17). It is reproducible (18,19) and
Fig. 1. Planes and points to measure cervical column posture.
allows the clinician to evaluate the natural position of
the cervical vertebraes and the inclination of the cer-
vical column and head posture. Based on the vertical
reference, a horizontal line (HOR) was traced perpen-
dicular to the vertical one (Fig. 1). These two lines
were the references to calculate the angles between
head and neck in the cephalogram. All the measure-
ments to evaluate the head and cervical column pos-
ture can be seen in Figs 2 and 3.
Head and cervical column posture
The points and planes can be seen in Fig. 1.
CV2ip: point located in the lower posterior angle of
the odontodes vertebrae.
CV4ip: point located in the lower posterior angle of
the body of the fourth cervical vertebrae.
CVT: tangent to the posterior wall of the fourth
cervical vertebrae that goes through CV4ip.
OPT: tangent to the posterior wall of the odontodes
that goes through CV2ip.
Fig. 2. Angles formed by CVT with VV and HOR.
© 2013 John Wiley & Sons Ltd
 CERVICAL COLUMN POSTURE AND AIRWAY DIMENSIONS IN BRUXIST 813

program developed under Matlab 5
3*. The validation

of the method was previously performed by other
authors with computed tomography in upright pos-
ture, using the size and position of soft palate and
uvula, volume and position of tongue, hyoid position,
mandibulomaxillary protrusion and size of the pha-
ryngeal airway space (21). It presented good internal
reliability coefficients (Cronbach’s a = 0
73) and high
test–retest reliability (Pearson’s r = 0
79). The analysis
considers as landmarks stable structures such as the
posterior nasal spine (PNS) that makes the analysis
reproducible. The measurements in the lateral cepha-
logram to calculate the anteroposterior airway size
were the following (Fig. 4):
ad1: the distance between the points that intersect
the anterior and posterior pharyngeal walls in a line
that goes from nasal spine (PNS) to basion (Ba).
ad2: the distance between the points that intersect the
anterior and posterior pharyngeal walls in a line that
goes from sella (S) to the posterior nasal spine (PNS).
Angle ad1-ad2: angle formed by ad1 and ad2.

Fig. 3. Angles formed by OPT with VV and HOR.

VV: a vertical 0
5-mm-wide wire was put in front

and parallel to the nasion of the cephalostat to reg-
ister the perfect vertical line (VV).
HOR: based on the vertical reference, a horizontal line
(HOR) was traced perpendicular to the vertical one.
The following angles were measures to analyse the
cervical column posture (Figs 2 and 3) (17).:
Angle between CVT and VV: the wider the angle,
the more forward posture of the cervical column.
Angle between CVT and HOR: the narrower the
angle, the more significant the forward inclination
of the cervical column.
Angle between OPT and VV: the wider the angle, the
more forward the posture of the cervical column.
Angle between OPT and HOR: the narrower the
angle, the more relevant the anterior inclination of
the cervical column.

Airway dimensions

The digital record of lateral cephalograms was pro- Fig. 4. Diagram of measurements taken to evaluate the airway
cessed in agreement with Sayinsu et al. (20) using a dimensions.

© 2013 John Wiley & Sons Ltd

814 C . C . R E S T R E P O et al.

OAW1: the distance between the points where the

Results
functional occlusal plane intersects the anterior
and posterior pharyngeal walls. Twelve women and eleven men composed the bruxist
OAW2: the distance between points where a line group, while eleven women and eleven men were
passing through hyoid (hy) and C2 i intersects the part of the control group. More forward inclination of
anterior and posterior pharyngeal walls. the head and cervical column was found for the brux-
OAW3: the distance between the points where a ist group only for the measurements dealing with the
line passing through hy and C4 i intersects the tangent to cv2ip (OPT) with both planes, the VV and
anterior and posterior pharyngeal walls. HOR (Table 1). The mean value for the variable OPT-
Angle OAW2-OAW3: angle formed by OAW2 HOR presented less value for bruxist than for controls,
and OAW3. and the variable OPT-VV presented a mean value
SPPS: anteroposterior width of the pharynx mea- higher for bruxist than for controls. All other mea-
sured between the posterior pharyngeal wall and surements regarding the cervical column posture did
the dorsum of the soft palate on a line parallel to not present statistically significant differences when
the Frankfort horizontal (FH) plane that runs comparing both groups.
through the middle of a line from PNS to the Regarding the airway dimensions, IPS and OAW3
extreme point of the soft palate (P). (oropharynx) were found to have smaller dimension
MPS: anteroposterior width of the pharynx mea- for bruxist adults when comparing both groups. Mea-
sured between the posterior pharyngeal wall and surements of the nasopharynx were not found to
the dorsum of the tongue on a line parallel to the
FH plane that runs through P.
IPS: anteroposterior width of the pharynx mea-
Table 1. Comparison of head and cervical column posture
sured between the posterior pharyngeal wall and between bruxist and non-bruxist young adults
the dorsum of the tongue on a line parallel to the
FH plane that runs through C2 i. Variable Group Angles (s.d.) P-value
The examiners evaluating the condition of bruxism CVT_HOR Bruxist (n = 23) 75 435 (4843) 0
091
were not aware of who were those that analysed the Non-bruxist (n = 22) 77 230 (4466)
X-ray images. OPT_HOR Bruxist (n = 23) 81 534 (4611) 0
004
Non-bruxist (n = 22) 85 151 (5937)
CVT_VV Bruxist (n = 23) 14 145 (8117) 0
102
Error of method Non-bruxist (n = 22) 13 925 (3583)
OPT_VV Bruxist (n = 23) 5085 (3650) 0
009
A calibration of the X-ray technique and a standardi- Non-bruxist (n = 22) 1203 (4195)
sation of the digital tracing of the cephalogram were
performed. The tracing of the cephalogram was stan-
dardised between two investigators with 10 X-rays, Table 2. Comparison of the airway dimensions between the
bruxist and control groups
scanned and traced three times each by each of two
of the investigators (ICC >0
7 and Kappa > 0
6 for the
Bruxist Control
head and cervical column posture and ICC> 0
9 and
n = 23 n = 22
Kappa > 0
7 for the airway dimensions). Variable Mean s.d. Mean s.d. P-value

ad1 (mm) 12
8  3
8 14
4  4
2 0
17

Statistical analysis ad2 (mm) 7
8  3
0 8
2  2
6 0
54
OAW1 (mm) 7
4  4
5 7
8  3
8 0
47
Univariated analysis was performed. Distributions OAW2 (mm) 6
8  2
1 11
3  1
6 0
06
were tested using the Shapiro–Wilk test. The data OAW3 (mm) 6
2  2
9 9
2  3
8 0
04
were compared using the Mann–Whitney U-test or t- SPPS (mm) 11
4  4
3 10
0  3
1 0
34
IPS (mm) 5
6  3
1 9
5  2
8 0
03
test depending on the normality of the quantitative
ad1-ad2 (°) 33
5  5
9 31
2  4
3 0
28
variables. For all tests, significance was set at 5%
OAW2-OAW3 (°) 34
5  5
0 34
3  5
1 0
58
(P < 0
05).

© 2013 John Wiley & Sons Ltd

 CERVICAL COLUMN POSTURE AND AIRWAY DIMENSIONS IN BRUXIST
present statistically significant differences, when com-
paring both groups (Table 2).
Discussion
The present cross-sectional study aimed to compare
the head and cervical posture and the airway dimen-
sions in cephalograms of young adults with and with-
out report of bruxism. The hypothesis was that
cervical column posture must be more forwarded in
bruxist subjects, as an attempt to increase airway
patency. The oropharynx was found to have less
dimensions, and the cervical column posture, to be
more forwarded in bruxist adults, when compared
with controls.
Investigations in children found more forwarded
positions of the cervical column and anterior head
posture in bruxist subjects (5,6). The study by Velez
et al. (5), performed in children, found differences in
all the measurements, using the same method by
Solow and Tallgren (17). However, in this investiga-
tion, differences were found only for the measure-
ments taking the Atlas vertebrae (cv2ip) as a
reference, but for both measurements with HOR and
VV. The angles CVT-HOR, OPT-HOR and OPT-VV
presented almost the same differences between brux-
ist and non-bruxist in children (5) and adults
(approximately 2°, 4° and 4°, respectively). When
comparing the angle CVT-VV between adults and
children, strong differences can be seen. Children pre-
sented a 4-degree disparity when comparing sleep-
grinders and asymptomatic subjects, while adults
presented in this investigation only 1 degree of differ-
ence, when comparing both groups.
Even though, the instrument defined by Solow and
Tallgren was strictly used and interpreted in this
investigation (17), it lacks the inclusion of a tangent
line to connect the inferior – posterior angle of C7 to
the posterior wall of C2. With this line, compared
with VV, it could be better exposed the forward pos-
ture of the cervical column. The angulation of one
vertebra does not necessary means that the whole
cervical column is in a forward position. Thus, the
results about posture should be interpreted cautiously,
and further investigations are needed both to validate
an instrument using this new proposed measurement
and to use it in larger samples.
Regarding the airway dimensions, even though
respiratory alterations have been identified to be asso-
© 2013 John Wiley & Sons Ltd
815
ciated with the occurrence of sleep bruxism (22–24),
the airway dimensions of bruxist have not been tested
before. In the present study, measurements related to
the oropharynx were found to be narrower in bruxist
adults than in non-bruxist. Attempts have been made
to expand the airway dimensions through intra-oral
devices to advance the mandible (25) to reduce the
grinding activity. Actually in children, reduction in
sleep bruxism had also been reported after adenoton-
sillectomy (26).
The forwarded position of the head and cervical col-
umn, was found only for the measurements taken
with the second cervical vertebra. Previous studies
about the interactions between airway adequacy and
head posture, have demonstrated that minor adapta-
tions in natural head posture to an altered dimension
of the airway, are mainly caused by cranial extension
(27). Cervical column posture is an important factor
in maintaining airway patency (27). The forwarded
cervical column posture found in this investigation,
has also been found in patients with severe obstruc-
tive sleep apnoea (27). The tendency for a forwarded
and extended cervical column posture in subjects with
obstructive sleep apnoea (27) and with bruxism may
be an indication of a threshold level at which certain
anatomical and/or physiological characteristics of the
upper airway and related structures trigger changes in
natural head posture.
The oral airway resistance increases with modest
degrees of head and neck flexions in healthy adult
humans (28). Actually in healthy infants, hyperflex-
ion of the head has been shown to affect the airflow,
airway patency and pulmonary mechanisms (29,30).
Sleep bruxism has been correlated to hypopnea (31).
Additionally, rhythmic jaw movements have shown
to increase the oxygenated haemoglobin concentra-
tions in sensorimotor cortex (32). In this investiga-
tion, anterior cervical posture was found for the
sleep-grinders group. This characteristic could affect
the airflow in the bruxist adults and be part of the
aetiology of their parafunction (5). The mechanisms
and pathophysiology of these changes in bruxism are
still topics for future investigations. Cohort studies are
necessary to evaluate, in a long term, the relationship
between bruxism and narrow airway dimensions.
Thus, the interpretation should be taken with caution
until the results are further confirmed. Also, other
conditions, such as abnormal posture habits resulting
from desk work, TV and games, should be evaluated
816 C . C . R E S T R E P O et al.
in future investigations, as could be confusion vari-
ables.
Acknowledgments
The authors are grateful to Physiotherapists Martha
Tamayo and Veronica Tamayo who helped them to
make the physiotherapeutic evaluation to the
included subjects. This study was supported by CES
University and Cero 70.
Ethical approvals
The procedures, possible discomforts or risks, to which
the subjects were going to be exposed, as well as pos-
sible benefits were fully explained to the participants,
and the written informed consent was obtained prior
to the investigation. The institutional ethics commit-
tee of CES University was informed about the whole
methods and approved the study.
Conflict of interest
There was no conflict of interest developing the pres-
ent investigation.
References
1. Lobbezoo F, Ahlberg J, Glaros AG, Kato T, Koyano K, Lavig-
ne GJ et al. Bruxism defined and graded: an international
consensus. J Oral Rehabil. 2013;40:2–4.
2. Manfredini D, Lobbezoo F. Relationship between bruxism
and temporomandibular disorders: a systematic review of lit-
erature from 1998 to 2008. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod. 2010;109:26–50.
3. Oksenberg A, Arons E. Sleep bruxism related to obstructive
sleep apnea: the effect of continuous positive airway pres-
sure. Sleep Med. 2002;3:513–515.
4. Manfredini D, Landi N, Fantoni F, Segu M, Bosco M. Anxi-
ety symptoms in clinically diagnosed bruxers. J Oral Reha-
bil. 2005;32:584–588.
5. Velez AL, Restrepo CC, Pel
aez A, Gallego G, Alvarez E, Ta-
mayo M et al. Head posture and dental wear evaluation of
bruxist children with primary teeth. J Oral Rehabil.
2007;34:663–670.
6. Motta LJ, Martins MD, Fernandes KP, Mesquita-Ferrari RA,
Biasotto-Gonzalez DA, Bussadori SK. Craniocervical posture
and bruxism in children. Physiother Res Int. 2011;16:57–
61.
7. Young D, Rinchuse D. The craniofacial morphology of brux-
ers versus non bruxers. Angle Orthod. 1999;69:14–18.
8. Lavigne GJ, Kato T, Kolta A, Sessle BJ. Neurobiological
mechanisms involved in sleep bruxism. Crit Rev Oral Biol
Med. 2003;14:30–46.
9. Lavigne GJ, Rompr
e PH, Poirier G, Huard H, Kato T, Mont-
plaisir JY. Rhythmic masticatory muscle activity during sleep
in humans. J Dent Res. 2001;80:443–448.
10. Khoury S, Rouleau GA, Rompr
e PH, Mayer P, Montplaisir
JY, Lavigne GJ. A significant increase in breathing ampli-
tude precedes sleep bruxism. Chest. 2008;134:332–337.
11. Carra MC, Bruni O, Huynh N. Topical review: sleep brux-
ism, headaches, and sleep-disordered breathing in children
and adolescents. J Orofac Pain. 2012;26:267–276.
12. Landry-Sch€ onbeck A, de Grandmont P, Rompr
e PH, Lavigne
GJ. Effect of an adjustable mandibular advancement appli-
ance on sleep bruxism: a crossover sleep laboratory study.
Int J Prosthodont. 2009;22:251–259.
13. Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije
M. Long-term follow-up of a randomized controlled trial of
oral appliance therapy in obstructive sleep apnea. Respira-
tion. 2011;82:162–168.
14. Wetselaar P, Lobbezoo F, Koutris M, Visscher CM, Naeije
M. Reliability of an occlusal and nonocclusal tooth wear
grading system: clinical use versus dental cast assessment.
Int J Prosthodont. 2009;22:388–390.
15. Buysse DJ, Young T, Edinger JD, Carroll J, Kotagal S. Clini-
cians’ use of the International Classification of Sleep Disor-
ders: results of a national survey. Sleep. 2003;26:48–51.
16. Wetselaar P, Lobbezoo F, Koutris M, Visscher CM, Naeije
M. Reliability of an occlusal and nonocclusal tooth wear
grading system: clinical use versus dental cast assessment.
Int J Prosthodont. 2009;22:388–390.
17. Solow B, Tallgren A. Head posture and craniofacial mor-
phology. Am J Phys Anthropol. 1976;44:417–435.
18. Vig PS, Showfety KJ, Phillips C. Experimental manipulation
of head posture. Am J Orthod Dentofacial Orthop.
1980;77:258–268.
19. Cooke M, Wei SH. The reproducibility of natural head pos-
ture: a methodological study. Am J Orthod Dentofacial Ort-
hop. 1988;93:280–288.
20. Sayınsu K, Isik F, Arun T. Sagittal airway dimensions fol-
lowing maxillary protraction: a pilot study. Eur J Orthod.
2006;28:184–189.
21. Olszewska E, Sieskiewicz A, Rozycki J, Rogalewski M, Tara-
sow E, Rogowski M et al. A comparison of cephalometric
analysis using radiographs and craniofacial computed
tomography in patients with obstructive sleep apnea syn-
drome: preliminary report. Eur Arch Otorhinolaryngol.
2009;266:535–542.
22. Khoury S, Rouleau GA, Rompr
e PH, Mayer P, Montplaisir
JY, Lavigne GJ. A significant increase in breathing ampli-
tude precedes sleep bruxism. Chest. 2008;134:332–337.
23. Ohayon MM, Li KK, Guilleminault C. Risk factors for sleep
bruxism in the general population. Chest. 2001;119:53–61.
24. Sj€
oholm TT, Lowe AA, Miyamoto K, Fleetham JA, Ryan CF.
Sleep bruxism in patients with sleep-disordered breathing.
Arch Oral Biol. 2000;45:889–896.
© 2013 John Wiley & Sons Ltd
 CERVICAL COLUMN POSTURE AND AIRWAY DIMENSIONS IN BRUXIST
25. Landry ML, Rompr
e PH, Manzini C, Guitard F, de Grand-
mont P, Lavigne GJ. Reduction of sleep bruxism using a
mandibular advancement device: an experimental con-
trolled study. Int J Prosthodont. 2006;19:549–556.
26. DiFrancesco RC, Junqueira PA, Trezza PM, de Faria ME,
Frizzarini R, Zerati FE. Improvement of bruxism after T & A
surgery. Int J Pediatr Otorhinolaryngol. 2004;68:441–445.
27. Ozbek MM, Miyamoto K, Lowe AA, Fleetham JA. Natural
head posture, upper airway morphology and obstructive
sleep apnoea severity in adults. Eur J Orthod. 1998;20:133–
143.
28. Amis TC, O’Neill N, Wheatley JR. Oral airway flow dynam-
ics in healthy humans. J Physiol. 1999;515:293–298.
29. Reiterer F, Abbasi S, Bhutani VK. Influence of head-neck
posture on airflow and pulmonary mechanics in preterm
neonates. Pediatr Pulmonol. 1994;17:149–154.
© 2013 John Wiley & Sons Ltd
817
30. Carlo WA, Beoglos A, Siner BS, Martin RJ. Neck and body
position on pulmonary mechanics in infants. Pediatrics.
1989;84:670–674.
31. Oksenberg A, Arons E. Sleep bruxism related to obstructive
sleep apnea: the effect of continuous positive airway pres-
sure. Sleep Med. 2002;3:513–515.
32. Iida T, Sakayanagi M, Svensson P, Komiyama O, Hirayama
T, Kaneda T et al. Influence of periodontal afferent inputs
for human cerebral blood oxygenation during jaw move-
ments. Exp Brain Res. 2012;216:375–384.
Correspondence: Claudia C. Restrepo, CES-LPH Research Group,
Universidad CES, Calle 10 A No. 22-04, Medell
ın, Colombia.
E-mail: martinezrestrepo@une.net.co