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Management of obstructive sleep apnoea in children with modified monobloc appliances.
AIM: This was to investigate the effect of the use of an orthodontic appliance in the treatment of obstructive sleep apnoea (OSA) in children using polysomnographic variables. METHODS: 10 boys and 10 girls with OSA aged between 4 to 8 years, referred from an otolaryngology clinic because of sleep apnoea, wore modified monobloc devices nightly for 6 months. Polysomnography was used for each patient for baseline diagnosis of OSA and also for post therapy assessment. RESULTS: The median obstructive apnoea- hypopnoea index decreased after 6 months of therapy with oral appliances. The mean (+/-SD) number of episodes of OSA was 7.88+/-1.81 before treatment and 3.66+/-6.80 after 6 months (p<0.001). CONCLUSIONS: The modified monobloc appliance is suggested for use in children with OSA and may be an effective therapeutic alternative in children with mild to moderate OSA.
Occlusal interferences and temporomandibular dysfunction.
Disagreement exists regarding the relationship between occlusal interferences and temporomandibular joint dysfunction (TMD). This study sought to determine how a balanced occlusion, providing uniform contact in centric relation, would affect signs and symptoms of TMD. A randomly chosen group of 60 patients with occlusal interferences and signs and symptoms of TMD used a mandibular orthotic to balance their occlusions at centric relation (CR). When the occlusions of symptomatic patients were balanced in CR, there was a significant reduction or elimination of TMD complaints, suggesting a relationship between balancing occlusion in CR and optimum management of TMD.
Optimizing clinical longevity in the anterior: direct composite veneer, porcelain veneer, or full crown.
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Gastroesophageal reflux disease: a dental concern.
Oral chemical erosion can be caused by several factors. The most significant and most frequent is gastroesophageal reflux disease (GERD). Asymptomatic patients with GERD often are unaware that they may have a potential life-threatening condition. The dental profession is in a position to identify the subtle oral signs of the disease and has the obligation to be alert to the signs of gastroesophageal reflux, making appropriate referrals when necessary. The purpose of this article is to raise awareness concerning earlier detection of the subtleties of chemical erosion, particularly from GERD. A severe case of asymptomatic chemical erosion caused by GERD is presented.
The use of a removable appliance to improve oral continence in an elderly dentate patient.
Challenges in the treatment of our older dentate patients are arising more frequently, and novel solutions may be required to overcome them. This case report describes the treatment given to an elderly dentate female patient, whose lax peri-oral musculature was preventing a satisfactory oral seal from being achieved. This resulted in constant "drooling" and much social disability in an otherwise fit and gregarious lady. A simple removable appliance was provided to increase support to the tissues at the angles of the mouth. An immediate relief of the salivary leakage was achieved and maintained. Simple solutions may be available to problems which may cause great distress to our patients reducing the quality of their lives. This solution to the problem of peri-oral leakage, of a normal volume of saliva, may be useful for many other patients with similar problems, following loss of peri-oral muscle tone with age.
[Dental implants in tooth grinders].
Bruxism (tooth grinding and clenching) is generally considered a contraindication for dental implants, although the evidence is usually based on clinical experience only. So far, studies to the possible cause-and-effect relationship between bruxism and implant failure do not yield consistent and specific outcomes. This is partly due to the large variation in the technical and the biological aspects of the investigations. Although there is still no proof that bruxism causes overload of dental implants and their suprastructures, a careful approach is recommended. Practical advices as to minimize the chance of implant failure are given. Besides the recommendation to reduce or eliminate bruxism itself, these advices concern the number and dimensions of the implants, the design of the occlusion and articulation patterns, and the use of a hard nightguard.
Dahl appliances used for the restorative management of localized anterior tooth erosion.
Dahl partial bite-raising appliances have been used over the past 30 years for the management of occlusal tooth tissue loss, particularly in patients who have lost normal occlusal vertical dimension. The more recent use of Dahl-type appliances for individual teeth has changed the restorative management of patients with localized anterior tooth erosion. The Dahl treatment principle can be applied to those patients with and without the loss of occlusal vertical dimension. Palatal bite-raising platforms can be used to re-establish anterior tooth guidance for disocclusion of the posterior teeth without occlusal interferences. The treatment principle is illustrated with clinical cases.
The bicuspid block MORA convertible appliance.
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Post-traumatic stress disorder: considerations for dentistry.
A dental patient with post-traumatic stress disorder (PTSD) may present with greater dental and behavioral challenges than most dental patients. The background review of PTSD's initiating factors, diagnostic criteria, and medical management should help practitioners better understand and manage these challenges. Many of the challenges the clinician may encounter and managing recommendations are described. A case report of a PTSD patient complaining of constant bilateral tooth pain of the maxillary and mandibular bicuspids and molars is presented. Recommended techniques for identifying the tooth pain source and contributing factors are provided. The primary contributing factor for the patient's tooth pain was determined to be his severe tooth clenching activity. A maxillary acrylic appliance provided some pain reduction and a subsequent mandibular soft occlusal appliance worn opposing the maxillary appliance provided additional relief.
Altered jaw posture and occlusal disruption patterns following mandibular advancement therapy for sleep apnea: a preliminary study of cephalometric predictors.
PURPOSE: Reports of irreversible alteration in jaw posture and destructive occlusal contact relationships in individuals using mandibular advancement devices for obstructive sleep apnea are beginning to appear. This study sought cephalometric means of identifying such individuals before commencing therapy. MATERIALS AND METHODS: Cephalograms of 34 obstructive sleep apnea sufferers who had worn mandibular advancement devices for 2 years were compared retrospectively with baseline films taken at commencement of therapy and analyzed for signs of morphologic changes in jaw position and occlusal relationship. In affected patients, two distinct morphologic species of mandibular reposturing became evident: (1) bilateral posterior open bite with destructive incisal attrition; and (2) less destructive intermediate open bite over the premolar and first molar regions. From the observed morphology patterns, gonial angle and maxillary-mandibular plane angle were analyzed as possible vertical cephalometric risk predictors, with newly defined pterygoid advancement proportion (PtAP) as a horizontal predictor. RESULTS: Three patients displayed the posterior open bite pattern and had gonial angles < or = 119 degrees and maxillary-mandibular plane angles < or = 16 degrees, with PtAP values > or = 0.48. Prediction intervals for the five intermediate open bite cases were 118 degrees < or = gonial angle < or = 128 degrees, and 23 degrees < or = maxillary-mandibular plane angle < or = 32 degrees. PtAP values were > or = 0.52. CONCLUSION: Cephalometric analysis can help practitioners identify which apnea patients might be likely to develop irreversible mandibular postural changes from wearing a jaw-repositioning device.
Intraoral orthotics for treatment of TMD.
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Long term analysis of conservative therapy for TMJ dysfunction: a patient evaluation.
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The clinical use of night guards: occlusal objectives.
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Occlusion, bruxism, and dental implants: diagnosis and treatment for success.
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Clinical management of regional odontodysplasia.
Regional odontodysplasia (ROD) is a rare, localized developmental anomaly of the dental tissues with distinctive clinical, radiographic, and histologic findings. The purpose of this study was to describe the characteristics and clinical management of 2 patients diagnosed with ROD at the Pediatric Dentistry Service at the Hospital Sant Joan de Déu, Barcelona, Spain. In both cases, temporary and permanent dentition were involved. It was concluded that therapeutic decisions during childhood must be based on the degree of involvement and each case's functional and aesthetic needs. Autotransplantation may be a good partial treatment option during the period of mixed dentition in some cases. Definitive treatment will include prosthetic rehabilitation with implants once the patient reaches adulthood.