Down Syndrome is a common developmental disability. Patients with DS may have many co-morbities associated with the condition, which include cardiac abrnormalities and severe periodontal disease. This case illustrates how a patient with advanced periodontitis was treated in the Special Care Clinic at UOP, Dugoni School of Dentistry.
Optimized patient centered care in complex surgical cases requires comprehensive preparation through both clinical examination and radiographic interpretation. Our case demonstrates how diagnostic imaging can reveal critical radiographic findings that alter treatment approach. Pre-operative preparation involving thorough clinical and radiographic examination, in combination with excellent clinician rapport, leads to a biopsychosocial approach to dental treatment, emphasizing whole patient care. Biopsy returned from oral pathology with diagnosis of odontogenic keratocyst (OKC). At the time of publication, the patient is nearing definitive treatment of the cystic lesion with enucleation and removal of tooth #16. In our case, thorough radiographic interpretation, the professional responsibility of each clinician, functioned as a tool to optimize communication and patient care during pre-surgical planning and post-surgical follow-up. To resolve this biopsychosocial challenge, the oral surgeon demonstrated whole patient care through diligent and precise follow-up, while maintaining excellent rapport with both the patient and guardian/parent, further helping to stabilize the extrinsic patient factors. A clinician’s responsibility is not only the patient’s dental care, but also the overall health and needs of the patient. A biopsychosocial approach to complex dental treatments allows clinicians to better prepare for challenging cases, lean on additional appropriate specialists, and determine a plan that is understandable and manageable for the patient and guardian/parent in the situation.
Abstract Introduction: In recent years, there has been a growing focus on understanding the impact of oral cancer on patients' quality of life. Prosthetic rehabilitation techniques, such as maxillary obturators, often in conjunction with reconstructive surgery, have emerged as interventions to address the challenges posed by post-maxillectomy abnormalities. Objective: This study aims to systematically review and evaluate the effectiveness of maxillofacial prosthetic rehabilitation using obturators in enhancing the quality of life of patients following maxillectomy. Methodology: Systematic review of identified literature spanning the timeframe from 2000 to 2020 was used. The comprehensive search encompassed widely recognized databases including PubMed, Medline, Web of Science, and the Cochrane Central Register of Controlled Trials and used PRISMA search strategy. Results: Among the 841 identified sources only thirteen were reviewed in details. Studies demonstrated the degree of therapy, pain, ingestion and speech impairment, and obturator functioning were the main factors affecting patients’ health-related quality of life (HRQOL) following radiation therapy and resection. Conclusion: The use of an obturator prosthesis improves the quality of life of patients following surgery. However, larger, well-designed, multicenter, and longitudinal studies are necessary to evaluate the effects of various reconstruction and retention techniques, as well as sociodemographic factors on patients’ HRQOL.
ABSTRACT Statement of problem: Indirect restorations may not fit the patient’s teeth, or they may require excessive adjustment. If multiple casts from the same impression are equivalent, dentists can use new pristine casts to determine if fit problems have a laboratory or clinical cause. If the problem is from the laboratory, it may be correctable on a pristine cast. Purpose: The purpose of this in vitro study is to determine if the areas critical for indirect restoration fit are equivalent on 6 casts made over 29 days from a single polyvinylsiloxane impression. Material and Methods: Eight impressions were made of a reinforced plaster reference cast with a fixed partial denture preparation from teeth #3-#5. Forty-eight casts were fabricated from these impressions at 1 hour, 3 hours, 22 hours, 8 days, 15 days, and 29 days. Half of the casts were made with low-expansion mounting stone, the other half were made with high-expansion type 5 stone. All casts were scanned to create STL files. Geomagic Control X was used to compare critical areas of the experimental cast STL files to the reference cast STL file by making two 2-dimensional slices facial-lingually through crown preparations #3 and #5, followed by 2 more 2-dimensional slices mesial-distally through interproximal contact points and crown preparations. Comparison points on these 2-dimensional slices were made on mesial, distal, facial, and lingual preparation walls and margins, on occlusal surfaces, and on interproximal contact areas of teeth #2 and #6. These planes and comparison points were precisely transferable across multiple substitutions of different experimental cast STL files. Therefore, precise point deviations from the reference cast were made across multiple experimental casts. Control data were obtained by comparing the original reference cast STL file to a second reference cast STL file made after the reference cast was repositioned on the scan table to test scanner accuracy, by comparing an experimental cast to the reference cast both early and late in the comparison sequence to test Geomagic algorithm consistency, and by comparing a new reference cast STL file to the original reference cast STL file to test reference cast deterioration. Data were analyzed with Tukey HSD and Games-Howell post hoc tests. A power analysis on trial data showed that 8 impressions would be enough for significant results. Results: There were no statistical differences among all 48 casts when using comparison points p > 0.6. The 48 experimental casts’ comparison points average deviation from the reference cast was -9.9 microns for negative numbers with a standard deviation of 7.7, and 11.7 microns for positive numbers with a standard deviation of 9.3. The highest point deviation was 46 microns. Control data showed that only the limits of scanner accuracy produced data uncertainty in this experiment, and that it was +/- 13 microns. Conclusions: When points on casts critical for indirect restoration fit are measured, 6 casts made from a single polyvinylsiloxane impression over 29 days with either type-5 stone or mounting stone are equivalent. Clinical Implications: Restorative dentists can use extra casts to determine if indirect restoration fit problems have a laboratory or clinical source. Laboratory problems may be correctable on these casts.
This study examines the interdisciplinary collaboration between dental and occupational therapy schools to support dental education on autism spectrum disorder (ASD). An occupational therapy student created a recorded training module to educate international dental students on ASD. The participants completed a self-reported pre- and post-survey questionnaire examining their confidence levels in interacting with the ASD population and their awareness of other healthcare professions. The survey results showed improvements in confidence levels for identifying characteristics of ASD, communicating with clients with ASD, identifying sensory-based strategies, navigating uncooperative behaviors, and providing education for at-home care. There was an increase in the awareness that dental professionals' collaboration with other professionals, such as occupational, speech, and ABA therapists, can improve the outcomes of oral care that they provide. This study demonstrates the exploration of interdisciplinary collaboration between dental and occupational therapy at an academic level to support the dental experiences of the ASD population.
Synopsis: Applying and reproducing knowledge doctrines are two major themes in teaching and learning exercises in laboratory technique courses. Data reviewed in this study examines the correlation of applying and reproducing knowledge. Exercises included occlusion wax-ups pertaining to application and esthetic wax-ups pertaining to reproduction of knowledge. Methods: Student performances in five consecutive graduating classes from 2013 to 2017 over five year period were observed and association between the two exercises measured. Mean scores in individual and combined groups were assessed. Data showed trends for high and low performers in three modes: combined, occlusion and esthetic performances analyzed. Results: Overall combined groups performed similarly with 0.35% mean difference and insignificant in both occlusion and esthetic wax-up exercises. In combined data, high performing students had less disparity between occlusion and esthetic performances in comparison to low performers which performed higher in reproducing exercises. Conclusion: This study confirms beginners have different learning modes, majority of learners are able to perform similarly in various modes however, low performers experienced more containment and were able to perform higher in a specific mode. These findings provide evidence that regular assessments in defining learning modes can identify any shortcomings early on in dental curricula.
Periodontitis and type 2 diabetes mellitus are associated with each other in a bidirectional relationship. The mechanism by which diabetes affects periodontitis is understood to be due to the inflammatory effects of hyperglycemia (high blood glucose levels) and a hospitable environment for sugar-consuming bacteria. Periodontitis is known to be associated with higher levels of glycated hemoglobin (HbA1c), a long-term measurement of blood glucose control, and treatment of periodontitis reduces HbA1c. Inflammation caused by periodontitis induces insulin resistance (which leads to higher blood glucose levels), but due to the complex nature of inflammation it is difficult to single out one specific cause and effect relationship. Tumor necrosis factor-alpha (TNF-α) is a cytokine produced by macrophages and monocytes during acute inflammation. TNF-α is of interest due to its association with the disruption of insulin receptors in skeletal muscle cells and dysfunction of the pancreatic β-cells that produce insulin and is found to be elevated in patients with periodontitis. Treatment of periodontitis reduces the burden of inflammation on the body’s metabolic controls to improve control of blood glucose levels. Thus, oral health care is associated with general healthcare to provide better outcomes and supplemental treatments to improve patient conditions at the margin.
