Sleep disordered breathing in infants and children: a review of the literature.

The objective of this report was to review the etiology, diagnosis, and treatment of sleep disordered breathing (SDB) in children and infants. English peer-reviewed SDB literature identified by MEDLINE and a manual search conducted between 1999 and 2006 was selected. The keywords used for the search included: (1) children; (2) sleep disorder; (3) snoring; and (4) obstructive sleep apnea. A total of 153 manuscripts was identified. A delay in treatment of SDB children may be caused by several factors and may result in serious but generally reversible problems, including: (1) impaired growth; (2) neurocognitive and behavioral dysfunction; and (3) cardiorespiratory failure. Adenotonsillectomy is the treatment of choice, and continuous positive airway pressure may be an option for patients who are not candidates for surgery or who do not respond to surgery. Minimal information is available concerning the dental treatment of these disorders. With the devastating effects sleep disorders can have on children and their families, dentists must recognize obvious symptoms and refer these patients for management by physicians.

Maxillomandibular relationship philosophies for prosthodontic treatment: a survey of dental educators.

STATEMENT OF PROBLEM: A variety of treatment philosophies persist concerning the need for coincidence of centric occlusion (CO) and maximum intercuspation (MI) in prosthodontic restoration; however, no consensus exists. PURPOSE: The purpose of this study was to determine the philosophies of dental educators throughout the United States at both the predoctoral and postdoctoral levels and to compare their attitudes toward desirable maxillomandibular relationships in defined clinical situations. MATERIAL AND METHODS: A survey was constructed with 5 clinical scenarios presented describing patients with a difference between maximum intercuspation and centric occlusion. The survey was mailed to 171 dentists involved in either predoctoral or postdoctoral dental programs in the United States; including 56 dental schools; the Army, Navy, and Air Force postdoctoral programs; 8 Department of Veterans Affairs postdoctoral programs; and 7 hospital-based programs. Descriptive statistics of the responses were provided. Chi-squared (alpha=.05) and Fisher's exact test analyses (alpha=.05) comparing predoctoral and postdoctoral program responses for each question were performed. RESULTS: Forty-three predoctoral dental school program responses were received. Forty-one postdoctoral program directors, including the dental school-based programs, 3 armed service branches, 2 Veterans Administration programs, and 1 hospital-based program responded to the survey. Fifteen respondents indicated that they represented both predoctoral and postdoctoral programs, and these data were deleted from the sample. Summarized results for each question reflect on whether the clinicians philosophically believed patients were better off with the elimination of an existing occlusal interference between MI and CO or not. There was no statistically significant difference seen between the predoctoral and postdoctoral responses. CONCLUSION: The controversy regarding the preferred mandibular position for treatment of dentulous and partially edentulous patients continues among dental educators at both the predoctoral and postdoctoral levels in the United States.

Removable partial denture occlusion.

No single occlusal morphology, scheme, or material will successfully treat all patients. Many patients have been treated, both successfully and unsuccessfully, using widely varying theories of occlusion, choices of posterior tooth form, and restorative materials. Therefore, experience has demonstrated that there is no one righ r way to restore the occlusion of all patients. Partially edentulous patients have many and varied needs. Clinicians must understand the healthy physiologic gnathostomatic system and properly diagnose what is or may become pathologic. Henderson [3] stated that the occlusion of the successfully treated patient allows the masticating mechanism to carry out its physiologic functions while the temporomandibular joints, the neuromuscular mechanism, the teeth and their supporting structures remain in a good state of health. Skills in diagnosis and treatment planning are of utmost importance in treating these patients, for whom the clinician's goals are not only an esthetic and functional restoration but also a lasting harmonious state. Perhaps this was best state by DeVan [55] more than 60 years ago in his often-quoted objective. "The patient's fundamental need is the continued meticulous restoration of what is missing, since what is lost is in a sense irretrievably lost." Because it is clear that there is no one method, no one occlusal scheme, or one material that guarantees success for all patients, recommendations for consideration when establishing or reestablishing occlusal schemes have been presented. These recommendations must be used in conjunction with other diagnostic and technical skills.

A technique to determine a desired preparation axial inclination.

The guidelines recommended in the literature for the convergence angle of a crown preparation vary from 3 to 24 degrees. There is a lack of guidelines on techniques to achieve a specific axial inclination. The purpose of this article was to present a practical technique, with a diamond rotary cutting instrument of known axial inclination, to determine the diamond rotary cutting instrument angulations required to achieve the desired axial inclination of a preparation.

The teaching and treatment of upper airway sleep disorders in North American dental schools.

STATEMENT OF PROBLEM: Many dental patients suffer from upper airway sleep disorders (UASD) that affect the quantity and quality of their sleep. These disorders vary from minor annoyances to life-threatening conditions. Even though dentists can play a role in the successful treatment of these patients with oral devices, few do. This lack of participation, in part, may be due to lack of education. PURPOSE: The purpose of this study was to determine which North American dental schools include the treatment of UASD in their curriculum. This information may prove helpful to other schools in determining whether, and to what degree, they should teach about UASD and its treatment options. MATERIAL AND METHODS: A survey instrument (questionnaire) was mailed to all of the North American dental schools (n = 64) affiliated with the American Association of Dental Schools. The questionnaire consisted of 9 multipart questions. Major categories of questions included the following: (1) Is the subject of UASD a part of the school curriculum? If so, in what department is it taught? (2) Are oral devices fabricated for patients or is the experience only at the didactic level? (3) What diagnostic procedures are required? (4) What types of oral devices are fabricated and what is the success rate/recall frequency? (5) What is the patient source? (6) If this subject area is not covered either didactically or clinically, why not? The data were analyzed by use of descriptive statistics. RESULTS: Forty-three of the 64 schools that received the survey responded. Forty-two percent of the schools that responded are teaching the treatment of UASD with oral devices. There is no apparent consensus with regard to whether to teach the subject, at what level, or to what degree. CONCLUSION: Even though many dental patients suffer from potentially life-threatening sleep disorders, many of which could be treated with oral devices, fewer than half of the reporting dental schools currently include this area as part of their curriculum. This lack of inclusion is caused primarily by a lack of familiarity with the information available and a lack of available curriculum time.

Treating the modern complete denture patient: a review of the literature.

This article reviews the physical and mental compromises of today's patients, techniques, materials, occlusion, impressions, and soft liners and makes recommendations as to managing these compromises when fabricating complete dentures. References used were primarily from the "classical literature," and an effort was made to ascertain whether these treatment recommendations are appropriate for today's more difficult patients. An effort was made to incorporate recent recommendations where appropriate.