Atención odontológica humanizada a un paciente con neurofibromatosis tipo 1 atendido en una clínica de odontología de especialización infantil: reporte de Caso / Humanized dental care for a patient with type 1 neurofibromatosis attended in a specialized children's dentistry clinic: case report / Atendimento odontológico humanizado a paciente com neurofibromatose tipo 1 atendido em ambulatório especializado de odontologia infantil: relato de caso

Este trabajo tiene como objetivo relatar el abordaje individualizado, inclusivo y humanizado de un niño de 4 años y tres meses, con diagnóstico de neurofibromatosis tipo 1, atendido en la Carrera de Especialización en Odontopediatría de la Escuela de Graduados, Facultad de Odontología, Universidad de la Repú blica, Montevideo, Uruguay. En el examen clínico se pudo observar cicatrices derivadas del tratamiento quirúrgico del neurofibroma plexiforme en la zona cervical y la presencia de hipotonicidad muscular oral. Al examen clínico intraoral, se observaron amplias zonas desdentadas a consecuencia de exodoncias de quince dientes deciduos. Presentaba lesiones activas de caries en los dientes remanentes, acompañado de biopelícula generalizada y sangrado gingival provocado. Se realizó un abordaje integral del paciente y la terapia rehabilitadora mediante el uso de prótesis parcial removible superior e inferior. Concluímos que el tratamiento odontológico educativo, preventivo, restaurador y rehabilitador fue satisfactorio y la empatía, como proceso dinámico, involucró mecanismos cognitivos, afectivos y conductuales, y fue reconocida por sus efectos positivos en la promoción de la salud bucal del paciente.

Este trabalho tem como objetivo relatar uma abordagem odontológica individualizada, inclusiva e humanizada, enfatizando a importância do tratamento de uma criança de 4 anos e três meses, com diagnóstico de neurofibromatose tipo 1, que foi encaminhada e tratada en la clínica de la Carrera de Especialización en Odontopediatria de la Escuela de Graduados, Facultad de Odontología, Universidad de la República. O exame clínico revelou cicatrizes decorrentes do tratamento cirúrgico do neurofibroma plexiforme que acometia o pescoço da criança e hipotonicidade muscular oral. Ao exame clínico intraoral, quinze dentes decíduos estavam ausentes e cinco com lesões de cárie na primeira infância, além de presença generalizada de biofilme microbiano nas superfícies dentais e sangramento gengival provocado. Foi realizado tratamento odontológico necessário ao paciente, com os devidos cuidados e terapia reabilitadora com prótese parcial removível superior e inferior. Concluímos que o tratamento odontológico educacional, preventivo, restaurador e reabilitador foi satisfatório e a empatia, como processo dinâmico, envolveu mecanismos cognitivos, afetivos e comportamentais e foi reconhecida por seus efeitos positivos na promoção da saúde bucal do paciente.

This paper aims to report an individualized, inclusive, and humanized dental approach, emphasizing the importance of treating a child aged four years and three months with neurofibromatosis type 1. The patient was referred and treated at the Clinic of the Specialization Course in Pediatric Dentistry of the Graduate School, School of Dentistry, Universidad de la República, Montevideo, Uruguay. The clinical examination revealed scars from the surgical treatment of the plexiform neurofibroma and neck and oral muscle hypotonicity. The intraoral clinical examination showed large edentulous areas as 15 deciduous teeth were missing. The patient had active carious lesions, generalized microbial biofilm on the tooth surfaces, and gingival bleeding. A comprehensive treatment was provided, as well as restorative therapy with upper and lower removable partial dentures. We conclude that the dental educational, preventive, restorative, and rehabilitation treatment was satisfactory. Furthermore, empathy, as a dynamic process, involved cognitive, affective, and behavioral mechanisms. It also helped enhance the patient's oral health.

Oral Rehabilitation with Implant-Retained Overdenture in a Patient with Down Syndrome.

Down syndrome, known as trisomy 21, is the most common chromosomal disorder. The disorder affects mental and systemic development as well as oral structure, including dental anomalies, high susceptibility of periodontal disease, and poor quality of alveolar bone. This report presents a case of dental rehabilitation by means of dental implants of a patient with Down syndrome. Two titanium dental implants were placed in the maxilla, and three titanium dental implants were installed in the mandible. One implant was lost during the osseointegration period. The prosthetic rehabilitation was performed with implant-retained maxillary and mandibular overdentures with the Locator attachment system. After a 2-year follow-up period, the patient was doing well, and all implants were clinically stable with no signs of bone loss or inflammation. The present study emphasizes that implant-retained overdentures with Locator attachment system could be a therapeutic option even for patients with Down syndrome. This therapy prevents crestal bone loss around the implants, improves functional and esthetic outcomes, and provides optimum oral hygiene for patients with mild mental impairment. Careful patient selection and education of patients and caregivers are essential considerations for a successful and safe treatment with dental implants in Down syndrome patients.

Could the screening for correct oral health reduce the impact of death due to bolus asphyxia in adult patients? A forensic case report.

INTRODUCTION: "Bolus death" or "Café Coronary syndrome" refers to death due to asphyxia caused by an occlusion of the upper airways due to food. In this kind of asphyxia, the food bolus obstructs the larynx or the bronchial branches. This kind of event often affects subjects with acute intoxication due to alcohol or drugs, or with edentulism and with neurological or psychiatric diseases. CASE REPORT: An elderly woman, suffering from schizophrenia, was found dead in her house due to food bolus asphyxia. The post-mortem toxicological analysis on the deceased's biological fluids revealed the presence of tricyclic antidepressants, antipsychotics and neuroleptics. Study of the oral cavity showed the presence of partial edentulism and periodontal disease. HYPOTHESIS: We hypothesize that this kind of asphyxia in adults can be prevented. We believe that there are two major preventable factors: edentulism and salivation disorders in elderly and neuropsychiatric patients. The primary prevention of these pathologies would deal with the basic physician, similarly to other screenings already effectively in place. CONCLUSIONS: It is possible to prevent fatal asphyxia in subjects who suffer from this kind of diseases through appropriate screening. This prevention strategy would greatly reduce the amount of choking deaths in adults.

Crestal Sinus Floor Elevation with Autogenous Press-Fit Dowel Bone Harvested Using Trephine Drills: A New Method.

The aim of this study was clinical and radiographic evaluation of sinus floor lifting from the alveolar crest with trephine bur and autogenous bone graft. In this research, a press-fit dowel bone technique with application of an autogenous bone block was used for elevating the sinus floor. Ten closed sinus lift surgeries were performed on 10 patients; all patients possessed atrophic ridges in an edentulous maxilla. Bone height of the ridge ranged between 3 and 5 mm. Surgery included forming a bony cylinder with a trephine bur to reach the sinus cortical floor and then elevating the sinus floor bone with anosteotom and placing an autogenous bone block at the site and fitting it with strikes of a hand mallet. The amount of an osteotom sinus floor height gain was measured during implant placement and via radiography before surgery and four months postsurgery. Average height of the sinus floor bone after surgery was 8.33 mm with SD = 1.39 mm. Mean bone height gain after surgery in evaluated patients was 3.47 mm with SD = 1.4 mm. As a result, bone sinus floor height following surgery was significantly increased (P value = 0.044), with a significant difference between sinus floor bone height before and after surgery (P value = 0.041). No significant difference was observed between sinus floor bone height gain and sex, age, and smoking before and after the operation. The sinus floor lift method by trephine and autogenous bone graft is a practical and simple way to reduce the time needed for implantation in patients with moderate atrophy of the posterior maxilla.

Clinical factors in prosthodontic treatment of children with genetic defects.

BACKGROUND: Prosthodontic treatment of children with genetic disorders is an area that is rarely examined in the current specialist literature. Few prosthodontists will undertake treatment of such patients, who will more often be referred to an orthodontic specialist. After examining the 4 cases of children with genetic disorders described in this paper, it can be concluded that when a prosthodontist includes a few additional procedures in the treatment process, he or she can successfully help such patients. OBJECTIVES: The aim of this paper is to indicate the clinical difficulties faced by prosthodontists who undertake prosthodontic rehabilitation of children with genetic disorders. MATERIAL AND METHODS: The paper is based on data collected during the prosthodontic treatment of 4 children, aged 5-12 years with genetic defects, and analysis of the body of work concerning these defects and their treatment. RESULTS: Presentation of guidelines for the prosthodontic treatment process and creation of dentures for treated children based on extended procedures. CONCLUSIONS: A prosthodontist is a crucial person in a team of specialists treating disorders within the face among children with a genetic predisposition. A basic knowledge of orthodontics and psychology facilitates the treatment. Prosthetic restoration in the treatment group does not always require complicated operations. Individualization of the tools for downloading orthodontic impressions, designing denture elements and an increased number of checkups are the additional procedures. For the clinician, the emotional aspect of the treatment is the main impediment. Maintaining a good relationship with a patient and his or her caregivers requires interpersonal skills.

Lateral open bite and crossbite correction in a Class III patient with missing maxillary first premolars.

Posterior and Class III elastics were used to correct lateral open bite and anterior crossbite in a 29-year-old man. His occlusion, smile esthetics, and soft tissue profile were significantly improved after 25 months of active orthodontic treatment combined with 4 anterior restorations.

Having fewer than 21 teeth associated with poorer general health among South Australians.

OBJECTIVE: To explore whether having less than 21 teeth is associated with poorer general health in a representative population sample of South Australians. METHODS: Data were from a cross-sectional state-based survey, conducted from September to December 2013. Complete data were available for 2,908 participants (58 percent response rate). General health-related quality of life (HrQOL), as measured by the EuroQol instrument (EQ-5D-5L), was the main outcome measure. Total disutility scores were calculated, with the five individual EQ-5D dimensions then dichotomized into "no problems" and "at least one problem." The main explanatory variable was self-reported missing teeth, as assessed by having <21 teeth versus 21+ teeth in a questionnaire. RESULTS: Overall, disutility was low (0.09) (ranges from 0 to 1, with high scores indicating poorer general health). In multivariable analysis, total disutility was positively associated with older age, lower annual household income, lower levels of physical activity, being a current tobacco smoker, receiving mental health treatment and <21 teeth. When individual dimensions were considered, missing teeth remained significantly associated with mobility problems (PR 1.26, 95 percent CI 1.06, 1.50) and pain/discomfort (PR 1.16, 95 percent CI 1.06, 1.27). CONCLUSIONS: Missing teeth was associated with poor general health status as measured by EQ-5D-5L disutility. The relationship was especially evident with respect to mobility and pain/discomfort. The findings emphasize the importance of oral health as predictors of general health.

Association between posterior teeth occlusion and functional dependence among older adults in nursing homes in Japan.

AIM: To examine whether posterior teeth occlusion is associated with functional dependence regardless of the number of natural teeth among Japanese nursing home residents. METHODS: The present cross-sectional study included 234 residents aged >60 years from eight nursing homes in Aso City, Japan. Functional dependence in basic activities of daily living was measured using the Barthel Index, and the primary outcome was independence for essential personal care (Barthel Index ≥ 60 points). Posterior teeth occlusion was assessed by a dentist using the total number of functional tooth units, depending on the number and location of the remaining natural and artificial teeth on implant-supported, fixed, and removable prostheses. Logistic regression models were used to assess univariate and multivariate associations between the total number of functional tooth units and independence for essential personal care. Models were sequentially adjusted for the number of natural teeth, demographic characteristics, socioeconomic status, health behaviors and comorbidities. RESULTS: Independence for essential personal care was found in 14.1% of participants. Greater total numbers of functional tooth units were significantly associated with greater odds of independence for essential personal care (odds ratio 1.12; 95% confidence interval 1.01-1.24). The association remained significant after adjustment for the number of natural teeth and other possible confounders (odds ratio 1.14, 95% confidence interval 1.01-1.29). CONCLUSIONS: Posterior teeth occlusion was independently associated with functional dependence among nursing home older residents in Japan. The maintenance and restoration of posterior teeth occlusion might be preventive factors against late-life functional decline. Geriatr Gerontol Int 2017; 17: 622-627.

The Use of Telescopic Crowns in Removable Partial Denture Treatment for Patients with Severe Periodontal Disease: Two Patient Case History Reports.

Two patient case histories are described as examples of treatment of severe periodontitis in severely compromised partial dentitions. Management consisted of periodontal treatment and telescopic crown support for removable partial dentures with friction pin retention.

Fixed Implant Supported Rehabilitation of Partially Edentulous Posterior Maxilla in a Patient With Systemic Scleroderma: A Case Report.

Systemic Scleroderma (SSc) is an autoimmune disease that affects connective tissue, resulting in hardening skin, reduced vascular perfusion, gingival fibrosis, enlarged periodontal ligament, xerostomia, and trigeminal neuralgia. Secondary effects, including reduced oral opening and reduced manual dexterity may exacerbate the primary effects. Severe bone loss and premature tooth loss are common eventualities of SSc. Removable prosthetics can be a tedious option for these patients as the progression of the disease often leads to the impossibility of obtaining minimal standards of care, including stability, retention, and hygienic maintainability. Implant treatment of patients with Systemic Scleroderma is poorly documented, and common medications used to treat SSc have been considered relative contraindications to the prescription of dental implant therapy. This report describes 1 case after 2 years in function, where dental implants were successfully utilized to offer definitive fixed rehabilitation to a patient with SSc.

Associations between the number of natural teeth and metabolic syndrome in adults.

AIM: To explore associations between the number of natural teeth and metabolic syndrome in adults. MATERIAL AND METHODS: Cross-sectional data from the National Health and Nutrition Examination Survey 2005-2008 were used. Eligible adults (n = 5511) were classified into four groups by their number of natural teeth (excluding third molars): full dentition, 21-27 teeth, 1-20 teeth, or edentulous. Metabolic syndrome was defined by diagnostic guidelines from the American Heart Association and National Heart, Lung, and Blood Institute. Associations were analysed by survey logistic regression. Biometric and metabolic parameters in different dentition groups were compared. RESULTS: Adjusting for age, gender, race/ethnicity, ratio of family income to poverty, physical activity, smoking, and energy intake, tooth loss was significantly associated with metabolic syndrome (p = 0.002). Compared to participants with full dentition, the odds were 32% higher in those with 21-27 teeth, 55% higher in those with 1-20 teeth and 79% higher in edentulous participants. The number of natural teeth was inversely associated with body mass index, waist circumference, blood pressure, fasting plasma glucose and insulin concentrations (p < 0.01 for all); it was positively associated with serum HDL cholesterol concentration (p = 0.003). CONCLUSIONS: The number of natural teeth is inversely associated with the presence of metabolic syndrome in adults.

Treatment planning and dental rehabilitation of periodontally compromised partially edentulous patient: a case report - part II.

When planning a prosthetic rehabilitation of a periodontally compromised case, the clinician is often confronted with difficulties and dilemmas related to selecting the appropriate treatment that would provide long-term successful outcomes in function and esthetics. In such cases, a correct diagnosis and prognosis of the intraoral situation supported by evidence-based dentistry is the basis for the establishment of a proper treatment strategy. In this second part of a two-part treatment planning series, a systematic approach of patient examination and prognosis of each tooth is presented. Furthermore, different removable and fixed treatment possibilities are described and the rationale governing the decision-making process is revealed. The execution of the final treatment plan as specified by the concept of comprehensive dental care is outlined, and the final outcome is discussed according to the literature.

Tooth loss and its association with dietary intake and diet quality in American adults.

OBJECTIVES: To investigate associations between the number of natural teeth and energy intake, nutrient intake, and diet quality in adults. METHODS: Eligible adults who participated in the National Health and Nutrition Examination Survey during 2005-2008 were included in the present study (n=9140). Participants were classified into three groups depending on the total number of natural teeth (excluding third molars): full dentition (28 teeth), moderate dentition (21-27 teeth), and poor dentition (20 teeth or less). Dietary intake and diet quality were estimated from the first 24-h dietary recall data. RESULTS: Participants in the poor dentition group had significantly lower energy intake than those with moderate dentition (P<0.05), however, both groups did not significantly differ from those who had full dentition. Adjusting for sociodemographic characteristics, physical activity, smoking status, and energy intake, the intake of protein as well as most vitamins and minerals were positively associated with the total number of natural teeth (P<0.05); an inverse association was observed for carbohydrate intake (P<0.001). Diet quality, as measured by the Healthy Eating Index 2005, was inversely associated with tooth loss (P<0.001). CONCLUSIONS: Tooth loss in adults is associated with lower diet quality and reduced intake of most nutrients; this may partly explain for the higher risk of chronic diseases in this population. CLINICAL SIGNIFICANCE: People with missing teeth are recommended to monitor their dietary intake to avoid nutrient deficiency and to improve their diet quality for better health.

Treatment planning and dental rehabilitation of a periodontally compromised partially edentulous patient: a case report - Part I.

When planning a prosthetic rehabilitation of a periodontally compromised case, the clinician is often confronted with difficulties and dilemmas related to selecting the appropriate treatment modality that would provide a long-term longevity in terms of function and esthetics. In such cases, a correct diagnosis and prognosis of the intraoral situation supported by evidence-based dentistry is the basis for the establishment of a proper treatment strategy. In this two-part treatment planning series, a systematic approach of patient examination and prognosis of each tooth is presented. Furthermore, different removable and fixed treatment possibilities are described and the rationale governing the decision-making process is revealed. The execution of the final treatment plan as specified by the concept of comprehensive dental care is outlined and the final outcome is discussed according to the literature.

Implant rehabilitation in bruxism patient.

A white female patient presented to the university clinic to obtain implant retained prostheses. She had an edentulous maxillary jaw and presented three teeth with poor prognosis (33, 34 and 43). The alveolar bone and the surrounding tissues were healthy. The patient did not report any relevant medical history contraindicating routine dental treatment or implant surgery, but self-reported a dental history of asymptomatic nocturnal bruxism. The treatment plan was set and two Branemark protocols supported by six implants in each arch were installed after a 6-month healing period. A soft occlusal splint was made due to the patient's history of bruxism, and the lack of its use by the patient resulted in an acrylic fracture. The prosthesis was repaired and the importance of using the occlusal splint was restated. In the 4-year follow-up no fractures were reported.

Full-mouth rehabilitation of a patient with severe deep bite: a clinical report.

Increasing the vertical dimension is essential to resolving problems associated with deep bite. Restorative dentistry, orthodontia, and oral surgery are the three disciplines that can help to gain the vertical dimension necessary in these patients. This clinical report presents the results of increasing vertical dimension with a full-mouth restorative treatment procedure for a 40-year-old male patient who exhibited severe deep bite. After clinical evaluation, extraoral examination showed a reduction of the lower facial height and protuberant lips, wrinkles, drooping, and overclosed commissures. In addition, intraoral examination showed a severe anterior deep-bite articulation, and upper incisors were in contact with the lower incisor labial tissue. A removable partial denture was made at increased occlusal vertical dimension (OVD) to use in the first stage of rehabilitation. Diagnostic wax-up was performed at the increased vertical dimension. Then, provisional crowns were fabricated according to this increased vertical dimension. Interim prostheses were used for 3 months as a guide for preparing the definitive restorations. The adaptation of the patient to the increased OVD was evaluated. During this period, he was asymptomatic. Following the evaluation period, definitive restorations were completed, and routine clinical assessments were made after 1 week, 1 month, 3 months, and 6 months, then after 1 and 2 years with visual and radiographic examinations.

Increased risk for premolar tooth loss in shortened dental arches.

OBJECTIVES: To assess sustainability of shortened dental arches (SDA) by determining time to 'first restorative intervention' of teeth and time to 'tooth loss' and comparing these outcomes with complete dental arches (CDA) and SDA plus removable dental prostheses (RDP). METHODS: Data (follow-up time ranged from 27.4 (SD 7.1) to 35.0 (SD 5.6) years; max. follow up: 45.8 years) from patient records of 59 subjects (23 SDA, 23 CDA, and 13 SDA plus RDP) participating in a prospective cohort study on shortened dental arches (SDA) were analysed. Group effects on survival were analysed using Cox regression models; where appropriate Kaplan-Meier analyses were done. RESULTS: Compared to SDA subjects, CDA subjects had a lower risk to receive a first restorative intervention in anterior teeth (HR=0.377; 95% CI [0.205-0.695]) and premolars (HR=0.470; 95% CI [0.226-0.977]). CDA subjects had a lower risk to lose premolars compared to SDA subjects (HR=0.130; 95% CI [0.053-0.319]). Risk for 'first restorative intervention' and for 'tooth loss' did not significantly differ between SDA with and without RDP. CONCLUSIONS: SDA subjects had an increased risk to lose premolars and to receive a first time restoration in anterior teeth and premolars compared to CDA subjects. SDA subjects with RDP had no increased risk to receive a first restorative intervention or for tooth loss compared to SDA without RDP. CLINICAL RELEVANCE: Subjects with shortened dental arches can be discerned as enduring at-risk patients. It is therefore recommended that shortened dental arch subjects receive intensive and continuous care to prevent further tooth loss.

The association between chewing and swallowing difficulties and nutritional status in older adults.

BACKGROUND: The aim of this study was to investigate the associations of chewing and swallowing dysfunctions to nutritional status in older adults. METHODS: This cross-sectional study comprised a convenience sample of 1065 community-dwelling older adults living in rural United States. Dietary assessment included the Block Full Length Food Frequency Questionnaire, 24-hour Food Intake Recall and Mini Nutritional Assessment. Classification of chewing and swallowing difficulties was determined by a criterion of outlined factors. RESULTS: In our sample, 113 (11%) had chewing difficulties, 51 (5%) had swallowing difficulties, and 11 (1%) had both. Compared to the Dietary Reference Intakes (DRIs), the study population was deficient in calories and several nutrients. Mean daily intake in individuals reporting chewing, swallowing, or difficulties with both were 1489 ± 360, 1461 ± 374 and 1374 ± 240 calories respectively. There was no statistically significant difference between the groups. Vitamin A, vitamin E and manganese were significantly lower in those with chewing difficulties while vitamin E and magnesium were significantly lower in individuals with swallowing difficulties (p < 0.05). CONCLUSIONS: These results emphasize the importance of chewing and swallowing difficulties in modulating nutritional outcomes in older adults. These co-morbidities should be monitored in this population and intake of nutrient dense foods should be increased in those at risk.

Virtopsy versus autopsy in unusual case of asphyxia: case report.

We report the case of a 70-year-old woman found dead in her apartment in the South of Italy in February 2011. The detailed data showed that the victim was affected by familiar-type paranoid schizophrenia. This finding was confirmed by the discovery of antipsychotic and tricyclic antidepressant drugs in the house and the deposition of her psychiatric therapist. Before the autopsy, a multislice computed tomography (MSCT) scanning of the thoracic and facial maxillo-cervical area was performed that has allowed anatomical identification and diagnosis of a mechanical obstruction as the cause of death. The autopsy has showed the presence of materials obstructing the trachea totally. Histological and toxicological investigations were carried out on the victim. The toxicological investigation has shown the presence of metabolites of tricyclic antidepressants and antipsychotics in the blood and urine. The histology showed the presence of foreign-origin materials (starch fibres) inside the pulmonary alveolus. The cause of death was asphyxia due to obstruction by food-origin material. In this case the radiological data have been compared with the autopsy and toxicological and histological data. The comparison of results has shown that MSCT scanning may aid in identification of occlusion and then in determination of the cause of death. In conclusion, MSCT scanning can be proposed in the cases of suspected asphyxia, as the screening procedure of first instance to produce preliminary information useful to rapidly develop the successive autopsy performance.

Treatment of anterior open bite and multiple missing teeth with lingual fixed appliances, double jaw surgery, and dental implants.

The treatment of adult patients with severe anterior open bite frequently requires orthognathic surgery, especially when the chin is retruded severely. If a patient has multiple missing posterior teeth, it is difficult to control the occlusal plane because it is challenging to obtain anchorage during orthodontic treatment. We report on a 25-year-old woman who had a skeletal Class II malocclusion, severe anterior open bite, vertical maxillary asymmetry, and severe dental caries on her molars. There was no posterior occlusal contact between the maxillary and mandibular molars since 5 of her molars had to be extracted because of severe caries. Lingual fixed appliances and double jaw surgery were performed to treat her skeletal and dental problems, and dental implants helped restore her masticatory function. Pretreatment, posttreatment, and retention photographs demonstrate effective, esthetically pleasing, and stable treatment results.