Adjustable tongue crib.

Thumb sucking and tongue thrusting habits are mostly counteracted and rehabilitated using a tongue crib. Most patients find the conventional crib difficult (due to its position and length) in the initial days of treatment and become uncooperative. Hence, few modifications are made to the traditional design of the tongue crib for easy adjustment of the crib height and angulation, which provides comfort to the patient.

Arginine vasotocin impacts chemosensory behavior during social interactions of Anolis carolinensis lizards.

In reptiles, arginine vasotocin (AVT) impacts the performance of and response to visual social signals, but whether AVT also operates within the chemosensory system as arginine vasopressin (AVP) does in mammals is unknown, despite social odors being potent modifiers of competitive and appetitive behavior in reptiles. Here, we ask whether elevated levels of exogenous AVT impact rates of chemical display behavior (e.g. tongue flicks) in adult males, and whether conspecific males or females can chemically discriminate between competitor males based on differing levels of exogenous AVT in green anoles (Anolis carolinensis). We injected wild-caught green anole males with either AVT (AVT-Males) or a vehicle control (CON-Males) solution, then presented treated males with a conspecific stimulus (Intruder-Male or Intruder-Female) and filmed 30-minute interactions. We found that AVT-Males were faster than CON-Males to perform a tongue flick to conspecifics, and faster to chemically display toward Intruder-Females, suggesting AVT increased male interest in available chemical information during social encounters. Intruders performed more lip smack behavior when interacting with AVT-Males than with CON-Males, and Intruder-Males performed more tongue flick behavior when interacting with AVT-Males than with CON-Males, suggesting anoles can discriminate between conspecifics based on exogenous AVT levels. We also found a reduction in Intruder movement behavior when Intruders were paired with AVT-Males. This study provides empirical support for AVT-mediated chemosensory behavior in reptilian social interactions, in a microsmatic lizard species, suggesting the mechanism by which mammalian AVP and non-mammalian AVT mediate chemosensory behavior during social interactions may be evolutionarily conserved.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children.

BACKGROUND: Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition. METHODS: A sample of 198 pre-school children, aged 3-5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children's parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic. RESULTS: Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04-0.47, p = 0.0004). This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42-5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17-4.37). CONCLUSIONS: Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Sonographic evaluation of tongue motions during upper airway stimulation for obstructive sleep apnea-a pilot study.

INTRODUCTION: The objective was to evaluate the feasibility of sonographic evaluation of functional tongue motion as a tool to evaluate postoperative outcomes in human subjects using breathing-synchronized stimulation of the hypoglossal nerve-a novel therapy option for patients with obstructive sleep apnea (OSA). MATERIAL AND METHODS: Sixteen patients with OSA (n = 16, age 60.4 ± 10.2, BMI 28.7 ± 2.4, AHI 35.0 ± 11.8) underwent sonographic evaluation of tongue motion after initiation of therapy with the Inspire II Upper Airway Stimulation system. Sonographic examination was performed in four different planes (A = floor of the mouth frontal, B = base of the tongue horizontal, C = floor of the mouth parallel to mandible, and D = floor of the mouth median sagittal) in an attempt to visualize tongue surface, tongue and hyoid motion, and the distance of protrusion. RESULTS: Identification of the tongue surface was achieved in all cases in planes B, C, and D and 81 % of patients in plane A. Tongue motion was evident on the right (implant) side in 63 % in plane A and 75 % in plane B. Distance of protrusion was measured in plane B at 1.04 cm (±0.51), in plane C at 1.08 cm (±0.47), and in plane D at 0.96 cm (±0.45). Hyoid protrusion was measured in plane C or D and was 0.57 cm (±0.39). Significant correlations among the three planes were observed, but there was no correlation to the reduction of apnea-hypopnea index. CONCLUSION: The results indicate feasibility of sonography to identify tongue and hyoid motions during upper airway stimulation. Useful sonographic planes and landmarks, which allow visualization of dynamic effects of upper airway stimulation, could be established. The evaluation of the tongue in a horizontal (B) and in a sagittal plane (D) appears to be superior to the other investigated planes. The approximate tongue protrusion needed to generate a significant reduction of AHI and ODI was 1 cm.

Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: a randomised controlled trial.

Tongue thrust, which is an oral reflex associated with sucking behaviour, may cause problems in swallowing, speech, oro-facial development and also drooling. We aimed to examine the effect of Functional Chewing Training (FuCT) on tongue thrust and drooling in children with cerebral palsy. The study included 32 children with a mean age of 58·25 ± 9·58 months who had tongue thrust. Children were divided into two groups: the FuCT group and control group receiving classical oral motor exercises. Each group received training for 12 weeks. Oral motor assessment was performed. Chewing performance level was determined with the Karaduman Chewing Performance Scale. Tongue thrust severity was evaluated with the Tongue Thrust Rating Scale. The Drooling Severity and Frequency Scale was used to evaluate drooling severity and frequency. The evaluations were performed before and after treatment. Groups were well matched in age, gender and oral motor assessment. No significant difference was found between groups in terms of pre-treatment chewing function, tongue thrust severity, drooling severity and frequency (P > 0·05). The FuCT group showed improvement in chewing performance (P = 0·001), tongue thrust severity (P = 0·046) and drooling severity (P = 0·002), but no improvement was found in terms of drooling frequency (P = 0·082) after treatment. There was no improvement in chewing performance, tongue thrust, drooling severity and frequency in the control group. A significant difference was found between groups in favour of FuCT group in tongue thrust severity (P = 0·043). This study showed that the FuCT is an effective approach on the severity of tongue thrust and drooling in children with CP.

Reliability and validity of a tool to measure the severity of tongue thrust in children: the Tongue Thrust Rating Scale.

This study aimed to develop a scale called Tongue Thrust Rating Scale (TTRS), which categorised tongue thrust in children in terms of its severity during swallowing, and to investigate its validity and reliability. The study describes the developmental phase of the TTRS and presented its content and criterion-based validity and interobserver and intra-observer reliability. For content validation, seven experts assessed the steps in the scale over two Delphi rounds. Two physical therapists evaluated videos of 50 children with cerebral palsy (mean age, 57·9 ± 16·8 months), using the TTRS to test criterion-based validity, interobserver and intra-observer reliability. The Karaduman Chewing Performance Scale (KCPS) and Drooling Severity and Frequency Scale (DSFS) were used for criterion-based validity. All the TTRS steps were deemed necessary. The content validity index was 0·857. A very strong positive correlation was found between two examinations by one physical therapist, which indicated intra-observer reliability (r = 0·938, P < 0·001). A very strong positive correlation was also found between the TTRS scores of two physical therapists, indicating interobserver reliability (r = 0·892, P < 0·001). There was also a strong positive correlation between the TTRS and KCPS (r = 0·724, P < 0·001) and a very strong positive correlation between the TTRS scores and DSFS (r = 0·822 and r = 0·755; P < 0·001). These results demonstrated the criterion-based validity of the TTRS. The TTRS is a valid, reliable and clinically easy-to-use functional instrument to document the severity of tongue thrust in children.

Imitation of Non-Speech Oral Gestures by 8-Month-Old Infants.

This study investigates the oral gestures of 8-month-old infants in response to audiovisual presentation of lip and tongue smacks. Infants exhibited more lip gestures than tongue gestures following adult lip smacks and more tongue gestures than lip gestures following adult tongue smacks. The findings, which are consistent with predictions from Articulatory Phonology, imply that 8-month-old infants are capable of producing goal-directed oral gestures by matching the articulatory organ of an adult model.

Individual oral symptoms in burning mouth syndrome may be associated differentially with depression and anxiety.

BACKGROUND: Burning mouth syndrome (BMS) is an idiopathic disease characterized by the feeling of burning in the oral cavity. Ten per cent of patients presenting to oral medicine clinics have BMS. Anxiety and depression are common co-morbidities in BMS, but it is not known if they are associated with specific BMS symptoms. OBJECTIVE: In an exploratory analysis, this study examined the association of generalized anxiety and depression with individual BMS symptoms. METHODS: Forty-one patients were recruited from a dental outpatient clinic (30 with BMS and 11 with other oral conditions), evaluating specific BMS symptoms and their intensity. Anxiety and depression symptoms were assessed using a standardized measure (Clinical Interview Schedule-Revised). RESULTS: Taste change (p = 0.007), fear of serious illness (p = 0.011), metallic taste (p = 0.018) and sensation of a film on the gums (p = 0.047) were associated with an excess of psychiatric symptoms. More specifically, metallic taste (coefficient = 0.497, 95% CI = 0.149-0.845; p = 0.006) and sensation of film on gums (coefficient = 0.625, 95% CI = 0.148-1.103; p = 0.012) were associated significantly with higher scores for depressive symptoms; taste change (coefficient = 0.269, 95% CI = 0.077-0.461; p = 0.007), bad breath (coefficient = 0.273, 95% CI = 0.065-0.482; p = 0.012) and fear of serious illness (coefficient = 0.242, 95% CI = 0.036-0.448; p = 0.023) were associated with higher anxiety scores. CONCLUSION: Specific BMS symptoms are associated differentially with generalized anxiety and depression. Dental practitioners should ascertain which BMS symptoms are predominant and be mindful of the association of certain symptoms with anxiety or depression and, where necessary, consider medical consultation.

Implant therapy for a patient with Down syndrome and oral habits: A clinical report.

This clinical report describes prosthodontic therapy with an implant-supported partial fixed dental prosthesis for a patient with Down syndrome and concomitant oral habits, including tongue thrusting and thumb sucking.

Open-bite treatment with vertical control and tongue reeducation.

An open-bite malocclusion with a tongue-thrust habit is a challenging type of malocclusion to correct. A 12-year-old girl came for orthodontic treatment with a severe anterior open bite, extruded posterior segments, a tongue-thrust habit, and lip incompetency. Her parents refused surgical treatment, so a nonextraction treatment plan was developed that used palatal temporary skeletal anchorage devices for vertical control and mandibular tongue spurs to reeducate the tongue. Interproximal reduction was also used to address the moderate to severe mandibular crowding. An abnormal Class I occlusion was achieved with proper overbite and overjet, along with a pleasing smile and gingival display.

[Effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition].

OBJECTIVE: To assess the effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Beijing. METHODS: This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior cross bite, posterior cross bite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple Logistic regressions were applied to analyze the associations. RESULTS: It was found that a short duration of breast-feeding (never or ≤6 months) was directly associated with posterior cross bite (OR=3.13, 95%CI=1.11-8.82, P=0.031) and no maxillary space (OR=1.63, 95%CI=1.23-2.98, P=0.038). In children breast-fed for ≤6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR=4.21, 95%CI=1.85-9.60, P=0.000 2). The children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of class II canine relationship compared with those who were bottle-fed for 6-18 months. Non-nutritive sucking habits were also found to affect occlusion: a prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit was associated with excessive overjet and absence of lower arch developmental space. Tongue-thrust habit was associated with anterior open bite (OR=4.21, 95%CI=1.85-9.60, P=0.000 2) and posterior cross bite (OR=7.24, 95%CI=1.30-40.13, P=0.024). Lower lip sucking habit was associated with deep overjet and had a negative association with class III canine relationship. Unilateral chewing was associated with spacing in mandibular (OR=1.57, 95%CI=1.03-2.41, P=0.037). Mouth breathing was associated with chronic rhinitis and adenoidal hypertrophy and had an association with spacing in maxillary. The chi-square test did not indicate a statistically significant association between upper lip sucking habit and any occlusal characteristics. CONCLUSION: Breast-feeding duration was shown to be associated with the prevalence of posterior crossbite, or no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a longer duration of bottle-feeding were more likely to develop class II canine relationship. Children who had an oral habit were more likely to develop abnormal occlusal characteristics.

Severe Anterior Open Bite during Mixed Dentition Treated with Palatal Spurs.

Deleterious oral habits, such as non-nutritive sucking or tongue thrusting, if not intercepted at an early stage can cause complex malocclusions. This manuscript describes a clinical case report of a successful interception of a severe anterior dental open bite caused by thumb sucking and tongue thrusting habits. The case involved a six-year-old female patient treated with the use of palatal spurs and maxillary removable crib followed by monitoring the development of dental occlusion. At the end of the interceptive phase acceptable results were achieved, showing the efficacy of the treatment undertaken as well the importance of an early intervention to remove harmful oral habits.

Interdisciplinary Management of Patient with Advanced Periodontal Disease.

This case report describes the interdisciplinary management of an adult patient with advanced periodontal disease. Treatment involved orthodontic and periodontal management. Good esthetic results and dental relationships were achieved by the treatment.

Dilemmas in Treatment of Recurrent Recalcitrant Dental Anterior Open Bite.

An anterior open bite is one of the most difficult occlusal abnormalities to treat. Quite often this aberration entails dental component and/or skeletal component. The skeletal open bite will require intrusion of the posterior sextants with the assistance of bite blocks, temporary anchorage devices, high pull headgear, and as a last resort - orthognathic surgery. The orthodontic treatment should be augmented with the orofacial myofunctional therapy. In this article, the author describes 3 different variations of treatment of the dental anterior open bite, first on acrylic models, and then on the actual patients. Consideration should be given to patients with a 'short upper lip," and in this case, surgical correction should be entertained.

Articulation and oromyofunctional behavior in children seeking orthodontic treatment.

OBJECTIVES: The purpose of this controlled study is to document articulation and oromyofunctional behavior in children seeking orthodontic treatment. In addition, relations between malocclusions, articulation, and oromyofunctional behavior are studied. MATERIALS AND METHODS: The study included 56 children seeking orthodontic treatment. The control group, consisting of 54 subjects matched for age and gender, did not undergo orthodontic intervention. To determine the impact of the occlusion on speech, the Oral Health Impact Profile was used. Speech characteristics, intelligibility and several lip and tongue functions were analyzed using consensus evaluations. RESULTS: A significant impact of the occlusion on speech and more articulation disorders for/s,n,l,t/were found in the subjects seeking orthodontic treatment. Several other phenomena were seen more often in this group, namely more impaired lip positioning during swallowing, impaired tongue function at rest, mouth breathing, open mouth posture, lip sucking/biting, anterior tongue position at rest, and tongue thrust. Moreover, all children with a tongue thrust showed an anterior tongue position at rest. CONCLUSIONS: Children seeking orthodontics have articulatory and oromyofunctional disorders. To what extent a combined orthodontic and logopaedic treatment can result in optimal oral health (i.e. perfect dentofacial unit with perfect articulation) is subject for further multidisciplinary research.

Swallowing disorders in Parkinson's disease: impact of lingual pumping.

BACKGROUND: Lingual pumping (LP) is a repetitive, involuntary, anteroposterior movement of the tongue on the soft palate that is executed prior to transferring the food bolus to the pharynx, but we also observed LP when multiple swallows were taken. LP may be associated with rigidity and bradykinesia in patients with Parkinson's disease (PD). This phenomenon tends to be more prevalent in dysphagic PD patients, and its impact on swallowing dynamics remains poorly understood. OBJECTIVE: To evaluate how LP interferes with the oral and pharyngeal phases of the swallowing of foods of different consistencies and volumes. METHODS: We used videofluoroscopy to study the swallowing of 69 PD patients performing 10 swallows of barium mixed with foods of different consistencies and volumes. RESULTS: LP was associated with the unstable intra-oral organization of the bolus, the loss of bolus control, the pharyngeal retention of food and food entering the airway. This abnormal movement was also associated with a shorter oral transit time and was found to be more prevalent with food of thicker consistencies. CONCLUSIONS: LP is associated with swallowing incoordination and with food entering the airway. Preventive measures to minimise the pulmonary or nutritional consequences of this behaviour are necessary.

Influence of non-orthodontic intervention on digit sucking and consequent anterior open bite: a preliminary study.

OBJECTIVES: This study aimed to assess behavioural and occlusal outcomes of non-orthodontic intervention (NOI) in a sample of children, 4-12 years of age, in Australia, in order to establish clinical relevance. MATERIALS AND METHODS: Data from 91 patient records of 4- to 12-year-old children reporting a habit of digit sucking, from two clinics in north-eastern Australia, were de-identified and used. Each patient had been examined at two visits, separated by an interval of 4 months, using standard clinical procedures. RESULTS: Of the 77 children who received a 4-month NOI, 69 (89.6%) had ceased their digit sucking habit by the end of the NOI period [χ2=67.0, degrees of freedom (d.f.)=1, P<0.001]. Of the 72 subjects who had front teeth, the number with anterior open bite decreased from 37 (51.4%) to 12 (16.7%) upon completion of NOI (χ2=21.3, d.f.=1, P<0.001). Among the 32 patients with a measurable overjet, the mean overjet was found to decrease from 4.2±2.4 mm to 3.1±1.9 mm after implementation of NOI (t=5.8, d.f.=31, P<0.001). Children who received NOI were more likely to quit the digit sucking habit in the 4-month period (P<0.001, OR=51.8, 95% CI: 9.8-273.9) and were more likely to appear without anterior open bite at a 4-month recall (P<0.001, OR=30.0, 95% CI: 5.9-151.6). CONCLUSIONS: This study demonstrated clinical relevance of NOI on the cessation of a digit sucking habit, closure of anterior open bite and reduction of overjet. Further investigations are indicated.

Nonsurgical approach to Class I open-bite malocclusion with extrusion mechanics: a 3-year retention case report.

Anterior open bite is one of the most challenging malocclusions for orthodontic treatment. The high incidence of relapse is a major concern. Therefore, accurate initial examination, diagnosis, treatment plan, and consideration of habitual risk factors are crucial for a successful outcome without unwanted sequelae. Excellent patient compliance for retainer wear is also a critical factor. This case report shows the 3-year stability of a nonsurgical and nonextraction orthodontic treatment of a 5-mm anterior open-bite malocclusion in a 12-year-old girl with extrusion mechanics and habit modification. After 2 years of orthodontic treatment, excellent outcomes were achieved. With an appropriate retention protocol, the long-term stability of the treatment was favorable.

Exploring consequences of short- and long-term deafness on speech production: a lip-tube perturbation study.

Studies have reported strong links between speech production and perception. We aimed to evaluate the role of long- and short-term auditory feedback alteration on speech production. Eleven adults with normal hearing (controls) and 17 cochlear implant (CI) users (7 pre-lingually deaf and 10 post-lingually deaf adults) were recruited. Short-term auditory feedback deprivation was induced by turning off the CI or by providing masking noise. Acoustic and articulatory measures were obtained during the production of /u/, with and without a tube inserted between the lips (perturbation), and with and without auditory feedback. F1 values were significantly different between the implant OFF and ON conditions for the pre-lingually deaf participants. In the absence of auditory feedback, the pre-lingually deaf participants moved the tongue more forward. Thus, a lack of normal auditory experience of speech may affect the internal representation of a vowel.

The efficacy of Italian guidelines in promoting oral health in children and adolescents.

AIM: The purpose of the study was to evaluate the efficacy of the guidelines on oral health published by the Italian Health Ministry. STUDY DESIGN: 1239 patients (582 girls and 657 boys) with a mean age of 4.46 (SD 2.81) years were evaluated before application of the guidelines by paediatricians (T0) for the presence of caries, gingivitis, diseases of the oral mucosa, and malocclusion. Only patients aged 6 months, 3 years, 6 years, and 9 years at T0 were taken into consideration. All patients were reevaluated after application of the ministerial guidelines (T1). METHODS: the study took place over a 3-year period. Enrolled patients referred to the outpatient clinics of three paediatricians of the Province of Genoa who strictly applied the ministerial guidelines. STATISTICS: Chi square test analysis was performed to evaluate a statistically significant decrease in the incidence of caries, gingivitis and diseases of the oral mucosa. RESULTS: After a 3-year follow-up collected data underlined a statistically significant decrease in the incidence of dental caries, gingivitis and oral mucosal diseases after implementation of the recommended ministerial guidelines. A statistically significant decrease of malocclusions was also evident in the elder patients (12 years old at T1). CONCLUSION: The accurate implementation of the Guidelines is supported. Only collaboration and increased synergy between paedodontists and paediatricians can fulfill the objectives which were the reason for publishing the "National guidelines for the promotion of oral health and the prevention of oral diseases in developmental age".