Comparison of the prevalence of malocclusion and oral habits between children with cerebral palsy and healthy children.

BACKGROUND: Cerebral palsy (CP) represents for children an important problem of health and affects roughly 2 per 1000 live births and is the most common pediatric developmental motor disability. Therefore, the purpose of this study was to determine the prevalence, type and severity of malocclusion and oral habits in children with Cerebral Palsy (CP) and to compare them with a control group of healthy children in Sana'a city. MATERIALS AND METHODS: A prospective, case-control study was made of two groups, a cerebral palsy and a control group. The study population consisted of 60 children who had CP, and a control group of 60 matched children with no physical or mental disabilities. Data were collected using a questionnaire and assessment for malocclusion was done clinically. The patients were compared with equal number of age-matched controls. The inclusion criteria were individuals aged over 6 years; absence of previous orthodontic treatment; no missing permanent first molars. RESULTS: Results showed an increased prevalence of malocclusion in children with cerebral palsy. Molar class II relationship was statistically higher in cerebral palsy children than healthy control (P = 0.001). Cerebral palsied children are likely to have a significantly increased protrusion of the anterior teeth (P < 0.001) when compared with normal children. Mouth breathing and Tongue thrust. Habits were significantly higher in the CP group (p = 0.0001) when compared with normal children. CONCLUSION: The prevalence of malocclusion was higher in children with Cerebral palsy than in normal children, and the present study concludes that in children with Cerebral Palsy, more oral Habits problems due to oral motor dysfunctions are common and problems of mouth breathing and Tongue thrust produce different malocclusion and poor oral hygiene complications in these children.

Which factors influence the oral health of nursing-home residents with cognitive and motor impairments?

BACKGROUND: There is limited information available about the oral and denture hygiene and oral health of nursing-home residents with cognitive and motor impairments. AIMS: The purpose of this study was to identify factors influencing the oral and denture hygiene and oral health of nursing-home residents with cognitive and motor impairments. METHODS: The study was performed in nine nursing-homes in Germany. Sociodemographic and general data were collected for all participants (n = 150). The Clinical Dementia Rating (CDR) was used to identify the presence of dementia, and the Apraxia Screening Test (AST) was used to identify motor impairment. A comprehensive dental examination was also performed. This included the documentation of dental and denture status and the number of decayed, missing and filled teeth (DMFT). In addition, dental and denture hygiene were assessed using the Plaque Index (PI) and the Denture Hygiene Index (DHI). Univariate and multivariate regression models were used to analyse possible factors affecting the dependent target variables. RESULTS: In multivariate regression analysis, the factors that most strongly influenced greater PI were a lower number of medications taken (p = 0.018), poorer general health (p = 0.013) and the presence of dementia (p < 0.010). A more advanced age (p = 0.036) and longer nursing-home stay (p = 0.048) had a negative effect on the DHI. Furthermore, gender (p = 0.037, in favour of women), poorer general health (p = 0.003), presence of dementia (p = 0.003), and the absence of natural teeth (p = 0.028) influenced poorer oral health. The factors most strongly influenced greater number of missing teeth were a more advanced age (p = 0.021) and longer nursing-home stay (p = 0.015). In terms of fewer filled teeth, a shorter nursing-home stay (p = 0.002) was the factor most strongly influenced this. CONCLUSIONS: Poorer general health and the presence of apraxia and cognitive impairment are the main determinants for poorer oral hygiene and oral health among nursing-home residents. A longer nursing-home stay also seems to be relevant for oral health and denture hygiene.

Reconstruction of Oromandibular Defect After Tumor Resection by Sternomastoid-clavicular Flap.

ABSTRACT: The study aims to evaluate sternocleidomastoid-clavicular osteo-myocutaneous flap (SCM-OMCF) for reconstruction of mandibular defects after tumor resection. In the period between 2010 and 2018, thirteen patients with primary mandibular tumors underwent mandibular resection and reconstruction with SCM-OMCF. Patients were followed up for 10 to 66 months. Hospital was 13 ±â€Š4 days. All patients started fluid in the 2nd day. The mean time to start oral fluid was 7.5 ±â€Š0.8 day. Four (30.8%) patients suffered from complications (infection and salivary leak in 1 case due to partial flap loss, donor wound dehiscence in 1 case, deep venous thrombosis in 1 case and chest infection in 1 case). None of our cases experienced motor disability. Two cases (15.9%) underwent reoperations. The overall aesthetic outcome was found excellent in 5 cases, satisfactory in 5 cases and fair in 3 cases. The functional outcomes were satisfactory. Tumor recurrences were detected in 2 (15.9%) patients. Two patients died during follow up within 2 years after 1st surgery due to local and distant recurrences. SCM-OMCF is a versatile, safe and simple technique for reconstructing mandibular defects less than 11 cm.

Postural adaptation to microgravity underlies fine motor impairment in astronauts' speech.

Understanding the role of anti-gravity behaviour in fine motor control is crucial to achieving a unified theory of motor control. We compare speech from astronauts before and immediately after microgravity exposure to evaluate the role of anti-gravity posture during fine motor skills. Here we show a generalized lowering of vowel space after space travel, which suggests a generalized postural shift of the articulators. Biomechanical modelling of gravitational effects on the vocal tract supports this analysis-the jaw and tongue are pulled down in 1g, but movement trajectories of the tongue are otherwise unaffected. These results demonstrate the role of anti-gravity posture in fine motor behaviour and provide a basis for the unification of motor control models across domains.

Management of internal and external root resorption in primary teeth of a 3-year-old with myelomeningocele: A case report.

BACKGROUND: Myelomeningocele (MMC) is a severe manifestation of spina bifida. Children with MMC have motor disability, hydrocephalus, skeletal abnormalities, and mental retardation. These individuals are more susceptible to caries due to poor oral hygiene, carbohydrate-rich diet, prolonged use of sugar-containing medications and limited motor abilities. Latex allergy is an important factor to be considered during the dental rehabilitation of such patients. CASE REPORT: A 3-year-old girl visited the dental clinic with the chief complaint of multiple carious teeth and H/o neural tube defect (NTD) which had been operated on at the age of 6 weeks. On dental examination, multiple dental abscesses and severe early childhood caries were noted. Radiographic evaluation revealed internal root resorption of tooth "K" and external root resorption of tooth "T." The two teeth were treated with ledermix paste followed by obturation with Vitapex® (Diadent Group International Inc., Burnaby, BC, Canada) along with triple antibiotic paste and placement of stainless steel crown (SSC). A latex-free environment was maintained during the entire treatment to prevent allergic reaction. A follow up after 42 months indicated clinical and radiographical success. CONCLUSION: The paper reports succesfull management of internal and external root resorption as well as latex allergy in a dental operatory. The dental perspective while dealing with patients having NTD is limited. Explaining the particulars of the treatment plan will aid in management of such cases .

Childbirth and motherhood in women with motor disability due to a rare condition: an exploratory study.

BACKGROUND: Rare diseases may result in motor impairment, which in turn may affect parenthood. Our purpose was to evaluate perinatal outcomes, parenting needs, mother-infant interactions and infant development in a set of volunteer women with motor impairment due to a rare disease. In a parenting support institution, we recruited a consecutive series of 22 volunteer pregnant women or young mothers, recorded perinatal outcomes, and followed mother-infant interaction and relationship and infant development up to 14 months postpartum. Cases with intellectual or psychic disability were not included. RESULTS: There were 11 genetic diseases (2 Spinal Muscular Atrophy, 1 Charcot-Marie-Tooth, 1 autosomal dominants myopathy, 1 mitochondrial disease, 2 Elhers-Danlos, 1 Friedreich ataxia, 1 spinocerebellar ataxia, 1 tetrahydrobiopterine deficiency,1 Ectrodactyly), and 11 rare non-genetic conditions (2 spine tumors, 2 strokes, 1 juvenile chronic arthritis, 3 birth injuries, 1 inflammatory myopathy, 1 congenital amputation, and 1 traumatic amputation). These resulted in 10 impairments of four limbs, 4 impairments of both lower limbs, 7 unilateral impairments, and one distal tremor. Social deprivation Epices score, Cutrona social support scale, Edinburg Postnatal Depression scale, and Spielberger State/Trait Anxiety Inventory were unremarkable. Perinatal outcome: 4 gestational diabetes, 1 pre-eclampsia, 9 caesareans, 6 assisted and 7 spontaneous vaginal deliveries, 20 term live-births and 2 premature deliveries (35-36 weeks). Twelve women declared they were self-sufficient for daily activities; six declared they were self-sufficient to provide basic care to their baby. Distribution of the Brunet-Lezine child development score was normal. The parent-infant relationship global assessment scale (PIR-GAS) was well adapted in 2 cases, adapted in 8, perturbed in 7, significantly perturbed in 2, and distressed in 3 (mean 71.8; 95% CI 49.6-93.9). This was unrelated to any somatic or emotional characteristics of the participants. Coding interactive behavior revealed that infant engagement was lower and infant avoidance greater than in controls (p < 0.05). CONCLUSION: Infant development was normal, but mother-infant interactions were altered in half of the participants independently from the degree of motor impairment, underscoring the need for parenting support, even for parents who are self-sufficient in daily activities.

Orofacial function in children with Speech Sound Disorders persisting after the age of six years.

Purpose: The aim was to investigate, describe and analyse speech characteristics, intelligibility, orofacial function and co-existing neurodevelopmental symptoms in children with SSD of unknown origin, persisting after six years of age.Method: The study included 61 children with SSD (6-17 years) of unknown origin, referred for a speech and oral motor examination. The severity of SSD was estimated using Percentage Consonants Correct (PCC) and Percentage Vowels Correct (PVC) and assessments of resonance based on Swedish Articulation and Nasality Test (SVANTE). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Parents completed the Intelligibility in Context Scale (ICS) and a questionnaire including questions about heredity, medical and neurodevelopmental conditions, and speech development.Result: SSD varied according to PCC (8-95%) and PVC (55-100%) measurements. Percentages of co-occurring disorders included: 51% resonance deviations, 90% intelligibility issues, and 87% orofacial difficulties. The most affected orofacial domains were "Chewing and swallowing" (41%), "Masticatory muscles and jaw function" (38%) and "Sensory function" (38%). The majority (64%) had co-existing dysfunctions relating to general motor and neurodevelopmental disorders.Conclusion: Children with persistent SSD are at risk for orofacial dysfunction, general motor difficulties and other neurodevelopmental disorders and therefore should be screened for co-occurring disorders.

An Open-Label Uncontrolled Trial of the Efficacy and Safety of a Hug with Singing and Rocking for Promotion of Relaxation in Pediatric Patients with Severe Motor and Intellectual Disabilities: Study Protocol.

Children with severe motor and intellectual disabilities (SMID) are continually exposed to stress due to their need to receive daily care. In particular, chronic physical and acute mental stress derived from daily medical care due to unstable health status are issues specific to SMID children. Therefore, it is important to approach these issues for the maintenance of their lives and quality of life. Seventeen children with a SMIDmedical care dependent group (SMID-MCDG) score of 25 or more will be enrolled in this study. Intervention by a hug while singing and rocking will be performed once a week for 24 weeks. The practitioner will sing, and slowly rock the child back and forth. Primary endpoint is high-frequency component of heart rate variability by frequency analysis. Secondary endpoints are low-frequency/high-frequency components of heart rate variability by frequency analysis, activity of salivary amylase, the incidence of adverse events, and changes in appearance. Frequency analysis of heart beat changes and salivary amylase activity are used as physiological indexes for assessing response to being held while singing and rocking. In this study, we will examine the efficacy and safety of hugging while singing and rocking as a practice of Ryouiku to promote relaxation in SMID-MCDG children.

Hypotonia and delayed motor development as an early presentation of Lowe syndrome: case report and literature review.

We describe a boy who presented with neonatal hypotonia, followed by delayed motor development and growth impairment. Further evaluation revealed rickets caused by proximal renal tubular dysfunction. At age 3, the boy exhibited dysmorphic features and bilateral cataract. Genetic analysis of the OCRL gene showed a novel variant in exon 13: c.1250T>A, p.Val417Asp; in silico and segregation analysis confirmed the variant to be pathogenic, compatible with the diagnosis of the oculocerebrorenal syndrome of Lowe. Lowe syndrome is a rare multisystemic disorder; the diagnostic triad requires involvement of the eye, central nervous system and the proximal renal tubule. Typical clinical features are congenital cataract, glaucoma, hypotonia, mental and behavioral problems, benign skin lesions, platelet dysfunction and dental abnormalities. Phenotypic features early in life may be nonspecific, which is illustrated by this case with a late manifestation of cataract. Because an early diagnosis can lead to better counseling and treatment, we suggest urinary testing for proteinuria as a part of the evaluation of children with unexplained hypotonia.

Oral opportunistic infections in institutionalized patients with motor and intellectual disabilities.

To establish a basic strategy for prevention of aspiration pneumonia in patients with motor and intellectual disabilities, we investigated oral opportunistic pathogen (OOP) infections in 31 such patients who were resident at a welfare home. Patients received special oral care from a dental hygienist once a week. OOP samples were collected by scraping the dorsal surface of the tongue, and then cultured. For each patient, the basic reasons for admission and the degree of intellectual disability and mobility were recorded. OOPs were found in 61.3% of the patients, of which methicillin-sensitive Staphylococcus aureus (MSSA) was the most commonly detected (38.7%). A significantly high proportion of male patients were OOP-positive, and a significantly high proportion of patients with mental retardation were Candida sp.-positive. However, multivariate logistic regression revealed that disability was not associated with OOP positivity. No correlation was found between OOP positivity and disability. Nevertheless, special oral care may be beneficial for maintenance of oral health in patients with disabilities.

Comparação da segurança de dois motores no preparo com o Sistema Profile / Comparison of safety in two motors during preparation of the Profile System

Os sistemas rotatórios foram desenvolvidos com o advento a liga de níquel-titânio para favorecer uma maior rapidez no preparo biomecânico.Para realização do método empregam-se motores com torque e velocidades controladas, podendo hoje, alguns motores apresentarem a opção de reverso automático ou auto- reverso. Destaca-se entre eles o X-Smart (auto-reverso) e o Endoplus (reverso automático). O presente trabalho teve como objetivo analisar o tempo de preparo e de formação empregando o Sistema Profile para instrumentação com os dois motores. Para isso 28 blocos de resina com canais simulados com curvatura de 300 foram instrumentados com o Sistema Profile, empregando a técnica do fabricante, sendo que os blocos foram divididos em dois grupos em função do motor empregado, obedecendo ao seguinte: Grupo 1 – Motor Endoplus (reverso automático); Grupo 2 – X-Smart (auto-reverso). Para ambos os motores a velocidade empregada foi de 250rpm e o torque de 2N/cm...

Rotary systems were developed with the advent of the nickel-titanium alloy to facilitate a faster biomechanic preparation. In this regard it is used engines with controlled torque and speed and, nowadays, some engines present the option to auto reverse or auto-reverse. Prominent among them is the X-Smart (auto-reverse) and Endoplus (automatic reverse). This study aimed to analyze the time of preparation and deformation using the Profile system for instrumentation with both engines. For this 28 resin blocks with simulated canals with curvature of 30º were instrumented with Profile system, employing the technique of the manufacturer, and the blocks were divided into two groups according to the motor used, as follows: Group 1 - Engine Endoplus (auto reverse), Group 2 - X-Smart (auto-reverse). For both engine the speed used was 250rpm and torque of 2N/cm...

Discinesia tardia - diagnóstico e tratamento farmacológico ao alcance do cirurgião-dentista / Tardive dyskinesia - diagnosis and pharmacological treatment within the reach of dentists

Discinesia tardia é uma síndrome irreversível caracterizada pelo aumento involuntário da atividade motora. Acomete especialmente o idoso e 20% dos indívíduos em uso de neurolépticos e andipressivos. Outros fatores de risco incluem o gênero feminino, co-morbidade psiquiátrica, transtornos extrapiramidais, fumo, diabetes e pacientes com prótese total mal adaptada. A fisiopatologia da desordem inclui alterações em neurônios dopaminérgicos, serotoninérgicos e gabaérgicos. Esta revisão tem como objetivo descrever as manifestações clínicas das discinesias orofaciais induzidas por fármacos, próteses mal adaptadas ou em decorrência de doenças hereditárias e sistêmicas, propondo tratamentos eficazes, preventivos e ao alcance do cirurgião-dentista.