Hyposalivation and periodontal disease as oral non-articular characteristics in rheumatoid arthritis.

OBJECTIVE: To investigate the association among rheumatoid arthritis (RA), saliva production, and periodontal status. METHODS: An observational study was carried out on 103 subjects with RA and 103 without RA matched by sex and age. Rheumatologic evaluation included serological and clinical variables. A full mouth periodontal examination was performed according to the American Academy of Periodontology (1999). Resting and stimulated whole salivary flows were determined after spiting during 5 min. RESULTS: RA was associated with a higher prevalence of severe periodontitis (12% vs. 4%), with a marked reduction in resting and stimulated saliva production, and with a higher prevalence of resting (19% vs. 0%) and also stimulated hyposalivation (54% vs. 10%), compared with the control group. The differences in mean resting and stimulated salivary flows between RA and control groups persisted after the exclusion of people with hyposalivation. Saliva production was not associated with the presence or the severity of periodontal disease, or with the rheumatic clinical characteristics of the patients. CONCLUSIONS: More than 50% of people with RA have some degree of reduction in their salivary flows, an affection not associated with the periodontal status or rheumatic activity, which are the expression of the two related inflammatory diseases. The influence of autonomic dysfunction on hyposalivation can be considered. While periodontitis would be a disease-associated comorbidity of RA, poor saliva production should be included among the extra-articular manifestations. Key Points • Rheumatoid arthritis patients are more prone to suffer from periodontitis and/or hyposalivation. • Periodontal disease is more prevalent in people with rheumatoid arthritis and also an association was found between the severities of both pathologies. • More than 50% of people with RA would have some degree of reduction in their salivary flows, an affection not associated with the periodontal status or rheumatic activity. • Reduced saliva production in rheumatoid arthritis patients should be included among the extra-articular manifestations.

Disease activity and subcutaneous nodules are associated to severe periodontitis in patients with rheumatoid arthritis.

Rheumatoid arthritis (RA) was significantly associated with increased overall risk of periodontitis, both chronic, inflammatory pathologies leading to connective tissue breakdown and bone destruction. To identify clinical and/or serological variables routinely evaluated during follow-up of people with RA which are associated with the severity of their periodontal disease. An observational, cross-sectional study was carried out, which included RA patients according to ACR/EULAR 2010 criteria having chronic periodontal disease. RA clinical parameters (disease duration, erythrocyte sedimentation rate, serum C-reactive protein, disease activity (DAS28) and rheumatoid factor, presence of bone erosions and rheumatic nodules) and also corticosteroid therapy were considered. Periodontitis was evaluated according to the American Academy of Periodontology (1999) and chronic periodontitis was assessed by full mouth periapical radiographic examination, periodontal probing depth, clinical attachment level and bleeding index. A total of 110 subjects with RA and chronic periodontitis were included. The female/male relation was 5.1, and no significant differences between genres were found in rheumatic or oral variables. RA patients with longer disease duration, higher disease activity and with rheumatic nodules had significantly greater periodontitis severity. Multivariate analysis confirmed that severe periodontitis was associated with DAS283 4.1 (OR 51.4, CI 95% 9.4-281.5) and the presence of rheumatic nodules (OR 6.4, CI 95% 1.3-31.6). Disease activity and rheumatic nodules were strongly associated with severe periodontitis. Based on these findings it would be desirable to include interdisciplinary management at an early stage of RA to ensure comprehensive treatment of both pathologies.

Psychoprophylaxis for oral conscious sedation for dental care in Down syndrome adults with behavioral disorder.

Down syndrome (DS) presents with prevalent diseases in the oral cavity and the need of constant dental care and follow-up. The use of conscious sedation (CS) for dental care in adult DS with behavioral disorders is poorly documented. The aim of this study was to evaluate the effectiveness and safety of CS procedures with oral midazolam using previous psychoprophylaxis sessions in DS adult patients with behavioral disorders. METHODS: Twenty-nine DS adults with behavioral disorders. The patients were managed with psychoprophylaxis followed by oral CS using 15 or 30 mg midazolam. Vital parameters were monitored. The Houpt and Brietkopf and Buttner scales were used. RESULTS: Patients under CS received an initial dose of 15 mg midazolam; however, 51.72% needed a 30 mg dose at the following sessions. Results showed that 71.4% treated with the 15 mg dose had Houpt scale overall behavior scores of 4 or 5, while 93.33% of those receiving 30 mg had scores of 5 or 6 (chi-square = 15.95 p < .01). CONCLUSION: Psychoprophylaxis sessions followed by CS procedures using oral midazolam in adult DS with behavioral disorders were shown to be a useful strategy to perform routine dental treatment safely. Midazolam produces anterograde amnesia, and participants were more cooperative in the following visits.

Development of an intraoral device for facial muscle retraining and its clinical application.

The aim of this work was to develop a facial neuromuscular retraining technique for cases of facial palsy, involving an easy-to use intraoral device that allows correcting abnormal neuromuscular patterns and improving esthetics. Facial palsy is a motor alteration of multiple origin that results in facial asymmetry. Treatment remains controversial to date and includes, surgical anastomosis and decompressive and plastic surgery, corticosteroids therapy, injection of botulinum toxin, and administration of other medicinal drugs. Physical therapy involving electrical stimulation and feedback are also used to retrain facial muscles. A removable thermopolymerized acrylic intraoral device with wrought wire clasps was developed and constructed. The device was used on a patient with facial palsy who was instructed to wear it 4 times a day during 20 minutes and perform exercises in front of the mirror, trying to coordinate the action of the device with the smile movement on the unaffected side of the face. Digital photographs of the patient were taken during smile movement and at rest with and without the device, and movements of the oral commissures were compared using specific software. Results showed anatomic and nonanatomic indices of facial motion for the lower part of the face with the device to be 1.77 and 0 respectively. The device improved facial symmetry during rest by opposing traction forces of the contralateral muscles, resulting in a better position of the filtrum during rest, and allowed the patient to exercise smile movements at home.

Development of an intraoral device for facial muscle retraining and its clinical application

El objetivo de este trabajo fue desarrollar una técnica de reeducación de la musculatura facial lesionada en cuadros de parálisis facial, por medio de una aparatología intraoral de sencilla manipulación para el paciente, que permita corregir patrones neuromusculares incorrectos y mejore la estética. La parálisis facial es una alteración motora de múltiple etiología que resulta en una simetría facial. Sus tratamientos actuales en constante discusión incluyen cirugías de anastomosis, descompresivas y estéticas, terapia con corticoesteroides, toxina botulínica y otros medicamentos. Además se aplican terapias físicas con electroestimulación y feedback para reentrenar la musculatura facial. Se diseñó y confeccionó un aparato intraoral removible de acrílico de termopolimerización y retenedores de alambre forjado según técnica de laboratorio convencional. Se aplicó a un caso clínico de parálisis facial instalando el sistema e indicando el uso diario, 4 veces al día, realizando ejercicios al espejo durante 20 minutos cada ez, tratando de coordinar la acción del aparato con la sonrisa del lado sano. Se tomaron fotografías digitales de la paciente en reposo y sonrisa con el sistema puesto y sin el sistema y se compararon los movimientos comisurales con software. Se observó que el índice de movimiento anatómico para la porción inferior de la cara fue de 1,77 y el índice de movimiento no anatómico para la porción inferior de la cara fue de 0 (con el sistema instalado). El dispositivo utilizado mejoró la asimetría facial en reposo oponiéndose a la tracción de los músculos contralaterales, logrando una mejor ubicación del filtrum en reposo, permitiendo que el paciente practique en su casa movimientos simulatorios de una sonrisa.

The aim of this work was to develop a facial neuromuscular retraining technique for cases of facial palsy, involving an easyto use intraoral device that allows correcting abnormal neuromuscular patterns and improving esthetics. Facial palsy is a motor alteration of multiple origin that results in facial asymmetry. Treatment remains controversial to date and includes, surgical anastomosis and decompressive and plastic surgery, corticosteroids therapy, injection of botulinum toxin, and administration of other medicinal drugs. Physical therapy involving electrical stimulation and feedback are also used to retrain facial muscles. A removable thermopolymerized acrylic intraoral device with wrought wire clasps was developed and constructed. The device was used on a patient with facial palsy who was instructed to wear it 4 times a day during 20 minutes and perform exercises in front of the mirror, trying to coordinate the action of the device with the smile movement on the unaffected side of the face. Digital photographs of the patient were taken during smile movement and at rest with and without the device, and movements of the oral commissures were compared using specific software. Results showed anatomic and nonanatomic indices of facial motion for the lower part of the face with the device to be 1.77 and 0 respectively. The device improved facial symmetry during rest by opposing traction forces of the contralateral muscles, resulting in a better position of the filtrum during rest, and allowed the patient to exercise smile movements at home.

Development of an intraoral device for facial muscle retraining and its clinical application

El objetivo de este trabajo fue desarrollar una técnica de reeducación de la musculatura facial lesionada en cuadros de parálisis facial, por medio de una aparatología intraoral de sencilla manipulación para el paciente, que permita corregir patrones neuromusculares incorrectos y mejore la estética. La parálisis facial es una alteración motora de múltiple etiología que resulta en una simetría facial. Sus tratamientos actuales en constante discusión incluyen cirugías de anastomosis, descompresivas y estéticas, terapia con corticoesteroides, toxina botulínica y otros medicamentos. Además se aplican terapias físicas con electroestimulación y feedback para reentrenar la musculatura facial. Se diseñó y confeccionó un aparato intraoral removible de acrílico de termopolimerización y retenedores de alambre forjado según técnica de laboratorio convencional. Se aplicó a un caso clínico de parálisis facial instalando el sistema e indicando el uso diario, 4 veces al día, realizando ejercicios al espejo durante 20 minutos cada ez, tratando de coordinar la acción del aparato con la sonrisa del lado sano. Se tomaron fotografías digitales de la paciente en reposo y sonrisa con el sistema puesto y sin el sistema y se compararon los movimientos comisurales con software. Se observó que el índice de movimiento anatómico para la porción inferior de la cara fue de 1,77 y el índice de movimiento no anatómico para la porción inferior de la cara fue de 0 (con el sistema instalado). El dispositivo utilizado mejoró la asimetría facial en reposo oponiéndose a la tracción de los músculos contralaterales, logrando una mejor ubicación del filtrum en reposo, permitiendo que el paciente practique en su casa movimientos simulatorios de una sonrisa.(AU)

The aim of this work was to develop a facial neuromuscular retraining technique for cases of facial palsy, involving an easyto use intraoral device that allows correcting abnormal neuromuscular patterns and improving esthetics. Facial palsy is a motor alteration of multiple origin that results in facial asymmetry. Treatment remains controversial to date and includes, surgical anastomosis and decompressive and plastic surgery, corticosteroids therapy, injection of botulinum toxin, and administration of other medicinal drugs. Physical therapy involving electrical stimulation and feedback are also used to retrain facial muscles. A removable thermopolymerized acrylic intraoral device with wrought wire clasps was developed and constructed. The device was used on a patient with facial palsy who was instructed to wear it 4 times a day during 20 minutes and perform exercises in front of the mirror, trying to coordinate the action of the device with the smile movement on the unaffected side of the face. Digital photographs of the patient were taken during smile movement and at rest with and without the device, and movements of the oral commissures were compared using specific software. Results showed anatomic and nonanatomic indices of facial motion for the lower part of the face with the device to be 1.77 and 0 respectively. The device improved facial symmetry during rest by opposing traction forces of the contralateral muscles, resulting in a better position of the filtrum during rest, and allowed the patient to exercise smile movements at home.(AU)