The masticatory normative indicator.

There is no established quantitative, objective method to differentiate individuals with good masticatory function from those lacking this attribute. The aim of this study was to specify a normal range of median particle size values for masticated raw carrots collected just before being swallowed. The masticatory normative indicator (MNI) value thus obtained was based on seven studies carried out by different investigators using different methods for measuring particle size in carrot boluses. A simple mathematical transformation of variables and the choice of an interval of +/-1.96 times the standard deviation gave 4.0 mm as the upper limit of normal median particle size for carrots in a population of young persons with good oral health. This value identifies boluses that may be considered as resulting from impaired mastication, as illustrated in healthy individuals with experimentally hampered mastication, denture wearers, and individuals presenting with obesity or Down syndrome.

Masticatory dysfunction in persons with Down's syndrome. Part 2: management.

The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health; orofacial dysfunction results and feeding and swallowing are impaired. These problems have been described in an earlier article. Different techniques are proposed for the prevention of the development of orofacial dysfunction in Down's syndrome. In particular, early myofunctional therapy coupled with appliance wear has been shown to be successful over the long term when multidisciplinary management is possible. Functional or conventional orthodontic treatment may be successful for older children when performed concurrently with the use of appropriate behaviour management techniques. More recently, techniques for the compensation of masticatory dysfunction in adults have been proposed, although further research is necessary to confirm their efficacy. The aim of this second article was to review techniques for the prevention, treatment and compensation of orofacial dysfunction in persons with Down's syndrome from birth to adulthood.

Masticatory dysfunction in persons with Down's syndrome. Part 1: aetiology and incidence.

The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health. Orofacial dysfunction is on account of poor neuromotor control, muscle weakness, dental anomalies, dysmorphology and intercurrent illness. In particular, feeding and swallowing are impaired. The aim of this first article was to summarize the orofacial difficulties encountered by persons with Down's syndrome at all stages of life and to explain their aetiology. Indicators are proposed for the identification of masticatory problems within this population and reduced masticatory efficiency is discussed in relation to repercussions on oral and general health and on the social integration of persons with Down's syndrome. A second article will describe techniques for preventing, treating and compensating for masticatory dysfunction in this population.

Impact of teaching requirements for students on the activity of a university dental hospital.

OBJECTIVES: This study aimed at investigating the influence of teaching requirements on the clinical activity of a dental hospital. METHOD: The annual clinical activity of seven classes of fifth-year students (n = 294) was monitored between 1994 and 2001 within the conservative dentistry and endodontic departments of a French dental hospital. The variables chosen were: (i) the mean number of procedures performed per student, and (ii) the proportion of different types of treatment within the global activity (i.e. endodontic treatment, anterior, and posterior restorations). These data were analysed in relation to changes in student assessment criteria over time. RESULTS: Quantitative clinical teaching requirements were removed for the academic year 1998-99 and student clinical activity subsequently decreased by 32.7%, going from 51.9 +/- 12.2 dental procedures on average per student in 1997-98, to 29.1 +/- 7.2 in 2000-01. The mean number of patients treated per student also declined significantly during this period. The size of the minimum clinical requirement altered over the years prior to being removed altogether and a positive correlation existed between the volume of activity and the minimum requirement over this time. The types of treatment provided changed independently from the assessment criteria over the study period. There was a decrease in the percentage of amalgams placed and an increase in the number of posterior composites. A negative correlation existed between the evolution of these two types of treatment. CONCLUSION: This study demonstrates that the clinical activity of a department in a dental teaching hospital is directly related to the assessment criteria fixed by the university. This may have repercussions for hospital services.