Natural History of Mandibular Function in Spinal Muscular Atrophy Types 2 and 3

Background: Hereditary proximal spinal muscular atrophy (SMA) is characterized by abnormal alpha motor neuron function in brainstem and spinal cord. Bulbar dysfunction, including limited mouth opening, is present in the majority of patients with SMA but it is unknown if and how these problems change during disease course. Objective: In this prospective, observational, longitudinal natural history study we aimed to study bulbar dysfunction in patients with SMA types 2 and 3. Methods: We included 44 patients with SMA types 2 and 3 (mean age was 33.6 (95% CI 28.4;38.9) and re-examined them after on average 4 years. None were treated with SMN-modulating treatments before or during the course of this study. Longitudinal assessments included a questionnaire on mandibular and bulbar function, the Mandibular Function Impairment Questionnaire (MFIQ), and a clinical examination of masticatory performance, maximum voluntary bite force, and mandibular movements including the active maximal mouth opening. Results: We found significant higher MFIQ scores and a significant decrease of all mandibular movements in patients with SMA type 2 (p < 0.001), but not in SMA type 3. Masticatory performance and maximum voluntary bite force did not change significantly. Mean reduction of active maximal mouth opening at follow-up was 3.5 mm in SMA type 2 (95%CI: 2.3; 4.7, p < 0.001). SMA type 2 was an independent predictor for a more severe reduction of the mouth opening (β = –2.0 mm (95%CI: –3.8; –0.1, p = 0.043)). Conclusions: Bulbar functions such as mandibular mobility and active maximum mouth opening decrease significantly over the course of four years in patients with SMA type 2

A systematic review of interventions after restoring the occluding surfaces of anterior and posterior teeth that are affected by tooth wear with filled resin composites

OBJECTIVES: The aim of this systematic review was to assess intervention rates of direct composite restorations in the worn dentition based on data published in clinical trials. METHODS: Searches of electronic data bases, grey Literature and hand searches were completed, and selection criteria were applied at the title, abstract and full paper stages. Unavailable full papers or papers with unsuitable data were excluded. A reference search was conducted, and a final set of papers were selected for data analysis. Data were extracted and noted as any intervention required or performed, or intervention free. Descriptive statistics were used to summarise the findings and the odds ratios were calculated. RESULTS: 1683 titles were found in the initial searches. On application of selection criteria, 140 abstracts were selected (Kappa 0.885), 17 papers were chosen by 3 reviewers (Kappa 0.914 - 0.942) and 12 selected for statistical analysis (Kappa 0.924). A total of 3540 composites in 386 participants were analysed, with 1919 in the anterior region, and 1044 in the posterior region of these 11.7 % required intervention. Annual Intervention Rates (AIR) ranged from 0.8 to 17.9% reflecting the variation in reporting. CONCLUSION: There was wide variation between studies on the type of intervention. Overall the intervention rate of 11.6 % shows a favourable outcome but suggests some form intervention may be needed. CLINICAL SIGNIFICANCE: Direct composites remain a viable option to treat tooth wear but the outcome varies. Provided patients appreciate that some maintenance may be needed they are an effective intervention

Diagnostics and Management of Pediatric Headache:An Exploratory Study among Dutch Physical Therapists

Physiotherapists are often part of a multidisciplinary treatment plan for children with headaches. The literature on physical therapeutic diagnostics and management of headaches is often focused on adults. To gain insight, identify knowledge gaps, and increase the evidence needed for clinical physical therapeutic practice with children with headaches, an exploratory method is warranted. The purpose of this study was to describe the views, beliefs, and experiences of physical therapists regarding diagnostics and treatment options for children with headaches. The method consisted of a survey and two peer consultation group meetings. A total of 195 individual surveys were returned and 31 out of 47 peer consultation groups participated. Most participants were specialized in pediatric physical therapy (93.3%). They use the 4P-factor model (predisposing, precipitating, perpetuating, and protective factors) as a guiding principle in the diagnostic and therapeutic process in children with headaches. This model helps to organize and to understand how a variety of factors interact in a biopsychosocial relationship. Pediatric physical therapists focus their treatments on factors interfering with movement and functional abilities of the child with headaches. Knowledge of how temporomandibular disfunction can relate to headaches is currently insufficient for pediatric physical therapists.</p

A community-based oral health promotion model for HIV patients in Nairobi, East District in Kenya: a study protocol

<em>Background</em>: General HIV-related orofacial lesions, most commonly oropharyngeal candidiasis, have a typical clinical appearance and can be recognised by members of the community. Although affected patients often experience pain leading to compromised eating and swallowing, barriers such as social stigma and lack of knowledge regarding available services may prevent them from seeking early care. Educating the community about these lesions through community health workers (CHWs) who are democratically elected community members may encourage individuals affected to seek early oral health-care in the health facilities. A health facility (HF) is a health centre mainly run by clinical officers (CO),<em> i.e. </em>personnel with a 3-year medical training, and nurses. This study aims to evaluate the effect of a CHW training programme on: i) their knowledge and recognition of HIV-related oral-facial lesions at a community level; and ii) referral of affected patients from the community to the HFs. <em>Design and Methods</em>: All 800 CHWs in 2 administrative divisions of Nairobi East District (test group n=400; control group n=400) will be selected. The test group will receive training. CHWs in both groups will be assessed at 4 time points: −3, 0, +3 and +6 months with reference to the training on: i) their knowledge of HIV-related orofacial lesions (using a written questionnaire); and ii) their performance in referring affected patients to the HFs (using clinical data). <em>Expected Impact</em>: Early recognition of HIV-related orofacial lesions at a community level will prompt community members to seek early oral care, leading to early HIV testing and counselling regarding failure of antiretroviral therapy, while treatment outcomes are still favourable

Increased risk for premolar tooth loss in shortened dental arches

Item does not contain fulltextOBJECTIVES: 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

Clinical interpretation of a masticatory normative indicator analysis of masticatory function in subjects with different occlusal and prosthodontic status

Item does not contain fulltextOBJECTIVES: To analyse the masticatory function of subjects characterised by different occlusal and prosthodontic status. Using Optosil((R)) as a test food, the masticatory normative indicator (MNIOPT) was used to differentiate between sufficient ('normal') and impaired masticatory function. METHODS: Outcomes of occlusal force and masticatory tests were aggregated from three earlier studies dealing with four denture groups and three natural dentition groups. The four denture groups had a complete removable dental prosthesis in the upper jaw, and displayed one of the four following lower jaw prosthodontic rehabilitations: (i) complete removable dental prosthesis on a low mandible; (ii) complete removable dental prosthesis on a higher mandible; (iii) overdenture on natural roots; and (iv) overdenture on dental implants. The three natural dentition groups were: (i) shortened dental arch; (ii) complete dentition in older participants, and (iii) complete dentition in younger participants. All participants were women. They performed the same tests twice, and outcomes were averaged. RESULTS: A MNIOPT value of 3.68 mm was determined from the participants with complete natural dentitions. Applying the MNIOPT to the participants in the denture groups pointed at a considerable chance for impaired masticatory function, except for participants in the overdenture -implants group. The four denture groups compensated for reduced masticatory efficiency by increased number of masticatory cycles and prolonged mastication time until 'swallowing'. Nevertheless, they also 'swallowed' larger particles compared to the complete dentition group. CLINICAL SIGNIFICANCE: For a given patient or for a group of subjects with specific dental conditions, MNI enables to discriminate between a sufficient ('normal') and an impaired masticatory function