A new tongue advancement technique for sleep-disordered breathing: side effects and efficacy

We examined the efficacy and the acceptance of an oral device (SnorEx) causing a forward displacement of the tongue for the treatment of sleep-disordered breathing (SDB). Twenty-three consecutive subjects with SDB were investigated. Noncompliance (NC) of use of the oral appliance was observed in 74% (17 of 23) of the subjects. NC patients were characterized by unacceptable local side effects of the prosthesis, lacking improvement of indicators of daytime well-being, and a missing reduction of the respiratory disturbance index (RDI). The device was tolerated without side effects in 26% (6 of 23) of the subjects. In these compliant (C) subjects the RDI, EDS, and snoring improved significantly (p < 0.05) compared with baseline values. After 6 mo using the device, five of the six C patients were still using it. We conclude that the high rate of noncompliance and the low efficacy of the SnorEx prosthesis preclude large-scale use of this treatment modality in patients with SDB and snoring since the local side effects are the principal cause of NC. No useful predictive parameter of treatment compliance or treatment success was found. Thus, this dental appliance should be prescribed only for selected patients failing other treatment modalities seen by an experienced sleep-disorders specialist.

[Dental materials--problem substances in allergologic diagnosis? I: Analysis of test results in patients with mouth mucosa/dental material problems]

Patch testing as a part of the diagnostic evaluation of patients suffering from oral mucosal complaints or with symptoms where dental materials are suspected to be the cause is hampered by numerous difficulties. The ingredients of denture materials as well as their liberation in the oral cavity are often unknown. Contact with many of the potential ingredients of denture materials can occur on other occasions, as well, thus making it difficult to find out where the patient has acquired his or her sensitization. The special morphological and immunological situation in the oral mucosa may produce tolerance of substances which evoke a positive patch test reaction on the skin of the back. This paper introduces the possible spectrum of allergens in these patients and discusses the difficulties in the assessment of the relevance of positive patch test reactions. From August 1992 to July 1994, 756 patients with complaints of the oral mucosa and/or suspected contact allergy to denture materials were patch tested in the departments of dermatology joining the Information Network of Departments of Dermatology in Germany (IVDK). Among these patients, women were overrepresented, while individuals with atopic dermatitis were underrepresented. The allergen spectrum included amalgam, mercury compounds, gold salts, palladium chloride and methyl methacrylate. However, the epidemiological value of these data is limited. A second part of this paper will review the various groups of allergens.

Influence of alterations in the oral environment on speech production

We examined the influence on temporal aspects of three consonants, /k/, /c/ and /s/, of alterations in the oral environment produced by either palatal augmentation or by an increase in the vertical dimension of occlusion. Voice onset time (V.O.T.) for /k/ and /c/ was influenced more than aspiration time by the palatal augmentation. Consonant duration for /s/ was also influenced by palatal augmentation. Significant influence of an increase in vertical dimension on the timing was not recognized. Speech disorder caused by the malformation of palate seems to be more frequent than that caused by vertical dimension. Adaptation to prostheses would seem to be definitely concerned with orosensory feedback.

Diagnosis and treatment of an oral base-metal contact lesion following negative dermatologic patch tests

We report a confirmed case of intraoral contact mucositis secondary to nickel dental alloy hypersensitivity. The lesion resolved after removal of the offending prosthesis. The patient responded negatively to dermatologic patch tests, but a positive intraoral rechallenge confirmed the mucositis diagnosis. A nonreactive, gold alloy prosthesis was inserted for a successful result.

Occupational skin allergy in the dental profession

Dental personnel are exposed to a high number of sensitizing chemicals such as acrylics, metals, anesthetics, fragrances, and antimicrobials. Although these chemicals usually cause allergic contact dermatitis, they also may cause immediate contact reactions. Usually the diagnostics involve patch testing, but prick testing needs to be performed to confirm immediate allergy. This article reviews the important causes and diagnostics of skin allergy in dental personnel. Special attention is given to the acrylates and methacrylates.

Clinical perspectives of periodontal and restorative interactions

Restorative treatment and periodontal health are directly interrelated. A restorative treatment plan must consider periodontal support and provide for adequate maintenance of the health of the periodontium. For example, prosthetic design must facilitate hygiene practices and not violate the physiologic dimensions of the periodontium. The relation of the periodontium to margin preparation, margin placement, crown contours, and pontic design are discussed in this article.

[Studies on metal allergy in the field of dentistry--treatment with application of X-ray fluorescence spectroscope analysis in detection of allergen metals]

The most effective method to treat metal allergy may be allergen elimination. Information on the exact location of the allergens becomes essential for this treatment. An XRFS (X-ray fluorescence spectroscope) was used for the detection of such elements and applied for the treatment of these patients. 1. Evaluation of the apparatus preceding its clinical application proved that the reliability and the detection limit for pure elements were comparative to those of the Electron Probe Microanalyzer. A notable decrease in the emitted X-ray intensity was observed when a sample was analyzed through a medium with thickness of more than 5 mm. 2. The analysis results of the restorations showed that the most frequently used alloys were Ag-Sn-Hg amalgams, Au-Ag-Pd alloys and Ag alloys. Some of the elements with high prevalence rates were Ag, Cu, Zn, Au, Pd, Sn, and Hg. 3. Personal and household items suspected of containing allergen metals were analyzed. Some of the frequently detected elements were Fe, Cu, Mn, Zn, Ni, Cr, and Au. 4. With XRFS, analysis of bulk metals and those samples in various forms became possible. A clinical case with the lesion resolved after the allergen elimination was reported. This proved that the use of XRFS enabled us to deal more definitely and effectively towards metal allergy.

Contact dermatitis and adverse oral mucous membrane reactions related to the use of dental prostheses

The latest trends in the use and composition of dental prostheses have been reviewed, and 66 patients referred by dermatologists and odontologists patch tested. The allergen series used were: TRUE Test standard series; Chemotechnique dental screening series; specially prepared metals series. The allergens found to be positive, in order of frequency, were: nickel, cobalt, potassium dichromate, rhodium, palladium, mercury, beryllium, methyl methacrylate, copper and zinc.

Subjective reports of oral dryness in an older adult population

In this study of an older adult population almost one-fifth reported oral dryness. It was the most common of 22 oral symptoms and complaints. In a logistic regression analysis of predictors of oral dryness three variables had significant independent effects: income, taking prescribed medications and experiencing a stressful life change within the previous 6 months. Subjects with oral dryness had more decayed crown surfaces than those without but there was no association with decayed root surfaces. Nor were there any significant associations between reports of oral dryness and a number of indicators of periodontal health. Those with dryness were more likely to report other oral symptoms such as unpleasant taste, a burning sensation in the tongue and other parts of the mouth and pain from dentures. They were also more likely to report problems chewing food, problems with eating and communication and were more likely to be dissatisfied with their oral health. Given its prevalence and effects, oral dryness constitutes an important health issue among older adults.

Occupational allergic contact dermatitis caused by exposure to acrylates during work with dental prostheses

Between 1974 and 1992, we were consulted by 4 patients (an orthodontist, 2 dental technicians and a dental worker trained in-house) who had developed occupational allergic contact dermatitis from working with dental prostheses. All patients had positive allergic patch test reactions to methyl methacrylate (MMA), the acrylate which is the most widely used in work with prostheses. All but the orthodontist also reacted to dimethacrylates, which are used in cross-linked dental prostheses. The last patient, investigated in 1992, had been exposed mainly to light-cured acrylics, which are similar in composition to dental composite resins. These acrylics, only recently introduced into prosthetic work, contain more potent acrylic sensitizers than MMA. Accordingly, dental personnel working with prostheses may face a higher risk of sensitization than previously. To detect cases of occupational allergic contact dermatitis, we suggest that patients working with dental prostheses should be patch tested with MMA, 2-hydroxyethyl methacrylate, dimethacrylates, epoxy acrylates and urethane acrylates.