Head and cervical spine postures in complete denture wearers

Prosthetic Rehabilitation and Its Effect on Head Posture

Background: Edentulism is a debilitating and irreversible condition. It is often accompanied by compromises in the surrounding joint’s range of motion and changes in the posture of the head. The natural head position is maintained by a balanced tension between cranio-cervical bones, myofacial structures and the dental occlusion. Loss of teeth may cause changes in the head posture that may disturb the patency of the spinal cord and lead to the loss of postural balance. Therefore, this study aimed at evaluating the head posture in the edentulous subjects before and after prosthetic rehabilitation.

Methods: A total of 16 completely edentulous subjects were selected for the study. Removable complete denture prosthesis was fabricated for all the subjects. Lateral photographs were taken at different time intervals i.e., pre-rehabilitation, 30 minutes, 2 days and 30 days post-rehabilitation. The cranio-vertical angle obtained was digitally calculated using Kinovea software and the results obtained were statistically analysed.

Results: The paired-sample t-test and repeated measures analysis of variance showed an increase in the cranio-vertical angulation of edentulous subjects after rehabilitation, indicating a mild extension of the head.

Conclusion: The insertion of prosthesis leads to a mild extension of the head. Hence, rehabilitation with a removable prosthesis has a positive effect on the head posture and could therefore aid in maintaining a stable head posture.

Head Posture and Postural Balance in Community-Dwelling Older Adults Who Use Dentures

Background and objectives: Tooth loss and consequent denture use and impaired posture and postural balance are more prevalent in older adults than in the young ones. The aim of this cross-sectional study was to identify the association between denture use, head posture, postural balance, and neck muscle strength (NMS). Materials and methods: We included 107 participants (56 in the non-denture use group and 51 in the denture use group) and measured their NMS, forward head posture, and postural balance. Forward head posture was measured using the craniocervical angle (CRA). Postural balance was assessed using a timed up-and-go test (TUG) and postural sway. An independent t-test was used to analyze the differences between the groups; Pearson correlation analysis was used to analyze the correlation of period of denture use, head posture, and postural balance. Results: We found that the denture use group had lower NMS, smaller CRA, longer TUG, and longer postural sway length than the non-denture use group. Duration of denture use was significantly correlated with TUG. Conclusions: Our findings reveal that denture use does not help with NMS, forward head maintain NMS, head posture, and postural balance in older adults.

Baseline of upper teeth: (a) Control organ for spatial navigation? (b) Weak point for misaligned posture and pain?

Our observations question both the current doctrine of spatial orientation as processed by vestibular, visual and proprioceptive impressions as well as the horizontal alignment of the eye axis. Indeed our observations suggest spatial orientation as a physically based, largely mechanically transmitted interaction between individual and environment. It is controlled by an interface defined by the baseline of upper teeth. It simultaneously constitutes both body and environment acting as an integral part of that environment. Consequently, the baseline of upper teeth is part of the aforementioned environment. Instead of the eye axis during spatial orientation it aligns the true horizontal absolutely. This was tested by fixing a cross to upper teeth. While walking, running and jumping it did not deviate by more than 2° from the external axis. Subsequently, we inclined the baseline of upper teeth by inserting an asymmetric wafer so that it angulated the eye axis. Immediately, head, visual and vestibular axes tilted unstably with misaligned body posture. Only the indicative cross remained stably aligned to the external axes. The person felt "upright", not noticing his posture had changed. He was then instructed to straighten his shoulders and trunk until his posture was objectively nearly upright again. The voluntary correction caused the indicative cross to tilt. The person felt uneven while being more upright. We concluded that the automatic posture works by "synchronizing" the baseline of upper teeth to the external axis and that the synchronized position is supported by the vestibular system. Benefit of an interface is that the body's movements in the environment simultaneously happen within the baseline of upper teeth. Therein the vectors of the body and the environment are calculated to remain in balance. This model introduces the transmission of the vector information to postural muscles by the dura mater, controlled by tension between C0-C2. The information is skewed by bony dislocations between C0-C2 caused by an inclination of the interface. The resulting misalignments of posture are foreseeable and specifically correspond to the type of inclination. They occur in a broad section of the population. Diagnosed as muscular weakness, they may cause therapy resistant common diseases like back and joint pain after 5-10 years. Following our observations, the inclination of the baseline of upper teeth originates from inattentive changes in the length of upper teeth in dental treatment. Multiple treatments optimizing teeth length in long term patients improved the patients' situation.

The inconclusiveness of research on functional pathologies of the temporomandibular system and body posture: Paths followed, paths ahead: A critical review

Objective: Literature on the functional pathologies of the temporomandibular system (FPTS) in its relationships with body posture is plagued with inconclusiveness. Despite being sometimes altogether disregarded, the issue is most relevant, due to its clinical implications. This paper aims for a deeper understanding of the origins of the inconclusiveness of research on such relationships by means of a critical analysis of the scientific literature on the subject, in order that clinicians may better treat patients with FPTS.Methods: Analysis of over 100 studies, published from 1918 through March 2018 in the PubMed database, using descriptors temporomandibular joint disorders and posture.Results: The analysis of the paths followed by researchers allowed for pinning down several methodological issues that may have led to the prevailing ambiguity on the matter.Conclusion: This review then proposes certain standardization of procedures in future studies, to be conducted by a proposed consortium of researchers.

Teeth and Covariates: Association with Risk of Falls

Purpose

Falls occur commonly in geriatric populations and undesirably influence their life, morbidity, and mortality. The aim of this study was to analyze the association between the number of teeth present among the elderly population and covariates in relation to the risk of falls.

Materials and Methods

This study was conducted at various old age homes in the Klang Valley region of Malaysia involving the geriatric population aged 60 years and above. A detailed questionnaire consisting of sociodemographic data including sex, age, household income, and dental variables such as the number of teeth and chewing difficulty was obtained. The Tinetti test (TT) was used to evaluate the patients' ability to walk, to maintain postural balance, and to determine their risk of falling. The short version of the Geriatric Depression Scale was used to assess depression among the participants, and the Barthel Scale was used to analyze the subject's ability to perform the activities of daily living (ADL).

Results

Statistically significant association was observed in relation to the number of teeth present and risk of falls (p < 0.05). Subjects who had 19 teeth or less in total had moderate to highest risk of falls (p=0.001) in comparison with subjects who had 20 teeth or more. Those aged 70 years and above showed the highest risk of falls (p=0.001) in comparison with the subjects aged between 60 and 69 years. Subjects with depression (p=0.03) and presence of illness related to fall showed statistically significant difference (p=0.001) in comparison with those who did not suffer from the same. Compromised ADL (p=0.001) (which included ability to perform several tasks like indoor mobility, climbing stairs, toilet use, and feeding) and low monthly income (p=0.03) was also observed among subjects who had higher risk of falls.

Conclusion

According to the results achieved, there was a high statistically significant association observed between the number of teeth present, age, depression, ADL, and presence of illness in relation to the risk of falling among the geriatric population. Henceforth, oral rehabilitation of elderly patients with less number of teeth may reduce their risk of falls.

A Clinical Study to Examine the Effect of Complete Denture on Head Posture/Craniovertical Angle

INTRODUCTION

Edentulous patients show some significant changes in ridge relationship caused by resorption of alveolar ridge. The changes are characterized by an upward rotation of mandible, increase in mandibular prognathism that ultimately results in change of natural head posture.

AIM

This clinical study was planned to know the effect of complete denture on head posture in different age groups of Indian completely edentulous population, after placement of complete denture at various time intervals.

MATERIALS AND METHODS

The sample consisted of completely edentulous patients without previous experience of the dentures. They were divided into 2 age groups: Group A (45-60) and Group B (61-75). During placement of complete denture craniovertical angle was measured with the help of custom made ruler protector device. Readings were taken before denture placement, immediately after denture placement, 30 minutes, 24 hours and 30 days after dentures placement.

RESULTS

The results of this study indicated that in most of the patients (90%) despite their age, change in head posture (extension) occurred immediately after the denture placement. Thereafter reading remains same for measurement at 30 minutes and 24 hours of denture placement. However after 30 days, observation revealed that all the patients showed reduced craniovertical angle (flexion). Even though the values of craniovertical angle remain higher than its baseline in both groups, significant changes were noticed only in Group A.

CONCLUSION

Findings revealed that head posture was significantly altered by the placement of dentures in completely edentulous patients. Within the time interval of 30 minutes and 24 hours extension of head posture remained constant with slight variation. Although after 30 days, changes remained significant for group 'A', but no significant changes were observed in the subjects of group 'B'.

Influence of defective complete dentures renewal on TMD; an MRI and clinical controlled prospective study

BACKGROUND

The influence of complete denture occlusion on temporomandibular disorder (TMD) is controversial. Some studies found that defective occlusion contributes to the development of TMD, while others found no correlation.

OBJECTIVE

This prospective controlled study evaluated the relationship between renewal of old defective complete dentures and TMD as evidenced both by clinical examination and magnetic resonance imaging (MRI) findings.

MATERIALS AND METHODS

The study included 25 complete denture patients with signs and symptoms of TMD and 21 asymptomatic controls. Clicking was a common finding in all symptomatic joints. All selected participants needed complete denture renewal. MRI and clinical assessment following research diagnostic criteria for TMD guidelines (RDC/TMD) were carried out at baseline and 2 years after new complete denture insertion. Temporomandibular joint (TMJ) pain, muscle pain, clicking and movement limitation were the assessed signs and symptoms. MRIs were conducted to evaluate the TMJs for disc displacement, disc morphology and joint effusion.

RESULTS

Complete denture renewal significantly improved the signs and symptoms of TMD in symptomatic group (p < 0.01). Only in the symptomatic group, treatment resulted in a significant increase in joints displaying superior (normal) disc position (symptomatic p < 0.001; asymptomatic p = 0.157). New dentures did not affect disc morphology in both groups (p = 0.5 for both groups) but significantly reduced joint effusion in the symptomatic group (symptomatic p < 0.001; asymptomatic p = 0.5). Relationship between clinical and MRI findings was not one to one.

CONCLUSIONS

New complete dentures had a positive impact on TMD signs and symptoms, disc position and joint effusion but not on disc morphology.

Changes in temporomandibular disorders after treatment with new complete dentures

A total of 250 edentulous patients (118 non-denture and 132 denture wearing) awaiting treatment for new complete dentures were examined for signs and symptoms of temporomandibular disorders. Signs and symptoms of temporomandibular disorder (TMD) were evaluated before prosthetic treatment, 3 months and 3 years after denture insertion by means Helkimo's Anamnestic and Clinical Dysfunction Indices. Before treatment began, patients were observed to have a low prevalence of signs and symptoms of TMD. This prevalence decreased, but was not statistically significant, in the 3 months and 3 years after denture insertion. No statistically significant correlations were found between signs and symptoms of TMD and denture retention, stability, occlusal errors, freeway space, age of present denture, or number of sets of dentures.

Need for occlusal therapy and prosthodontic treatment in the management of temporomandibular disorders. Part II: Tooth loss and prosthodontic treatment

The second part of this review, evaluating the literature on the relationship between dental occlusion and temporomandibular disorders (TMDs), focuses on the aetiological importance of tooth loss and the place of prosthodontic replacement in the treatment of TMD. Loss of teeth and lack of posterior occlusal support seem to have little influence on the development of TMD, which calls into question the use of prosthodontic restoration as prevention or treatment for TMD. In addition, there are practically no studies assessing the benefit of instrumental analysis in diagnosis or comparing the outcome of prosthodontic treatment with simple reversible methods in the management of TMD. There is a trend in the current literature to abandon any treatment, including positioning appliances and prosthodontic measures, to 'recapture the disk' in patients with disk displacements because of the favourable, long-term results achieved after using more simple methods. It is concluded that prosthetic therapy in TMD patients is not appropriate for initial TMD treatment and should only be carried out on prosthodontic indications after reversible treatment has alleviated pain and dysfunction.

Clinical morbidity and sequelae of treatment with complete dentures

Wearing complete dentures may have adverse effects on the health of both the oral and the denture-supporting tissues. This article is a review of selected literature on the sequelae of treatment with complete dentures in the specific areas of residual ridge resorption, mucosal reactions, burning mouth syndrome, temporomandibular disorders, and patient satisfaction. Recent literature found with a Medline search from 1952 to 1996 is included in this review. Residual ridge resorption is an inevitable consequence of tooth loss and denture wearing, with no dominant causative factor having been found. Mucosal reactions have a multifactorial cause, most of which can be easily treated. Most patients are satisfied with their complete dentures. Correlations between anatomic conditions and denture quality and patient satisfaction are weak. Psychologic factors seem to be extremely important in the acceptance of and adaptation to removable dentures. There are still no reliable methods to predict the outcome of complete denture treatment and there are many problems related to treatment with complete dentures. Although the prevalence of an edentulous condition is decreasing, the great number of edentulous people warrants the continuing efforts of basic and clinical research on removable partial dentures. Complete denture prosthodontics will remain an important part of dental education and practice. In addition to clinical and technical skills, insight into patient behavior and psychology and communication techniques are also necessary.