[TEAS for prevention and treatment of orthodontic toothache and oral dysfunction: a randomized controlled trial]

OBJECTIVE

To observe the clinical efficacy of transcutanclus electrical acupoint stimulation (TEAS) on prevention and treatment of orthodontic toothache and oral dysfunction.

METHODS

A total of 85 patients of malocclusions in the preliminary diagnosis were randomly divided into a control group (20 cases), a psychological intervention group (22 cases), a medication group (20 cases) and a TEAS group (23 cases). Orthodontics treatment was given in all the groups. Patients in the control group received no further treatment; patients in the psychological intervention group received comprehensive psychological intervention, including cognitive education and music therapy; patients in the medication group received oral administration of ibuprofen; patients in the TEAS group received TEAS at Juliao (ST 3), Jiachengjiang (Extra) and auricular point Ya (LO1). The treatment was given twice a day, one in morning and one at night, for 7 days. The pain scores of orthodontic toothache and changes of oral dysfunction were observed in all groups.

RESULTS

(1) At 5 time points from the 12th hour to the 4th day, the scores of spontaneous pain in TEAS group were lower than those in the control group (all P < 0.01); during the time points, the scores in TEAS group were lower than those in the psychological intervention group (P < 0.05, P < 0.01), which were similar to those in the medication group (all P > 0.05). (2) During the peak cycle of spontaneous toothache, the scores of irritation pain in TEAS group were significantly lower than those in the control group (all P < O.01), regardless of time-point statistics or general statistics; the scores of irritation pain in the TEAS group were also significantly lower than those in the psychological intervention group (all P < 0.01), which were similar to those in the medication group (all P > 0. 05). (3) Compared with control group, the grading of talking disorder in the remaining groups did not change significantly (P > 0.05). (4) Compared with control group, the grading of moderate-severe eating disorder in TEAS group was significantly reduced (P < O.05), which was not different from that in the medication group (P > 0.05). The differences of the grading of moderate-severe eating disorder were not significantly different between the psychological intervention group and control group (P > 0.05). (5) There were 3 cases of digestive system adverse reactions in the medication group.

CONCLUSION

TEAS can efficiently prevent orthodontic toothache and oral dysfunction, which is superior to psychological intervention and similar to medication. In addition, it can avoid possible side-effect of medication.

Normal variations of oral anatomy and common oral soft tissue lesions: evaluation and management

Examination of the oral cavity can provide significant diagnostic information regarding the general health of the patient. The oral cavity is affected by a multitude of pathologic conditions of variable cause and significance; however, there are numerous normal variations of oral soft tissue structures that may resemble a pathologic state. Understanding these variations assists practitioners to discriminate between normal versus abnormal findings and determine the appropriate course of management, if necessary.

Uniformity in selection for subsidized orthodontic care--focus on borderline treatment need

In the county of Stockholm, subsidized orthodontic care is offered to roughly 25% of persons under the age of 19. Stockholm County Council has signed contracts with experienced orthodontists (consultants) to carry the responsibility of screening and offering subsidized treatment to those having the most urgent treatment need. For this purpose the orthodontist is free to use whatever yardstick he/she finds most useful. The Swedish Medical Board Index (SMBI) is most commonly used, and was used by the consultants in this study. It is obvious that the selection process under these conditions must be affected by a subjective opinion and consequently the inter-examiner variation would be large, especially for subjects presenting with borderline treatment need. The aim of the study was to evaluate the uniformity in selection of subjects for subsidized orthodontic care with focus on borderline treatment need. Six consultant orthodontists volunteered to participate. Each orthodontist was asked to recruit patients whom they considered to have borderline treatment need. 34 adolescents; 25 girls and 9 boys (mean age 14.5 +/- 1.68 years), were recruited. These patients were individually assessed by each orthodontist. The interexaminer agreement was tested by use of Cohen's kappa statistics (kappa = 0.324). Since all six orthodontists fully agreed in only one third of the cases the validity of the assessments with the present guidelines is insignificant, at least in subjects with borderline treatment need.

The Influence of Craniofacial Growth in a Case of Transverse Facial Cleft

This report presents the case of a female patient bearing a right-side transverse facial cleft. She has received interdisciplinary treatment since birth. At regular intervals, dental casts were made, and profile and full-face photographs, lateral and postero-anterior cephalograms were taken during the course of orthodontic treatment and maxillofacial surgery. We evaluated her diagnostic records with the intent of documenting the effects of growth and therapy on the skeletal structures of the facial cranium and on occlusion, and to show the influence on facial esthetics. Her facial morphology and occlusion were manifest at birth and in the primary dentition. The maxilla and mandible deviated from the midsagittal plane toward the cleft side, with the mandible considerably more affected, revealing a markedly posterior position. The lateral skeletal deviation of both jaws increased slightly during growth, yet the midline deviation of the dental arches and malocclusion clearly worsened. The increasing deviation was not obvious in full-face photographs. Especially in the primary and mixed dentition, the mandible shifted to the anterior, which was visible in both the lateral cephalograms and profile photographs. On the whole, however, no noteworthy alteration in the character of the craniofacial morphology occurred by the time growth was complete, despite functional jaw-orthopedic and maxillofacial surgical treatment consisting of two distraction osteogenesis procedures.

Recession occurrence in patients treated with fixed appliances--preliminary report

PURPOSE

The aim of the study was to evaluate the dependence of gingival recession, malocclusion and factors that may lead to recessions of the gingiva in patients applying for orthodontical treatment.

MATERIAL AND METHODS

The study involved 52 randomly selected patients treated with fixed appliances due to occlusal irregularities and dental abnormalities. Data obtained from the examination and selected parameters from cephalometric analysis were placed in a chart including ANB skeletal class and Wits parameter, lower incisor position IMPA, dental abnormalities, extractions due to orthodontical indications and recession etiopathic factors. Statistical analysis of obtained data was conducted using variance analysis. Statistically significant were assumed those calculations for which value of significance level p < or = 0.05.

RESULTS

Recession was observed in 18 patients of the 52 examined. Skeletal I class was found in 11 patients (61.12%) and in 8 cases Wits parameter corresponded with skeletal class III (44.4%). Among the patients examined normal incisor inclination was observed in 6 patients (33.33%), whereas 12 cases revealed inclination irregularities (66.66%). Clinical examination disclosed dental defects in 13 patients (72.22%) and in 12 cases recession etiopathic factors were recognized (66.66%). Statistically significant differences between periodontal biotype and gingival recession of 43, 31, 33 teeth were estimated.

CONCLUSIONS

Anatomical factors, malocclusion and dental irregularities were fund to be the main cause of the single and/or multiple recessions. Patients applying for orthodontic treatment due to occlusal abnormalities should remain under particular control in case of symptoms suggesting the incidence of recession, particularly when recessions are already present.

Vertical Changes in Patients with Complete Unilateral and Bilateral Cleft Lip, Alveolus and Palate

AIMS AND METHODS

Twelve UCLP and eleven BCLP patients who had been treated according to the Hanover treatment protocol were evaluated by means of cephalometric analysis and cast measurements. The aim of this investigation was to demonstrate changes in the vertical plane and in incisor position in the course of craniofacial growth compared to age-matched non-cleft controls. Lateral cephalograms and casts were analyzed for each cleft patient at age 10 and 15 and compared with corresponding data of a non-cleft control group (n = 20).

RESULTS

A vertical growth impairment of the maxilla was registered in patients with cleft lip, alveolus and palate. The maxilla of the cleft patients showed a significant clockwise rotation while the inclination of the mandible remained virtually unchanged. Both upper and lower incisors, which were significantly retruded at the beginning of the late mixed dentition, could be protruded in the course of craniofacial growth, development of the dentition and treatment, but remained retruded in comparison with the non-cleft controls. The posterior midfacial height was highly significantly shorter in both UCLP and BCLP patients at both evaluation timepoints, whereas the anterior lower jaw height was greater than in the control group

Focal dermal hypoplasia: management of complex dental features

A 17 year-old female who presented for treatment of grossly carious lower first molar teeth had multiple features of Focal Dermal Hypoplasia (FDH). These included enamel pitting and hypoplasia, anomalies of shape, size and positioning of teeth, as well as soft tissue papillomas and telangiectasis of tongue. A case report and a synopsis of the syndrome (FDH) are presented, the oral aspects of the condition are reviewed and the management of the complex dental anomalies is discussed.

Pediatric oral pathology. Soft tissue and periodontal conditions

Pediatric patients can present with various intraoral lesions that require accurate diagnosis, treatment or reassurance, and possible referral for a dental evaluation. Periodic review of oral soft-tissue pathology can help the medical team to easily recognize common and rare abnormalities affecting children. Recent years have brought new insights into the causes and treatment of periodontal diseases of children, making prevention or treatment of many formerly untreatable conditions possible. Early detection of these oral conditions may be life saving.

Imaging of orofacial clefting disorders

This article discusses the imaging and clinical features of patients with facial clefts. Patients with facial clefts are classified according to interocular distance. Typing of facial clefts is emphasized to determine which patients need to undergo not only imaging, but also imaging of the brain, to assess associated intracranial anomalies. The genetics, treatment, and implications that these clefting disorders have on the growth of the face are also discussed.

[Orthodontic anomalies in children with open-mouth posture]

Open-mouth posture is related to the development of orthodontic anomalies. The etiology of these anomalies is discussed. Guidelines for diagnosis, prevention and interceptive measures are given.

Genetics in oral-facial growth and diseases

Much debate has taken place over the relative importance of heredity and environment in the development of various diseases and conditions. Dental problems are not often easily categorised into either genetic or environmental, because most anomalies involve the interaction of both factors. Since many genetic disorders involve the orofacial region, the importance of the subject is paramount in dentistry to enable a proper understanding of the development of the various conditions and the treatment of patients presenting with those conditions. The incidence of newborn children with any congenital anomaly is estimated to be as high as 2 to 3 per cent, with more than half of these abnormalities, including minor manifestations, found in the head and neck region. It is therefore not unusual for dentists to be the first to recognise such conditions in their patients and be responsible for providing the necessary treatment. This paper describes many conditions, genetically or partly genetically mediated, which affect the oro-facial tissues, and offers descriptions by which the clinician can start to identify those conditions.

[Open mouth posture. A review]

Open mouth posture is a risk factor for otitis media with effusion, orthodontic anomalies and possible other medical disturbances. In this article the relation between open mouth posture and orthodontic anomalies is discussed. The importance of early diagnosis, prevention and (interceptive) treatment is emphasized.

The midline: diagnosis and treatment

The importance of coordinated midlines often is unappreciated as it relates to the treatment plan for the orthodontic case. All three of the patient's midlines--facial, maxillary, and mandibular--must be considered if ideal correction is to be achieved. Proper differential diagnosis of the cause will allow the practitioner to appropriately use either inter- or intraarch mechanics for the resolution of midline discrepancies. Midline correction should be undertaken from the initiation of treatment and once all midlines are coordinated they should be maintained as a guide for any further force systems used in completing the case. Functional, dental, and iatrogenic midline discrepancies are discussed pertaining to their diagnosis and treatment.