Modified maxillary occlusal splint for prevention of cheek biting: a clinical report

Oral Self-Mutilation in Lesch–Nyhan Patients: A Cross-Sectional Study

Lesch–Nyhan syndrome (LNS) is a rare genetic condition resulting from an inherited disorder of purine metabolism. It is characterized by the lack of one enzyme, hypoxanthine-guanine phos-phoribosyltransferase (HGPRT), which is responsible for purine salvage. The main manifestations of this syndrome are hyperuricaemia, reduction in cognitive abilities, self-aggressive behavior, choreoathetosis, spasticity, and retarded development. The aim of the study was to investigate the means of treatment and efficacy of prevention of oral self-injury behavior (SIB) in patients with LNS. Information regarding the type and treatment of oral SIB in 19 LSN Italian patients (mean age 23.3 years) was gathered via a structured telephone interview of their parents. A total of 84% of the patients showed some form of self-injury behavior; the first form to manifest itself was finger biting (37%), followed by lip biting (25%), and then tongue biting (18%). Furthermore, 74% of cases featured oral SIB, and tooth extraction was found to be the most frequent form of treatment practiced (71%). This study has revealed the great difficulty parents and carers face in managing forms of oral SIB; dental extraction was the most common choice, despite its invasive nature and far-reaching consequences in regard to the psychosocial status of the patients.

On-site treatment of oral ulcers caused by cheek biting: A minimally invasive treatment approach in a pediatric patient

In small children, it would be desirable for oral lesions, especially on the symmetrical sides, to be screened carefully, and for treatment to begin with minimal interventions including on-site medication and remedies to discontinue the bad routine. Minimal invasive approach and differential diagnosis are considered to be the main solutions for oral ulcers in pediatric patients.

Correction of cheek biting in a dentate patient

Postsurgical injury by teeth to oral mucosa (reconstructed by a flap) can lead to ulceration and subsequent infection at the reconstructed site. A prompt intervention by fabricating a specially designed prosthesis to deflect the reconstruction flap away from the occluding teeth has been described for the treatment of cheek biting in the present clinical report.

Checking the cheek bite injury: fabrication of an interim cheek guard appliance

Among the various sequelae associated with the treatment of oral carcinoma (both surgical and radiotherapy), the two conditions that can be of serious concern are reduced mouth opening and mucositis. The limited mouth opening can lead to entrapment of buccal mucosa in between teeth during the chewing cycle, which in turn can lead to further injury of the mucosa. A simple method has been described by the authors to prevent the cheek bite by fabrication of a cheek guard appliance. Favorable results were seen within a few days after insertion of the appliance.

Habitual biting of oral mucosa: A conservative treatment approach

Chronic biting of oral mucosa is an innocuous self inflicted injury, commonly seen in children suffering from developmental and psychological problems and has rarely been reported in normal unaffected individuals. The management strategies vary from counseling, prescription of sedatives to different prosthetic shields. The paper highlights the efficacy of a simple approach using soft mouth guard in the management of self inflicted lesions due to habitual biting of oral mucosa in two normal healthy children.

Cheek bumper prosthesis for a patient with a neurofibromatous lesion in the left cheek

Neurofibromatous lesions of the oral cavity affect the chewing cycle by interposition of cheek mucosa during contact of opposing teeth. In this report, an intraoral prosthesis was fabricated to restore and improve oral function and reduce the incidence of cheek biting on the neurofibromatous lesion. The prosthesis successfully reduced the incidence of cheek biting and improved the patient's oral competency. This report describes the procedure for making an intraoral cheek bumper prosthesis to improve patient oral function.

Occlusal splints for treating sleep bruxism (tooth grinding)

BACKGROUND

Sleep bruxism is an oral activity characterised by teeth grinding or clenching during sleep. Several treatments for sleep bruxism have been proposed such as pharmacological, psychological, and dental.

OBJECTIVES

To evaluate the effectiveness of occlusal splints for the treatment of sleep bruxism with alternative interventions, placebo or no treatment.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (to May 2007); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1); MEDLINE (1966 to May 2007); EMBASE (1980 to May 2007); LILACS (1982 to May 2007); Biblioteca Brasileira de Odontologia (1982 to May 2007); Dissertation, Theses and Abstracts (1981 to May 2007); and handsearched abstracts of particular importance to this review. Additional reports were identified from the reference lists of retrieved reports and from article reviews about treating sleep bruxism. There were no language restrictions.

SELECTION CRITERIA

We selected randomised or quasi-randomised controlled trials (RCTs), in which splint therapy was compared concurrently to no treatment, other occlusal appliances, or any other intervention in participants with sleep bruxism.

DATA COLLECTION AND ANALYSIS

Data extraction was carried out independently and in duplicate. Validity assessment of the included trials was carried out at the same time as data extraction. Discrepancies were discussed and a third review author consulted. The author of the primary study was contacted when necessary.

MAIN RESULTS

Thirty-two potentially relevant RCTs were identified. Twenty-four trials were excluded. Five RCTs were included. Occlusal splint was compared to: palatal splint, mandibular advancement device, transcutaneous electric nerve stimulation, and no treatment. There was just one common outcome (arousal index) which was combined in a meta-analysis. No statistically significant differences between the occlusal splint and control groups were found in the meta-analyses.

AUTHORS' CONCLUSIONS

There is not sufficient evidence to state that the occlusal splint is effective for treating sleep bruxism. Indication of its use is questionable with regard to sleep outcomes, but it may be that there is some benefit with regard to tooth wear. This systematic review suggests the need for further investigation in more controlled RCTs that pay attention to method of allocation, outcome assessment, large sample size, and sufficient duration of follow up. The study design must be parallel, in order to eliminate the bias provided by studies of cross-over type. A standardisation of the outcomes of the treatment of sleep bruxism should be established in the RCTs.

Prevention of Habitual Cheek Biting: A Case Report

Oral and peri-oral structures can be traumatized by self-injurious behavior (SIB). Various articles have described prostheses used to prevent SIB-related injuries to the oral tissues of patients who have developmental or medical problems, such as psychological problems, congenital syndromes or mental retardation; however, reports of oral SIB in individuals unaffected by the above conditions are scarce. This case report describes the use of a removable prosthesis to prevent a stress-induced cheek biting habit in 15-year-old girl who did not have any of the commonly related conditions. The report discusses the importance of designing a prosthesis that protects tissues, while considering injury severity and the patient's healthas well as her ability to cooperate with treatment.

The fabrication of cast metal guidance flange prostheses for a patient with segmental mandibulectomy: a clinical report

Deviation of the mandible toward the resected side is dependent upon the amount of soft and hard tissue resected, the method of surgical site closure, the degree of impaired tongue function, the presence and condition of teeth, the loss of proprioceptive sense of occlusion, and the timing of prosthodontic therapy. Prosthodontic therapy combined with physical therapy may be beneficial for reducing and minimizing mandibular deviation. This clinical report describes the fabrication of cast metal guidance flange prostheses. The supporting flanges assist in controlling mandibular deviation and coordinate masticatory movements for a patient following a segmental mandibulectomy.

Buccal mucosa ridging and tongue indentation: incidence and associated factors

Buccal mucosa ridging and tongue indentation have been considered as one of the visible and reliable signs of bruxism. However, there have not been any reports justifying this relationship scientifically. Moreover, there have not been any studies reporting specific procedures to assess them. Thus, the purpose of the present study was to determine the clinical incidence of buccal mucosa ridging and tongue indentation and assess the possible relationship between certain factors that can influence their occurrence. A total of 244 (178 males and 66 females) dentulous adults from 20 to 59 years of age, who were employees at the Bank of Yokohama, were randomly selected. At first, the buccal mucosa ridging and tongue indentation were classified into three groups based in their intensity: none, mild, and severe. The incidence of both conditions in the different age groups, as well as the incidence by gender was evaluated. Furthermore, the possible relationships between buccal mucosa ridging and tongue indentation and age, gender, clenching awareness, grinding awareness, headache, neck stiffness, vertical dimension, temporomandibular joint (TMJ) pain to palpation, masticatory muscle tenderness to palpation, and the presence of premature contacts were evaluated using the chi-square test. A positive relationship was found between the occurrence of buccal mucosa ridging and tongue indentation and gender (p < 0.01); both conditions were observed more frequently in females than in males. A positive relationship was also found to age; the group between 20-29 years old showed the highest incidence. The vertical dimension had a positive relationship with the occurrence of both buccal mucosa ridging and tongue indentation. Other factors evaluated did not show any correlation.

Oral splints: the crutches for temporomandibular disorders and bruxism?

Despite the extensive use of oral splints in the treatment of temporomandibular disorders (TMD) and bruxism, their mechanisms of action remain controversial Various hypotheses have been proposed to explain their apparent efficacy (i.e., true therapeutic value), including the repositioning of condyle and/or the articular disc, reduction in the electromyographic activity of the masticatory muscles, modification of the patient's "harmful" oral behavior, and changes in the patient's occlusion. Following a comprehensive review of the literature, it is concluded that any of these theories is either poor or inconsistent, while the issue of true efficacy for oral splints remains unsettled. However, the results of a controlled clinical trial lend support to the effectiveness (i.e., the patient's appreciation of the positive changes which are perceived to have occurred during the trial) of the stabilizing splint in the control of myofascial pain. In light of the data supporting their effectiveness but not their efficacy, oral splints should be used as an adjunct for pain management rather than a definitive treatment. For sleep bruxism, it is prudent to limit their use as a habit management aid and to prevent/limit dental damage potentially induced by the disorder. Future research should study the natural history and etiologies of TMD and bruxism, so that specific treatments for these disorders can be developed.