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At least 181 records · Page 10Linked to original sources

Improving mouth guards.

Mouth guards and materials were tested to provide information for a more protective yet more comfortable product. Ethylene-vinyl acetate copolymer materials varying in thickness and stiffness were tested for their mechanical, thermal, and water-absorption properties. Thickness was measured before and after fabrication of the mouth guard. During fabrication, thicknesses decreased from 25% to 50% for the custom-fabricated mouth guards and 70% to 99% for the mouth-formed (boil-and-bite), off-the-shelf, over-the-counter mouth guards. The thicker the material is, the greater the resulting energy absorption is. It is therefore essential that the thickness in the occlusal portion of the mouth guard remain optimal after fabrication. A mouth guard with a stiffer insert, which softens at a higher temperature in the occlusal portion, is proposed as a more protective mouth guard.

Absorption↗

Congenital analgesia. Report of a case.

A case of an injured, necrotic tongue in a child of 12 months was investigated. It was found that the patient was suffering from congenital analgesia. The injury was due to errupted lower incisor teeth, and the injury healed following their extraction. We believe that in cases of repeated self-injury of the tongue some form of sensory disturbance should be considered.

Humans↗

Prevention of self-inflicted trauma in comatose patients.

A solution to the problem of self-inflicted trauma to the tongue in decerebrate and comatose patients is outlined. The neurophysiology of jaw movement in the comatose patient is the basis of design of an intraoral fixed appliance which prevents discoordinate or neuropathologic mandibular chewing movements and facilitates healing of pre-existing lesions. Described in detail are the fabrication, insertion, and maintenance of this protective prosthesis, with emphasis on the need for joint effort between the neurosurgery and dentistry teams.

Child↗

Masseter muscle nodule due to bruxism. A case in point.

A 16-year-old white boy had a soft subcutaneous mass in the right masseter muscle. The pediatrician and two surgeons the patient had previously consulted had disagreed as to the origin of the mass and its treatment; their recommendations had ranged from leaving it alone to surgical excision. Treatment involved an orthopedic oral appliance restoring vertical dimension to its genetic norm and galvanic muscle stimulation. After 1 year the mass was eliminated.

Adolescent↗

Lesch-Nyhan syndrome and the lower lip guard.

Lesch-Nyhan syndrome, a rare inborn error of metabolism, is characterized by mental retardation and factitious oral lesions, which cause immense difficulties in its management. A case of an 11-year-old boy, the elder of two siblings with this condition, who had severe self-inflicted injuries to oral and perioral tissues is presented highlighting the different treatment modalities considered. A tailor-made lipguard proved to provide the best cosmetic result short term.

Child↗

Quality assurance in fractionated stereotactic radiotherapy.

The recent development of fractionated stereotactic radiotherapy (SRT), which utilises the relocatable Gill-Thomas-Cosman frame (GTC 'repeat localiser'), requires comprehensive quality assurance (QA). This paper focuses on those QA procedures particularly relevant to fractionated SRT treatments, and which have been derived from the technique used at the Royal Marsden Hospital. They primarily relate to the following: (i) GTC frame fitting, initially in the mould room, and then at each imaging session and treatment fraction; (ii) checking of the linear accelerator beam geometry and alignment lasers; and (iii) setting up of the patient for each fraction of treatment. The precision of the fractionated technique therefore depends on monitoring the GTC frame relocation at each fitting, checking the accuracy of the radiation isocentre of the treatment unit, its coincidence with the patient alignment lasers and the adjustments required to set the patient up accurately. The results of our quality control checks show that setting up to a mean radiation isocentre using precisely set-up alignment lasers can be achievable to within 1 mm accuracy. When this is combined with a mean GTC frame relocatability of 1 mm on the patient, a 2-mm allowance between the prescribed isodose surface and the defined target volume is a realistic safety margin for this technique.

Brain Neoplasms↗

Oral health issues for adolescent athletes.

Adolescent athletes are faced with a myriad of influences that can affect their oral health. During these formative years, the choices adolescents make regarding health could have repercussions throughout their lives. Health professionals can play an important role in educating their patients to make wise decisions. By becoming more aware of the health risks to which athletes are exposed,health professionals can learn to recognize these unhealthy behaviors and recommend appropriate prevention and cessation strategies to their patients who participate in sports.

Adolescent↗

Uncertainty in treatment of head-and-neck tumors by use of intraoral mouthpiece and embedded fiducials.

PURPOSE: To reduce setup error and intrafractional movement in head-and-neck treatment, a real-time tumor tracking radiotherapy (RTRT) system was used with the aid of gold markers implanted in a mouthpiece. METHODS AND MATERIALS: Three 2-mm gold markers were implanted into a mouthpiece that had been custom made for each patient before the treatment planning process. Setup errors in the conventional immobilization system using the shell (manual setup) and in the RTRT system (RTRT setup) were compared. Eight patients with pharyngeal tumors were enrolled. RESULTS: The systematic setup errors were 1.8, 1.6, and 1.1 mm in the manual setup and 0.2, 0.3, and 0.3 mm in the RTRT setup in right-left, craniocaudal, and AP directions, respectively. Statistically significant differences were observed with respect to the variances in setup error (p <0.001). The systematic and random intrafractional errors were maintained within the ranges of 0.2-0.6 mm and 1.0-2.0 mm, respectively. The rotational systematic and random intrafractional errors were estimated to be 2.2-3.2 degrees and 1.5-1.6 degrees , respectively. CONCLUSIONS: The setup error and planning target volume margin can be significantly reduced using an RTRT system with a mouthpiece and three gold markers.

Adult↗

Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy.

PURPOSE: To analyze three-dimensional setup uncertainties for multiple regions of interest (ROIs) in head-and-neck region. METHODS AND MATERIALS: In-room computed tomography (CT) scans were acquired using a CT-on-rails system for 14 patients. Three separate bony ROIs were defined: C2 and C6 vertebral bodies and the palatine process of the maxilla. Translational shifts of 3 ROIs were calculated relative to the marked isocenter on the immobilization mask. RESULTS: The shifts for all 3 ROIs were highly correlated. However, noticeable differences on the order of 2-6 mm existed between any 2 ROIs, indicating the flexibility and/or rotational effect in the head-and-neck region. The palatine process of the maxilla had the smallest right-left shifts because of the tight lateral fit in the face mask, but the largest superior-inferior movement because of in-plane rotation and variations in jaw positions. The neck region (C6) had the largest right-left shifts. The positioning mouthpiece was found effective in reducing variations in the superior-inferior direction. There was no statistically significant improvement for using the S-board (8 out of 14 patients) vs. the short face mask. CONCLUSIONS: We found variability in setup corrections for different regions of head-and-neck anatomy. These relative positional variations should be considered when making setup corrections or designing treatment margins.

Algorithms↗

Effect of wearing a mouthguard on the vestibulocollic reflex.

It has been speculated that the use of a mouthguard improves athletic ability such as muscular strength and equilibrium. The postural system is equipped with response patterns that correct for unexpected perturbations. These responses are driven by immediate feedback from visual, vestibular, and somatosensory information. These are integrated by the central nervous system. We analysed the possibility that wearing a mouthguard influences vestibular information via the vestibulocollic reflex (VCR) in the sagittal plane. The input of the VCR is vestibular afferent activity and its output is neck muscle activation. With the subject in the supine position, the apparatus used in this study induces the VCR by subjecting the head to abrupt vertical acceleration by sudden free fall under the head's own weight. Surface electromyographic (EMG) recordings in the sternocleidomastoid muscles (SCM) of 14 participants were analysed. There were no significant differences in the amplitude of the VCR within the left and right SCM whether subjects were or were not wearing a mouthguard (P=0.3227 within left SCM; P=0.9686 within right SCM). These results suggest that wearing a mouthguard has no effect on the VCR in the sagittal plane when supine, and so that vestibular sensory information is unaffected by wearing a mouthguard, in this context. Further research is required to examine whether this also holds true in more functional, upright and dynamic body positions.

Adult↗

An evaluation of the use of passive shimming to improve frontal sensitivity in fMRI.

The presence of the head in an MRI scanner leads to inhomogeneities in the magnetic field. These cause the 'susceptibility artifacts' of image distortion and signal dropout. In this paper, we evaluate a technique called passive shimming, which has the potential to reduce field inhomogeneities and the resultant artifacts. A piece of a magnetically active material (pyrolytic graphite) is held on the roof of the participant's mouth by a plastic mouth mould. We evaluate the effects in several different ways. We show that the presence of a shim reduces field inhomogeneity across much of the brain. From field maps, we generate simulations of EPI image intensity and BOLD sensitivity. Both of these are mainly improved by the presence of shim, although there were small reductions in some regions. Measured EPI image intensity also mostly increased. Finally, we ran a reward-punishment task in our subjects, and found that the presence of a shim increased functional sensitivity in the orbitofrontal cortex. Using the BOLD sensitivity measure, we provide estimates of the improvement to be expected in functional studies for a range of neural structures. Passive shims are quick to make and reasonably comfortable to wear, and have substantial potential for researchers investigating inferior frontal brain regions using MRI.

Artifacts↗

Fabrication of a custom diving mouthpiece using a thermoforming material.

Scuba divers may suffer from temporomandibular joint dysfunction and related problems associated with the use of commercially available diving mouthpieces. Several authors have recommended that custom diving mouthpieces be fabricated for relieving the symptoms of diver's mouth syndrome. The lost wax technique is commonly used for this purpose but may be time-consuming and is technically complicated. This article describes a simplified technique using thermoforming material for fabricating a custom diving mouthpiece.

Diving↗