Mouthguards, nightguards, palliatives and collaboration.
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Trauma to oral soft tissues in comatose patients may be more widespread than reported, as no extensive study of this problem has been conducted. Various appliances for the prevention of self-inflicted injuries to oral tissues particularly in children and the physically and mentally challenged have been documented, but there is little information on their use in adult comatose patients. Because comatose patients lack cerebral control of the masticatory cycle, they can easily injure themselves. Although it is not uncommon for patients with a decreased level of consciousness and in need of intensive care to be restrained to prevent injury due to involuntary movement of the limbs, head and neck restraint is often difficult and may be dangerous to the patient. This case report presents a simple solution to the problem of self-inflicted trauma to oral tissues.
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OBJECTIVE: Functional magnetic resonance imaging (fMRI) was used to detect the cerebral cortical somatotopy during maximum voluntary clenching with and without soft splint in patients with hemimasticatory spasms (HMS) and the central mechanisms of HMS and the rule of the splint therapy. METHODS: Four HMS patients were selected and the spasms sides were right in two cases and left in the other two cases. FMRI images were obtained on Elscint/GE 2.0 Tesla MR system. Block design was used and the movement pattern was the onset of spasms after maximum voluntary clenching with and without soft splint. The fMRI data were analyzed by SPM99 software. RESULTS: With the onset of spasms after maximum voluntary clenching, the activation of motor cortex in 3 HMS patients was found lateral dominance on the left side, and the other one showed bilateral activation. All the 4 patients were found activation in cingulate area. With the onset of spasms after maximum clenching wearing soft splints, the activation of motor cortex showed no lateral dominance on the left side, and 3 patients were not found activation in cingulate area. CONCLUSIONS: The changes of the activation in motor cortex and cingulate area during the onset of spasms after clenching with and without soft splint might be the central mechanisms of the rule of splint therapy, through which the soft splint might function in alleviating muscle pain.
Dental, oral, facial, and cranial injuries can be reduced by the use of mouthguards and faceguards. Disadvantages of mouthguard use are based mostly on lack of information. There is a growing endorsement for the use of mouthguards and faceguards, presenting the dental profession with a major opportunity to improve the oral health of athletes.
Prevention of traumatic tooth injuries during sports practice in children who are particularly at risk due to their dental and maxillary morphology is important when establishing a certificate of aptitude to sport. In some children this may provide an occasion to propose an orthodontal correction for dental protrusion. In any case, fitted protective mouth-pieces made by a competent dental surgeon should be recommended. They are preferable to the commonly available gum shields, which are not secure enough.
Lesch-Nyhan syndrome is a rare X-linked recessive disorder of purine metabolism, caused by complete absence of the enzyme hypoxanthine-guanine phosphoribosyl transferase. Persons affected with this incurable disease are developmentally and physically delayed, and suffer from self-injurious behavior. The most typical feature results in partial or total destruction of perioral tissues. The purpose of this paper was to discuss a case of Lesch-Nyhan syndrome with self-mutilative behavior and lip injuries, including some suggestions of a preventive approach avoiding the extraction of teeth. A soft mouthguard fabricated to prevent the destruction of perioral soft tissues and combined psychiatric pharmacologic therapy proved to have satisfactory results.
As the young athletes in our practices become involved in organized sports or recreational activities, it is important for dentists to take a proactive role and encourage parents of these kids to wear proper protective equipment to prevent oral injuries. Dentists must educate themselves and their young patients about the prevention of such injuries. Prevention is an obligation of dentistry as well as a critical patient responsibility. Safe sports participation should be the goal of any sports program and the dental profession should enthusiastically work to achieve this goal in every community.
Dealing with the personal endoral protections today it is possible to choose between different methods, which present various difficulties in application, but result in being more functional and comfortable than semi-individual protections. The cost shouldn't be a determining factor in athletes wanting maximum performances. In addition, in the case of athletes with cranium-mandibular diseases, articular clicks, and other problems, the personal endoral protection, represents not only an efficient method of prevention, but serves as a therapy.
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The spin-off applications of mouthguards are many and varied. Their uses range from protective to therapeutic and span all areas of medicine and dentistry. The designs range from simple minor modifications of the soft athletic mouthguard to sophisticated adaptations containing gears or electric switches. Their creative applications have provided relief to the cancer patient, increased independence to the handicapped and limited mobility patient, protection to the dentition of the patient undergoing general anesthesia, relief for the TMJ syndrome sufferer, and decreased risk of damage to the teeth and palate of the intubated infant, to name only a few. The adaptations and applications of this simple device are inspired by the needs of the patient and limited only by the imagination of the provider.