Production of two Nasal Sounds by Speakers with Cleft Palate.

Many speakers with cleft palate develop atypical consonant productions, especially for pressure consonants such as plosives, fricatives, and affricates. The present study investigated the nature of nasal sound errors. The participants were eight female and three male speakers with cleft palate between the ages of 6 to 20. Speakers were audio-recorded, and midsagittal tongue movement was captured with ultrasound. The speakers repeated vowel-consonant-vowel with the vowels /α/, /i/, and /u/ and the alveolar and velar nasal consonants /n/ and /η/. The productions were reviewed by three listeners. The participants showed a variety of different placement errors and insertions of plosives, as well as liquid productions. There was considerable error variability between and within speakers, often related to the different vowel contexts. Three speakers co-produced click sounds. The study demonstrated the wide variety of sound errors that some speakers with cleft palate may demonstrate for nasal sounds. Nasal sounds, ideally in different vowel contexts, should be included in articulation screenings for speakers with cleft palate, perhaps more than is currently the case.

Perceptual, durational and tongue displacement measures following articulation therapy for rhotic sound errors.

Outcomes of articulation therapy for rhotic errors are usually assessed perceptually. However, our understanding of associated changes of tongue movement is limited. This study described perceptual, durational and tongue displacement changes over 10 sessions of articulation therapy for /ɹ/ in six children. Four of the participants also received ultrasound biofeedback of their tongue shape. Speech and tongue movement were recorded pre-therapy, after 5 sessions, in the final session and at a one month follow-up. Perceptually, listeners perceived improvement and classified more productions as /ɹ/ in the final and follow-up assessments. The durations of VɹV syllables at the midway point of the therapy were longer. Cumulative tongue displacement increased in the final session. The average standard deviation was significantly higher in the middle and final assessments. The duration and tongue displacement measures illustrated how articulation therapy affected tongue movement and may be useful for outcomes research about articulation therapy.

Long-term effectiveness of parent education using the "baby oral health" model on the improvement of oral health of young children.

Purpose. To determine the long-term effectiveness of comprehensive education given to parents and caregivers with respect to the incidence of preventable oral diseases, utilization of dental services, and retention of knowledge related to oral health. Methods. Group presentations on oral health were conducted for caregivers of infants (n = 161) using an interactive audio-visual aid. Followup occurred at 18 months. A comparison group (n = 181) was enrolled from the same community groups. Chi-square and Fisher's exact tests were used to analyze findings. Results. There was a difference in caries incidence, knowledge levels of caregivers, and utilization of dental services (P < 0.05) when comparing the SGB to the SGFU. Conclusions. One-time exposure to parent education using a comprehensive interactive audio-visual aid has an effect on reducing caries incidence and increasing dental utilization. While most knowledge is retained by parents, there is some attrition in the information retained over an 18-month time period. This emphasizes the importance of repeated reinforcement of the same concepts over a shorter time span.

Resolution of maxillary sinus mucositis after endodontic treatment of maxillary teeth with apical periodontitis: a cone-beam computed tomography pilot study.

INTRODUCTION: Apical periodontitis (AP) is an inflammatory response that can affect the maxillary sinus. This study characterized maxillary sinus mucositis adjacent to teeth with AP and assessed its resolution after endodontic treatment. METHODS: Thirty maxillary sinuses in subjects (n = 29) who had AP associated with maxillary posterior teeth were imaged with cone-beam computed tomography (CBCT). When mucositis was detected, its resolution was assessed with CBCT scanning 3 months after treatment, and periapical healing was assessed using the periapical index (PAI) after 6 months. RESULTS: Excluding 5 sinuses obscured by sinusitis, mucositis was detected in 14 of 25 sinuses (56%). Nonsignificant inverse association was observed between the mucosal lining thickness and the distance from the sinus to root apices with AP. Four noncompliant subjects were discontinued. Three months after treatment, mucositis was fully resolved in 3 of 10 subjects (30%), partially resolved in 3 of 10 subjects (30%), unchanged in 3 of 10 subjects (30%), and worsened in 1 subject (10%). Six months after treatment, 6 of 10 subjects (60%) had reduced PAI scores classified as healed or healing. The subject with expanded mucositis at 3 months was not healing at 6 months. CONCLUSIONS: Within the limited sample of this pilot study, CBCT imaging revealed a lower-than-expected prevalence of mucositis adjacent to teeth with AP. Fully resolved mucositis was not common 3 months after endodontic treatment, suggesting that in specific cases it might linger beyond 3 months after the elimination of the endodontic infection. Because of the low statistical power, the association between the resolution of mucositis and periapical healing could not be explored.

An ultrasonographic investigation of cleft-type compensatory articulations of voiceless velar stops.

Ultrasound imaging was used to investigate the articulation of the voiceless velar stop [k] in five speakers with compensatory articulation related to cleft palate. The perceptual evaluation of the acoustic realization and the visual assessment of the tongue movement for the target sound were made by three examiners. The analysis revealed a variety of different compensatory strategies that included glottal stops, pharyngeal stops, midpalatal stops and glottal and velar co-productions. One patient produced palatal click sounds together with a midpalatal stop. The ultrasound imaging also revealed covert articulatory movements that would have been missed in a purely perceptual analysis. The analysis of the ultrasound images points to subphonemic aspects of cleft-type compensatory articulation that are important to understand for speech therapy.

A single appliance for the correction of digit-sucking, tongue-thrust, and posterior cross bite.

Clinical management of non-nutritive sucking habits and the resulting dentofacial changes often require multiple appliances to correct, leading to increased treatment time and costs. The aim of this paper was to introduce a single appliance combining a Teflon roller, a slow palatal expander, and a tongue crib appliance that is designed to correct the: (1) sucking habit; (2) anterior open bite; (3) posterior crossbite; (4) tongue thrust; and (5) molar relationships without the need for multiple treatment strategies. Moreover, the fixed-removable design ensures patient compliance, yet allows the appliance to be easily removed by the clinician for adjustments.

Early childhood caries and access to dental care among children of Portuguese-speaking immigrants in the city of Toronto.

OBJECTIVE: To determine the influence of accessibility of dental services and other factors on the development of early childhood caries (ECC) among Toronto children 48 months of age or younger with at least one Portuguese-speaking immigrant parent. METHODS: This population-based case-control study involved 52 ECC cases and 52 controls (i.e., without ECC) identified from community centres, churches and drop-in centres by a process of network sampling. Caries status (dmft/s) was assessed by clinical examination. Access to dental care and risk factors for ECC were determined through a structured interview with the Portuguese-speaking parent. RESULTS: Forty (77%) of the children with ECC but only 28 (54%) of controls had never visited a dentist. Thirty (58%) mothers of children with ECC but only 13 (25%) mothers of controls had not visited a dentist in the previous year. Bivariate analyses revealed that low family income, no family dentist, no dental insurance, breastfeeding, increased frequency of daily snacks and low parental knowledge about harmful child feeding habits were associated with ECC. Non-European-born parents and parents who had immigrated in their 20s or at an older age were 2 to 4 times more likely to have a child with ECC than European parents and those who had immigrated at a younger age. Lack of insurance, no family dentist and frequency of snacks were factors remaining in the final logistic regression model for ECC. CONCLUSIONS: The strongest predictors of ECC in this immigrant population, after adjustment for frequent snack consumption, were lack of dental care and lack of dental insurance. These findings support targeting resources to the prevention of ECC in children of new immigrants, who appear to experience barriers to accessing private dental care and who are exposed to many of the determinants of oral disease.

Development and testing of an audio-visual aid for improving infant oral health through primary caregiver education.

PURPOSE: To create and test an audio-visual (AV) aid for providing anticipatory guidance on infant oral health to caregivers. METHODS: A DVD-video containing evidence-based information about infant oral health care and prevention in accordance with the American Academy of Pediatric Dentistry guidelines has been developed (www.utoronto.ca/dentistry/newsresources/kids/). It contains comprehensive anticipatory guidance in the areas of pregnancy, oral development, teething, diet and nutrition, oral hygiene, fluoride use, acquisition of oral bacteria, feeding and oral habits, causes and sequelae of early childhood caries, trauma prevention, early dental visits and regular dental visits. A questionnaire was developed to test the knowledge of expectant and young mothers (n = 11) and early childhood educators (n = 16) before and after viewing the video. RESULTS: A significant lack of knowledge about infant oral health was indicated by the proportion of "I don"t know" (22%) and incorrect (19%) responses to the questionnaire before the viewing. Significant improvement in knowledge (32%; range -3% to 57%; p < 0.001) was indicated by the proportion of correct responses (91%) following a single viewing of the AV aid. CONCLUSION: This AV aid promises to be an effective tool in providing anticipatory guidance regarding infant oral health in high-risk populations. Unlike existing educational materials, this aid provides a comprehensive, self-directed, evidence-based approach to the promotion of infant oral health. Widespread application of this prevention protocol has the potential to result in greater awareness, increased use of dental services and reduced incidence of preventable oral disease in the target populations.

Shear bond strengths of orthodontic brackets cemented to bovine enamel with composite and resin-modified glass ionomer cements.

PURPOSE: The purpose of this in vitro study was to determine the effects of short- and long-term storage on the shear bond strength of metal, polycarbonate, and ceramic orthodontic bracket bases using autopolymerizing resin composite and resin-modified glass ionomer cements (RMGIC). The glass ionomer cement was applied in both a wet and a dry environment. METHODS: With a method developed in the authors' laboratory, orthodontic brackets were cemented under constant pressure to embedded bovine incisor enamel. All cements were mixed and applied in accordance with the manufacturer's instructions. The specimens were stored in water at 37 degrees C for 24 hours, 7 days, or 180 days. After the lapse of each time interval, they were shear tested to failure. The shear bond strengths (SBSs) were converted to megapascals (MPa). An adhesive remnant index (ARI) was used to record the site of the residual cement. RESULTS: There were no precipitous increases or decreases in SBS over a lapsed time of 180 days, although some variations occurred between 24 hours and 7 days. Similar findings were recorded for ARI. CONCLUSIONS: The bracket base-cement combinations produce clinically sustainable SBSs over time. Selection of the cement may be important in patients who exhibit a high risk for caries.

The influence of orthodontic bracket base design on shear bond strength.

Many bracket base designs and adhesive materials are in clinical use today. Bases have evolved from perforated metal bases to the present foil mesh bases, and treatments range from none, to spraying metal alloy onto the base, to the most common treatment of microetching. The purpose of this study was to determine the effect of orthodontic bracket base design on mean shear bond strength 1 hour or 24 hours after bonding. For each time group, 12 specimens of 6 types of metal brackets were bonded to bovine incisors with Transbond XT (3M Unitek, Monrovia, Calif) light-cured composite resin. Brackets were debonded 1 hour or 24 hours later, and the shear bond strength was recorded. Six debonded brackets of each type from each time group were selected at random and sandblasted. All the teeth were cleaned, and half were rebonded with used brackets, and half were rebonded with new brackets. Bond strength was measured again, 1 hour or 24 hours later. Representative specimens were inspected under the scanning electron microscope. Bracket base design significantly affected mean shear bond strength. Speed (60-gauge, microetched foil-mesh base; Strite Industries, Cambridge, Ontario, Canada) had the highest bond strength at 1 hour; followed by Time (machined, integral, microetched base with mechanical undercuts; American Orthodontics, Sheboygan, Wis); American Master Series (80-gauge foil-mesh base; American Orthodontics); Ovation Roth (80-gauge layered onto 150-gauge, microetched foil-mesh base; GAC, Central Islip, NY); Orthos Optimesh XRT (100-gauge microetched foil-mesh base; Ormco, Orange, Calif); and, finally, the nickel-free brackets (injection molded, 100-gauge, microetched, foil-mesh base; World Class Technology, McMinnville, Ore). The 24-hour results were similar except that Time had the highest mean shear bond strength (ANOVA, P <.05). Chairside sandblasting significantly affected the 1-hour, but not the 24-hour, mean shear bond strengths (ANOVA, P <.05). Sandblasting appears to be an effective method of cleaning bracket bases before rebonding.