The 'lifespan' of mandibular repositioning appliances.

Introduction Mandibular replacement appliances (MRAs) can be used in the treatment of snoring, mild to moderate obstructive sleep apnoea and as a second-line treatment where continuous positive airway pressure (CPAP) fails. There is currently a paucity of evidence as to how long these appliances last.Aims Assess the replacement rate for MRAs using this as a proxy for lifespan; estimate the period prevalence of temporomandibular joint disorder (TMJD) and bruxism in the study population.Methods Prospective observational study as part of service evaluation. Data from consecutive patients seeking a replacement MRA were collected over a three-month period, yielding a sample of 60. The mean time between the provision of appliances was calculated in months. Reasons for replacement were sought, collated and categorised. Patients were asked to report any TMJD symptoms and bruxing.Results The mean replacement rate was 36.7 months. The main reasons for replacement were: device condition; fit and reduced effectiveness; and other minor reasons reported. Period prevalence of TMJD was 6.7%; bruxism was reported in 5% of patients.Conclusions A 'lifespan' of ust over three years for thermoplastic MRAs is estimated. The main reasons for replacement were: condition, poor fit and reduced effectiveness. MRAs do not appear to increase the frequency of TMJD and bruxism.

Dental management of a child patient with Noonan's syndrome.

UNLABELLED: This case report describes a 9-year-old Caucasian girl who required comprehensive dental treatment under general anaesthesia but gave a history of Noonan's syndrome. The patient was extremely needle phobic. Because of the association between Noonan's syndrome and underlying coagulopathies, for which no previous investigations were evident, dental treatment had to be postponed pending further investigation. The patient was referred to a haematologist and underwent coagulation screening, which revealed the presence of von Willebrand's disease. The patient was prescribed Desmopressin to raise plasma levels of factor VIII: C and von Willebrand's factor (VWF) in order that dental treatment, including extractions, could be carried out under an in-patient general anaesthetic. CLINICAL RELEVANCE: Congenital heart defects and bleeding diatheses are regarded as a common association of Noonan's syndrome. Witt et al estimated that around one-third of the patients have an associated bleeding disorder, although a later report suggested that as many as 74% of the coagulation profiles could be abnormal. Most of the bleeding problems are reported to be mild, and resolve with age in some patients, but, clearly, they may cause problems during dental treatment, necessitating haematological investigations and a multidisciplinary approach.

Allergic contact stomatitis from colophony.

UNLABELLED: Colophony is an ubiquitous contact sensitizer which may be present in dental materials, such as periodontal dressings, impression materials, cements, fix adhesives and varnishes. Exposure to a sensitizer in a hypersensitive person may initiate an allergic contact dermatitis/stomatitis. This usually occurs after direct skin/mucosa contact with the sensitizer. This paper reports the case of a colophony hypersensitive male who developed contact stomatitis after dental treatment with a colophony-containing product. CLINICAL RELEVANCE: Sensitizing colophony is present in Duraphat 2.26%F varnish, a fluoride varnish used all over the world. A case of hypersensitivity to Duraphat 2.26%F varnish is presented in a patient who, at the initial visit, indicated only an allergy to sticking plasters.

Malignant vasovagal syncope.

UNLABELLED: We report the case of a 21-year-old male whose frequent episodes of loss of consciousness in the dental surgery culminated in the postponement of treatment, pending further investigation. The patient was referred to a cardiologist and submitted to head-up tilt testing, which evoked prolonged asystole, associated with loss of consciousness and mild generalized twitching, confirming a diagnosis of malignant vasovagal syncope. Before dental treatment could be completed, the patient was successfully treated with disopyramide and dual-chamber pacemaker implantation. CLINICAL RELEVANCE: Dentistry can predispose patients to fainting (syncope or vasovagal episode) owing to fear, pain, unusual sights and smells, anxiety, fatigue and fasting, so knowledge of extreme forms of this response are of relevance.