Effect of obturators on facial form following surgery for head and neck cancer and impact on the perception of appearance.

OBJECTIVES: To describe the correlation between changes in the surface area and depth of the face in individuals wearing an obturator compared with it not being in place, and self-reported Quality of Life in relation to appearance. METHODS: Difference images were created from stereophotogrammetry images recorded from research participants with and without their obturators in place. On the difference images of the face, surface areas and mean depths were calculated. Oral health impact profile questionnaires (OHIP-49) were completed. RESULTS: Data from 19 research participants were recorded. The mean size of the outlined area of the face when the obturators were present compared to when they were not was 1411 mm2 (SD ± 848). Similarly the mean depth differences ranged up to 6.14 mm. Although a proportion of the individuals reported effects in relation to their quality of life, there were no statistically significant relations between the surface areas and mean depths with the participants' responses to the quality of life questions. CONCLUSIONS: There are clear changes in facial tissues, both in relation to surface area and depths when obturators are worn compared to when they are not. There is no simple relationship between the extent of facial change with and without an obturator and quality of life around appearance. The determinants of changed quality of life in this group of patients require greater exploration.

A study to compare the oral health impact profile and satisfaction before and after having replacement complete dentures constructed by either the copy or the conventional technique.

AIMS: To assess the oral health impact profile (OHIP) on edentulous subjects who needed to have their dentures replaced either by a copy technique or a conventional technique, and to determine whether any change in the subjects' assessment of their original and replacement dentures impacted on oral health related quality of life parameters. BACKGROUND: The OHIP is an instrument used to measure subjects' perceptions of the social impact of oral disorders on their well being. Changes in the OHIP may occur when subjects need to have their complete dentures replaced. Furthermore, it is possible that the method by which the dentures are constructed may impact on this. METHODS: A total of 65 edentulous subjects were studied. Thirty-three subjects had their dentures constructed by a copy technique and 32 by a conventional technique. Subjects completed the OHIP-14 questionnaires before and after being provided with a set of replacement complete dentures. They also assessed specific features of the upper and lower dentures. Responses were recorded on a Likert scale. RESULTS: For many subjects, the responses in the before treatment questionnaires were at the lower end of the Likert scale, indicating that there were no major impacts on oral health related quality of life parameters. There were no major differences between the copy denture subjects and the conventional denture subjects in relation to the change in OHIP scores before and after treatment. Generally subjects expressed improved satisfaction with the new lower denture. However, for the copy denture group there were significant improvements for all seven assessments compared with only five out of seven assessments for subjects in the conventional group. CONCLUSION: For these groups of edentulous subjects, although they may need dentures to be replaced after a period of wear, this does not necessarily have significant impacts on oral health related quality of life parameters. It seems likely that this is the main reason why the provision of new dentures by either a copying or conventional technique did not result in major changes to the OHIP.

Peer review amongst restorative specialists on the quality of their communication with referring dental practitioners.

OBJECTIVE: A peer review study was carried out to assess the written communication between consultants and specialist registrars in restorative dentistry with the referring general dental practitioners. METHODS: Seven people took part in the study and each presented referral and reply letters for five patients whom they had seen for consultation. The referral letters were used for information only and were not used in the peer review process. Each participant inspected the referral and reply letters from the other six participants. The reply letters were anonymously peer reviewed by using a proforma containing agreed criteria in relation to appropriate factors to include in the reply letter. The reviewer also ranked the letter in relation to overall quality on a 1-10 point scale. RESULTS: It was found that the participants' letters generally conformed positively with the agreed criteria although there were some differences between individuals. There were particular problems identified in relation to tooth notation. Reply letters commonly used different forms of tooth notation to the referring practitioners. CONCLUSIONS: The ranking of the letters generally indicated that the participants' replies were judged to be favourable by their peers. There may be scope for continuing this study in relation to peer review by other groups of professionals, in particular practitioners in primary dental care.

Identifying the position of an ear from a laser scan: the significance for planning rehabilitation.

Laser scanning techniques are used to plan the construction of prosthetic ears as dimensional measurements between anthropometric points can be accurately measured on a screen image. The aim of this study was to determine if these techniques could be used to assess the position of ears on the face. Computer-generated images were created from laser scans of 20 subjects. Frames of reference were constructed by locating a series of anthropometric points on the face from which three orthogonal planes were constructed. A central reference point was identified at the intersection of the three orthogonal planes. Dimensional measurements were made between anthropometric points on the ear and the reference planes. The differences between anthropometric points and the reference planes on the left and right sides of the face were small. It was possible to describe the location of points three-dimensionally with respect to a central reference point. The development of frames of reference and a central reference point would appear to offer many advantages in the assessment and description of ear position for patients requiring reconstruction with prostheses.

Voluntary and reflex control of the human temporalis muscle.

Electromyographic recordings (EMGs) were made in 10 human subjects from the anterior and posterior parts of the temporalis muscle using skin surface electrodes. The activities produced by voluntary maximal clenching tasks and the reflex responses to electrical stimulation of the muco-gingival junction were studied. In most subjects, maximum activity in both parts of the muscle occurred when clenching in the intercuspal position (anterior temporalis: 7 of 10 subjects; posterior temporalis: 9 of 10 subjects). Clenching maximally in the retruded position usually resulted in less activity; when this activity was expressed as a percentage of the maximum achieved by each subject for that part of the muscle, the median values were: anterior temporalis, 68% and posterior temporalis, 79%. Clenching in the protruded position produced little or no activity (median values: anterior temporalis, 3%; posterior temporalis, 5%). There were no significant differences between the EMG activities of the anterior and posterior parts of the muscle during these tasks when the activities were normalized to the maximum achieved in each part of the muscle. Application of electrical stimuli at the muco-gingival junction (upper incisor region) produced reflex inhibitions and excitations in both parts of the muscle. There were no significant differences in the thresholds of these reflexes between the anterior and posterior parts of the muscle. Furthermore, there was little difference between the two parts of the muscle in terms of the latencies, durations and magnitudes of the responses. Thus the results of the study suggest that there are similar neural control mechanisms for the anterior and posterior parts of the temporalis muscle despite the common view that these parts of the muscle have different functions.