Use of palatal lift and palatal augmentation prostheses to improve dysarthria in patients with amyotrophic lateral sclerosis: a case series.

STATEMENT OF PROBLEM: Amyotrophic Lateral Sclerosis (ALS) is a progressive, adult onset neurodegenerative disorder manifesting itself as a loss of motor capabilities and untimely death. The dysarthria seen in patients with ALS who have bulbar symptoms causes severe problems with communication. The struggle to be understood comes at a time when progressive cumulative disabilities make communication with family, friends, and healthcare workers vital. The use of palatal lift/augmentation prostheses for dysarthria in ALS is not a frequently requested procedure by neurologists. PURPOSE: The purpose of this retrospective outcomes study was to evaluate the effectiveness of this treatment on improving speech function and intelligibility in this group of patients. This study also reviews the history, incidence, pathogenesis, and speech characteristics of the patient with ALS. METHODS: A retrospective study of 25 patients treated with a prosthesis was performed using chart reviews and phone/office interviews to evaluate the efficacy of a palatal lift and/or augmentation prosthesis to improve speech in ALS patients. RESULTS: Twenty-one patients (84%) treated with a palatal lift demonstrated improvement in their dysarthria, specifically in reduction of hypernasality, with 19 (76%) benefiting at least moderately for 6 months. Of the 10 patients treated with a combination palatal lift and augmentation prosthesis, 6 (60%) demonstrated improvement in articulation. A majority of patients indicated it was easier to speak with less effort involved when wearing the prosthesis. CONCLUSION: On the basis of this preliminary retrospective study, the use of a palatal lift/augmentation prosthesis should be considered in ALS patients with dysarthria.

The use of colored elastomeric "O"s as a motivational instrument for patients with anodontia: report of case.

Complete and/or removable partial dentures are the most commonly selected treatment for the prosthodontic management of young patients who present with oligodontia or anodontia such as in the case of patients with ectodermal dysplasia. Bakri, Belanger and Nowak have reported on the different ways that these prostheses can be modified to ease the child's burden of growing up with missing teeth and having to wear prostheses that make them different from their peers. Some of their suggestions include the placement of diastemas, the use of artificial "baby" teeth and their subsequent replacement with permanent teeth to simulate the primary and mixed dentition stages. They have also recommended deleting primary teeth to mimic the normal exfoliation pattern. The purpose of this article is to report the attitude change and improvement in self-esteem experienced by two young girls from the simple addition of colored elastomeric molded "O"s to the orthodontic appliances placed on their prostheses.

A simple method of adding palatal rugae to a complete denture.

Restoring patients' speech is an important goal in complete denture fabrication. For those patients who have difficulty with their speech patterns accommodating to the introduction of a prosthesis, texture in the palatal region may prove helpful. This article describes methods of incorporating palatal rugae in a newly fabricated and existing complete denture.

Radiotherapy for head and neck neoplasms.

The use of radiotherapy has proven to be an effective technique in the control and cure of head and neck neoplastic disease. Unfortunately, radiotherapy also has a significant negative impact on the oral health of patients and the dental care they require. For dental professionals to be valuable members of the oncology treatment team, they must have a sound understanding of the dental needs and proper treatment of these patients. As background information, a brief overview of ionizing radiation and its effect on mammalian tissue is presented. In addition, the oral complications of ionizing radiation are reviewed, and prevention and treatment protocols discussed.

Immunopharmacology.

Clinicians, in general, must understand the basis of immunomodulation; management principles associated with organ transplantation, autoimmune diseases, and allergic reactions; and complications of therapy. They must recognize that these patients require multidisciplinary treatment and coordination of care. Oral health care providers must recognize that immunotherapy may produce adverse effects by direct toxicity at the cellular level or indirectly, characterized by myeloimmunosuppression, and respond to the obligation to deliver quality care, competently and timely before, during, and after immunotherapy.

The "jiffy" denture: a simple solution to a sometimes difficult problem.

The use of an interim denture helps prepare basal seat tissues, muscles, and joints to reach a more normal and healthy condition before definitive denture placement. This state is achieved through proper denture fabrication, occlusal adjustments, and tissue conditioning. This article focuses on the indications, technique, and postoperative care that are involved in making an interim denture in a matter of hours. A case report demonstrates the procedure and patient management that is used to obtain a successful result.

Fibrous dysplasia: a case report.

Fibrous dysplasia is a benign fibro-osseous disorder that often affects both the maxilla and mandible. The dentist, therefore, is often the first person to identify and diagnose the disease. This article focuses on the pathology, diagnosis, clinical course, and treatment of this complex problem. A case report demonstrates the multidisciplinary approach to the management of this disease entity.

Overdentures in partial anodontia: simple solutions for complex problems.

Congenital defects in children and adolescents can present complex and challenging dental problems, including arch discrepancies, palatal defects, and malposed or otherwise disrupted dentition. Traditional treatment is often time-consuming, expensive, and in extensive defects, frequently compromised at best. The overdenture prosthesis, often overlooked, is a relatively simple and expedient solution to many of these severe problems, and the prosthetic techniques are familiar and readily employed by dentists without specialized training. This article reviews the general principles employed in these techniques and offers examples of successful treatment for several of the more commonly occurring congenital dental defects.

A quick method for processing MDX-4-4210 silicone rubber.

An alternative method for processing MDX-4-4210 silicone elastomer that eliminates the recommended de-airing phase has been described. As a result, it is possible to have the processed prosthesis in hand in 30 minutes or less (in small prostheses). In addition, the use of a relatively large and costly vacuum machine is avoided. No clinical differences with respect to stability, strength, or duration between prostheses processed in this manner or the standard method have been noted.

Principles of surgical management of midfacial carcinoma.

A series of large, midfacial, squamous cell and basal cell carcinomas treated by the Departments of Otolaryngology and Dermatology (Cleveland Clinic Foundation) are reported. Most cases required total/partial resection of the external nose, upper lip, hard palate, nasal septum, and adjacent midfacial soft tissues. Emphasis is placed on the principles of preoperative and intraoperative management as it relates to intraoral prosthetic design and total margin control of the surgical specimen. The immediate and delayed reconstructive philosophy and techniques employed here are discussed in detail. Recurrence rates and free-to-disease survival times are also reviewed.

Esthetics for denture patients.

Denture esthetics has been discussed in terms of the anatomic-physiologic and artistic phases. It is the responsibility of the dentist to apply the principles discussed in an effort to produce a natural appearing denture. Excessive dependence on auxiliary personnel in meeting the esthetic needs of the patient can only encourage the denturist movement and quick, low-cost denture clinics. Faced with this threat, we must not shirk our responsibilities.