Stroke (cerebrovascular disease) is second cause of long-term nursing care in Japan. There are two main type of stroke: ischemic (cerebral infarction) and hemorrhagic (intracerebral hemorrhage, subarachnoid hemorrhage). Stroke causes oral dysfunction due to declined brain function. Oral dysfunction after stroke is sensory, motor, and cognitive dysfunction, and its severity and symptom could depend on stages of stroke recovery.
Dysphagia rehabilitation play a main role of oral health management of stroke patients, however, oral function such as oral hygiene and dentures tends to be poor. It is therefore important to provide the evaluation and care of oral health with seamless interdisciplinary approach of medical and dental professions in community such as hospitals, nursing-care facilities, and home-care. Prosthetic dentistry would play an important role in this oral health management of stroke patients, because denture treatment is limited to dentists.
Parkinson’s disease (PD) is the second most common degenerative neurological disorder after Alzheimer’s disease. Therefore we frequently encounter the cases in such as home-visit dental treatment. Oral dyskinesia and difficulty of maintaining mouth-opening pose challenges to various kinds of dental treatment as well as oral hygiene management. If patient’s posture and oral function disorder progresses, it is often the case that the control of the denture gets worse and becomes gradually hard to use it. There is dysphagia to a high rate in PD, but that is not necessarily related to the physical movement disorder. In addition, silent aspiration: aspiration without any outward signs of swallowing difficulty is often found in some cases. The factors affecting convalescence are as follows: Oral hygiene management and rehabilitation with regards to dysphagia, oral function management for the supplement of water, ingesting nourishment and taking medicine management, response to saliva aspiration with dysphagia, salivation and temporomandibular joint luxation.
The author considers that dentistry should cope with these factors.
Neurodegenerative diseases are intractable neurological diseases including such as Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis. Pathologically, it is characterized by neuronal cell death and abnormal protein accumulation in the brain. Currently, there are some therapeutic agents for each disease, but a fundamental treatment method for preventing the progression of the disease or returning it to a normal state has not been established. Therefore, at present, there is no choice but to deal with the disorders of their own oral and swallowing function according to symptoms. Careful attention to individual patients is required.
Drugs that cause functional and structural disorder to the oral cavity may cause oral hypofunction. It can be divided roughly into the drugs which lower consciousness level and attention, the drugs which cause reduction of the saliva secretion, the drugs which cause motor function failure of the oral cavity, the drugs which cause the taste disorder, the drugs which causes the oral mucositis. For management of drug-induced oral hypofunction, change and reduction of the drug are effective in cooperation with the medical doctor, but there are many cases in which the change is impossible. In addition to the correspondence to the cause drug, it is important to improve and maintain the oral cavity environment. Specific management should be taken for drug-induced taste disorders and oral mucositis caused by anticancer agents. It is important to correctly understand the information of prescribed medicine.
Purpose: A 57-year-old female was referred to our hospital complaining of esthetic disorder due to osteochondroma of her right condylar head. After mandibular condylar tumor resection, an intraoral inspection revealed wide-area bilateral open-bite. The appropriate position of the mandible including horizontal balance was investigated using a provisional restoration. After confirming the horizontal balance of the mandible and the absence of new temporomandibular joint symptoms with normal mandibular movement, prosthetic treatment was performed to reconstruct mastication and esthetic functions.
Discussion: Osteochondroma is a slow-growing benign tumor, so it took a long time for the patient to recognize facial asymmetry by herself. Functional recovery was achieved through a prosthetic procedure that applied different occlusal vertical dimensions to the left and right sides of the mandible. However, the mandible returned to its original position that had held a horizontal balance after the condyle resection surgery. As a result, it was considered that the right side contacted prematurely and wide-area bilateral open-bite appeared. Searching for an appropriate mandibular position, the occlusal vertical dimension and reconstructing anterior guidance were deemed to greatly affect the prognosis in this and similar cases.
Conclusion: The prosthetic procedure using a provisional restoration while maintaining the mandibular horizontal balance was successfully applied to bilateral open-bite which widely appeared after mandibular condyle resection. It is likely that post-surgical tissue stabilization will need several months to a year in benign tumors that have been growing for a long time. It is suggested that appropriate prosthetic intervention according to the three-dimensional changes in the jaw position is required in such cases.
Patient: The patient was a 22-year-old female with a chief complaint of insufficient retention of a maxillary denture and fluid leakage to the nasal cavity. The patient had a history of cleft lip and palate. The support, bracing and retention of the maxillary denture were inadequate and blocking of the oronasal fistula was insufficient. We fabricated a new partial denture with Akers clasps, embrasure clasps and obturator prosthesis.
Discussion: For the obturator of the new denture, tissue conditioner was replaced by resin. As a result, satisfactory plugging of the oronasal fistula was obtained. Furthermore, by setting retainers with adequate support, bracing and retention for the denture, we obtained a good treatment result.
Conclusion: Secure plugging of the oronasal fistula and adequate retainers resolved the inadequate support, bracing and retention, and fluid leakage to the nasal cavity for this patient with maxillary anterior teeth missing and oronasal fistula.
Patient: A 75-year-old female visited our institution with a chief complaint of detachment of the (6)54(3)21| bridge, in which only the maxillary left central incisor and mandibular right central incisor had occlusal contact with the remaining teeth. The patient was diagnosed with mastication difficulty because of lower denture incompatibility and esthetic failure due to missing maxillary incisors. The functionally generated pathway (FGP) and bite pressure impression techniques were applied after occlusal elevation was achieved with treatment dentures to adjust for the lack of denture space; upper- and lower-jaw metal-base dentures were constructed as final prostheses.
Discussion: The application of the FGP and bite pressure impression techniques may have facilitated the transfer of information, which was obtained using treatment dentures, to the final prostheses.
Conclusion: Objective and subjective functional evaluations at 3 years after the implantation of the last prosthesis were favorable, suggesting that prosthetic treatment for this patient was effective.
Patient: The patient was a 47-year-old female with the complaint of esthetic dissatisfaction with the maxillary anterior teeth. As a result of clinical examination, transposition of the maxillary lateral incisor, defective crown restoration, caries of the teeth and discoloration were identified as problems.
Discussion: It is suggested that the main reason for success in this treatment was appropriate resolution of the various problems. In addition, each problem that occurred on neighboring teeth was treated by esthetic rehabilitation of the upper anterior teeth but also improvement by crown restoration.
Conclusion: Various problems causing esthetic dissatisfaction should be diagnosed precisely and suitably treated for each problem. It may be possible to perform prosthodontic treatment to achieve high patient satisfaction with esthetic improvement.
Patient: A 64-year-old male presented with a chief complaint of masticatory dysfunction. After examinations, the patient was diagnosed with severe attrition of the mandibular anterior teeth and decreased occlusal vertical dimension. Prosthetic reconstruction of the occlusion was used as an objective criterion in this case. The occlusal vertical dimension was evaluated using provisional restorations and treatment dentures. Then the patient was treated with the final prosthetic restoration. A favorable prognosis was observed three years after the treatment.
Discussion: Improvements in masticatory disorder and esthetics were obtained following occlusal reconstruction.
Conclusion: Setting an objective criterion using cephalometric analysis may be useful for determining the occlusal vertical dimension.
Patient: The patient was a 70-year-old male who visited the prosthodontic clinic with a chief complaint that he could not chew foods on the right side. He had deep overbite and no occlusal contact of the anterior teeth in the centric relation. Moreover, his occlusion was close to anteroposterior non-vertical stop occlusion.
Discussion: Fixed prostheses and treatment dentures were provided as prosthodontic treatment for missing teeth.
Three years and four months after placement of the definitive dentures, symptoms of myalgia of the masticatory muscle were observed, yet there was nothing of concern in his remaining teeth, periodontal tissue, temporomandibular joint or prostheses, and he was making steady progress.
Conclusion: Placement of fixed prostheses in the upper posterior region and removable partial dentures designed in consideration of rigid support in the upper anterior region and lower posterior region could recover masticatory function and maintain remaining posterior occlusal support for a long period.
Patient: The patient was an 82-year-old edentulous woman who complained of masticatory disturbance caused by instability of complete dentures. In order to establish unilateral balance in the new dentures, standardized digital pictures of the upper and lower casts which recorded unilateral balancing areas were taken, and the occlusal map was composed using digital processing software. Based on the analysis results, artificial teeth were arranged.
Discussion: The occlusal map and the artificial tooth arrangement focusing on the establishment of unilateral balance improved the chief complaint and obtained good results.
Conclusion: The occlusal map used in this case was very useful as an index of artificial tooth arrangement in order to examine the maxillomandibular residual ridge relationship and to establish unilateral balance.
Patient: The patient was a 64-year-old male who was referred by a head and neck surgeon for preoperative examination of carcinoma of the floor of the mouth and tongue. After surgery, his tongue and floor of the mouth were reconstructed using a rectus abdominis flap. The patient developed dysarthria and dysphagia due to a decline in tongue mobility. A treatment denture was placed which aimed to both recover oral function and determine the form of the final prosthesis. Functional training determined the shape of the final prosthesis.
Discussion: Speech and swallowing functions were improved by the treatment denture and final prosthesis. Favorable results were obtained by cooperation with dentists and speech therapists throughout the process from the early postoperative period.
Conclusions: The form of the prosthesis in coordination with functional movement is important to improve both dysarthria and dysphagia in patients with reduced tongue mobility after surgery.