1/73. Treating severe bruxism with botulinum toxin. BACKGROUND: Locally administered botulinum toxin, or BTX, is an effective treatment for various movement disorders. Its usefulness in treating bruxism, however, has not been systematically evaluated. SUBJECTS AND methods: The authors studied 18 subjects with severe bruxism and whose mean duration of symptoms was 14.8 /- 10.0 years (range three-40 years). These subjects audibly ground their teeth and experienced tooth wear and difficulty speaking, swallowing or chewing. Medical or dental procedures had failed to alleviate their symptoms. The authors administered a total of 241 injections of BTX type A, or BTX A, in the subjects' masseter muscles during 123 treatment visits. The mean dose of the BTX A was 61.7 /- 11.1 mouse units, or MU (range 25-100 MU), per side for the masseter muscles. RESULTS: The mean total duration of response was 19.1 /- 17.0 weeks (range six-78 weeks), and the mean peak effect on a scale of 0 to 4, in which 4 is equal to total abolishment of grinding, was 3.4 /- 0.9. Only one subject (5.6 percent) reported having experienced dysphagia with BTX A. CONCLUSION: The results of this study suggest that BTX administered by skilled practitioners is a safe and effective treatment for people with severe bruxism, particularly those with associated movement disorders. It should be considered only for those patients refractory to conventional therapy. Future placebo-controlled studies may be useful in further evaluating the potential of BTX in the treatment of bruxism. ( info) |
2/73. Abrasion, erosion, and abfraction combined with linear enamel hypoplasia: a case report. Linear enamel hypoplasia is a developmental disturbance of enamel resulting in clinically visible horizontal defects in enamel that are present on eruption of the tooth. Nondevelopmental lesions of the hard tissues of the tooth, including carious, abrasion, erosion, attrition, and abfraction lesions, require varying amounts of time after tooth eruption to develop. Because linear enamel hypoplasia lesions are present on eruption and are exposed to the factors responsible for abrasion, erosion, and abfraction, nondevelopmental lesions could occur within them in any combination. This report describes a patient with multiple teeth with linear enamel hypoplasia lesions containing nondevelopmental defects as well as nondevelopmental defects that occurred separately. Severe pain and a unique lesion morphology were associated with the linear enamel hypoplasia defects. Affected teeth were extracted because of advanced periodontitis and were sectioned to determine the nature of the enamel and dentin lesions. ( info) |
3/73. Restoring esthetics and anterior guidance in worn anterior teeth. A conservative multidisciplinary approach. BACKGROUND: Developments in adhesive dentistry have given the dental profession new restorative materials and technology to restore esthetics and function to the worn anterior dentition. This article illustrates, through a clinical case study, the clinical requirements for restoring esthetic harmony and functional stability to the worn anterior dentition. CASE DESCRIPTION: The author presents the case of a 24-year-old man who sought esthetic dental treatment because he was unhappy with the appearance of his maxillary anterior teeth. The review of his dental history revealed that he ground his teeth at night. The author performed a complete evaluation of the causes of the patient's bruxism and created a diagnostic preview to, among other things, develop the relationship between the condylar and anterior guidance and to establish the esthetic requirements for the final restorations. Treatment included periodontal recontouring, tooth preparation and placement of temporary and then permanent restorations; the patient also was given an occlusal guard to protect the restorations against future bruxing. CLINICAL IMPLICATIONS: Whatever the cause of occlusal instability, it is important that the restorative dentist be able to recognize its signs--such as tooth hypermobility, tooth wear, periodontal breakdown, occlusal dimpling, stress fractures, exostosis, muscle enlargement and loss of posterior disclusion. When restoring the worn dentition, the clinician should bear in mind the five P's: proper planning prevents poor performance. ( info) |
4/73. tongue piercing and associated oral and dental complications. The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role. ( info) |
5/73. The use of implants in the occlusal rehabilitation of a partially edentulous patient: a clinical report. This article describes the occlusal rehabilitation of a partially edentulous patient who did not want a removable partial denture. Implants and extensive fixed restorations were used to restore posterior support and treat severely worn dentition, respectively. The treatment offered the patient a functional and esthetic result. ( info) |
6/73. Dental erosion: diagnostic-based noninvasive treatment. Lesions that result from dental erosion can be difficult to recognize--particularly when abrasion and attrition are also present. Consequently, dental erosion is often misdiagnosed and mistreated by radical restorative modalities that compromise the vitality of the pulp. This article provides clinicians with knowledge concerning the diagnosis of the complex lesions of dental wear and demonstrates the conservative treatment of this condition. Two cases that exhibit marked tooth wear in anterior teeth and their subsequent restoration utilizing occlusal principles and composite resin are presented. ( info) |
7/73. Syndromes with salivary dysfunction predispose to tooth wear: case reports of congenital dysfunction of major salivary glands, Prader-Willi, congenital rubella, and Sjogren's syndromes. Four cases-of congenital dysfunction of the major salivary glands as well as of Prader-Willi, congenital rubella, and Sjogren's syndromes-were identified in a series of 500 patients referred for excessive tooth wear. Although there was evidence of consumption of highly acidic drinks, some occlusal parafunction, and unacceptable toothbrushing habits, salivary dysfunction was the salient factor predisposing a patient to tooth wear in these syndromal cases. The 500 subjects have been characterized either as having medical conditions and medications that predispose them to xerostomia or lifestyles in which workplace- and sports-related dehydration lead to reduced salivary flow. Normal salivation, by buffering capacity, clearance by swallowing, pellicle formation, and capacity for remineralization of demineralized enamel, protects the teeth from extrinsic and intrinsic acids that initiate dental erosion. Thus, the syndromes, unrelated in many respects, underline the importance of normal salivation in the protection of teeth against tooth wear by erosion, attrition, and abrasion. ( info) |
8/73. A question of space: options for the restorative management of worn teeth. The prevalence of tooth surface loss has increased in recent years. The essence of management is an effective preventive regime; however, in many instances restoration may also be necessary. A number of strategies is available for creating sufficient space to enable restoration and several techniques for restoration known. This article reviews the significance of the vertical dimension of occlusion and describes the restorative management of a patient affected by severe tooth wear. ( info) |
9/73. tooth wear: use of overlays with metallic structures. This work is a clinical case report of a patient presenting with marked tooth wear in all teeth, a reduction in the vertical dimension of occlusion, and fatigue in the muscles of mastication. The treatment proposed and effected used a muscle-relaxing appliance and mandibular and maxillary overlay appliances which were adjusted according to the occlusal contacts, vertical dimension of occlusion, and the mandibular positioning. The results obtained were satisfactory in terms of relaxing the muscles involved, reestablishing the dimensions of the lower third of the face, and the functional activities of deglutition, mastication, and speech. ( info) |
10/73. Soft tissue root coverage as treatment for cervical abrasion and caries. Root exposure caused by gingival recession may result in cervical abrasion, root caries, root sensitivity, and compromised esthetics. Although cervical root lesions can be treated with Class V restorations, there may be advantages in treating them with soft tissue grafts for root coverage since they restore the dento-gingival unit to its prerecession condition. The rationale for root coverage with soft tissue grafts is reviewed and two cases are presented of successful root coverage procedures in which gingival recession associated with cervical abrasion and caries was present. ( info) |