Changes In Mouth Opening Research Articles

Restorabite™: Phase II trial of jaw stretching exercises using a novel device for patients with trismus following head and neck cancer.

Patients treated for oral cancer, may experience restricted mouth opening (trismus). Barriers such as cost have limited the utilization of traditional jaw stretching devices, and consequently, patients experience problems with swallowing, oral care, communication, and cancer surveillance. The safety and efficacy of Restorabite™, a new device designed to overcome these barriers, is evaluated prospectively over 12 months. This phase II investigator-led trial included patients with chronic trismus underwent 10-weeks of trismus therapy using Restorabite™. Safety, adherence, changes in mouth opening, and patient-reported outcomes are presented. 114/120 participants with trismus completed the intervention, and 104 had their progress monitored for 12 months. Thirteen participants withdrew due to tumour recurrence. At the completion of the intervention, mouth opening improved by 10.4 mm (p < .001). This increased to 13.7 mm at 12 months (p < .001). Patient reported outcome all significantly improved and 47 participants were no longer classified as having trismus. There were no serious treatment related adverse events. In patients with trismus following head and neck cancer treatment, a 10-week programme of jaw stretching exercises using Restorbite™ safely improves mouth opening and associated quality of life outcomes with high adherence and the benefits are maintained for 12-months.

Reduced mouth opening in patients with head and neck cancer treated with radiation therapy: an analysis of the Clinical Registry of Dental Outcomes in Head and Neck Cancer Patients (OraRad)

ObjectivesTrismus/reduced mouth opening (RMO) is a common side effect of radiotherapy (RT) for head and neck cancer (HNC). The objective was to measure RMO, identify risk factors for RMO, and determine its impact on quality of life (QOL). Patients and MethodsOraRad is an observational, prospective multicenter cohort study of patients receiving curative intent RT for HNC. Interincisal mouth opening measurements (n = 565) and patient reported outcomes were recorded before RT and every 6 months for 2 years. Linear mixed-effects models were used to evaluate change in mouth opening and assess the relationship between trismus history and change in QOL measures. ResultsInter-incisal distance decreased from a mean (SE) of 45.1 (0.42) mm at baseline to 42.2 (0.44) at 6-months with slight recovery at 18-months (43.3, 0.46 mm), but no additional improvement by 24-months. The odds of trismus (opening <35mm) were significantly higher at 6 months (OR=2.21, 95% CI: 1.30 to 3.76) and 12 months (OR=1.87, 95% CI: 1.08 to 3.25) compared to baseline. Females were more likely to experience trismus at baseline and during follow up (p<0.01). Patients with oral cavity cancer had highest risk for trismus at baseline and post-RT (p<0.01). RMO was associated with higher RT dose to primary site and receiving concomitant chemotherapy (p<0.01). Trismus was associated with self-reported difficulty opening the mouth and dry mouth (p<0.01). ConclusionsDecrease in mouth opening is a common treatment-related toxicity after RT with some recovery by 18-months. Trismus has a significant impact on survivor QOL. Statement of Clinical RelevanceDecrease in mouth opening is a common treatment related toxicity after RT, which has a significant impact on survivor QOL. Variability in restricted mouth opening after RT is related to specific patient, cancer, or treatment characteristics.

Physiotherapy and associated factors affecting mouth opening changes in noma patients during initial hospitalization at an MSF-supported hospital in Northwest Nigeria-A retrospective cohort study.

Noma is a rapidly progressing infection of the oral cavity, which can cause the disintegration of the cheek, nose and eye, in under a week. One of the most disabling sequelae is trismus, the restriction of mouth opening, which results in difficulties in speech, mastication, social feeding habits and maintenance of oral hygiene. Restriction of mouth opening among noma patients mostly begins during the transition between World Health Organisation (WHO) stage 3 (gangrene) and stage 4 (scarring) of the disease. This study aims to describe the impact of physiotherapy in noma patients hospitalised with stages 3 and 4 of the disease and to identify factors that influence change in mouth opening of noma patients. This study is a retrospective analysis of routinely collected data from patients admitted at Noma Children Hospital, Sokoto, Northwest Nigeria between 1 May 2018 and 1 May 2020. Eligible patients included stage 3 and 4 noma patients who had not undergone any surgical reconstruction or trismus release surgery but received physiotherapy assessment and treatment during initial hospitalization. Factors associated with a change in mouth opening were identified using paired t-test analysis, bivariate and multivariate analyses. The mean difference in the mouth opening from admission to discharge was 6.9mm (95% CI: 5.4 to 8.3, p < 0.0001). Increased number of physiotherapy sessions and patient age above three years were significant predictors of improvement in mouth opening (p-value 0.011, 0.001 respectively). Physiotherapy treatment received within an adequate number of physiotherapy sessions for stage 3 and 4 noma patients during the period of the first hospitalization is important and results in a significant increase in mouth opening. Hence, noma patients at these stages should routinely undergo physiotherapy as part of a holistic approach to treatment.

Quality of life following simple tooth extraction (Non — Surgical): A prospective longitudinal study

The objective of this study was to evaluate quality of life among adult patients after non surgical extraction of teeth under local anaesthesia. The present study was conducted among 80 patients who were above 18 years and wanted extraction of one or two teeth. Following extraction, 80 patients were given a questionnaire (in English, Hindi, and Punjabi) with questions about post-operative quality of life. Patients were contacted by phone to inquire about their status on days 2, 4, and 7. Out of 80 patients, 95%, of the patients continue to do their social activities on day 2after extraction. 34 patients felt pain and swelling, 10 patients felt change in their physical appearance. 12 patients did not go to work, but out of these 10 females were housewives and were not working already. 14patients said that extraction affected their work performance. Only 6 subjects took the help of somebody to do their work, 19 patients felt difficulty in swallowing, 2 patients reported taste perception changes, 26 patients felt changes in mouth opening, five patients had interrupted meals ,10% of the patients reported changes in ability to speak and 6 patients had problem falling asleep on day 2. 100% of the patients had no issues on day 7. It is concluded that the patient's quality of life is affected by simple extraction, particularly on the first and second post-extraction days. The most affected domains were "Pain and swelling felt" and "Change in mouth opening". After a simple extraction, the patient's quality of life was negatively affected for the first two days before improving throughout the duration of the follow-up period. Therefore, the patient should be informed about how a simple extraction can affect their quality of life immediately following surgery and how it might cause them to change their regular routine.

Oral adverse outcomes associated with the buccal mucosa graft for urethroplasty

The buccal mucosa graft (BMG) is the standard graft for reconstructive urology, but management of the donor site remains under debate. The authors compared postoperative oral adverse outcomes between management methods (closure, nonclosure, or xenograft-assisted closure). A retrospective cohort study was conducted, enrolling patients treated at Harborview Medical Center, Seattle, Washington. The patients had a history of urethroplasty using a unilateral BMG, and the primary outcome variables were postoperative oral adverse outcomes, defined as subjective changes in mouth opening, smile, chewing, speech, intraoral bleeding, paresthesia, trismus, and infection. Multivariate and regression analyses were performed. The sample was composed of 137 patients (95% male; mean age, 48 years). The mean surface areas of the BMG for closure, nonclosure, and xenograft were 1059, 1178, and 1228 mm2, respectively. Thirty-four patients completed the survey (7 closure, 17 nonclosure, and 10 xenograft). Multiple linear regression showed a significant difference between the 3 groups with respect to patient-reported chewing ability and trismus favoring xenograft at larger graft sizes (P < .01). Xenograft-assisted closure may reduce long-term oral adverse outcomes associated with trismus and subjective changes in chewing, mouth opening, speaking, and smiling with larger grafts. In addition, limited postoperative patient education for oral rehabilitation exercises was noted.

Lyophilised Amniotic Membrane in Intraoral Surgical Defects: A Prospective Clinical Study.

Introduction:The incidence of infection and scarring in intraoral raw wounds are decreased when wounds are grafted with biological materials. The favourable results of many studies about amniotic membrane in wound healing inspired us to investigate the effects of lyophilised amniotic membrane in intaoral surgical defects. The aim of this study was to evaluate the healing of oral mucosal defects after application of lyophilised amniotic membrane (AM).Methods:Fifteen patients with oral precancerous lesions were included in this study. Lyophilised amniotic membrane was applied to the intraoral surgical defect, after wide excision of the lesion. The effectiveness of the lyophilised AM was evaluated by scoring the following parameters operability, haemostatic status, pain, feeding situation, epithelialisation, change in mouth opening, mucosal suppleness and safety.Results:The lyophilised amniotic membrane has been found to be effective in this study after evaluation of the parameters. No infection or allergic reaction was noticed after application of the lyophilised amniotic membrane in intraoral surgical defects.Discussion:In our study, the size and site of the surgical defect influenced the scar contracture so we suggest lyophilised AM may not prevent scarring for extensive surgical defects. All other findings regarding the effectiveness of lyophilised amniotic membrane in oral wound healing are in accordance with the findings of other studies conducted on hyperdry and cryopreserved AM.Conclusion:Within the limitations of the study, the results showed that the lyophilised amniotic membrane is a cost effective material for immediate coverage of the intraoral surgical defects.

Oral Adverse Outcomes Associated with the Buccal Mucosa Graft for Urethroplasty

The buccal mucosal graft (BMG) has become the standard graft material in reconstructive urology due to its large surface area and compatibility.1 Currently, there are 3 methods to manage the BMG donor site, including primary closure, healing via secondary intention, and graft-assisted closure. The ideal technique for managing the BMG donor site remains disputed, as postoperative oral complications have been reported with all 3 techniques. Based on prior studies, the researchers hypothesize that larger BMG grafts are associated with more oral adverse outcomes.2 This study sought to ask the following research question: In subjects undergoing urethroplasty with BMG, does the method of donor site management (closure, non-closure, or xenograft-assisted closure) have an association with long-term postoperative oral adverse outcomes?A retrospective cohort study was conducted, enrolling a sample of patients treated at Harborview Medical Center, Seattle, WA, between January 2012 and December 2018. Eligible subjects had a history of urethroplasty utilizing a unilateral BMG treated more than 2 years ago. An IRB-approved survey was designed to assess oral adverse outcomes using a Likert scale for responses. Predictor variables were donor site management methods, defined as closure, non-closure, and xenograft-assisted closure. The primary outcome variables were presence/absence of postoperative oral adverse outcomes, defined as subjective changes in mouth opening, smile, chewing, speech, intraoral bleeding, paresthesia, trismus, and infection. Other study variables included the BMG surface area, review of oral rehabilitation instructions, and patient satisfaction. Descriptive, univariate, and multiple linear regression statistics were computed, with statistical significance set at P < .05.The sample was composed of 137 subjects (95% male; mean age 48 years). The mean surface area of the BMG for closure, non-closure, and xenograft was 1059mm2, 1178mm2, and 1228mm2, respectively. Thirty-nine patients replied to the survey (response rate 29%); after applying exclusion criteria, 34 were included in the analysis (7 closure, 17 non-closure, and 10 xenograft-assisted closure). Univariate analyses between survey questions and donor site management methods did not show significant differences in subjective paresthesia, change in speech, smile, chewing ability, mouth opening, trismus, or satisfaction. Multiple linear regression was performed to assess the effect of BMG surface area on the association between type of wound closure and survey responses. The xenograft group was associated with the best-rated ability to chew and decreased trismus, when accounting for larger graft surface area (P < .01). Although not statistically significant, multiple trends suggest xenograft-assisted closure out-performed primary closure and non-closure with respect to changes in speech, smile, mouth opening, and satisfaction with increasing graft sizes. Conversely, with increasing graft size, the xenograft group was associated with more paresthesia. Seventy-seven percent of survey respondents reported that they did not receive oral rehabilitation instructions.This study suggests that xenograft-assisted closure may reduce long-term oral adverse outcomes associated with trismus, subjective changes in chewing, mouth opening, speaking, and smiling with larger graft sizes. However, increased BMG surface area was associated with paresthesia in this group. Additional studies with a larger sample size are needed to support these findings. Finally, regardless of closure method, the researchers note a lack of postoperative patient education for oral rehabilitation exercises and wound care. The addition of this practice will improve long-term outcomes associated with intraoral healing.

Comparative Evaluation of Preoperative Local and Systemic Intramuscular Administration of Dexamethasone Injection in Mandibular Third Molar Impaction Surgery

Statement of the problemThe study aimed to evaluate the effect of systemic and local intramuscular administration of dexamethasone on pain and mouth opening and postoperative swelling following mandibular third molar impaction surgery and to verify its effect on functional outcome. Materials and methodsThe study comprised of 36 cases graded as moderately difficult according to the Pederson difficulty index, further subdivided equally into 2 groups. In Group I, 2ml of 8mg dexamethasone was injected intramuscularly in the masseter muscle 2 hours prior to surgery. In Group 2, a 2ml injection of 8mg dexamethasone was injected in the deltoid muscle 2 hours prior to surgery (Figure 1). All the patients were evaluated for pain, mouth opening, and postoperative swelling at first, third, and seventh postoperative day, and intergroup comparisons were made for both groups. Methods of data analysisStatistical analysis was performed using SPSS software (IBM Corp, Armonk, NY). Data were presented as mean and appropriate. Statistical tests were applied. ResultsBoth groups showed improvement in mouth opening with the resolution of pain and postoperative swelling in the last follow-up. However, Group I showed a considerable reduction in swelling and pain with less trismus when compared with Group II at all intervals (Table 1). Outcomes dataFor Group I, the mean changes in mouth opening were noted to be 26.94±1.06 mm, 31.05±1.03mm, 36.87±0.72, respectively at first, third, and seventh postoperative day from the initial mean mouth opening of 37.67±1.89mm (Figure 2). Mean changes in mouth opening for patients in Group II were noted to be 23.06±0.99mm, 27.88±0.99, and 35.05±0.63, respectively at first, third, and seventh postoperative day (Figure 4). The highest pain score was seen at first postoperative day after surgery (7.15±1.08 in Group I; 8.5±1.44 in Group II). The mean score for pain obtained was 5.11±1.01; 1.01±0.82, and 5.38±1.37; 2.069±1.12 for Group I and Group II at the end of postoperative third and seventh day, respectively. The average postoperative swelling for Group I was 5.83±1.18mm, 4.73±0.83mm, and 4.47±0.58mm, respectively, at first, third, and seventh postoperative day. Similarly, the average postoperative swelling was 6.93±1.72mm, 6.05±0.94mm, and 4.64±0.81mm at first, third, and seventh postoperative day in Group II. ConclusionLocal intramuscular injection of dexamethasone through intra-buccal approach can be a simple, useful adjunct in the surgical treatment of impacted third molars for minimizing swelling, trismus, and pain following surgical extraction.

Age-related dynamics of mouth opening and tongue mobility in children with various forms of epidermolysis bullosa

Was to assess age-related changes in mouth opening and tongue mobility in children with various forms of epidermolysis bullosa (EB). Materials and methods. The study comprised 50 EB children (mean age 8.8±3.9 years). Oral slit width (the distance between mouth commissures at rest), mouth opening amplitude (the distance between incisive edges of the lower and upper incisors) were measured by orthodontic caliper. Tongue mobility was assessed using Bristol Tongue Assessment Tools (BTAT). The results were compared with 55 healthy age-matched controls (mean age 9.3±3.7 years). Mean moth opening in EB group was 22.6±11.1 mm which is twice lower than in controls (44.3±7.2 mm). The amplitude was progressively increasing in EB patients in the mixed dentition period but then dropped drastically in the permanent dentition because of oral fibrosis. Tongue mobility was lower in EB group when compared to controls even in cases with anatomically appropriate frenulum fixation sites. In permanent dentition maximal tongue raising was 8 times lower than in controls. Microstomia and ankyloglossia were very specific for dystrophic EB patients while in EB simplex, junctional EB and Kindler syndrome the values were similar to healthy controls. Microstomia, limited mouth opening and tongue mobility are typical oral features of dystrophic EB patients. Age-related dynamics shows progressive growth of the values in mixed dentition with significant lowering after so preventive measures for oral fibrosis are more feasible before permanent dentition phase.

Masseter muscle flap for reconstruction of intra-oral defects in patients with early cancer of posterior-inferior parts of the oral cavity

IntroductionEarly carcinomas of the oral cavity in the posterior-inferior regions poses a challenge for reconstruction due to the lack of muscle support underneath and the limited space available to use some of the frequently-used flaps. ObjectiveThis study was done to evaluate the efficacy of the superiorly based masseter muscle flap in reconstruction of intra-oral post- ablation defects in patients with early oral carcinoma of the posterior-inferior part of the oral cavity. MethodsA superiorly based masseter muscle flap were used to reconstruct the post-surgical intra- oral defect in 60 patients with early squamous cell carcinoma (T<4cm) of the posterior-inferior part of the oral cavity. The patients were followed up at 1-week and 1-month postoperatively to check for flap viability, complications, change in mouth opening and deviation of the mandible on mouth opening. To rule out any recurrence in the oral cavity masseter flaps, the patients were followed up for 1 year. ResultsThe flap was viable in all patients and underwent mucosalization. 7/60 patients had postoperative infections, while 2/60 patients developed an oro-cutaneous fistula which required a secondary corrective procedure. The mean±standard deviation of change in mouth opening at 1 week postoperatively was +1.917±3.36mm, which increased to +2.633±2.95mm at 1 month after surgery. The Friedman test revealed that there was a statistically significant change in mouth opening from preoperative period to the1 week and 1 month postoperative periods (p=0.000). Female patients showed better improvement in mouth opening postoperatively. The ipsilateral deviation of the mandible on mouth opening was between 0–5mm in 39 patients, 5–10mm in 17 patients and more than 10mm in 4 patients. There were no recurrences noted in the masseter flaps used. ConclusionThe study infers that the superiorly based masseter muscle flap is a reliable method for reconstruction in early oral cancer patients yielding good functional results and acceptable cosmesis with nominal postoperative complications.

The Application of Pre-operative Three-Dimensional Models in the Management of Mandibular Pathology: Is it Really Useful? An Institutional Study.

To assess the usefulness of 3D models for the surgical management of mandibular pathology requiring resection with continuity defects reconstructed using reconstruction plates. A bidirectional study was conducted in 40 patients, 20 each in group 1 and 2. Group 1 included those patients taken up for resection with continuity defects and reconstruction using reconstruction plates without using 3D models and Group 2 included those patients managed similarly with 3D models. Pre-operative pathological model and mirrored model was fabricated for accurate placement and pre-bending of plates and determining the position and length of the screws. The level of understanding of the patients with regards to the diagnosis and extent of the disease (VAS 0-10), treatment planning (VAS 0-10), accuracy of fixation by a blinded surgeon (VAS 0-5), operative time, change in the mouth Opening, occlusal disturbance, implant-related complications was assessed as outcome measures and tested statistically. The level of understanding of the patients with regards to the diagnosis and extent of the disease, treatment planning, operative time and accuracy of fixation was found to be statistically significant with superior performance in Group 2. No statistical significance was elicited in the change in mouth opening. No limitation in the mandibular range of movements and occlusal disturbance was found in any patient. No implant-related complications were found during the follow-up. 3D model fabrication can serve as a valuable adjunct in improving clinical outcomes with minimal operating time, increased patient compliance and radiological accuracy of fixation.

Can costochondral grafts fulfil ramus-condyle unit reconstruction goals in children with temporomandibular joint ankylosis?

The purpose of this study was to analyse whether costochondral grafts (CCG) fulfil temporomandibular joint (TMJ) reconstructive goals in children with TMJ ankylosis. A total of 23 patients (12 male, 11 female, aged 3–16 years) with unilateral or bilateral TMJ ankylosis operated on between January 2014 to April 2018 were included in the study. Maximal incisal opening (MIO), frequency of reankylosis, and growth of CCG, were evaluated at one month and six months for one year, and after that once yearly. Mouth opening changes with time were assessed by the Friedman test and growth was compared at follow up and analysed using the paired t test. Mean (range) follow up was 18 (12–48) months. Study results revealed follow up MIO at 12 months was highly significant (p=0.001). Out of 27 CCG studied, only one graft had undergone re-ankylosis. Based on the predetermined criteria using condylion to gnathion (Co–Gn) measurement in the posteroanterior cephalogram, CCG were categorised into optimum, sub-optimum, and overgrowth. However, long-standing TMJ ankylosis cases still displayed mandibular asymmetry at the end of the study, even with “optimal growth” radiographically. Overall comparison between the immediate postoperative and last follow up Co-Gn measurements in either unilateral or bilateral cases was not significant. CCG with functional matrix maintained the growth of the mandible and MIO in TMJ ankylosis. It can be concluded that CCG partially fulfils reconstructive goals; however, patients need to be followed up till the end of puberty for a substantive conclusion.

An audit to evaluate changes in mouth opening in patients receiving total prosthetic replacement of the temporomandibular joint at Poole Hospital

Introduction Temporomandibular joint disorders (TMD) affect 30% of adults. When conservative measures and surgical interventions are ineffective at improving symptoms, a total prosthetic replacement of the temporomandibular joint (TMJ) can be considered.

Comparison of Efficacy of Lycopene and Lycopene-Hyaluronidase Combination in the Treatment of Oral Submucous Fibrosis.

Background:Oral submucous fibrosis (OSMF) is a chronic progressively scarring disease of the oral cavity. Lycopene is a powerful antioxidant obtained from tomatoes and has the highest singlet oxygen quenching capacity and a high capacity of quenching other free radicals in vitro among dietary carotenoids. Hyaluronidase is a substance prepared from the testes and semen of mammals that modifies the permeability of connective tissue through the hydrolysis of hyaluronic acid.Objective:To evaluate the efficacy of lycopene and lycopene−hyaluronidase combination, and to compare the efficacy of lycopene and lycopene−hyaluronidase combination in the treatment of OSMF.Study Design:The study consisted of 45 patients with OSMF divided into three equal groups. Patients in Group A were given Lycored 16 mg daily in two equally divided doses for 3 months. Patients in Group B were given LycoRed along with hyaluronidase intralesional injection of 1500 IU twice weekly for 3 months. Patients in Group C were given placebo capsules. Patients were evaluated after 3 months. The following parameters were recorded: mouth opening, visual inspection, palpatory findings, and burning sensation.Results:There was statistically significant change in mouth opening and burning sensation for lycopene and lycopene–hyaluronidase combination than in the placebo group in the treatment of OSMF, but the lycopene–hyaluronidase combination did not show any statistically significant change when compared with lycopene alone.Conclusion:Lycopene appears to be a very promising antioxidant in the management of oral submucous fibrosis, both in clinical and symptomatic improvement.

Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations

BackgroundMost head and neck (H&N) cancer patients receive high-dose external beam radiation therapy (RT), often in combination with surgery and/or chemotherapy. Unfortunately, high-dose RT has significant adverse effects on the oral and maxillofacial tissues, some of which persist for the life of the patient. However, dental management of these patients is based largely on individual and expert opinion, as few studies have followed patients prospectively to determine factors that predict adverse oral sequelae. In addition, many previous studies were conducted before wide-spread adoption of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The objective of this multi-center study is to systematically evaluate the oral health of subjects for 2 years after commencement of RT, with the goal of identifying risk factors that predict adverse oral outcomes post-RT.MethodsThis is a prospective multi-center longitudinal cohort study of H&N cancer patients who receive high-dose RT with curative intent. Planned enrollment is 756 subjects at 6 primary clinical sites (and their affiliated sites) in the USA. A baseline visit is conducted prior to the beginning of RT. Follow-up visits are conducted at 6, 12, 18 and 24 months from the start of RT. The primary outcome measure is the 2-year rate of tooth loss in patients who have received at least one session of external beam RT for H&N cancer. Secondary outcome measures include the incidence of exposed intraoral bone; incidence of post-extraction complications; change in Decayed Missing and Filled Surfaces (DMFS); change in periodontal measures; change in stimulated whole salivary flow rates; change in mouth opening; topical fluoride utilization; chronic oral mucositis incidence; changes in RT-specific quality of life measures; and change in oral pain scores.DiscussionThis study will contribute to a better understanding of the dental complications experienced by these patients. It will also enable identification of risk factors associated with adverse outcomes such as tooth loss and osteoradionecrosis. These findings will support the development of evidence-based guidelines and inform the planning of future interventional studies, with the goal of advancing improvements in patient care and outcomes.Trial registrationClinicalTrials.gov Identifier NCT02057510, registered 5 February 2014.

Response of lycopene in treatment of oral submucous fibrosis

Introduction: Oral Submucous Fibrosis (OSF) is a well-known precancerous condition with malignant transformation rate as high as 7.6%. It results in marked rigidity of oral cavity and an eventual inability to open the mouth. Although OSF has a high rate of morbidity but no reliable treatment modality for its management has been developed yet. Objective: To determine the frequency of positive response of oral lycopene in the treatment of patients with Oral Submucous Fibrosis. Methods:A descriptive case series of patients with OSF was conducted at our institution for a period of 6 months i.e.18-11-2014 to 18-05-2015 in the Department of Oral &amp; Maxillofacial Surgery, King Edward Medical University, Lahore. Data was collected by using non-probability sampling technique. After informed consent, all patients were prescribed lycopene 30 mg BD dose for a period of 6 months. Changes in mouth opening (IIO) was measured every month for each patient. Data was entered and analyzed using SPSS 20. Results: A total number of 100 cases were selected for this study. Mean age of the patients was 27.24±8.22 of which 53(53%) were male and 47(47%) were female cases. Positive response of lycopene was noted in 76(76%) of cases while 24(24%) did not respond to the treatment. No adverse effects reported during the treatment period as well as during follow-up. Conclusion: It is concluded that the lycopene can and should be used as a first line of treatment in the management of Oral Submucous fibrosis.

Dynasplint Trismus System exercises for trismus secondary to head and neck cancer: a prospective explorative study.

PurposeThe Dynasplint Trismus System (DTS) can be used to treat trismus secondary to head and neck cancer. We conducted a prospective study with the following aims: (1) to determine the effects of DTS exercises on changes in mouth opening, pain, mandibular function, quality of life (QoL), and symptomatology and (2) to analyze the patients’ perception on DTS exercises, including user satisfaction, experiences, comfort, and compliance.MethodsThe patients were instructed to exercise with the DTS for at least 16 weeks. Changes in mouth opening, pain, mandibular function, QoL, and symptomatology were evaluated, as well as the patients’ perception of DTS exercises.ResultsEighteen consecutive patients were included. Baseline mouth opening was 22.6 mm (sd 7.6). After the patients completed the DTS exercise program, mouth opening increased (7.1 mm, sd 4.7) and perceived difficulty of opening the mouth improved significantly (p < 0.05). No significant effects were found in mandibular function, QoL, and overall symptomatology. The patients’ perception was diverse. They reported effectiveness and positive feelings of the results and would recommend DTS exercises to other patients. About half of them thought DTS exercises were burdensome.ConclusionsMouth opening increased significantly after the DTS exercise program, relative to baseline. About one third of the gained increase was lost in the follow-up period. In general, the patients were satisfied about the effects and the DTS exercise program.

Mouth opening in patients irradiated for head and neck cancer: A prospective repeated measures study

Aims of this prospective cohort study were (1) to analyze the course of mouth opening up to 48months post-radiotherapy (RT), (2) to assess risk factors predicting decrease in mouth opening, and (3) to develop a multivariable prediction model for change in mouth opening in a large sample of patients irradiated for head and neck cancer. Mouth opening was measured prior to RT (baseline) and at 6, 12, 18, 24, 36, and 48months post-RT. The primary outcome variable was mouth opening. Potential risk factors were entered into a linear mixed model analysis (manual backward-stepwise elimination) to create a multivariable prediction model. The interaction terms between time and risk factors that were significantly related to mouth opening were explored. The study population consisted of 641 patients: 70.4% male, mean age at baseline 62.3years (sd 12.5). Primary tumors were predominantly located in the oro- and nasopharynx (25.3%) and oral cavity (20.6%). Mean mouth opening at baseline was 38.7mm (sd 10.8). Six months post-RT, mean mouth opening was smallest, 36.7mm (sd 10.0). In the linear mixed model analysis, mouth opening was statistically predicted by the location of the tumor, natural logarithm of time post-RT in months (Ln (months)), gender, baseline mouth opening, and baseline age. All main effects interacted with Ln (months). The mean mouth opening decreased slightly over time. Mouth opening was predicted by tumor location, time, gender, baseline mouth opening, and age. The model can be used to predict mouth opening.

Herbal Formulation (Tooth Paste): Anti-Precancerous Properties

Toothpaste can be employed as a vehicle to improve and prevent oral health of individuals and population. Different modalities of treatment are offered for different dental and oral diseases, but the major drawback of these conventional drug therapies are side effects associated with their use. This has led to the interest in the discovery of novel anti-infective natural compounds. The formulation is based on polyherbal extracts which display no side effects on the oral cavity as well as other body organs. To confirm the performance of the toothpaste formulation, the technology (Oral Sure, Orange Herbs Pvt Ltd, India) was evaluated in vivo on 20 patients (oral leukoplakia, oral lichen planus, submucous fibrosis and erythroplakia). Valid diagnostic tests were evaluated for diagnosing oral pre-cancerous lesions. Pain control and lesion healing were the two main clinical variables for evaluating improvement of oral leukoplakia, oral lichen planus and oral submucous fibrosis. But, in the case of oral submucous fibrosis, changes in mouth opening were also evaluated. The final outcome was always confirmed by clinical examination. Clinical and histopathological examinations were conducted beside the collection of serum and salivary samples taken prior to treatment with the toothpaste formulation. Serum and salivary biomarkers of oral cancer were analyzed. One week after the clinical improvement of disease, clinical and histopathological examinations were repeated on serum and saliva samples. It showed that pain scores and lesion size in oral leukoplakia, submucous fibrosis and lichen planus improved significantly [1]. In the case of submucous fibrosis, mouth opening recovered significantly following twice a day brushing regimen using the formulation [1]. So, this tooth paste might be help in prevention measure of oral health.

Post-operative steroids in the management of capsulitis following TMJ arthroscopy

Post-operative steroids in the management of capsulitis following TMJ arthroscopy