Orofacial Disorders Research Articles

Review of New Trends in Myofunctional Therapy: Occlusion, Muscles and Posture, by Saccomanno and Paskay (2020)

<p>The field of myofunctional therapy (MT) is complex, as it covers theoretical and practical information on many topics to effectively assess and treat orofacial myofunctional disorders, also known as myofunctional disorders, including tongue thrust, tongue posture, tongue-tie, orthodontic concepts, oral habits, and more. This review summarizes the strengths and usefulness of the book <em>New Trends in Myofunctional Therapy: Occlusion, Muscles and Posture (Saccomanno & Paskay, 2020). </em>The review informs the audience about various important features of the book, chapter materials, and the overall usefulness of the content for professionals working in MT. Providing cutting-edge information, the book draws substantive support from various interdisciplinary journal articles and clinical textbooks. Overall, the book is beneficial to leading professionals in MT as a resource for assessing and treating orofacial myofunctional disorders.</p>

Early orthodontists, their challenges, and their significant impact on orofacial myology

<p>“Knowing your history can give you the tools to shape your future.” Gloria Feldt’s insightful quote inspires us to delve into the past and learn from those who came before us. This article chronicles the journey of several individuals who shaped the field of orthodontics and influenced the formation of the specialty of orofacial myology. The early years of orthodontics were challenging. In addition to the struggle to elevate the focus of orthodontics beyond mechanics, there was the challenge to convince academia to deem it worthy of post-graduate study. Dr. Edward H. Angle left his indelible mark on orthodontics and planted seeds regarding the mutual relationship of dentition with oral-facial muscles, respiration, and oral habits. In the mid-1900s, Dr. Walter J. Straub picked up the mantle. His stated quest was to identify and rectify dental relapse. His search led him to investigate allergies, oral habits, bottle feeding, and swallowing. There were others, but primarily as a result of these two men, the International Association of Orofacial Myology (IAOM) was created. Over the past 50 years, the IAOM has continued to grow, evolve, and set the gold standard for excellence in the treatment of orofacial myofunctional disorders.</p>

Development of a concept for a mobile application to support orofacial myofunctional therapy

This study aimed to develop a concept for a mobile health application, an app-based exercise tool, to support the treatment of orofacial myofunctional disorders by speech-language therapists (SLTs). Method:A sequential mixed research design combining qualitative research and user-centered software development was applied. Qualitative interviews and focus groups were conducted with eight SLTs, one patient and three relatives to gather ideas for an app to support orofacial myofunctional therapy. On the basis of the findings, a paper-based prototype was developed, which was then evaluated by seven end users, to refine the concept of the app. Results: Qualitative data on desirable functionalities were clustered into topics and related subcategories containing general ideas for the app – a control mechanism, a reward system, the visualization of exercises, and pop-up messages for reminders and recommendations. The paper prototype was developed that addressed these functionalities. Discussion: An app-based exercise tool is considered to have added value for orofacial myofunctional therapy. A prototype for a mobile application is ready for programming and subsequent testing in the treatment of orofacial myofunctional disorders by conducting additional interviews to ascertain patients’ perceptions.

Immediate Effect of Mulligan's Mobilization with Movement on Forward Head Posture and Postural Sway in Temporomandibular Joint Dysfunction

Context: Temporomandibular joint dysfunction (TMJD) is defined as orofacial disorders including pain, clicking in the temporomandibular joint (TMJ), fatigue of the masticatory muscles, and limitation of mandibular movements. TMJD is responsible for forward head posture (FHP) and postural sway leading to neck pain, headache, and absenteeism from work affecting their quality of life. Management of the dysfunction can alleviate pain and improve work efficiency. Aim: The aim of this study is to evaluate the immediate effect of Mulligan's mobilization with movement (MWM) on numeric pain rating scale (NPRS), maximum mouth opening (MMO), FHP, and postural sway in participants with TMJD. Settings and Design: Pre-and postexperimental study conducted in tertiary care hospital in Belagavi, Karnataka, India. Methodology: Of 59 screened, 39 participants between the age group of 20–40 years of both genders were screened based on the scores obtained from Fonseca's Questionnaire and those eligible were recruited. One session of TMJ MWM was administered and outcome measures were assessed preintervention and immediately postintervention using NPRS, MMO, postural sway, and craniovertebral angle. Statistical Analysis Used: Wilcoxon matched-pairs test and paired t-test were used for pre-and posttest scores of variable. Results: After data analysis, the severity of pain, MMO, postural sway, and FHP showed significant improvement postintervention (P < 0.0001). Conclusion: One session of MWM for TMJ was effective in alleviating pain, improving mouth opening, postural sway, and FHP immediately posttreatment in participants with TMJD.

Orofacial Dental Pain and Its Management – A General Guide and Systemic Review

Pain is one of the main symptoms for which patients seek medical attention. Pain has been designated as the “Fifth vital sign” to mark its importance as health status indicator. Orofacial dental pain may be due to various conditions affecting numerous structures local to or distant to the oral cavity including the meninges, cornea, oral, nasal, sinus mucosa, dentition, musculature, salivary glands and temporomandibular joint. Evidence support the fact that the most commonly experienced orofacial pain is dental in nature. The dental reasons should be well thought of as the first step even in cases where orofacial pain is poorly localized. One of the most common reasons for seeking dental care is said to be pain and dysfunction, usually involving the teeth and surrounding tissue. Musculoskeletal, vascular and neuropathic causes of orofacial pain occur very frequently. Orofacial disorders may have pain and associated symptoms arising from a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be syndromes in which pain constitutes the primary problem, such as TMJ disorder pain or headache.

Factors associated with awake bruxism according to perceptions of parents/guardians and self-reports of children.

Bruxism is a repetitive activity of the masticatory muscles that has been associated with orofacial disorders and psychosocial factors AIM: The aim of this study was to investigate associations between possible awake bruxism (PAB) and family functioning, bullying, and dental caries in children 8-10years of age. A school-based study was conducted with 739 pairs of parents/guardians and children. The parents/guardians answered the Family Adaptability and Cohesion Evaluation Scales for the establishment of family functioning. Information on bullying due to dental conditions was collected from the children. Dental caries in the children was evaluated using International Caries Detection and Assessment System criteria. A directed acyclic graph was used to define the theoretical model and select control factors. Descriptive analysis was performed, followed by multivariate logistic regression for complex samples. Considering the parental reports, fewer years of mother's schooling, a low family income, very flexible family adaptability, and cavitated dental caries were associated with PAB. The female sex, bullying, and orofacial dysfunction were associated with self-reported PAB. Therefore, the factors associated with PAB differ according to the reports of parents/guardians or self-reports of children. Healthcare providers should consider both reports for a more effective intervention addressing PAB.

Digitomotography in children with oro-facial dysfunction (OFD, oro-facial myofunctional disorders) and childhood apraxia of speech (CAS).

Oro-facial dysfunctions (OFDs; oro-facial myofunctional disorders) in children and childhood apraxia of speech (CAS) often cause severe problems in articulation, chewing, swallowing and oral posture. Pathognomonic symptoms could yet not be identified, but central problems in planning, programming, timing and automating oro-facial, as well as other fine motor skills, are assumed to be affected. To investigate the nature of motor and coordinative deficits in OFD and CAS, digitomotography was applied. The testing focused on recording frequency, force, rhythm and regularity of the index finger including speeded and metronome tapping tasks. 25 children with OFD (7 girls and 18 boys, age 7.9±2.3) and 5 children with CAS (0 girls and 5 boys, age 7.6±2.3), and 31 healthy controls (12 girls and 19 boys, age 9.3±2.2) were tested. Statistical significance was accepted at α = 0.05. ANOVA test, non-parametric Mann-Whitney U test, Kruskal-Wallis test and Spearman's rank correlation coefficient were used. Cross-sectional data revealed consistent significant differences between children with OFD and healthy controls concerning frequency, force, rhythm and regularity of index finger tapping. Individuals with CAS showed particularly low results. Tapping results correlated with disease burden. These findings support that underlying superordinated sensorimotor deficits exist. This may help phenotyping and influence diagnostical and therapeutical approaches.

Machine Learning and Intelligent Diagnostics in Dental and Orofacial Pain Management: A Systematic Review.

Purpose The study explored the clinical influence, effectiveness, limitations, and human comparison outcomes of machine learning in diagnosing (1) dental diseases, (2) periodontal diseases, (3) trauma and neuralgias, (4) cysts and tumors, (5) glandular disorders, and (6) bone and temporomandibular joint as possible causes of dental and orofacial pain. Method Scopus, PubMed, and Web of Science (all databases) were searched by 2 reviewers until 29th October 2020. Articles were screened and narratively synthesized according to PRISMA-DTA guidelines based on predefined eligibility criteria. Articles that made direct reference test comparisons to human clinicians were evaluated using the MI-CLAIM checklist. The risk of bias was assessed by JBI-DTA critical appraisal, and certainty of the evidence was evaluated using the GRADE approach. Information regarding the quantification method of dental pain and disease, the conditional characteristics of both training and test data cohort in the machine learning, diagnostic outcomes, and diagnostic test comparisons with clinicians, where applicable, were extracted. Results 34 eligible articles were found for data synthesis, of which 8 articles made direct reference comparisons to human clinicians. 7 papers scored over 13 (out of the evaluated 15 points) in the MI-CLAIM approach with all papers scoring 5+ (out of 7) in JBI-DTA appraisals. GRADE approach revealed serious risks of bias and inconsistencies with most studies containing more positive cases than their true prevalence in order to facilitate machine learning. Patient-perceived symptoms and clinical history were generally found to be less reliable than radiographs or histology for training accurate machine learning models. A low agreement level between clinicians training the models was suggested to have a negative impact on the prediction accuracy. Reference comparisons found nonspecialized clinicians with less than 3 years of experience to be disadvantaged against trained models. Conclusion Machine learning in dental and orofacial healthcare has shown respectable results in diagnosing diseases with symptomatic pain and with improved future iterations and can be used as a diagnostic aid in the clinics. The current review did not internally analyze the machine learning models and their respective algorithms, nor consider the confounding variables and factors responsible for shaping the orofacial disorders responsible for eliciting pain.

Orofacial features in children with microcephaly associated with Zika virus: A scoping review

To analyze published scientific evidence about the most common orofacial disorders in children with microcephaly associated with ZIKV infection. Through a scoping review, we respond to the search question was formulated: "What are the orofacial alterations in children with microcephaly associated with ZIKV?" It was performed a search in PubMed, EMBASE, Scopus, and Health Virtual Library. It was selected papers wrote in English, Portuguese, or Spanish. An evidence quality analysis was performed using the Agency for Healthcare Research and Quality classification. It was included 11 studies performed in the Brazilian Northeast region. The studies were carried out between 2018 and 2020. The main related alterations were delay in the tooth-eruption and deformation in the oral structures. The results observed in our work show moderate scientific evidence regarding the association of ZIKV with orofacial alterations in children with microcephaly due to the classifications of the quality of evidence of each one of the included studies. The main changes reported were in the chronology of tooth eruption, alteration in teeth, and oral structures.

A brief discussion on theoretical basis and clinical application of "treatment of orofacial diseases by using Hegu(LI4)"

In traditional Chinese medicine, the well-known saying that "in the treatment of disorders of the orofacial region, Hegu(LI4)is usually taken" is a highly summary of functions of acupoint LI4, the Yuan-primary point of the Large Intestine Meridian of Hand Yangming. By consulting the related literature and viewing from the angle of differentiation of meridians, the present paper expounded the characteristics of location, the attributed meridian and clinical functions of LI4, and summarized its underlying mechanisms in the treatment of some orofacial disorders revealed by experimental researches. In addition, some examples of clinical application of LI4 were listed, including peripheral facial palsy, oral diseases, problems of the nose and headache.

Myofunctional therapy. Part 1: Culture, industrialisation and the shrinking human face.

Culture, industrialisation and the shrinking human face: Why is it important? Over the past 300,000 years, not only has the way we consume food from birth through our lifetime changed, there have also been changes related to the methods of food preparation, availability, processing, and storage. These diet-related factors, along with other epigenetic factors, have led to a widespread increase in orofacial myofunctional disorders (OMDs) and resultant human malocclusion phenotypes (HMPs) worldwide. Currently there is an increasing need for resolution of HMPs in early childhood and associated OMDs. This review will include reports of cases and describe the nature of the problem and strategies for effective solutions.

Mandibular propulsion and dental implant rehabilitation for an edentulous patient with class II malocclusion and severe obstructive sleep apnea

Introduction: Orthognathic surgery can be a treatment for occlusal, oro-facial functional disorders and esthetics discrepancies as well as for obstructive sleep apnea. It is often practiced after an orthodontic preparation, but in edentulous patients, the preparation can be replaced with implant supported prosthesis to simulate the final occlusion. Observation: A patient presenting severe obstructive sleep apnea, vertical and sagittal insufficiency of the lower third of the face and poor dental health was treated with a guided mandibular advancement and an almost complete implant supported prosthesis rehabilitation. At first, the implants were placed and immediately loaded, giving the patient a class 2 occlusion. Then, an orthognathic surgery was performed, giving the patient a class 1 occlusion, and then the final prosthesis was made. Commentaries: The interest of this case is the combined treatment of the obstructive sleep apnea, the dental and facial deformities by mandibular retrognathia and the edentulous jaws. The gold standard for obstructive sleep apnea is a maxillary and mandibular advancement. In this case, for esthetic and anatomic reasons, a mandible propulsion alone has been performed, showing a positive and stable result for the treatment of obstructive sleep apnea. The use of surgical guide permitted to plan the treatment with more accuracy. Conclusion: This case combines a fixed prosthetic rehabilitation, which permitted to guide the orthognathic surgery and the treatment of obstructive sleep apnea.

Orofacial myofunctional therapy with children ages 0-4 and individuals with special needs

Purpose: The purposes of this paper are to 1) define variations in terminology and treatment methodology for orofacial myofunctional disorders (OMDs) in children 0-4 years of age and in special populations, and 2) compare and contrast service delivery models for children ages 0-4 and individuals with special needs versus older children and children who are neurotypical. Method: A literature review of scholarly articles, professional presentations, poster presentations, blogs, and social media were analyzed using three tiers of evidence-based practice to include: 1) clinical expertise/expert opinion; 2) external and internal evidence and 3) client/patient/caregiver perspectives. Results: Professional texts and publications used consistent language when discussing treatment of OMDs in young children and children with special needs. Terminology and treatment approaches for young children and/or children with special needs who present with OMDs were inconsistent in social media and professional presentations. Discussion: The treatment modalities used in orofacial myofunctional therapy to stimulate oral motor responses depend upon age and cognitive status. OMDs should certainly be treated in infants, young children and individuals with special needs according to the methods of the pediatric feeding specialist. Orofacial myofunctional therapy requires volitional control and self-monitoring; as such, it is contraindicated for infants and toddlers as well as those individuals who cannot actively engage in therapeutic techniques.

An introduction to clinical simulation (CS) for orofacial myologists: COVID-19’s impact on clinical education

COVID-19 has forced educational institutions to increasingly rely on technology to provide appropriate clinical experiences for students. Simulations and case studies have been used for decades, but COVID-19 thrust these resources into the forefront of clinical education. Clinical simulation (CS) is the use of alternative methods in the clinical preparation of students (American-Speech-Language-Hearing Association [ASHA], 2020). Forms of CS include simulators, standardized patients, virtual patients, digital mannequins, immersive reality, task trainers, and computer-based interactive experiences and often incorporate case studies (ASHA). This article draws upon clinical education in the primary certification fields for those who practice orofacial myofunctional therapy: speech-language pathology and dentistry. It is designed to be a CS primer for these clinicians by presenting types of simulation-based learning, experiences specific to orofacial myofunctional disorders (OMDs), advantages and disadvantages, supporting evidence, best practices, and enhancement of critical thinking skills. There is a need to increase the representation of OMD-related content in CS experiences.

Saliva as a Diagnostic Tool in Orofacial Disorders

Saliva is formed by major exocrine organs, namely the parotid gland, “sub-mandibular” gland and “sublingualglands” and many minor “salivary glands.” Nature has bestowed saliva “The natural source” with manyfunctional capabilities that have a crucial value in maintaining the well being of mouth. Saliva plays a majorrole in the protection of oral tissues, food preparation, digestion, lubrication and speech.1 But one purposenot given by life is the utilization of saliva for investigative value, it is the human who has to explore thisprecious wonder fluid marvelously studded with clues about the human body in health and disease. Saliva asa diagnostic aid in orofacial disorders is the traditional monitoring tool for various diagnosis.2

Impact of Oral Myofunctional Therapy on Orofacial Myofunctional Status and Tongue Strength in Patients with Tongue Thrust

Introduction: Tongue thrust is a frequent clinical condition characterized by abnormal patterns of movements and altered tongue posture on the mouth floor. It might contribute to determining alterations in the maxillofacial morphology and in the development of malocclusion. Several therapeutic options are available for treatment. In particular, the orofacial myofunctional therapy (OMT) is frequently adopted even if only few studies have analyzed its efficacy using validated instruments and no information is available regarding the effect of dentition on the results obtained with OMT. Objective: To evaluate the effect of OMT through a validated instrument and explore the role of dentition on its efficacy. Methods: A total of 22 consecutive patients with tongue thrust were enrolled. According to the presence of mixed or complete dentition, the cohort of patients was divided into 2 groups. Each patient underwent OMT according to the Garliner method (10 weekly sessions of 45 min each in hospital and daily exercises at home). The efficacy of OMT was evaluated using the Orofacial Myofunctional Evaluation with Scores (OMES), a validated protocol developed for the assessment of orofacial myofunctional disorders, and the Iowa Oral Performance Instrument (IOPI) to measure the peak isometric pressure exerted by the anterior and posterior part of the tongue. Both OMES and IOPI were administered before and at the end of the treatment. Results: A significant improvement in the OMES scores was demonstrated after OMT. No significant differences between the patients with intermediate and mixed dentition obtained in both the pre- and post-treatment conditions were demonstrated in the OMES scores. Similarly, a significant increase in the peak isometric tongue pressure in both the anterior and posterior parts of the tongue was demonstrated after OMT in the groups. No differences between the two groups in both the pre- and post-treatment conditions were demonstrated in the IOPI scores. Conclusions: OMT improves orofacial motricity and tongue strength in patients with tongue thrust regardless of the type of dentition.

Variable expression of Van der Woude syndrome: A case report

AbstractVan der Woude syndrome (VWS) is an autosomal dominant disorder with a rare clinical manifestation of orofacial disorders with deletion in the 1q32‐q41 chromosome band. In our study we present a clinical case of a 1‐year old boy with a bilateral cleft lip, a cleft palate and bilateral congenital pits on the lower lip and a father with various clinical presentations of VWS.

Purpose: To demonstrate the speech-language pathology practice in patients pre and post orthognathic surgery.

The Speech-Language Pathologist is the health professional with full graduation on Speech-Language Pathology, who acts independently both in public and private services. The professional is responsible for health promotion, prevention, assessment and diagnose, guidance, therapy (habilitation and rehabilitation) and improvement of speech-language pathology features as peripheral and central hearing function, vestibular function, oral language and writing, voice, fluency, speech articulation and myofunctional orofacial system, cervical, and swallowing. Also, the professional practices teaching, research and managerial activities (2 Speech-Language Pathology Regional Council definition – CRFa2). Currently, the Federal Speech-Language Pathology Council (CFF) recognizes 12 specialties: Audiology, Language, Orofacial Myofunctional Disorders, Collective Health, Voice, Dysphagia, Educational Speech-Language Pathology, Gerontology, Neurofunctional Speech Therapy, Occupational Health Speech-Language Pathology, Neuropsychology, and Fluency. Orofacial Myofunctional Disorders: the Speech-Language Pathologist is the professional who habilitates / rehabilitates breathing, sucking, chewing, swallowing, facial expression and speech articulation which provides better life and communication conditions (CRFa2). In 1997, at Dentistry Faculty of Sao Paulo University – USP, I started as assistant Speech-Language Pathologist in research and clinic of patients from the Traumatology Orthognathic Surgery, Temporomandibular Joint Dysfunction, and Face Trauma; since then working in rehabilitation of orthognathic patients. The Speech-Language Pathologist compose the multidisciplinary team, which is essential during pre-surgery orofacial myofunctional disorder assessment and to contribute to virtual surgery planning; and after, rehabilitating the function speeding up the recovery and results. The Speech-Language Pathologist works to organize the neuromotor programming after the bones bases relocation always aiming the function according to each patient features, to assess possible adaptations and inappropriate myofunctional compensations, awareness/ comprehension/ muscle memory and functional activation. Therapeutic resources that assist clinical practice: drainage of facial edema, cryotherapy, thermotherapy, laser therapy, electrical stimulation, surface electromyography (all resources part of the professional speech-language pathologist practice).

Tongue Posture, Tongue Movements, Swallowing, and Cerebral Areas Activation: A Functional Magnetic Resonance Imaging Study

The aim of this study was to pinpoint the cerebral regions implicated during swallowing by comparing the brain activation areas associated with two different volitional movements: tongue protrusion and tongue elevation. Twenty-four healthy subjects (11—males 22 ± 2.9 y; 13—females 23 ± 4.1 y; were examined through functional magnetic resonance imaging (fMRI) while performing two different swallowing tasks: with tongue protrusion and with tongue elevation. The study was carried out with the help of fMRI imaging which assesses brain signals caused by changes in neuronal activity in response to sensory, motor or cognitive tasks. The precentral gyrus and the cerebellum were activated during both swallowing tasks while the postcentral gyrus, thalamus, and superior parietal lobule could be identified as large activation foci only during the protrusion task. During protrusion tasks, increased activations were also seen in the left-middle and medial frontal gyrus, right thalamus, inferior parietal lobule, and the superior temporal gyrus (15,592-voxels; Z-score 5.49 ± 0.90). Tongue elevation activated a large volume of cortex portions within the left sub-gyral cortex and minor activations in both right and left inferior parietal lobules, right postcentral gyrus, lentiform nucleus, subcortical structures, the anterior cingulate, and left insular cortex (3601-voxels; Z-score 5.23 ± 0.52). However, the overall activation during swallowing tasks with tongue elevation, was significantly less than swallowing tasks with tongue protrusion. These results suggest that tongue protrusion (on inferior incisors) during swallowing activates a widely distributed network of cortical and subcortical areas than tongue elevation (on incisor papilla), suggesting a less economic and physiologically more complex movement. These neuromuscular patterns of the tongue confirm the different purpose of elevation and protrusion during swallowing and might help professionals manage malocclusions and orofacial myofunctional disorders.

Utilizing an Objective Simulated Clinical Examination (OSCE) for orofacial disorders.

Journal of Dental EducationVolume 85, Issue S1 p. 1022-1023 ADVANCING THROUGH INNOVATION Utilizing an Objective Simulated Clinical Examination (OSCE) for orofacial disorders Eric T. Stoopler DMD, FDSRCS, FDSRCPS, Corresponding Author Eric T. Stoopler DMD, FDSRCS, FDSRCPS [email protected] Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA Correspondence Eric T. Stoopler, DMD, FDSRCS, FDSRCPS, Penn Dental Medicine, 240 South 40th Street, Room 206, Philadelphia, PA 19104, USA. Email: [email protected]Search for more papers by this authorArthur S. Kuperstein DDS, Arthur S. Kuperstein DDS Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USASearch for more papers by this authorThomas R. Berardi DDS, Thomas R. Berardi DDS Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USASearch for more papers by this authorThomas P. Sollecito DMD, FDS RCSEd, Thomas P. Sollecito DMD, FDS RCSEd Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USASearch for more papers by this author Eric T. Stoopler DMD, FDSRCS, FDSRCPS, Corresponding Author Eric T. Stoopler DMD, FDSRCS, FDSRCPS [email protected] Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USA Correspondence Eric T. Stoopler, DMD, FDSRCS, FDSRCPS, Penn Dental Medicine, 240 South 40th Street, Room 206, Philadelphia, PA 19104, USA. Email: [email protected]Search for more papers by this authorArthur S. Kuperstein DDS, Arthur S. Kuperstein DDS Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USASearch for more papers by this authorThomas R. Berardi DDS, Thomas R. Berardi DDS Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USASearch for more papers by this authorThomas P. Sollecito DMD, FDS RCSEd, Thomas P. Sollecito DMD, FDS RCSEd Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, Pennsylvania, USASearch for more papers by this author First published: 12 August 2020 https://doi.org/10.1002/jdd.12383Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume85, IssueS1Supplement: Advancing Through Innovation in a Challenging TimeJune 2021Pages 1022-1023 This article also appears in:Advancing Through Innovation in a Challenging Time RelatedInformation