Part of the book: Oral Cancer
Cerebral palsy is a permanent neuromuscular motor disorder that gives rise to many functional problems, including impaired swallowing, chewing and speech. Maxillary transverse deficiency and Angle Class II malocclusion are common. Some of these functional problems can be due to maxillary malocclusion. To our knowledge, no case series has yet been published on orthodontic treatment in children with cerebral palsy. In this chapter, we provide an overview of this topic based on the literature and on our own clinical experience. We consider that some patients with cerebral palsy are susceptible to orthodontic treatment. The keys to success are appropriate patient selection, based on anatomical, physiological and behavioural characteristics, and the degree of involvement of parents and caregivers. Among parents of cerebral palsy children undergoing orthodontic therapy, the perceived level of overall satisfaction was very high and expectations were often exceeded; however, these results are conditioned by factors such as the Peer Assessment Rating (PAR) index. Although some authors reported improvements in aesthetics, speech and oral function, an objective assessment of functional improvement is still lacking. In our experience, correction of resting position and management of neuromuscular alterations are essential if successful orthodontic treatment is to be achieved and relapses avoided.
Part of the book: Cerebral Palsy
Up to date causal relationship has been demonstrated between dental manipulations and the onset of infective endocarditis (IE). However, since 1955, numerous expert committees have proposed antibiotic prophylaxis (AP) to prevent bacteraemia of oral origin. Controversy regarding the efficacy of AP prior to the dental procedures has intensified in recent years because of the lack of conclusive evidence on its efficacy for the prevention of IE and on its cost-effectiveness, as well as the possibility of allergic reactions and the emergence of antibiotic resistance. Accordingly, AP is now maintained exclusively for patients at highest risk and who require the manipulation of the gingival or periapical regions of the teeth or perforation of the oral mucosa. In the context of a restrictive policy, the National Institute for Health and Clinical Excellence (NICE) of the United Kingdom published a new guideline in 2008 stating that “AP against IE is not recommended for persons undergoing dental procedures”, regardless of risk status and of the nature of the procedure to be performed. The NICE guideline has generated further controversy, and expert committees in other countries continue to publish prophylactic regimens for the prevention of IE secondary to dental procedures. In this chapter, we discuss the principal guidelines currently applicable in Europe, the USA and Australia, and we draw particular attention to the need for randomised clinical trials.
Part of the book: Contemporary Challenges in Endocarditis
Three-dimensional (3D) evaluation of oral and maxillofacial pathology, in comparison with two-dimensional (2D) radiological studies, offers many advantages that can assist in the diagnostic and in the preoperative evaluation of certain lesions and conditions of the jaws, reducing the risk of intraoperative and postoperative complications. The introduction of cone beam computed tomography (CBCT) represents an important technological advance in the context of oral and maxillofacial radiology as it permits the acquisition of high-quality 3D images and dynamic navigation over an area of interest in real time, with a short scan time and lower dose of radiation than conventional computed tomography (CT). The initial indications for CBCT have been extended by the progressive addition of new ones such as evaluation of the extent of osteonecrotic lesions of the jaw due to bisphosphonates, preoperative staging of oral cancer, and planning reconstructive surgery. As a consequence, this radiological technique represents an interesting complement to conventional radiology in those clinical situations in which 3D imaging can facilitate diagnosis and/or treatment.
Part of the book: Computed Tomography