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Special Care in Dentistry : Official... 2024Epidermolysis bullosa (EB) is a rare genetic disorder characterized by skin fragility and blister formation. The phenotypic presentation is broad with four major types,...
INTRODUCTION
Epidermolysis bullosa (EB) is a rare genetic disorder characterized by skin fragility and blister formation. The phenotypic presentation is broad with four major types, being Recessive Dystrophic EB (RDEB) the most severe, including oral anomalies such as severe microstomia, ankyloglossia, vestibule obliteration and occlusal anomalies, turning orthodontic treatment into a challenge.
AIM
This case report aims to present the comprehensive treatment of a patient with severe RDEB, including periodontal surgery, orthodontic fixed braces with mini-screws and oral rehabilitation with anterior veneers.
CASE REPORT
A 27-year-old female patient with severe RDEB received orthodontic treatment in the upper jaw to improve malalignment and anterior crossbite. After 13 months of treatment with fixed appliances, miniscrews were placed in the anterior segment to intrude and procline the upper incisors. Oral surgery was performed to increase the vestibule depth of the upper lip. Once edge-to-edge occlusion was obtained, anterior veneers were placed to improve aesthetic and stabilize occlusion, especially with the lack of posterior support.
DISCUSSION
The multidisciplinary treatment approach, involving orthodontic treatment, periodontal surgery and oral rehabilitation, played a crucial role in achieving favorable results. This case highlights the successful use of miniscrews as a viable orthodontic approach for patients with severe RDEB.
Topics: Humans; Female; Epidermolysis Bullosa Dystrophica; Adult; Bone Screws; Orthodontic Anchorage Procedures; Dental Veneers; Orthodontics, Corrective
PubMed: 38054659
DOI: 10.1111/scd.12947 -
Journal of Human Lactation : Official... Feb 2024Breastfeeding behaviors and experiences exist on a continuum. What differentiates normal from dysfunctional is defined by frequency and severity. No current validated...
BACKGROUND
Breastfeeding behaviors and experiences exist on a continuum. What differentiates normal from dysfunctional is defined by frequency and severity. No current validated tool addresses the subjective experience of dyads with a predictive score that can be followed over time.
RESEARCH AIM
To create and validate a self-report tool to assess breastfeeding and evaluate its ability to predict risk of breastfeeding dysfunction.
METHODS
This study used a cross-sectional design to determine the validity of a novel instrument to assess breastfeeding dysfunction. We gave the initial questionnaire to 2085 breastfeeding dyads. We assessed content validity by comparison with other tools. We used exploratory factor analysis with varimax rotation for concept identification and Cronbach's alpha for internal consistency. We employed logistic regression to assess the tool's ability to differentiate between normal breastfeeding and breastfeeding dysfunction.
RESULTS
Factor analysis mapped 17 questions to four concepts to create a score (FLIP; flow, latch, injury [to the nipple], and post-feed behavior). Internal consistency and reliability of the scores in these concepts were acceptable (Cronbach's alpha ≥ 0.087 for all measures). A logistic regression model that controlled for infant age, with a breastfeeding dysfunction risk classification threshold of 60%, yielded a correct classification of 88.7%, with 93.1% sensitivity, 64.6% specificity, and a 6.5% false positive rate.
CONCLUSIONS
The FLIP score was determined to be a valid and reliable instrument for quantifying the severity of breastfeeding dysfunction in children under 1 year old. Further studies will assess its usefulness in the management of breastfeeding dysfunction.
Topics: Infant; Female; Child; Humans; Breast Feeding; Lingual Frenum; Cross-Sectional Studies; Reproducibility of Results; Treatment Outcome
PubMed: 38037896
DOI: 10.1177/08903344231209306 -
Children (Basel, Switzerland) Nov 2023The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in... (Review)
Review
AIM
The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy.
MATERIALS AND METHODS
A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: "lingual", "frenulectomy", "frenulotomy", "frenulum", "ankyloglossia", and "laser."
RESULTS
A total of 14 articles were included in this review, including four prospective observational studies, one case-control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table.
CONCLUSIONS
In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period.
PubMed: 38002899
DOI: 10.3390/children10111808 -
Journal of the American Dental... Jan 2024Ankyloglossia is a congenital alteration that affects the tongue's mobility, influencing craniofacial development; however, its association with malocclusion is still... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ankyloglossia is a congenital alteration that affects the tongue's mobility, influencing craniofacial development; however, its association with malocclusion is still unclear. This systematic review and meta-analysis investigated the association between ankyloglossia and malocclusion in patients.
TYPES OF STUDIES REVIEWED
The authors conducted a systematic review and meta-analysis of observational studies that investigated the association between malocclusion and the presence of ankyloglossia in any age group, used any assessment tool to diagnose ankyloglossia, and considered all types of malocclusion. The authors conducted searches in 8 electronic databases through July 1, 2022. They used Joanna Briggs Institute appraisal tools to assess the methodological quality and the Grading of Recommendations, Assessment, Development and Evaluations approach to assess the certainty of the evidence.
RESULTS
Eleven studies (5 cross-sectional, 6 case-control) included 2,904 patients and over 13 occlusal alterations. The certainty of the evidence ranged from low through very low. Patients with Angle Class III malocclusion had similar or more inserted lingual frenula than patients with Class I malocclusion (standard mean difference, 0.37; 95% CI, -0.50 to 1.25) and Class II malocclusion (standard mean difference, 0.55; 95% CI, -0.52 to 1.63). Patients with Class III malocclusion had clinically significant increased mouth opening reduction compared with patients with Class I malocclusion (mean difference, 6.67; 95% CI, 4.01 to 9.33) and Class II malocclusion (mean difference, 5.04; 95% CI, 2.35 to 7.72) patients.
PRACTICAL IMPLICATIONS
There is uncertain evidence that ankyloglossia may be associated with the development of occlusal alterations. Ankyloglossia did not influence the Angle classification. Clinicians should closely follow children with ankyloglossia to evaluate whether this condition interferes with the occlusion. Future research should prospectively follow up on the long-term association between ankyloglossia and malocclusion. The protocol was registered a priori in the PROSPERO database (CRD42021248034). No amendments were deemed necessary after the registration of the protocol. Some subgroup analyses planned a priori were not possible, such as the severity of ankyloglossia, sex, and age, due to the lack of studies reporting data for these subgroups.
Topics: Child; Humans; Ankyloglossia; Cross-Sectional Studies; Malocclusion; Malocclusion, Angle Class III; Malocclusion, Angle Class II
PubMed: 37999659
DOI: 10.1016/j.adaj.2023.09.014 -
Diagnostics (Basel, Switzerland) Nov 2023To effectively address breastfeeding issues for neonates and mothers, one must understand the physiology of breastfeeding and the anatomical components involved in...
To effectively address breastfeeding issues for neonates and mothers, one must understand the physiology of breastfeeding and the anatomical components involved in sucking, swallowing, and respiration. This study compared the tongue position and movement of neonates with tongue ties versus healthy controls during sucking. A new objective ultrasonography diagnostic approach was also introduced for the orofacial region. This retrospective study evaluated B-mode and M-mode ultrasonography images from 30 neonates clinically diagnosed with tongue tie, and a control group of 30 neonates. B-mode ultrasound images were used to examine several characteristics to locate the nipple in the oral cavity during breastfeeding. Anatomic M-mode ultrasound images were used to assess tongue movement during sucking. The nipple moved farther from the intersection of the hard and soft palates during the sucking cycle in the ankyloglossia group than in the control group ( < 0.05). Compared to the control group, neonates with ankyloglossia have a lower capacity to lift the anterior tongue toward the palate when sucking ( < 0.05). There was no significant difference in tongue movement metrics between the two groups ( > 0.05). Our findings were consistent with earlier research. The novel measurement method will offer a new perspective on breastfeeding.
PubMed: 37998570
DOI: 10.3390/diagnostics13223435 -
Facial Plastic Surgery Clinics of North... Feb 2024Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact... (Review)
Review
Robin sequence, macroglossia, and ankyloglossia are disorders affecting the tongue and mandible in the pediatric population. Each of these can have a significant impact on breathing, feeding, speech, dentition, and craniofacial growth. This review discusses the interdependent and coordinated development of both the tongue and mandible, the functional impacts of these disorders, and appropriate management strategies.
Topics: Humans; Child; Tongue; Macroglossia; Mandible
PubMed: 37981411
DOI: 10.1016/j.fsc.2023.08.002 -
Cureus Oct 2023A congenital condition called ankyloglossia, or tongue tie, is characterized by an excessively short or tight lingual frenum that restricts the tongue's movement and...
A congenital condition called ankyloglossia, or tongue tie, is characterized by an excessively short or tight lingual frenum that restricts the tongue's movement and flexibility. Although ankyloglossia, or tongue tie, is not a serious sign, it can cause a variety of challenges, such as difficulty with newborn feeding, speech problems, and many mechanical and social problems since there are restricted tongue movements, such as protrusion of the tongue. It is recommended to get a lingual frenectomy to treat ankyloglossia. A 24-year-old female patient reported to the Department of Periodontics with class II, moderate lingual tie, or ankyloglossia. Under local anesthesia, the lingual frenectomy is performed with a diode laser by placing a hemostat across the frenal attachment at the base of the tongue, and an incision is made. The laser surgery took less time and was more comfortable for the patient because there was less discomfort. There was no postoperative pain or hemorrhage. The above case report can appreciate the normal frenal attachment that is more than 16 mm, and the patient can hold the tip of the tongue and function comfortably. A follow-up visit after three months revealed normal frenal attachment and complete healing of the frenum. This case report demonstrates unequivocally that lingual frenectomy using a diode laser has advantages over traditional procedures in that it reduces or eliminates postoperative pain and minimizes hemorrhage and swelling.
PubMed: 37942373
DOI: 10.7759/cureus.46667 -
PloS One 2023Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have...
BACKGROUND
Maternal folic acid supplementation is protective against the development of neural tube defects (NTDs) in babies. However, recent public-facing communications have raised concerns about a causal relationship between folic acid supplementation, particularly after the first trimester, and ankyloglossia (tongue-tie) in infants. Non-evidence-based communications are potentially harmful because they could adversely affect adherence to folic acid supplementation, increasing NTD occurrence. This study aimed to review evidence on the relationships between maternal folic acid supplementation during preconception and/or pregnancy and the risk of ankyloglossia in infants.
METHODS
We searched the databases MEDLINE, EMBASE, Cochrane CENTRAL, and Scopus. We searched for observational, and interventional studies, and systematic reviews investigating the effect of maternal folic acid supplementation during preconception or pregnancy on the occurrence of ankyloglossia in offspring. The search was registered on PROSPERO on 01/12/2022, ID: CRD42022375862.
RESULTS
The database searches yielded 93 articles. After removing duplicates and screening titles and abstracts, 26 remained. One article was judged relevant for inclusion in analyses; a case-control study that directly mentions the relationship between folic acid supplementation and ankyloglossia. This study reported that regular intake of folic acid supplements was higher in women with infants with ankyloglossia. However, this study has limitations regarding design, selection bias, and confounding, calling the findings into question.
CONCLUSIONS
Insufficient evidence exists for a relationship between folic acid supplementation and ankyloglossia. Currently, the benefits of folic acid supplementation far outweigh the risks. This must be clearly communicated to patients by their clinicians during preconception and antenatal care.
Topics: Female; Pregnancy; Infant; Humans; Ankyloglossia; Case-Control Studies; Folic Acid; Dietary Supplements; Neural Tube Defects; Tongue
PubMed: 37922258
DOI: 10.1371/journal.pone.0294042 -
Breastfeeding Medicine : the Official... Nov 2023
Ankyloglossia in Monochorionic Diamniotic and Dichorionic Diamniotic Twins: A Cross-Sectional Study, by Feitosa, et al. Breastfeed Med 2023;18(7):528-533; doi: 10.1089/bfm.2022.0239.
PubMed: 37855881
DOI: 10.1089/bfm.2022.0239.correx -
Journal of Oral Rehabilitation Feb 2024The buccal frenum is connective tissue that adheres the mucosa of the cheek to the alveolar process. When restricted, this condition is commonly known as a buccal- or... (Review)
Review
BACKGROUND
The buccal frenum is connective tissue that adheres the mucosa of the cheek to the alveolar process. When restricted, this condition is commonly known as a buccal- or cheek-tie. Restrictive buccal frena are often treated during tongue- and lip-tie procedures, yet widely accepted classification, diagnostic and treatment guidelines are lacking.
OBJECTIVE
Provide a scoping review on the evaluation and management of buccal-ties, including diagnosis, classification, symptoms and treatment, by surveying healthcare providers with experience evaluating and managing oral restrictions.
METHODS
Literature review and IRB-approved survey to assess practice patterns among healthcare providers identified from online directories of tongue-tie release providers and associated allied health professionals.
RESULTS
A multidisciplinary group of 466 providers responded. About 87% indicated that they assess buccal restrictions. Evaluation methods included finger sweep (89.1%), visual inspection (76.4%), tissue blanching (66.5%) and functional assessment (53.4%). Around 94% of providers reported that objective and subjective findings are both needed for diagnosis and that an estimated 5%-10% of infants may be affected. About 70% of providers release buccal-ties (if needed) simultaneously with tongue-ties, and 76.8% recommend post-operative stretches as necessary for optimal healing. Respondents indicated a need for further research, evidence-based assessments, a classification system and treatment protocols.
CONCLUSION
Evaluating a buccal frenum to diagnose a symptomatic buccal-tie relies upon visual inspection, palpation and assessment of oral function. Survey data and clinical experience are summarized to review classification systems, diagnostic/evaluation criteria and treatment recommendations as a foundational cornerstone for future works to build upon.
Topics: Humans; Infant; Ankyloglossia; Delivery of Health Care; Health Personnel; Lingual Frenum
PubMed: 37823364
DOI: 10.1111/joor.13609