Oral health deterioration is common after neurological injury and may contribute to functional impairment beyond the oral cavity. In stroke rehabilitation, impaired oral conditions coexist with orofacial dysfunction and dysphagia, yet the mechanistic pathways linking oral health to swallowing impairment and downstream nutritional consequences remain poorly defined. This study examined the interrelationships between oral health, orofacial function, dysphagia, and malnutrition using structural equation modelling (SEM). Ninety-two stroke survivors admitted to a neurorehabilitation center underwent standardized assessments of oral health, orofacial function, dysphagia severity at admission, and nutritional screening at week 4. Oral health and orofacial function were modelled as latent variables. SEM was used to quantify pathways linking oral health to malnutrition risk, with bivariate comparisons stratified by dysphagia status. Poor oral health was significantly associated with reduced orofacial function (β = -0.41, p < 0.001), which in turn was associated with dysphagia severity (β = -0.51, p < 0.001). Dysphagia showed a direct association with malnutrition risk (β = 0.31, p = 0.031). While poor oral health exerted a direct effect on malnutrition risk (β = 0.33, p = 0.023), the indirect pathway linking poor oral health to malnutrition through orofacial dysfunction and dysphagia was not statistically significant (β = 0.063, p = 0.091). The model identified a coherent oral-orofacial-swallowing pathway consistent with nutritional vulnerability after stroke. These findings position oral health as an important factor associated with swallowing impairment and nutritional vulnerability after stroke within a modeled pathway. Integrating oral and orofacial assessments into post-stroke care may support earlier identification of patients at risk for functional decline and systemic complications. Oral health deterioration was associated with malnutrition risk after stroke, directly and via impaired orofacial function and dysphagia. Integrating oral and orofacial function measures into routine post-stroke assessments may improve early risk stratification and support coordinated dental and rehabilitation care.
Oral cancer is an increasing global health problem, and its early diagnosis is of great importance. Worldwide, several studies have assessed dentists' knowledge and practices regarding oral cancer. However, there is a lack of available data on this subject in Tunisia. This study aimed to assess knowledge, attitudes, and practices related to oral cancer among dentists in Tunisia. This was a cross-sectional study. A structured questionnaire was distributed to 350 dentists (255 females, 72.9%; 95 males, 27.1%) practicing in both public and private sectors across different regions of Tunisia. The mean age of participants was 30 years (range: 24-49), and their professional experience varied from less than 5 years to more than 20 years. Dentists' knowledge about risk factors and clinical presentations of oral cancer development, and their current practices were assessed. Associations between knowledge levels and sex, seniority, specialty, type of practice, and sources of information were examined using the χ² test and Fisher's exact test. The majority of participants identified tobacco (93.4%) and alcohol consumption (45.4%) as major risk factors for oral cancer. Oral medicine university specialists aged under 40 years had the best scores in identifying the floor of the mouth as the most common site for oral cancer, erythroplakia and leukoplakia as the most likely potentially malignant lesions, and squamous cell carcinoma as the most common histological type. Dentists have a crucial role in the early detection of oral cancer. This study revealed important gaps in Tunisian dentists' knowledge, particularly regarding risk factors beyond tobacco and alcohol, and highlighted the need to strengthen educational strategies for oral cancer detection and prevention.
To evaluate the physical component of the quality of life of patients with post-traumatic defects of the upper and middle part of the visceral skull. The study included 78 patients over the age of 18 with post-traumatic defects and deformities of the middle zone of the face. All patients underwent an analysis of the mechanism of injury and the nature of the damage. The physical component of quality of life was assessed using the SF-36 questionnaire in several key areas: physical functioning, limitations in daily life due to health problems, as well as pain intensity and overall perception of one's condition. The SF-36 physical component summary score assessment showed that all patients experienced moderate pain (48.1±7.9 points) and significant limitation of physical activity (47.3±6.1 points), which led to noticeable difficulties in daily life and overall health deterioration. Diplopia (r=0.83), pain in the injured area (r=0.85), and limited jaw mobility (r=0.80) (p <0.0001) also lead to significant limitations and poor health outcomes. The prospects of this study are the standardization and digitalization of the preoperative examination protocol for patients with injuries to the bones of the visceral part of the skull. The results are of great clinical importance for the development of comprehensive rehabilitation programs for patients with post-traumatic deformities of the middle zone of the facial part of the skull, which corresponds to modern approaches to personalized treatment strategies. Оценка физического компонента качества жизни (КЖ) пациентов с посттравматическими дефектами верхней и средней зон висцерального отдела черепа. В исследование были включены 78 пациентов старше 18 лет с посттравматическими дефектами и деформациями средней зоны лица. У всех пациентов проведен анализ механизма травмы и характер повреждений. Физический компонент КЖ у оценивали с помощью опросника SF-36 по нескольким ключевым направлениям: способность к физическим нагрузкам, ограничения в повседневной жизни, вызванные проблемами со здоровьем, а также интенсивность боли и общее восприятие своего состояния. Оценка качества физического компонента КЖ по шкале SF-36 показала, что все пациенты испытывали боль средней интенсивности (48,1±7,9 балла) и значительное ограничение физической активности (47,3±6,1 балла), что привело к заметным трудностям в повседневной жизни и общему ухудшению состояния здоровья. Кроме того, к существенным ограничениям и ухудшению качества здоровья приводят диплопия (r=0,83), боль в области нанесения удара (r=0,85) и ограничение подвижности челюсти (r=0,80; p<0,0001). Перспективы настоящего исследования заключаются в стандартизации и цифровизации протокола предоперационного обследования пациентов с травмами костей висцерального отдела черепа. Результаты имеют важное клиническое значение для разработки комплексных программ реабилитации пациентов с посттравматическими деформациями средней зоны лицевого отдела черепа, что соответствует современным подходам персонализированной стратегии лечения.
Temporomandibular disorders (TMD), particularly the myofascial subtype, are common and impair quality of life. Although conservative treatments are effective, limited access and adherence issues highlight the need for alternative approaches such as telerehabilitation. To evaluate the effects of a supervised telerehabilitation program, comparing its physical and psychosocial outcomes with those of a standard home-based exercise program in individuals with myofascial TMD. In this randomized, single-blind trial, 50 individuals with myofascial TMD were assigned to a telerehabilitation (TeleR, n = 25) or a home-based exercise group (HomeEx, n = 25), both following the same 6-week standardized exercise protocol. Outcomes included pain intensity (NPRS, primary), palpation pain, cervical-mandibular range of motion (ROM), TMD severity (FAI), oral habits (OBC), oral health-related quality of life (OHIP-14) and neck disability (NDI); analyses used non-parametric tests and GEE with FDR correction. Significant improvements were found across all outcomes within both groups (p < 0.05, r = 0.72-0.88). TeleR showed greater reductions in pain intensity (p < 0.001), cervical and mandibular ROM except for lateral excursion, and in TMD severity, OBC, OHIP-14 and NDI scores (p = 0.001-0.004). Palpation pain decreased in all muscles in both groups (p < 0.001), with greater improvements in the masseter muscles in TeleR (OR = 1.69-1.82; p < 0.001). Both telerehabilitation and home-based exercise programs effectively improve physical and psychosocial outcomes in myofascial TMD patients in the short term. Telerehabilitation is more effective in reducing pain scores and increasing maximum mouth opening. Long-term clinical studies are needed to confirm the efficacy of telerehabilitation. Registered at ClinicalTrials.gov under the identification number NCT06526845.
To analyse the biopsychosocial impact of burning mouth syndrome (BMS) on quality of life related to oral health, and to study the influence of perceived invalidation, stigma, and catastrophising on the experience of pain. Observational study of cases and controls with a sample of 226 participants (BMS group n = 156 and Control group n = 70), recruited at the University Dental Clinic of the Morales Meseguer Hospital. The following tests were administered: BPI-SF (pain and functioning interference), SSCI-8 (global stigma), ISC (internalised stigma), 3*I (perceived invalidation), HADS (anxiety and depression), PCS-6 (catastrophising scale), OHIP-14 (quality of life related to oral health) and the diagnostic legitimacy perception scale. The BMS patients presented significantly worse scores in all the variables analysed with respect to the healthy controls (p < 0.001), especially in oral health quality of life and catastrophising. In the regression models, the perceived invalidation showed an independent and consistent association with a worse oral health quality of life (p < 0.001), higher intensity of pain (p < 0.001) and higher perceived stigma (p < 0.001). BMS had a strong impact on the quality of life and emotional well-being of the patients. The perceived invalidation emerged as a factor that is closely related to pain, stigma, and deterioration of quality of life, which supports the need for a comprehensive approach that includes not only clinical management but also the recognition and validation of the experience of the patient. These findings reinforce the need for a multidisciplinary approach that includes clinical, psychological, and social dimensions in the management of BMS.
Global population ageing has intensified the need to identify determinants of functional decline beyond disease-specific measures. Within the World Health Organization framework of intrinsic capacity (IC), oral health has emerged as a potentially important factor in healthy ageing. To examine oral frailty as a multidimensional condition potentially associated with decline across IC domains in older adults. This narrative review synthesized current evidence on the relationship between oral frailty and IC within the framework proposed by the World Health Organization. Literature searches were conducted in PubMed, Scopus and Web of Science for studies published between January 2000 and September 2025 using predefined terms related to oral frailty, oral function, ageing, frailty and IC domains. Eligible publications included peer-reviewed original studies, longitudinal cohort studies, systematic reviews and meta-analyses examining oral frailty or oral health indicators in relation to ageing, frailty or IC domains. Mechanistic, epidemiological and clinical evidence suggested that oral frailty may be associated with decline across cognition, locomotion, vitality, sensory function and psychological well-being through biological, nutritional, neuromuscular, inflammatory and psychosocial pathways. Cross-sectional and longitudinal findings indicated that impaired oral function may be associated with disability, multimorbidity and mortality independently of conventional oral disease indicators. However, available evidence remains limited by heterogeneous definitions and predominantly observational study designs. Oral frailty may represent a multidimensional marker of declining intrinsic capacity and reduced functional resilience in later life. Integrating oral frailty assessment into geriatric care strategies may support interventions aimed at preserving autonomy and promoting healthy ageing.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Radiation-induced oral mucositis (RIOM) is a common and debilitating complication of radiotherapy for head and neck cancer (HNC), frequently leading to severe pain, impaired oral intake, and treatment interruption. Nutritional interventions that support mucosal integrity may reduce mucosal injury and improve recovery. To evaluate the effects of oral L-arginine and L-glutamine supplementation on the severity and recovery of radiation-induced oral mucositis and their association with salivary inflammatory and regenerative biomarkers. In this triple-blind, parallel-arm randomized clinical trial, 84 patients receiving radiotherapy for HNC were allocated to oral L-arginine, L-glutamine, or maltodextrin control three times daily from Week 2 of radiotherapy until treatment completion. RIOM severity was assessed using the WHO scale at Weeks 2, 5, and 7. Salivary interleukin-6 (IL-6), nitric oxide (NO), and epidermal growth factor (EGF) were measured. Longitudinal changes were analysed using linear mixed-effects models, and associations with mucositis severity were evaluated using correlation and receiver operating characteristic analyses. At Week 5, severe mucositis occurred in 92.9% of controls compared with 17.9% and 3.6% in the arginine and glutamine groups (p < 0.001). Intervention groups showed lower IL-6 and NO levels and higher EGF levels (p < 0.001). Biomarkers were significantly correlated with mucositis severity, and IL-6 demonstrated excellent discrimination of severe mucositis (AUC = 0.988). Oral arginine and glutamine supplementation was associated with reduced severity and enhanced recovery of RIOM. Nutritional amino acid supplementation may represent a useful adjunct in supportive oral care and oral rehabilitation for patients undergoing radiotherapy. The study was prospectively registered at ClinicalTrials.gov (Identifier: NCT07020754) on June 6, 2025.
Adherence to physical activity (PA) during hospitalization remains low in patients with oral cancer, despite the benefits of early mobilization emphasized in oncological rehabilitation protocols. Insight into how patients perceive PA in the immediate postoperative period is crucial for designing effective, patient-centered interventions. This qualitative study explored patients' experiences of PA during hospitalization following oral cancer surgery. A qualitative study was conducted using semistructured interviews guided by the behavior change wheel (BCW) framework. Dutch-speaking patients treated for oral cancer at the oral and maxillofacial department of University Hospitals Leuven (Belgium) and head and neck surgical oncology department of University Medical Center Utrecht (The Netherlands) were purposively sampled. Interviews were conducted at discharge, transcribed verbatim, and thematically analyzed in NVivo (QSR International, version 12, Burlington, MA, USA). Fifteen patients were included until saturation occurred. Seven overarching themes were identified: (A) barriers to PA, (B) activities of daily living (ADL), (C) support, (D) emotional state, (E) perceptions of PA, (F) PA patterns, and (G) recovery expectations. Walking was the most common activity, but participation was restricted by fatigue, medical devices, and a predominantly passive hospital culture. PA was strongly linked to regaining autonomy, coping with confinement, and preparing for discharge. Despite substantial barriers, patients with oral cancer demonstrate intrinsic motivation to remain active. However, this motivation often remains unmet due to insufficient personalized support and limited integration of PA into routine care. Perioperative physiotherapeutic interventions may help to overcome barriers and promote sustainable engagement in recovery-oriented activity.
Partial edentulism in the posterior maxilla is frequently complicated by alveolar bone resorption and maxillary sinus pneumatization, limiting implant placement and negatively affecting oral health-related quality of life (OHRQoL). Minimally invasive sinus augmentation techniques, such as CAS KIT-assisted indirect sinus elevation, aim to reduce surgical morbidity; however, evidence regarding patient-reported outcomes and quality of life following such interventions remains limited. To evaluate oral health-related quality of life and patient-reported outcomes following implant rehabilitation using CAS KIT-assisted indirect maxillary sinus augmentation. This longitudinal observational study included 34 patients who underwent CAS KIT-assisted transcrestal sinus augmentation with implant placement in the posterior maxilla. Postoperative recovery and satisfaction were assessed using the HRQOLquestionnaire over seven postoperative days. OHRQoL was evaluated using the OHIP-14 questionnaire at baseline and one month after prosthetic rehabilitation. Data were analyzed using repeated measures ANOVA with a significance level set at p < 0.05. HRQOLscores showed a statistically significant improvement over the seven-day postoperative period (p < 0.001), with stabilization observed from Day 5 onward. OHIP-14 scores demonstrated a highly significant reduction from baseline to post-intervention assessment (p < 0.001), indicating marked improvement in OHRQoL across all participants. CAS KIT-assisted indirect sinus augmentation followed by implant rehabilitation results in rapid postoperative recovery and significant improvement in patient-reported outcomes, supporting its role as a predictable and patient-centered treatment modality for posterior maxillary rehabilitation.
Temporomandibular disorders (TMDs) impair oral health-related quality of life (OHRQoL) through pain, dysfunction and psychosocial distress. Oral behaviours may exacerbate these impacts, but their associations across TMD subtypes remain underexplored. This study examined oral behaviours across TMD subtypes and their relationships with psychological distress, alongside their four-dimensional impacts on OHRQoL. A total of 989 first-visit TMD patients (mean age 29.7 years [SD 10.6]; 80.6% female) completed the Oral Behaviour Checklist, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Oral Health Impact Profile for TMDs. Diagnoses followed DC/TMD protocol, classifying participants into intra-articular (IT: 28.9%), pain-related (PT: 38.4%) and combined (CT: 32.7%) TMD subtypes. Jaw overuse behaviour (JOB) was categorised as normal (NO: 18.6%), low (LO: 29.4%) or high (HO: 52.0%). Analyses included nonparametric tests, Spearman correlations and logistic regressions (α = 0.05). CT and PT reported more frequent waking-state nonfunctional oral activities (WN), higher psychological distress and poorer OHRQoL than IT. HO showed significantly greater impairment across all four OHRQoL dimensions: oral function, orofacial pain, orofacial appearance and psychosocial impact. Appearance and function consistently ranked highest among dimensions. Depression and anxiety were moderately correlated with psychosocial impact (rs = 0.51-0.65). High JOB was associated with younger age (OR 0.95), higher education (ORs 2.01-2.59) and depression (OR 1.07). Low OHRQoL was linked to female sex (OR 1.67), older age (OR 1.03), PT/CT subtypes (ORs 2.49-3.60), WN (OR 1.16) and anxiety (OR 1.29). Oral behaviours, especially WN, are significantly associated with psychological distress and multidimensional OHRQoL impairment in TMD patients, with distinct patterns across diagnostic subtypes.
Burning mouth syndrome (BMS) and occlusal dysesthesia (OD) are chronic oral sensory disorders that present without evident local pathology yet frequently cause substantial diagnostic and therapeutic challenges in oral medicine practice. Although both conditions may clinically overlap, their mechanistic relationship remains poorly understood. To compare the pathophysiological mechanisms of BMS and OD, examine their potential overlap, and propose a hypothesis-generating conceptual framework of oral sensory dysregulation. Relevant literature was identified through searches of PubMed, Scopus, and Google Scholar using combinations of the terms "burning mouth syndrome," "occlusal dysesthesia," "phantom bite syndrome," "central sensitization," and "small fibre neuropathy." Additional studies were identified through manual review of reference lists. Priority was given to clinically and mechanistically relevant neuroimaging, psychophysical, and pharmacological studies. This review was conducted as a narrative synthesis rather than a systematic review. Current evidence suggests that BMS involves trigeminal small-fibre dysfunction with subsequent central nociceptive amplification, whereas OD predominantly reflects maladaptive central processing of otherwise intact periodontal mechanoreceptive input. Despite these mechanistic differences, both conditions demonstrate overlapping features including affective comorbidity, sensory hypervigilance, altered prefrontal and frontostriatal involvement, and responsiveness to centrally acting pharmacological agents. Clinical overlap between BMS and OD has also been reported, particularly in treatment-refractory presentations. BMS and OD may represent distinct but partially overlapping phenotypes within a broader framework of oral sensory dysregulation. Recognition of shared and divergent mechanisms may improve differential diagnosis, support mechanism-informed pharmacological management, and guide future hypothesis-driven research in oral medicine.
This study aimed to evaluate the oral health and self-perceived status of juvenile female inmates. A cross-sectional study was conducted among 100 female juvenile inmates aged 11-14 years, selected through convenience sampling. Data were collected using a self-administered questionnaire covering sociodemographics, Decayed, Missing, and Filled Teeth (DMFT), Oral Hygiene Index-Simplified (OHI-S), and the Child Perceptions Questionnaire (CPQ11-14) for self-perceived oral health. Statistical analysis was performed using the Pearson correlation coefficient. Decayed, Missing, and Filled Tooth scores were significantly associated with CPQ categories, with 63.3% of caries-free children reporting excellent oral health-related quality of life (OHRQoL). As DMFT increased, OHRQoL declined-only 25.8% with DMFT = 2 reported excellent OHRQoL, while 12.9% rated it poor. Similarly, better oral hygiene was linked to higher OHRQoL: 55.6% of children with good hygiene reported excellent OHRQoL, compared to 40.6% with fair hygiene. Poorer clinical status correlated with lower self-perceived OHRQoL. The study highlights a clear link between poor oral health and negative self-perception among female juvenile inmates. Integrating oral health care with education and psychological support in detention settings is crucial to improve their overall well-being, self-esteem, and rehabilitation outcomes.
<p><strong>Introduction: </strong>Total laryngectomy (TL) remains the standard treatment for advanced la‑ ryngeal cancer, and its perioperative management requires close collaboration within a multidisciplinary team, including anaesthesiologists and clinical nutritionists.</p><p><strong>Aim:</strong> The aim of this study was to analyse the perioperative course of patients un‑ dergoing TL from both an anaesthesiologist's and a nutritionist's perspective, with a particular focus on the feasibility and performance of structured data extraction from electronic medical records using large language models (LLMs).</p><p><strong>Material and methods:</strong> We performed a single‑centre retrospective analysis of 43 consecutive patients undergoing TL (ICD‑9 codes 30.32, 30.39, 30.41, 30.49) be‑ tween January 2024 and April 2026. Clinical data, including physician notes (n = 845), nursing notes (n = 2578), discharge summaries (n = 173), and consultations (n = 123), were subjected to structured extraction using large language models (gemma-3-31Bit/gemma-4-26B-it). Demographics, tumour stage, length of stay (LOS), periopera‑ tive nutrition, pharmacotherapy, postoperative complications, temporal laboratory trends, and rehabilitation were analysed.</p><p><strong>Results: </strong>The cohort comprised 35 men (81%) and 8 women (19%), with a mean age of 66.4 9.8 years; pT4a (49%) and pN0 (82%) predominated. Median LOS was 15.0 days (IQR 13.1-16.5). Enteral nutrition via nasogastric tube was used in 95% of patients, and oral intake was initiated at a median of postoperative day 13. Multimodal anal‑ gesia based on intravenous paracetamol (60%), ketoprofen (47%), and metamizole (40%) was routinely employed, while strong opioids were used in only 5% of pa‑ tients. Postoperative complications occurred in 22.5% of cases, with pharyngocuta‑ neous fistula (PCF) being the most frequent (12.5%). In‑hospital mortality was 0%, and overall mortality during a median 12‑month follow‑up was 2.3%. CRP peaked on postoperative day 3 (mean 114 mg/L). Pharmacologic VTE prophylaxis was admi‑ nistered in 65% of patients.</p><p><strong>Conclusions:</strong> In TL patients, enteral feeding forms the backbone of nutritional sup‑port, and multimodal analgesia provides effective pain control, whereas VTE pro‑phylaxis and other modifiable elements of perioperative care warrant optimization within prehabilitation and ERAS-based protocols.</p><p>&nbsp;</p>.
This study investigated the clinical characteristics and management of free flaps for oral and maxillofacial reconstruction. A total of 689 subjects were categorized into the no-flap crisis group (620 flaps in 620 subjects) and the flap crisis group (80 flaps in 69 subjects). Demographic and clinical data, including gender, age, disease types, body mass index, preoperative chemoradiotherapy, poor lifestyle habits, postoperative length of stay, medical cost, intraoperative blood loss, during of surgery, hypertension and diabetes mellitus, were analyzed. In the flap crisis group, the distribution characteristics of flap types and the timing of crisis were examined. The overall survival rate of free flaps was 95% (95% CI [93.4-96.6]), with a salvage rate of 49.28% (95% CI [37.2-61.4]). The two groups did not significantly differ in age, body mass index, preoperative chemoradiotherapy, hypertension, diabetes mellitus or poor lifestyle habits. However, significant differences were observed in postoperative length of stay, during of surgery, medical cost and intraoperative blood loss. Within the flap crisis group, 65 flaps (94.20%) underwent crisis within the first 84 hours, and flap crisis showed a strong association with flap failure. Free flap reconstruction is a dependable method, with most crises occurring within 84 hours, highlighting the imperative for early surgical exploration to avert necrosis.
Corticobulbar symptoms, including dysarthria and dysphagia, are frequent manifestations of Huntington's disease, yet evidence on speech and swallowing rehabilitation remains limited. This study explored the potential effects of a home-based corticobulbar rehabilitation program on selected speech and swallowing-related clinical outcomes in Huntington's disease. This prospective, non-randomized, observational controlled study included 40 adults with genetically confirmed Huntington's disease. Twenty-five patients entered a 6-month home-based corticobulbar rehabilitation program, while 15 received standard care without structured speech or swallowing rehabilitation. Six patients in the rehabilitation group discontinued the program because of rapid progression of corticobulbar symptoms; therefore, complete-case outcome analyses included 34 patients: 19 rehabilitation completers and 15 controls. Speech and swallowing outcomes were assessed at baseline and month 6 by blinded speech-language pathologists using an exploratory clinical rating scale. Secondary outcomes included body mass index and Unified Huntington's Disease Rating Scale Total Motor Score. No intervention-related adverse events were reported among completers. Breathy voice worsened in 6 control patients but in none of the rehabilitation completers (p = 0.004). Speech rate normalization was more frequent in the rehabilitation group than in controls (p = 0.003). Oral residue decreased more frequently in the rehabilitation group, whereas it increased more frequently in controls (p = 0.039). Body mass index was relatively preserved in the rehabilitation group overall (p = 0.025). UHDRS Total Motor Score changes favored rehabilitation but were considered exploratory because motor assessment was not blinded. Home-based corticobulbar rehabilitation may be feasible and associated with favorable exploratory changes in selected speech and swallowing parameters in Huntington's disease.
The Oral Behaviours Checklist (OBC) is widely used, but its latent structure remains unclear. This study was designed to clarify its latent structure and to identify common factors and isolated items relevant to TMD assessment. A cross-sectional study of 1014 patients with TMD (79.1% female; median age, 25.0 years) was conducted. The waking-state OBC's structure was examined using Bayesian exploratory factor analysis (EFA) and validated by confirmatory factor analysis (CFA). Network analysis was used to identify central and isolated items and to examine bridging connections with depression, anxiety, jaw function, and oral health-related quality of life. Bayesian EFA revealed a robust five-factor structure for the waking-state OBC: (1) Awake Bruxism, (2) Jaw Posturing, (3) Oral Manipulation, (4) Jaw Bracing, and (5) Functional Behaviours. This structure was supported by sensitivity analyses and demonstrated good fit in CFA (CFI = 0.943, TLI = 0.919, RMSEA = 0.050, SRMR = 0.044). Network analysis identified three isolated items. Only the Awake Bruxism factor was significantly associated with pain-related TMD and pain intensity. Cross-scale network analysis showed the Oral Manipulation factor was a central bridge to depression, while Awake Bruxism items bridged to anxiety, jaw dysfunction, and reduced oral health-related quality of life. The waking-state OBC exhibits a five-factor structure, with three isolated items that should be evaluated separately. For clinical efficiency, focusing on the core 'Awake Bruxism' items is justified, whereas factor-specific scoring is recommended in research to capture the heterogeneity of oral behaviours.
To explore the therapeutic effects of OMT in children with AOB in the mixed dentition phase, including a reduced form of OMT (focusing exclusively on breathing pattern and resting postures; OMTBPO) and traditional OMT (also including strength training and correction of swallowing; OMTBPSS). In this double-baseline, longitudinal study, eight children with AOB (mean age 8.1 years old) were randomly allocated to the OMTBPO (n = 4) or OMTBPSS group (n = 4). Each participant received 7.5 h of OMT across 10 sessions. Outcomes included occlusal parameters, Photographic Open bite Severity Index (POSI) and Peer Assessment Rating (PAR) using 3D intraoral scans, orofacial function based on clinical and standardized assessment (Orofacial Myofunctional Evaluation with Scores; OMES), strength and endurance measurements, and oral health-related quality of life (child oral health impact profile - ortho; COHIP-ortho). Immediately post-therapy, anterior tongue strength had significantly increased in the full sample. At three-month follow-up, palatal volume, lateral lip endurance, and OMES function and deglutition scores had significantly increased, and vertical overbite had decreased. The PAR index showed a significant proportional reduction of 35% from baseline to the last follow-up moment (on average 6 months after therapy). The OMTBPO group showed significantly lower rates of atypical tongue posture and interdental articulation at six-month follow-up. This study took a first step in exploring the effectiveness of OMT components in mixed-dentition AOB. Measurable short- to mid-term functional and occlusal improvements were found, and comparable outcomes between protocols suggest that posture-focused OMT may be an efficient interceptive approach. Further research including randomized controlled trials with larger sample sizes is required to provide evidence on efficacy and long-term stability.
Orthodontic treatment is often sought for aesthetic and psychosocial reasons, while the functional consequences of dental malocclusions remain less frequently integrated into clinical decision-making. To evaluate how the presence, type, and combinations of dental malocclusions affect masticatory performance using Indicator of Anatomical Malocclusion (IAM) with objective physiological measures of mastication. Masticatory performance was assessed using a two-colour chewing gum mixing test (20 chewing cycles; Hue-Check Gum), with colour homogeneity quantified as percentage mixing index (Mix%). Deficient performance was defined as Mix% < 85.44%. Malocclusion was characterized using Angle's classification, number of functional dental units, and IAM assessing craniofacial anomalies, dental number anomalies, crowding, anteroposterior, transverse, and vertical discrepancies. Associations between malocclusion and masticatory performance were explored using univariate followed by logistic regression analyses. The study included 345 patients (age 14.6 ± 6.9 years) seeking orthodontic consultation. 57.1% of participants exhibited deficient masticatory performance. Independent predictors of deficient mastication included IAM items related to dental number anomalies (OR = 2.59; 95% CI: 1.16-5.75), transverse discrepancies (OR = 1.91; 95% CI: 1.03-3.53), age (OR = 0.92; 95% CI: 0.88-0.96), and Angle Class II/III (OR = 1.65; 95% CI: 1.02-2.66). Subgroup analyses showed that transverse discrepancies increased deficiency in Class I malocclusion, while Class III participants exhibited high prevalence regardless of anomalies. The combination of transverse discrepancy and infraocclusion was associated with the highest prevalence of deficiency (75%). Using objective masticatory assessment, masticatory performance is associated with dental malocclusions characteristics, and the coexistence of specific traits as captured by the IAM. These findings support the integration of functional evaluation into orthodontic diagnosis. Interventional studies are needed to determine whether orthodontic treatment improves masticatory performance.
Tooth count and edentulism have long served as key indicators in oral health research, though edentulism is becoming rarer in Western societies. In contrast, occlusal pairs as an alternative measure, and their association with sociodemographic factors, have received far less attention. Aim of the study was to gain population-level information on the number of teeth and posterior occlusal pairs (POPs) in the Finnish adult population and whether they are associated with sociodemographic factors. Study employed data from the nationwide Healthy Finland 2023 cross-sectional study. Participants aged 20 years and over (n = 1798) were examined clinically by trained dentists. Outcome variables were number of teeth and POPs. Sociodemographic explanatory factors were age, sex, marital status, education level, area of residence, income and urbanization. Associations were tested with Poisson regression analyses. Prevalence of edentulism was 4.2%. Participants had an average of 24.8 teeth (SD 7.3) and 6.5 POPs (SD 2.8). Those aged 20-54 years had almost complete dentition (mean 27.1-29.1 teeth). Older age, lower education, lower income, and being widowed were associated with a lower number of teeth and POPs. Being unmarried or living in Eastern or Northern Finland was associated with a lower number of teeth, whereas rural residence was associated with fewer POPs. Finnish adult oral health has continued improving in terms of number of teeth and prevalence of edentulism. However, better sociodemographic status is still associated with higher tooth count and POPs, education level having the strongest association.