PREVENTION OF CANDIDIASIS IN PATIENTS USING REMOVABLE DENTURES

Despite innovations in orthopedic dentistry, removable dentures belong to the most popular orthopedic care category. Removable dentures are combined stimuli that affect the mucous membrane and neuro-receptor apparatus. Acrylic plastic prostheses, widely used in prosthetic dentistry, have a negative side mechanical, chemical-toxic, sensitizing, and thermal insulating effect on oral tissue and prosthetic impression area. This is often complicated by a violation of the biocenosis of the oral cavity, the growth of pathogenic microflora that releases toxins, especially an increase in the number of yeast colonies that irritate the oral mucosa and prosthetic stomatitis. It was observed 100 patients with oral candidiasis of various age groups from 45 to 65 years. Of these, 60 patients with removable plate prostheses; 40 patients with partially removable prostheses. Chronic forms of candidiasis were diagnosed in 40 patients and with exacerbation of chronic forms of candidiasis in 60 people. The number of untreated carious cavities and poor hygienic condition of the oral cavity directly affects the severity of candidiasis. Acute forms of candidiasis were observed mainly in patients with high DMF and PMA indices. The severity of candidiasis depends on the degree and duration of wearing dentures and hygienic conditions - the most severe forms of invasive candidiasis were observed in the presence of removable plate prostheses, the complete absence of teeth, and the use of a prosthesis for more than 10-15 years. A combined lesion of the oral mucosa and the red border of the lips was observed mainly in patients older than 60 years. The presence of candidiasis in the oral cavity in patients with removable plate prostheses leads to a statistically significant change in the indicators of local immunity of the oral cavity: an increase in the concentration of serum IgG and IgA and the values of the coefficient of the balance of local immunity factors.

Two-year clinical and economic burden, risk and outcomes following application of software-assisted hexapod ring fixation systems

Background Multiplanar external fixation systems that employ software-assisted deformity correction consist of rings connected by angled struts, defined as hexapod ring fixators (HRF). Costs and outcomes associated with the application of HRFs are not well documented. This study was designed to provide a nationwide baseline understanding of the clinical presentation, risks, outcomes and payer costs, and healthcare resource utilization (HCU) of patients requiring application of an HRF, from the day of, and up to 2 years, post-application. Methods Patients with HRF application (“index”) between 2007 and 2019 within the IBM Marketscan® Commercial Claims database were identified and categorized based on diagnosis: acquired deformity, arthropathy, congenital deformity, deep infection, nonunion, fracture, and other post-operative fracture sequelae. Demographics, comorbidities at index, complications post-index, HCU, and payments were analyzed. Payments were estimated using a generalized linear model and were adjusted for inflation to the 2020 consumer price index. Rates of deep infection and amputation were estimated up to 2 years post-index using Poisson regressions, and risk factors for each were estimated using logistic regression models. Results Six hundred ninety-five patients were included in our study (including 219 fractures, 168 congenital deformities, 68 deep infections, 103 acquired deformities). Comorbidities at index were significantly different across groups: less than 2% pediatrics vs 18% adults had 3 or more comorbidities, < 1% pediatric vs 29% adults had diabetes. Index payments ranged from $39,250–$75,350, with 12-months post-index payments ranging from $14,350 to $43,108. The duration of the HRF application ranged from 96 days to 174 days. Amputation was observed in patients with deep infection (8.9, 95% confidence interval (CI): 3.2–23.9%), nonunion (5.0, 95%CI: 1.6–15.4%) or fracture (2.7, 95%CI: 0.9–7.6%) at index. Complicated diabetes was the main predictor for deep infection (odds ratio (OR): 5.14, 95%CI: 2.50–10.54) and amputation (OR: 5.26, 95%CI: 1.79–15.51). Conclusions Findings from this longitudinal analysis demonstrate the significant heterogeneity in patients treated with HRF, and the wide range in treatment intensity, payments, and outcomes. Risks for deep infection and amputation were primarily linked to the presence of complicated diabetes at the time of HRF application, suggesting a need for careful management of comorbid chronic conditions in patients requiring HRF for orthopedic care.

Comprehensive study of dental orthopedic morbidity in elderly people and the ways to eliminate it

Relevance. The social profile of senile people has some differences from other age categories of patients. People of the older age group dream of finding harmony with the outside world, preserving the love of the nearest and dearest and relatives and the opportunity to communicate with the opposite sex. Dental health and the resulting quality of life contributes to this in many ways. A smile, laughter, the ability to talk without feeling embarrassed by splashing saliva, bad breath or visible absence of teeth, taking your favorite food together with the nearest and dearest are the main indicators of their life quality dependent on dental health, without which it is impossible to imagine a modern person High prevalence of dental diseases among senile people cause a high need for making various dental prosthetic structures. Studying dental health of this category of citizens can become a promising area of practical healthcare, a comprehensive study of this issue has determined the relevance and purpose of this publication.Materials and methods. The object of the study was senile people, 75-89 years old, who sought dental orthopedic care in municipal healthcare institutions of Cheboksary, the Chuvash Republic. The sample size was 481 people.Results. It was found that the maximum number of patients in the age group of 75-88 years - 188 persons (39.1%) - had complete absence of teeth, the total number of patients with the first, second, third and fourth classes according to the Kennedy classification of dentition defects was 56 persons (11.6%), 143 persons (29.7%), 79 persons (16.4%), 15 persons (3.2%), respectively. The total number of patients with the first Kennedy subclasses (class 1-3) was 135 persons (33.1%), with the second subclasses – 69 persons (16.9%), with the third subclasses - 53 persons (13.0%). The analysis of dental prosthetic structures mounted in elderly patients showed that the total number of orthopedic structures amounted to 4,615 units, among which there were pin structures - 1,328 units (28.8%); the total number of artificial dental crowns was 1,662 units (36.0%); the total number of prosthetic bridges – 620 units (13.4%); removable laminar dentures in partial loss of teeth – 445 units (9.6%); clasp prostheses – 184 units (4.1%); removable laminar dentures in complete loss of teeth – 376 units (8.1%).Conclusions. All types of dental orthopedic diseases are commonly found in patients of senile age, they had all kinds of dental prosthetic structures made. The choice of the dental prosthetic design used in orthopedic dental rehabilitation was determined by the type of dentition defect and met the principles of rational prosthetics.

Digital mental health intervention for orthopedic patients with symptoms of depression and/or anxiety: Pilot feasibility study (Preprint)

BACKGROUND Depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. Nevertheless, addressing mental health is not yet a routine part of standard orthopedic treatment, in part due to access related barriers. Digital mental health intervention offers the potential to be a scalable resource that could feasibly be incorporated into orthopedic care. OBJECTIVE The primary purpose of this study was to assess the feasibility of introducing a digital mental health intervention (Wysa) within an outpatient orthopedic setting to patients who endorse coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. METHODS In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a non-surgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and/or Anxiety score ≥ 55). Enrollment was performed face-to-face by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided two months of access to a mobile app called Wysa, which is an established, multi-component digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engaging with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at two-month follow-up between high Wysa users and low Wysa users, defined by a median split. RESULTS The recruitment rate was 61/208 (29%), retention rate was 51/61 (84%), and engagement rate was 44/61 (72%). Compared to low users, high Wysa users achieved greater improvement in PROMIS Anxiety (between-group difference -4.2 points [95% CI -8.1 to -0.2], P=.044) at two-month follow-up. Between-group differences in PROMIS Depression (-3.2 points [-7.5 to 1.2], P=.15) and Pain Interference (-2.3 points [-6.3 to 1.7], P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function were comparable between groups. CONCLUSIONS Delivery of a digital mental health intervention within the context of orthopedic care is feasible and demonstrates potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. CLINICALTRIAL ClinicalTrials.gov NCT202005219

PREVENTION OF CANDIDIASIS IN PATIENTS USING REMOVABLE DENTURES

Background: Despite innovations in orthopedic dentistry, the manufacture of removable dentures belongs to the most popular orthopedic care category. Removable dentures are combined stimuli that affect the mucous membrane and neuro-receptor apparatus. Acrylic plastic prostheses, widely used in prosthetic dentistry, have a negative side mechanical, chemical-toxic, sensitizing, and thermal insulating effect on oral tissue and prosthetic impression area. This is often complicated by a violation of the biocenosis of the oral cavity, the growth of pathogenic microflora that releases toxins, especially an increase in the number of yeast colonies that irritate the oral mucosa and prosthetic stomatitis. According to the WHO, one-fifth of the world s population suffers or has suffered various candidiasis forms at least once. The worldwide increase in the incidence of the disease is primarily related to the fact that this infection is opportunistic, more than half of the world s population is a carrier of fungi of this kind, i.e., in most cases, it is an endogenous infection, which makes candidiasis different from other opportunistic mycoses. Aims: The purpose of this study was to study the prevalence of candidiasis in patients using removable dentures and to evaluate the effectiveness and prevention of candidiasis treatment. Methods: 100 patients with oral candidiasis of various age groups from 45 to 65 years were observed. Of these, 60 patients with removable plate prostheses; 40 patients with partially removable prostheses. Results and Discussion: Chronic forms of candidiasis were diagnosed in 40 patients and with exacerbation of chronic forms of candidiasis-60 people. The number of untreated carious cavities and poor hygienic condition of the oral cavity directly affects the severity of candidiasis. Acute forms of candidiasis were observed mainly in patients with high DMF and PMA indices. The severity of candidiasis depends on the degree and duration of wearing dentures and hygienic conditions - the most severe forms of invasive candidiasis were observed in the presence of removable plate prostheses, the complete absence of teeth, and the use of a prosthesis for more than 10-15 years. A combined lesion of the oral mucosa and the red border of the lips was observed mainly in patients older than 60 years. Conclusions: The presence of candidiasis in the oral cavity in patients with removable plate prostheses leads to a statistically significant change in the indicators of local immunity of the oral cavity: an increase in the concentration of serum IgG and IgA and the values of the coefficient of the balance of local immunity factors.

CONDITIONAL TISSUE CONDITION IN PATIENTS WITH PROSTHETIC DENTISTS IN THE PROCESS OF ORTHOPEDIC TREATMENT WITH PROSTHESES MODIFIED BY NANOMATER

The main cause of prosthetic stomatitis belongs to the chemical and toxic action of the residual monomer of the prosthesis base, which is a protoplasmic poison. Occurrence of prosthetic stomatitis depends not only on quality of production of prosthesis in laboratory though at non-observance of technology indicators of residual monomer can reach 2-5%, but also at individual intolerance at its minimum concentration in a prosthesis after polymerization - 0,2-0 .5%. The aim of our study was to increase the effectiveness of orthopedic treatment of patients with prosthetic stomatitis by coating the plastic of removable prostheses with nanoscale materials. Materials and methods. To solve this goal, we studied the condition of the tissues of the prosthetic place of patients with prosthetic stomatitis with prosthetic removable prostheses with modified plastic. Orthopedic dental treatment of 50 people was examined and performed, including 25 people (the second group, prostheses were not covered with nanoparticles) and 25 people (the third group, prostheses were covered with nanoparticles). The first control group consisted of 10 people without signs of pathology. Prior to treatment, all patients had removable acrylic plastic dentures. The reason for seeking orthopedic care was a violation of masticatory function and the inability to use previously made prostheses due to the development of pain in the soft tissues of the prosthetic place. Complaints of pain were observed in all patients of varying intensity, impaired fixation and stabilization of the prosthesis due to swelling of the mucous membrane of the soft tissues of the prosthetic place, heartburn and dryness were observed in 90% of patients. Complaints were also about speech and aesthetic defects. Patients of III group after two weeks of using prostheses were coated with the inner surface of the prosthesis, which is in direct contact with the mucous membrane of the prosthetic place with molecules of fullerene C60, by magnetron sputtering. For this purpose, the prostheses were removed from the patients for several days and returned after the coating with the nanomaterial, after which the observation was continued. The results. After coating the prostheses in patients of group III with Fullerene C60, we observed the disappearance of inflammation of the mucous membrane under the prosthesis and patients noted the absence of discomfort. Рatients in II group had a negative dynamics in 80% and had diffuse inflammation of the mucous membrane under the prosthesis. Within 3 months of use, 18 patients (72%) in II group reported that they stopped using removable dentures during the day, due to unpleasant pain under the prosthesis, and used only during meals and during conversations. In contrast to II group, patients in III group did not notice discomfort when using plate prostheses. Conclusions. Obtained in the course of the work convincingly prove the effectiveness of the use of removable plate prostheses with nanocoating for the treatment and prevention of prosthetic stomatitis in patients. This is evidenced by the data of objective examination and the disappearance of complaints from patients.

THE IMPACT OF COVID-19 ON THE ORTHOPEDIC CARE SYSTEM IN A PRIVATE HOSPITAL

ABSTRACT Objective: To evaluate and compare the patient flow in the emergency department and the number of surgeries performed, as well as to determine the incidence of diseases due to the impact generated by the pandemic in April, May, June, and July 2020. Methods: This is a retrospective cross-sectional study that analyzed medical records using the TASY Phillips software. The 2019 information was compiled and served as a basis accomplish our comparative analyses. The ICD-10 was used to determine the different conditions considering the highest incidence of them. Results: there was a reduction in attendance of 49.3%; the reduction in the number of surgeries was 34.39%; among the main diagnoses in decreasing order were: Pain in the Lumbar Spine (18.76%), Joint Pain (14.82%), Neck Pain (7.7%), Ankle Sprain (4.2%) and Pain in the Limb (3.54%). Conclusion: There was a decrease in the number of visits and the overall incidence of surgeries in our service. Level of Evidence II, Retrospective Study.

COMPREHENSIVE STUDY OF DENTAL ORTHOPEDIC MORBIDITY IN ELDERLY PEOPLE AND THE WAYS TO ELIMINATE IT

Social longevity of elderly people is largely determined by their dental health. The ability to talk freely without feeling socially awkward due to bad breath or visible absence of teeth greatly facilitates the lives of elderly people engaged in work. Unfortunately, the majority of elderly people have compromised dentitions, restored by dental prosthetic structures that meet social and functional requirements to varying degrees. The high need of elderly people in stomatological orthopedic treatment and the demand for comprehensive dental rehabilitation determined the relevance and purpose of this publication. Research methods. The object of the study was elderly people aged 60-74 years who sought dental orthopedic care in dental medical organizations, the sample size was 408 persons. Results. The maximum number of patients in the 60-74 age group was found to have complete absence of teeth – 26.5%, the total number of patients with the first, second, third and fourth classes according to Kennedy classification was 13,3%, 24,7%, 24,9%, 10,6% accordingly. The total number of patients with the first Kennedy subclasses (class 1-3) was 135 persons (33.1%), with the second subclasses – 69 persons (16.9%), with the third subclasses – 53 persons (13.0%). Conclusions. All types of orthopedic dental structures were manufactured for elderly patients. The choice of the dental prosthetic design used in orthopedic dental rehabilitation was determined by the type of dentition defect and met the principles of rational prosthetics.

P092 Infantile osteopetrosis: a case report Traduction en Anglais

Background Infantile osteopetrosis is a rare genetic disorder characterized by increased bone density due to defective osteoclastic resorption. Case report We report the case of a 6 years old girl, born of a consanguineous marriage, hospitalized in our department for bone deformations and visual disturbances. On clinical examination, there was conjunctival pallor, thoracic deformity, genu-valgum and dentigenesis disorder as well as nystagmus and severe loss of visual acuity. The complete blood count showed regenerative normochromic normocytic anaemia as well as thrombocytopenia. Assessment for infectious disorders was negative. The skeletal X-ray revealed diffuse osteocondensation of the skeleton. The CT scan of the rock bones of cranial bases revealed bilateral segmental stenosis of the facial canal with densification of the ossicular chain and thickening of the stapes. Cranio-orbital MRI revealed bilateral optic duct stenosis with atrophy of the optic nerves and chiasma. The diagnosis of osteopetrosis was retained according to this set of clinical and radiological arguments. Unfortunately, the genetic study could not be performed. Histocompatible bone marrow transplant may be curative but was not available for our patient. Genetic counseling was offered for the family as well as dental and orthopedic care. Conclusion Infantile osteopetrosis is a rare but serious pathology that can have severe functional repercussion and even be life-threatening, requiring early diagnosis and management.