Bhushan Kumar

Patient-reported outcomes in children suffering with mild to moderate tonsillitis versus those in children with severe tonsillitis

OBJECTIVE To quantify the impact that mild to moderate tonsillitis has on quality of life in children and compare it to that of severe tonsillitis. METHODS In this prospective study, parents of children aged 0-16 years completed the Paediatric Throat Disorders Outcome Test, and quality of life scores in the tonsillitis groups were compared. RESULTS A hundred children were recruited: 58 had severe tonsillitis and were offered surgery, and 42 had mild to moderate tonsillitis and were managed conservatively. The mean outcome test scores in those children undergoing surgery were 36.7 for tonsillectomy patients and 36.9 for adenotonsillectomy patients, compared with a score of 31.5 for the mild to moderate tonsillitis patients (p = 0.019). CONCLUSION Children with mild to moderate disease had significantly better quality of life scores than those with severe disease. It is thought that those with mild to moderate disease have short-term improvements in general quality of life after surgery, which disappear in the medium term. This transient improvement needs to be balanced against the morbidity of the surgery and the cost burden to the National Health Service. The results of this study support the national drive towards limiting tonsillectomy to children with severe tonsillitis or obstructive sleep apnoea.

Waiting-list prioritization in the National Health Service

The aim of this study was to find out whether there is a consensus of opinion among healthcare providers and different sections of the public on the relative prioritization of common otolaryngological conditions for outpatient consultations and inpatient treatment. ENT consultants, general practitioners, administrators, NHS employees, non-ENT patients and members of the general public were given common scenarios of otolaryngological conditions and asked to prioritize them in order of importance. All the groups gave top priority for patients with suspected cancer of the larynx (outpatients) and for surgical treatment of cancer. Children with hearing problems were more commonly ranked in the top three categories than children requiring treatment for sore throats. All groups assigned those requiring rhinoplasty, treatment for snoring or hearing aids to the last three ranks. This study shows that there is a remarkable uniformity of opinion in determining clinical priorities which is similar to the traditional policies practised by UK ENT consultants.

Full mouth rehabilitation of Kennedy class 1 edentulous situation complicated with excessive deep bite: an interdisciplinary approach

Oral rehabilitation of bilateral mandibular edentulous posterior segments becomes even more difficult if patient had severe deep bite in natural dentition. This case report demonstrates the intelligent way of managing severe deep-bite by adapting multi-disciplinary approach. Involved steps are: Mandibular subapical osteotomy of mandibular anterior segment to lower down the fragment; secondly, the maxillary anteriors were done with crown lengthening followed by decreased incisal display and thirdly by restoring vertical dimension of occlusion by replacement of missing posterior teeth. The addition of surgical intervention (anterior mandibular osteotomy) in the present case has found to be effective and quick adjunctive in achieving functional improvement in occlusion by reducing anterior teeth overlap (deep bite), by decreasing incisal guidance steepness and esthetic display of anterior teeth. Bilateral edentulous situation was managed by precision attachment retained cast partial denture. A satisfactory functional and esthetic result was obtained.

Restricted mouth opening and its definitive management: A literature review

Purpose: This review was intended to discuss the various possible modifications suggested in the literature for prosthetic steps and surgical corrective procedures in nonresponding or complicated cases during rehabilitation of patients with restricted mouth opening. Material and Methods: Medline, PubMed, and Google were searched electronically for articles using keywords: microstomia and treatment options for restricted mouth opening. The various articles on prosthodontic rehabilitation in microstomia were segregated. From these, various modifications in the prosthetic steps were reviewed. Results: Oral hygiene maintenance is difficult for patient either due to limited access or due to associated lack of manual dexterity, so dental decay and periodontal problems are more extensive in such patients; hence, tooth loss is a common finding. All prosthetic procedures require wide mouth opening to carry out various steps, starting from tray placement during impression making to the final prosthesis insertion, especially removable prosthesis. Various prosthetic modifications given by authors are included in this review for each step in prosthodontic management. A total of eight stock tray designs, 12 custom tray designs, and 17 removable prosthesis designs are discussed along with fixed (either tooth-supported or implant-supported) and maxillofacial prosthesis. However, some patients require surgical intervention also for the correction of microstomia either for function or for esthetic purpose before prosthetic rehabilitation and are also enumerated here. Conclusion: Among all prosthetic restorative options, removable prosthesis is most difficult for dentist to fabricate as conventional methods are either very difficult or impossible to apply. To get a more accurate final prosthesis, we need to modify these steps according to the existing case. Several modifications available are discussed here which can help while managing these patients.

A comparative study for plaque removing efficacy between commonly used denture cleansers in India

Aim: A comparative study for plaque removing efficacy between toothpaste, liquid handwashing soap, and two chemical-soak denture cleansers (clinsodent denture cleansing powder and fittydent denture cleansing tablet). Materials and Methods: A total of 140 healthy complete denture patients were selected and checked for denture cleansing using toothpaste, liquid handwashing soap, and two chemical denture cleansers: Clinsodent powder and fittydent tablets. Cleansing with plain water was kept as control for twenty patients. Results: The data were analyzed using Wilcoxon signed ranks test for checking the efficacy. The Kruskal–Wallis test was used for comparing the plaque removing efficacies of each denture cleanser used in the study. All four denture cleansers were significantly effective in removing plaque when compared with plain water, but there was no significant difference among them. Conclusions: There was no significant difference among action of four denture cleansers used in this study. Thus we can infer that patients can use liquid handwashing soap or commercial products to overcome disadvantages of toothpastes. Recommendation from the results of this study is the use of liquid handwashing soap for cleansing after every meal and soaking of the denture in commercial denture cleanser during the night.

An Innovative Solution To Slumped Cheeks: “Spring Retained Cheek Plumper”- A Case Report.

Completely edentulous ridges and their residual ridge resorption are two inevitable physiologic/ pathologic processes which cause functional and esthetic impairment of the patient. Sometimes in cases where ridge resorption is more and artificial denture is not able to support facial soft tissues adequately; it leads to sunken/hollow cheek appearance. Such cases are ideal candidates for cheek plumper. However, these appliances stretch cheeks away from denture flange resulting in loss of vacuum seal, hence poor retention. Few patients feel discomfort in their facial muscles due to prolonged wearing, so the removable plumpers are more accepted by patients as compared to fixed ones. In this article a simplified design of removable cheek plumper is discussed which can be easily fabricated within available resources and lower jaw is restored with implant supported overdenture to combat the problem of retention loss.