Pernilla Odile Malin Östenson

• Mahic, Malik; Östenson, Pernilla Odile Malin & Nordgarden, Hilde (2024). OROFACIAL FINDINGS IN THREE CHILDREN WITH MIRAGE SYNDROME. Fulltekst i vitenarkiv Vis sammendrag

  Background: MIRAGE syndrome, a rare a multisystem condition attributed to a variant in the SAMD9 gene, is characterized by Myelodysplasia, Infection, Restriction of growth, Adrenal hypoplasia, Genital phenotypes, and Enteropathy. Despite its clinical complexity, orofacial manifestations, orofacial function, and techniques for behavioral management support have, to our knowledge, not been addressed in the literature. We present, with consent from their parents, experiences and clinical data, from three children with this very rare syndrome (<1/1000 000). Results: The parents of all three children, one girl and two boys, reported intense tooth grinding and premature loss of primary teeth occurring before the age of 3. Following the exfoliation of teeth, the intensity in tooth grinding notably diminished. Other reported risk factors related to oral health included gastroesophageal reflux, frequent vomiting, tube feeding, dependence on breathing support, and self-inflected injury to the face. Moreover, the children exhibited aversion to tactile stimulation in various daily life scenarios. Through our observations, implementing an orofacial stimulation and training program proved effective in enhancing tolerance to touch, fostering acceptance of tooth brushing and wearing breathing mask. It also heightened their engagement in oral activities. Clinical examination revealed excessive tooth wear, and microdontia was noted in the girl. Exfoliated teeth exhibited complete or nearly complete root lengths, while no indications of infections were observed in either exfoliated or mobile teeth upon radiographic evaluation. Conclusion: Our findings indicates that children with MIRAGE syndrome have both behavioral and medical health conditions that may affect their oral health and quality of life. We therefore suggest that oral health professionals contributes in the multidisciplinary approach in MIRAGE syndrome.

• Mahic, Malik; Östenson, Pernilla Odile Malin; Yttervoll, Anna H. Haverinen & Nordgarden, Hilde (2022). INTERDISCIPLINARY COLLABORATION AND PRACTICAL APPLICATION OF ORAL MOTOR THERAPY (OMT) IN TWO CASES WITH REDUCED MOUTH OPENING IN DYSTROPHIC EPIDERMOLYSIS BULLOSA (DEB). Fulltekst i vitenarkiv Vis sammendrag

  Case description Case 1: A 21-year-old woman was considered for wisdom tooth removal in general anesthesia. She had a small mouth opening caused by significant scar tissue and reduced oral vestibule. She had rigid musculature in the orofacial area. Case 2: A 10-year-old boy was referred for dental treatment, diagnosed with dental crowding and severe dental caries in a permanent molar. Tooth brushing was difficult due to reduced mouth opening. To improve and maintain mouth opening before and after dental treatment, we made individualised and structured training and follow-up programs. The programs included stretching, oral motor excercises, and to make them more aware of their oral motor activities. Tootbrushes were individually adjusted. The patients maintained/improved orofacial function during the treatment period. Mouth opening varied in relation to training intensity. Both patients became more aware of their facial expressions, tounge, and jaw activities. Muscle strenght and endurance, as well as speech improved. They also took more initiative in social contexts and communication. Both patients received dental treatment during the training period. Clinical implications Individuals with DEB and reduced orofacial function may benefit from interdisciplinary health services. Increasing mouth opening and adapting dental hygiene products may easy prophylactic measures as well as dental treatment. The exercises should be adjusted to fit with the patient's daily actctivities, symptoms, general condition, and motivation. This means that both the choice of exercises and the intensity of the training may vary over time in order to maintain or improve quality of life. Conclusions: should highlight the most important finding(s) and be based on the observed results. Orofacial training may improve oral motor skills and mouth opening, and hence improve oral health in patients with DEB. Individualised stimulation and training programs are important. Small variations in daily routines can have an impact on oral function. Changing challenges over time requires countinious evaluation and adaption of the programs.

• Östenson, Pernilla Odile Malin; Clasen, Anne Beate Sønju & Wigen, Tove Irene (2022). Characteristics of patients in need of dental treatment under general anesthesia. Fulltekst i vitenarkiv Vis sammendrag

  Dental treatment under general anesthesia (GA) is an option when conventional treatment cannot be accomplished due to un-cooperation and systemic or intellectual disabilities. Aim: The aim of this retrospective study was to describe characteristics of and dental treatment needs in patients referred for dental treatment under GA in the Public Dental Services in Oslo. Methods: All patients receiving dental treatment under GA in 2016 were included. Data was extracted from dental records and included: age, health conditions, reason for referral, recorded symptoms, dmft/DMFT and received treatment. Data was analyzed using SPSS. The study was performed as part of quality assurance system required by law in the dental services, and did not require ethical approval. Anonymized data was recorded. Results: In total 173 patients aged 2-71 years were included. Half, 95 patients (55%), were children and adolescents. The majority, 141 patients (82%), had one or more medical disorders, whereas 32 patients (18%) were medically healthy. The most common medical disorder was intellectual disability followed by epilepsy, autism spectrum disorder (ASD), genetic syndromes and cerebral palsy. Sixteen genetic syndromes were registered; Downs syndrome was most common. Barriers for conventional treatment were dental behavior management problems, anxiety, immaturity, spasm and gagging. The most frequent dental reason for referral was caries (97 patients (56%)). In 55 patients (32%), patients or caregivers reported oral symptoms. Mean dmft for preschool children (≤5 years) was 8.5 (SD 5.9), for children and adolescents 3.1 (SD 3.3) and for adults (>18 years) 12.5 (SD 11.9). Restorative treatment was performed in 141 patients (82%) and extractions in 107 (62%). Other dental treatments were endodontic, periodontal, prosthodontic, surgical, orthodontic and prophylactic treatments. Conclusion: Treatment in GA was received by a heterogenic group with varied and extensive treatment needs. The majority of patients treated under GA had intellectual disability.

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