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The article discusses the emergence of special care dentistry as a dental specialty in the U.S. Topics covered include the development of more expertise among dental specialists, education requirements for dentists and the creation of the Special Care Dentistry Association (SCDA). Also explained is the effect of proposing a dental specialty that lacks a precise definition.

Objectives/Hypothesis To determine whether snoring sound intensity measured after a first soft palate radiofrequency (RF) session for simple snoring helps predict the final result of the treatment. Study Design Observational retrospective study. Methods We conducted a retrospective review of 105 subjects presenting with simple snoring or mild sleep apnea. All patients underwent two to three sessions of RF-assisted stiffening of the soft palate. In addition, uvulectomy was performed in case of a long uvula, and two paramedian trenches were created in the presence of palatal webbing. Snoring sound intensity was evaluated by the bed partner after each session. Results Eighty-six men and 19 women were included in the study. Mean age was 51.7 ± 9.8 years, and mean body mass index was 24.7 ± 4.4 kg/m2. The mean apnea/hypopnea index was 6.6 ± 4.2/h. The mean snoring sound intensity, as evaluated on a 10-cm visual analog scale (VAS), decreased from 8.2 ± 1.5 to 3.5 ± 2.2 after all sessions ( P < .0001). A score of 3 was determined as being a score that satisfied the bed partner. Two groups were formed according to the final snoring sound intensity, using 3 as a threshold. Both groups had similar preoperative characteristics, but the snoring sound intensity was significantly lower after the first session in the group with final score <3 ( P = .01). Similarly, a VAS score >7 after the first session was associated with a final score <3 in 30% of the cases. Conclusions Snoring sound intensity after the first RF session helps predict the final outcome of RF-assisted stiffening of the soft palate for simple snoring. Level of Evidence 4. [ABSTRACT FROM AUTHOR]

We report a case of fatal Hirschsprung's disease (HD) discovered at autopsy. A 20-year-old man collapsed at home. Emergency medical personnel found him in cardiac arrest and all resuscitative efforts failed. He had a past history of chronic constipation since infancy. Forensic autopsy revealed a megacolon full of gas and stools. Microscopic examination showed absence of ganglion cells in a short segment of the rectum and enterocolitis in the left and transverse colon. HD is rarely described in adults. In many cases, patients complained of constipation since infancy but the affection remained misdiagnosed. The relative good tolerance of the disease is usually due to a short aganglionic bowel segment. Enterocolitis is a frequent and severe complication of HD in children but is rarely described in adults. This case suggests the importance of HD diagnosis in childhood in order to avoid fatal complications with forensic consequences. [ABSTRACT FROM AUTHOR]

OBJECTIVES/HYPOTHESIS Obstructive sleep apnea syndrome is due to pharyngeal obstructions, which can take place at the level of the soft palate. Temperature-controlled radiofrequency ablation has been introduced as being capable of reducing soft tissue volume and excessive compliance. The aim of the study was to evaluate prospectively the possible efficacy of temperature-controlled radiofrequency ablation applied to the soft palate in subjects with mild to moderate obstructive sleep apnea syndrome.STUDY DESIGN Twenty-nine patients with a respiratory disturbance index between 10 and 30 events per hour, body mass index equal to or less than 30 kg/m , and obstruction at the level of the soft palate were included in a pilot, prospective nonrandomized study.METHODS Snoring and daytime sleepiness were evaluated subjectively. Treatment (maximum of three sessions) was discontinued when the bed partner was satisfied with the snoring level. A full night recording was performed at least 4 months after the last treatment.RESULTS Mean snoring level decreased significantly from 8.6 ± 1.3 to 3.3 ± 2.5 on a visual analogue scale (0-10). Daytime sleepiness decreased nonsignificantly. Mean respiratory disturbance index decreased significantly from 19.0 ± 6.1 events per hour to 9.8 ± 8.6 events per hour. Mean lowest oxygen saturation value increased nonsignificantly from 85.3% ± 4.1% to 86.4% ± 4.4%. Of the patients, 65.5% were cured of their disease.CONCLUSIONS Temperature-controlled radiofrequency ablation was effective in selected patients with mild to moderate obstructive sleep apnea syndrome. A full-night polysomnography is required after completion of treatment to rule out residual disease. [ABSTRACT FROM AUTHOR]

The article focuses on the educational debt of graduating dental seniors. Topics discussed include a survey of dental school seniors by the American Dental Education Association (ADEA), a new accreditation standard established by the Commission on Dental Accreditation (CODA), and a study by the Association of American Medical Colleges (AAMC), which showed that student mean debt at public institution was 162,736 dollars.

The author reflects on the people with intellectual disabilities (ID) in the U.S. He states that people with ID must be formally designated by the U.S. government as a medically underserved population (MUP). An overview of the Index of Medical Underservice (IMU), a method of the U.S. Department of Health and Human Services to establish criteria for designation of MUP, is offered. The author suggests that the nation need to support and honor people with ID.

The article discusses what orthodontics is. To date, there is no universally accepted definition of what orthodontic health is. A therapy, roughly defined, is a treatment for a disorder or deficiency, which aims to bring an unhealthy person to health. An enhancement is an improvement or extension of some characteristic, capacity, or activity. If orthodontic health care is viewed and promoted as both therapy and enhancement, it will develop greater capacity for expanding its patient pool to include those individuals who are seeking an alternative to traditional comprehensive orthodontic care.

The author reflects on the online publication of the Volume 35 of the journal "Special Care in Dentistry." He discusses the benefits of online publication including carbon footprint reduction, increased discoverability and accessibility and active links to citing and referenced articles in other journals. He also acknowledges the contribution of Editorial Board members and peer-reviewers to the production of the Volume 34 of the journal.

The author discusses the difference between health and disability. Topics discussed include the definition of the World Health Organization (WHO) of health as a state of complete physical and social well being, the development of the International Classification of Functioning, Disability and Health (ICF), and the medical and social models which are used as disability conceptual models.

A call for papers on dentistry is presented.

The author reflects on challenges faced by dental personnel in assuring proper handling of increasing access to dental care for patients with special needs in the U.S. as of 2013. The author refers to a discussion that indicates that predoctoral and postdoctoral dental school curriculum might benefit from modification and augmentation in the area of special care dentistry. Also discussed are features of a new Commission on Dental Accreditation (CODA) standard for treating such patients.

The author reflects on the factors which drive senior dental students and postdoctoral residents on their choice of career. The author states that some students are opting to specialize, in which they hope that the income of specialist is greater than a general practitioner. The author also mentions the balance family life and professional life. The author adds that some graduates, their career decisions are based on the first impression on dentistry.

An introduction is presented in which the editor discusses various reports within the issue on topics including the dental treatment of patients with special needs, oral care services for people with physical, developmental, or cognitive conditions, and evidence-based clinical practice.

Objectives: To explore the feasibility of a new approach to reduce lingual tonsil hypertrophy using radiofrequency in a patient with obstructive sleep apneaMethods: A 50-year-old patient who had had 3 consecutive procedures to treat upper airway disorders (UPPP, bimaxillary advancement, and radiofrequency tongue base reduction) still complained of daytime sleepiness. His respiratory disturbance index was 41 events per hour. His clinical examination showed major lingual tonsil hypertrophy. Radiofrequency of the lingual tonsils trough a cervical approach was performed with a sonographic and fluoroscopic control and under potentialized local anesthesia. A retractable 2 cm active electrode mounted on a 5 cm mandrel was introduced through the skin midway between the hyoid bone and the mandible in the midline. Eleven thousand joules were delivered in several points in the lingual tonsilsResults: The patient did not complain of any pain during the procedure. He could eat within 4 hours. His tongue mobility remained normal. Nevertheless, the patient expressed pain for the 2 following weeks. There was no sign of clinical infection. A tomodensitometry showed oedema but no abscess. Five months after the procedure, the patient was no longer somnolent. The volume of the lingual tonsils decreased. His respiratory disturbance index was 8.Conclusion: Lingual tonsil radiofrequency is possible using a cervical approach under local anesthesia thus avoiding a possible difficult intubation. The fluoroscopy helped determine the position of the electrode in the sagittal and horizontal planes. Lingual tonsil hypertrophy can induce obstructive sleep apnea. By reducing the lingual tonsil volume, a patient could be cured. [Copyright &y& Elsevier]