Salivary Sensor for Xerostomia in Edentulous Patients PDF

DENTAL TECHNIQUE A salivary sensor for the management of xerostomia in edentulous patients Vasudevan Karthikeyan, MDS,a Naveen Gopi Chander, MDS, DNB, MFDS, RCPS,b and Kuttae Visw...

DENTAL TECHNIQUE A salivary sensor for the management of xerostomia in edentulous patients Vasudevan Karthikeyan, MDS,a Naveen Gopi Chander, MDS, DNB, MFDS, RCPS,b and Kuttae Viswanathan Anitha, MDSc The rehabilitation of acquired ABSTRACT maxillofacial defects requires This article describes a method for managing xerostomia in edentulous patients with a newly an interdisciplinary approach developed salivary sensor. A micropressure sensor unit with a capsule to hold artificial salivary as the patients present with substitute was built into the dental prosthesis. This sensor prosthesis can help patients overcome many difficulties.1 Depending mouth dryness, improves patient comfort, and aids in retention of the prosthesis. (J Prosthet Dent on the nature of the disease 2018;-:---) and the size and extent of the defect, the patient may have been subjected to surgical Various management strategies have been suggested resection, radiotherapy, chemotherapy, or a combination for xerostomia, including gustatory and pharmacological of these.2 The effectiveness of each therapeutic measure means of increasing salivary flow and the use of overrides its limitations. Xerostomia or dryness of mouth mouthwash, chewing gum, lozenges, oral buffering from the lack of normal secretions is one of the major products, artificial salivary substitutes, lubrication sprays, limitations of radiation therapy.3 Saliva is an important rinses, and acupuncture.5 For patients who cannot oral fluid for mastication, swallowing, taste perception, tolerate sialogogues because of side effects or hyper- lubrication, and buffering action and improves patient sensitivity, palliative support with alternative methods comfort when present in adequate quantity and has to be considered.8,9 In spite of the availability of 4,5 quality. numerous topical oral sialogogues, there is no strong The retention and stability of an obturator prosthesis evidence for the superiority of one over others. even with adequate salivary presence is compromised This present report puts forward a new dental tech- because of the loss of the resected diseased tissues inside nique wherein an obturator prosthesis was made with an the oral cavity. Thus, the presence of saliva contributes to inbuilt sensor for the management of xerostomia. Sen- the effectiveness of the maxillofacial prosthesis.6 The sors are those devices that detect physical, chemical, and intensity of the dry oral condition and its durability de- biological signals and provide a way for those signals to pends on the dosage of radiation provided. Nearly 50% be analyzed and recorded. They give information about to 70% reduction in salivary flow has been reported after signals which could not be otherwise directly detected by 10 to 16 Gy radiation.4 The volume, consistency, and pH the senses and can sense physical properties such as of saliva becomes damaged,5 and the synchronous temperature, pressure, vibration, sound level, or light administration of chemotherapy amplifies the salivary intensity.10 Among the many available sensors, pressure 7 gland dysfunction. Such patients should receive imme- sensors can measure gases or liquids and express the diate palliative care. force required to stimulate the flow of a fluid. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. a Postgraduate student, Department of Prosthodontics, Sri Ramaswamy Memorial Dental College, Chennai, India. b Professor, Department of Prosthodontics, Sri Ramaswamy Memorial Dental College, Chennai, India. c Reader, Department of Prosthodontics, Sri Ramaswamy Memorial Dental College, Chennai, India. THE JOURNAL OF PROSTHETIC DENTISTRY 1 2 Volume - Issue - Solenoid Capsule position control N Solenoid S current control Figure 1. Components of sensor unit. Figure 2. Tube for addition of artificial salivary substitute. TECHNIQUE 1. Make a preliminary impression of the max- illectomy defect by covering the entire defect area with irreversible hydrocolloid impression material (Zelgan Plus; Dentsply Sirona). 2. Use dental stone (Ultra stone; Kalabhai Karson Pvt Ltd) to make the preliminary cast for fabricating a custom tray. 3. Block extreme undercuts with baseplate wax (Modelling Wax No. 2; Hindustan) and construct a custom tray with single thickness full spacer design. 4. Fabricate a custom tray with autopolymerizing polymethyl methacrylate resin (Cold Cure; Dental Products of India-RR) by using the sprinkle on Figure 3. Sensor placed within prosthesis. technique of 2- to 4-mm thickness. 5. Make a definitive impression with monophase 13. Evaluate the passive seating of the part of the flask polyvinyl siloxane impression material (Aquasil that contains the teeth on its counterpart without Monophase; Dentsply Sirona). any resistance. 6. Bead and box the definitive impression with wax 14. Take another flask cope and seat it over the flask (Rolex Beading and Boxing Wax; Deccan Dental) to drag containing the definitive cast, fill it with obtain the definitive cast for obturator fabrication. dental plaster, and dewax. 7. Use autopolymerizing polymethyl methacrylate 15. After wax elimination, pack the flask with heat- resin to make an interim denture base (DPI Cold polymerizing polymethyl methacrylate denture Cure; Dental Products of India-RR) and wax the base resin (DPI Heat Cure; Dental Products of occlusal rims to record the jaw relation. India) to obtain a hollow shim and palatal portion 8. Arrange the teeth (Acry Rock; Ruthinium Dental of the denture with teeth. Products) for verification of the trial prosthesis. 16. Separate the processed flasks. A projection of 9. Complete the denture waxing. Seal the waxed dental plaster in the obturator region will be seen. prosthesis onto the cast. Now bevel the acrylic resin borders around the 10. Invest the cast with dental plaster (Plaster of Paris; defect area and adapt a sheet of light-polymerizing The Ramaraju Surgical Cotton Mills Ltd) and acrylic resin sheet (Profibase; VOCO GmbH) to eliminate the wax by boiling. cover this portion. 11. After dewaxing, use a 3-mm thickness of modeling 17. Before light polymerizing the adapted resin sheet, wax to block out the undercuts in the cast. gently scrape and remove the projection of dental 12. Adapt a 3-mm thickness of modeling wax onto the plaster in the defect area just enough to accom- palatal defect area to create a shim. Create a ledge modate the sensor component. around the periphery of the defect with wax to 18. The sensor unit (555 integrated circuit chip; leave an opening to the defect portion. Murata Electronics India Pvt Ltd) consists of 3 THE JOURNAL OF PROSTHETIC DENTISTRY Karthikeyan et al - 2018 3 layers. The base layer contains a battery sealed technology, their application in dental prosthetics will within the denture and is followed by the middle increase. layer, which is made up of medical-grade silicone (Fig. 1). SUMMARY 19. The silicone is in the form of a sponge-like struc- A removable dental prosthesis was fabricated with inbuilt ture so that it can absorb the saliva substitute. sensors to help in the management of xerostomia. A 20. Inject 20 mL of artificial saliva substitute (Wet micropressure sensor was incorporated into the pros- Mouth; ICPA Health Products Ltd) through the thesis to detect a dry mouth. On detecting a dry mouth, tube connected to the silicone pouch (Fig. 2). tongue pressure ejects artificial saliva from a capsule in- 21. The outermost layer of the sensor unit consists of a side the sensor. The addition of a small sensing unit salivary pressure transducer which converts the helps with detection of the dry mouth. Saliva substitute is mechanical stimuli of the tongue into electro- released according to the requirement of the patient and magnetic stimuli when the tongue is pressed unnecessary dispensing and frequent replacement of against the sensor. artificial saliva is avoided. In the future, the use of mi- 22. With the sensor unit in place, use autopolymeriz- crosensing units will become more straightforward in ing acrylic resin (DPI Cold Cure; Dental Products prosthodontics. of India-RR) to close the opening between the denture base and light cure resin sheet. REFERENCES 23. Place the processed base containing the sensor unit onto the initial flask with the teeth. 1. Keyf F. Obturator prostheses for hemimaxillectomy patients. J Oral Rehabil 24. Evaluate both units of the flask for passive fit. If 2001;28:821-9. 2. Koyama S, Sasaki K, Inai T, Watanabe M. Effects of defect configuration, size, there is any resistance, trim the resin portion until and remaining teeth on masticatory function in post-maxillectomy patients. the components of the flask seat completely. J Oral Rehabil 2005;32:635-41. 3. Depprich R, Naujoks C, Lind D, Ommerborn M, Meyer U, Kübler NR, et al. 25. Pack using heat-polymerizing polymethyl meth- Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic therapy with obturator prostheses. Int J Oral Maxillofac Surg acrylate denture base resin (DPI Heat Cure; Dental 2011;40:71-9. Products of India) to secure the denture teeth onto 4. Turner MD. Hyposalivation and xerostomia: etiology, complications, and medical management. Dent Clin North Am 2016;60:435-43. the processed base holding the sensor unit. 5. Mercadante V, Al Hamad A, Lodi G, Porter S, Fedele S. Interventions for the 26. After processing, retrieve the prosthesis to observe management of radiotherapy-induced xerostomia and hyposalivation: a systematic review and meta-analysis. Oral Oncol 2017;66:64-74. the sensor unit incorporated in the prosthesis 6. Murakami M, Nishi Y, Kamashita Y, Nagaoka E. Relationship between (Fig. 3). medical treatment and oral dryness diagnosed by oral moisture-checking device in patients with maxillofacial prostheses. J Prosthodont Res 2009;53: 67-71. 7. Jawad H, Hodson NA, Nixon PJ. A review of dental treatment of head and DISCUSSION neck cancer patients, before, during and after radiotherapy: part 1. Br Dent J 2015;218:65-8. The technique described in this report is a way to fabri- 8. Epstein JB, Beier Jensen S. Management of hyposalivation and xerostomia: criteria for treatment strategies. Compend Contin Educ Dent 2015;36: cate a dental prosthesis with inbuilt microsensors for 600-3. ejection of artificial saliva. The prosthesis contains a mi- 9. Tschoppe P, Wolgin M, Pischon N, Kielbassa AM. Etiologic factors of hyposalivation and consequences for oral health. Quintessence Int 2010;41: cropressure sensor unit and a transduction unit to 321-33. convert the input signal into output source.11 The input 10. Schott TC, Ludwig B, Glasl BA, Lisson JA. A microsensor for monitoring removable-appliance wear. J Clin Orthod 2011;45:518-20. signal is mouth dryness, and the output action is ejection 11. Hori K, Ono T, Tamine K, Kondo J, Hamanaka S, Maeda Y, et al. Newly of the incorporated saliva substitute. The micropressure developed sensor sheet for measuring tongue pressure during swallowing. J Prosthodont Res 2009;53:28-32. sensor works on the principle of mechanical bending of a 12. Cheri MS, Shahraki H, Sadeghi J, Moghaddam MS, Latifi H. Measurement thin silicon diaphragm by tongue pressure. The strain and control of pressure driven flows in microfluidic devices using an optofluidic flow sensor. Biomicrofluidics 2014;8:054123. associated with the deformation of the diaphragm is 13. Yang Z, Dong T, Halvorsen E. Identification of microfluidic two-phase flow measured by tiny doped silicon piezoresistors placed in patterns in lab-on-chip devices. Biomed Mater Eng 2014;24:77-83. 14. Pourriahi M, Gurman P, Daich J, Cynamon P, Richler A, Elman N, et al. The strategic positions in the diaphragm. Doped silicon has use of micro-electro mechanical systems in vascular monitoring: implications high resolution and sensitivity, producing the output for clinical use. Expert Rev Med Devices 2016;13:831-7. signal when deformed.12,13 Although sensors play an essential role in artificial Corresponding author: Dr Kuttae Viswanathan Anitha prostheses for capturing senses, their application is still Department of Prosthodontics in its infancy. The limitations that restrict the use of Sri Ramaswamy Memorial Dental College Ramapuram sensors in prostheses include biocompatibility, diffi- Chennai 600089 culty in fabricating the unit, weight of the unit, sensor INDIA Email: [email protected]; [email protected] efficacy, standardization in output saliva ejection, and durability.14 However, with the development of sensor Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry. Karthikeyan et al THE JOURNAL OF PROSTHETIC DENTISTRY