Mouth-operated devices for handicapped persons

MAXILLOFACIAL PROSTHETICS TEMPOROMANDIBULAR *JOINT DENTAL IMPLANTS I. KENNETH

Section

ADISMAN,

Mouth-operated Maya

Zalkind,

Hebrew

are

devices D.M.D.,*

University-Hadassah

P

eople whose hands a heavy burden

editor

are to

Zila

for

handicapped

Mitrani,**

School

and of

Dental

paralyzed as a result others. Being handicapped,

of

Noah

persons Stern,

Medicine,

disease, these

D.M.D.,

Jerusalem,

accident, or people depend

M.S.D.***

Israel

war injury on other

persons in the performance of the most simple everyday tasks. Therefore, it is of primary importance to rehabilitate them, at least to the extent of reducing their dependence on other people. This article describes a mouth-operated device which helps invalid persons by limited use of their hands to perform simple, routine tasks, thus minimizing their dependence on others. REVIEW

OF

THE

LITERATURE

Several mouth-operated instruments have been suggested for crippled persons whose hands arc incapacitated. 1- Is All these instruments have an intraoral and an extraoral part. The main requirement of such a device is that it should cause minimal damage to the stomatognathic system. The extraoral part of the device is made of a straight rod. Sometimes it is a pen or pencil, sometimes a simple stick connected with the intraoral part.l-‘” The instruments differ mainly in their intraoral structure, which can be made of either hard material such as acrylic resin5 or soft material such as latex” or silicon rubber.7 Instruments built with a soft intraoral part are quite comfortable to the patient, but they tend to absorb colors and odors. Therefore, the intraoral part must be changed often, which can be a complicated procedure that is expensive for the patient. Several structural varieties may be used for the intraoral part. Some are built SO that only the anterior teeth can touch them,“, 9 while others are contacted by only Supported in part by a grant from the Joint Research Hadassah School of Dental Medicine, Jerusalem, Israel. *Instructor, Department of Oral Rehabilitation. **Dental Technician, Department of Oral Rehabilitation. ***Lecturer

652

in Prosthodontics,

Department

of Oral

Fund

Rehabilitation.

of

the

Hebrew

University-

Mouth-operated

Fig:. the

1. Mouth-operated side.

device

Fig. 2. A palatal view of the Fig. 3. Acrylic resin covers Fig. 4. The inferior surface of the lower

for

handicapped

intraoral

part

patients

devices for the handicapped 653

as seen

(A) from

above

and

(B)

1

of the device.

approximately

2 mm.

of the intraoral

part

of the buccal contains

surfaces

an impression

of the posterior of the occlusal

teeth. surfaces

teeth.

the posterior teeth. + 6 Other devices cover buccal or labial parts of the teeth by two intraconnected arches.lvlopl1 Still other instruments do not touch the teeth at all and have contact only with the gums.12 The devices can be divided into two additional main categories: electrically operated devices3 and mechanically operated devices.l>4-1gThose operated by electricity have a major disadvantage. Another person must assistin their operation. The operation of these instruments also depends on the supply of electric current. In addition, instruments having a delicate and complicated operation system may break down. Devices which are operated by mechanical meansare simple and, therefore, considerably more advantageous than those operated electrically. THE

PROPOSED

DEVICE

The mouth-operated device proposed resemblesthose previously described, but has someadvantageous modifications (Fig. 1) .

654

Zalkind,

Mitrani,

.I. I’roathet. Decembrr,

and Stern

Fig. 5. The arch-shaped metal piece connects the intraoral (A) from above and (B) from the side.

-,r-

,._._-”

-.-,

*yl~..“-~~,“~,.l,

_ire”_./_.-

-~^

,

=.,_

..,

part with the extraoral

Drnt. 1975

part: views

“..

Fig. 6. The pencil mark indicates the extent of the intraoral part of the device. Fig. 7. A roll of acrylic resin in a doughIike consistency is placed on the arch-shaped piece.

metal

of the device. The extraoral part is a hollow aluminum tube, about Description 50 Gm. in weight. The outer third of the tube is bent downward in an obtuse angle of 130 degrees, while the end nearest the patient is connected with the intraoral part. The length of the tube must be adjusted according to the needs of each patient with particular attention to visual acuity. The average length of the tube is 2.5 to 30 cm. A rubber piece is installed in the active end of the tube to avoid slipping of the device during operation. A pencil, pen, or other writing or drawing device can be placed at the active end. The intraoral part of the instrument resembles an upper diagnostic splint. It is made of acrylic resin and contacts the palate and occlusal and incisal edges of all upper teeth, extending approximately 2 mm. on the labial and buccal sides (Figs. 2 and 3). On the inferior surface of the intraoral part are imprints of the lower teeth at a depth of approximately 2 mm. that were made while the lower jaw was in centric relation (Fig. 4). The mouth-operated device is 2 to 3 mm. thick to be within the limits of the interocclusal distance. The intraoral and extraoral parts are connected by an arch-shaped metal piece (Fig. 5) which is embedded in the acrylic resin and soldered to the aluminum tube. Advantages of the device. (1 j The intraoral part is made of acrylic resin. It will not absorb odors, but will absorb pigments to a minimal extent. However, it is easily cleaned.

Volume Number

34 6

Mouth-operated

Fig.

8. The

devices

are kept

in a special

devices

stand

for

when

the handicapped

655

not in use.

(2) The occlusal forces are equally distributed over the device since it fits over all teeth. (3) The acrylic resin surrounding all teeth adds to the retention and the stability of the device when it is in the mouth. (4) The lower jaw is in centric relation when closed into the device and is within the interocclusal distance, which assures minimal muscular tension, reduces the possibility of disturbances to the periodontium and the temporomandibular joints, and allows unimpeded swallowing and easy breathing. (5) The aluminum tube and arch-shaped metal piece are made of a light material which will not rust. (6) The obtuse angle at the outer third of the device allows for comfortable and easy operation. Fabrication of the device. Complete impressions of the upper and lower jaws are made with alginate (irreversible hydrocolloid) impression material. Two upper working casts and one lower working cast are prepared. An upper and a lower cast are mounted on an articulator in centric relation. A line indicating the limits of the intraoral part of the device is drawn on the unmounted upper working cast 2 mm. from the incisal edges of the anterior teeth and occlusal surfaces of the posterior teeth. In addition, a line is drawn across the palate of the cast connecting the distal parts of the second molars (Fig. 6) . The intraoral part is made of cold-curing acrylic resin and is 1 to 2 mm. thick. Conventional laboratory procedures are used. An arch-shaped metal piece, 1 mm. thick and 1 cm. wide, is prepared, with holes for retention and a central strap in the palatal direction. This metal piece is soldered to the extraoral aluminum tube (see Fig. 5). The acrylic resin stent is placed on the upper cast which is mounted on the articulator, and the arch-shaped metal piece is connected to it with cold-curing acrylic resin. Then a roll of acrylic resin in the size and width of the metal piece is added to cover the strap (Fig. 7). The lower cast is closed into the soft cold-curing acrylic resin so as to leave a 2

656

Zalkind,

Fig. 9. The patient a pencil; B, typing push-button phone;

Mitrani,

J. I’roathrt. December,

and Stern

uses the mouth-operated on an electric typewriter; and E, pressing on a light

device for a number of activities: C, switching on a transistor switch or a bell button.

to 3 mm. space between the teeth. The imprints of the lower acrylic resin at a depth of approximately 2 mm. (Fig. 4j. The intraoral part is adjusted and polished. REPORT

Dent. 1975

A, writing with D, using a

radio;

teeth are left in the

OF A PATIENT

A 25-year-old man: at present a fourth-year student at the Hebrew University, was wounded during war-time activity. His spinal cord was injured, and consequently, he is paralyzed from the shoulders downward. This man has been using the oral device for five consecutive years. The device is located in a special stand on his desk (Fig. 8). When he wants to use it, he approaches the device with his mouth and seats it to place between his teeth by swallowing. Then he can perform some actions independently such as writing with a pencil, using an electric typewriter,

Mouth-operated

Fig. 10. A complete series of periapical five years.

radiographs

dt wices for

the handicapped

65; 7

of the patient after using the device for

turning on a transistor radio, using a push-button phone, pressing on a light switch or a bell button, turning pages in a book, and drawing (Fig. 9). Clinical and radiographic examinations were made five years after the patient had begun using the device. No pathosis or traumatic problems could be discerned (Fig. 10). The instrument itself has undergone no deformation and has not absorbed odors or pigments during the five-year period. This type of oral device has been supplied to eight handicapped persons. SUMMARY A mouth-operated device designed for paralyzed persons was described. This device enables invalid persons to perform simple, everyday actions. The uses and advantages of the instrument as compared to other types were discussed. References 1. Buckley, R. R.: The Acrylic Mouthpiece for Poliomyelitis and Cerebral Palsy Patients, J. Dent. Child. 26: 248-251, 1959. 2. Swallow, J. N.: The Dental Care of the Cerebral Palsied Child, Cerebral Palsy Bull. 3: 488-492, 1961. 3. Evans, B. A., and Cooley, A. M.: Writing, Typing, and Painting Aids for the Respirator Patient, Am. J. Occup. Ther. 10: 85-87, 1956. 4. Bastable, A. D.: Typewriter Frame and Mouthstick for the Quadriplegic With Neck Involvement, Am. J. Occup. Ther. 10: 7-12, 1956. 5. Davey, K. W.: Oral Prosthesis for Cerebral Palsy Children, J. Can. Dent. Assoc. 31: 497-504, 1965. 6. Thorpe, S. L., and Wells, R. F.: Liquid Latex Mouthpiece, Am. J. Occup. Ther. 11: 73-74, 1957. 7. Swallow, J. N.: A Mouth Appliance for Handicapped Persons, Br. Dent. J. 115: 31-33, 1963. 8. Moore, J. C.: Reading Aids for a Qaudriplegic Patient, Am. J. Occup. Ther. 10: 119-120, 1956. 9. Ey, M. C.: Ejectable Mouth Stick, Am. J. Occup. Ther. 10: 121-133, 1956. 10. Buckley, R. R.: Mouthpieces for the Handicapped, J. Dent. Child. 24: 174-178, 1957. 11. Buckley, R. R., and Slominski, A. H.: The Acrylic Mouthpiece, Am. J. Occup. Ther. 12: 23-25, 1958. 12. Yeakel, M. H., and Margetis, P. M.: A New Technique for Fabricating Temporary Mouthpiece Appliances, Am. J. Occup. Ther. 22: 168-172, 1968.

658 13. 14. 15. 16. 17. 18. 19.

Zalkind,

Mitrani,

J, l’rosthet. Decrmbrr.

and Stern

Dent. 1975

Norris, M.: A Mouthstick Prosthesis for Independence, Am. J. Occup. Ther. 22: 174-175, 1968. Emmett, R.: The Pincer Mouthstick, Am. J. Occup. Ther. 11: 288-289, 1957. Erickson, L. B.: Keyboard Fun for Children With Osteogenesis Imperfecta and Other PhysicaI Limitations, Inter-Clinic Information Bull. 12: 15-17, 1973. Blaine, H. L., and Nelson, E. P.: A Mouthstick for QuadripIegic Patients, J. PROSTHET. DENT. 29: 317-322, 1973. Bartling, D.: Dental Care of Handless Persons and the Provision of Mouth-Supported Devices for Their Use (I), Quintessence Int. 4: 37-42, 1973. Bartling, D.: Dental Care of Handless Persons and the Provision of Mouth-Supported Devices for Their Use (II), Quintessence Int. 4: 47-50, 1973. King, W. S.: Mouthstick Habilitation, J. Am. Dent. Assoc. 87: 839-843, 1973. THE

HEBREW

HADASSAH

P.O.

UNIVERSITY SCHOOL

Box

OF DENTAL

JERUSALEM,

ISRAEL

ARTICLES Bone-titanium W. L. Kydd,

Prosthetic Steven

implant

to mechanical

John

facial

F. Carter,

paralysis

Ph.D.,

cements

R. Scott,

Writer” Part II

Sakai, D.M.Sc.

Hratch

A. Abrahamian,

casting D.D.S.,

to practical

D.D.S.

alloys D.D.Sc.,

and

Hisafumi

theoretical

Node,

occlusal

D.D.S.

and its relationship

Sol Silverman, and Lawrence

D.D.S., Garfinkel,

A retentive

attachment

E. Stansbury,

findings

and

to dental

D.D.S., D.D.Sc., Yoshihiro and Takao Fusayama, D.D.S.,

of “Cusp Part I and

stress

Ph.D.

for unilateral

D.D.S.,

of polycarboxylate

Self-image

Bruce

response

and C. H. Daly,

support

Saito, D.D.Sc.,

Application problems. William

TO APPEAR IN FUTURE ISSUES

D.D.S.,

J. Larsen,

Adhesion Chikaaki D.D.S.,

MEDICIKE

1172

M.S.D., M.A.

D.D.S.,

to denture Sidney

for overdentures M.S.

acceptance

I. Silverman,

D.D.S.,

Beverly

Silverman,

Ph.D.,