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Background: Limited systemic sclerosis (SSc), or scleroderma, is characterized by widespread vasculopathy, excessive multiorgan fibrosis, and autoantibody. The early stages of SSc are challenging to diagnose because of their similarity to other autoimmune conditions. Inappropriate SSc treatment can increase the risk of disability, morbidity, and mortality. Different pathogenesis pathways incur various manifestations in the skin and the oral cavity. In this scenario, dentists play an essential role in managing oral SSc manifestations. Proper oral examination, diagnosis, and therapy help to increase the confidence and patient’s quality of life. Case Report: A 24-year-old female patient with SSc was referred from the Internal Medicine Department to the Oral Medicine Department because of lip soreness for 2 weeks, resulting in difficulty eating and opening the mouth. A complete anamnesis and clinical examination were done. The patient was diagnosed with an oral ulcer caused by SSc, cheilitis exfoliative, drug-induced pigmentation, xerostomia, and acute pseudomembranous candidiasis. The oral lesion in this patient was concluded as an oral ulcer caused by SSc because the patient had already stopped using methotrexate for 2 weeks before the ulceration appeared. The oral treatment included sodium chloride (NaCl 0.9%), vaseline album, hyaluronic acid mouthwash, and nystatin. Oral lesions had a significant improvement after 3 days of treatment. Conclusion: The SSc manifestation that appeared on the oral cavity of the patient as microstomia, tongue stiffness, and oral ulcer resulted in inadequate clinical examination, and diagnosis. Treatments for this oral SSc were challenging.

Tricho-dento-osseous syndrome (TDO) is a rare autosomal dominant disorder with complete penetrance. Common clinical features include abnormalities of hair, teeth, and skull. Dental management of TDO patients is quite challenging in terms of existing dental and skeletal problems. The current article presents a 12-year-old girl suffering TDO, followed by a review on the published literature pertaining to the dental management of TDO patients. Patient history included, rejected corneal transplantation, stone-forming kidneys, and several previous dental treatments. She was noted to have signs of mandibular prognatia, frontal bossing of the skull, mild bilateral tibial bowing, microstomia, and labial fissures. Dental findings included severe generalized enamel defects, discolored teeth, microdontia, anterior open-bite, posterior cross-bite, deep periodontal pockets, hyperplastic inflamed gingiva, taurodontism of permanent molars, dental periapical radiolucencies, and missing teeth. She was the only child of healthy, nonconsanguineous parents with no familial history of similar congenital syndrome or dental abnormalities. A treatment plan was established based on medical/dental history and findings, using a team-based approach. This article emphasizes the importance of a multidisciplinary approach for the dental management of patients suffering TDO.

The Erasmus syndrome describes the association of generalised progressive scleroderma following exposure to silica with or without silicosis. We report a case of Erasmus Syndrome in a 55-year old labourer presenting with shortness of breath, arthralgia, Raynaud’s phenomenon, skin tightening and microstomia along with pulmonary arterial hypertension. Among investigations, serological markers were strongly positive, high-resolution computed tomography chest showed evidence of interstitial lung disease (ILD) with mediastinal lymphadenopathy and histopathology of skin biopsy were suggestive of systemic sclerosis. Correlating the occupational history, clinical features, haematological investigations and histological findings, a diagnosis of Erasmus syndrome was safely made.

Microstomic patients may experience a significant limitation in the mandibular opening. The prosthetic rehabilitation of microstomic patients presents difficulties at all stages, from preliminary impressions to prosthetic fabrication. This clinical report described the method of fabrication of sectional denture for patients with microstomia caused by burns. The denture was fabricated in two pieces, and patients inserted and removed the denture easily.

When the mouth opening is restricted, it can hinder the successful dental treatment. This limited mouth opening may be due to some surgical treatment, oral submucous fibrosis, temporomandibular joint disorder, burns, space infections, trauma, neoplasm, radiotherapy, and scleroderma. This case report describes the simplified prosthodontic management of a completely edentulous patient with limited mouth opening by providing sectional maxillary and mandibular dentures joined by hinges.

Microstomia is a definite prosthetic hindrance in the construction of complete removable prosthesis. To rehabilitate a patient with microstomia the methods and designs incorporated in the prosthesis have to be modified. This clinical report describes a modified sectional impression procedure and a method of approximating the sectional trays for a completely edentulous female patient with limited oral opening due to scleroderma. This article also presents a method of fabricating single piece collapsible record bases for jaw relation for the patient with microstomia.

This case report exemplifies the anesthetic technique of blocking bilateral infraorbital and mental nerves for release of contractures of mouth. A 30 year old female patient of post-acid burn contractures of chest wall and mouth was scheduled for contracture release and skin grafting. Airway assessment revealed severe restriction of mouth opening with limited restriction of neck movements. Contracture release of mouth conducted by blocking bilateral infraorbital and mental nerves, which facilitated intubation easily. This case report highlights the practical advantage of nerve blocks for release of contracture mouth, in case of anticipated difficult airway, over other conventional methods.

The branch of prosthodontics is not only science, but also an art of handling patients who present with limitations in continuing with normal impression procedures. One such limitation is the difficulty in mouth opening. It may be due to fracture, trauma, oral submucous fibrosis, temporomandibular joint ankylosis, etc. This case report describes the innovative technique of primary impression, sectional custom tray, sectional denture base and customized hinge for hinge denture.

The rarest of its kind, the electrical injuries of the commissure areas of the mouth pose a potential threat in terms of management to the practitioner. The most commonly affected young toddlers, in their teething period, chew onto the female end of the live extension wire cord. Saliva which acts a medium transports the electrical current to the fragile mucosa of the oral cavity thereby leading to the treacherous burn injuries. Since children have an overall lower fat component and different surface area to volume ratio, which impacts on the risk of deep tissue damage compared to adults with equivalent injury. The review outlines: (1) A detailed review of literature reflecting the various treatment modalities proposed by different practitioners worldwide and (2) the prosthetic therapy for the conservative management of the electrical injuries of the oral cavity.

Epidermolysis bullosa (EB) represents a group of hereditary skin disorders manifested by an exceptional tendency of the skin and mucosa to form bullae and vesicles following minor friction and trauma. The pathogenesis of these disorders is unknown. Depending on the type, the clinical manifestations vary from very mild to a disfiguring and disabling disease. Along with the systemic complications, the oral findings like early childhood caries, microstomia, and limited mouth opening are quite evident in these children. Health care professionals should be aware of preventive and therapeutic measures to be adopted in order to provide a safe and effective dental treatment in these patients. The present case documents a child diagnosed of EB with early childhood caries, describing the phases and difficulties of dental treatment, and also presents a novel impression technique.

Oral submucous fibrosis (OSMF) is a precancerous condition. It causes difficulty in swallowing, chewing and speaking due to the presence of microstomia. Limited mouth opening is considered as a hindrance in prosthodontic rehabilitation of a patient. Special impression procedures and techniques should be considered for making an impression in such cases. This article describes the fabrication of a split impression tray to make a secondary impression of an edentulous patient having OSMF.

Microstomia due to isolated orofacial injury arising from the explosion of cell phone battery is extremely rare. Such devastating injuries are generally associated with warfare. We recently encountered a case in an 18-year-old student, whose lower face was literally blown off in a cell battery blast injury. Initial resuscitation, debridement and primary repair were carried out in a local plastic surgery clinic. Six months later, he reported to us with gross microstomia; inability to eat solid foods and look after his oral hygiene. Secondary repair was undertaken to correct his deformity utilizing local soft tissues to achieve satisfactory mouth opening. Subsequently, prosthodontic rehabilitation was carried out by providing complete dentures to allow him resume near normal life.

Microstomia following burns of the face remains a significant challenge. This article describes the experience in the reconstruction of post-burns microstomia with bilateral oral commissurotomy and buccal mucosa flaps. Four patients aged from 15 to 29 years had commisurotomy and buccal mucosa advancement flaps. All the patients were operated under local anesthesia with sedation. The procedure was bilateral in three patients. There were three females and one male. The most common cause of microstomia was flame burns in three patients while one patient sustained burns to the face following assault with acid. Pre-operative mean mouth opening was 20 mm and post-operative mean mouth opening was 35 mm in the four patients. Median follow-up was 57 days (range 12-472 days). Late follow-up visits revealed that the improvement in mouth opening remained satisfactory. The technique remains useful in restoration of the oral aperture. The operation is easily performed and it is recommended for immediate and delayed reconstruction of the commissure. The functional and aesthetic results are generally well-acceptable.

Aglossia congenita (AC), congenital total absence of the tongue, is a very rare midline developmental anomaly, hypothesized to be associated with vascular disruption between the fourth and eighth week of gestation. It was classified by Hall (1971) as part of oromandibular limb hypogenesis syndrome (OLHS) type I B. Most of the cases reported with OLHS are actually hypoglossia with limb abnormalities whereas isolated aglossia is an extremely rare entity. A case of isolated AC is presented in a 28-year-old Indian male. He had long narrow face, tapering chin, low set ears, and microstomia. Intraorally, he had narrow palatal vault, constricted oropharyngeal isthmus, oligodontia, and maxillo-mandibular hypoplasia. Interestingly, the patient showed a median palatal groove, which has not been reported before. He also had an unusual acquired adaptive mechanism to compensate for aglossia. This report presents the manifestations of this rare syndrome, its complications, differential diagnosis, and rehabilitation strategies.

Making impressions in microstomia patients is often cumbersome. A modification of standard impression procedure is often necessary while treating such patients. This article describes the fabrication of a custom sectional impression tray with interlocking type of a handle for definitive impression procedures in a microstomia patient.

Microstomia is defined as an abnormally small oral orifice which can be due to various factors. Microstomia is a definite prosthodontic hindrance to carry out the different treatment successfully. To rehabilitate a patient with microstomia, successfully, the methods and designs incorporated in the prosthesis have to be modified. In the past, various techniques have been tried, incorporating certain biological and scientific methods to rehabilitate patients with microstomia. This article reviews the previously described treatment modalities in case of patients with microstomia.

Dentists occasionally come across patients with constricted oral openings. As the size of the oral opening decreases, the difficulty of the required treatment increases. A maximal oral opening that is smaller than the size of a complete denture can make prosthetic treatment challenging. Several techniques have been described for such situations, where either standard impression trays or the denture itself becomes too difficult to place and remove from the mouth. The literature contains various reports on the fabrication of sectional or hinged tray/complete dentures, utilizing various mechanisms for connecting each of the components. A case report and technique of a simplified and practical design for fabrication of mandibular/maxillary sectional trays and complete denture have been presented here; this technique utilizes components that are commonly available, to simplify the treatment modality of limited oral access to the prosthesis.

Microstomia, an abnormally small oral orifice, can manifest as a sequela of burns involoving the oral and perioral tissues due to contraction of the tissues and hypotonia of the circumoral musculature. Regardless of the etiology, scar contracture results in deformities that produce esthetic and functional impairment. Changes in the circumoral anatomy prevent optimal dental care and maintenance of good oral hygeine. The anatomic changes may detrimentally alter eating, speech, and mandibular motion. Prosthetic treatment involves providing physical resistance to scar contracture by maintaining the oral commisssures in their normal relationship by means of a splint. This article describes a method to fabricate a dynamic commissural splint and decribes its use in two cases.