Perspectives on the Psychosocial Management of Oromandibular Dystonia

Abstract

Oromandibular dystonia (OMD) is a rare disorder of movement characterized by tonic muscle contractions that can result in involuntary, repetitive, and patterned muscle contractions of the lingual musculature, labial musculature, and/or muscles of mastication. As a result, dysarthria can be present that can lead to reduced speech intelligibility and have an adverse impact on psychosocial functioning. In this article, we will describe the clinical and speech characteristics of OMD and the various methods of treatment. Then we will introduce and describe patient-reported outcome measures that assess two aspects of psychosocial functioning: communicative participation and quality of life. We will describe the current state of knowledge as it relates to communicative participation and quality of life in this clinical population, and, finally, we will advocate that speech-language pathologists have a unique role in the care of individuals with OMD through the inclusion of patient-reported outcome measures to provide a comprehensive and holistic management plan.KEYWORDS: Oromandibular dystonia, dysarthria, psychosocial outcomes, communicative participation, quality of life Learning Outcomes: As a result of this activity, the reader will be able to (1) summarize common medical management approaches for treating individuals with oromandibular dystonia; (2) summarize the current assessment tools and instruments used to assess communicative participation and quality of life in individuals with dysarthria; and (3) describe how patient-reported outcome measures can impact and inform clinical practice in this clinical population.Oromandibular dystonia (OMD) is a disorder of movement characterized by tonic muscle contractions that can result in involuntary, repetitive, and patterned muscle contractions of the lingual musculature, labial musculature, and/or muscles of mastication. 1 In 1899, Gowers first described OMD as a condition producing clonic and tonic jaw

Oromandibular Dystonia: An Update for Dental Professionals

“…According to the literature women are commonly affected than men. 9,19 However, this review slight male predominance (51%) was noted. Mastication and tongue muscles are most frequently affected in OMD causing involuntary jaw opening/closing movements, jaw deviation, tongue thrusting, lip pursing.…”

“…Dystonia associated with another known disease is classified as secondary. 19 The diagnosis of OMD is clinical. Due to its manifestation in various forms and severity, diagnosis of this condition is complicated.…”

“…The literature review suggests pharmacotherapy, botulinum toxin type A (BTX) injections, fabrication of occlusal appliances, surgery (peripheral and/or central), chemo denervation, physiotherapy, and occupational therapy as potential treatment options. 1,18,19 Various medications such as anticholinergics, antiparkinson drugs, anticonvulsants, dopamine receptor antagonists, levodopa and lithium were used in the management of OMD. 1 Botulinum neurotoxin is the most effective treatment for symptomatic OMDs.…”

“…Facial appearance, articulatory precision and hyperactive movement's improvement was observed with bite block therapy. 19 Watt et al 3 reported a patient who presented with a 'sensory trick' that is patient symptoms were alleviated by occluding on a pen in between his premolar teeth. Watt et al 3 constructed dental appliances to mimic that effect which was helpful for their patient.…”