Effect of a hyperbolide mastication apparatus for the treatment of severe sleep bruxism in a child with cerebral palsy: Long-term follow-up

Purpose: Sleep bruxism is common among the various oromotor alterations found in individuals with cerebral palsy (CP). Few studies have investigated the use of the mastication device denominated hyperbola (HB) and none was found describing the use of such a device for the treatment of bruxism in children with CP. The aim of the present study was to evaluate the effect of the HB on electromyographic (EMG) activity in the jaw-closing muscles and the reduction in sleep bruxism in a child with CP using surface EMG analysis before and after nine months of treatment. Methods: A seven-year-old boy with severe spastic CP and sleep bruxism was enrolled in this study. The HB was chosen as the treatment option for sleep bruxism in this case because the child did not accept an occlusal splint. The HB has a hyperbolic shape and is made of soft, non-toxic, odorless, tasteless silicone. There are five different sizes of HB manufactured based on the diversity of tooth sizes. This device produces proprioceptive excitation in the dentoalveolar nerve, spindles and Golgi tendon organs. HB has been employed for the treatment of temporomandibular disorder, abnormal oro-dental development, abnormal occlusion, xerostomy, halitosis and bruxism. HB therapy was performed for 5 min six times a day over a nine-week period. Surface EMG of the mandible at rest and during maximum contraction was performed on the masseter and temporalis muscles bilaterally to evaluate electromyographic activity before and after nine months of HB usage. Results: HB usage led to a visible tendency toward the reorganization of mastication dynamics, achieving a marked balance in electromyographic activity of the jaw-closing muscles and improving the child's quality of life. Conclusion: Based on the findings of the present study, this noninvasive therapy may be useful for individuals with cerebral palsy due to its positive effects and low cost, which allows its use in the public health realm. Further clinical studies with a larger sample size are needed to validate these results and allow the development of a new treatment protocol for patients with spastic cerebral palsy. © 2013 Elsevier Ltd. All rights reserved.

Alternative pathways for catecholamine action in oral motor control

Orofacial movement is a complex function performed by facial and jaw muscles. Jaw movement is enacted through the triggering of motoneurons located primarily in the trigeminal motor nucleus (Mo5). The Mo5 is located in the pontine reticular formation, which is encircled by premotor neurons. Previous studies using retrograde tracers have demonstrated that premotor neurons innervating the Mo5 are distributed in brainstem areas, and electrophysiological studies have suggested the existence of a subcortical relay in the corticofugal-Mo5 pathway. Various neurotransmitters have been implicated in oral movement. Dopamine is of special interest since its imbalance may produce changes in basal ganglia activity, which generates abnormal movements, including jaw motor dysfunction, as in oral dyskinesia and possibly in bruxism. However, the anatomical pathways connecting the dopaminergic systems with Mo5 motoneurons have not been studied systematically. After injecting retrograde tracer fluorogold into the Mo5, we observed retrograde-labeled neurons in brainstem areas and in a few forebrain nuclei, such as the central nucleus of the amygdala, and the parasubthalamic nucleus. By using dual-labeled immunohistochemistry, we found tyrosine hydroxylase (a catecholamine-processing enzyme) immunoreactive fibers in close apposition to retrograde-labeled neurons in brainstem nuclei, in the central nucleus of the amygdala and the parasubthalamic nucleus, suggesting the occurrence of synaptic contacts. Therefore, we suggested that catecholamines may regulate oralfacial movements through the premotor brainstem nuclei, which are related to masticatory control, and forebrain areas related to autonomic and stress responses. (C) 2005 Elsevier B.V.. All rights reserved.

Analysis of Masticatory Cycle Efficiency in Complete Denture Wearers

Purpose: This study assessed masticatory efficiency and duration of the masticatory cycle in 14 asymptomatic patients with severe bone resorption. All patients had worn complete dentures for over 10 years. Recall visits were scheduled at 5 months and 1 year after receiving new dentures.Materials and Methods: Fourteen patients were evaluated in this study. The Research Diagnostic Criteria questionnaire and tests of the efficiency and duration of the masticatory cycle were performed with artificial food before, 5 months after, and 1 year after new dentures were delivered. Masticatory efficiency was assessed using a sieve system; artificial food was ground for 35 masticatory cycles and monitored by the operator.Results: Masticatory efficiency at 5 months was significantly improved for the 0.42-mm mesh. An improvement in masticatory efficiency and a reduction in mastication time were observed with the new dentures after 1 year.Conclusion: The results of this study indicated that 5 months did not allow enough time to demonstrate improved muscular capacity and ability after receiving new dentures. After 1 year, the duration of the masticatory cycle was reduced, and masticatory efficiency was significantly improved.

What is the role of lipopolysaccharide on the tribocorrosive behavior of titanium?

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Electromyographic activity of the mandible muscles at the beginning and end of masticatory cycles in patients with complete dentures

The aim of this study was to assess the electrical activity of the masseter and anterior temporal muscles in subjects with severe bone resorption at two different times: ( a) the initial period, with the complete dentures they had worn for over 10 years, and (b) the final period, 5 months after having new dentures put into place. Twelve asymptomatic subjects were asked to respond to the questionnaire, according to the research diagnostic criteria for temporomandibular disorders, before denture rehabilitation and 5 months after the new dentures were put in place. The electrical activity of the muscles was recorded during mastication in the initial and final period, using artificial food (Optocal). The operator monitored the 35 chewing cycles that were repeated to grind the artificial food. After wearing the new dentures for 5 months, the right anterior temporal muscle showed a statistical difference before and after denture rehabilitation at the beginning and end of mastication. Muscular capacity and ability reduced the electrical activity in the masseter muscles after rehabilitation. Copyright (c) 2008 S. Karger AG, Basel.

Silent Period of Masticatory Cycles in Dentate Subjects and Complete Denture Wearers

Purpose: The purpose of this study was to assess, through electromyographic activity (EMG), the silent period (SP) of masseter and anterior temporal muscles in dentate subjects (DS) and complete denture wearers (CDW).Materials and Methods: The evaluations were performed at the initial and final period of the mastication for the DS group. For the CDW group, the evaluations were performed at the initial period of mastication, with old complete dentures worn for more than 10 years (OCDW) and at the final period of the mastication with new complete dentures (NCDW), 5 months after rehabilitation. Twenty-four asymptomatic subjects (12 DS, 12 CDW) answered a questionnaire based on the Research Diagnostic Criteria for temporomandibular disorders. The CDW group answered the questionnaire before and after new denture insertion and after 5 months of rehabilitation. The SP of the muscles was recorded through EMG at the initial and final periods of mastication using artificial food (Optocal). The operator monitored 35 chewing cycles performed to grind the artificial food and selected eight open-close-clench-chewing cycles for the record.Results: The SP of the muscles analyzed with new complete dentures showed no statistical difference in comparison to the old dentures. There was a statistically significant difference in the SP between the CDW and DS groups for initial and final chewing.Conclusion: Lowered muscular capacity and ability reduced the SP of muscles after rehabilitation with NCDWs.

Light-Emitting Diode Therapy in Chemotherapy-Induced Mucositis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Moebius Syndrome: Clinical Manifestations in a Pediatric Patient

Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication improved. (Pediatr Dent 2009;31:289-93) Received March 8, 2008 vertical bar Lost Revision July 22, 2008 vertical bar Revision Accepted July 28, 2008

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Absence or weak correlation between chewing side preference and lateralities in primary, mixed and permanent dentition

Objectives: To determine whether chewing side preference (CSP) is correlated to lateralities (handedness, footedness, eyedness and earedness) in primary, mixed and permanent dentitions.Design: Three-hundred subjects were divided into 3 groups: Group 1-100 children 3-5 years old, primary dentition; Group 2-100 children 6-12 years old, mixed dentition; Group 3 - 100 subjects 18-47 years old, permanent dentition. CSP was determined using a method developed by Mc Donnell et al.(9) Subjects were given a piece of gum and the position of the chewing gum was recorded 7 times as right or left. Subjects were classified as 'observed preferred chewing side' (OPCS) when they performed 5/7, 6/7 or 7/7 strokes on the same side. OPCS corresponded to the CSP. Laterality tests were performed for handedness, footedness, eyedness and earedness tasks. The Chi-square (chi(2)) and phi correlation (r) tests were used to investigate significant correlations between CSP and sidedness.Results: There was a significant correlation between chewing and earedness (p = 0.00), although there was weak positive correlation (r = 0.30) for primary dentition. There were significant correlations between chewing and handedness (p = 0.02; r = 0.25) and chewing and footedness (p = 0.02; r = 0.26), however, there were weak positive correlations for mixed dentition; there were significant correlations between chewing and handedness (p = 0.02; r = 0.26); chewing and footedness (p = 0.00; r = 0.33) and chewing and earedness (p = 0.01; r = 0.29); however, there were weak positive correlations for permanent dentition.Conclusion: It may be concluded that CSP can be significantly correlated with: earedness for primary dentition; handedness and footedness for mixed dentition; handedness, footedness and earedness for permanent dentition, but these are weak positive relationships. Future work on larger samples of left- and right-sided individuals is required to validate the findings. (C) 2012 Elsevier Ltd. All rights reserved.

Relação entre perdas dentárias e queixas de mastigação, deglutição e fala em indivíduos adultos

OBJETIVO: investigar se as perdas dentárias em indivíduos adultos apresentam relação com as queixas de fala, mastigação e deglutição. MÉTODOS: participaram deste estudo 50 indivíduos adultos, trabalhadores de uma Avícola, do município de Bariri (SP), com faixa etária entre 18 e 52 anos. Os participantes selecionados foram submetidos à avaliação odontológica por um cirurgião-dentista e à entrevista fonoaudiológica, por duas fonoaudiólogas, em um consultório do município que mantém contrato de prestação de serviço com a Avícola. Para análise dos resultados, foram comparados os indivíduos com e sem perda dos elementos dentários, denominados de grupo experimental (GE) e grupo controle (GC), respectivamente, a partir da aplicação do teste Qui-Quadrado. RESULTADOS: os resultados revelaram maior ocorrência de mastigação unilateral no GE. Queixas quanto à dificuldade e dor na mastigação estiveram presentes apenas no GE, com diferença estatisticamente significante entre os grupos (p<0,05). O tempo de deglutição mostrou-se inadequado para a maioria dos indivíduos em ambos os grupos. A maioria dos indivíduos do GC mencionou utilizar algum tipo de líquido para facilitar a deglutição. Nenhum indivíduo mencionou queixas de fala. CONCLUSÃO: os achados revelaram que a ausência de elementos dentários em indivíduos adultos apresentou relação apenas entre dificuldade e dor durante a mastigação.

Muscular, functional and orthodontic changes in pre school children with enlarged adenoids and tonsils

Introduction: Hypertrophy of the adenoids and palatine tonsils is the second most frequent cause of upper respiratory obstruction and, consequently, mouth breathing in children. Prolonged mouth breathing leads to muscular and postural alterations which, in turn, cause dentosketetal changes. Objective: the aim of this study was to determine muscular, functional and dentoskeletal alterations in children aged 3-6 years. Materials and methods: Seventy-three children, including 44 with tonsil hypertrophy and 29 controls, were submitted to otorhinolaryngologic, speech pathologic and orthodontic assessment. Results: Otorhinolaryngologic evaluation revealed a higher incidence of nasal obstruction, snoring, mouth breathing, apneas, nocturnal hypersalivation, itchy nose, repeated tonsillitis and bruxism in children with tonsils hypertrophy. Speech pathologic assessment showed a higher incidence of open lip and lower tongue position, and of hypotonia of the upper and lower lips, tongue and buccinator muscle in these children, accompanied by important impairment in mastication and deglutition. Orthodontic evaluation demonstrated a higher incidence of lower mandible position in relation to the cranial base, a reduction in lower posterior facial height, transverse atresia of the palate, and a dolicofacial pattern. Conclusion: Postural and functional alterations anticipate dentoskeletal changes, except for the facial pattern. Postural alterations and the skeletal pattern seem to play an important role in infant dentofacial growth. (C) 2003 Elsevier B.V. Ireland Ltd. All rights reserved.

Patients' Expectations of and Satisfaction with Implant-Supported Fixed Partial Dentures and Single Crowns

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Chewing in temporomandibular disorder patients: an exploratory study of an association with some psychological variables

Aims: To compare kinematic parameters (ie, amplitude, velocity, cycle frequency) of chewing and pain characteristics in a group of female myofascial temporomandibular disorder (TMD) patients with an age-matched control female group, and to study correlations between psychological variables and kinematic variables of chewing. Methods: Twenty-nine female participants were recruited. All participants were categorized according to the Research Diagnostic Criteria for TMD (RDC/TMD) into control (n = 14, mean age 28.9 years, SD 5.0 years) or TMD (n = 15, mean age 31.3 years, SD 10.7) groups. Jaw movements were recorded during free gum chewing and chewing standardized for timing. Patients completed the Depression, Anxiety, and Stress Scales (DASS-42), the Pain Catastrophizing Scale (PCS), the Fear of Pain Questionnaire-III (FPQ-III), and the Pain Self-Efficacy Questionnaire (PSEQ). Statistical analyses involved evaluation for group differences, and correlations between kinematic variables and psychological questionnaire scores (eg, depression, anxiety, stress) and pain intensity ratings. Results: Velocity and amplitude of standardized (but not free) chewing were significantly greater (P < .05) in the TMD group than the control group. There were significant (P < .05) positive correlations between pain intensity ratings and velocity and amplitude of standardized chewing but not free chewing. There were significant (P < .05) positive correlations between depression and jaw amplitude and stress and jaw velocity for standardized but not free chewing. Conclusion: This exploratory study has provided data suggesting that psychological factors, manifesting in depression and stress, play a role in influencing the association between pain and motor activity. J OROFAC PAIN 2011;25:56-67

Kinesiographic study of complete denture movement related to mucosa displacement in edentulous patients.

The mucosa that covers the residual ridges of edentulous patients may present some distortion or displacement when occlusal loading is applied in complete dentures. This distortion and movement of the denture can result in acceleration of residual ridge resorption and loss of retention and stability. The aim of this study was to analyze the pattern of upper complete denture movement related to underlying mucosa displacement. A sample of 10 complete denture wearers was randomly selected, which had acceptable upper and lower dentures and normal volume and resilience of residual ridges. The kinesiographic instrument K6-I Diagnostic System was used to measure denture movements, according to the method proposed by Maeda et al.7, 1984. Denture movements were measured under the following experimental conditions: (A) 3 maximum voluntary clenching cycles and (B) unilateral chewing for 20 seconds. The results showed that under physiological load, oral mucosa distortion has two distinct phases: a fast initial displacement as load is applied and a slower and incomplete recovery when load is removed. Intermittent loading such as chewing progressively reduces the magnitude of the denture displacement and the recovery of the mucosa is gradually more incomplete.