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.

Effect of denture fabrication and wear on closest speaking space and interocclusal distance during deglutition

Statement of problem. The accuracy of assessing maxillomandibular relationships for trial bases and dentures using phonetic and swallowing methods has not been compared to that observed with definitive prostheses. Thus, there is no evidence to prove whether measurements obtained through such methods remain the same after adaptation to dentures.Purpose. This study investigated changes in the closest speaking space, interocclusal rest space, and interocclusal distance during deglutition in edentulous patients during and after complete denture treatment.Material and methods. Eighteen edentulous subjects participated in this study and measurements were performed after 7 Intervals of time: (1) with occlusion rims and record bases following creation of the maxillomandibular relationship record, (2) with trial dentures, (3) at Insertion of definitive complete dentures, (4) 1 week, (5) 2 weeks, (6) 1 month, and (7) 3 months after insertion. Recordings of interocclusal distances were made with a mandibular kinesiograph. Closest speaking space was measured during the pronunciation of the word 'seis'. The distance between postural rest position and centric occlusion, or interocclusal rest space, was measured using a kinesiograph. Interocclusal distance during deglutition was tested by recording the closest mandibular position recorded during swallowing of 20 mL of water. Data were analyzed using repeated-measure ANOVA, followed by the Student-Newman-Keuls test (alpha=.05).Results. A significant (P <.01)reduction in the mean closest speaking space was found when it was evaluated using occlusion rims and record bases (4.6 mm) compared with other stages (3.0 to 3.4 mm). No significant differences were found in mean interocclusal rest space and interocclusal distance during deglutition among the time periods evaluated.Conclusions. The presence of occlusion rims can influence mandibular position during pronunciation of the /s/ sound. The arrangement of artificial teeth changes the closest speaking space. However, rest position and deglutition were not affected, either during denture fabrication or short-term use.

Effects of mandibular fixed implant-supported prostheses on masticatory and swallowing functions in completely edentulous elderly individuals

Purpose: To evaluate the effect of oral rehabilitation with immediately loaded fixed implant-supported mandibular prostheses on chewing and swallowing in elderly individuals. Materials and Methods: Fifteen completely edentulous patients aged more than 60 years (10 women and rive men), wearing removable dentures in both arches, had a mandibular denture replaced by an implant-supported prosthesis. All individuals were evaluated before surgery and again 3, 6, and 18 months later with regard to mastication and swallowing conditions. Examinations entailed an interview, evaluation of tactile sensitivity of the face, and observation of food intake, masticatory type, formations of bolus, and pain during mastication. The swallowing evaluation comprised observation of clinical signs related to the oral and pharyngeal stages of swallowing, as well as the presence of oral residue. The findings of different evaluations before and 3, 6, and 18 months after the surgical-prosthetic procedure were statistically compared by analysis of variance for repeated measurements at a significance level of 5%. Results: The questionnaire revealed a reduction in complaints of masticatory and swallowing disturbances, a decreased need for liquid ingestion, and reduced choking and coughing. Clinical evaluations showed improved oral function and bolus propulsion for both solid and paste-consistency foods; pain during mastication was also resolved. Conclusion: Treatment with mandibular implant-supported dentures had positive effects on the clinical aspects of mastication and swallowing in elderly individuals.

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

Caracterização e classificação da deglutição orofaríngea do idoso institucionalizado: avaliaçao clínica fonoaudiológica

Pós-graduação em Bases Gerais da Cirurgia - FMB

Noninvasive and multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta: a pediatric case report

Case Report. An 8-year-old girl with amelogenesis imperfecta (AI) reported unsatisfactory aesthetics, difficulty in mastication, and dental hypersensitivity. The intraoral examination observed mixed dentition, malocclusion in anteroposterior relationships, anterior open bite, and dental asymmetry. A hypoplastic form of AI was diagnosed in the permanent dentition. A multidisciplinary planning was performed and divided into preventive, orthopedic, and rehabilitation stages. Initially, preventive treatment was implemented, with fluoride varnish applications, in order to protect the fragile enamel and reduce the dental sensitivity. In the second stage, the patient received an interceptive orthopedic treatment to improve cross-relationship of the arches during six months. Finally, the rehabilitation treatment was executed to establish the vertical dimension. In the posterior teeth, indirect composite resin crowns were performed with minimally invasive dental preparation. Direct composite resin restorations were used to improve the appearance of anterior teeth. Follow-Up. The follow-up was carried out after 3, 6, 12, and 18 months. After 18 months of follow-up, The restoration of integrity, oral hygiene, and patient satisfaction were observed . Conclusion. Successful reduction of the dental hypersensitivity and improvement of the aesthetic and functional aspects as well as quality of life were observed.

Light-Emitting Diode Therapy in Chemotherapy-Induced Mucositis

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Determinação da relação central. Estudo sobre as posições laterais da mandíbula, em relação à linha mediana facial, em função de dois métodos para esta determinação.

The authors studied the lateral positional desviations of the mandible, in relation to the facial median line in 30 (thirty) full edentulous patients, with the purpose to verify the influence of the unstrained guided (chinpoint guidance) and deglutition methods for the determination of centric relation. According the results obtained they conclude that the unstrained guided method produced a mandibular lateral desviation with a mean value of the 0.752 mm and in the deglutition method the mean value observed was 1.109 mm. The statistical analysis of the results revealed for the unstrained guided method a proportion of the points to the right and left of the median line not statistically significant, while for the deglutition method the difference was statistically significant at a level of 5%.

Mastigação simulada e digestão ácido-enzimática de sementes de leguminosas forrageiras tropicais

This study aimed to evaluate the effect of simulated chewing in the laboratory on the survival of seeds of four tropical forage legumes (butterfly pea, Clitorea ternatea; estilosantes, Stylosanthes capitata/S. macrocephala 'Campo Grande; archer, Macrotyloma axillare and perennial soybean, Neonotonia wightii) submitted to different periods of acid enzymatic digestion in vitro. Three trials were conducted to observe the percentage of destroyed seeds by the mastication; to compare the germination of the seeds (intact seeds, simulated mastication, scarification with sandpaper, mastication and scarification with sandpaper). And, finally the seeds were incubated at 39oC with hydrochloric acid and pepsin for: 0, 2, 4, 8, 12 and 24 hours. The percentages of not destroyed seeds in mastication (archer, 91,5; perennial soybean, 88.0; butterfly pea, 82.1, and estilo, 81.1), associated with the beneficial effects of scarification on germination (64.7, 60.0, 92.0 e 87.3%, respectively) and the effects of time of acid-enzymatic digestion (75% higher if they stay 24 hours in HCl + pepsin) associated to the hard and not permeable coats of legume seeds, allow a high potential for resistance, and to pass intact through the digestive tract of cattle, being able to germinate when defecated in the pastures. However, estilo should not be included in the feeding of cattle for this purpose, because it do not resists the acid-enzyme digestion.

Planejamento protético para pacientes adultos portadores de fissura labiopalatal congênita, que não obtiveram oportunidade de um tratamento reabilitador ideal: execução de casos clínicos para pacientes selecionados

Although one cannot prevent the birth of human beings with cleft palate lesions one can adopt attitudes and various procedures entirely viable to rehabilitate and recuperate these persons through a team work composed of the facilities of a hospital, physician, dentist, psychotherapist, epeech pathologist, pedagogue and a social worker. In order to reduce the suffering of these patients we took up this work to prove that even if not in an ideal manner nevertheleses in an acceptable one we can reintegrate these persons to their families, friends and social milieu, offering them more security in their social, psychic and human relationships. We have made a review of the literature during the last three decades where we found many possibilities of prosthetic recuperations which concerns esthetics, mastication and maxillomandibular relationships beyond allowing these pacients conditions to perform satisfactory the functions of deglution and speech. We have selected and executed 5 clinical cases out of 15 pacients formely choosen looking to different prosthetic plannings. We have also shown the major contribution that the osseous integrated implants can offer to the rehabilitation and recuperation of pacients whith congenitall labio palatal lesions. To simplify the understanding we tried to discuss the most varied types of prosthesis in well defined subjects having a separate approach for each of them and we still showed that the specificity of each case leads to a specific type of rehabilitation founded om esthetics, occlusion, osseous suport, edentulous space, and above all based in the common sense and Professional integrity

Kinesiographic study of deglutition in dentate individuals and complete denture wearers

Swallowing is used as a clinical method in prosthodontics to determine and record jaw relationships. The aim of this study was to perform a quantitative evaluation, in naturally dentate subjects and complete denture wearers, of three measurements associated with the mandibular position during the act of swallowing water: 1. intermaxillary distance on vertical axis; 2. anteroposterior deviation; and 3. lateral deviation. Two groups were selected: Group I (GI) included 40 subjects with complete dentition (mean age 45.27 yrs) and Group II (GII) included 40 bimaxillary edentate subjects, complete denture wearers (mean age 63.92 yrs). A kinesiographic instrument was used for analysis. Three records were taken for each measurement and a mean value obtained. It was concluded that: 1. intermaxillary distance on vertical axis and horizontal deviation were similar for both groups; 2. there was a significant intermaxillary distance on the vertical axis; and 3. for anteroposterior and lateral axis, results showed moderate deviation in relation to maximal intercuspation (MI).

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke

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

Oropharyngeal dysphagia and language delay in partial trisomy 9p: case report

The phenotype of partial trisomy 9p includes global developmental delay, microcephaly, bulbous nose, downturned oral commissures, malformed ears, hypotonia, and severe cognitive and language disorders. We present a case report and a comparative review of clinical findings on this condition, focusing on speech-language development, cognitive abilities and swallowing evaluation. We suggest that oropharyngeal dysphagia should be further investigated, considering that pulmonary and nutritional disorders affect the survival and quality of life of the patient. As far as we know, this is the first study of a patient with partial trisomy 9p described with oropharyngeal dysphagia.

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.