Esophageal contractions, bolus transit and perception of transit after swallows of liquid and solid boluses in normal subjects

CONTEXT: Esophageal dysphagia is the sensation that the ingested material has a slow transit or blockage in its normal passage to the stomach. It is not always associated with motility or transit alterations. OBJECTIVES: To evaluate in normal volunteers the possibility of perception of bolus transit through the esophagus after swallows of liquid and solid boluses, the differences in esophageal contraction and transit with these boluses, and the association of transit perception with alteration of esophageal contraction and/or transit. METHODS: The investigation included 11 asymptomatic volunteers, 4 men and 7 women aged 19-58 years. The subjects were evaluated in the sitting position. They performed swallows of the same volume of liquid (isotonic drink) and solid (macaroni) boluses in a random order and in duplicate. After each swallow they were asked about the sensation of bolus passage through the esophagus. Contractions and transit were evaluated simultaneously by solid state manometry and impedance. RESULTS: Perception of bolus transit occurred only with the solid bolus. The amplitude and area under the curve of contractions were higher with swallows of the solid bolus than with swallows of the liquid bolus. The difference was more evident in swallows with no perception of transit (n = 12) than in swallows with perception (n = 10). The total bolus transit time was longer for the solid bolus than for the liquid bolus only with swallows followed by no perception of transit. CONCLUSION: The results suggest that the perception of esophageal transit may be the consequence of inadequate adaptation of esophageal transit and contraction to the characteristics of the swallowed bolus.

Perception of social support by individuals with diabetes mellitus and foot ulcers

OBJECTIVE: To evaluate the perception of social support and the relationship of sociodemographic, clinical and metabolic control variables in individuals with diabetes mellitus and foot ulcers in an outpatient unit. METHODS: A quantitative cross-sectional approach was carried out using a social support network inventory. RESULTS: Participants had a high perception of social support; family and health professionals were identified as the main support sources. Fasting plasma glucose values were directly related with social support. CONCLUSION: Family members were identified as the main support source, which emphasizes their importance in the health care process.

Effects of active and passive lacebacks on antero-posterior position of maxillary first molars and central incisors

The purpose of this study was to compare the effects of active and passive lacebacks on antero-posterior position of maxillary first molars and central incisors during leveling phase. Twenty-three subjects with Class I and Class II malocclusion were treated with first premolars extraction using preadjusted appliances (MBT 0.022-inch brackets). The leveling phase was performed with stainless steel archwires only. The sample was divided into 2 groups: 14 subjects received active lacebacks (Group 1) and 9 subjects received passive lacebacks (Group 2). Lacebacks were made from 0.008-inch ligature wire. Lateral cephalometric radiographs were taken pre- and post-leveling phase. Student's t-test was applied to determine the differences between pre- and post-leveling mean values and to determine the mean differences between groups. In Group I, the first molars showed a significant mesial movement, whereas no change was observed in Group 2. In both groups, maxillary central incisor crowns moved to lingual side. In conclusion, active laceback produced anchorage loss of maxillary first molars whereas passive laceback did not affect the position of these teeth. Active and passive lacebacks were effective in preventing central incisor proclination.

Open bite: diagnosis, treatment and stability

Open bite has fascinated Orthodontics due to the difficulties regarding its treatment and maintenance of results. This anomaly has distinct characteristics that, in addition to the complexity of multiple etiological factors, have aesthetic and functional consequences. Within this etiological context, several types of mechanics have been used in open bite treatment, such as palatal crib, orthopedic forces, occlusal adjustment, orthodontic camouflage with or without extraction, orthodontic intervention using mini-implants or mini-plates, and even orthognathic surgery. An accurate diagnosis and etiological determination are always the best guides to establish the objectives and the ideal treatment plan for such a malocclusion. This report describes two cases of open bite. At the end of the treatment, both patients had their canines and molars in Class I occlusion, normal overjet and overbite, and stability during the posttreatment period.

Temporomandibular disorders and parafunctional oral habits: an anamnestic study

OBJECTIVE: To assess the frequency and severity of the signs and symptoms of temporomandibular disorders (TMD), the frequency of parafunctional oral habits and the correlation between the variables by means of the patients' perception regarding their problem. METHODS: One hundred patients diagnosed with TMD, through a clinical examination of their masticatory system, answered the questions of a previously published protocol concerning the signs and symptoms most frequently reported in the literature. RESULTS: According to the results from the non parametric statistical analysis, the frequency for the following signs and symptoms was significant: Fatigue and muscle pain, joint sounds, tinnitus, ear fullness, headache, chewing impairment and difficulty to yawn (p<0.01) and otalgia (p<0.05). As to the parafunctional oral habits, there was a significant presence of teeth clenching during the day and night (p<0.01) and teeth grinding at night (p<0.05). The variable correlation analysis showed that there was a positive correlation between symptom frequency and severity; age was correlated with the presence of otalgia, cervical pain and teeth sensitivity, besides being correlated with muscle and joint pain severity. Habit frequency was negatively correlated with age. TMD duration was also positively correlated with the symptoms of tinnitus, ear fullness, muscle and joint pain. CONCLUSION: The study results showed that the anamnestic assessment using ProDTMMulti can predict the severity of the TMD case.

Influence of palatoplasty on occlusion of patients with isolated cleft palate

OBJECTIVE: This study compared the dental arch morphology of adult patients with isolated cleft palate in order to verify the influence of palatoplasty on occlusion. METHODS: Cast models of 77 patients, 30 males and 47 females, with an average age of 21 years and no syndromes were taken. They were in the permanent dentition and had not undergone orthodontic treatment. The sample was divided into non-operated and operated patients, the latter having been submitted to palatoplasty at a mean age of 2.2 years. RESULTS: Almost 80% of the sample exhibited sagittal discrepancies in the inter-arch relationship, with a Class II malocclusion prevailing (59.74%) followed by Class III (20,78%), regardless of palatoplasty. Transverse analysis showed a 23% incidence of posterior crossbite also not influenced by palatoplasty. Intra-arch relationship indicated that constriction and crowding on the upper arch were more frequent in the operated group (p=0.0238 and p=0.0002, respectively), showing an influence of palatoplasty on its morphology. The predominant morphological characteristics in patients with isolated cleft palate were a Class II malocclusion, upper dental arch constriction and upper and lower anterior crowding. CONCLUSION: The influence of palatoplasty was restricted to constriction and crowding of the upper dental arch, with no interference from the extension of the cleft, except for the upper crowding, which occurred more in patients with complete cleft palates.