Evaluation of oro-facial function in young subjects with temporomandibular disorders.

The aim of this study was to evaluate bite force (BF) and oro-facial functions at different dentition phases (initial-mixed, intermediate-mixed, final-mixed and permanent dentition) in children and adolescents diagnosed with temporomandibular disorders (TMDs). The sample was selected from four public schools in Piracicaba, São Paulo, Brazil. Of the 289 participants recruited, aged 8-14 years old, 46 were placed into the TMD group. TMD was diagnosed using Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (2011). Oro-facial functions were evaluated using the Nordic Orofacial Test-Screening (NOT-S), which involves both an interview and a clinical examination. BF was measured using a digital gnathodynamometer. Age and body mass index (BMI) were also considered. The data were analysed by the following tests: Kolmogorov-Smirnov test, Student's t-test, Spearman and Pearson coefficients, Qui-square test, Fisher's exact or binomial test, as indicated. Moreover, univariate and multivariable logistic regression were applied. For the TMD group, scores associated with NOT-S interview and NOT-S total were higher than for the control group (P = 0.033 and P = 0.0062, respectively). No differences in BF between genders or groups (P > 0.05) were detected. Variables included in the multivariate logistic regression were BMI and NOT-S total. Based on this analysis, NOT-S total was associated with TMDs. Reported sensory function was the specific domain within NOT-S interview that established the significant difference between the groups (P = 0.021). The TMD group also had a greater number of alterations in the face-at-rest domain of the NOT-S exam (P = 0.007). Concluding, it did not detect an association between TMDs and either dentition phase or BF. Instead, BF correlated with age and BMI. Oro-facial dysfunction was associated with TMD in the studied sample, but this association may be bidirectional, requiring further researches.

Changes in the oral-health-related quality of life of Brazilian children after an educational preventive programme: an 1-month longitudinal evaluation.

OBJECTIVE: This 1-month longitudinal study assessed whether the oral status and the oral-health-related quality of life (OHRQoL) of children changed after four sessions of an educational preventive programme. STUDY POPULATION AND METHODS: Fifty Brazilian students (11-12 year old) were examined for signs and symptoms of gingivitis using the Community Periodontal Index and two questions about gingival bleeding. The OHRQoL was measured using the Brazilian Portuguese version of the Child Oral Impacts on Daily Performances (Child-OIDP). Higher scores indicated worse OHRQoL. The results were analysed using the Shapiro-Wilk, Chi-square, Wilcoxon signed-rank and Mann-Whitney tests. The magnitude of the mean change was calculated using the effect size. RESULTS: Twenty-four percentage of children had more than six sites with bleeding at follow-up compared with 58% at baseline. There was a significant decline in the intensity and extension of impacts at follow-up. A significant improvement in the clinical status and oral hygiene was observed for both transitional categories. There was a significant decline in the Child-OIDP scores of those reporting 'much improved'. A significant improvement in the global ratings of oral health was observed at follow-up. CONCLUSIONS: In the studied sample, an improvement occurred with respect to the severity of disease, intensity and extension of impacts and global ratings of oral health after 1-month follow-up. These results suggest that improving the global transition in health by enhancing coping and management skills while inducing slight changes in the clinical status and the specific aspects of health compromised by the disease is possible.

Electromyographic evaluation of masticatory muscles at rest and maximal intercuspal positions of the mandible in children with sleep bruxism.

UNLABELLED: In adults, sleep bruxism (SB) may be related to reports of pain or fatigue in the muscles of mastication, resulting from multiple muscle contractions that occur during the night. In children, little is known about the consequences of this parafunction. PURPOSE: The objective was to compare the electromyographic activity (EMG) of the masseter and anterior portion of the temporalis muscles in children with and without SB; acquisitions were made at rest (RE) and in maximal intercuspal (MI) positions of the mandible. METHODS: Twenty children with signs and symptoms of SB (mean age 7.20 years ± 0.52) and 20 controls without signs or symptoms of SB (mean age 7.40 years ± 0.50) were selected. The controls were matched to the type of occlusal morphology evaluated according to Björk et al. (Acta Odontol Scand 22:27-40, 1964). Muscle activity was measured with the mandible at RE, MI and maximal clenching with cotton roll (MC), on the left and right sides. Data from the RE and MI (mV) were normalized by calculating them as % MC. The results were analyzed by descriptive statistics, Shapiro-Wilk test, Wilcoxon and Mann-Whitney tests. RESULTS: The subjects' age did not differ significantly between groups. EMG of temporalis muscle at RE differed between the right and left sides in both groups. There was no significant difference in EMG of masseter and temporalis muscles between groups. CONCLUSION: Children with SB showed no significant difference in EMG of masticatory muscles at RE and in MI positions of the mandible when compared with the control group.

Relationship between orofacial function, dentofacial morphology, and bite force in young subjects.

OBJECTIVE: The aim was to evaluate the relationship between orofacial function, dentofacial morphology, and bite force in young subjects. SUBJECTS AND METHODS: Three hundred and sixteen subjects were divided according to dentition stage (early, intermediate, and late mixed and permanent dentition). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Orthodontic treatment need, bite force, lateral and frontal craniofacial dimensions and presence of sleep bruxism were also assessed. The results were submitted to descriptive statistics, normality and correlation tests, analysis of variance, and multiple linear regression to test the relationship between NOT-S scores and the studied independent variables. RESULTS: The variance of NOT-S scores between groups was not significant. The evaluation of the variables that significantly contributed to NOT-S scores variation showed that age and presence of bruxism related to higher NOT-S total scores, while the increase in overbite measurement and presence of closed lip posture related to lower scores. Bite force did not show a significant relationship with scores of orofacial dysfunction. No significant correlations between craniofacial dimensions and NOT-S scores were observed. CONCLUSION: Age and sleep bruxism were related to higher NOT-S scores, while the increase in overbite measurement and closed lip posture contributed to lower scores of orofacial dysfunction.

Masticatory performance and taste perception in patients submitted to cancer treatment.

The aim of this study was to analyse mastication and the sense of taste in 39 patients submitted to cancer treatment in different areas of the body and to compare these variables with those of 44 control individuals within the same age range. The following aspects were assessed: dental status (DMFT); stimulated and non-stimulated salivary flow; sense of taste (salty, sweet, bitter and sour); and masticatory performance (MP), through the calculation of X(50). Logistic regression models were established to test the association between the independent variables and cancer treatment. Cancer patients had lesser stimulated salivary flow, a smaller number of teeth and occlusal units, worse MP, higher salty, sweet and sour taste scores and a lower bitter taste score (P < 0·05). A significant positive correlation was found between MP and the DMFT index in both groups (P < 0·05), meaning that a lower DMFT index value denoted a smaller X(50) value (better masticatory performance). The logistic regression model revealed that patients who had undergone cancer treatment had a greater probability of exhibiting a smaller number of teeth, higher salty and smaller bitter taste scores (P < 0·05). It was concluded that patients who were submitted to cancer treatment presented oral physiology alterations when compared with control subjects at the same age range.

Evaluation of masticatory performance and bite force in children with sleep bruxism.

The aim of this study was to evaluate the association between masticatory performance (MP) and bite force (BF) in children with sleep bruxism (SB) during the mixed dentition stage, considering also the occlusal characteristics. The sample was composed by 52 healthy children of both genders, aged 6-10 years. From those, 22 presented signs and symptoms of SB and 30 were the controls. SB diagnosis consisted of both parental report and presence of tooth wear. MP was evaluated by the individual's ability to communicate an artificial chewable test material for determining the median particle size (X50) and distribution of particles in the different sieves (b). BF was measured using a digital gnathodynamometer with fork strength of 8 mm. The results were submitted to descriptive statistics, Mann-Whitney and chi-square tests, Spearman's correlation and multiple logistic regression. Mean BF and X50 did not differ between groups with and without SB. A significant negative correlation was observed between BF and X50 only in the group of children with SB. Moreover, the logistic regression model showed an association between the presence of SB and higher b index. The other independent variables included in the model showed no association with SB. BF did not differ between children with and without SB. Besides, higher BFs in children with SB meant better MP; however, they were more likely to present chewed particles retained in the larger aperture sieves, consequently requiring more chewing cycles to break down the test material in smaller particles.

Associations between oral health-related quality of life and emotional statuses in children and preadolescents.

OBJECTIVES: To evaluate the associations between oral health-related quality of life (OHRQoL) and emotional statuses in children and preadolescents. METHODS: One hundred and forty-five Brazilian students (8-14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well-being (OWB). The Revised Children's Manifest Anxiety Scale (R-CMAS) and Children's Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non-paired t test/one-way ANOVA, Pearson's correlation test, and multiple linear regression analyses. RESULTS: 11-14-year-old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Children's Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (ß =0.312; P < 0.001) and the OWB model retained TMD (ß = 0.271; P < 0.001) and CDI scores (ß=0.175; P < 0.05). CONCLUSIONS: Children and preadolescents with poor emotional well-being are more sensitive to the impacts of OH and its effects on OWB.

Salivary cortisol, alpha-amylase and heart rate variation in response to dental treatment in children.

OBJECTIVE: Anxiety and stress are usually related to the dental treatment situation. The objective was to investigate salivary cortisol and alpha-amylase levels (salivary biomarkers) and heart rate in children undergoing a minor dental procedure (dental prophylaxis). STUDY DESIGN: In total, 31 children (range 84-95 months) of both genders without caries or history of dental treatment/pain/trauma were selected. Three saliva samples were gathered: one prior to dental prophylaxis, one immediately after and one ten minutes later. Weight and height were assessed, and heart rate was evaluated prior to and during the procedure. Data were analyzed by correlation tests and t-test/Wilcoxon (alpha = 0.05). RESULTS: Higher cortisol and amylase levels were observed before prophylaxis compared to afterward. Cortisol and amylase levels did not show a significant correlation, nor did salivary biomarkers and body mass index. However, heart rate and amylase levels showed a significant positive correlation. CONCLUSIONS: In the studied sample, certain anticipation of the dental treatment was observed because higher cortisol and amylase levels were observed before, rather than after the event; moreover a significant correlation between amylase levels and heart rate was observed Thus, salivary biomarkers may be a valuable tool for evaluating anxiety-producing events, such as dental treatment, in children.

Evaluation of facial asymmetry and masticatory muscle thickness in children with normal occlusion and functional posterior crossbite.

AIM: The aim of this study was to evaluate facial asymmetry and the thickness of the masticatory muscles in young children with normal occlusion and functional posterior crossbite. METHODS: The sample comprised 72 children of both genders (64.71±7.04 months) in the primary and early mixed stage of dentition, divided into four groups: primary-normal occlusion (PriN; N=19), primary-crossbite (PriC; N=19), mixed-normal occlusion (MixN; N=27), and mixed-crossbite (MixC; N=16). The thickness of the masseter and anterior portion of the temporalis muscle at rest and during maximal clenching were assessed by ultrasonography. Facial morphology and asymmetry were evaluated by standardized front-view photographs, in which the following measurements were recorded: anterior face height (AFH), bizygomatic facial width (BFW), angle of the eye (AE) and angle of the mouth (AM) (interpupillary and commissure planes in relation to mid-sagittal plane, respectively). RESULTS: The results showed that muscle thickness did not differ significantly between the sides of the dental arches in all groups (paired t-test). Only the groups with normal occlusion presented significant positive correlation between AE and AM (Pearson's correlation test). In PriN, only body weight was significantly related to masseter thickness; in MixN, facial morphology contributed significantly to masseter thickness at rest and maximal clenching, while the covariates weight, height and age did not relate to muscle thickness (stepwise backward multiple regression). CONCLUSION: In the studied sample, children with crossbite presented greater facial asymmetry than those with normal occlusion, and a greater masseter thickness was related to larger faces in the mixed dentition.

Oral health-related quality of life in children: part I. How well do children know themselves? A systematic review.

OBJECTIVE: Paediatric oral disorders are likely to have a negative effect on the quality of life. Until recently, children's oral health-related quality of life (OHRQoL) was measured using parents as informants. Instruments have now been developed, which have demonstrated that with appropriate questionnaire techniques, valid and reliable information can be obtained from children. The aim of this study was to make a systematic review of the existing literature about child perceptions of OHRQoL and their validation. METHODS: A computerized search was conducted using Medline, ISI, Lilacs and Scielo for children's perception of OHRQoL. The inclusion criteria were: the articles should contain well-validated instruments and provide child perceptions of OHRQoL. RESULTS: From 89 records found, 13 fulfilled the criteria. All studies included in the critical appraisal of the project suggested good construct validity of overall child perceptions of OHRQoL. However, children's understanding of oral health and well-being are also affected by variables (age, age-related experiences, gender, race, education, culture, experiences related to oral conditions, opportunities for treatment, childhood period of changes, back-translating questionnaire, children self-perceived treatment need). CONCLUSIONS: The structure of children's self-concept and health cognition is age-dependent as a result of their continuous cognitive, emotional, social and language development. By using appropriate questionnaire techniques, valid and reliable information can be obtained from children concerning their OHRQoL.

Oral health-related quality of life in children: part II. Effects of clinical oral health status. A systematic review.

OBJECTIVE: Children are affected by numerous oral and orofacial disorders, which have the potential to compromise functioning, well-being and the quality of life (QoL). The purpose of this paper was to review the literature about children's clinical oral health status and health-related quality of life (HRQoL) and to assess the respective association. MATERIALS AND METHODS: The authors searched Medline, ISI, Lilacs and Scielo for articles from 1985 to 2007. The inclusion criteria were randomized, cross-sectional, longitudinal or retrospective studies that used well-validated oral health-related QoL instruments, children self-applied questionnaires and quantitative measurements of clinical oral health status. RESULTS: Of the 402 articles that were critically assessed, 12 studies were included in the critical appraisal of the project. CONCLUSIONS: There is a relationship between clinical oral health status and HRQoL in children. In the studies that suggested weak relationships between children's oral conditions and HRQoL, the explanations were low disease levels in the sample, the conditions under investigation may have caused immeasurably low levels of impact or the impacts were mediated by inter- and intravariables according to culture and education. Moreover, relationships between biological or clinical variables and HRQoL outcomes are not direct, but mediated by a variety or personal, social and environmental variables, as well as by the child development, which have influence on the comprehension about the relationship among health, illness and QoL. So, longitudinal studies are necessary to determine validity, responsiveness and minimal clinically important difference.

Oral health-related quality of life in children: part III. Is there agreement between parents in rating their children's oral health-related quality of life? A systematic review.

OBJECTIVE: One issue that receives a great deal of attention is the comparison between measurement of children's oral health-related quality of life (OHRQoL) reports with those of their parents. However, the extent to which parents understand the effects of ill-health on their children's lives remains unanswered. The purpose of this systematic review was to identify the literature on the nature, extent and the pattern of agreement/disagreement between parent and child reports about child OHRQoL and assess the association between them. MATERIALS AND METHODS: The literature was searched using MEDLINE, ISI, Lilacs and Scielo, from January 1985 to March 2007. The selected studies used well-validated instruments and provided children's and parent's perceptions of child OHRQoL. RESULTS: A total of 87 articles were retrieved and five were selected for the review, which showed that children and parents do not necessarily share similar views about child OHRQoL. Some parents may have limited knowledge about their children's OHRQoL, particularly the impact on social and emotional well-being. CONCLUSIONS: Valid and reliable information can be obtained from parents and children using appropriate questionnaire techniques. Although the parents' reports may be incomplete due to lack of knowledge about certain experiences, they still provide useful information.

Molar bite force and its correlation with signs of temporomandibular dysfunction in mixed and permanent dentition.

The aim of the study was to evaluate molar bite force (BF) magnitude and its correlation to the signs of temporomandibular dysfunction (TMD), gender, weight, height and age in 101 students ranging in age from 6 to 18 years (32 boys/21 girls with mixed dentition and 23 boys/25 girls with permanent dentition). TMD clinical signs were evaluated using the Craniomandibular Index (CMI), and two subscales, the Dysfunction Index (DI) and the Palpation Index (PI). BF was determined with a pressurized tube connected to a sensor (MPX5700-Motorola SPS). anova, Tukey's test, and Pearson's and Spearman's coefficients were evaluated. BF was higher in the permanent dentition (P < 0.05). There was no difference in BF between genders within the groups, but boys with permanent dentition had higher values than children with mixed dentition (P < 0.05). The girls with permanent dentition presented negative correlation in BF with PI and CMI (P < 0.05). BF was positively correlated with weight, height and age in the permanent dentition group (P < 0.05). It was concluded that BF increased from mixed to permanent dentition, with an assumed enhancing influence of body variables and ageing. The TMD signs in older girls were correlated to decreasing BF, suggesting an influence of muscle tenderness preventing subjects from exerting maximum BF.

Ultrasound and tomographic evaluation of temporomandibular joints in adolescents with and without signs and symptoms of temporomandibular disorders: a pilot study.

OBJECTIVES: Condylar position in the glenoid fossa has been linked to temporomandibular disorders (TMDs); however its importance in TMD aetiology is still unclear. The purpose of this study was to determine joint spaces and condylar position in adolescents with TMDs using ultrasound static images and linear corrected tomograms at the mandibular rest position. METHODS: Craniomandibular index (CMI) and a symptom questionnaire were assessed in 217 subjects aged 12-18 years. Those with the lowest and the highest scores were divided into control (n=20) and SSTMD (presence of signs and symptoms of TMD) groups (n=20). Ultrasound images and tomography were used to measure the distance between the capsule and the lateral surface of the condyle and to determine the condyle location at the mandibular resting position, respectively. RESULTS: The mean distances obtained from ultrasound images did not correlate with CMI scores and they did not differ between the two groups (P>0.05). Posterior positioned condyles were determined on tomograms, and they were more prevalent both in the SSTMD group (P=0.05) and in girls (P<0.05). CONCLUSIONS: Even though there was a significant difference in condyle position between the control and SSTMD groups, determined by axially corrected tomograms, it cannot be inferred that posteriorly positioned condyles can predict TMDs. In addition, there was no association between the articular capsule and the lateral condyle surface distances measured by ultrasound using a 10 MHz linear transducer and the clinical diagnosis of TMD. Further studies in diagnostic imaging of TMJs with ultrasound should be encouraged, since it has some useful diagnostic applications and does not require special facilities.

Evaluation of condylar position from transcranial projections in primary dentition.

OBJECTIVES: To evaluate the condylar position through transcranial radiographs in children between 3 years and 6 years old and to associate it with morphological characteristics of primary dentition. METHODS: The extraoral transcranial radiographs were taken with plain films using the Accurad-200 head holder (Denar Company, Anaheim, CA), and then they were digitized using a Hewlett Packard 6390 Scanner. The condylar position was determined according to Gelb's template, in postural rest position (RP) and maximum intercuspal position (MI), and it was associated with the characteristics: normal occlusion (n=36), open bite with or without overjet greater than 3 mm (n=27), unilateral or bilateral posterior cross bite (n=14), overbite greater than 3 mm (n=15). The chi-square and the Fisher Exact Test were used to analyse the data. RESULTS: It was verified that when using Gelb's template, there was not a significant association between the occlusion type found and the position of the condyle in the glenoid fossa when considering the entire patient sample (P>0.05). There was a great variability in positions, and most of the children had asymmetric condyles (55.43% in MI and 51.09% in RP). Children with normal occlusion and malocclusion presented the same proportions of condylar position in both mandibular positions. CONCLUSIONS: In conclusion, the results of this study showed that the condylar position in small children with different morphological occlusions presented great variability.

Bite force determination in adolescents with and without temporomandibular dysfunction.

The aims of this study were to compare bite force in adolescents with and without temporomandibular dysfunction (TMD), and to investigate the influence of gender, age, height and weight on bite force magnitude. The TMD was evaluated using a self-report questionnaire and the Craniomandibular Index, which has two subscales, the Dysfunction Index and the Palpation Index. Subjects with lower and upper extremity values were used to integrate the control (Group I -n = 20) and TMD (Group II -n = 20) groups, respectively. In addition, the TMD group should have at least one subjective symptom. Bite force was determined with a transducer, which consisted of a pressurized rubber tube connected to a sensor element (MPX 5700 - Motorola SPS, Austin, TX, USA). Analysis of covariance, Pearson's coefficient, Mann-Whitney and t-tests were applied to analyse the data. The results showed that Group II presented smaller values for bite force than Group I and boys had greater values than girls in Group II (P < 0.05). Bite force values were significantly smaller for girls between groups (P < 0.05), whereas for boys there was no statistical difference. Weak positive correlation between bite force and weight, height and age (P > 0.05) and significant negative correlation between bite force and Palpation and Craniomandibular Indexes (P < 0.05) were found. It was concluded that decreased bite force was correlated with TMD in girls, primarily with muscle tenderness.

Relationship between oral parafunctional/nutritive sucking habits and temporomandibular joint dysfunction in primary dentition.

UNLABELLED: The aim of this study was to evaluate the relationship between nutritive and parafunctional habits and the presence of temporomandibular dysfunction (TMD) in children with primary dentition. METHODS: Ninety nine children, aged 3-5 years, were examined to check for the presence or absence of signs and symptoms of TMD (headache, preauricular pain, earache, masticatory muscle tenderness, deviation on opening, occlusal interference and asymmetric movement of the mandible), oral parafunctions (bruxism, nail biting, finger/thumb sucking, speech alteration, mouth breathing, pacifier and atypical swallowing) and nutritive habits (breast- or bottle-feeding) through interview and clinical examination. The results were submitted to descriptive statistical analysis and Fisher's exact test. RESULTS: The results showed that only atypical swallowing was positively related to TMD (P < 0.0001); other oral parafunctional and nutritive habits were not related to TMD. CONCLUSIONS: It was concluded that parafunctional habits, with the exception of atypical swallowing, and feeding methods were not determinants for the presence of signs and/or symptoms of TMD in the sample of children included in the study.

Bite force determination in children with primary dentition.

The aim of this study was to determine the bite force with primary dentition in 30 children with normal occlusion (group I), cross bite (group II) and open bite (group III). The magnitude of the bite force was determined through a pressurized transmitter tube (pressure sensor MPX 5700 Motorola), which was connected to a converse analog/digital electronic circuit. The children bit the tube with maximum force three times successively for 5 s, with a 10 s interval among each bite, and the sign was sent directly to the computer. The highest value of the three, for each patient, was considered. Analysis of variance evaluated difference among the three groups. The means of maximum bite force were 213 17, 249 63 and 241 19 N for the groups, respectively, and there were no significant statistical differences among them (P > 0.05). The analysis of correlation showed that the weight, height and bite force presented weak positive correlation (r=0.24 and 0.23). It was concluded that in the studied groups the type of occlusion did not affect the maximum values of the bite force and body variables had a small influence in this magnitude.