Myofunctional Speech Therapy for Facial Rejuvenation and Orofacial Function Improvement: A Systematic Review.

This review aims to reveal the effectiveness of myofunctional speech therapy on facial rejuvenation and/or improvement of orofacial function. A systematic review of four medical electronic databases (Medline, Google Scholar, SciELO, and LILACS) was conducted between January and March 2023. The research question was defined using the PICO model: Population (P): adult subjects with signs of physiological aging of facial skin. Intervention (I): aesthetic speech therapy (facial exercises and/or myofunctional therapy). Control (C): absence of treatment. Outcome (O): facial rejuvenation. Through the search process, a total of 472 potentially relevant articles were identified. A total of 21 studies were included in the review. Most of the studies required the participants to perform exercises learned during the weekly session on a daily basis. The subjects underwent an integrated treatment with facial exercises and worked on the stomatognathic functions for different durations. Many differences were found in the evaluation tools used to investigate the starting situation and the effects obtained following the treatment. At the diagnostic level, there was no concordance in the choice of the most appropriate scales and assessment tools, but great heterogeneity was observed. Indeed, forty-eight percent of the studies collected objective data through the use of various instruments (oral devices, electromyographs, cutometers, muscle ultrasound scans, and laser scans of the face). The observed improvements included not only a reduction in wrinkles and frown lines but also decreased muscle tension and slackness, enhanced facial symmetry and lip competence, improved skin elasticity, and restored stomatognathic function. These changes led to myofunctional restoration and facial rejuvenation, resulting in increased satisfaction with self-image and proprioception.

Chewing Function with Efficiency Tests in Subjects Wearing Clear Aligners.

This study assessed the masticatory function of participants wearing clear aligners in order to determine whether these devices can be worn even when eating and therefore worn to extend treatment time and boost treatment effectiveness. An intercontrol test was conducted on 20 patients who received Invisalign® treatment. Each participant was instructed to chew two pieces of Hue-Check Gum® chewing gum (one pink and the other blue) in 5, 10, and 20 cycles both with and without aligners. After being removed from the oral cavity, the gum was dried and pressed using a 1 × 50 × 50 mm model that was 3D printed with a transparent layer in between. After being scanned on both sides with a flatbed scanner at 600 dpi, the samples were saved as jpg files and subjected to an optoelectronic examination using ViewGum software. To validate the procedure, a control group from a different institution (University of Bern) was used. A statistical analysis of the data was carried out. The Shapiro-Wilk test was used to confirm the normality of the samples. A one-way ANOVA test, a homogeneity of variance test, and a t-test did not reveal statistically significant differences between the two control groups, thus validating the methodology employed. In summary, clear aligners do not radically change the masticatory function while they are worn. As a result, clinicians can exploit the aligners for chewing to obtain a better fit of the plastic material to the dental surface and to attachments. Treatment times for patients could also be shorter.

Analysis of General Knowledge on Obstructive Sleep Apnea Syndrome (OSAS) among Italian Pediatricians.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is a disorder characterized by partial or total airway obstruction during sleep. Studies have shown variability in the level of knowledge and awareness about OSAS among pediatricians. The management of childhood obstructive sleep apnea syndrome (OSAS) depends on the severity of the disease, the presence of comorbidities, and the child's age. The American Pediatric Academy recommends a multidisciplinary approach involving a pediatrician, a sleep specialist, and an otolaryngologist to provide comprehensive care for children with OSAS. The aim of this cross-sectional study is to evaluate the level of knowledge among pediatricians in Italy regarding the diagnosis of pediatric OSAS. MATERIAL AND METHODS: An anonymized survey was conducted among Italian pediatricians. The survey was administered electronically using Google Forms, and a total of 350 pediatricians were invited to participate. Out of the 350 invitations, 299 pediatricians responded to the survey. The statistical analysis performed consisted of descriptive analysis. The study included 297 pediatricians. RESULTS: Pediatricians demonstrated proficiency in identifying common nocturnal and day symptoms of OSAS. A majority (68.9%) considered the oral and otorhinolaryngologist areas during checkups. Approximately 70.6% took patient weight into account, and 62.8% were aware of the regional diagnostic-therapeutic-assistance pathway. CONCLUSIONS: According to the results of this manuscript, there is evidence of a good level of knowledge about OSAS, but disseminating more information about OSAS and all the health issues associated with this syndrome is suggested. This study also has limitations caused by the complexity of the pathology.

Temporomandibular disorders: the most common diagnostic approaches.

BACKGROUND: Temporomandibular disorders (TMDs) are a heterogeneous group of conditions involving the temporomandibular joint complex, and surrounding musculature and osseous components. They are a multifactorial disease that can be determined by organic, genetic aspects, oral parafunctional habits, and psychological stress. They have an annual incidence of more than 5% of the population and about 6% to 12% of the population is affected by symptoms. The diagnostic criteria (DC), introduced by Dworkin, is considered the standard system to diagnose this disease in a specific way. Imaging can support the diagnosis of TMD when history and physical examination findings are equivocal. The aim of the study was to evaluate instrumental examinations and therapies, clinicians prefer to use in different cases of TMDs. METHODS: An anonymized survey, available in two languages (Italian and English), was given to 450 patients, 398 (120 males, 274 females and 4 who did not answer) of different private dental practices were considered, using Google Form (Google LLC, Mountain View, CA, USA) and used an electronic platform, from September 2021 to February 2022. There was no reminder sent to patients to let them feel free to answer. RESULTS: We performed binary regression for oral bite prescription considering common symptoms and found that the most representative is jaw block (P=0.007, exponential value [EXP]=0.509), followed by TMJ noises (P=0.01, EXP=0.503) and feeling stressed (P=0.04, EXP=1.125) while headache and tinnitus resulted not significant. CONCLUSIONS: The study highlighted that magnetic resonance imaging (MRI) is the most instrumental examination adopted by the clinicians and the oral splint(bite) is the therapy most widespread nowadays, even if TMDs are a multifactorial disease that is not, probably, only linked to an alteration of dental occlusion.

Risk factors and prevention of choking.

Choking (or foreign body airway obstruction) is a widespread phenomenon with serious consequences of morbidity and mortality. Choking (often also called suffocation) can be caused by food or inedible objects and leads to various degrees of asphyxiation or lack of oxygen in the blood stream. The incidence is very high in both young children and adults, especially seniors. However, since not all choking episodes end up in the emergency room or become fatalities, they often escape statistics. Although episodes of choking from non-edible bodies are infrequent, they affect mostly young children. Three of the most common risks for choking in general are neurological disorders, dysphagia and dental issues (few or no teeth, unstable or unsuitable prosthesis or orthodontic appliances).  The purpose of this study was to evaluate the risk factors of choking and ways to reduce/avoid this event. We reported data on a series of 138 patients admitted to the emergency department following a choking event, at a hospital in Rome, Italy. The age group of the analyzed population ranged from 1 to 88 years, with the most represented age group of these between 40 and 59, with a similar distribution between males and females. The types of foods on which people choked reflected the seasonal, traditional and local foods: 67% of patients reported choking on fish bones followed by meat bones (9%)  and artichokes (3%). Three relevant non-food choking elements reported were: orthodontic items, toothpicks and pins (one occurrence each). We also reported on two clinical cases of patients choking on meat and a chicken bone. In conclusion, choking awareness and prevention are essential for implementing potential life-saving precautions. Prevention is the first tool to reduce the occurrence of this event, therefore it is necessary to analyze the risk factors and educate the population to eliminate them. Proper chewing and oral manipulation are paramount functions in preventing choking, along with meal-time supervision if little children and elderly. Then, it behooves the healthcare professionals to disseminate knowledge.

The Effects of the Myobrace® System on Peripheral Blood Oxygen Saturation (SpO2) in Patients with Mixed Dentition with Oral Dysfunction.

INTRODUCTION: Myobrace® is an orthodontic device that has the purpose of correcting oral dysfunctions, thus predisposing the physiological growth of the jaws, aligning teeth, and optimizing face development. This device is usually associated with Myobrace® Activities to reach this target. Considering the lack of studies in the literature about peripheral blood oxygen saturation (SpO2) and the use of preformed oral devices, the aim of this study is to quantify the change in blood oxygen saturation (SpO2) in patients treated with the Myobrace® System in mixed dentition. MATERIALS AND METHODS: In this study, 23 children (11 females and 12 males) were involved, who were affected by different oral dysfunctions and were treated with a Myobrace®. Blood oxygen saturation measurements were taken at baseline and after every four months for a year. The SpO2 measurements were taken in the rest position and with a closed mouth for a total of 12 min-6 min with and 6 min without the Myobrace® oral device. All data points were anonymized and recorded on an Excel spreadsheet. A statistical analysis was carried out. RESULTS: Therapy with a Myobrace® in patients with mixed dentition resulted in a statistically significant increase in oxygen saturation. In particular, in patients with a closed mouth, a statistically significant increase in oxygen saturation was observed, bringing it from 97.66% to 99.00%, while in the rest position, the increase was from 98.03% to 99.07%. CONCLUSIONS: The use of Myobrace® devices in patients with mixed dentition could lead to a significant improvement in blood oxygen saturation.

Malocclusion and Scoliosis: Is There a Correlation?

INTRODUCTION: Scoliosis is a complex three-dimensional malformation of the spine. Although its etiology is still being investigated, it is clear that a number of factors can influence this syndrome. The spinal deformity of idiopathic scoliosis can be viewed from an etiopathogenetic perspective as a symptom of a complicated condition with a multifactorial etiology. Numerous studies have established its relationship with malocclusion, but it is still unclear how these factors interact. Malocclusion is a change in the physiological alignment of the upper and lower teeth that can be either dental or skeletal in origin. This study's objective is to assess the relationship between scoliosis and malocclusion. MATERIAL AND METHODS: A total of 646 patients were enrolled (554 females and 92 males), 447 with scoliosis and 199 without, from private dental and orthopedic practices, to answer an anonymous questionnaire. They were selected in private dental and orthopedic practices where they had dental and orthopedic examinations. Twenty-two patients were excluded because of a lack of answers. Participants were given a bilingual survey, in English and Italian, composed of 13 questions formulated specifically for this study, using Google Forms (Google LLC, Mountain View, CA, USA). RESULTS: Univariate analysis of the question "Do you have scoliosis?" shows a significant correlation with the following questions: "Was scoliosis a family issue?" (p < 0.05 OR 7.30 IC: 3.05-17.46) "Do you have malocclusion?" (p < 0.05, OR: 1.19 IC:1.0-1.34) and "Was mal-occlusion a family issue?" (p < 0.01, OR: 1.39 IC 1.10-1.77). Performing a multivariate analysis for the same variables, the best predictors of scoliosis were "Was scoliosis a family issue?" (p < 0.001) and "Was malocclusion a family issue?" (p < 0.05), while the question "Do you have malocclusion" lost significance. CONCLUSION: This study adds further confirmation that there might be an important connection between malocclusion and scoliosis; it suggests that dentists and orthopedists have to check, as early as possible, for the probable presence of both pathologies to avoid a severe progression which, in most cases, may require significant therapy and even surgery.

Upper Airway Changes and OSAS Risk in Patients after Mandibular Setback Surgery to Treat III Class Skeletal Malocclusion.

INTRODUCTION: Mandibular setback surgery (MSS) is one of the treatment options to resolve mandibular prognathism in patients suffering from skeletal class III malocclusion, which cannot be treated with simple orthodontic treatment. The mandibular setback surgical operation can involve changes in the pharyngeal morphology, resulting in a narrowing of the posterior airway space (PAS). This aspect is associated with an increase in airflow resistance, which increases the risk of developing snoring or obstructive sleep apnea syndrome (OSAS). The aim of this study is to evaluate the medium- and long-term effects of mandibular setback surgery on the upper airways and its possible association with OSAS in patients suffering from class III skeletal malocclusion. MATERIAL AND METHODS: A total of 12 patients (5 males and 7 females) were enrolled in this study. The statistical tests highlighted a significant change in the PAS and BMI values in relation to T0, before surgery (PAS: 12.7 SD: 1.2; BMI: 21.7 SD: 1.2), and T1, after surgery (PAS: 10.3 SD: 0.6, p < 0.01; BMI: 23.8 SD: 1.2, p < 0.05). Sample size was calculated to detect an effect size of 0.9, with statistical power set at 0.8 and the significance level set at 0.05. RESULTS: No statistically significant correlation was found between the extent of mandibular setback, PAS and BMI change. CONCLUSION: This study confirms the effects of mandibular setback surgery on the upper airways, reporting a statistically significant PAS reduction in the medium- and long-term follow-up. On the other hand, no direct correlation was identified with OSAS risk, at least for the small mandibular setback (<8 mm), despite the statistically significant increase in BMI.

The importance of promoting oral health in schools: a pilot study.

Promotion of oral health has an essential role in the maintenance of teeth in adults. However, health education must start from an early age, in order to monitor the child's growth and prevent pathologies. Schools are in charge of the overall education of children and of guidance to parents but could also be engaged in the promotion of oral health, supported and counseled by pediatricians and dentists. The purpose of this pilot study is to evaluate whether school age children could be taught, successfully, basic oral sciences and dental hygiene, by a professional, during school hours. In this pilot study, an anonymized test was administered to 45 children of age between 8 and 10, both before and after an interactive lecture on oral health, to assess the effectiveness of the lesson and acquisition by the children of knowledge on oral health. After the presentation, the majority of the children were able to answer correctly to the questionnaire that was given to them (test, retest) which was related to dental anatomy and pathology (number of teeth, cavities, halitosis), and dental hygiene tools and practices (brushes, floss, mouth wash, tongue scrapers). The children seemed to be receptive to learning while in school, and a specific educational session of dental hygiene and oral health seems to be the right approach to ensure children can identify dental hygiene tools and use them appropriately.

Chewing Efficiency Test in Subjects with Clear Aligners.

The aim of this study was to evaluate the masticatory function of subjects with clear aligners and to propose a simple and repeatable method for the clinical and experimental evaluation of masticatory function. For the testing we used almonds, a natural substance that can be easily found and stored, has intermediate consistency and hardness, is insoluble in saliva, and has the ability easily lose the moisture absorbed in the mouth. Thirty-four subjects using the Invisalign® (Align Technology, Santa Clara, CA, USA) protocol were randomly selected. This was an "intercontrol test", i.e., all subjects under the same conditions acted as controls but also as cases whilst wearing the clear aligners. Patients were asked to chew an almond for 20 s, once with aligners and once without aligners. The material was then dried, sieved, and weighted. Statistical analysis was performed to investigate any significative differences. In all our subjects, the efficiency of chewing with clear aligners was found to be comparable to the efficiency of chewing without clear aligners. In detail, the average weight after drying was 0.62 g without aligners and 0.69 g with aligners, while after sieving at 1 mm, the average weight was 0.08 g without aligners and 0.06 g with aligners. The average variation after drying was of 12%, and after sieving at 1 mm, it was 25%. In summary, there was no substantial difference between chewing with or without clear aligners. Despite some discomfort in chewing, the clear aligners were well tolerated by most subjects, who wore them without difficulty even during meals.

Predictability of Invisalign® Clear Aligners Using OrthoPulse®: A Retrospective Study.

This preliminary retrospective study evaluates how effective the OrthoPulse® (Biolux Technology, Austria) is in increasing the predictability of orthodontic treatment in patients treated with Invisalign® clear aligners (Align Technology Inc., Tempe, AZ, USA). A group of 376 patients were treated with Invisalign® orthodontic clear aligners in association with an OrthoPulse®. The OrthoPulse® was prescribed for 10 min a day for the entire duration of the orthodontic treatment. The OrthoPulse® App remotely tracked the percentage compliance of each patient. The number of aligners planned with the ClinCheck software at the beginning of the treatment and the number of total aligners (including the adjunctive aligners) used to finish the treatment were then considered. After applying inclusion/exclusion criteria, a total of 40 patients remained in the study and were compared with a control group of 40 patients with the same characteristics as the study group. A statistical analysis was carried out to investigate whether using OrthoPulse® led to a statistical reduction in the number of adjunctive aligners, thus leading to a more accurate prediction of the treatment. The statistical analysis showed that patients who used OrthoPulse® needed fewer finishing aligners and a greater predictability of the treatment was obtained. In fact, in the treated group the average number of additional aligners represented 66.5% of the initial aligners, whereas in the control group 103.4% of the initially planned aligners were needed. In conclusion, in patients treated with clear aligners, OrthoPulse® would appear to increase the predictability of orthodontic treatment with clear aligners, thus reducing the number of finishing phase requirements.

Physiotherapists and Osteopaths' Attitudes: Training in Management of Temporomandibular Disorders.

Temporomandibular disorders (TMDs) are a condition which has multifactorial etiology. The most acknowledged method to classify TMDs is the diagnostic criteria (DC) introduced firstly by Dworkin. This protocol considers different aspects that are not only biological, but even psychosocial. Diagnosis is often based on anamnesis, physical examination and instrumental diagnosis. TMDs are classified as intra-articular and/or extra-articular disorders. Common signs and symptoms include jaw pain and dysfunction, earache, headache, facial pain, limitation to opening the mouth, ear pain and temporomandibular joint (TMJ) noises. This study regards two kind of clinicians that started in the last years to be more involved in the treatment of TMDs: osteopaths (OOs) and physiotherapists (PTs). The purpose is to analyze their attitude and clinical approach on patients affected by TMDs. Four hundred therapists answered an anonymous questionnaire regarding TMJ and TMDs. OOs showed greater knowledges on TMDs and TMJ and, the therapists with both qualifications seemed to be most confident in treating patients with TMDs. In conclusion this study highlights OOs and all the clinicians with this qualification, have a higher confidence in treating patients with TMD than the others. Dentists and orthodontists, according to this study, should co-work with OOs and PTs, because they are the specialists more requested by them than other kinds of specialists.

The Potential of Digital Impression in Orthodontics.

BACKGROUND: Over the past 20 years, there have been many innovations in orthodontic diagnosis and therapy. Among the innovations, there is the taking of dental impressions (DIs). Dental impressions are the negative imprint of hard and soft tissues of one or both arches, and they allow a plaster model to be formed, i.e., a positive reproduction. Traditional dental impressions can be made of different materials, such as alginate, while digital impression is captured by an intra-oral scanner. Digital impression, despite the evident advantages, has not yet replaced the conventional impression. The aim of this study is to evaluate which dental impressions are the most used by dentists. For this purpose, we considered 120 questionnaires sent electronically to patients of different dental private practices from different countries, where the dentists can use both techniques. The results highlighted that the kind of impression adopted is very much influenced by the type of therapy and orthodontic devices used in the treatment. We can conclude that, despite the advent of digital technology, conventional impressions are still used for fixed devices, while digital impressions are more adopted for orthodontic customized devices and therapies with clear aligners, that are very widespread among adult patients.

The Influence of SARS-CoV-2 Pandemic on TMJ Disorders, OSAS and BMI.

The pandemic of the 21st century had a significant influence on the lives of the world population in a negative way. This situation determined a change of lifestyle; it caused the necessity of social isolation for a great number of people. In fact, people tended to avoid crowded environments, social events, to reduce medical checks and sports activities, favoring sedentary life because of fear of the virus. This social attitude brought a high level of stress that worsened many health conditions. This study has the aim of evaluating the possible influence of the pandemic on temporomandibular joint (TMJ) disorders, obstructive sleep apnea syndrome (OSAS) and body mass index (BMI). An anonymized survey, available in two languages (Italian and English), was given to 208 patients from different private dental practices. In this questionnaire, the patients shared experiences about their life during the pandemic. The article highlighted that during this health emergency, there was an increase in body weight in the considered sample. This brought a worsening of OSAS in 65% of patients with a previous diagnosis. Eventually, an increase in TMJ disorders and orofacial pain was reported.

The Influence of the COVID-19 Pandemic on Orthodontic Treatments: A Survey Analysis.

Coronavirus disease 2019 represents the pandemic of the 21st century that has negatively affected the lives of the whole of humanity. For many months, the only weapons to fight against this infection were protective masks and social isolation. During recent months, fear of the virus has led people to avoid crowded environments and events, and to reduce medical checks, limiting them only to emergencies. Outpatient clinics, doctors' offices, and all closed-in environments were required to limit the patients' access. Nowadays, the presence of specific protocols around the world, and the extended vaccination campaign, have allowed a reduction of many restrictions. Unfortunately, the virus is still widespread, and dental practice and dental treatments suffer the consequences. Dental therapies in general, and in particular orthodontics, are not considered lifesaving. Due to this, orthodontists, in this historical time, must find solutions for motivating patients to start or continue therapies, while providing a safe way for them to do so. There are orthodontists who have developed, during this period, different ways to help them in treating and communicating with patients. Aim: The aim of this study is to assess the influence of the pandemic on the choice to start orthodontic treatment, oral health care, and the importance placed on the appearance of dental occlusions. Materials and Methods: This study is a survey analysis of 159 people, which was posted in Facebook groups of adult orthodontic patients. The timestamps and answers of responses were analyzed to avoid duplicated or interrupted questionnaires. Conclusions: This study found that the current health emergency has not reduced the demand for orthodontic care, while some patients' behaviors are changing in relation to oral hygiene and the importance that they attribute to dental health. It seems that dentists' availability plays a key role in this period of sanitary emergency.