Nutritional status and dietary habits in older adults with fixed implant dental prostheses: a case-control study.

Aim: To evaluate the nutritional status, nutritional risk, and dietary habits of patients treated with bimaxillary implant-supported fixed prostheses in comparison with a group of natural dentate patients. Methods: A study group (n = 25, 8 women, mean age = 70.6 ± 7.5 years) with bimaxillary implant-supported fixed prostheses and a control group (n = 25, 13 women, mean age = 69.0 ± 5.3) with a mean of 27.7 ± 1.8 natural teeth were recruited. The nutritional status and nutritional risk of the participants were evaluated with Mini Nutritional Assessment (MNA) and Seniors in the Community: Risk Evaluation for Eating and Nutrition; (SCREEN-14), while the dietary habits were recorded by data from a three-day dietary record. The data were analyzed with the Mann-Whitney U-test and independent t-test to evaluate the differences between the groups. Results: The results showed that although both the groups had normal nutrition status as revealed by the MNA scores the study group showed significantly higher BMI (p = 0.005) but lower SCREEN-14 (p = 0.012) scores, than the control group. The results also showed that higher SCREEN-14 scores were significantly associated with higher odds of being in the control group, with an odds ratio of 1.159 (p = 0.024). Further, the results of the analysis of the dietary records showed that the participants in the study group consumed fewer meals (p = 0.006) and fewer varieties of food (p < 0.001), particularly fewer fruits (p = 0.011) than the control group. Conclusion: The results indicate that people with fixed implant prostheses may be susceptible to nutritional deficiencies according to the SCREEN-14 scores compared to their natural dentate counterparts. Further, people with implant prostheses also tend to have higher BMI and consume a smaller variety of foods, especially fruits, than the natural dentate control group.

An umbrella review on the association between factors of oral health and cognitive dysfunction.

An increasing number of systematic reviews and meta-analyses have been published on the association between oral health and cognitive dysfunction, also known as oral-cognitive links. However, there is great diversity in the oral and cognitive factors included in these studies, with different opinions for clinical practice drawn from the evidence. To understand which oral and cognitive factors are involved in those associations, we conducted an umbrella review of 28 systematic reviews, including 12 meta-analyses, on oral-cognitive links. We found that (a) periodontal diseases, oral microbiome, and dementia were frequently studied, while other factors, such as mastication and mild cognitive impairment, were less commonly investigated, and (b) severe deterioration of oral health, such as severe periodontitis or extensive tooth loss, rather than the presence of oral diseases alone, was strongly associated with cognitive dysfunction. In conclusion, the diversity of oral and cognitive factors included in the review studies reflects the complexity of oral-cognitive links. Clarifying the factors helps to form evidence-based clinical advice for healthcare.

White matter abnormalities mediate the association between masticatory dysfunction and cognition among older adults.

BACKGROUND: Masticatory parameters, such as reduced number of teeth and posterior contacts, have been shown to be associated with reduced cognitive status. The underlying mechanisms that affect these associations, are however, not well understood. OBJECTIVES: The study aims to investigate the association between masticatory dysfunction and cognition and explore the mediating effect of brain structure. METHODS: In this cross-sectional study, 45 older adults with subjective masticatory dysfunction (mean age 72.3 ± 4.0 years) were included. Mini-Mental State Examination score <25, brain trauma, neurological disease, neurodegenerative disorders, depression or poor Swedish language skills were criteria for exclusion. Cognitive functions (executive function and episodic memory) and masticatory dysfunction defined by functional occluding status (FOS; the number of occluding units and number of remaining teeth) were analysed with partial correlation models. Structural magnetic resonance imaging was performed on 28 feasible participants. Multiple regression analyses were performed to evaluate the predictive value of brain structure and white matter hypointensities (WM-hypo) on cognitive functions. A mediation analysis was applied to assess significant predictor/s of the association between FOS and cognition. RESULTS: Both episodic memory and executive functions were positively correlated with FOS. WM-hypo predicted cognitive status (executive function, p ≤ .01). WM-hypo mediated 66.6% (p = 0.06) of the association between FOS and executive functions. CONCLUSION: Associations between FOS and cognitive functions are reported, where FOS, a potential modifiable risk factor, was related to both episodic memory and executive functions. The mediating effect of WM-hypo on the association between FOS and executive functions highlights the impact of the vascularisation of the brain on the link between mastication and cognition. The present study provides increased knowledge that bridges the gap between masticatory dysfunction and cognition.

Subjective and objective evaluation of masticatory function in patients with bimaxillary implant-supported prostheses.

BACKGROUND: People perform poorly in masticatory function tests despite well-functioning prostheses. However, it is unclear whether there is an agreement between subjective and objective measures of mastication. OBJECTIVES: To investigate the association between subjective and objective measures of masticatory function in patients with bimaxillary implant-supported prostheses. MATERIALS AND METHODS: An experimental group (n = 25, age = 70.6 ± 7.5 years, eight women) with bimaxillary implant-supported fixed prostheses and a control group (n = 25, age = 69.0 ± 5.3, 13 women) with natural dentition were recruited. The participants in the experimental group were included if they had been using the prosthesis for at least a year and had no obvious complaints with their prostheses. The control group was people with natural dentition and without any prostheses or complaints related to the masticatory system. The masticatory function was evaluated objectively with food comminution and mixing ability tests, and subjectively with jaw function limitation scale (JLFS) and oral health impact profile (OHIP). RESULTS: The experimental group performed poorly in both objective tests (p < .001). However, there was no significant differences between the two groups in total JFLS (p = .114) and OHIP (p = .312) scores. Though, there were certain positive correlations between the food comminution test and JFLS subdomains in the control group, and a positive correlation between food comminution test and specific subdomains of OHIP in the experimental group indicating poor correlation between the subjective and objective measures. CONCLUSION: Although patients with implant prostheses show poor masticatory performance, there is no agreement in the objective and subjective measures of mastication.

Assessment of masticatory function in older individuals with bimaxillary implant-supported fixed prostheses or with a natural dentition: A case-control study.

STATEMENT OF PROBLEM: A clinical assessment of the masticatory performance of edentulous people treated with bimaxillary implant-supported fixed prostheses is lacking. PURPOSE: The purpose of this case-control study was to compare the masticatory performance of edentulous people treated with bimaxillary implant-supported fixed prostheses to that of those with a natural dentition by using a simplified comminution test with hard viscoelastic test food and a mixing ability test. MATERIAL AND METHODS: Thirty-six participants were recruited and divided into 2 equal groups (n=18) based on their dental status. The experimental group (7 women, mean ±standard deviation age=69.8 ±7.5 years) had bimaxillary implant-supported fixed prostheses, and the control group (9 women, mean ±standard deviation age=68.3 ±5.6 years) had a natural dentition. A hard viscoelastic food comminution test and a mixing ability test with 2-colored chewing gum were performed in both groups. The number and total area of the particles during the comminution test and the variance of hue during the mixing ability test were measured. The data were analyzed with the parametric (paired t test) and nonparametric (Mann-Whitney U) tests to assess differences between the groups (α=.05). RESULTS: The experimental group exhibited significantly fewer pieces in the food comminution test than the control group (P=.001). The experimental group also showed significantly higher variance of hue values than the control group (P<.001). CONCLUSIONS: Patients treated with bimaxillary implant-supported prostheses had reduced masticatory performance in comparison to those with a natural dentition, despite having been provided with satisfactory and well-functioning prostheses.

Chewing and its influence on swallowing, gastrointestinal and nutrition-related factors: a systematic review.

The study aimed to evaluate the hypothesis that chewing is a mechanical and physiological contributor to swallowing, physiologic/pathologic processes of the gastrointestinal tract (GIT), and nutrition-related factors. A search strategy was applied to three different databases to investigate if chewing function in adults affects the swallowing, physiologic/pathologic processes of the GIT, and nutrition-related factors compared to controls with no exposure. The included studies were evaluated for methodological quality and risk of bias and certainty of evidence. The results showed 71 eligible studies. Overall, the results showed that 46 studies supported the hypothesis while 25 refuted it. However, the GRADE analysis showed low to very low certainty of the evidence to support the hypothesis that chewing is an important contributor in the swallowing process, and physiologic/pathologic processes in the GIT. The GRADE analysis also showed a moderate to very low certainty of the evidence to suggest that chewing function contributes to nutrition-related parameters. The overall results of the current study showed that a majority (64.7%) of the studies (46 out of 71) supported the hypothesis. However, robust studies with proper design, adequate sample size, and well-defined outcome parameters are needed to establish conclusive evidence.

Motor Performance and Skill Acquisition in Oral Motor Training With Exergames: A Pilot Study.

Objective: To investigate the effects of oral-motor training with exergames on motor performance and motor skill acquisition in two different age groups. Methods: Thirty-two healthy participants were recruited in the current pilot study and divided equally into two groups (Gen Z and Baby Boomers) according to their age. A pair of electromyographic (EMG) electrodes were placed on the participants' masseter muscles. The EMG device communicated via Bluetooth with a mobile video game in response to the electromyographic activity of the masseter muscles during clenching. During the experimental session, participants were asked to play a video game in five blocks of 5 min each, with a 3-min break between each time block. The goal of the game was to collect as many coins (game points) as possible and to dodge/avoid upcoming obstacles (game life). Motor performance was assessed by performance scores and the number of game lives. Skill acquisition was measured by task efficiency (ratio of performance scores and number of game lives) across time blocks. Results: The results of the study showed significantly lower performance scores (p < 0.001), a higher number of game lives (p < 0.001), and lower task efficiency in the Baby Boomer group compared to the Gen Z group. Specifically, the results showed that there was a significant difference in task efficiency between the first and second, third and fourth, fourth- and fifth-time blocks in the Gen Z group (p < 0.002). However, there was only a significant difference between first- and second-time blocks in the Baby Boomer group (p = 1.012), suggesting that skill acquisition in the Baby Boomer group did not change significantly over the course of the time blocks. Conclusion: The study showed higher motor performance and superior motor skill acquisition with novel exergame training in the Gen Z group compared to the Baby Boomer group. The results of the study indicate that there is an improvement in oral motor skills with short-term training, yet the differences in oral motor skills between the two groups are still evident. The Baby Boomer group, unlike the Gen Z group, did not show robust improvement in task efficiency over the course of the series.

Long-term results of a randomized clinical trial of 2 types of ceramic crowns in participants with extensive tooth wear.

STATEMENT OF PROBLEM: Evidence is sparse regarding the long-term outcomes of restorative treatment of patients with extensive tooth wear. PURPOSE: The purpose of this long-term prospective randomized clinical trial was to evaluate the performance and success rate of pressed lithium disilicate (LD) and translucent zirconia (TZ) crowns in participants with extensive tooth wear. MATERIAL AND METHODS: A total of 62 participants with extensive tooth wear (17 women, 45 men; mean age 44.8 years; range 25-63 years) received a total of 713 crowns, LD=362 and TZ=351. Both types of crowns had chamfer preparations and were adhesively luted with dual-polymerizing composite resin cement (PANAVIA F 2.0; Kuraray Noritake Dental Inc). The restorations were clinically reevaluated on average 14, 31, 39, 54, and 65 months after insertion of the crowns according to the modified United States Public Health Service (USPHS) criteria. RESULTS: After an observation period of up to 6 years, the survival rate for both types of crowns was 99.7%, with 1 lost LD crown after 1 year as a result of loss of retention and 1 lost TZ crown after 3 years because of tooth fracture at the cemento-enamel junction. The success rates were similar for both types of crowns: 98.6% for LD and 99.1% for TZ. Reasons for failures were that 3 participants in each group developed apical lesions, minimal ceramic fractures, or their crowns were rebonded after loss of adhesion. Assessment of color at baseline was significantly different with a better match for LD (84.8% Alfa, 15.2% Bravo) than for TZ crowns (36.5% Alfa, 63.5% Bravo), including TZ crowns with veneered porcelain (P<.001). Secondary caries and cracks did not occur. A post hoc analysis of clinical performance did not indicate any significant differences between extensive tooth wear with primarily mechanical or chemical factors. CONCLUSIONS: No differences were found between the 2 types of ceramic materials concerning the long-term success and clinical performance, except that TZ crowns were rated by a blinded clinician as less esthetic than LD crowns. The use of high-strength ceramic materials, as well as reliable adhesive bonding, are probably the key factors in the long-term success of ceramic crowns in participants with extensive tooth wear independent of the specific etiology.

Cognitive changes and neural correlates after oral rehabilitation procedures in older adults: a protocol for an interventional study.

BACKGROUND: Epidemiological studies show an association between masticatory function and cognitive impairment. This has further strengthened the notion that tooth loss and impaired masticatory function may be risk factors for dementia and cognitive decline. Animal experiments have indicated a causal relationship and several possible mechanisms have been discussed. This evidence is, however, lacking in humans. Therefore, in the current interventional study, we aim to investigate the effect of rehabilitation of masticatory function on cognition in older adults. METHODS: Eighty patients indicated for prosthodontic rehabilitation will be randomly assigned to an experimental or a control group. Participants will conduct neuropsychological assessments, masticatory performance tests, saliva tests, optional magnetic resonance imaging, and answer questionnaires on oral health impact profiles and hospital anxiety and depression scale before, 3 months, and 1 year after oral rehabilitation. The difference between the two groups is that the control group will be tested an additional time, (at an interval of about 3 months) before the onset of the oral rehabilitation procedure. The primary outcome is a change in measures of episodic memory performance. DISCUSSION: Although tooth loss and masticatory function are widespread in older people, it is still an underexplored modifiable risk factor potentially contributing to the development of cognitive impairment. If rehabilitation of masticatory function shows positive effects on the neurocognitive function, this will have great implications on future health care for patients with impaired masticatory status. The present project may provide a new avenue for the prevention of cognitive decline in older individuals. TRIAL REGISTRATION: The protocol for the study was retrospectively registered in ClinicalTrials.gov Identifier: NCT04458207, dated 02-07-2020.

Defining pleasant touch stimuli: a systematic review and meta-analysis.

Pleasantness is generally overlooked when investigating tactile functions. Addition of a pleasant stimulus could allow for a more complete characterisation of somatosensory function. The aims of this review were to systematically assess the methodologies used to elicit a pleasant sensation, measured via psychophysical techniques, and to perform a meta-analysis to measure the effect of brush stroking velocity on touch pleasantness. Eighteen studies were included in the systematic review, with five studies included in the meta-analysis. The review found that factors such as texture, velocity, force, and the duration of continuous stroking influence tactile evoked pleasantness. Specifically, using a soft material and stroking at a velocity of 3 cm/s with light force is generally considered as particularly pleasant. The meta-analysis showed that a brush stroking velocity of 30 cm/s was rated as less pleasant than 3 cm/s, on the forearm. The present study collates the factors that are most likely to provide a stimulus to elicit a pleasant sensation. The results should be important for studies requiring a well-defined pleasant stimulus including neurosensory assessment protocols, allowing for a more complete multimodality assessment of somatosensory function.

Modulation of experimental facial pain via somatosensory stimuli targeting sensations of different valence.

BACKGROUND: Knowledge of pain modulation from oro-facial somatosensory stimuli with different valence (pleasant-unpleasant) is limited. OBJECTIVES: To investigate (a) the modulatory effects of painful, pleasant and unpleasant somatosensory stimuli on two models of experimental facial pain, (b) whether modulation could be changed by blocking peripheral nerves via application of a local anaesthetic, EMLA, or blocking endogenous opioid receptors via naltrexone and (c) whether pain ratings were significantly correlated with participant psychological profiles. METHODS: Thirty-eight healthy women received experimental facial skin burning pain or jaw myalgia for four randomised sessions on different days. The painful region was stimulated with mechanical or thermal painful, pleasant, unpleasant and control stimuli, with ratings recorded before and during stimulation. Sessions differed in pre-treatment: EMLA/naltrexone/placebo tablet/cream. RESULTS: Significant effects of thermal or mechanical stimuli (P < .017), but not session (P > .102), were found on pain ratings for both models. In myalgia, painful cold resulted in a greater reduction in pain ratings than unpleasant cold, pleasant cold, control and pleasant warmth (P < .004). Decreases in pain ratings from painful, unpleasant and pleasant mechanical stimuli were greater than control (P < .002). In burning pain, painful cold resulted in a greater reduction in pain ratings than all but one of the other thermal stimuli (P < .033). The pleasant mechanical stimulus reduced pain ratings more than all other mechanical stimuli (P ≤ .003). There were no significant correlations between pain and psychometrics. CONCLUSION: Valence-targeted thermal and mechanical stimuli modulated experimental myalgia and skin burning pain (P < .017). Partially blocking peripheral afferents or opioid receptors did not affect modulation.

Behavioral learning and skill acquisition during a natural yet novel biting task.

OBJECTIVE: To investigate the effect of short-term training on behavioral learning and skill acquisition during a natural yet novel biting task. METHODS: Thirty (18 women) healthy volunteers in the age range of 18-32 years were divided into a naive (n = 17) and expert (n = 13) groups based on the self-reported familiarity to perform a complex behavioral biting task. The volunteers participated in a single experimental session divided into three sets with three series, each with ten trials of a standardized biting task. The task was to position, split and retrieve a sunflower seed from its shell without crushing the seed. The two consecutive sets were separated by fifteen minutes of short-term training. During the short-term training, the participants repeatedly performed the biting task for about fifteen minutes. A five-point grading system was devised to determine the performance and video registrations were made to determine the duration of the task. RESULTS: There was a significant main effect of training on the task performance scores (P < .001). The performance scores of the naive group before training was significantly lower than all the sets of the expert group (P < .010). The performance scores of the naive group were also significantly better after training than before (P = .001). However, the expert group took significantly shorter time to complete the task than the naive group. CONCLUSION: The results of the present study show a significant effect of training on the performance of a complex behavioral biting task. Training resulted in improved performance scores and a subtle decrease in the duration of the task.

An ultrafast system for signaling mechanical pain in human skin.

The canonical view is that touch is signaled by fast-conducting, thickly myelinated afferents, whereas pain is signaled by slow-conducting, thinly myelinated ("fast" pain) or unmyelinated ("slow" pain) afferents. While other mammals have thickly myelinated afferents signaling pain (ultrafast nociceptors), these have not been demonstrated in humans. Here, we performed single-unit axonal recordings (microneurography) from cutaneous mechanoreceptive afferents in healthy participants. We identified A-fiber high-threshold mechanoreceptors (A-HTMRs) that were insensitive to gentle touch, encoded noxious skin indentations, and displayed conduction velocities similar to A-fiber low-threshold mechanoreceptors. Intraneural electrical stimulation of single ultrafast A-HTMRs evoked painful percepts. Testing in patients with selective deafferentation revealed impaired pain judgments to graded mechanical stimuli only when thickly myelinated fibers were absent. This function was preserved in patients with a loss-of-function mutation in mechanotransduction channel PIEZO2. These findings demonstrate that human mechanical pain does not require PIEZO2 and can be signaled by fast-conducting, thickly myelinated afferents.

Clinical presentation of two phenotypes of tooth wear patients.

OBJECTIVE: To assess the clinical presentation of wear lesions in two phenotypes of tooth wear (TW) patients based on distribution and morphological features of wear. MATERIALS AND METHODS: 103 patients (mean age = 43.1 years) were divided into two groups based on cluster analysis; cluster A (61 patients) and cluster B (42 patients). The distribution of wear lesions, scores of presence or absence of 10 defined morphological TW criteria and number of teeth fulfilling each criteria were compared between groups. Intra- and inter-examiner reliability of the 10 TW criteria was determined by Cohen's kappa and intraclass correlation coefficient. RESULTS: While cluster A had more wear in maxillary anterior teeth and mandibular molars compared with the same opposing tooth groups (p < 0.001, p < 0.007 respectively), there were no differences for cluster B. Cluster A was characterized by higher prevalence of 4 chemical morphological criteria and the highest number of teeth affected by one chemical criteria, whereas cluster B had a higher prevalence of one mechanical criteria and higher number of teeth affected by an additional mechanical criteria. Both intra- and inter-examiner values for the defined TW criteria were fair to excellent. CONCLUSION: The results may indicate a more chemical background for TW in cluster A and mechanical background in cluster B. Furthermore, clinicians may use certain clinical features of TW to distinguish between individuals who belong to a specific TW cluster with a presumed chemical or mechanical etiology. These preliminary findings need to be confirmed in future studies.

Vibratory stimulus to the masseter muscle impairs the oral fine motor control during biting tasks.

PURPOSE: To investigated the effect of vibratory stimulus on masseter muscles during oral fine motor biting tasks. METHODS: Sixteen healthy individuals (age: 24.5 ± 2.4 years) participated in experiment I during which the participants were asked to "hold and split" half a roasted peanut placed on a force transducer with their front teeth. The participant performed ten series with ten trials of the "hold and split" behavioral task while vibratory stimulus was applied on the masseter muscle every alternate series. Further, fourteen participants participated (age: 25.2 ± 4.8 years) in experiment II during which they performed a series each of the behavioral task at baseline, an adjusted baseline without and with vibration as well as with and without visual feedback. Hold and split forces along with the variability of hold force and duration and force rate during the split were measured. RESULTS: The results of the study showed an increase in the magnitude of the hold force (P = 0.002), force rate during the split (P < 0.001) and a significant decrease in the duration of split (P < 0.001) due to the vibratory stimulus. However, there was no significant effect of the vibratory stimulus on the variability of hold forces (P = 0.879) or mean split force (P = 0.683) during the "hold and split" behavioral task. The results of experiment II also showed an increase in hold force due to the vibratory stimulus (P < 0.001). CONCLUSIONS: Vibratory stimulus to the masseter muscles impairs the oral force control during a standardized biting task and provide further insight into the sensorimotor regulation of the masticatory system.

Assessment of experimental orofacial pain, pleasantness and unpleasantness via standardized psychophysical testing.

BACKGROUND: Somatosensory assessment within the orofacial region may be performed using highly standardized quantitative sensory testing (QST). However, the function of the C-tactile (CT) afferent, a nerve fibre linked to the perception of pleasant touch, is usually not evaluated. Furthermore, the perception of unpleasantness is also rarely assessed, a dimension not only limited to a painful experience. Therefore, the primary aim was to apply standardized QST stimuli as well as standardized pleasant stimuli and evaluate their potential capacity for evocation of perceived pain, pleasant and unpleasant sensations in the facial region. METHODS: Twenty-one female participants underwent QST as per the protocol derived from the German Research Network on Neuropathic Pain. For the first time, two modified protocols were used to investigate stimuli for perceived pleasantness and unpleasantness. RESULTS: Thermal stimuli provided separate thresholds for each sensation. From certain mechanical stimuli (e.g., vibration), overlap between the perceived sensations of pleasantness and unpleasantness was identified. It was not possible to evoke only an unpleasant sensation without a painful contribution, and both these sensations increased significantly when utilizing an increasing pinprick force (p < 0.011). Between dynamic stimuli, the brush was rated as significantly more pleasant than the cotton wool tip (p = 0.015). A quadratic model provided the best fit for velocity against mean pleasantness ratings (R2  = 0.62 ± 0.08), supporting previous CT afferent literature to some extent. CONCLUSION: Stimuli were generally not isolated to one sensation, highlighting the multidimensional construct of stimulus perception and the need for scales to capture this. SIGNIFICANCE: The battery of QST tests from the DFNS protocol has been modified to investigate pleasant and unpleasant sensations. This allows the evaluation of psychophysical properties across standardized dimensions to provide a thorough view of somatosensory function and to better understand the affective spectrum of somatosensory function.

Phenotypes of patients with extensive tooth wear-A novel approach using cluster analysis.

OBJECTIVES: Explore a new approach to identify phenotypes of tooth wear (TW) patients using an unsupervised cluster analysis model, based on demographic, self-report, clinical, salivary and electromyographic (EMG) findings. METHODS: Data was collected for 34 variables from 125 patients, aged 17-65 years, with a TW index > grade 2. Demographic information and presumed risk factors for chemical and mechanical TW were collected. A 14-item stress scale was completed and salivary flow rates, pH and buffer capacity were measured. Sleep bruxism was assessed with a portable single channel EMG device. RESULTS: The final cluster model comprised 16 variables and 103 patients and indicated two groups of TW patients; 61 participants in cluster A and 42 in cluster B. Cluster assignment was determined by several presumed mechanical risk factors and diseases affecting saliva. Cluster B had the highest percentage of sleep bruxism self-reports (A 1.6%, B 92.9%, p ≤ 0.001), awake bruxism self-reports (A 45.9%, B 85.7%, p ≤ 0.001), heavy sport exercises (A 1.6%, B 21.4%, p = 0.001); and highest percentage of diseases affecting saliva (A 13.1%, B 47.6%, p ≤ 0.001). A notable finding was the lack of significant differences between clusters in many other presumed risk factors for mechanical and chemical TW. CONCLUSION: TW patients can be clustered in at least two groups with different phenotypic characteristics but also with a large degree of overlap. Based on this type of algorithm, tools for clinical application may be developed and underpin TW classification and treatment planning in the future.

Effect of Sudden Deprivation of Sensory Inputs From Periodontium on Mastication.

OBJECTIVE: To investigate the effect of sudden deprivation of sensory inputs from the periodontium on jaw kinematics and time-varying activation profile of the masseter muscle. METHODS: Fourteen (age range: 22-26 years; four men) healthy and natural dentate volunteers participated in a single experimental session. During the experiment, the participants were asked to eat six hard visco-elastic test food models, three each before and after an anesthetic intervention. The movements of the jaw in three dimensions and electromyographic (EMG) activity of the masseter muscle on the chewing side were recorded. RESULTS: The results of the study showed no significant differences in the number of chewing cycles (P = 0.233) and the duration of chewing sequence (P = 0.198) due to sudden deprivation of sensory inputs from the periodontium. However, there was a significant increase in the jaw opening velocity (P = 0.030) and a significant increase in the duration of occlusal phase (P = 0.004) during the anesthetized condition. The EMG activity of the jaw closing phase was significantly higher during the control condition [116.5 arbitrary units (AU)] than anesthetized condition (93.9 AU). The temporal profile of the masseter muscle showed a biphasic increase in the excitatory muscle drive in the control condition but this increase was virtually absent during the anesthetized condition. CONCLUSION: Sudden deprivation of sensory inputs from the periodontium affects the jaw kinematics and jaw muscle activity, with a clear difference in the time-varying activation profile of the masseter muscle. The activation profile of the masseter muscle shows that periodontal mechanoreceptors contribute to approximately 20% of the EMG activity during the jaw closing phase.

Excitatory drive of masseter muscle during mastication with dental implants.

Previously we have reported a biphasic increase in excitatory drive of the masseter muscle during natural chewing in young adults. We now hypothesize that sensory inputs from the periodontal mechanoreceptors (PMRs) are responsible for the late increase in excitatory drive during this biphasic movement. 13 participants with implant-supported bridges in both jaws, and thus lacking PMRs, and 13 participants with natural dentition chewed and swallowed model food of different hardness. Electromyographic (EMG) activity of the masseter muscle was recorded, along with the position of the mandible, and the muscle activity and jaw kinematics during the different phases of the chewing cycle were analyzed. Throughout the entire masticatory sequence, the excitatory drive of the masseter muscle during the jaw closing increased in a biphasic manner for the dentate participants; whereas biphasic elevation was observed only during the middle and last segments in the implant participants. Dentate participants exhibited significantly greater boosting of the EMG activity during late jaw closing than the implant participants, irrespective of food hardness and segment of the masticatory sequence. Sensory information from PMRs are required for boosting the enhancement of masseter muscle activity during the late jaw closing, during tooth-food contact.