Developing a protocol for a preventive oral health exam for elderly people (EDePAM) using E-Delphi methodology.

The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

Do subjects with forced lip closure have different perioral and jaw muscles activity?

Objective: To evaluate the activity of mentalis (MN), buccinator (BC), and suprahyoid (SH) muscles among participants with different lip competence..Methods: Sixty-three participants were classified clinically and assigned to the following groups of 21 each: 1) competent lips (competent), 2) incompetent lips (incompetent), or 3) forced lip closure (forced). Activity was recorded at rest, swallowing, speaking, reciprocal compression of the lips, and chewing.Results: MN activity in incompetent was significantly higher than competent at rest, and it was significantly higher in incompetent and forced when compared with competent during swallowing (p< .05). No differences among incompetent and forced were observed (p> .05). During speaking, reciprocal compression of the lips, and chewing, MN activity did not show significant differences among groups. BC and SH activity did not show significant differences (p> .05).Conclusion: MN activity during swallowing can be considered a relevant biomarker to differentiate between forced and competent participants.

Effect of laterotrusive occlusal scheme on chewing duration, external intercostal muscular activity, heart rate, and oxygen saturation.

Objective: To evaluate the effect of the laterotrusive occlusal scheme on chewing duration, external intercostal (EIC) electromyographic (EMG) activity, heart rate (HR), and oxygen saturation (OS) during different tasks in the upright seated position.Methods: Fifty young participants, 25 with canine guidance and 25 with group function, were included. Chewing duration, bilateral EIC EMG activity, HR, and OS were recorded during the following tasks: 1) chewing until swallowing threshold; 2) laterotrusive teeth grinding.Results: Chewing duration, bilateral EIC EMG activity, HR, and OS showed no significant differences between the two laterotrusive occlusal schemes during the tasks studied.Conclusion: These results suggest that chewing duration, EIC muscle activity, HR, and OS were not significantly influenced by the laterotrusive occlusal scheme. Therefore, when a modification of the laterotrusive occlusal scheme is needed during oral rehabilitation or orthodontic treatment, canine guidance or group function should not significantly change EMG activity of EIC muscles.

Developing a protocol for a preventive oral health exam for elderly people (EDePAM) using E-Delphi methodology

Abstract The aim of this study was to develop a Preventive Oral Health Exam for Elderly People (EDePAM), using the e-Delphi technique, to diagnose oral health problems in people 65 or older. The e-Delphi technique was used with experts in multiple stages, and in a final workshop, where an agreement on an examination protocol was reached for diagnosing dental caries, oral mucosa lesions, periodontal diseases, and masticatory function disorders. Quantitative analyses of all the rounds of the e-Delphi method were conducted. It was agreed that the International Caries Detection and Assessment System (ICDAS) should be used together with a modified version of the Nyvad criteria to detect and assess caries lesions. It was also agreed that an assessment was needed of the different factors involved in determining caries risk, namely socioeconomic level, access to fluoride, level of dependence/functionality, salivary flow, history of head and neck cancer treatment, use of medications that decrease salivary flow, diet, use of removable dental prostheses, exposure of root surfaces, and caries history. Furthermore, patients would be required to undergo an examination of the oral mucosa, where any existing lesion should be described in terms of its clinical appearance, location, and risk potential. It was also agreed that an assessment of masticatory function should be performed using the Leake index, together with chewing-gum combined with a color scale to categorize masticatory performance. The number of pairs of occluding antagonist teeth was considered as the best predictor of masticatory function. The 2018 classification by the American Academy of Periodontology (AAP) / European Federation of Periodontology (EFP) was accepted as the standard to assess periodontal status, and it was agreed that this assessment should include an evaluation of clinical attachment loss and bleeding on probing. The novel EDePAM was considered as appropriate for conducting a functional assessment of oral health by providing a comprehensive diagnosis of oral diseases.

Mandibular border movements: The two envelopes of motion.

BACKGROUND: The envelope of motion is a diagrammatic representation of the mandibular border movements. Classically, those movements are carried out eccentrically; starting from the position of maximal intercuspation, the mandible describes an excursion movement until reaching maximal mouth opening. Reverse movements would describe a different path, but up to now concentric development of mandibular border movements has not been considered. Literature states that beyond mandibular border movements limits, no movement is possible. Therefore, it is of great interest to compare both paths-both envelopes of motion-and define the actual limits of mandibular movement. OBJECTIVE: The aim of this study was to compare the geometric characteristics of mandibular border movements carried out eccentrically and concentrically by healthy subjects. METHODS: Sixteen individuals aged between 18 and 27 years, molar class I and with no temporomandibular disorders, participated in the study. Eccentric and concentric mandibular movements were recorded using a 3D electromagnetic articulograph. Data were processed with computational scripts developed in MATLAB. Maximum mouth opening, trajectories, displacement ranges, polygon areas and chewing cycle area/ mandibular border movements area ratio were analysed. RESULTS: The frontal plane showed significant differences in all the parameters evaluated. Higher values were registered in the concentric area of the border movement envelope (P = .008) and in the trajectories on both sides. Statistical differences were observed in polygon areas (P = .006) in the sagittal plane and right ranges (P = .046) in the horizontal plane. CONCLUSION: Concentric mandibular movements revealed significant differences in three-dimensional trajectories in the frontal plane.

Awake teeth grinding in participants with canine guidance or group function: Effect on diaphragm EMG activity, heart rate, and oxygen saturation.

Objective: To compare the effect of canine guidance or group function on diaphragm activity, heart rate, and oxygen saturation during awake teeth grinding at different body positions. Methods: Fifty healthy participants, 25 with canine guidance and 25 with group function, were included. Bilateral electromyographic (EMG) recordings of the diaphragm (DIA) during awake teeth grinding were performed in standing, seated upright, and right lateral decubitus positions. Simultaneously, heart rate and oxygen saturation were measured. Results: EMG activity of the DIA muscle was similar in the working side and non-working side between participants with canine guidance and group function in the different body positions studied. The heart rate and oxygen saturation showed no significant differences between the two groups. Conclusion: EMG activity of the DIA muscle, the heart rate, and oxygen saturation during teeth grinding are not significantly influenced by the type of laterotrusive occlusal scheme.

Effect of breathing type on electromyographic activity of respiratory muscles during tooth clenching at different decubitus positions.

OBJECTIVE: To compare the effect of breathing type on electromyographic (EMG) activity of respiratory muscles during tooth clenching at different decubitus positions. METHODS: Forty young men participants were included, 11 with upper costal, 9 with mixed, and 20 with costo-diaphragmatic breathing type. EMG recordings of diaphragm (DIA), external intercostal (EIC), sternocleidomastoid (SCM), and latissimus dorsi (LAT) muscles during tooth clenching in the intercuspal position were performed in dorsal, left lateral, and ventral decubitus positions. RESULTS: DIA EMG activity was higher in subjects with upper costal or mixed than with costodiaphragmatic breathing type (p = 0.006; 0.021, respectively), whereas it was similar between upper costal and mixed breathing types. EIC, SCM, and LAT activity was similar among breathing types. CONCLUSION: Higher DIA activity would be a risk factor to exceed the adaptive capability of healthy subjects with upper costal or mixed breathing type.

Electromyographic activity of the jaw muscles and mandibular kinematics in young adults with theoretically ideal dental occlusion: Reference values

BACKGROUND: A necessary step to use neuromuscular analysis as diagnostic tool is to establish normal reference values for the physiological range in a healthy population. Surface electromyographic (sEMG) activity of the jaw muscles and mandibular kinematics were measured in young adults with theoretically ideal dental occlusion to determine normal reference values during different tasks. Differences between the sexes were evaluated. MATERIAL AND METHODS: Forty young adults (20 men, 20 women; mean age 22.8 ± 3.9 years) with theoretically ideal dental occlusion were selected using very restrictive criteria. sEMG activity of the anterior temporalis (AT), posterior temporalis, masseter (MA), and suprahyoid muscles were evaluated in the rest position and during swallowing, mastication, and clenching. Mandibular kinematics in the rest position and during maximum excursions were assessed. Asymmetry, activity, and torque indices and MA/AT ratios were calculated. RESULTS: For all muscles, sEMG values were 1.01-3.57 miV at rest, 3.50-10.85 miV during swallowing, and 41.04- 86.59 miV during mastication. During clenching, values were 230.08-243.55 miV for the AT and MA muscles. Mean total asymmetry, activity, and torque indices at rest were 20.34 %, -15.04 %, and 19.02 %, respectively; during clenching, these values were 6.14 %, -2.62 %, and 4.46 %. MA/AT ratios were near 1. Kinematic measurements during lateral excursion, protrusive and maximum opening were 7.54, 8.44, and 37.38 mm respectively; lateral mandibular shift was 1.41 mm; freeway and lateral displacement at rest were 1.40 and 0.26 mm. Right MA activity during mastication and clenching was higher in men than women. CONCLUSIONS: Reference values for sEMG activity and mandibular kinematics were determined. Some muscular asymmetry and torque were observed

Effect of natural mediotrusive contact on electromyographic activity of jaw and cervical muscles during chewing.

OBJECTIVE: This study evaluated the effect of a natural mediotrusive contact on the electromyographic (EMG) activity of the anterior temporalis and sternocleidomastoid muscles during chewing in healthy subjects. MATERIALS AND METHODS: The study sample included two groups of 15 subjects each (Group 1: with natural mediotrusive contact; Group 2: without natural mediotrusive contact). Bilateral surface EMG activity was recorded on anterior temporalis and sternocleidomastoid muscles during unilateral chewing of a half cookie and unilateral chewing of a piece of apple. Anterior temporalis and sternocleidomastoid muscle activity was normalized against activity recorded during maximal voluntary clenching in intercuspal position and maximal intentional isometric head-neck rotation to each side, respectively. The partial and total asymmetry indexes were also calculated. Data were analyzed using Mann-Whitney, Wilcoxon and unpaired t-test. RESULTS: EMG activity of anterior temporalis and sternocleidomastoid muscles showed no significant difference between the groups. EMG activity of anterior temporalis was similar between working and non-working sides during chewing in both groups. EMG activity of sternocleidomastoid muscle was higher in the working side than in the non-working side in Group 2 subjects. Asymmetry indexes were not significantly different between groups. CONCLUSIONS: The similar EMG pattern and asymmetry indexes observed suggest the predominance of central nervous control over peripheral inputs on anterior temporalis and sternocleidomastoid motor neuron pools.

Electromyographic activity during awake tooth grinding tasks at different jaw posture in the sagittal plane.

OBJECTIVE: The goal of this study was to evaluate the electromyographic (EMG) activity of the anterior temporalis, suprahyoid, infrahyoid and trapezius muscles during tooth grinding at different jaw posture tasks. MATERIALS AND METHODS: Participants were 30 healthy subjects with natural dentition, bilateral molar support and incisive protrusive guidance. Bipolar surface electrodes were located on the right side of the subject. EMG recordings were performed in the following tasks: (A) Eccentric grinding from intercuspal position to protrusive edge-to-edge contact position; (B) concentric grinding from protrusive edge-to-edge contact position to intercuspal position; (C) eccentric grinding from intercuspal position to the maximum voluntary retrusive position; and (D) concentric grinding from the maximum voluntary retrusive position to intercuspal position. The results were analyzed statistically by Friedman test and Wilcoxon signed rank-sum test. RESULTS: EMG activity in the anterior temporalis and infrahyoid muscles was significantly higher during task C than the other tasks. EMG activity in the suprahyoid muscles was significantly higher during task C than task D. EMG activity in the trapezius muscle was significantly higher during task C than tasks A and B. CONCLUSIONS: The higher EMG activity recorded in task C could become important when its frequency, duration and magnitude are enough to exceed the adaptation capability of the individual.