Oral motor function in obesity.

BACKGROUND: Obese individuals may have impaired oral sensory functioning and abnormal oral motor function, a consequence of fat deposition in muscles. OBJECTIVE: To evaluate the oral motor function in obese individuals. MATERIAL AND METHODS: Three observational cross-sectional studies were performed. In total, 140 participants were evaluated: (1) orofacial myofunctional evaluation (OMES) was performed in 26 obese and 26 control subjects; (2) time taken for suction of 50 ml of water through straws of 3 mm and 6 mm of diameter was measured in 30 obese and 30 control subjects; (3) the oral phase of swallowing of 5 ml moderately thick and 5 ml extremely thick boluses was analysed by videofluoroscopy in 14 obese and 14 control subjects. Obese and non-obese control subjects had body mass index ≥40 kg/m2 and <30 kg/m2 , respectively. RESULTS: Obese subjects had worse oral myofunctional evaluation scores in posture/appearance (lips, jaw, cheeks, tongue and hard palate), in mobility (lips, tongue, jaw and cheeks) and in breathing, deglutition and mastication functions (p ≤ .020). The OMES total score was 73.5 ± 5.5 in obese and 92.8 ± 3.7 in controls subjects (p < .001). There was no difference between the groups in the time taken for 50 ml of water suction through the 3-mm- or 6-mm-diameter straw. Videofluoroscopic evaluation of the bolus swallowed demonstrated a longer oral preparation time in obese individuals for both boluses (p ≤ .040) and no difference in oral transit time (p ≥ .140). CONCLUSION: A moderate change in oral motor function was observed in obese individuals with BMI ≥40 kg/m2 .

Changes in jaw and neck muscle coactivation and coordination in patients with chronic painful TMD disk displacement with reduction during chewing.

The treatment of a complex temporomandibular disorder (TMD), such as disk displacement with reduction (DDR) associated with arthralgia and myalgia, may depends on understanding the impairments in muscle function. The aim of this study was to investigate the behavior of the anterior temporalis, masseter and sternocleidomastoid muscles in the time and frequency domains during chewing in patients with chronic painful TMD-DDR using electromyographic (EMG) analysis. Thirty-three patients who met the diagnostic criteria for TMD and 32 volunteers without TMD (control group) underwent clinical examination, chewing pattern classification and EMG analysis. For the EMG analyses, the side of habitual unilateral chewing, as determined by the chewing pattern classification, was selected for recording; in cases of bilateral chewing, the recording side was randomly selected. The EMG-EMG coherence function and EMG-EMG transfer function (gain and phase) values were obtained at the first chewing frequency peak, and the working-side masseter signal was used as a reference in the analyses of the other muscles. Compared to the control group, the TMD group showed a longer chewing stroke duration (P = 0.01) as well as changes in the coactivation and coordination strategies of the jaw muscles, evidenced by greater relative energy expenditure (P< 0.01) and impaired differential recruitment (P< 0.05) and coherence (P< 0.01). Delays in peak and temporal asynchrony occurred in the jaw and neck muscles (P< 0.05). Patients with chronic painful TMD-DDR during chewing presented changes in the jaw and neck muscles, with more compromised function of the former, which are specific to chewing.

Orofacial Motor Functions and Temporomandibular Disorders in Patients With Sjögren's Syndrome.

OBJECTIVE: Sjögren's syndrome (SS) induces difficulty in chewing and swallowing due to low salivary flow. However, these symptoms may be associated with other factors, such as orofacial myofunctional disorders and temporomandibular disorder (TMD), which have not been comprehensively assessed in this population. The aims of this study were to investigate orofacial muscles and functions as well as the presence of TMD in patients with SS compared with a group without SS and to analyze whether the patients' experience of limitations in orofacial functioning is associated with the orofacial functional status and muscle pain related to TMD. METHODS: Women with SS based on the 2002 American-European Consensus Group criteria and volunteers paired by age and sex were compared. The examinations included the orofacial myofunctional evaluation with scores (OMES) protocol, tongue and lip strength measures, and electromyography of the masticatory muscles. TMD investigations included clinical examination, self-report of symptoms, and assessment according to the Jaw Functional Limitation Scale. RESULTS: Patients with SS present with impaired muscle and orofacial functions based on lower scores of all categories of OMES (P < 0.0001), tongue strength (P = 0.0003-0.0004), and masticatory muscle activity (P = 0.0002-0.007), as well as worse TMD signs and symptoms (P < 0.05) and jaw functional limitation (P < 0.0001-0.0003). CONCLUSION: Patients' experiences with limitation in mastication and swallowing were associated with orofacial myofunctional status and muscle pain related to TMD. Those disorders should be monitored along with disease control and must be addressed in the clinical evaluation to prevent nutritional and metabolic comorbidities in patients with SS.

Tongue strength, masticatory and swallowing dysfunction in patients with chronic temporomandibular disorder.

BACKGROUND: The possible factors related to functional impairment and limitations in patients with temporomandibular disorders (TMDs) still need to be clarified because recovery of orofacial functions is a goal of their treatment. OBJECTIVE: To investigate whether chronic TMD patients had any changes in tongue strength, besides the difficulty in chewing and orofacial functional impairment, compared to a control group. Moreover, to examine whether tongue strength, chewing difficulties, and orofacial functions were associated. METHODS: Twenty-three patients with chronic TMD according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and volunteers without TMD (control group) were compared. Strength measures were obtained using the Iowa Oral Performance Instrument (IOPI) during tongue protrusion (TPS) and swallowing of saliva (SS) tasks. A scale was used to investigate self-reported chewing difficulties, and the orofacial muscles and functions were evaluated using the orofacial myofunctional evaluation with scores protocol (OMES). RESULTS: Compared to the control group, TMD patients showed reduced TPS and SS, higher difficulty in chewing and worse myofunctional orofacial conditions. Tongue strength was correlated with mastication and swallowing behaviors, as well as with general myofunctional status. Chewing difficulty increased with decreasing tongue strength and with worsening of orofacial muscles and functions. CONCLUSION: Patients with chronic TMD showed reduced tongue strength and worse masticatory and swallowing functions, and these aspects were interrelated. CLINICAL RELEVANCE: The present results contribute additional evidence regarding the impairment of orofacial muscles other than jaw elevator muscles in patients with chronic TMD.

Swallowing changes related to chronic temporomandibular disorders.

OBJECTIVES: To investigate whether chronic temporomandibular disorder (TMD) patients showed any changes in swallowing compared to a control group. Moreover, it was examined whether swallowing variables and a valid clinic measure of orofacial myofunctional status were associated. MATERIAL AND METHODS: Twenty-three patients with chronic TMD, diagnosed with disc displacement with reduction (DDR) and pain, according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), and 27 healthy volunteers (control group) were compared. Surface electromyography (EMG) of the temporalis, masseter, sternocleidomastoid, and suprahyoid muscles was performed during swallowing tasks of thin liquid (10 and 15 mL) and spontaneous saliva. Data were normalized. RESULTS: Compared to the control group, TMD patients showed a prolonged duration of swallowing for liquid and saliva and required a longer time to reach the activity peak and half the integral. While the overall mean value of the relative peaks was similar for the groups, the suprahyoid peak was significantly lower in the TMD group during swallowing of liquid. Moreover, TMD patients recruited the jaw elevator muscles proportionally more than controls. The orofacial myofunctional status was moderately correlated with EMG parameters. CONCLUSION: Patients with chronic TMD showed temporal prolongation and changes in the relative activity of the muscles during the swallowing tasks. CLINICAL RELEVANCE: The present results contribute additional evidence regarding the reorganization of muscle activity in patients with chronic TMD.

Obstructive sleep apnea: focus on myofunctional therapy.

PURPOSE: Orofacial myofunctional therapy (OMT) is a modality of treatment for children and adults with obstructive sleep apnea (OSA) to promote changes in the musculature of the upper airways. This review summarizes and discusses the effects of OMT on OSA, the therapeutic programs employed, and their possible mechanisms of action. METHODS: We conducted an online literature search using the databases MEDLINE/PubMed, EMBASE, and Web of Science. Search terms were "obstructive sleep apnea" in combination with "myofunctional therapy" OR "oropharyngeal exercises" OR "speech therapy". We considered original articles in English and Portuguese containing a diagnosis of OSA based on polysomnography (PSG). The primary outcomes of interest for this review were objective measurement derived from PSG and subjective sleep symptoms. The secondary outcome was the evaluation of orofacial myofunctional status. RESULTS: Eleven studies were included in this review. The studies reviewed reveal that several benefits of OMT were demonstrated in adults, which include significant decrease of apnea-hypopnea index (AHI), reduced arousal index, improvement in subjective symptoms of daytime sleepiness, sleep quality, and life quality. In children with residual apnea, OMT promoted a decrease of AHI, increase in oxygen saturation, and improvement of orofacial myofunctional status. Few of the studies reviewed reported the effects of OMT on the musculature. CONCLUSION: The present review showed that OMT is effective for the treatment of adults in reducing the severity of OSA and snoring, and improving the quality of life. OMT is also successful for the treatment of children with residual apnea. In addition, OMT favors the adherence to continuous positive airway pressure. However, randomized and high-quality studies are still rare, and the effects of treatment should also be analyzed on a long-term basis, including measures showing if changes occurred in the musculature.

Reliability and Validity of the Italian Version of the Protocol of Orofacial Myofunctional Evaluation with Scores (I-OMES).

OBJECTIVE: To evaluate the reliability, validity, and responsiveness of the Italian OMES (I-OMES). PATIENTS AND METHODS: The study consisted of 3 phases: (1) internal consistency and reliability, (2) validity, and (3) responsiveness analysis. The recruited population included 27 patients with orofacial myofunctional disorders (OMD) and 174 healthy volunteers. Forty-seven subjects, 18 healthy and all recruited patients with OMD were assessed for inter-rater and test-retest reliability analysis. I-OMES and Nordic Orofacial Test - Screening (NOT-S) scores of the patients were correlated for concurrent validity analysis. I-OMES scores from 27 patients with OMD and 27 age- and gender-matched healthy subjects were compared to investigate construct validity. I-OMES scores before and after successful swallowing rehabilitation in patients were compared for responsiveness analysis. RESULTS: Adequate internal consistency (Cronbach α = 0.71) and strong inter-rater and test-retest reliability (intraclass coefficient correlation = 0.97 and 0.98, respectively) were found. I-OMES and NOT-S scores significantly and inversely correlated (r = -0.38). A statistical significance (p < 0.001) was found between the pathological group and the control group for the total I-OMES score. The mean I-OMES score improved from 90 (78-102) to 99 (89-103) after myofunctional rehabilitation (p < 0.001). CONCLUSION: The I-OMES is a reliable and valid tool to evaluate OMD.

An index for the evaluation of 3D masticatory cycles stability.

OBJECTIVES: To introduce an index (Masticatory Stability Index, MSI) to analyze the stability of chewing cycles in standardized conditions and test it in a group of patients with subclinical mild temporomandibular disorder (TMD). DESIGN: 23 subjects with mild subacute TMD and 21 healthy subjects were involved; they all responded to a questionnaire about signs and symptoms of TMD (ProTMDmulti) and underwent a myofunctional orofacial evaluation with scores, using the protocol of orofacial myofunctional evaluation with scores (OMES). Their mandibular kinematics was assessed with a 3D motion capture system during deliberate unilateral gum chewing. The MSI was computed synthesizing the information contained in nine kinematics parameters into a single global figure. Patients' and controls' MSI were compared considering the preferred and non-preferred chewing side using a 2-way ANOVA (factors: group, side). RESULTS: Together with a lower total score of myofunctional orofacial status, the TMD group showed a reduced stability based on MSI (p<0.05). CONCLUSIONS: The MSI is an efficient method to measure the stability of the masticatory cycles. These preliminary results encourage validating the index on a larger sample. The variability in the motor behavior of chewing can impair the objectivity of its evaluations in several types of patients, including those with TMD. The MSI could be useful to complement clinical assessments, providing data for planning the rehabilitation of masticatory function in these patients.

Patients with myogenic temporomandibular disorders have reduced oxygen extraction in the masseter muscle.

OBJECTIVE: The objective of the present study is to investigate if changes in the oxygen saturation of masseter muscle during a chewing task can differentiate patients with myogenic temporomandibular disorders (TMD) from healthy subjects and if these differences are related to the gravity of the disorder and to the orofacial myofunctional status. MATERIALS AND METHODS: Twelve women with moderate TMD (TMD group; 37 ± 16 years) and ten healthy control women (CTRL group 24 ± 5 years) participated. Validated protocols were used to evaluate the severity of TMD and the orofacial myofunctional status. Oxygen saturation in the masseter muscle was measured using near-infrared spectroscopy (NIRS) during unilateral chewing of a silicon device. Data were compared using Student's t test, Mann-Whitney test, and Spearman's rank correlation coefficient. RESULTS: The women of the TMD group showed higher total score of severity of symptoms of TMD, lower total score of the orofacial myofunctional status, and lower oxygen extraction capacity during mastication than healthy control subjects (p < 0.01). Moreover, percentage O2 extraction was significantly related to the severity of signs/symptoms of TMD and of orofacial myofunctional disorders (p < 0.01). CONCLUSION: Women with TMD had a lower muscle oxygen extraction capacity than healthy subjects: the higher the signs and symptoms' severity, the lower the O2 extraction. NIRS proposes as an important instrumental method to assess the metabolic alterations in the muscles of patients with TMD. CLINICAL RELEVANCE: The findings could be useful to complement clinical assessments, favoring the diagnosis and providing extra data for planning the rehabilitation of TMD patients, especially those with associated myofunctional orofacial disorders.

Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy.

OBJECTIVES: The purposes of this study were (1) to identify possible differences in muscular and orofacial functions between children with obstructive sleep apnea (OSA) and with primary snoring (PS); (2) to examine the standardized difference between normal values of myofunctional scores and those of subjects with OSA or PS; and (3) to identify the features associated with OSA. METHODS: Participants were 39 children (mean age 8 ± 1.2 years) of which, 27 had a diagnosis of OSA and 12 had PS. All participants were examined by an otorhinolaryngologist and underwent overnight polysomnography. Orofacial characteristics were determined through a validated protocol of orofacial myofunctional evaluation with scores (OMES), surface electromyography of masticatory muscles, and measurements of maximal lip and tongue strength. Reference values in the OMES were included to quantify the standardized difference (effect size = ES) relative to the groups studied and in the regression analysis. RESULTS: The OSA group had lower scores in breathing and deglutition, more unbalanced masticatory muscle activities than PS group (P < 0.05), but both groups had similar reductions in orofacial strength. OSA had a large ES (Cohen's d > 0.8) in all analysed OMES scores, while PS group showed small and medium differences in breathing and mastication scores, respectively. The mobility of the stomatognathic components score was the most important to contribute for group status (57%, P < 0.0001) in the regression analysis. CONCLUSION: Children with tonsillar hypertrophy and OSA had relevant impairments in orofacial functions and lesser muscular coordination than children with PS.

Reorganization of muscle activity in patients with chronic temporomandibular disorders.

OBJECTIVE: To investigate whether reorganization of muscle activity occurs in patients with chronic temporomandibular disorders (TMD) and, if so, how it is affected by symptomatology severity. METHODS: Surface electromyography (sEMG) of masticatory muscles was made in 30 chronic TMD patients, diagnosed with disc displacement with reduction (DDR) and pain. Two 15-patient subgroups, with moderate (TMDmo) and severe (TMDse) signs and symptoms, were compared with a control group of 15 healthy subjects matched by age. The experimental tasks were: a 5s inter-arch maximum voluntary clench (MVC); right and left 15s unilateral gum chewing tests. Standardized sEMG indices characterizing masseter and temporalis muscles activity were calculated, and a comprehensive functional index (FI) was introduced to quantitatively summarize subjects' overall performance. Mastication was also clinically evaluated. RESULTS: During MVC, TMDse patients had a significantly larger asymmetry of temporalis muscles contraction. Both TMD groups showed reduced coordination between masseter and temporalis muscles' maximal contraction, and their muscular activity distribution shifted significantly from masseter to temporalis muscles. During chewing, TMDse patients recruited the balancing side muscles proportionally more than controls, specifically the masseter muscle. When comparing right and left side chewing, the muscles' recruitment pattern resulted less symmetric in TMD patients, especially in TMDse. Overall, the functional index of both TMDmo and TMDse patients was significantly lower than that obtained by controls. CONCLUSIONS: Chronic TMD patients, specifically those with severe symptomatology, showed a reorganized activity, mainly resulting in worse functional performances.

Normalizing surface electromyographic measures of the masticatory muscles: Comparison of two different methods for clinical purpose.

PURPOSE: To compare a new normalization technique (wax pad, WAX) with the currently utilized cotton roll (COT) method in surface electromyography (sEMG) of the masticatory muscles. METHODS: sEMG of the masseter and anterior temporalis muscles of 23 subjects was recorded while performing two repetitions of 5s maximum voluntary clenches (MVC) on COT and WAX. For each task, the mean value of sEMG amplitude and its coefficient of variation were calculated, and the differences between the two repetitions computed. The standard error of measurement (SEM) was calculated. For each subject and muscle, the COT-to-WAX maximum activity increment was computed. Participant preference between tasks was also recorded. RESULTS: WAX MVC tasks had larger maximum EMG amplitude than COT MVC tasks (P<0.001), with COT-to-WAX maximum amplitude increments of 61% (temporalis) and 94% (masseter) (P=0.006). WAX MVC had better test-retest repeatability than COT. For both MVC modalities, the mean amplitude (P>0.391) and its coefficient of variation were unchanged (P>0.180). The WAX task was the more comfortable for 18/23 subjects (P=0.007). CONCLUSION: WAX normalization ensures the same stability level of maximum EMG amplitude as COT normalization, but it is more repeatable, elicits larger maximum muscular contraction, and is felt to be more comfortable by subjects.

Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up.

This study investigated the efficacy of combining low-level laser therapy (LLLT) with oral motor exercises (OM-exercises) for rehabilitation of patients with chronic temporomandibular disorders (TMDs). Eighty-two patients with chronic TMD and 20 healthy subjects (control group) participated in the study. Patients were randomly assigned to treatment groups: GI (LLLT + OM exercises), GII (orofacial myofunctional therapy-OMT-which contains pain relief strategies and OM-exercises), and GIII (LLLT placebo + OM-exercises) and GIV (LLLT). LLLT (AsGaAl; 780-nm wavelength; average power of 60 mW, 40 s, and 60 ± 1.0 J/cm²) was used to promote analgesia, while OM-exercises were used to reestablish the orofacial functions. Evaluations at baseline (T1), after treatment immediate (T2), and at follow-up (T3) were muscle and joint tenderness to palpation, TMD severity, and orofacial myofunctional status. There was a significant improvement in outcome measures in all treated groups with stability at follow-up (Friedman test, P < 0.05), but GIV did not show difference in orofacial functions after LLLT (P > 0.05). Intergroup comparisons showed that all treated groups had no difference in tenderness to palpation of temporal muscle compared to GC at follow-up (Kruskal-Wallis test, P < 0.01). Moreover, GI, GII, and GIII showed no difference from GC in orofacial functional condition (T2 and T3) while they differed significantly from GIV (P < 0.01). In conclusion, LLLT combined with OM-exercises was more effective in promoting TMD rehabilitation than LLLT alone was. Similar treatment results were verified with the OMT protocol.

Impaired orofacial motor functions on chronic temporomandibular disorders.

Because temporomandibular disorders (TMDs) rehabilitation continues to be a challenge, a more comprehensive picture of the orofacial functions in patients with chronic pain is required. This study assessed the orofacial functions, including surface electromyography (EMG) of dynamic rhythmic activities, in patients with moderate-severe signs and symptoms of chronic TMD. It was hypothesized that orofacial motor control differs between patients with moderate-severe chronic TMD and healthy subjects. Seventy-six subjects (46 with TMD and 30 control) answered questionnaires of severity of TMD and chewing difficulties. Orofacial functions and EMG during chewing were assessed. Standardized EMG indices were obtained by quantitative analysis of the differential EMG signals of the paired masseter and temporal muscles, and used to describe muscular action during chewing. TMD patients showed significant greater difficulty in chewing; worse orofacial scores; longer time for free mastication; a less accurate recruitment of the muscles on the working and balancing sides, reduced symmetrical mastication index (SMI) and increased standardized activity during EMG test than healthy subjects. SMI, TMD severity and orofacial myofunctional scores were correlated (P<0.01). Impaired orofacial functions and increased activity of the muscles of balancing sides during unilateral chewing characterized the altered orofacial motor control in patients with moderate-severe chronic TMD. Implications for rehabilitation are discussed.

Mandibular kinematics and masticatory muscles EMG in patients with short lasting TMD of mild-moderate severity.

Mandibular kinematic and standardized surface electromyography (sEMG) characteristics of masticatory muscles of subjects with short lasting TMD of mild-moderate severity were examined. Volunteers were submitted to clinical examination and questionnaire of severity. Ten subjects with TMD (age 27.3years, SD 7.8) and 10 control subjects without TMD, matched by age, were selected. Mandibular movements were recorded during free maximum mouth opening and closing (O-C) and unilateral, left and right, gum chewing. sEMG of the masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position, and during gum chewing. sEMG indices were obtained. Subjects with TMD, relative to control subjects, had lower relative mandibular rotation at the end of mouth opening, larger mean number of intersection between interincisal O-C paths during mastication and smaller asymmetry between working and balancing side, with participation beyond the expected of the contralateral muscles (P<0.05, t-test). Overall, TMD subjects showed similarities with the control subjects in several kinematic parameters and the EMG indices of the static test, although some changes in the mastication were observed.

Treatment for TMD with occlusal splint and electromyographic control: application of the FARC protocol in a Brazilian population.

The purpose of this study was to apply Functional Anatomy Research Center (FARC) Protocol of TMD treatment, which includes the use of a specific type of mandibular occlusal splint, adjusted based on the electromyographic index, in a group of 15 patients with disc displacement, classified according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and then analyzing the results compared with the control group. The clinical evaluations were completed both before and after the treatment. Electromyographic (EMG) data was collected and recorded on the day the splint was inserted (visit 1), after one week (visit 2) and after five weeks of treatment (visit 3). The control group consisted of 15 asymptomatic subjects, according to the same diagnostic criteria (RDC/TMD), who were submitted to the same evaluations with the same interval periods as the treatment group. Immediately after splint adjustment, masseter muscle symmetry and total muscular activity were significantly different with than without the splint (p < 0.05), showing an increased neuromuscular coordination. After treatment, significant variations (p < .05) were found in mouth opening and in pain remission. There were no significant differences among the three sessions, either with or without the splint. There were significant differences between the TMD and control groups for all analyzed indices of muscular symmetry, activity and torque, with the exception of total muscular activity. The use of the splint promoted balance of the EMG activities during its use, relieving symptoms. EMG parameters identified neuromuscular imbalance, and allowed an objective analysis of different phases of TMD treatment, differentiating individuals with TMD from the asymptomatic subjects.

Electromyographic indices, orofacial myofunctional status and temporomandibular disorders severity: A correlation study.

This study examined whether there is an association between surface electromyography (EMG) of masticatory muscles, orofacial myofunction status and temporomandibular disorder (TMD) severity scores. Forty-two women with TMD (mean 30 years, SD 8) and 18 healthy women (mean 26 years, SD 6) were examined. According to the Research Diagnostic Criteria for TMD (RDC/TMD), all patients had myogenous disorders plus disk displacements with reduction. Surface EMG of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices were obtained. Validated protocols were used to determine the perception severity of TMD and to assess orofacial myofunctional status. TMD patients showed more asymmetry between right and left muscle pairs, and more unbalanced contractile activities of contralateral masseter and temporal muscles (p<0.05, t-test), worse orofacial myofunction status and higher TMD severity scores (p<0.05, Mann-Whitney test) than healthy subjects. Spearman coefficient revealed significant correlations between EMG indices, orofacial myofunctional status and TMD severity (p<0.05). In conclusion, these methods will provide useful information for TMD diagnosis and future therapeutic planning.

Surface electromyographic assessment of patients with long lasting temporomandibular joint disorder pain.

The normalized electromyographic characteristics of masticatory muscles in patients with temporomandibular joint disorders (TMD) and healthy controls were compared. Thirty TMD patients (15 men, 15 women, mean age 23 years) with long lasting pain (more than 6 months), and 20 control subjects matched for sex and age were examined. All patients had arthrogenous TMD according to the Research Diagnostic Criteria for TMD (RDC/TMD). Surface electromyography of masseter and temporal muscles was performed during maximum teeth clenching either on cotton rolls or in intercuspal position. Standardized EMG indices and the median power frequency were obtained, and compared between the two groups and sexes using ANOVAs. During clenching, the TMD patients had larger asymmetry in their temporalis muscles, larger temporalis activity relative to masseter, and reduced mean power frequencies than the control subjects (p<0.05, ANOVA). In both groups, the mean power frequencies of the temporalis muscles were larger than those of the masseter muscles (p<0.001). No sex related differences, and no sex × group interactions were found. In conclusion, young adult patients with long lasting TMD have an increased and more asymmetric standardized activity of their temporalis anterior muscle, and reduced mean power frequencies, relative to healthy controls.

Effects of orofacial myofunctional therapy on temporomandibular disorders.

The objectives of the current study were to analyze the effects of orofacial myofunctional therapy (OMT) on the treatment of subjects with associated articular and muscular temporomandibular disorders (TMD). Thirty subjects with associated articular and muscular TMD, according to the Research Diagnostic Criteria (RDC/TMD), were randomly divided into groups: 10 were treated with OMT (T group), 10 with an occlusal splint (OS group), and 10 untreated control group with TMD (SC). Ten subjects without TMD represented the asymptomatic group (AC). All subjects had a clinical examination and were interviewed to determine Helkimo's Indexes (Di and Ai), the frequency and severity of signs and symptoms, and orofacial myofunctional evaluation. During the diagnostic phase, there were significant differences between groups T and AC. There were no significant differences between group T and OC and SC groups. During the final phase, groups T and OS presented significant improvement, however, the group T presented better results and differed significantly from group OS regarding the number of subjects classified as Aill; the severity of muscular pain and TMJ pain; the frequency of headache and the muscles and stomatognathic functions. The group T differed significantly from the SC group but no longer differed significantly from the AC group. OMT favored a significant reduction of pain sensitivity to palpation of all muscles studied but not for the TMJs; an increased measure of mandibular range of motion; reduced Helkimo's Di and Ai scores; reduced frequency and severity of signs and symptoms; and increased scores for orofacial myofunctional conditions.

Expanded protocol of orofacial myofunctional evaluation with scores: Validity and reliability.

OBJECTIVE: Clinical evaluation of the stomatognathic system is indispensable for the diagnosis of orofacial myofunctional disorders. In order to obtain a more precise diagnosis, the protocol of orofacial myofunctional evaluation with scores (OMES protocol) (Int. J. Pediatr. Otorhinolaryngol. 72 (2008) 367-375) was expanded in terms of number of items and scale amplitude. The proposal of this study is to describe the expanded OMES protocol (OMES-E) for the evaluation of children. Validity of the protocol, reliability of the examiners and agreement between them were analyzed, as also were the sensitivity, specificity and predictive values of the instrument. METHODS: The sample consisted of videorecorded images of 50 children, 25 boys (mean age=8.4 years, SD=1.8) and 25 girls (mean age=8.2 years, SD=1.7) selected at random from 200 samples. Three speech therapists prepared for orofacial myofunctional evaluation participated as examiners (E). The OMES and OMES-E protocols were used for evaluation on different days. E1 evaluated all images, E2 analyzed children with recordings from 1 to 25 and E3 analyzed children with recordings from 26 to 50. The validity of OMES-E was analyzed by comparing the instrument to the OMES protocol using the Pearson correlation test complemented with the split-half reliability test (p<0.05). The linear weighted Kappa coefficient of agreement (Kw'), the sensitivity, specificity and predictive values and the prevalence of OMD were calculated. RESULTS: There was a statistically significant correlation between the OMES and OMES-E protocols (0.79>r<0.94, p<0.01) and a significant test-retest correlation with the OMES-E (0.75>r<0.86, p<0.01), with a reliability range of 0.86-0.93. The correlation and reliability coefficients between examiners were: E1×E2 (r=0.74, 0.84), E1×E3 (r=0.70, 0.83) (p<0.01). Kw' coefficients with moderate and good strength predominated. The OMES-E protocol presented mean sensitivity=0.91, specificity=0.77, positive predictive value=0.87 and negative predictive value=0.85. The mean prevalence of OMD was 0.58. CONCLUSION: The OMES-E protocol is valid and reliable for orofacial myofunctional evaluation.