Impact of obesity on the structures and functions of the stomatognathic system: A morphofunctional approach.

OBJECTIVE: The prevalence of obesity is increasing significantly worldwide, raising great concern among health professionals. This observational study evaluated the electromyographic activity and thickness of the masseter and temporalis muscles, in addition to the maximum molar bite force, in obese and eutrophic subjects. METHODS: Sixty subjects were divided into three groups: I (7-12 years), II (13-20 years), III (21-40 years) and sex: with 10 men and 10 women for each group. Electromyographic recordings of the masticatory muscles were obtained during mandibular tasks. The masticatory muscles thicknesses were obtained at rest and during dental clenching. The maximum molar bite forces were measured on the right and left sides. The difference in outcome measures between the groups and sex was analyzed using Mann-Whitney U test (p < 0.05) and analysis of covariance (ANCOVA). RESULTS: Electromyographic activity in the masseter and temporal muscles consistently displayed lower levels in obese subjects of both sexes across all three age groups during mandibular tasks. Additionally, greater thickness of the masticatory muscles was observed in obese subjects of both sexes across all three age groups. Obese women in Group II displayed higher values of molar bite force, both on the right and left sides, compared to eutrophic women. On the other hand, women in Group III exhibited higher values of molar bite force on the right side in comparison to eutrophic women. CONCLUSIONS: This study underscores the potential impact of obesity on the morphofunctional aspects of the stomatognathic system in subjects aged 7 to 40 years.

Relation between oro-facial thermographic findings and myofunctional characteristics in patients with obstructive sleep apnoea.

AIM: To evaluate the thermographic characteristics of oro-facial structures and submental triangle of participants with obstructive sleep apnoea (OSA), as well as to investigate its correlation with the anatomy, posture and functions of the oro-facial structures. METHOD: Eighteen patients diagnosed with OSA by polysomnography (OSA group; 57.4 ± 15.8 years) and 13 healthy participants screened for OSA (control group; 57.8 ± 18.1 years) were included. All participants answered to questionnaires for OSA and excessive daytime sleepiness, and were submitted to infrared image thermography analysis of facial regions of interest (ROIs), oro-facial myofunctional evaluation (OMES-E protocol) and masticatory performance. Statistical analysis included one-way ANOVA and Pearson/Spearman correlation test. RESULTS: Obstructive sleep apnoea group showed lower thermographic measures in many ROIs in the frontal and lateral views of the face, including the submental triangle region, and lower scores of aspect/posture and performance of oro-facial structures, as well lower total score of OMES-E evaluation (P < .05). Scores of aspect/posture and mobility were correlated with the temperature of some ROIs in the frontal and lateral views. CONCLUSION: Lower facial skin and submental triangle region temperatures, measured by infrared thermography, and a worse oro-facial myofunctional condition were identified in the group of individuals with OSA. The higher temperatures of the ROIs were correlated with the better status of aspect/posture and performance of the oro-facial myofunctional structures.

Congenital heart disease in children: Orofacial myofunctional aspects, eating behavior and facial temperature

OBJECTIVE: To characterize the eating behavior, orofacial, speech myofunctional conditions, and facial temperature of children with congenital heart disease. METHOD: This is a cross-sectional and analytical study. The sample consisted of 30 children with heart disease (cyanotic or acyanotic; mean of 5.48 ± 0.84 years old) and 28 healthy children (4.98 ± 0.64 years old). Parents were given a questionnaire to assess eating behaviors (Montreal Children's Hospital Feeding Scale). The orofacial myofunctional assessment protocol (OMES-E), the Child Language Test (ABFW), and thermography infrared of facial temperature were used. Data analysis was conducted by student's t-tests, Chi-square, logistic regression, and correlation analysis. RESULTS: Eating behavior in Parents did not perceive eating behavior differences between the heart disease and control groups. However, the percentage of children with some feeding difficulty was higher in the heart disease group. There was a difference between groups regarding the appearance and posture of structures, the mobility of the mandibular and cheek, swallowing function, and the total function score. Thermographic variables did not differ between the groups, but better performance in orofacial functions correlated with the temperature of the labial commissure and lower lip points. CONCLUSIONS: The frequency of children with eating difficulties was higher among those with congenital heart disease, as was the increased facial temperature at the medial eyelid commission point when submitted to interventional procedures. The orofacial myofunctional aspects showed changes in posture and position, mobility, and orofacial functions among children with heart disease as compared to the control group. There was a correlation between the temperature of the thermo-anatomical points of the labial commissure and the lower lip as well as the OMES-E function score. (AU)

Congenital heart disease in children: Orofacial myofunctional aspects, eating behavior and facial temperature.

OBJECTIVE: To characterize the eating behavior, orofacial, speech myofunctional conditions, and facial temperature of children with congenital heart disease. METHOD: This is a cross-sectional and analytical study. The sample consisted of 30 children with heart disease (cyanotic or acyanotic; mean of 5.48 ± 0.84 years old) and 28 healthy children (4.98 ± 0.64 years old). Parents were given a questionnaire to assess eating behaviors (Montreal Children's Hospital Feeding Scale). The orofacial myofunctional assessment protocol (OMES-E), the Child Language Test (ABFW), and thermography infrared of facial temperature were used. Data analysis was conducted by student's t-tests, Chi-square, logistic regression, and correlation analysis. RESULTS: Eating behavior in Parents did not perceive eating behavior differences between the heart disease and control groups. However, the percentage of children with some feeding difficulty was higher in the heart disease group. There was a difference between groups regarding the appearance and posture of structures, the mobility of the mandibular and cheek, swallowing function, and the total function score. Thermographic variables did not differ between the groups, but better performance in orofacial functions correlated with the temperature of the labial commissure and lower lip points. CONCLUSIONS: The frequency of children with eating difficulties was higher among those with congenital heart disease, as was the increased facial temperature at the medial eyelid commissions point when submitted to interventional procedures. The orofacial myofunctional aspects showed changes in posture and position, mobility, and orofacial functions among children with heart disease as compared to the control group. There was a correlation between the temperature of the thermo-anatomical points of the labial commissure and the lower lip as well as the OMES-E function score.

Masticatory behaviour and chewing difficulties in young adults with temporomandibular disorders.

BACKGROUND: Difficulties and limitations on masticatory function are among the main reasons why patients with temporomandibular disorder (TMD) seek care. OBJECTIVE: To evaluate the masticatory behaviour and perception of chewing difficulties in adults with mild TMD of recent onset, considering the presence of malocclusion. METHODS: Eighty-one young adults were divided into groups according to the presence of TMD and malocclusion: Non-TMD Normal Occlusion (n = 18), Non-TMD Malocclusion (n = 22), TMD Normal Occlusion (n = 18) and TMD Malocclusion (n = 23). TMD was assessed using the TMD Research Diagnostic Criteria and volunteers also answered questionnaires regarding their perception about jaw functional limitation and difficulty to chew foods of different textures. Masticatory and swallowing behaviours were assessed using the Orofacial Myofunctional Evaluation with Scores (OMES) protocol. Chewing time and chewing frequency taken to ingest the test-food were also obtained. Two-way-ANOVA was used to analyse the TMD, occlusion and TMD × occlusion interaction effects. RESULTS: Temporomandibular disorder effect was observed on vertical jaw mobility and jaw function limitation total scores, meaning that groups differed in the perception of opening limitation and mandibular limitation according to TMD status with a medium effect size. Also, more changes in chewing function (OMES-chewing score) and higher chewing frequency was observed in the presence of TMD (P < 0.05). Occlusion effect was only observed on OMES-swallowing score and no TMD × occlusion interaction effect was observed. CONCLUSION: Changes in chewing behaviour, frequency and perception of mandibular limitation was observed in the presence of TMD, pointing out the importance of functional evaluation when planning and establishing a treatment plan.

Study of the association between gait variability and physical activity.

BACKGROUND: Gait variability can be considered an indirect measure of gait stability, in particular regarding temporal or spatial variability assessment. Physical activity, such as walking, is advised for the elderly and can be improved by gait stability. The aim of this study was to investigate the associations between gait stability and physical activity in women of different age ranges. METHODS: Forty-two healthy women of different age ranges (18-40 yrs. and 65-75 yrs.) were recruited in the study. To assess physical activity, the subjects wore a multi-sensor activity monitor for a whole week, inferring the time spent in moderate to vigorous physical activity (MVPA). MVPA were analysed in bouts of at least 10 subsequent minutes (MVPAbouts) and in overall minutes (MVPAtot). A kinematic analysis was performed with an optoelectronic system to calculate gait variability - expressed as standard deviation (SD) and coefficient of variability (CV) of step width, stride length, stance and swing time (during treadmill walking at different speeds). RESULTS: Elderly women, with high walking speed (5 km/h), and moderate step width variability (CV = 8-27%), met the recommended levels of physical activity (MVPAtot and MVPAbouts). Furthermore, gait variability, adjusted for age and number of falls, was significantly and negatively associated with MVPAtot only at 3.5 km/h, and with MVPAbouts only at 4 km/h. CONCLUSIONS: In a population of healthy elderly women, gait variability was significantly and negatively associated with the level of physical activity. Healthy elderly women, with moderate gait variability (step width variability), and high preferred walking speed, seem to be able to meet the recommended levels of physical activity.

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.

Signs and symptoms of temporomandibular disorders in women and men.

INTRODUCTION: Women are more likely to present temporomandibular disorders (TMD); however, studies comparing genders in Brazilian samples are rare. PURPOSE: To analyze the proportion of men and women, as well as the association between gender and age, problem duration, and TMD symptoms in patients admitted to an university clinic for treatment. METHODS: Interview and assessment data of protocols from 1,000 patients diagnosed with TMD were collected and analyzed and then divided into two groups, male (n = 177) and female (n = 823). The exploratory analysis was based on contingency tables and χ2 test was carried out. Subsequently, the logistic regression model was used and the odds ratios (OR) concerning the evaluated comparisons were calculated. RESULTS: Females were more prevalent in the sample, and mean ages and TMD duration were similar between the groups, with higher occurrence in young adults (19 to 40 years old). The OR values showed an association between the female gender and the signs/symptoms of pain in the temporomandibular joint, pain in the facial muscles, neck and shoulders, headache, fatigue in the muscles of mastication, otologic symptoms, and dysphonia. Women had two times higher chances of presenting these symptoms than men. CONCLUSION: In the sample of Brazilian patients with TMD, the number of women who presented a higher prevalence of painful symptoms was greater, followed by otologic symptoms and complaints of dysphonia. The prevalence of joint noise was similar in both studied groups.

Sinais e sintomas de desordem temporomandibular em mulheres e homens / Signs and symptoms of temporomandibular disorders in women and men

RESUMO Introdução: Mulheres são mais susceptíveis às desordens temporomandibulares (DTM), contudo, estudos que tenham comparado os gêneros em amostras brasileiras são raros. Objetivo: Analisar a proporção de homens e mulheres, bem como a associação entre o gênero e as variáveis idade, duração do problema e sintomas de DTM em pacientes admitidos para tratamento em uma clínica universitária. Métodos: Foram coletados e analisados dados de entrevista e avaliação de mil protocolos de pacientes com diagnóstico de DTM, divididos em 2 grupos, masculino (n=177) e feminino (n=823). Foi realizada a análise exploratória a partir de tabelas de contingência e teste do χ2. Posteriormente, foi utilizado o modelo de regressão logística e calculadas as odds ratio brutas (OR) referentes às comparações avaliadas. Resultados: Na amostra prevaleceu o gênero feminino e as médias de idade e de duração da DTM foram semelhantes entre os grupos, predominando a faixa etária de adultos jovens (19 a 40 anos). Os valores de OR evidenciaram associação entre o gênero feminino e os sinais/sintomas dor na articulação temporomandibular (ATM), dor nos músculos faciais, pescoço e ombros, cefaleia, fadiga nos músculos mastigatórios, sintoma otológico e disfonia, tendo sido a chance das mulheres os apresentassem duas vezes maior do que os homens. Conclusão: Na amostra de pacientes brasileiros com DTM foi maior o número de mulheres e essas apresentaram maior prevalência de sintomas dolorosos, seguidos pelos otológicos e queixas de disfonia. A prevalência de ruído articular foi semelhante nos grupos estudados.

ABSTRACT Introduction: Women are more likely to present temporomandibular disorders (TMD); however, studies comparing genders in Brazilian samples are rare. Purpose: To analyze the proportion of men and women, as well as the association between gender and age, problem duration, and TMD symptoms in patients admitted to an university clinic for treatment. Methods: Interview and assessment data of protocols from 1,000 patients diagnosed with TMD were collected and analyzed and then divided into two groups, male (n = 177) and female (n = 823). The exploratory analysis was based on contingency tables and χ2 test was carried out. Subsequently, the logistic regression model was used and the odds ratios (OR) concerning the evaluated comparisons were calculated. Results: Females were more prevalent in the sample, and mean ages and TMD duration were similar between the groups, with higher occurrence in young adults (19 to 40 years old). The OR values showed an association between the female gender and the signs/symptoms of pain in the temporomandibular joint, pain in the facial muscles, neck and shoulders, headache, fatigue in the muscles of mastication, otologic symptoms, and dysphonia. Women had two times higher chances of presenting these symptoms than men. Conclusion: In the sample of Brazilian patients with TMD, the number of women who presented a higher prevalence of painful symptoms was greater, followed by otologic symptoms and complaints of dysphonia. The prevalence of joint noise was similar in both studied groups.

Translation and cross-cultural adaptation of the protocol of orofacial myofunctional evaluation with scores for Italian Language.

UNLABELLED: The protocol of orofacial myofunctional evaluation with scores (OMES-protocol or AMIOFE in Portuguese language) is a validated instrument for the diagnosis of orofacial myofunctional disorders that can be used in clinical practice for speech-language pathologists. Because in the Italian language there is no validated tool for such purpose, this study was developed. PURPOSES: To translate and culturally adapt the OMES-protocol for Italian language and determine the normal score value in a group of young Italian adults. METHODS: The OMES-protocol was translated from English to Italian by three bilingual individuals. From these translations, a consensus version was prepared by a research committee (three speech therapists and one physician and submitted to a committee of judges composed by eight speech therapists experienced in the area. The authors of the original version verified and approved the Italian version of the protocol. The instrument was tested via evaluations of 40 young and grown-up Italians (age range: 18-56 years) performed by two speech therapists. A cutoff score, previously described, was used to determine the mean and standard deviation. RESULTS: The translation stage and the final Italian version of the OMES-protocol are shown. The mean of scores for individuals with and without orofacial myofunctional disorders were presented. CONCLUSION: The Italian version of the OMES-protocol was developed, translated, and cross-culturally adapted. Normal values for young and adult Italian subjects are presented.

Tradução e adaptação transcultural do protocolo de avaliação miofuncional orofacial com escores para a Língua Italiana / Translation and cross-cultural adaptation of the protocol of orofacial myofunctional evaluation with scores for Italian Language

RESUMO O protocolo de avaliação miofuncional orofacial com escores (protocolo AMIOFE) é um instrumento validado para o diagnóstico de distúrbios miofuncionais orofaciais que pode ser utilizado por fonoaudiólogos em sua prática clínica. O presente estudo foi desenvolvido porque não há um instrumento validado para esta finalidade em língua Italiana. Objetivos: traduzir e realizar a adaptação transcultural do protocolo AMIOFE para a língua italiana e determinar os valores dos escores de normalidade em um grupo de jovens e adultos italianos. Métodos: o protocolo AMIOFE foi traduzido da língua inglesa para a italiana por três indivíduos bilíngues. A partir dessas traduções, uma versão de consenso foi preparada por um comitê de pesquisa (três fonoaudiólogos e um médico) e submetida a um comitê de juízes, composto por oito fonoaudiólogos italianos experientes na área. Os autores da versão original verificaram e aprovaram a versão italiana do protocolo. O instrumento foi testado por meio de avaliações de 40 sujeitos italianos jovens e adultos (faixa etária entre 18 e 56 anos de idade), realizadas por dois fonoaudiólogos. O ponto de corte, previamente descrito, foi usado para determinar as médias e desvios-padrão. Resultados: a etapa de tradução e a versão final da versão italiana do protocolo AMIOFE foram apresentadas, bem como as médias dos escores para os sujeitos com e sem distúrbio miofuncional orofacial. Conclusão: a versão italiana do protocolo AMIOFE foi desenvolvida, traduzida e adaptada transculturalmente. Valores de normalidade para sujeitos italianos jovens e adultos foram apresentados.

ABSTRACT The protocol of orofacial myofunctional evaluation with scores (OMES-protocol or AMIOFE in Portuguese language) is a validated instrument for the diagnosis of orofacial myofunctional disorders that can be used in clinical practice for speech-language pathologists. Because in the Italian language there is no validated tool for such purpose, this study was developed. Purposes: To translate and culturally adapt the OMES-protocol for Italian language and determine the normal score value in a group of young Italian adults. Methods: The OMES-protocol was translated from English to Italian by three bilingual individuals. From these translations, a consensus version was prepared by a research committee (three speech therapists and one physician and submitted to a committee of judges composed by eight speech therapists experienced in the area. The authors of the original version verified and approved the Italian version of the protocol. The instrument was tested via evaluations of 40 young and grown-up Italians (age range: 18-56 years) performed by two speech therapists. A cutoff score, previously described, was used to determine the mean and standard deviation. Results: The translation stage and the final Italian version of the OMES-protocol are shown. The mean of scores for individuals with and without orofacial myofunctional disorders were presented. Conclusion: The Italian version of the OMES-protocol was developed, translated, and cross-culturally adapted. Normal values for young and adult Italian subjects are presented.

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.

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.

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.

Orofacial myofunctional disorder in subjects with temporomandibular disorder.

To determine the frequency and degree of orofacial myofunctional disorder (OMD) in a sample of patients with temporomandibular disorder (TMD), the dental records of 240 patients with a diagnosis of TMD were reviewed. Mean patient age and mean TMD duration, gender frequency, complaints, and signs and symptoms were calculated. The results showed that the sample studied was quite characteristic of a TMD group. The presence of the following signs/symptoms was significant: muscular pain, TMJ pain, joint noise, at least one otologic symptom, headache, and neck and shoulder pain. Most subjects presented some degree of OMD, with grade high prevailing over grade low. The importance of evaluating the stomatognathic structures and functions during the clinical examination of patients with TMD is emphasized.

Confiabilidade da eficiência mastigatória com beads e correlação com a atividade muscular / Reliability of masticatory efficiency with beads and correlation with the muscle activity

TEMA: a avaliação da eficiência mastigatória pela análise colorimétrica com beads, pode ser um método promissor, mas não há relatos sobre a sua confiabilidade. OBJETIVO: investigar a confiabiabilidade das beads para teste de eficiência mastigatória e a correlação com a atividade eletromiográfica dos músculos masseter e temporal anterior. MÉTODO: participaram dezenove sujeitos adultos jovens, nove do gênero masculino e dez do feminino com idades entre dezoito e vinte-oito anos, com dentição completa, sem histórico de desordem temporomandibular, trauma, cirurgia na região de cabeça e pescoço, tratamento ortodôntico ou fonoaudiológico. O teste de eficiência mastigatória foi realizado com beads nas condições: mastigação habitual, mastigação unilateral direita e esquerda, com duração de 20 segundos. Simultaneamente, foi realizada a eletromiografia. A atividade em máxima intercuspidação habitual dos dentes também foi registrada. A quantidade de fucsina liberada após a mastigação foi medida usando o espectrofotômetro Beckman DU-7 UV-Visible (Beckman Inc., Palo Alto, CA, USA). RESULTADOS: houve alta confiabilidade do teste de eficiência mastigatória (r = 0,86, p < 0,01) e correlação significante com a atividade eletromiográfica (r = 0,76, p < 0,01). Também houve correlações positivas quando as provas foram analisadas separadamente. CONCLUSÃO: o teste de eficiência mastigatória realizado com beads mostrou-se um método confiável e correlacionado positivamente à atividade eletromiográfica dos músculos temporal anterior e músculos masseter.

BACKGROUND: the use of the colorimetric method with beads to evaluate mastigatory efficiency may be promising, however no report is found about its reliability. AIM: to investigate the reliability of the beads to test masticatory efficiency and its correlation with the electromyographic activities of the anterior temporal and masseter muscles. METHODS: participants of this study were nineteen young adults, nine males and ten females, aged eighteen to twenty-eight years, with full dentition, Angle class I, with no history of temporomandibular disorder, neurological or cognitive deficit, previous or current tumors or traumas in the head and neck region, and orthodontic treatment or orofacial myofunctional therapy. The masticatory efficiency test was performed using beads, fuchsine-containing granules, in the folowing conditions: habitual chewing, right and left unilateral chewing, for 20 seconds. Electromyographic recordings were obtained simultaneously. Also, the maximal clenching was registered. The amount of fuchsin released upon chewing was measured using a Beckman DU-7 UV-Visible Spectrophotometer (Beckman Inc., Palo Alto, CA, USA). RESULTS: high reliability was observed for the masticatory efficiency test (r = 0.86, p < 0.01) and correlation with the electromyographic activities (r = 0.76, p < 0.01). Also, positive and significant correlations were observed when the conditions were separately analyzed. CONCLUSION: the masticatory efficiency test performed with beads proved to be a reliable method and positively correlated to the electromyographic activities of the anterior temporal and masseter muscles.

Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy.

The aim of this study was to investigate the frequency of otologic symptoms and their relationship to orofacial signs and symptoms of temporomandibular disorder (TMD), and the effect of orofacial myofunctional therapy. The study was conducted on eight asymptomatic subjects (Group C) and 20 subjects with articular TMD, randomly distributed over two groups: one treated using orofacial myofunctional therapy (OMT Group) and a control group with TMD (Group CTMD). Patient selection was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). All subjects submitted to a clinical examination with self-reporting of symptom severity, and to orofacial myofunctional and electromyographic evaluation at diagnosis and again, at the end of the study. Correlations were calculated using the Pearson test and inter- and intragroup comparisons were made (p < 0.05). In the diagnosis phase, subjects with TMD reported earache (65%), tinnitus (60%), ear fullness (90%), and 25% of the asymptomatic subjects reported tinnitus. The otologic symptoms were correlated with tenderness to palpation of the temporomandibular muscles and joints and with orofacial symptoms. Only the OMT group showed a reduction of otologic and orofacial symptoms, of tenderness to palpation and of the asymmetric index between muscles. OMT may help with muscle coordination and a remission of TMD symptoms.

Protocol of orofacial myofunctional evaluation with scores.

OBJECTIVE: In the literature there is no validated instrument for the clinical evaluation of the orofacial myofunctional condition of children that will permit the examiner to express numerically his perception of the characteristics and behaviors observed. The proposal of this study is to describe a protocol for the evaluation of children aged 6-12 years in order to establish relations between the orofacial myofunctional conditions and numerical scales. The protocol validity, reliability of the examiners and agreement between them was analyzed. METHODS: Eighty children aged 6-12 years participated in the study. All were evaluated and 30 were selected at random for the analyses (age range: 72-149 months, mean=103.3, S.D.=23.57). Individuals with and without orofacial myofunctional disorders were included. The examiners were two speech therapists properly calibrated in orofacial myofunctional evaluation. Two protocols were constructed. One, based on traditional models, was called traditional orofacial myofunctional evaluation (TOME), and the other, with the addition of numerical scales, was called orofacial myofunctional evaluation with scores (OMES). The clinical conditions included were: appearance, posture and mobility of lips, tongue, cheeks and jaws, respiration, mastication and deglutition. Statistical analysis was performed using the split-half reliability method. Means, standard deviations and the Spearman correlation coefficient were also calculated. RESULTS: There was a statistically significant correlation between the evaluations of 30 children assessed with the TOME and OMES protocols (r=0.85, p<0.01). The reliability between protocols was 0.92. The test-retest reliability of the OMES instrument was 0.99 and the correlation was 0.98. Reliability between examiners 1 and 2 using the OMES protocol was 0.99, and the correlation was 0.98 (p<0.01). CONCLUSION: The OMES protocol proved to be a valid and reliable instrument for orofacial myofunctional evaluation, permitting the grading of orofacial myofunctional conditions within the limits of the selected items.

Reliability of masticatory efficiency with beads and correlation with the muscle activity.

BACKGROUND: the use of the colorimetric method with beads to evaluate mastigatory efficiency may be promising, however no report is found about its reliability. AIM: to investigate the reliability of the beads to test masticatory efficiency and its correlation with the electromyographic activities of the anterior temporal and masseter muscles. METHODS: participants of this study were nineteen young adults, nine males and ten females, aged eighteen to twenty-eight years, with full dentition, Angle class I, with no history of temporomandibular disorder, neurological or cognitive deficit, previous or current tumors or traumas in the head and neck region, and orthodontic treatment or orofacial myofunctional therapy. The masticatory efficiency test was performed using beads, fuchsine-containing granules, in the following conditions: habitual chewing, right and left unilateral chewing, for 20 seconds. Electromyographic recordings were obtained simultaneously. Also, the maximal clenching was registered. The amount of fuchsin released upon chewing was measured using a Beckman DU-7 UV-Visible Spectrophotometer (Beckman Inc., Palo Alto, CA, USA). RESULTS: high reliability was observed for the masticatory efficiency test (r = 0.86, p < 0.01) and correlation with the electromyographic activities (r = 0.76, p < 0.01). Also, positive and significant correlations were observed when the conditions were separately analyzed. CONCLUSION: the masticatory efficiency test performed with beads proved to be a reliable method and positively correlated to the electromyographic activities of the anterior temporal and masseter muscles.

Controle motor da fala: teoria e provas de avaliação / Speech motor control: theory and assessment taks

Objetivo: revisar a literatura a respeito do controle motor da fala e da avaliação clínica das estruturas orofaciais envolvidas na produção da fala e elaborar um protocolo aplicável na clínica fonoaudiológica. Métodos: consulta bibliográfica no período de 1987 a 2005, análise estatística descritiva (porcentagem) das propostas de avaliação de 13 publicações e reunião das provas com ocorrência acima de 42% nos textos consultados. Resultados: os aspectos de maior ocorrências nas propostas de avaliação foram: postura/posição da língua (92%), abertura bucal (83%), tipo mastigatório – preferência (83%), deglutição – contração dos músculos masseteres e interposição lingual (83%), conformação, largura e profundidade do palato duro (75%) postura de lábios (75%), mobilidade do palato mole (67%), fala – articulação, desvio no percurso da mandíbula e acúmulo de saliva (42%). Conclusão: foram reunidas provas e estratégias utilizadas em avaliações do sistema de produção da fala podendo indicar caminhos para a prática clínica e contribuir para o estabelecimento de metas terapêuticas e o acompanhamento de resultados de casos clínicos.