Influence of Breathing Modes and Facial Growth Patterns on Electromyographic Fatigue of Masticatory Muscles in Children.

Introduction Changes in breathing patterns affect the harmonious development of the structures of the craniofacial system, leading to changes in posture, occlusion, and facial growth patterns. However, little is known about how these changes influence the muscle contraction patterns, either at rest or while functioning, and either in a normal or unbalanced condition. Objective To study the masseter and anterior temporal muscles fatigue during mastication in nasal- and mouth-breathing children, also considering their facial growth patterns. Methods: A total of 70 children aged 6 to 12 years old who met the study criteria were assessed. Speech-language-hearing, otorhinolaryngologic, and cephalometric assessments were performed to divide them into groups. In the electromyographic assessment, the children were asked to chew gum following a metronome until they felt fatigued. The median frequency of the muscles was analyzed at 15, 30, 45, and 60 seconds of mastication. The reported time of fatigue perception was recorded. The data were analyzed with analysis of variance (ANOVA) and the Kruskal-Wallis and the Mann-Whitney U tests. Results There were no median frequency decrease patterns nor differences in the myoelectric manifestations and reported time of fatigue between the groups. Conclusion The masticatory muscles did not reveal fatigue in the electromyographic analysis; however, the fatigue time was reported, despite the absence of physiological fatigue. The breathing mode, the facial growth pattern, and the association between them did not interfere with the behavior of the median frequency of the electromyographic signal and the fatigue time perception.

Influence of Breathing Modes and Facial Growth Patterns on Electromyographic Fatigue of Masticatory Muscles in Children

Abstract Introduction Changes in breathing patterns affect the harmonious development of the structures of the craniofacial system, leading to changes in posture, occlusion, and facial growth patterns. However, little is known about how these changes influence the muscle contraction patterns, either at rest or while functioning, and either in a normal or unbalanced condition. Objective To study the masseter and anterior temporal muscles fatigue during mastication in nasal- and mouth-breathing children, also considering their facial growth patterns. Methods: A total of 70 children aged 6 to 12 years old who met the study criteria were assessed. Speech-language-hearing, otorhinolaryngologic, and cephalometric assessments were performed to divide them into groups. In the electromyographic assessment, the children were asked to chew gum following a metronome until they felt fatigued. The median frequency of the muscles was analyzed at 15, 30, 45, and 60seconds of mastication.The reported time of fatigue perception was recorded. The data were analyzed with analysis of variance (ANOVA) and the Kruskal-Wallis and the Mann-Whitney U tests. Results There were no median frequency decrease patterns nor differences in the myoelectric manifestations and reported time of fatigue between the groups. Conclusion The masticatory muscles did not reveal fatigue in the electromyographic analysis; however, the fatigue time was reported, despite the absence of physiological fatigue. The breathing mode, the facial growth pattern, and the association between them did not interfere with the behavior of the median frequency of the electromyographic signal and the fatigue time perception.

Agreement among instruments of quantitative evaluation of the hard palate in children / Concordância entre instrumentos de avaliação quantitativa do palato duro em crianças

ABSTRACT Purpose To evaluate the agreement among instruments of the quantitative evaluation of hard palate. Methods This cross-sectional study was performed with a sample of 30 children aged 6 to 11 from Santa Maria, Southern Brazil. The instruments for palate measurements evaluated were: digital caliper, used directly in the oral cavity and in plaster casts, Korkhaus tridimensional bow, used directly in the oral cavity and in plaster casts, and Dolphin Imaging Software used for measurements in cone-beam computed tomography (CBCT). The agreement among different instruments was evaluated using the Intraclass Correlation Coefficient (ICC). Results The means of all transversal dimensions obtained by cone-beam computed tomography were lower than those of the other instruments - the agreement values in the width between the canines and in the width between the first molars were lower when comparing the cone-beam computed tomography and the other instruments. In the width between the first and second premolars, all comparisons showed acceptable agreement values. Good concordance values were obtained when comparing the palate depth at the second premolar region when using a bow divider inside the oral cavity and in the cast. Conclusion Most instruments presented satisfactory agreement in the measurements related to the transverse plane of the hard palate. However, when the vertical plane was evaluated, only the bow divider applied to both cast and oral cavity presented ideal agreement.

RESUMO Objetivo Avaliar a concordância entre instrumentos de avaliação quantitativa do palato duro. Método Este estudo transversal foi realizado com uma amostra de 30 crianças de 6 a 11 anos de Santa Maria, sul do Brasil. Os instrumentos de medidas do palato avaliados foram: paquímetro digital, utilizado diretamente na cavidade oral e em modelos de gesso, arco tridimensional Korkhaus, usado diretamente na cavidade oral e em modelos de gesso, e Dolphin Imaging Software utilizado para medições em tomografia computadorizada de feixe cônico (CBCT). A concordância entre os diferentes instrumentos foi avaliada por meio do Coeficiente de Correlação Intraclasse (ICC). Resultados As médias de todas as dimensões transversais obtidas pela tomografia computadorizada de feixe cônico foram menores do que as dos outros instrumentos - os valores de concordância na largura entre os caninos e na largura entre os primeiros molares foram baixos na comparação entre a tomografia computadorizada de feixe cônico e os demais instrumentos. Na largura entre o primeiro e o segundo pré-molar, todas as comparações apresentaram valores de concordância aceitáveis. Valores de concordância aceitáveis também foram obtidos ao comparar a profundidade do palato na região do segundo pré-molar com o uso de um divisor de arco dentro da cavidade oral e no gesso. Conclusão A maioria dos instrumentos apresentou concordância satisfatória nas medidas relacionadas ao plano transverso do palato duro. Porém, quando avaliado o plano vertical, apenas o divisor de arco aplicado tanto no gesso quanto na cavidade oral apresentou concordância ideal.

Reference parameters for normality and associated factors to hard palate during mixed dentition phase / Parâmetros de referência para normalidade e fatores associados ao palato duro durante a fase de dentição mista

ABSTRACT Purpose To evaluate the association among dimensions of the hard palate according to the sexes, skin color, and periods of the mixed dentition and present reference parameters of normality for this stage of development. Methods This cross-sectional study evaluated a representative sample of children between the ages of 7 and 13 years in Santa Maria, southern Brazil. The outcomes of the study were the dimensions of the palate: width measurements and depth. Sociodemographic characteristics and related oral measures were also assessed. Adjusted linear regression model were used to evaluate the effect of the predictor's variables on the dimensions of the hard palate in millimeters. The reference standards for the hard palate normality were presented in mean, standard deviation, and 95% confidence interval. Results A total of 569 children were evaluated. The hard palate dimensions were larger in the male sex and smaller in the first transitional period of mixed dentition. Skin color had an influence on the hard palate width at the level of the premolars, and the width measurements were smaller in white individuals. Posterior cross bite, Angle Class II and III malocclusions and non-nutritional sucking habits caused reduction in the hard palate width measurements. Conclusion Different dimensions of the hard palate are influenced by demographic variables such as sex, skin color, and mixed dentition period. Children of the female sex, white-skinned and in the first transition period of mixed dentition had smaller dimensions of the hard palate. Establishing normality reference standards in measurements of the palates guides the clinical practice.

RESUMO Objetivo Avaliar a associação entre as dimensões do palato duro de acordo com os sexos, cor da pele e períodos da dentição mista e apresentar parâmetros de normalidade de referência para esta fase de desenvolvimento. Método Este estudo transversal avaliou uma amostra representativa de crianças com idade entre 7 e 13 anos em Santa Maria, sul do Brasil. Os desfechos do estudo foram as dimensões do palato: medidas de largura e profundidade. Características sociodemográficas e medidas orais relacionadas também foram avaliadas. Modelos de regressão linear ajustados foram utilizados para avaliar o efeito das variáveis preditoras sobre as dimensões do palato duro em milímetros. Os padrões de referência para a normalidade do palato duro foram apresentados em média, desvio padrão e intervalo de confiança de 95%. Resultados Foram avaliadas 569 crianças. As dimensões do palato duro foram maiores no sexo masculino e menores no primeiro período de transição da dentição mista. A cor da pele influenciou a largura do palato duro ao nível dos pré-molares, sendo as medidas de largura menores nos brancos. Mordida cruzada posterior, más oclusões de Classe II e III de Angle e hábitos de sucção não nutricionais causaram redução nas medidas da largura do palato duro. Conclusão As diferentes dimensões do palato duro são influenciadas por variáveis demográficas como o sexo, cor da pele e período de dentição mista. Crianças do sexo feminino, de cor de pele branca e no primeiro período de transição de dentição mista apresentaram menores dimensões do palato duro. O estabelecimento de padrões de referência de normalidade nas medidas do palato orienta a prática clínica.

Reference parameters for normality and associated factors to hard palate during mixed dentition phase.

PURPOSE: To evaluate the association among dimensions of the hard palate according to the sexes, skin color, and periods of the mixed dentition and present reference parameters of normality for this stage of development. METHODS: This cross-sectional study evaluated a representative sample of children between the ages of 7 and 13 years in Santa Maria, southern Brazil. The outcomes of the study were the dimensions of the palate: width measurements and depth. Sociodemographic characteristics and related oral measures were also assessed. Adjusted linear regression model were used to evaluate the effect of the predictor's variables on the dimensions of the hard palate in millimeters. The reference standards for the hard palate normality were presented in mean, standard deviation, and 95% confidence interval. RESULTS: A total of 569 children were evaluated. The hard palate dimensions were larger in the male sex and smaller in the first transitional period of mixed dentition. Skin color had an influence on the hard palate width at the level of the premolars, and the width measurements were smaller in white individuals. Posterior cross bite, Angle Class II and III malocclusions and non-nutritional sucking habits caused reduction in the hard palate width measurements. CONCLUSION: Different dimensions of the hard palate are influenced by demographic variables such as sex, skin color, and mixed dentition period. Children of the female sex, white-skinned and in the first transition period of mixed dentition had smaller dimensions of the hard palate. Establishing normality reference standards in measurements of the palates guides the clinical practice.

Agreement among instruments of quantitative evaluation of the hard palate in children.

PURPOSE: To evaluate the agreement among instruments of the quantitative evaluation of hard palate. METHODS: This cross-sectional study was performed with a sample of 30 children aged 6 to 11 from Santa Maria, Southern Brazil. The instruments for palate measurements evaluated were: digital caliper, used directly in the oral cavity and in plaster casts, Korkhaus tridimensional bow, used directly in the oral cavity and in plaster casts, and Dolphin Imaging Software used for measurements in cone-beam computed tomography (CBCT). The agreement among different instruments was evaluated using the Intraclass Correlation Coefficient (ICC). RESULTS: The means of all transversal dimensions obtained by cone-beam computed tomography were lower than those of the other instruments - the agreement values in the width between the canines and in the width between the first molars were lower when comparing the cone-beam computed tomography and the other instruments. In the width between the first and second premolars, all comparisons showed acceptable agreement values. Good concordance values were obtained when comparing the palate depth at the second premolar region when using a bow divider inside the oral cavity and in the cast. CONCLUSION: Most instruments presented satisfactory agreement in the measurements related to the transverse plane of the hard palate. However, when the vertical plane was evaluated, only the bow divider applied to both cast and oral cavity presented ideal agreement.

Nasal patency and otorhinolaryngologic-orofacial features in children / Patência nasal e características otorrinolaringológicas e orofaciais em crianças

Abstract Introduction: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. Objective: To compare nasal patency and otorhinolaryngologic-orofacial features in children. Methods: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. Results: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p = 0.006 and p = 0.002), nasal obstruction report (p = 0.027 and p = 0.023), runny nose (p = 0.004 and p = 0.012), unsystematic lip closure during mastication (p = 0.040 and p = 0.026), masticatory speed reduced (p = 0.006 and p = 0.008) and altered solid food swallowing (p = 0.006 and p = 0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p = 0.040), reduced hard palate width (p = 0.037) and altered speech (p = 0.004). Higher absolute values were found in children with increased tongue width (p = 0.027) and, higher absolute and predicted (%) in children with mild everted lip (p = 0.008 and p = 0.000). Conclusions: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Resumo Introdução: A obstrução nasal é um sintoma comum na infância relacionado a rinite e hipertrofia das tonsilas faríngeas. Na presença de obstrução nasal, a patência nasal pode estar reduzida e a respiração nasal ser substituída por respiração oral. Alterações orofaciais e otorrinolaringológicas estão relacionadas a esse modo de respiração. A avaliação objetiva das vias aéreas superiores pode ser obtida através da medida da patência nasal. Objetivo: Comparar a patência nasal e características otorrinolaringológicas e orofaciais em crianças. Método: Foram submetidas 123 crianças de seis a 12 anos, de ambos os sexos, a avaliação fonoaudiológica, de acordo com o protocolo de avaliação Miofuncional Orofacial, exame clínico e endoscópico otorrinolaringológico e medição da patência nasal, com o uso do pico de fluxo inspiratório nasal em valores absolutos e valores estimados (% pico de fluxo inspiratório nasal). Resultados: Valores mais baixos de pico de fluxo inspiratório nasal e % pico de fluxo inspiratório nasal foram encontrados em crianças com sono agitado (p = 0,006 e p = 0,002), relato de obstrução nasal (p = 0,027 e p = 0,023), rinorreia (p = 0,004 e p = 0,012), fechamento não sistemático dos lábios durante a mastigação (p = 0,040 e p = 0,026), velocidade mastigatória reduzida (p = 0,006 e p = 0,008) e alteração da ingestão de alimentos sólidos (p = 0,006 e p = 0,001). O pico de fluxo inspiratório nasal foi menor em crianças com conchas inferiores pálidas (p = 0,040), redução da largura do palato duro (p = 0,037) e alterações da fala (p = 0,004). Valores maiores foram encontrados em crianças com largura da língua aumentada (p = 0,027). Valores maiores de pico de fluxo inspiratório nasal e % de pico de fluxo inspiratório nasal foram observados em crianças com lábio levemente evertido (p = 0,008 e p = 0,000). Conclusões: A patência nasal foi menor em crianças com sono agitado, sinais e sintomas de rinite, redução da largura do palato duro e alterações nas funções de mastigação, deglutição e fala. Enfatiza-se também que a maioria das crianças apresentava sinais e sintomas de rinite alérgica.

Nasal patency and otorhinolaryngologic-orofacial features in children.

INTRODUCTION: Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement. OBJECTIVE: To compare nasal patency and otorhinolaryngologic-orofacial features in children. METHODS: One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values. RESULTS: Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p=0.006 and p=0.002), nasal obstruction report (p=0.027 and p=0.023), runny nose (p=0.004 and p=0.012), unsystematic lip closure during mastication (p=0.040 and p=0.026), masticatory speed reduced (p=0.006 and p=0.008) and altered solid food swallowing (p=0.006 and p=0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p=0.040), reduced hard palate width (p=0.037) and altered speech (p=0.004). Higher absolute values were found in children with increased tongue width (p=0.027) and, higher absolute and predicted (%) in children with mild everted lip (p=0.008 and p=0.000). CONCLUSIONS: Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment.

PURPOSE: : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. METHODS: 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. RESULTS: Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). CONCLUSION: We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment / Variáveis associadas ao diagnóstico de respiração oral baseado em uma avaliação multidisciplinar

ABSTRACT Purpose : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. Methods 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. Results Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). Conclusion We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

RESUMO Objetivo Este estudo foi conduzido para identificar as variáveis associadas ao diagnóstico de respiração oral em crianças, baseado nos domínios multidisciplinares. Método Cento e dezenove crianças, de seis a 12 anos, realizaram uma avaliação abrangente composta por uma anamnese e exames fonoaudiológico (estruturas orofaciais e funções estomatognáticas), otorrinolaringológico (avaliação clínica e endoscópica), odontológico (conservação oral e oclusão) e fisioterapêutico (postura corporal e permeabilidade nasal). A permeabilidade nasal foi aferida utilizando-se o Pico de Fluxo Inspiratório Nasal (PFIN) e a escala NOSE (Nasal Obstruction Symptom Evaluation). Foi realizada uma regressão logística múltipla, considerando o modo respiratório como variável dependente e as covariáveis de cada avaliação multidisciplinar como variáveis associadas. Resultados Foi encontrada uma associação do diagnóstico de respiração oral com variáveis de cada domínio profissional: relato de obstrução nasal (Odds ratio - OR=5,55), tempo de uso de chupeta (OR=1,25), tipo facial convexo (OR=3,78), ângulo nasolabial obtuso (OR=4,30), postura de lábios entreabertos e abertos (OR=4,13), postura de língua no assoalho oral (OR=5,88), largura do palato duro reduzida (OR=2,99), contrações inesperadas durante a mastigação (OR=2,97), tonsilas faríngeas obstrutivas (OR=8,37), má oclusão classe II de Angle (OR=10,85) e estado gengival regular (OR=2,89). Conclusão Concluiu-se que o diagnóstico multidisciplinar é importante, uma vez que as avaliações dos domínios fonoaudiológico, otorrinolaringológico e odontológico obtiveram variáveis associadas ao diagnóstico de respiração oral. As variáveis relacionadas à postura corporal e permeabilidade nasal não foram associadas ao diagnóstico de respiração oral.

Comparação da função ventilatória e da atividade elétrica dos músculos inspiratórios acessórios entre adultos jovens com respiração nasal e oral / Comparison of ventilatory function and electrical activity of the accessory inspiratory muscles in young adults with nasal and mouth breathing

Objetivo: Avaliar a função ventilatória, o pico de fluxo inspiratório nasal, as pressões respiratórias máximas, a atividade elétrica dos músculos inspiratórios acessórios e a relação entre as variáveis, em adultos com respiração oral (RO), comparando-os com adultos com respiração nasal (RN). Métodos: Estudo transversal, controlado com 77 participantes, entre 18 e 30 anos, ambos os sexos, distribuídos em Grupo RO (n = 38) e RN (n = 39). Foram avaliados por espirometria, manovacuometria, para obtenção da Pressão Inspiratória Máxima (PImáx) e Pressão Expiratória Máxima (PEmáx); medida do pico de fluxo inspiratório nasal (PFIN) e eletromiografia de superfície (EMG) dos músculos esternocleidomastoideo (ECM) e trapézio superior durante testes de PImáx e PFIN. Resultados: O grupo RO apresentou valores significativamente menores de PImáx (91 versus 100%), PEmáx (91,6 versus 102,6%) e PFIN (121,4 versus 147,7 l/min). Houve diferença (p < 0,01) na atividade EMG do ECM, com valores menores no grupo RO. A PImáx se correlacionou com o PFIN (r = 0,48, p < 0,01). Conclusão: Os RO apresentaram menores valores de PFIN, PImáx, PEmáx e de amplitude da atividade EMG dos músculos inspiratórios acessórios durante inspirações rápidas, quando comparados aos RN. Traz como contribuição para a prática clínica, a importância de uma investigação global do modo respiratório, não envolvendo apenas intervenções médicas, ortodônticas e miofuncionais, mas também os aspectos ventilatórios e musculares, sobre os quais se identificou a influência da RO. (AU)

Objective: To evaluate the ventilatory function, peak nasal inspiratory flow, respiratory muscle strength, electrical activity of the accessory inspiratory muscles and the relationship between the variables comparing mouth (MB) and nasal-breathing (NB) adults. Methods: Consisted in a cross-sectional, controlled study with 77 participants, between 18 and 30 years old, both sexes, distributed into MB (n=38) and NB (n=39) group. They were assessed by manovacuometry, for acquisition of the Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP) measures; peak nasal inspiratory flow meter (PNIF) and, surface electromyography (sEMG) of the of the sternocleidomastoid (ECM) and upper trapezius muscles, during MIP and PNIF. Results: The MB group presented values significantly lower on the MIP (91 versus 100%), MEP (91.6 versus 102.6%) and PNIF (121.4 versus 147.7 l/min). There was difference (p<0.01) in the ECM muscle activity, with lower values in the MB group. The MIP measure correlated to the PNIF (r=0.48, p<0.01). Conclusion: The adults MB presented smaller values of PNIF, MIP, MEP, and EMG amplitude of accessory inspiratory muscles during fast inspiration when compared to the NB. As a contribution to clinical practice, the importance of a global investigation of the respiratory mode, involving not only medical, orthodontic and myofunctional interventions, but also the ventilatory and muscular aspects, on which the influence of RO was identified. (AU)

Body posture and pulmonary function in mouth and nose breathing children: cross-sectional study / Postura corporal e função pulmonar em crianças respiradoras orais e nasais: estudo transversal

Abstract Introduction: Mouth breathing can lead to changes in body posture and pulmonary function. However, the consequences are still inconclusive and a number of studies are controversial. Objective: Evaluate and correlate spirometric parameters and postural measures in mouth breathing children, and compare them to nose breathers. Methods: two groups of 6 to 12 year-old children were evaluated: mouth breathers (MB, n = 55) and nose breathers (NB, n = 45). Spirometry and body posture analysis using photogrammetry (SAPo 0.68® v) were carried out. The following spirometric measures were evaluated: peak expiratory flow (PEF), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio (%) and forced expiratory flow between 25% and 75% of FVC (FEF 25-75%). Biophotogrammetric measures analyzed were: horizontal alignment of acromions (HAA) and anterior superior iliac spine (HAASIS), Charpy angle, horizontal alignment of the head (HAH), cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), cervical distance (CD) and lumbar distance (LD). Results: There were no intergroup differences in spirometric and postural variables. Positive and moderate correlations were found between CL and CD measures with PEF, FEV1, FVC and FEF 25-75%, while weak correlations were observed between lumbar lordosis and PEF, FEV1 and FVC. Conclusion: The breathing mode had no influence on postural and respiratory measures. However, greater forward head posture, with smaller cervical lordosis, was related to higher lung volumes and flows in both groups.

Resumo Introdução: A respiração oral pode levar a alterações na postura corporal e na função pulmonar. Entretanto, tais implicações ainda são inconclusivas e alguns estudos são controversos. Objetivo: avaliar e correlacionar parâmetros espirométricos e medidas posturais em crianças respiradoras orais, comparando-as com respiradores nasais. Métodos: foram avaliadas crianças de 6 a 12 anos que compuseram os grupos: respiradores orais (RO, n = 55) e nasais (RN, n = 45). Foram realizadas espirometria e análise da postura corporal, por meio de biofotogrametria (SAPo v 0.68®). As medidas de espirometria utilizadas foram: pico de fluxo expiratório (PFE), volume expiratório forçado no primeiro segundo (VEF1), capacidade vital forçada (CVF), relação VEF1/CVF (%) e fluxo expiratório forçado entre 25% e 75% da CVF (FEF25-75%). As medidas biofotogramétricas analisadas foram: alinhamento horizontal dos acrômios (AHA) e das espinhas ilíacas ântero-superiores (AHEIAS), ângulo de Charpy, alinhamento horizontal da cabeça (AHC), lordose cervical (LC), cifose torácica (CT), lordose lombar (LL), distância cervical (DC) e distância lombar (DL). Resultados: Não houve diferença entre os grupos nas variáveis espirométricas e posturais. Foram encontradas correlações positivas e moderadas entre as medidas posturais LC e DC e as medidas de PFE, VEF1, CVF e FEF25-75%. Ainda, correlações fracas entre DL e PFE, VEF1 e CVF foram encontradas. Conclusão: Na amostra estudada, o modo respiratório não gerou influência nas medidas posturais e respiratórias. Porém, a maior projeção anterior da cabeça com menor lordose cervical se relacionou com maiores volumes e fluxos pulmonares, em ambos os grupos.

Medidas antropométricas orofaciais de crianças segundo o tipo facial / Anthropometric orofacial measurements of children according to facial type

RESUMO Objetivo: avaliar as medidas antropométricas orofaciais segundo o tipo facial de crianças do sexo masculino e feminino. Métodos: participaram do estudo 126 crianças, 64 do sexo feminino e 62 do sexo masculino, com idade entre sete anos e 11 anos. As medidas antropométricas orofaciais foram comparadas entre os tipos faciais obtidos por meio da análise cefalométrica. Inicialmente foi realizada análise descritiva dos tipos faciais de acordo com os sexos. Por meio da Análise de Variância, foi realizada a comparação das medidas antropométricas no sexo masculino e feminino isoladamente e, posteriormente, foi realizada a análise independe do sexo. Os dados foram analisados considerando nível de significância de 5%. Resultados: encontrou-se um número maior de braquifaciais, seguidos de mesofaciais e dolicofaciais na totalidade da amostra. Na comparação das medidas antropométricas entre os três tipos faciais, evidenciou-se no sexo masculino diferença significante na medida de terço facial inferior e no sexo feminino, nas medidas da altura facial, terço inferior e lábio inferior. Quando comparadas as medidas antropométricas de forma independente do sexo, evidenciou-se diferença significante no terço inferior, lados direito e esquerdo da face, lábios superior e inferior. Conclusão: como esperado, nas análises de todos os resultados, considerando ou não os sexos, as medidas antropométricas orofaciais foram menores nos braquifaciais, com maior evidência encontrada nas medidas relacionadas ao plano vertical inferior.

ABSTRACT Purpose: assess anthropometric orofacial measurements of boys and girls according to facial type. Methods: participants were 126 children, 64 girls and 62 boys, aged between seven and 11 years. Anthropometric orofacial measurements were compared between the facial types obtained by cephalometric analysis. Initially, a descriptive analysis of facial types was conducted based on sex. Anthropometric measurements in boys and girls were compared separately by analysis of variance, followed by sex-independent analysis. Data were analyzed considering a significance level of 5%. Results: a larger number of brachyfacial individuals were found in the sample, followed by mesofacial and dolichofacial subjects. Comparison of facial measurements for the three types showed a significant difference in the lower third of the face among boys, and in face height, lower third and lower lip among girls. When anthropometric measurements were compared independently of sex, a significant difference was observed in the lower third, right and left sides of the face, as well as the upper and lower lips. Conclusion: as expected, analyses of all the results, considering sex or not, found lower anthropometric orofacial measurements in brachyfacial individuals, which was most evident in measurements related to the lower vertical plane.

Programa de reabilitação auditiva: mudanças na autopercepção de restrição de participação em idosos / Aural rehabilitation program: changes in self-perceived participation restrictions on the elderly

Objetivo: Este estudo visa a apresentar um Programa de Reabilitação Auditiva voltado aos idosos, usuários de próteses auditivas, caracterizando a população atendida neste programa quanto ao tipo e grau de perda auditiva, idade de início da terapia, tempo de protetização e escolaridade, além de avaliar as mudanças na autopercepção de restrição de participação, após tal intervenção terapêutica. Método: Trata-se de uma pesquisa descritiva e qualitativa. Elaborou-se um Programa de Reabilitação Auditiva, com 12 sessões individuais de atendimento fonoaudiológico voltado ao público da terceira idade e fizeram parte da amostra dez idosos usuários de prótese auditiva bilateral. Para avaliar as mudanças na autopercepção da restrição de participação, utilizou-se o questionário Hearing Handicap Inventory for the Elderly ­ Screening (HHIE-S) em dois momentos distintos, pré e pós-participação, em tal programa. Resultados: Da caracterização da população, observou-se que a maioria tem baixo nível de escolaridade e, na sua maioria, é composta por homens e média de 77 anos de idade no início da terapia de reabilitação auditiva. A autopercepção de restrição de participação dos idosos diminuiu após treinamento auditivo, mostrando que tal intervenção trouxe benefícios a suas vidas. Conclusão: O estudo mostrou que programas de reabilitação auditiva podem acarretar melhora na qualidade de vida da população da terceira idade. (AU)

Objective: It aims to present a Aural Rehabilitation Program for the elderly, users of hearing aids, featuring the population served in this program on the type and degree of hearing loss, age at onset of therapy, prosthetization time and educational level. Besides assessing the changes in self-perceived participation restrictions after such therapeutic intervention. Method: This is a descriptive and qualitative research. It was conducted a Aural Rehabilitation Program, with 12 individual sessions of speech therapy aimed to the public of the third age and the sample consisted of ten elderly user of bilateral hearing aid. To assess changes in self-perceived participation restrictions, was used the Hearing Handicap Inventory for the Elderly ­ Screening questionnaire (HHIE-S) at two different moments, before and after participation in such program. Results: Of the population's characterization, it was observed that the majority have low level of education, mostly composed of men and average of 77 years of age at onset of aural rehabilitation therapy. The self-perceived participation restrictionsof the elderly decreased after auditory training, showing that suchintervention brought benefits to their lives. Conclusion: The study found that aural rehabilitation programs can lead to improvements in quality of life on the elderly population. (AU)

Influence of generalized joint hypermobility on temporomandibular joint and dental occlusion: a cross-sectional study. / Influência da hipermobilidade articular generalizada sobre a articulação temporomandibular e a oclusão dentária: estudo transversal.

PURPOSE: To evaluate the dental occlusion and temporomandibular joint in women with and without generalized joint hypermobility. METHODS: Generalized joint hypermobility was assessed by the Beighton score. Individuals were divided into two groups: with and without hypermobility. The Research Diagnostic Criteria for Temporomandibular Disorders was used to evaluate the temporomandibular joint. Dental occlusion was assessed according to Angle classification, overjet and overbite measures, presence of open bite or crossbite, pattern of disocclusion, and occlusal interference. RESULTS: Forty-three women participated voluntarily in the study: 17 in the group with hypermobility and 26 in the group without hypermobility. The frequencies of joint noise and deviation during mouth opening were greater in the hypermobility group (52.9% vs. 38.5% and 76.5% vs. 50%, respectively), but without statistical significance. None of the volunteers presented ideal occlusion and no significant difference was found in Angle Class between the groups. The hypermobility group presented a higher percentage of changes in occlusion (29.4% of overbite, 47.1% of overjet, and 17.6% of crossbite), with crossbite showing statistical difference between the groups. CONCLUSION: Hypermobility does not influence occlusion and range of mandibular motion in the women assessed. Nevertheless, the higher percentage of articular noise and uncorrected deviation during mouth opening shown by the group with hypermobility, even without statistical difference, may constitute evidence of correlation between hypermobility and temporomandibular disorder.

Influência da hipermobilidade articular generalizada sobre a articulação temporomandibular e a oclusão dentária: estudo transversal / Influence of generalized joint hypermobility on temporomandibular joint and dental occlusion: a cross-sectional study

RESUMO Objetivo Avaliar a oclusão dentária e a articulação temporomandibular de mulheres com e sem hipermobilidade articular generalizada. Método A hipermobilidade foi avaliada pelo Escore de Beighton, e as voluntárias foram distribuídas, conforme o escore obtido, em dois grupos: com e sem hipermobilidade. A articulação temporomandibular foi avaliada por meio do instrumento Critérios de Diagnóstico para Pesquisa de Desordens Temporomandibulares, e a avaliação oclusal compreendeu a classificação de Angle, presença de sobremordida, sobressaliência e mordida cruzada, padrão de desoclusão e interferências oclusais. Resultados 43 mulheres participaram voluntariamente da pesquisa, 17 no grupo com hipermobilidade e 26 no grupo sem hipermobilidade. A frequência de ruídos articulares e de desvio na abertura da boca foi maior no grupo com hipermobilidade (52,9% versus 38,5% e 76,5% versus 50%, respectivamente), sem diferença significante. Quanto à oclusão, nenhuma voluntária apresentou uma oclusão ideal e não se verificou diferença significativa na Classe de Angle entre os grupos. As alterações na oclusão obtiveram percentual maior no grupo com hipermobilidade (29,4% de sobremordida, 47,1% de sobressaliência e 17,6% de mordida cruzada), sendo que a mordida cruzada apresentou diferença estatística entre os grupos. Conclusão A hipermobilidade não influenciou a oclusão e as amplitudes de movimentos mandibulares nas mulheres avaliadas. Contudo, o maior percentual de ruídos articulares e de desvio não corrigido apresentado pelo grupo com hipermobilidade, mesmo sem diferença entre os grupos, pode constituir um indício de relação entre hipermobilidade e disfunção temporomandibular.

ABSTRACT Purpose To evaluate the dental occlusion and temporomandibular joint in women with and without generalized joint hypermobility. Methods Generalized joint hypermobility was assessed by the Beighton score. Individuals were divided into two groups: with and without hypermobility. The Research Diagnostic Criteria for Temporomandibular Disorders was used to evaluate the temporomandibular joint. Dental occlusion was assessed according to Angle classification, overjet and overbite measures, presence of open bite or crossbite, pattern of disocclusion, and occlusal interference. Results Forty-three women participated voluntarily in the study: 17 in the group with hypermobility and 26 in the group without hypermobility. The frequencies of joint noise and deviation during mouth opening were greater in the hypermobility group (52.9% vs. 38.5% and 76.5% vs. 50%, respectively), but without statistical significance. None of the volunteers presented ideal occlusion and no significant difference was found in Angle Class between the groups. The hypermobility group presented a higher percentage of changes in occlusion (29.4% of overbite, 47.1% of overjet, and 17.6% of crossbite), with crossbite showing statistical difference between the groups. Conclusion Hypermobility does not influence occlusion and range of mandibular motion in the women assessed. Nevertheless, the higher percentage of articular noise and uncorrected deviation during mouth opening shown by the group with hypermobility, even without statistical difference, may constitute evidence of correlation between hypermobility and temporomandibular disorder.

Assessment for oral feeding in preterm infants. / Avaliação para o início da alimentação oral de recém-nascidos pré-termo.

PURPOSE: To assess the accuracy of the Preterm Oral Feeding Readiness Scale (POFRAS) on the beginning of oral feeding in preterm infants and to verify the concordance between this tool and the Oral Feeding Skill Level. METHODS: 82 preterm infants were assessed by POFRAS regarding their readiness to initiate oral feeding and by the oral feeding skill level evaluation during the first oral feeding. POFRAS's accuracy was estimated regarding proficiency by a Receiver Operating Characteristics (ROC) curve. The concordance between the tools was obtained by analysis of the Kappa coefficient. RESULTS: POFRAS's global accuracy was of 71.29%. The cut-off value of 29 was the one that presented most optimization of the sensitivity based on specificity. The Kappa coefficient has shown a weak concordance between the instruments to identify infants able and unable to oral feeding (k=0.281). CONCLUSION: POFRAS's accuracy to initiate oral feeding considering the proficiency was similar to that obtained with the technique of translactation. We observed a weak concordance between the instruments. We suggest that, in clinical practice, both instruments should be used in a complementary manner, since both present important aspects of the preterm feeding behavior that together will better guide the necessary conduct to provide an effective and quick transition to full oral feeding in this population.

Relationship among perceived stress, anxiety, depression and craniocervical pain in nursing professionals under stress at work / Relação entre o estresse percebido, ansiedade, depressão e a dor craniocervical em profissionais de enfermagem sob estresse no trabalho

Abstract Introduction: The appearance and evolution of some clinical pain conditions may be influenced by stress and other psychosocial factors. Face, head and cervical muscles may increase their activity and tension in the presence of stress, leading to craniocervicomandibular pain in individuals exposed to stress. Objective: To assess the relationship among perceived stress, anxiety, depression and craniocervicomandibular pain in nursing professionals under stress at work. Materials and Methods: Forty-three women under stress at work, according to the Job Stress Scale (JSS), were assessed by the Perceived Stress Scale (PSS), the Hospital Anxiety and Depression Scale (HADS), pressure pain threshold, measured by algometry, and muscle sensitivity to hand palpation of the masticatory and cervical muscles. Results: A low moderate level of perceived stress was found in 62.79% of the sample, anxiety in 11.63% and depression in 9.30%. The psychosocial scales correlated with each other. No correlation was found between pressure pain threshold and perceived stress, anxiety and depression. The level of pain to hand palpation correlated with the perceived stress scores. Conclusion: Pressure pain threshold was not influenced by the psychosocial factors assessed. Pain intensity to hand palpation, however, was higher as the perception of stress increased.

Resumo Introdução: O aparecimento e evolução de algumas condições clínicas de dor podem ser influenciados pelo estresse e outros fatores psicossociais. A musculatura da face, cabeça e cervical podem aumentar sua atividade e tensão na presença do estresse, podendo provocar dor craniocervicomandibular nos indivíduos a ele expostos. Objetivo: Avaliar a relação entre estresse percebido, ansiedade, depressão e a dor craniocervicomandibular em profissionais da enfermagem sob estresse no trabalho. Materiais e Métodos: 43 mulheres sob estresse no trabalho, de acordo com a Escala de Estresse no Trabalho (JSS), foram avaliadas pelas Escalas de Estresse Percebido (PSS), Escala Hospitalar de Ansiedade e Depressão (HADS), limiar de dor à pressão, por algometria, e a sensibilidade muscular por palpação manual dos músculos mastigatórios e cervicais. Resultados: Nível moderado baixo de estresse percebido foi encontrado em 62,79% da amostra, ansiedade em 11,63% e depressão em 9,30%. As escalas psicossociais se correlacionaram entre si. Não houve correlação entre limiar de dor à pressão e estresse percebido, ansiedade e depressão. O nível de dor à palpação manual se correlacionou com os escores de estresse percebido. Conclusão: Os fatores psicossociais avaliados não influenciaram o limiar de dor à pressão. Entretanto, a intensidade da dor à palpação manual foi mais alta à medida que aumentou a percepção do estresse.

Avaliação para o início da alimentação oral de recém-nascidos pré-termo / Assessment for oral feeding in preterm infants

RESUMO Objetivo avaliar a acurácia do Preterm Oral Feeding Readiness Scale - POFRAS para iniciar a alimentação oral de recém-nascidos pré-termo e verificar a concordância entre este instrumento e o instrumento de avaliação do Nível de Habilidade Oral. Métodos Foram avaliados 82 recém-nascidos pré-termo quanto à prontidão para o início da alimentação oral através do POFRAS e da avaliação do Nível de Habilidade Oral, durante a primeira alimentação oral. A acurácia do POFRAS foi estimada em relação à variável proficiência, por meio da Curva ROC (Receiver Operating Characteristic Curve). Para a análise da concordância entre os instrumentos, foi utilizado o coeficiente Kappa. Resultados A acurácia global do POFRAS foi de 71,29%. O ponto de corte 29 foi o que apresentou melhor equilíbrio entre sensibilidade e especificidade. O coeficiente Kappa mostrou fraca concordância entre os instrumentos na identificação dos RN aptos e inaptos a mamar por via oral (k=0.281). Conclusão a acurácia do POFRAS para o início da alimentação oral, estimada por meio da variável proficiência, foi semelhante à obtida com a técnica de translactação. Observou-se fraca concordância entre os instrumentos avaliados. Sugere-se, portanto, que estes instrumentos de avaliação sejam usados de forma complementar na prática clínica, uma vez que ambos apresentam aspectos importantes do comportamento alimentar do prematuro, que ao serem analisados conjuntamente permitirão orientar a conduta necessária para propiciar uma transição alimentar mais breve e eficaz para essa população.

ABSTRACT Purpose To assess the accuracy of the Preterm Oral Feeding Readiness Scale (POFRAS) on the beginning of oral feeding in preterm infants and to verify the concordance between this tool and the Oral Feeding Skill Level. Methods 82 preterm infants were assessed by POFRAS regarding their readiness to initiate oral feeding and by the oral feeding skill level evaluation during the first oral feeding. POFRAS's accuracy was estimated regarding proficiency by a Receiver Operating Characteristics (ROC) curve. The concordance between the tools was obtained by analysis of the Kappa coefficient. Results POFRAS's global accuracy was of 71.29%. The cut-off value of 29 was the one that presented most optimization of the sensitivity based on specificity. The Kappa coefficient has shown a weak concordance between the instruments to identify infants able and unable to oral feeding (k=0.281). Conclusion POFRAS's accuracy to initiate oral feeding considering the proficiency was similar to that obtained with the technique of translactation. We observed a weak concordance between the instruments. We suggest that, in clinical practice, both instruments should be used in a complementary manner, since both present important aspects of the preterm feeding behavior that together will better guide the necessary conduct to provide an effective and quick transition to full oral feeding in this population.

Disfunção temporomandibular e dor craniocervical em profissionais da área da enfermagem sob estresse no trabalho / Temporomandibular dysfunction and craniocervical pain in professionals of the nursing area under work stress

RESUMO Objetivo: verificar a presença e severidade de Disfunção Temporomandibular, presença de cefaleia e cervicalgia e o limiar de dor muscular de músculos cervicais em profissionais de enfermagem sob estresse no trabalho. Métodos: 43 mulheres foram avaliadas quanto à presença e severidade de Disfunção Temporomandibular pelo instrumento Critérios de Diagnóstico para Pesquisa de Desordem Temporomandibular e pelo Índice Temporomandibular, respectivamente. Além disso, foram avaliadas quanto ao limiar de dor à pressão nos músculos cervicais por algometria e quanto à presença de cefaleia e cervicalgia. Resultados: disfunção Temporomandibular foi encontrada em 30,23% da amostra, com valor médio de escore de gravidade de 0,52. Entre as participantes com Disfunção Temporomandibular, 69,23% apresentavam depressão, 61,64% graduação I de dor crônica e Sintomas Físicos não Específicos incluindo e excluindo itens de dor em 46,15% e 61,64%, respectivamente. Cefaleia foi referida por 55,81% e cervicalgia por 60,47%. Não houve associação entre Disfunção Temporomandibular, cefaleia e cervicalgia. Os limiares de dor dos músculos cervicais apresentaram-se baixos tanto nos indivíduos com diagnóstico de Disfunção Temporomandibular quanto nos sem este diagnóstico, sem diferença significativa. O músculo esternocleidomastóideo apresentou-se com os menores limiares de dor à pressão. Conclusão: alta incidência de Disfunção Temporomandibular, cefaleia e cervicalgia foram detectadas nesta amostra. Disfunção Temporomandibular não influenciou a presença de cefaleia e/ou cervicalgia. A alta frequência de dor cervical e os baixos limiares de dor no músculo esternocleidomastóideo em todas as participantes demonstram o comprometimento dos músculos cervicais, resultante de possíveis posturas inadequadas e tensão muscular relacionadas ao estresse.

ABSTRACT Purpose : to investigate the presence of Temporomandibular Disorder, headache and neck pain and muscle pain threshold of cervical muscles in nursing professionals exposed to occupational stress. Methods: 43 women were evaluated for the presence and severity of Temporomandibular Disorder using the Diagnostic Criteria for Temporomandibular Disorder instrument and Temporomandibular Dysfunction Index, respectively. Furthermore, they were evaluated for the pain threshold to pressure on the cervical muscles by algometry and for the presence of headache and neck pain. Results: temporomandibular Disorder was found in sample 30.23% and 0.52 was the mean score of dysfunction severity. Of the participants with Temporomandibular Disorder, there presence of depression was found in 69.23%; 61.64% Grade I in Graded Chronic Pain and Specific Physical Symptoms including pain and excluding pain were 46.15% and 61.64%, respectively. Headache was reported by 55.81% and neck pain by 60.47%. There was no association between the presence of Temporomandibular Disorder, headache and neck pain. Pain pressure thresholds of cervical muscles were low in subjects with and without Temporomandibular Disorder, without statistical difference. The sternocleidomastoid muscle it´s the lowest value of pain pressure threshold. Conclusion: high incidence of Temporomandibular Disorder, headache and neck pain were detected in the studied sample. Temporomandibular Disorder was not associated with the presence of headache and / or neck pain. The high frequency of cervical pain and low pain pressure thresholds in the sternocleidomastoid muscle in all subjects demonstrate the involvement of the cervical spine and muscles in these professionals, resulting of possible improper postures and stress-related muscle tension.