Alceu Sergio Trindade Junior

Maximal bite force in young adults with temporomandibular disorders and bruxism

Parafunctional habits, such as bruxism, are contributory factors for temporomandibular disorders (TMD). The aim of this study was to evaluate the maximal bite force (MBF) in the presence of TMD and bruxism (TMDB) in young adults. Twelve women (mean age 21.5 years) and 7 men (mean age 22.4 years), composed the TMDB group. Ten healthy women and 9 men (mean age 21.4 and 22.4 years, respectively) formed the control group. TMD symptoms were evaluated by a structured questionnaire and clinical signs/symptoms were evaluated during clinical examination. A visual analogical scale (VAS) was applied for stress assessment. MBF was measured with a gnatodynamometer. The subjects were asked to bite 2 times with maximal effort, during 5 seconds, with a rest interval of about one minute. The highest values were considered. The data were analyzed with Shapiro-Wilks W-test, descriptive statistics, paired or unpaired t tests or Mann-Whitney tests when indicated, and Fishers exact test (p < 0.05). TMDB women presented lower values of MBF as compared to those presented by TMDB men and by the control group. MBF for TMDB men was similar to that of the control group. The proportion of TMDB women with muscle pain and facial/teeth/head pain upon waking up was significantly higher than that of men. Control women presented significantly lower stress scores than the others. It was concluded that MBF was reduced in TMDB women, as they presented more signs and symptoms. Men presented higher MBF values than women, but TMD and bruxism did not significantly decrease MBF. Stress was not an influencing factor for TMD and bruxism in men.

Masticatory function in temporomandibular dysfunction patients: electromyographic evaluation

Temporomandibular dysfunction (TMD) is a complex disturbance that involves the masticatory muscles and/or temporomandibular joint, causing damage to the masticatory function. This study evaluated the electromyographic activity of the masseter muscle during habitual mastication of bread, apple, banana, cashew nut and paraffin film (Parafilm M) in 25 adult subjects, of both gender, with TMD. The results were compared to those of a control group, composed of 15 adult subjects, of both sexes, free of signs and/or symptoms of TMD. The MYO-TRONICS Inc., K6-I computer software was used for electromyographic processing and analyzed the following parameters: duration of the act, duration of the masticatory cycle and number of cycles. No significant differences were found between subjects in the control group and individuals with TMD as to duration of the masticatory act and of the masticatory cycle, considering all materials used for mastication. The duration of the masticatory act and cycle was longer during mastication of paraffin film in both groups. The number of masticatory cycles was higher for mastication of apple in comparison to mastication of banana, in both groups. It can be concluded that the consistency of foods influences the duration parameters of the act, duration of the cycle and the number of masticatory cycles, and the behavior of the masticatory muscles in individuals with TMD during habitual mastication is similar to that verified in individuals without TMD.

Proposta de protocolo de avaliação clínica da função mastigatória

PURPOSE: to elaborate a protocol for the clinical evaluation of the masticatory function, aiming at aiding the speech pathologist to identify and interpret the clinical signals of the masticatory disorders, in its dynamics, in addition to allowing for inter-judge comparison and treatment continuation. METHODS: this protocol was elaborated based on the clinical practice of the speech pathologists that answered to a questionnaire sent by email; in the literature, according to the identification of the common points to all chewing evaluation protocols; in addition to the experience of the speech pathologists of HRAC/USP. RESULTS: the protocol for the clinical chewing evaluation considers aspects related to morphologic aspects and neurophysiology of the masticatory function. Conclusion: this study contributes to Speech Pathology, once that it searches, in the most possible complete manner, criteria for evaluating the chewing, guiding the clinical speech-language performance based on evidences.

Electromyographic evaluation of mastication and swallowing in elderly individuals with mandibular fixed implant-supported prostheses

This study evaluated the effect of implant-supported oral rehabilitation in the mandible on the electromyographic activity during mastication and swallowing in edentulous elderly individuals. Fifteen patients aged more than 60 years were evaluated, being 10 females and 5 males. All patients were edentulous, wore removable complete dentures on both dental arches, and had the mandibular dentures replaced by implant-supported prostheses. All patients were submitted to electromyographic evaluation of the masseter, superior orbicularis oris muscles, and the submental muscles, before surgery and 3, 6 and 18 months postoperatively, using foods of different textures. The results obtained at the different periods were analyzed statistically by Kruskal-Wallis non-parametric test. Statistical analysis showed that only the masseter muscle had a significant loss in electromyographic activity (p<0.001), with a tendency of similar response for the submental muscles. Moreover, there was an increase in the activity of the orbicularis oris muscle during rubber chewing after treatment, yet without statistically significant difference. Mandibular fixed implant-supported prostheses in elderly individuals revealed a decrease in electromyographic amplitude for the masseter muscles during swallowing, which may indicate adaptation to new conditions of stability provided by fixation of the complete denture in the mandibular arch.

Bite force evaluation in subjects with cleft lip and palate

The purpose of this study was to evaluate the masticatory function of subjects with cleft lip and palate by analyzing the bite force developed by these individuals. Bite force was evaluated in a group of 27 individuals with repaired unilateral cleft lip and palate (14 males and 13 females – aged 18-26 years) and compared to the data achieved from a group of 20 noncleft subjects (10 males and 10 females – aged 18-26 years). Measurement was achieved on three positions within the dental arch (incisors, right molars and left molars), three times at each position considering the highest value for each one. Statistical analysis was performed by ANOVA and Mann-Whitney test (α = 5%). There was a significant deficit in bite force in male individuals with cleft lip and palate compared to the male control group (p=0.02, p=0.004, p=0.003 for incisors, right and left molars, respectively). For the female group, the difference was not statistically significant (p=0.79, p=0.06, p=0.47). In the group of individuals with clefts, 92.6% were under orthodontic treatment, which could be a reason for the present findings, since it can decrease the bite force more remarkably in males than in females. In conclusion, the bite force is significantly reduced in men when comparing the cleft group to the noncleft group. In females, this reduction was not significant in the same way. However, the main reason for this reduction and for the different behavior between genders should be further investigated.

Diabetes mellitus e uso de drogas durante a gravidez e o risco de fissuras orofaciais e anomalias relacionadas

Abstract Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized.Objetivos: esta investigacion establecio la prevalencia de diabetes mellitus (DM) y el abuso de drogas en madres de ninos con malformaciones creaneofaciales (MCF). Metodos: 325 mujeres que tuvieron hijos (0-3 anos) con malformaciones fueron entrevistadas. Se obtuvieron datos referentes a: tipo de diabetes; uso de drogas licitas o ilicitas durante el embarazo; circunferencia de la cintura; y, glucemia en ayunas en la primera consulta prenatal. Resultados: el veintisiete por ciento de las mujeres tenian DM. Entre estas, el 89% tuvieron DM gestacional, el 5,5% DM tipo 1 y el 5,5% DM tipo 2. La prevalencia de DM en madres de hijos con MCF fue de 27%. Esto es significativamente mas alto que el promedio de la poblacion brasilena afectada por esa enfermedad, que es de 7,6% (p<0.01) (OR=4,5, 95%IC=3,5-5,8). Observando el abuso de drogas durante el embarazo, el 32% de las madres habia utilizado drogas y una correlacion positiva significativa fue observada entre el abuso de drogas y la ocurrencia de hendiduras y otras malformaciones craneofaciales (p=0,028) (OR=2,87; 95%IC=1,1-7,4). Conclusiones: la DM y el abuso de drogas durante el embarazo aumentan el riesgo de MCF y de anomalias relacionadas; se enfatiza la importancia del diagnostico precoz de DM y la prevencion del abuso de drogas, especialmente entre las mujeres embarazadas.Objetivos: avaliar a prevalencia de diabetes mellitus (DM) e o uso de drogas em maes de criancas com fissuras orofaciais (FOF). Metodo: 325 mulheres que tiveram filhos (0-3 anos) com fissuras foram entrevistadas. Os dados referentes tipo de diabetes, uso de drogas licitas / ilicitas durante a gravidez, circunferencia abdominal e glicemia em jejum na primeira consulta pre-natal foram coletados. Resultados: vinte e sete por cento das mulheres tinham DM. Destes, 89% tinham DM gestacional, 5,5% DM tipo 1 e 5,5% DM tipo 2. A prevalencia de DM em maes de criancas com FOF foi de 27%, significativamente mais elevado que a media da populacao brasileira que e de 7,6% (p <0,01) (OR = 4,5, IC de 95% = 3,5-5,8). Com relacao ao uso de drogas, 32% das maes eram usuarias drogas durante a gravidez e uma correlacao positiva foi observada entre o uso de drogas e a ocorrencia de FOF e anomalias relacionadas (p = 0,028) (OR = 2,87; IC95% = 1,1-7,4). Conclusoes: DM e uso de drogas durante a gravidez aumentam o risco de FOF e anomalias relacionadas e o diagnostico precoce de DM e a prevencao do uso de drogas, especialmente em mulheres gravidas, devem ser enfatizados.

La diabetes mellitus, el abuso de drogas durante el embarazo y el riesgo de malformaciones craneofaciales y anomalías relacionadas

Abstract Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized.Objetivos: esta investigacion establecio la prevalencia de diabetes mellitus (DM) y el abuso de drogas en madres de ninos con malformaciones creaneofaciales (MCF). Metodos: 325 mujeres que tuvieron hijos (0-3 anos) con malformaciones fueron entrevistadas. Se obtuvieron datos referentes a: tipo de diabetes; uso de drogas licitas o ilicitas durante el embarazo; circunferencia de la cintura; y, glucemia en ayunas en la primera consulta prenatal. Resultados: el veintisiete por ciento de las mujeres tenian DM. Entre estas, el 89% tuvieron DM gestacional, el 5,5% DM tipo 1 y el 5,5% DM tipo 2. La prevalencia de DM en madres de hijos con MCF fue de 27%. Esto es significativamente mas alto que el promedio de la poblacion brasilena afectada por esa enfermedad, que es de 7,6% (p<0.01) (OR=4,5, 95%IC=3,5-5,8). Observando el abuso de drogas durante el embarazo, el 32% de las madres habia utilizado drogas y una correlacion positiva significativa fue observada entre el abuso de drogas y la ocurrencia de hendiduras y otras malformaciones craneofaciales (p=0,028) (OR=2,87; 95%IC=1,1-7,4). Conclusiones: la DM y el abuso de drogas durante el embarazo aumentan el riesgo de MCF y de anomalias relacionadas; se enfatiza la importancia del diagnostico precoz de DM y la prevencion del abuso de drogas, especialmente entre las mujeres embarazadas.Objetivos: avaliar a prevalencia de diabetes mellitus (DM) e o uso de drogas em maes de criancas com fissuras orofaciais (FOF). Metodo: 325 mulheres que tiveram filhos (0-3 anos) com fissuras foram entrevistadas. Os dados referentes tipo de diabetes, uso de drogas licitas / ilicitas durante a gravidez, circunferencia abdominal e glicemia em jejum na primeira consulta pre-natal foram coletados. Resultados: vinte e sete por cento das mulheres tinham DM. Destes, 89% tinham DM gestacional, 5,5% DM tipo 1 e 5,5% DM tipo 2. A prevalencia de DM em maes de criancas com FOF foi de 27%, significativamente mais elevado que a media da populacao brasileira que e de 7,6% (p <0,01) (OR = 4,5, IC de 95% = 3,5-5,8). Com relacao ao uso de drogas, 32% das maes eram usuarias drogas durante a gravidez e uma correlacao positiva foi observada entre o uso de drogas e a ocorrencia de FOF e anomalias relacionadas (p = 0,028) (OR = 2,87; IC95% = 1,1-7,4). Conclusoes: DM e uso de drogas durante a gravidez aumentam o risco de FOF e anomalias relacionadas e o diagnostico precoce de DM e a prevencao do uso de drogas, especialmente em mulheres gravidas, devem ser enfatizados.

Diabetes mellitus and drug abuse during pregnancy and the risk for orofacial clefts and related abnormalities

Abstract Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM, 5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children with OFC was 27%, it is significantly higher than the average Brazilian population which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during pregnancy, 32% of the mothers used drugs and a significant positive correlation was observed between drug abuse and the occurrence of clefts and other craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related anomalies and early diagnosis of DM and prevention of drug abuse, especially in pregnant women, should be emphasized.Objetivos: esta investigacion establecio la prevalencia de diabetes mellitus (DM) y el abuso de drogas en madres de ninos con malformaciones creaneofaciales (MCF). Metodos: 325 mujeres que tuvieron hijos (0-3 anos) con malformaciones fueron entrevistadas. Se obtuvieron datos referentes a: tipo de diabetes; uso de drogas licitas o ilicitas durante el embarazo; circunferencia de la cintura; y, glucemia en ayunas en la primera consulta prenatal. Resultados: el veintisiete por ciento de las mujeres tenian DM. Entre estas, el 89% tuvieron DM gestacional, el 5,5% DM tipo 1 y el 5,5% DM tipo 2. La prevalencia de DM en madres de hijos con MCF fue de 27%. Esto es significativamente mas alto que el promedio de la poblacion brasilena afectada por esa enfermedad, que es de 7,6% (p<0.01) (OR=4,5, 95%IC=3,5-5,8). Observando el abuso de drogas durante el embarazo, el 32% de las madres habia utilizado drogas y una correlacion positiva significativa fue observada entre el abuso de drogas y la ocurrencia de hendiduras y otras malformaciones craneofaciales (p=0,028) (OR=2,87; 95%IC=1,1-7,4). Conclusiones: la DM y el abuso de drogas durante el embarazo aumentan el riesgo de MCF y de anomalias relacionadas; se enfatiza la importancia del diagnostico precoz de DM y la prevencion del abuso de drogas, especialmente entre las mujeres embarazadas.Objetivos: avaliar a prevalencia de diabetes mellitus (DM) e o uso de drogas em maes de criancas com fissuras orofaciais (FOF). Metodo: 325 mulheres que tiveram filhos (0-3 anos) com fissuras foram entrevistadas. Os dados referentes tipo de diabetes, uso de drogas licitas / ilicitas durante a gravidez, circunferencia abdominal e glicemia em jejum na primeira consulta pre-natal foram coletados. Resultados: vinte e sete por cento das mulheres tinham DM. Destes, 89% tinham DM gestacional, 5,5% DM tipo 1 e 5,5% DM tipo 2. A prevalencia de DM em maes de criancas com FOF foi de 27%, significativamente mais elevado que a media da populacao brasileira que e de 7,6% (p <0,01) (OR = 4,5, IC de 95% = 3,5-5,8). Com relacao ao uso de drogas, 32% das maes eram usuarias drogas durante a gravidez e uma correlacao positiva foi observada entre o uso de drogas e a ocorrencia de FOF e anomalias relacionadas (p = 0,028) (OR = 2,87; IC95% = 1,1-7,4). Conclusoes: DM e uso de drogas durante a gravidez aumentam o risco de FOF e anomalias relacionadas e o diagnostico precoce de DM e a prevencao do uso de drogas, especialmente em mulheres gravidas, devem ser enfatizados.

Atividade muscular da mastigação na anquilose temporomandibular

OBJETIVO: devido a presenca de importante disfuncao mastigatoria em casos com anquilose da articulacao temporomandibular (ATM), este trabalho analisou a abertura bucal e a atividade eletromiografica dos musculos mastigatorios para detectar mudancas nesses parâmetros apos a cirurgia de liberacao da anquilose mandibular. METODO: em 7 individuos com anquilose temporomandibular, entre 7 e 30 anos (mediana=9 anos), foi mensurada a distância interincisal maxima ativa (DIMA) e registrada a atividade eletromiografica (EMG) dos musculos masseteres e temporais durante a contracao voluntaria isometrica maxima (CVIM) e a mastigacao habitual, comparando-se os dados pre e pos cirurgicos pelo teste de Wilcoxon. RESULTADOS: maiores valores foram observados para a DIMA apos a cirurgia (p=0,0277); o indice de assimetria, nao mostrou diferenca entre os dois momentos avaliados para ambos os musculos estudados; os valores da EMG durante a CVIM diminuiram apos a cirurgia para os musculos masseter direito (p=0,0179) e esquerdo (p=0,0179), mas nao para os temporais; nao houve modificacao nos valores EMG para os musculos estudados, durante a mastigacao. CONCLUSAO: a cirurgia para liberacao da anquilose da ATM resultou em aumento da abertura bucal e diminuicao da amplitude dos potenciais de acao gerados durante a contracao voluntaria isometrica maxima para o musculo masseter, em ambos os lados; nao modificou o indice de assimetria dos musculos masseter e temporal, bem como a atividade eletromiografica do musculo temporal, bilateralmente, durante a contracao isometrica maxima e musculos masseter e temporal durante a mastigacao habitual.