Cláudia Lúcia Pimenta Ferreira

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.

Otologic Symptoms of Temporomandibular Disorder and Effect of Orofacial Myofunctional Therapy

Abstract 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.

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.

Orofacial Myofunctional Disorder In Subjects with Temporomandibular Disorder

Abstract 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

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.

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.

Nonequilibrium phase transitions in a model for the origin of life.

The requisites for the persistence of small colonies of self-replicating molecules living in a two-dimensional lattice are investigated analytically in the infinite diffusion or mean-field limit and through Monte Carlo simulations in the position-fixed or contact process limit. The molecules are modeled by hypercyclic replicators A that are capable of replicating via binary fission A+E-->2A with production rate s, as well as via catalytically assisted replication 2A+E-->3A with rate c. In addition, a molecule can degrade into its source materials E with rate gamma. In the asymptotic regime, the system can be characterized by the presence (active phase) and the absence (empty phase) of replicators in the lattice. In both diffusion regimes, we find that for small values of the ratio c/gamma these phases are separated by a second-order phase transition that is in the universality class of the directed percolation, while for small values of s/gamma the phase transition is of first order. Furthermore, we show the suitability of the dynamic Monte Carlo method, which is based on the analysis of the spreading behavior of a few active cells in the center of an otherwise infinite empty lattice, to address the problem of the emergence of replicators. Rather surprisingly, we show that this method allows an unambiguous identification of the order of the nonequilibrium phase transition.

Sinais e sintomas de desordem temporomandibular em mulheres e homens

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.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.

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

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

Gender- and age-related changes in three dimensional facial profiles of healthy Northern Sudanese persons

The study aimed to provide quantitative information about gender-related normative data and growth changes between childhood and young adulthood in the soft tissue facial profiles of Northern Sudanese individuals. The three dimensional coordinates of 50 landmarks on the facial soft tissues were obtained using a hand-held laser scanner in 654 healthy Northern Sudanese subjects (327 males and 327 females) aged 4-30 years. The subjects were divided into 8 nonoverlapping age groups [1]. From selected landmarks, 15 facial angles were calculated and averaged for gender and age: upper, middle, and lower facial, and mandibular corpus convexities in the horizontal plane; relative position of the exocanthia and nasion; facial convexity in the sagittal plane; midfacial to mandibular plane, nasal convexity, nasolabial, mentolabial, interlabial, maxillary prominence, and left and right gonial angles. Comparisons were performed by factorial analysis of variance. On average men had larger facial and mandibular corpus convexities in the horizontal plane than women (ANOVA, p<0.01); on the contrary, no gender differences were found for facial convexities in the sagittal plane. Gender significantly influenced also the relative position of exocanthia and nasion, the maxillary prominence angle and the gonial angles (p<0.01). All analysed measurements were influenced by age (p<0.001): nasal convexity and interlabial angle increased from childhood to young adulthood, while mentolabial and gonial angles, horizontal facial convexity and sagittal facial convexity including the nose decreased as a function of age. No consistent age-related patterns were found for the other evaluated angles. Data collected in the current study can be used as a database for the quantitative description of facial profiles in Northern Sudanese subjects during normal growth and development.