Cláudia Maria de Felício

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.

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

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

Desempenho mastigatório em adultos relacionado com a desordem temporomandibular e com a oclusão

BACKGROUND Temporomandibular disorder and mastication. AIM To compare subjects who present temporomandibular disorders to a control group considering mastication and to analyze the related variables. METHOD 20 subjects with temporomandibular disorder (TMD group) and 10 controls--selection based on clinical examination and anamnesis--responded to a questionnaire on the self-perception of pain severity and presence of noise in the temporomandibular joints, muscle pain, otologic symptoms, headaches, and jaw opening difficulties. The subjects were also submitted to a clinical examination regarding the number of teeth and functional occlusion--measurements of jaw opening and jaw lateral excursions, occlusal interferences, occlusal contacts of the working and non-working-side, and mastication evaluation. Mastication was evaluated in terms of time needed to eat a stuffed cookie, number of chewing strokes and type (unilateral or bilateral). The maximum force needed at first to break the cookie, verified with a TA-XT2 Texture Analyzer (Stable Micro Systems), was of 4341.8 g. The groups were compared using variance analysis and the correlations between variables were calculated using the Pearson product-moment test. RESULTS Most of the control subjects presented bilateral pattern of mastication, whereas the TMD group tended to present the unilateral pattern. Masticatory type scores and laterality measurements were significantly higher in the control group. The TMD group presented higher means in terms of: age, time of chewing, number of chewing strokes and TMD severity. Chewing time and type were positively correlated with TMD severity and negatively correlated with number of occlusal interferences. CONCLUSION In the TMD group, chewing differed from the normal physiological standard. The number of occlusal interferences and the severity of TMD were variables correlated to chewing.

Effects of Orofacial Myofunctional Therapy on Temporomandibular Disorders

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

Desordem Temporomandibular: relações entre sintomas otológicos e orofaciais

Os sintomas otologicos sao frequentes em pacientes com desordem temporomandibular, e estudos sao necessarios para elucidar os mecanismos envolvidos. OBJETIVO: O objetivo desse estudo clinico foi investigar a associacao de sintomas otologicos (otalgia, zumbido e plenitude auricular) com os achados audiologicos, os outros sinais/sintomas relacionados a desordem temporomandibular, e os habitos parafuncionais orais. FORMA DE ESTUDO: Prospectivo clinico. MATERIAL E METODO: 27 pacientes com desordem temporomandibular, da Clinica de Oclusao da Faculdade de Odontologia de Ribeirao Preto da Universidade de Sao Paulo, responderam um questionario sobre sinais, sintomas e habitos orais, e passaram por avaliacoes otorrinolaringologica e audiologica. Os dados foram analisados pelos testes Binomial, Exato de Fisher e correlacao produto-momento de Pearson. O indice de significância adotado foi p<0,05. RESULTADOS: Os sintomas otologicos foram presentes em 88,88% dos pacientes (59,26% apresentavam otalgia, 74,07% zumbido e 74,07% plenitude auricular). Nao houve associacao significante entre os sintomas otologicos e os achados audiologicos. Houve associacao significante entre os sintomas otologicos e os movimentos mandibulares e funcoes (falar, abrir e fechar a boca). Houve tambem correlacoes significantes entre o grau de severidade dos sintomas otologicos e o grau de outros sinais/sintomas de desordem temporomandibular; e entre o sintoma plenitude auricular e numero de habitos parafuncionais. CONCLUSAO: Este estudo fornece sustentacao adicional a nocao de que ha relacao entre desordem temporomandibular e sintomas otologicos. Nos pacientes com desordem temporomandibular as alteracoes do sistema estomatognatico, como a dor orofacial e a dificuldade nas atividades funcionais, foi associada de modo significante aos sintomas otologicos.

Correlação entre métodos de aleitamento, hábitos de sucção e comportamentos orofaciais

BACKGROUND The development of oral motor control depends partially on motor and sensory experiences. AIM To analyze the relationship between the duration of breastfeeding, artificial feeding and sucking habits, and of these parameters with the orofacial motor performance. METHOD Participants of this study were one hundred and seventy-six children aged 6 to 12 years. All subjects were submitted to an orofacial myofunctional clinical examination, using a protocol with scores, and parents/care takers were interviewed in respect to the feeding and sucking habits of their children. Correlations were calculated using the Spearman Test. RESULTS In the studied sample, the mean duration of breastfeeding was of 10.30 months (ranging from zero to 60 months), of artificial feeding was of 44.12 months (zero to 122 months) and of sucking habits was of 39.32 months (0 to 144 months). There was a negative correlation of breastfeeding duration with artificial feeding duration and sucking habits duration (p < 0001). The duration of the artificial feeding was positively correlated to the duration of sucking habits (p < 0001). The duration of breastfeeding was positively correlated with the mobility of the tongue and jaw (p = 0.05). There was a negative correlation of the duration of artificial feeding and the duration of sucking habits with the performance in mastication and swallowing, respectively, as well as with the duration of both types of sucking with the performance in the diadochokinesia test (p = 0.05). CONCLUSION The duration of natural breastfeeding presented a positive effect over the mobility of the orofacial structures. Deleterious effects of the prolonged duration of artificial feeding and sucking habits in the oral motor control were confirmed.

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

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

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.