Francesco Bortolotti

Effects of experimental occlusal interference on body posture: an optoelectronic stereophotogrammetric analysis

In recent years, there has been increasing interest in the relationship between dental occlusion and body posture both among people and in scientific literature. The aim of the present longitudinal study is to investigate the effects of an experimental occlusal interference on body posture by means of a force platform and an optoelectronic stereophotogrammetric analysis. An occlusal interference of a 0- to 2-mm-thick glass composite was prepared to disturb the intercuspal position while not creating interference during lateral or protrusive mandibular excursions. Frontal and sagittal kinematic parameters, dynamic gait measurements and superficial electromyographic (SEMG) activity of head and neck muscles were performed on 12 healthy subjects. Measurements were taken 10 days before the application of the occlusal interference, and then immediately before the application, the day after it, and at a distance of 7 and 14 days under four different exteroceptive conditions. The outcomes of this study show that an occlusal interference does not modify significantly over time static and dynamic parameters of body posture under different exteroceptive conditions. It has a minimal influence only on the frontal kinematic parameters related to mandibular position, and it induces a transient increase of the activity of masticatory muscles. In this study, the experimental occlusal interference did not significantly influence the body posture during a 14-day follow-up period.

Combined effects of repeated oral hygiene motivation and type of toothbrush on orthodontic patients: A blind randomized clinical trial

OBJECTIVE To investigate the effects on plaque index (PI) scores of manual or electric toothbrush with or without repeated oral hygiene instructions (OHI) and motivation on patients wearing fixed orthodontic appliances. MATERIALS AND METHODS One month after the orthodontic fixed appliance bonding on both arches, 60 patients were randomly assigned to four groups; groups E1 (n  =  15) and E2 (n  =  15) received a powered rotating-oscillating toothbrush, and groups M1 (n  =  15) and M2 (n  =  15) received a manual toothbrush. Groups E1 and M1 received OHI and motivation at baseline (T0) and after 4, 8, 12, 16, and 20 weeks (T4, T8, T12, T16, and T20, respectively) by a Registered Dental Hygienist; groups E2 and M2 received OHI and motivation only at baseline. At each time point a blinded examiner scored plaque of all teeth using the modified Quigley-Hein PI. RESULTS In all groups the PI score decreased significantly over time, and there were differences among groups at T8, T12, T16, and T20. At T8, PI scores of group E1 were lower than those of group E2, and at T12, T16, and T20, PI scores of groups M1 and E1 were lower compared to those of groups M2 and E2. A linear mixed model showed that the effect of repeated OHI and motivation during time was statistically significant, independently from the use of manual or electric toothbrush. CONCLUSIONS The present results showed that repeated OHI and motivation are crucial in reducing PI score in orthodontic patients, independent of the type of toothbrush used.

The prevalence of temporomandibular disorders in patients with late whiplash syndrome who experience orofacial pain: a case-control series study.

BACKGROUND The authors conducted a study to compare the frequency of specific temporomandibular disorder (TMD) diagnoses in patients who had late whiplash syndrome (LWS) with that in a control group. METHODS The authors recruited 65 patients who had orofacial pain and a previous diagnosis of LWS and 65 age- and sex-matched control patients who had chronic orofacial pain without a history of whiplash injury (WI) for a case-control series study. All patients completed a questionnaire pertaining to the Research Diagnostic Criteria for Temporomandibular Disorders and underwent a clinical examination. RESULTS The authors compared the frequency of TMD diagnoses in case patients with that in control patients by using a χ(2) test; they set the α level a priori at .05. The number of patients diagnosed with myofascial pain (MP) and disk displacement with reduction (DDWR) was significantly higher in the case group than in the control group (P = .002 and P = .001, respectively). CONCLUSIONS The results of this study show a higher frequency of MP and DDWR in patients with LWS than in patients with chronic orofacial pain and no history of WI. Practical Implications. Clinicians should be knowledgeable about the correlation between WI and TMD so they can inform and treat patients accurately.

Pressure pain threshold of the cervico-facial muscles in healthy elderly people: the role of gender, age and dominance

OBJECTIVE The aim of this study was to assess the impact of age on pressure pain threshold (PPT) of cervico-facial muscles in healthy geriatric subjects and to investigate the role of gender and dominance on nociception. BACKGROUND Musculo-skeletal pain is common in the elderly, but being subjective, it risks to be underdiagnosed and undertreated. A useful method for assessment of local pain is determining PPT through pressure algometry. Ageing process seems to increase PPTs, but reference values for the assessment of pain in geriatric subjects are lacking. METHODS In this study, PPTs in temporal muscle, masseter, sternocleidomastoid, occipital and splenius capitis of 97 healthy elderly subjects were measured using Fischer algometer. Participants were divided by age in four classes (years 65-69; 70-74; 75-79; ≥80). RESULTS Women had lower PPTs in all muscles compared with men. Comparing PPTs obtained from the right and the left side, no significant differences were recorded neither in men nor in women. When dividing subjects by age class and education, in both genders no significant differences were observed in PPTs among the groups, neither in the right nor in the left sides. CONCLUSION In conclusion, the present study reports reference PPT values for the cervico-facial muscles that can be applied to a population of healthy elderly subjects. After 65 years of age, further ageing does not influence PPTs in cervico-facial muscles whereas female gender has lower PPTs.

Late Whiplash SyndromeThe prevalence of temporomandibular disorders in patients with late whiplash syndrome who experience orofacial pain: A case-control series study

BACKGROUND The authors conducted a study to compare the frequency of specific temporomandibular disorder (TMD) diagnoses in patients who had late whiplash syndrome (LWS) with that in a control group. METHODS The authors recruited 65 patients who had orofacial pain and a previous diagnosis of LWS and 65 age- and sex-matched control patients who had chronic orofacial pain without a history of whiplash injury (WI) for a case-control series study. All patients completed a questionnaire pertaining to the Research Diagnostic Criteria for Temporomandibular Disorders and underwent a clinical examination. RESULTS The authors compared the frequency of TMD diagnoses in case patients with that in control patients by using a χ(2) test; they set the α level a priori at .05. The number of patients diagnosed with myofascial pain (MP) and disk displacement with reduction (DDWR) was significantly higher in the case group than in the control group (P = .002 and P = .001, respectively). CONCLUSIONS The results of this study show a higher frequency of MP and DDWR in patients with LWS than in patients with chronic orofacial pain and no history of WI. Practical Implications. Clinicians should be knowledgeable about the correlation between WI and TMD so they can inform and treat patients accurately.

Aging effect on pressure pain thresholds of head and neck muscles

Background and aims: Aging implies a physiological decline in skeletal muscle mass and strength, pain perception, transmission and processing, causing pain thresholds to increase (presbyalgesia). This study compares the pressure pain thresholds (PPTs) of 18 head and neck muscles in groups of young and elderly subjects. Methods: A cross-sectional study was conducted on 40 subjects, selected from a group of 97, referred for dental consultation. The inclusion criterion was subjects’ age (from 20 to 30, and over 65 years). Exclusion criteria were all conditions which may alter PPTs. In two groups, A (young subjects; 10 men, 10 women) and B (elderly subjects; 11 men, 9 women) PPTs were evaluated by one calibrated examiner with a Fischer algometer. Data are described with mean values ± standard error and the 95% confidence interval. The Mann-Whitney test was used to compare PPT values between the two groups (a=0.05). Results: There was a significant difference between the PPTs of group A and B, which were higher in the elderly group in all muscles except five. Conclusions: These preliminary data demonstrate that PPTs increase with aging in the muscles examined. Other confirmatory studies with a larger sample size are necessary.

Effects of experimental insoles on body posture, mandibular kinematics and masticatory muscles activity. A pilot study in healthy volunteers

BACKGROUND It has been hypothesized that different plantar sensory inputs could influence the whole body posture and dental occlusion but there is a lack of evidence on this possible association. OBJECTIVES To investigate the effects of experimental insoles redistributing plantar pressure on body posture, mandibular kinematics and electromyographic (EMG) activity of masticatory muscles on healthy subjects. METHODS A pilot study was conducted on 19 healthy volunteers that wore custom-made insoles normalizing the plantar pressure distribution for 2 weeks. Body posture parameters were measured by means of an optoelectronic stereophotogrammetric analysis; mandibular kinematics was analyzed by means of gothic arch tracings; superficial EMG activity of head and neck muscles was performed. Measurements were carried out 10 days before the insertion of the insoles, immediately before the insertion, the day after, 7 and 14 days after, in four different exteroceptive conditions. RESULTS The outcomes of the present study show that insoles do not modify significantly over time the parameters of body posture, SEMG activity of head and neck muscles and mandibular kinematics. CONCLUSIONS In this pilot study the experimental insoles did not significantly influence the body posture, the mandibular kinematics and the activity of masticatory muscles during a 14-day follow up period.

The Effects of Mandibular Advancement Device on Pressure Pain Threshold of Masticatory Muscles: A Prospective Controlled Cohort Study.

AIMS To determine if pressure pain thresholds (PPTs) of masticatory and neck muscles change after the application of a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA). METHODS A prospective study was conducted in a sample of 27 OSA patients (24 males and 3 females; mean age ± standard deviation [SD]: 54.8 ± 11.8, mean apnea-hypopnea index ± SD: 23.5 ± 13.3) and 27 age- and sex-matched healthy controls. Exclusion criteria were signs and symptoms of temporomandibular disorders (TMD), metabolic diseases, and use of antidepressants, analgesics, or anti-inflammatory drugs. A calibrated examiner evaluated PPTs of seven head and neck muscles bilaterally by using a Fischer algometer. In the OSA group, PPTs were recorded immediately before the MAD application (T₀), after 15 days (T₁), and after 6 months (T₂) of therapy; in the control group, PPTs were recorded at the same time intervals. PPT differences at baseline and over time within each group and between OSA and control groups were analyzed by Friedman and Mann-Whitney tests. RESULTS There were no PPT differences between groups at baseline. In the OSA group, PPTs of temporalis and masseter muscles decreased significantly at T₁ compared with T₀ (P < .05), but no differences were found at T₂. No significant PPT differences were found in the neck muscles or over time in the control group. CONCLUSION MAD application induces a decrease of PPTs of masticatory muscles at the beginning of the therapy, but a physiologic adaptation occurs by 6 months.