Jovana de Moura Milanesi

Impact of the mouth breathing occurred during childhood in the adult age: Biophotogrammetric postural analysis

OBJECTIVE This study aims to evaluate the impact of the mouth breathing occurred during childhood on the body posture in the adult age. METHODS 24 adults, of both genders, aged from 18 to 30 years old with report of clinical manifestations of mouth breathing during the childhood composed the study group (SG). The control group (CG) was composed by 20 adults in the same age, without any respiratory problem since the childhood up to the present time. All the volunteers underwent a physiotherapeutic evaluation consisted of anamnesis and postural biophotogrammetry (SAPo v 0.68(®)). The comparison between the data of the SG and CG was accomplished by Students t-test. RESULTS The biophotogrammetric analysis demonstrated that the SG showed more forward head posture confirmed by the angles A9 (p = 0.0000) and CL (p = 0.0414) and also by the cervical distance (p = 0.0079). Additionally, this group presented a larger angular measure of the lumbar lordosis (p = 0.0141) compared to the CG. CONCLUSION The results indicate that adults with mouth-breathing childhood have postural alterations, mainly in the head and lumbar column, which keeps for the whole life.

Childhood mouth-breathing consequences at adult age: ventilatory function and quality of life

Introduction Mouth breathing can affect the functions of the respiratory systems and quality of life. For this reason, children who grow up with this stimulus may have implications on physical and psychological aspects at adult age.Objective To evaluate childhood mouth-breathing consequences for the ventilatory function and quality of life at adult age.Materials and methods Prospective, observational and cross-sectional study with 24 adults, between 18 and 30 years old, mouth breathers during childhood, comprised the childhood mouth-breathing group (CMB). The childhood nasal-breathing (CNB) group was composed of 20 adults of the same age, without history of respiratory disease during all their lives. Measurements of maximal respiratory pressures, peak expiratory flow and 6-minute walk test were assessed. In addition, all the volunteers answered the Short Form-36 questionnaire (SF-36).Results The maximal inspiratory (p = 0.001) and expiratory (p = 0.000) pressures as well as the distance in the walk test (p = 0.003) were lower in the COB. The COB also presented lower score in the General Health domain of the SF-36 Questionnaire (p = 0.002).Conclusion Childhood mouth-breathing yields consequences for the ventilatory function at adult age, with lower respiratory muscle strength and functional exercise capacity. Conversely, the quality of life was little affected by the mouth breathing in this study.

Avaliação eletromiográfica dos músculos da mastigação de indivíduos com desordem temporomandibular submetidos a acupuntura

PURPOSE: To assess the effect of acupuncture on the electromyographic activity of masticatory muscles in patients with temporomandibular disorder (TMD). METHODS: Forty women, from 20 to 40 years old, with TMD diagnosis were assessed using the electromyography of the masseter and temporal (anterior fascicle) muscles. Participants were distributed into study group (SG), which received acupuncture treatment soon after the first assessment, and control group (CG), which received the treatment five weeks after this assessment. The electromyography was accomplished at the first evaluation (Av), immediately after one session of acupuncture (R1), and after ten sessions (R10) in the SG. The CG was evaluated at the beginning (Av) and after five weeks (R10), while waiting for the treatment. The acupuncture was carried out twice a week, for five uninterrupted weeks. Results were statistically analyzed. RESULTS: At the rest mandibular position, the SG showed a significant decrease in the left temporal muscle activity in R1, and in the right and left temporal muscles in R10. In the CG, the activity increased in the left temporal muscle after five weeks (R10). During chewing, the activity decreased in the right masseter in the SG. CONCLUSION: Acupuncture reduced the temporal muscles activity at rest mandibular position, providing better muscular balance between these and masseter muscles. There was not a uniform effect of the acupuncture on the assessed muscles assessed during maximal intercuspal position and chewing, showing no improvement in the quality of their activity.

Acupuntura como recurso terapêutico na dor e na gravidade da desordem temporomandibular

Este estudo avaliou o efeito da acupuntura no nivel de dor e gravidade da Desordem Temporomandibular (DTM). Participaram dele 40 mulheres entre 20 e 40 anos com DTM diagnosticada pelo Research Diagnostic Criteria (RDC/TMD). A dor foi avaliada pela escala visual analogica e a gravidade da desordem pelos Indices de Disfuncao Craniomandibular e de Fonseca. As 20 primeiras participantes foram submetidas a acupuntura duas vezes na semana por cinco semanas ininterruptas e, apos o periodo, foram reavaliadas. Os dados destas participantes constituiram os resultados para o grupo acupuntura. As demais voluntarias receberam o tratamento apos o primeiro grupo e seus dados, coletados no inicio e apos cinco semanas sem tratamento, foram utilizados para controle. Na analise estatistica foram levados em conta os testes de Wilcoxon para o nivel de dor e Indice Craniomandibular e Teste t de Student para o Indice de Fonseca, com nivel de significância de 5%. Houve reducao significante no nivel de dor (p=0,000) e na gravidade da DTM pelos Indices Craniomandibular (p=0,004) e de Fonseca (p=0,000) apos o tratamento. O grupo controle nao apresentou melhora. A efetividade da acupuntura foi demonstrada pela melhora no nivel da dor e na gravidade da DTM.

Efeito da fisioterapia sobre os parâmetros ventilatórios e a dinâmica tóraco-abdominal de crianças respiradoras bucais

This study aimed to evaluate the effects of the physiotherapy on the ventilatory parameters and thoracoabdominal dynamics of mouth breathing children. Ten mouth breathing children were undergone to 20 sessions of respiratory reeducation and postural correction through stretching and strengthening exercises on Swiss ball, diaphragmatic stimulation and stretching of the inspiratory accessory muscles. The data collected were measurements of the maximum inspiratory and expiratory pressures (MIP and MEP), inspiratory capacity (IC), peak expiratory flow (PEF), the chest wall mobility measured by the respiratory coefficient (Rc) at the levels of the axillary (RcA), xiphosternal (RcX) and umbilical (RcU) regions and biophotogrametry analysis of the Charpy angle. These were measured before and after 10 and 20 sessions. A 1-way repeated measures analysis of variance (ANOVA) was used to determine differences in variables among the three evaluations. Post-hoc comparisons were conducted with the Tukeys Test. It was considered a significance level of 5% (p<0.05). There were improvements on Charpy angle (p=0.048), IC (p=0.037), PEF (0.002), MIP (p=0.007), RcA (p=0.008) and RcX (p=0.041) measures. Although MEP and RcU improved their absolute values, the results were not statistically significant. The program of respiratory physiotherapy and postural correction produced positive effects on the ventilatory function of mouth breathing children.

Análise da postura craniocervical de crianças respiradoras bucais após tratamento postural em bola suíça

O estudo teve como objetivo avaliar a postura craniocervical de criancas respiradoras bucais apos tratamento postural em bola suica. Doze criancas respiradoras bucais foram submetidas a um protocolo de reeducacao postural constituido por exercicios de alongamento e fortalecimento muscular sobre a bola suica, estimulacao diafragmatica e alongamento dos musculos acessorios da inspiracao. A postura craniocervical foi avaliada atraves da analise biofotogrametrica. A posicao da anteriorizacao da cabeca foi aferida por meio do ângulo formado pelos pontos localizados no tragus direito e no processo espinhoso da setima vertebra cervical com a linha horizontal. A curvatura cervical foi avaliada pela distância horizontal de uma linha vertical tangenciando o apice da cifose toracica e o ponto de maior concavidade da curvatura cervical. As fotografias foram obtidas antes e apos dez atendimentos. A normalidade das variaveis foi verificada a partir do teste Shapiro-Wilk. Para as comparacoes entre as medias foi utilizado o teste t de Student para amostras dependentes admitindo-se nivel de significância de 5% (p<0,05). Verificou-se uma melhora na postura craniocervical, atraves da diminuicao da anteriorizacao da cabeca (p=0,00) e do restabelecimento da curvatura fisiologica da coluna cervical (p=0,01). O tratamento postural em bola suica proporcionou um melhor alinhamento da postura craniocervical, provavelmente pelo equilibrio dos musculos cervicais e maior acao diafragmatica.

Severidade da desordem temporomandibular e sua relação com medidas cefalométricas craniocervicais

Abstract Introduction : It is known that there is a relationship between the Temporomandibular Disorder (TMD) and craniocervical posture, but, besides the studies showed inconclusive results, the severity of signs and symp-toms of TMD is not considered. Objective : To correlate the severity of TMD index to craniocervical cephalo-metric measurements. Materials and methods : Thirty-two women, from 19 to 35 years old with a diagnosis of TMD (RDC/TMD), took part in the study. The severity of signs and symptoms of TMD was assessed by the Temoromandibular Index proposed by Pehling and calculated according to the physical examination findings of the RDC/TMD (Axis I). The craniocervical posture was evaluated by cephalometry through 11 measures related to the head, cervical spine, jaw and the hyoid bone position. Data normality was tested by Lilliefors test and correlations were performed by Spearman coefficient. Results : Moderate negative correlation was found between the CVT/Hor angle and Muscular (p = 0.0288) and Temporomandibular (p = 0.0394) Indices; between the CPL/Hor angle (anterior) when correlated with Functional (p = 0.0482) and Muscle indices (p = 0.0086) and between distance from the hyoid to the third cervical vertebra (Hy/C3) and Functional Index (p = 0.0155).

Implicações da respiração oral na função pulmonar e músculos respiratórios

The mouth breathing syndrome is characterized by a set of signs and symptoms, which may be present in subjects who replace the adequate and efficient nasal breathing mode by mouth or mixed breathing mode for more than six months. Mouth or mixed breathing mode may be associated to changes in the ventilatory function and mechanics. This review aims to further investigate the consequences of mouth breathing on the pulmonary function and respiratory muscles, emphasizing the development of such changes from childhood to adulthood. Eighteen articles were selected through PubMed and Web of Science databases and they were grouped in the text, covering the following topics:1) Implications of mouth breathing on the pulmonary function and 2)Implications of mouth breathing on the respiratory muscles. Based on the information from the articles analyzed, it can be noticed that a few studies rejected or did not find any relationship between pulmonary changes and mouth breathing. It is suggested that the muscular imbalance produced by these changes may contribute for the mechanical disadvantage of the diaphragm muscle and the increase of accessory inspiratory muscles work. Nevertheless, studies with more judicious methods, including objective and reproducible evaluation of the respiratory muscles are still needed.

Atividade elétrica dos músculos cervicais e amplitude de movimento da coluna cervical em indivíduos com e sem DTM

O objetivo da pesquisa foi avaliar a atividade eletrica e a dor a palpacao dos musculos cervicais, a amplitude de movimento (ADM) da coluna cervical e a relacao entre atividade eletrica e ADM cervical em individuos com e sem desordem temporomandibular (DTM). Participaram do estudo 53 voluntarios, sendo 24 com DTM e 29 sem, de ambos os generos, com 18 a 32 anos de idade. A DTM foi diagnosticada pelo criterio de diagnostico em pesquisa para DTM (Research Diagnostic Criteria for Temporomandibular Disorders). A eletromiografia dos musculos esternocleidomastoideo (ECOM) e trapezio superior foi realizada bilateralmente, na situacao de repouso, com frequencia de 2 KHz e filtro passa-faixa de 10-1000 Hz. As medidas de ADM de flexao, extensao, lateroflexao e rotacao foram realizadas com um fleximetro e a comparacao entre os grupos contou com o teste de Mann Whitney. O teste de Spearman foi aplicado para a correlacao entre as variaveis, com nivel de significância de 5%. Nao foi verificada nenhuma diferenca na ADM cervical entre os grupos. A atividade eletrica demonstrou-se significativamente maior nos musculos ECOM direito (p=0,0130), trapezio superior direito (p=0,0334) e esquerdo (p=0,0335) no grupo DTM em relacao ao grupo controle. Nao houve correlacao significante entre atividade eletrica e ADM cervical. A dor nos musculos cervicais apresentou-se significativamente maior apenas no musculo ECOM direito (p=0,0055). Conclui-se que os grupos estudados registraram diferenca na atividade eletrica dos musculos cervicais, sendo esta maior em individuos com DTM.

O gênero e a idade influenciam as dimensões do palato duro? Revisão sistemática da literatura

PURPOSE Analyze the influence of gender and age on hard palate dimensions and verify the reference parameters available in the literature. RESEARCH STRATEGIES Two reviewers independently performed a search at the Cochrane Library, PubMed-Medline and Web of Knowledge databases using descriptors according to the syntax rules of each database. SELECTION CRITERIA Observational or experimental human studies evaluating the dimensions of the hard palate or maxillary dental arch, with at least one transverse, vertical or sagittal plane measurement, in normal occlusions or class I malocclusions, and comparisons of the dimensions between genders and/or ages. DATA ANALYSIS Descriptive analysis with the following subdivisions: design, sample, evaluation instruments, measurements in millimeters, and statistical analysis. Quality of the included studies was verified by the Newcastle - Ottawa Quality scale. RESULTS Eighteen studies were selected and 11 presented results for hard palate or maxillary dental arch dimensions according to gender, six in age and gender and one in age only. CONCLUSION The dimensions were larger in males and progressive increase in the measurements was observed from birth to the permanent dentition period.