Paula Midori Castelo

Signs and symptoms of temporomandibular disorders in adolescents

The aim of this study was to verify the prevalence of signs and symptoms of temporomandibular disorders (TMD) in adolescents and its relationship to gender. The sample comprised 217 subjects, aged 12 to 18. The subjective symptoms and clinical signs of TMD were evaluated, using, respectively, a self-report questionnaire and the Craniomandibular Index, which has 2 subscales; the Dysfunction Index and the Palpation Index. The results of muscle tenderness showed great variability (0.9-32.25%). In relation to the temporomandibular joint, tenderness of the superior, dorsal and lateral condyle regions occurred in 10.6%, 10.6% and 7.83%, respectively, of the sample. Joint sound during opening was present in 19.8% of the sample and during closing in 14.7%. The most prevalent symptoms were joint sounds (26.72%) and headache (21.65%). There was no statistical difference between genders (p > 0.05), except for the tenderness of the lateral pterygoid muscles, which presented more prevalence in girls. In conclusion, clinical signs and symptoms of TMD can occur in adolescents; however, gender influence was not perceived.

Evaluating oral health-related quality of life measure for children and preadolescents with temporomandibular disorder.

BackgroundOral health-related quality of life (OHRQoL) in children and adolescents with signs and symptoms of temporomandibular disorder (TMD) has not yet been measured. This study aimed to evaluate the validity and reliability of OHRQoL measure for use in children and preadolescents with signs and symptoms of TMD.MethodsFive hundred and forty-seven students aged 8-14 years were recruited from public schools in Piracicaba, Brazil. Self-perceptions of QoL were measured using the Brazilian Portuguese versions of Child Perceptions Questionnaires (CPQ)8-10 (n = 247) and CPQ11-14 (n = 300). A single examiner, trained and calibrated for diagnosis according to the Axis I of the Research Diagnostic Criteria for TMD (RDC/TMD), examined the participants. A self-report questionnaire assessed subjective symptoms of TMD. Intraexaminer reliability was assessed for the RDC/TMD clinical examinations using Cohens Kappa (κ) and intraclass correlation coefficient (ICC). Criterion validity was calculated using the Spearmans correlation, construct validity using the Spearmans correlation and the Mann-Whitney test, and the magnitude of the difference between groups using effect size (ES). Reliability was determined using Cronbachs alpha, alpha if the item was deleted and corrected item-total correlation.ResultsIntraexaminer reliability values ranged from regular (κ = 0.30) to excellent (κ = 0.96) for the categorical variables and from moderate (ICC = 0.49) to substantial (ICC = 0.74) for the continuous variables. Criterion validity was supported by significant associations between both CPQ scores and pain-related questions for the TMD groups. Mean CPQ8-10 scores were slightly higher for TMD children than control children (ES = 0.43). Preadolescents with TMD had moderately higher scores than the control ones (ES = 0.62; p < 0.0001). Significant correlation between the CPQ scores and global oral health, as well as overall well-being ratings (p < 0.001) occurred, supporting the construct validity. The Cronbachs alphas were 0.93 for CPQ8-10 and 0.94 for CPQ11-14. For the overall CPQ8-10 and CPQ11-14 scales, the corrected item-total correlation coefficients ranged from 0.39-0.76 and from 0.28-0.73, respectively. The alpha coefficients did not increase when any of the items were deleted in either CPQ samples.ConclusionsThe questionnaires are valid and reliable for use in children and preadolescents with signs and symptoms of temporomandibular disorder.

Treatment of Chronic Periodontitis and Its Impact on Mastication

BACKGROUND The aim of the present study is to assess the impact of conventional periodontal treatment of chronic periodontitis on the perception of mastication. METHODS The patients (n = 28; age range: 23 to 56 years, mean age: 37.9 years) were evaluated on two occasions (before and after treatment) with a 45-day interval using the Oral Impact on Daily Performance questionnaire. An electromyography system was used for the determination of activity in muscles of mastication and bite force. Masticatory performance was assessed using a test material. The median particle size of the masticated material was determined using a sieve method and the Rosin-Rammler equation. The clinical criteria were the number of teeth and probing depth, both determined by a single calibrated observer masked to the treatment phase. The data were analyzed in the pretreatment and post-treatment periods using Wilcoxon test; Spearman correlation coefficient; and two multiple linear regression models (backward stepwise procedure). RESULTS There was a significant negative correlation between the number of teeth (number of mastication units) and difficulty eating (P <0.05) before and after treatment. Probing depth had a positive relationship with the total Oral Impact on Daily Performance score before treatment (P <0.01). CONCLUSIONS The subjective perception of the impact of oral health on mastication diminished after periodontal treatment. The number of teeth had considerable importance in the perception of impact on mastication in the sample studied.

Associations between oral health-related quality of life and emotional statuses in children and preadolescents.

OBJECTIVES To evaluate the associations between oral health-related quality of life (OHRQoL) and emotional statuses in children and preadolescents. METHODS One hundred and forty-five Brazilian students (8-14 years) were clinically examined for caries, gingivitis, fluorosis, malocclusions, and temporomandibular disorders (TMD). OHRQoL was measured using two global ratings of oral health (OH) and overall well-being (OWB). The Revised Childrens Manifest Anxiety Scale (R-CMAS) and Childrens Depression Inventory (CDI) were used to assess anxiety and depression, respectively. Saliva was collected 30 min after waking and at night to determine the diurnal decline in salivary cortisol (DDSC). The results were analyzed using non-paired t test/one-way ANOVA, Pearsons correlation test, and multiple linear regression analyses. RESULTS 11-14-year-old participants had higher CDI scores (P < 0.01) and DDSC concentrations (P < 0.001). Participants with fewer caries and without gingivitis had higher DDSC concentrations (P < 0.05). TMD patients had higher DDSC concentrations and OWB ratings (P < 0.001). Girls had higher Revised Childrens Manifest Anxiety Scale (RCMAS) scores (P < 0.01). There was positive correlation between RCMAS and CDI scores and OWB ratings (P < 0.05). The OH model retained age (β =0.312; P < 0.001) and the OWB model retained TMD (β = 0.271; P < 0.001) and CDI scores (β=0.175; P < 0.05). CONCLUSIONS Children and preadolescents with poor emotional well-being are more sensitive to the impacts of OH and its effects on OWB.

Maximal bite force, facial morphology and sucking habits in young children with functional posterior crossbite

Objective The maintenance of normal conditions of the masticatory function is determinant for the correct growth and development of its structures. Thus, the aims of this study were to evaluate the influence of sucking habits on the presence of crossbite and its relationship with maximal bite force, facial morphology and body variables in 67 children of both genders (3.5-7 years) with primary or early mixed dentition. Material and methods The children were divided in four groups: primary-normocclusion (PN, n=19), primary-crossbite (PC, n=19), mixed-normocclusion (MN, n=13), and mixed-crossbite (MC, n=16). Bite force was measured with a pressurized tube, and facial morphology was determined by standardized frontal photographs: AFH (anterior face height) and BFW (bizygomatic facial width). Results It was observed that MC group showed lower bite force than MN, and AFH/ BFW was significantly smaller in PN than PC (t-test). Weight and height were only significantly correlated with bite force in PC group (Pearson’s correlation test). In the primary dentition, AFH/BFW and breast-feeding (at least six months) were positive and negatively associated with crossbite, respectively (multiple logistic regression). In the mixed dentition, breastfeeding and bite force showed negative associations with crossbite (univariate regression), while nonnutritive sucking (up to 3 years) associated significantly with crossbite in all groups (multiple logistic regression). Conclusions In the studied sample, sucking habits played an important role in the etiology of crossbite, which was associated with lower bite force and long-face tendency.

Evaluation of masticatory performance and bite force in children with sleep bruxism.

The aim of this study was to evaluate the association between masticatory performance (MP) and bite force (BF) in children with sleep bruxism (SB) during the mixed dentition stage, considering also the occlusal characteristics. The sample was composed by 52 healthy children of both genders, aged 6-10 years. From those, 22 presented signs and symptoms of SB and 30 were the controls. SB diagnosis consisted of both parental report and presence of tooth wear. MP was evaluated by the individuals ability to communicate an artificial chewable test material for determining the median particle size (X50) and distribution of particles in the different sieves (b). BF was measured using a digital gnathodynamometer with fork strength of 8 mm. The results were submitted to descriptive statistics, Mann-Whitney and chi-square tests, Spearmans correlation and multiple logistic regression. Mean BF and X50 did not differ between groups with and without SB. A significant negative correlation was observed between BF and X50 only in the group of children with SB. Moreover, the logistic regression model showed an association between the presence of SB and higher b index. The other independent variables included in the model showed no association with SB. BF did not differ between children with and without SB. Besides, higher BFs in children with SB meant better MP; however, they were more likely to present chewed particles retained in the larger aperture sieves, consequently requiring more chewing cycles to break down the test material in smaller particles.

Assessment of the differences in masticatory behavior between male and female adolescents.

Chewing behavior may show sex differences; thus, the present study aimed to compare the masticatory aspects and the prediction of masticatory performance between male and female adolescents. Ninety-one healthy subjects (47 girls, 44 boys), caries-free and aged 14-17years, were included. Masticatory performance and maximal bite force were evaluated using a color-changeable chewing gum and digital gnathodynamometer, respectively. Masticatory behavior was assessed by the subjective aspect of the quality of the masticatory function (validated questionnaire) and the Orofacial Myofunctional Evaluation with Scores expanded (OMES-e) was used to determine chewing time, frequency of chewing cycles and other aspects. Salivary flow rate was also assessed. The physical examination involved measurements of facial morphometry, body weight, height, skeletal muscle mass, and dental/occlusal evaluations. It was observed that boys showed larger facial dimensions, higher bite force and chewing frequency and better masticatory performance than girls. They also showed shorter chewing time, fewer chewing cycles and lower score for OMES-e (that is, more changes in orofacial myofunctional aspects). Bite force showed a weak correlation with skeletal muscle mass only in boys (r=0.3035; p=0.0451). The masticatory performance was dependent on the bite force in boys (Adj R(2)=19.2%; Power=84.1%); among girls, masticatory performance was dependent on the frequency of chewing cycles and masticatory behavior (subjective aspect) (Adj R(2)=34.1%; Power=96.1%). The findings support the existence of sex differences in many masticatory aspects of function and behavior, hence the importance of considering sex differences when evaluating masticatory function and myofunctional therapy outcomes among young subjects.

Relationship between orofacial function, dentofacial morphology, and bite force in young subjects

OBJECTIVE The aim was to evaluate the relationship between orofacial function, dentofacial morphology, and bite force in young subjects. SUBJECTS AND METHODS Three hundred and sixteen subjects were divided according to dentition stage (early, intermediate, and late mixed and permanent dentition). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Orthodontic treatment need, bite force, lateral and frontal craniofacial dimensions and presence of sleep bruxism were also assessed. The results were submitted to descriptive statistics, normality and correlation tests, analysis of variance, and multiple linear regression to test the relationship between NOT-S scores and the studied independent variables. RESULTS The variance of NOT-S scores between groups was not significant. The evaluation of the variables that significantly contributed to NOT-S scores variation showed that age and presence of bruxism related to higher NOT-S total scores, while the increase in overbite measurement and presence of closed lip posture related to lower scores. Bite force did not show a significant relationship with scores of orofacial dysfunction. No significant correlations between craniofacial dimensions and NOT-S scores were observed. CONCLUSION Age and sleep bruxism were related to higher NOT-S scores, while the increase in overbite measurement and closed lip posture contributed to lower scores of orofacial dysfunction.

Masticatory performance and taste perception in patients submitted to cancer treatment

The aim of this study was to analyse mastication and the sense of taste in 39 patients submitted to cancer treatment in different areas of the body and to compare these variables with those of 44 control individuals within the same age range. The following aspects were assessed: dental status (DMFT); stimulated and non-stimulated salivary flow; sense of taste (salty, sweet, bitter and sour); and masticatory performance (MP), through the calculation of X(50). Logistic regression models were established to test the association between the independent variables and cancer treatment. Cancer patients had lesser stimulated salivary flow, a smaller number of teeth and occlusal units, worse MP, higher salty, sweet and sour taste scores and a lower bitter taste score (P < 0·05). A significant positive correlation was found between MP and the DMFT index in both groups (P < 0·05), meaning that a lower DMFT index value denoted a smaller X(50) value (better masticatory performance). The logistic regression model revealed that patients who had undergone cancer treatment had a greater probability of exhibiting a smaller number of teeth, higher salty and smaller bitter taste scores (P < 0·05). It was concluded that patients who were submitted to cancer treatment presented oral physiology alterations when compared with control subjects at the same age range.

Awakening salivary cortisol levels of children with sleep bruxism.

UNLABELLED The study of factors potentially associated with sleep bruxism (SB) may contribute to a better understanding of its nature and etiology. OBJECTIVES In this way, this cross-sectional study aimed to evaluate the association between SB and salivary cortisol levels, heart rate, and other parafunctional habits. DESIGN AND METHODS Data were collected in 100 healthy caries-free children of both genders, aged 7.23 ± 0.60 years, with (n=27) and without (n=73) signs and symptoms of SB by interview with the parents and clinical and physical examination. Salivary cortisol was measured immediately after waking up and 30min after awakening for the determination of the area under the response curve (AURC). Data were analyzed by descriptive statistics, normality test, and Spearman correlation test; a stepwise logistic regression model was used to verify the association between SB, as the dependent variable, and age, gender, body mass index (BMI), heart rate, presence of sucking habit, nail biting, enuresis, and AURC (α=0.05). RESULTS AURC did not correlate with BMI and heart rate. Only AURC showed a significant negative association with SB, while age, gender, BMI, heart rate and other parafunctional habits did not associate with SB. CONCLUSION In the studied sample, children with SB were more likely to present low concentrations of awakening salivary cortisol.