El envejecimiento y cambios bucodentales en el adulto mayor

Introducción: Todos los órganos y sistemas del cuerpo humano envejecen. No todos al mismo ritmo, pero ninguno está exento de las modificaciones que conlleva el paso del tiempo y el sistema estomatognático, no es la excepción. Modificaciones extraorales e intraorales hacen que se tengan unas condiciones, necesidades y susceptibilidades diferentes en esta etapa de la vida. Objetivo: Identificar la influencia del envejecimiento sobre las estructuras bucodental en el adulto mayor. Métodos: Se realizó una búsqueda electrónica de la literatura con los motores de búsqueda en las bases de datos: PubMed, Medline, Cochrane, Hinari y SciELO. Para búsqueda de la información se utilizaron las palabras clave atención estomatológica, adulto mayor, envejecimiento, lesiones bucales, enfermedades bucales, lesiones premalignas, cáncer bucal; todas fueron combinadas. Resultados: El envejecimiento de la cavidad bucal es una de las pocas características que unifica y define a todos los seres humanos. Durante el mismo se observan diversos cambios y modificaciones extraorales e intraorales y hacen que se tengan nuevas condiciones en los tejidos orales y periorales en diferentes etapas de la vida; como su impacto en estructuras como los dientes, periodonto, articulación temporomandibular, las glándulas salivales, piel, músculos, edentulismo, mucosa oral, lengua y hueso. Conclusiones: El envejecimiento es un fenómeno silencioso y preocupante que va socavando a los adultos mayores con el decursar del tiempo con un efecto significativo en las estructuras bucales que afecta el bienestar y la satisfacción con la vida de los individuos.

Introduction: All organs and the human body systems age. No all at the same rhythm, but no one is exempt of the modifications that it entails the passage of time and the stomatognathic system, it is not the exception. Extraoral and intraoral modifications make them have some conditions, needs and different susceptibilities in this stage of life. Objective: To identify the influence of aging on the oral and dental structures in the older adult. Methods: An electronic search of literature was carried out in the electronic data bases with the help of search engines: PubMed, Medline, Cochrane, Hinari y SciELO. Key words were used to search for information such as: dentistry attention, older adult, aging, oral injuries, oral diseases, injuries premalignant, oral cancer; all of them were combined for the search. Results: The aging of the oral cavity is one of the uncharacteristic that unifies and defines all the human beings. During the same, various extraoral and intraoral changes and modifications are observed and cause new conditions to be had in the oral and perioral tissues at different stages of life; as its impact on structures such as teeth, periodontium, temporomandibular joint, salivary glands, skin, muscles, edentulism, oral mucosa, tongue and bone. Conclusions: The aging is a silent and worrisome phenomenon that keeps on weakening the senior citizens with the passage of time with a significant effect in the oral structures that affects the well-being and the satisfaction with life of the individuals.

Qualitative Assessment of Surgical Repair of Three Types of Unilateral Cleft Lip

Abstract Objective: To assess the effect of the three types of unilateral cleft lip (UCL) [cleft lip only, cleft lip and alveolus, and cleft lip alveolus and palate] on the outcome of the repair. Material and Methods: This study was a case series of effect of types of UCL on the outcome of the repair. Fifteen subjects each were in three UCL phenotypes groups. Evaluation of the scar, lip, and nose was done qualitatively by both parents/guardians and professionals using a modified form of the criteria described by Christofides et al. (2006). Results: In the assessment of the surgical scar, the parents found a difference between the three types of cleft in terms of texture, shape, and width of the scar and presence of columella deviation. The professional assessors, however, only found the three types of cleft to be different in the presence of alar flattening. Conclusion: Differences truly exist in the outcome of surgical repair of the three types of unilateral cleft lip, especially in the aesthetics of the nose and in the width and shape of the residual lip scar. Thus, it is important to consider this in the assessment of UCL repair because putting the subtypes together might have a negative impact on the assessment.

Evaluation of Canine Transpositions and Related Dental Anomalies in a Turkish Pediatric Population

Abstract Objective: To investigate the prevalence and characteristics of canine transpositions and to evaluate associated dental anomalies in a pediatric population. Material and Methods: This study was carried out by evaluating the panoramic radiographs of 11.750 patients ranging in ages from 6 to 17 presented to a pedodontic clinic over 5 years. The patients with canine transposition were included in the study. Age at diagnosis, gender, classification and location of transposition, presence of other dental anomalies were recorded. Differences were analyzed using the Chi-squared test. Results: Canine transposition was detected in 73 teeth from 69 patients (0.6%). Transpositions were more common in girls than in boys (55.1%). Transposed canine teeth were more frequently observed unilaterally (89%). The most commonly found transposition type was type 2 (42%). A total of 49.3% of 69 patients had retained primary canine teeth, 20.3% had congenitally missing teeth, and 11.6% had peg-shaped, microdont lateral incisors. Impacted teeth excluding third molars and taurodontism were also observed. Conclusion: Although the canine transpositions are generally asymptomatic in children in the period of growth and development, the importance of early diagnosis is crucial to prevent various clinical problems.

Hedgehog pathway antagonist-induced oromandibular limb hypogenesis in mouse / 中华口腔医学杂志

Objective@#To analysis teratogenic effect of GDC-0449 to fetus and set up the animal model of GDC-0449 induced oromandibular limb hypogenesis in mouse for further research of its pathogenesis.@*Methods@#Twenty-seven pregnant Institute of Cancer Research (ICR) mice were randomly divided into: control group, embryonic day 8.5 (E8.5) exposed groups, E9.5 exposed groups, E10.5 exposed groups, E11.5 exposed groups, E12.5 exposed groups, E13.5 exposed groups, E14.5 exposed groups and E15.5 exposed groups. Each group had 3 mice. Exposed groups were treated with the Hedgehog pathway antagonist GDC-0449 at a single dose 150 mg/kg by oral gavage from E8.5 to E15.5. At E16.5, embryonic phenotypes were analyzed in detail by stereo microscope and histology. After establish an optimal dysmorphogenic concentration, 6 pregnant ICR mice were randomly divided into control group and the optimal group, embryonic phenotypes were analyzed by whole-mount skeletal staining and micro-computed tomography at E18.5.@*Results@#The mice were exposed to GDC-0449 on E11.5 and E12.5 had a high incidence of cleft palate. GDC-0449 exposed between E9.5 and E10.5 caused craniofacial and limb dysmorphology, including micrognathia, microglossia, ectrodactylia, partial anodontia and cleft palate. Most interestingly, these are extremely similar to oromandibular limb hypogenesis syndrome.@*Conclusions@#The results of this study indicate that GDC-0449 can be used to induce micrognathia, microglossia, ectrodactylia, partial anodontia and cleft palate. This work established a novel mouse model for oromandibular limb hypogenesis.

Apuntes sobre el envejecimiento del sistema estomatognático. Revisión de la literatura / Notes on Aging of the Stomatognathic System. A Literature Review

El envejecimiento es un proceso natural de duración variable, homogéneo para cada especie. Es un proceso que depende del tiempo y consiste en un progresivo incremento de la vulnerabilidad y la disminución de la viabilidad del organismo. Para poder realizar un diagnóstico y tratamiento de los trastornos temporomandibulares, para entender su significado y aplicación, es necesario conocer los cambios que ocurren con la edad. Se realizó la presente revisión de la literatura para actualizar los aspectos principales del envejecimiento del sistema estomatognático. Se realizó una exploración en internet empleando motores de búsqueda especializados y utilizando descriptores relacionados con el tema, se consultaron bases de datos de salud. Se concluyó que las principales características de la articulación temporomandibular durante el envejecimiento se expresan en cambios degenerativos sin que esto apunte a manifestaciones clínicas, ni exista una relación lineal entre la edad y los cambios radiográficos de la morfología condilar, se sugiere que el envejecimiento muscular en el sistema estomatognático está relacionado con la reserva de células madres que parece agotarse con la edad, así como el remodelado vascular que ocurre con el envejecimiento, que puede ser el responsable de los cambios de la función muscular.

Aging is a natural process of varying length that occurs similarly in each species. It is a time-dependent process characterized by a progressive increase in the vulnerability and a decrease in the viability of the organism. It is necessary to know the age-related changes in order to diagnose and treat temporomandibular disorders. This literature review aims to provide an update of the main aspects related to aging of the stomatognathic system. An Internet search was conducted using specialized search engines and descriptors related to this subject. Health databases were also consulted. It was concluded that the main characteristics of the temporomandibular joint during aging are degenerative changes, without necessarily causing clinical manifestations and without a linear relationship between age and radiographic changes in condylar morphology. It is suggested that aging of the stomatognathic muscles is related to the depletion of the stem cell pool and the vascular remodeling that occurs with aging, which may be responsible for changes in muscle function.

Effect of Vocal Fry on Voice and on Velopharyngeal Sphincter

Abstract Introduction It is known that the basal sound promotes shortening and adduction of the vocal folds and leaves the mucosa looser. However there are few studies that address the supralaryngeal physiological findings obtained using the technique. Objective To check the effectiveness of using vocal fry on the voice and velopharingeal port closure of five adult subjects, whose cleft palate has been corrected with surgery. Methods Case study with five subjects who underwent otolaryngology examination by means of nasopharyngoscopy for imaging and measurement of the region of velopharyngeal port closure before and after using the vocal fry technique for three minutes. During the exam, the subjects sustained the isolated vowel /a:/ in their usual pitch and loudness. The emission of the vowel /a:/ was also used for perceptual analysis and spectrographic evaluation of their voices. Results Four subjects had an improvement in the region of velopharyngeal port closure; the results of the spectrographic evaluation were indicative of decreased hypernasality, and the results of the auditory-perceptual analysis suggested improved overall vocal quality, adequacy of loudness, decreased hypernasality, improvement of type of voice and decreased hoarseness. Conclusion This study showed a positive effect of vocal fry on voice and greater velopharyngeal port closure.

Controle motor oral e funções orofaciais em indivíduos com deformidade dentofacial / Oral motor control and orofacial functions in individuals with dentofacial deformity

Objetivo Verificar se há relação entre o controle motor oral e as funções orofaciais em indivíduos com deformidade dentofacial (DDF). Métodos Participaram 16 indivíduos entre 18 e 40 anos, média de 28,37 anos, sendo sete indivíduos padrão II (três mulheres e quatro homens) e nove, padrão III (cinco mulheres e quatro homens). Foi realizada avaliação da diadococinesia (DDC) das emissões /pa/, /ta/, /ka/ e /pataka/. As funções de mastigação, deglutição e fala foram analisadas por consenso entre três fonoaudiólogas especialistas na área, a partir da filmagem, utilizando o protocolo MBGR. A correlação entre os resultados da DDC e das funções orofaciais foi obtida por meio do teste de Spearman. Resultados Foi observada correlação positiva entre os parâmetros de instabilidade da DDC na emissão do “pa” e “ka” e a função de mastigação. Houve correlação positiva entre deglutição e DDC para a emissão do “pa” no que se refere à instabilidade das emissões e, quanto à velocidade, houve correlação negativa para a média da taxa da DDC e correlação positiva para a média do período da DDC na emissão do “pa”. Quanto à fala, houve correlação negativa para a emissão do “pa”, para parâmetro de instabilidade. Conclusão O controle motor oral mostrou-se relacionado à gravidade da alteração das funções de mastigação e deglutição, no que se refere aos parâmetros instabilidade e velocidade da DDC. .

Purpose To determine the correlation between oral motor control and orofacial functions in individuals with dentofacial deformity (DFD). Methods Sixteen individuals from 18 to 40 years, (average 28.37 years) participated. Seven individuals were class II (three women and four men) and nine were class III (five women and four men). They were evaluated for diadochokinesis (DDK) using the emissions /pa/, /ta/, /ka/ and /pataka/. The chewing, swallowing, and speech functions were filmed and analyzed by three speech specialists, using the MBGR protocol. The correlation results between DDK and the orofacial functions were obtained through the Spearman test. Results A positive correlation was observed between the DDK instability parameters in issuing the “pa” and “ka” and the chewing function. There was a positive correlation between swallowing and DDK for “pa” emission regarding the instability. As for the speed, there was a negative correlation for the DDK mean rate and a positive correlation for the average DDK period at “pa” emission. As for the speech, there was a negative correlation for “pa” emission for the instability parameter. Conclusion The oral motor control was related to the severity of the change in chewing and swallowing functions regarding the DDK speed and instability paramenters. .

Chewing time and chewing strokes in different dentofacial deformities / Tempo e golpes mastigatórios nas diferentes deformidades dentofaciais

PURPOSE: To verify whether the number of chewing strokes and the chewing time are influenced by dentofacial deformities in habitual free mastication. METHODS: Participants were 15 patients with diagnosis of class II dentofacial deformity (GII), 15 with class III (GIII), and 15 healthy control individuals with no deformity (CG). Free habitual mastication of a cornstarch cookie was analyzed, considering the number of chewing strokes and the time needed to complete two mastications. Strokes were counted by considering the opening and closing movements of the mandible. The time needed to consume each bite was determined using a digital chronometer, started after the placement of the food in the oral cavity and stopped when each portion was swallowed. RESULTS: There were no differences between groups regarding both the number of strokes and the chewing time. However, with regards to the number of strokes, CG and GII presented a significant concordance between the first and the second chewing situation, which was not observed in GIII. The analysis of time showed significant concordance between the first and second chewing situation in CG, reasonable concordance in GII, and discordance in GIII. CONCLUSION: Dentofacial deformities do not influence the number of chewing strokes or the chewing time. However, class III individuals do not show uniformity regarding these aspects.

OBJETIVO: Verificar se o número de golpes e o tempo mastigatório são influenciados pela deformidade dentofacial, na mastigação habitual livre. MÉTODOS: Participaram 15 pacientes com deformidade dentofacial classe II (GII), 15 com classe III (GIII) e 15 indivíduos sem a deformidade (GC). Foi analisada a mastigação habitual livre de um biscoito de maisena, considerando o tempo e o número de golpes mastigatórios apresentados durante duas mastigações. A contagem dos golpes foi feita considerando os movimentos mandibulares de abertura e fechamento da mandíbula. O tempo para o consumo de cada mordida do alimento foi investigado por meio de um cronômetro digital, acionado após a colocação do alimento na cavidade oral e paralisado no momento da deglutição final de cada porção. RESULTADOS: Não houve diferenças entre os grupos, tanto para a variável referente ao número de golpes, quanto para a relacionada ao tempo. Entretanto, quanto ao número de golpes, observou-se que os grupos GC e GII apresentaram uma concordância significativa entre a primeira e a segunda situação de mastigação, o que não ocorreu com o GIII. Na análise do tempo, houve uma concordância significativa no GC entre a primeira e a segunda situação de mastigação; o GII apresentou uma concordância razoável entre as duas situações de mastigação e o GIII apresentou discordância entre as duas mastigações. CONCLUSÃO: As deformidades dentofaciais não influenciam no número de golpes mastigatórios e no tempo da mastigação. Entretanto, os indivíduos classe III não apresentam uma uniformidade nesses aspectos.

As implicações da classe II de angle e da desproporção esquelética tipo classe II no aspecto miofuncional / The implications of class II angle and class II type skeletal disproportion on the myofunctional aspect

TEMA: esse trabalho foi baseado na temática de que existe uma associação entre as más oclusões devido a alterações do crescimento craniofacial, e, por conseguinte, a existência de alterações miofuncionais. OBJETIVOS: estudar a associação entre as más oclusões tipo classe II desencadeadas por alterações do crescimento craniofacial e as disfunções do sistema estomatognático (alterações miofuncionais: fala, mastigação, deglutição e fonação). CONCLUSÃO: pode-se concluir que alterações estruturais da face podem ter influência na funcionalidade das mesmas, portanto, enfatiza-se a importância do trabalho multidisciplinar entre os profissionais envolvidos em cada uma dessas aéreas para que o prognóstico desses casos seja pertinente de relevantes melhoras.

BACKGROUND: this work has been based on the theme that there is an association between malocclusion due to change in craniofacial growth, and therefore, the existence of malfunctioning abnormalities. PURPOSE: to study the strong association among the malocclusion class II triggered by changes in craniofacial growth and dysfunctions of the stomatognathic system (myofunctional disorders - speech, chewing, swallowing and phonation). CONCLUSION: it may be concluded that structural changes of the face may affect its, and therefore, the importance of multidisciplinary work among professionals involved in each of those areas, is emphasized, so that the prognosis of these cases may have relevant and important improvements.

Adesão à terapia em motricidade orofacial no ambulatório de Fonoaudiologia do Hospital das Clínicas da Universidade Federal de Minas Gerais / Adhesion to orofacial myology therapy at the ambulatory of Speech and Language Pathology of the Hospital das Clínicas of Universidade Federal de Minas Gerais

OBJETIVO: Caracterizar o atendimento em motricidade orofacial no Ambulatório de Fonoaudiologia do Hospital das Clínicas da Universidade Federal de Minas Gerais quanto à adesão e sucesso da terapia, bem como comparar dados dos pacientes que buscaram atendimento ativamente no Ambulatório de Fonoaudiologia e dos pacientes encaminhados pelo Ambulatório do Respirador Oral da mesma instituição. MÉTODOS: Foram investigados 90 prontuários de todos os pacientes em alta ou desligados, que buscaram tratamento pelos Ambulatórios de Fonoaudiologia (Grupo MO) e do Respirador Oral (Grupo RO). Os resultados foram analisados empregando-se os testes Mann-Whitney e Qui-quadrado (5 por cento). RESULTADOS: Pelo cálculo da mediana, a duração da terapia foi equivalente a 6,0 meses, o número total de sessões foi igual a 17, o de atendimentos realizados 12 e o de faltas 4,5. Apenas 41,2 por cento dos pacientes realizava os procedimentos indicados pelo terapeuta. A conclusão do processo terapêutico foi majoritariamente o desligamento (73,3 por cento), sendo a maior causa o excesso de faltas (24,4 por cento). Os grupos diferiram quanto aos motivos de desligamento, havendo predomínio de faltas no grupo RO (p<0,01) e espera por outros profissionais no Grupo MO (p<0,01). Ocorreram associações significantes entre faltas e desligamentos (p<0,01) e adesão e desligamentos (p<0,01) no Grupo RO. CONCLUSÕES: As características pesquisadas foram predominantemente semelhantes nos grupos. Apesar de muitos pacientes seguirem as orientações total ou parcialmente, a adesão ficou prejudicada pelo excesso de faltas. Assim, o sucesso da terapia não foi alcançado na maioria dos casos.

PURPOSE: To characterize orofacial myology treatment offered at the Ambulatory of Speech and Language Pathology of the Hospital das Clínicas of Universidade Federal de Minas Gerais concerning adhesion and therapy success, as well as to compare data from patients who actively searched for therapy and those referred by the Oral Breathing Ambulatory of the same institution. METHODS: Ninety records of all patients that were discharged or resigned from treatment either at the Ambulatory of Speech and Language Pathology (MO Group) or at the Oral Breathing Ambulatory (RO Group) were investigated. The results were statistically analyzed using Mann-Whitney and Chi-square tests (5 percent). RESULTS: Median calculation showed that the duration of therapy was of 6,0 months, the total number of sessions was 17, the number of sessions carried out was 12 and the number of absences was equivalent to 4,5. Only 41.2 percent of the patients carried out the procedures recommended by the therapist. The conclusion of the therapeutic process was mainly resignation (73.3 percent), and excessive absences was most frequent reason for that (24.4 percent). The groups differed from each other regarding resignation reason: absences predominated as the reason for the RO Group (p<0,01), while the wait for other professionals was the most frequent reason for the MO Group (p<0,01). Significant associations regarding absences and resignation (p<0,01) and adhesion and resignation (p<0,01) were found in the RO Group. CONCLUSIONS: The researched characteristics were predominantly similar between the groups. Despite many patients followed recommendations totally or partially, adhesion was compromised by excessive absences. Thus, therapy success was not achieved in the majority of the cases studied.

O perfil fonoaudiológico do paciente portador de queimaduras de cabeça e pescoço internado no Hospital de Pronto Socorro de Porto Alegre/RS / The speech-language pathology profile of patients with burning of head and neck hospitalized at Emergency Hospital of Porto Alegre/RS

Objetivo: Traçar o perfil fonoaudiológico dos pacientes com queimaduras de cabeça e pescoço internados no Hospital de Pronto Socorro de Porto Alegre. Método: Foram avaliados pacientes com queimaduras entre 2º e 3º grau, acima de 18 anos, internados na Unidade de Terapia Intensiva do Hospital de Pronto Socorro de Porto Alegre e que estivessem próximos da sua alta hospitalar. Foram submetidos à avaliação por meio de um protocolo adaptado, validado nacionalmente, que investigou dados sociodemográficos e perfil fonoaudiológico dos pacientes referidos. Resultados: A amostra foi constituída de 10 pacientes, com etiologia predominante de queimadura por álcool, elétrica e chama, totalizando 6 (60%) casos. Todos os pacientes apresentaram dificuldade de deglutição; 70%, esforço ventilatório; 90%, abertura de boca reduzida. A alteração no tempo máximo de emissão teve maior prevalência no sexo masculino, com média de 10,67 segundos; alterações vocais foram encontradas em 7 (70%) pacientes e 9 (90%) apresentaram alterações articulatórias. A dor esteve presente em 3 (30%) pacientes. Conclusão: O perfil fonoaudiológico foi alterado na amostra investigada, conforme o esperado.

Objective: To describe the speech-language pathology profile of patients with burns of head and neck who were hospitalized at the Emergency Hospital of Porto Alegre. Methods: Assessed patients with burns between 2nd and 3rd degree over 18 years-old at the Intensive-Care Unit of Emergency Hospital of Porto Alegre and they were close to their discharge, underwent an evaluation by a protocol adapted nationally validated that investigated socio-demographic data and speech-language pathology of the referred patients. Results: The sample consisted of 10 patients with predominant etiology of alcohol-burning, electrical and flame, totaling 6 (60%) cases. All patients had difficulty swallowing, 70%, difficulty breathing, mouth opening reduced in 9 (90%) cases, changes in the maximum emission time was most prevalent in males with an average of 10.67 seconds, vocal changes were found in 7 (70%) patients and 9 (90%) showed articulation changes. The pain was present in 3 (30%) patients. Conclusion: As expected, the speech-language pathology profile was changed in the investigated sample.

History and development of Chinese Orthodontics / 北京大学学报(医学版)

Orthodontics in China has experienced two important stages. At its early stage from 1950 s to 1970 s orthodontics was a division of prosthodontic department in China. There were 3 top professors in this field, who got partly training at one time or another in USA and returned to China working in Beijing Medical College, the Fourth Military Medical University and Shanghai Second Medical College. Among them, Professor Mao of Beijing Medical College was regarded as the father of Chinese Orthodontics. Removable appliance was the main tool at that stage and Prof.Mao brought forward Mao’s Classification of Malocclusion which is still used in China. The rapid developing stage began in the 1980 s when China opened its door to the world. More and more orthodontists got further training abroad and brought back advanced techniques since then. Up to now, we have already had more than one thousand of orthodontic specialists and established its own organization——the Chinese Orthodontic Society (COS), which holds domestic orthodontic meetings and organize its members to attend international meetings. Right now, almost all advanced techniques in diagnosis and treatment are adopted in China, including 3D imaging, self-ligating bracket appliance, and implant anchorage. Chinese orthodontists have started to present or publish papers in international meetings and journals and more than tiat, started to develop new app-liances, such as Driving-Force Straight Wire Appliance, which has shown advantages in treating skeletal Class Ⅲ malocclusion.