Ejercicios motores orofaciales no verbales: uso y conocimiento de los fonoaudiólogos que trabajan con personas con trastornos de los sonidos del habla / Nonspeech oral motor exercises: use and knowledge of speech-language pathologists working with people with speech sound disorders

Estudios realizados en diferentes países (por ejemplo, Australia, Canadá, India, República de Irlanda, EE.UU., Reino Unido) han demostrado que los fonoaudiólogos utilizan ejercicios motores orofaciales no verbales (EMONV) para tratar los trastornos de los sonidos del habla (TSH), atrayendo atención hacia el sustancial debate que existe respecto a la eficacia clínica de estos ejercicios. En este contexto, el presente estudio tuvo como objetivo investigar y caracterizar el uso de los EMONV por parte de fonoaudiólogos portugueses que realizan intervenciones en TSH y evaluar el conocimiento que lo respalda. Para ello, se invitó a profesionales de la fonoaudiología que trabajan con niños con TSH a completar un cuestionario basado en Thomas y Kaipa (2015). Un total de 184 participantes respondió a la encuesta; 93,5% informó contar con conocimientos sobre los EMONV, 78.5% utiliza EMONV para el tratamiento de TSH y 80,2% los considera efectivos en el tratamiento del TSH (89% indicó que adquirió su conocimiento sobre EMONV a través de cursos de pregrado y posgrado; 98,5% informó que utiliza los EMONV para mejorar las funciones motoras de los órganos fonoarticulatorios). Este estudio ofrece una descripción general del uso de los EMONV por parte de fonoaudiólogos portugueses en la intervención en niños con TSH. Muchos de los participantes en este estudio informaron que utilizan EMONV en el tratamiento de TSH, independientemente de la falta de evidencia para respaldar su uso en este contexto. Estos hallazgos demuestran que el porcentaje de fonoaudiólogos en Portugal que utilizan EMONV es similar al encontrado en los EE.UU., Reino Unido, Canadá e India, pero diferente del porcentaje en Australia e Irlanda.

Previous studies, conducted in different countries (e.g. Australia, Canada, India, Republic of Ireland, USA, UK), have shown that speech-language pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to treat speech sound disorders (SSDs), bringing attention to the substantial debate regarding the clinical effectiveness of NSOMEs. The aim of the present study was to investigate and characterize the use of NSOMEs by Portuguese SLPs in the intervention of SSDs, and to analyze the evidence that supports it. To do so, SLPs who provide therapy to children with SSDs were invited to complete an online questionnaire, based on a previous survey conducted in India by Thomas and Kaipa (2015). A total of 184 participants responded to the survey; 93.5% reported knowing about NSOMEs, 78.5% used NSOMEs in their intervention for SSDs, and 80.2% considered them effective in treating SSDs (89% indicated that their knowledge about NSOMEs was acquired through graduate and post-graduate courses; 98.5% reported that theyused NSOMEs to improve the motor function of the articulators). This study offers an overview of Portuguese speech-language pathologists' reported use of NSOMEs as part of the intervention of speech sound disorders in children. Many of the participants in this study reported that they did use NSOMEs in SSD treatments, regardless of the lack of evidence to support their use in this context. Furthermore, the results show that the percentage of SLPs in Portugal using NSOMEs is similar to those found in the USA, UK, Canada, and India, but different from those in Australia and Ireland.

Effectiveness of simplified predictive intubation difficulty score and thyromental height in head and neck surgeries: an observational study / Eficácia do escore simplificado preditivo de dificuldade de intubação e da altura tiromentoniana em cirurgias de cabeça e pescoço: estudo observacional

Abstract Background and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores >10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.

Resumo Justificativa e objetivos: Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço. Método: Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs, determinados. Resultados: Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM. Conclusões: O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.

Relación entre Síntomas de Trastornos Témporomandibulares Auto-Reportados y el Movimiento Mandibular de Sujetos Adultos Jóvenes / Relationship Between Symptoms of Self-Reported Temporomandibular Disorders and Mandibular Movement of Young Adult Subjects

RESUMEN: Tanto la limitación del movimiento mandibular como el auto reporte de síntomas de trastornos témporomandibulares (TTM) son utilizados como elementos para el diagnóstico de pacientes en la clínica. Sin embargo, la relación entre la presencia de síntomas y el movimiento mandibular no está del todo clara. Por ello, el objetivo de este estudio fue relacionar la presencia de síntomas asociados a TTM con el movimiento mandibular en una muestra de sujetos adultos jóvenes y sanos. En este estudio exploratorio participaron 40 estudiantes de Odontología, médicamente sanos, con arco dentario maxilar y mandibular continuo y completo (hasta el primer molar). A cada uno se les solicitó responder un cuestionario de auto-reporte de síntomas asociados a TTM recomendado por la American Academy of Orofacial Pain (AAOP). También se realizó un registro y análisis de sus movimientos mandibulares utilizando articulografía electromagnética 3D, con el objetivo de correlacionar la presencia de síntomas con el rango y trayectoria de apertura, y el área comprendida en lo que se describe como polígono de Posselt en el plano frontal y sagital. No se encontraron diferencias significativas entre las respuestas a cada pregunta entre hombres y mujeres. De acuerdo a las respuestas y según Delcanho (1994), 12 participantes resultaron necesitar una evaluación más exhaustiva. En este grupo se encontró que el área del polígono de Posselt en el plano frontal, fue significativamente menor que el de aquellos participantes que no requieren una evaluación más exhaustiva (p=0,003). Los valores de la trayectoria de apertura mandibular varían según de que síntoma se trate. Los principales síntomas que afectarían los valores de los movimientos bordeantes son la "dificultad para abrir la boca" y el "ruido en las articulaciones mandibulares". Con este estudio, hemos puesto de manifiesto que la limitación del movimiento mandibular como signo de TTM debe evaluarse con cautela, debido a que según la presencia de determinados síntomas y otras características de los sujetos (como el sexo), su valor podría variar.

ABSTRACT: Both the limitation of mandibular movement and the self-report of symptoms of temporomandibular disorders (TMD) are used for the diagnosis of patients in clinical diagnosis. However, the relationship between the symptoms and mandibular movement is not entirely clear. Therefore, the objective of this study was to relate the presence of symptoms associated with TMD with mandibular movement in a sample of young and healthy adult subjects. This exploratory study involved 40 medically healthy dentistry students with a continuous and complete maxillary and mandibular arch (up to the first molar). Each subject was asked to answer a self-report questionnaire for symptoms associated with TTM recommended by the American Academy of Orofacial Pain (AAOP). We also recorded and analyzed their mandibular movements using 3D electromagnetic articulography, with the aim of correlating the presence of symptoms with the range and trajectory of opening, and the area included in what is described as a polygon of Posselt in the frontal and sagittal plane. No significant differences were found between the answers to each question between men and women. According to the responses and to Delcanho, 12 participants turned out to need a more exhaustive evaluation. In this group it was found that the area of the Posselt polygon in the frontal plane was significantly smaller than that of those participants who did not require a more extensive evaluation (p = 0.003). The values of the mandibular opening path vary depending on the symptom involved. The main symptoms that would affect the values of the bordering movements are the "difficulty to open the mouth" and "noise in the mandibular joints". With this study, we have shown that the limitation of mandibular movement as a sign of TMD should be assessed with caution, as, according to the presence of certain symptoms and other characteristics of subjects (such as sex), its value may vary.

Papel de la leptina en la fisiología y fisiopatología oral / Leptin’s role in oral physiology and physiopathology

Hace 20 años se caracterizó por primera vez a la leptina, como un péptido anorexigénico que actúa a nivel del hipotálamo y desde entonces se le ha descrito un papel clave en el funcionamiento de una gran diversidad de tejidos, siendo la boca un sitio blanco para muchas funciones mediadas por este péptido, tales como la inducción del crecimiento y diferenciación de diversos tejidos dentales y periodontales, la modulación de la percepción del sabor dulce en las papilas gustativas, la regulación de la deglución y la activación de la respuesta inmunológica. Por otra parte, la leptina juega un papel importante en la mediación de la respuesta ante diferentes agentes agresores en la boca, como las bacterias periodontopatógenas y el alcohol, además participa en ciertos tipos de cáncer en esta cavidad. Este resumen pretende dar una visión general de los diferentes roles que cumple la leptina a nivel bucal descritos hasta la fecha, comenzando por su función en la boca sana, hasta llegar a su participación en la fisiopatología bucal.

Leptin was characterized for the first time 20 years ago as an anorexigenic peptide that acts on the hypothalamus and has since been described as having a key role in the functioning of a great number of tissues. The mouth is one of the areas of the body where this peptide influences processes, such as growth induction and differentiation of various dental and periodontal tissues, modulation of sweet tastes’ perception in the taste buds, swallowing regulation and immune response activation. Moreover, leptin also plays an important role in mediating the response to different oral aggressors, such as periodontopathic bacteria and alcohol, as well as its involvement in certain types of mouth cancer. This review aims to provide an overview of leptin’s known roles on the oral cavity to date, ranging from its function in a healthy mouth to its involvement in oral physiopathology.

Oseopercepción: una puesta al día / Osseoperception: an update

La incorporación de implantes dentales al Sistema Estomatognático genera muchos cuestionamientos, entre ellos: ¿Cómo se explica que el paciente “sienta” a través de estos sistemas de anclaje?; ¿Por qué el paciente dice que mastica mejor que con las prótesis mucosoportadas?;¿Por qué a pesar de haber perdido dos componentes fisiológicos esenciales (dientes y periodonto) no se aprecian clínicamente importantes problemas dentro del sistema?; ¿Qué reordenamientos del sistema nervioso determinan la regulación motora luego de rehabilitado con estas técnicas? Es probable que las respuestas surjan a través del conocimiento de una nueva modalidad sensorial descriptacomo oseopercepción, la cual implica un reordenamiento de las áreas sensitivas y motoras de la corteza cerebral (neuroplasticidad).

Many questions arise from the introduction of dental implants into the stomatognathic system, for example: How can patients “feel” through these anchorage structures? Why does the patient feel that his mastication is improved with respect to the classic complete dentures? Why there are not remarkable alterations in the function of the stomatognathic system despite the loss of two essential componentsof this system? What rearrangements of the nervous system take place after the placement of dental implants that control the motor regulation of the stomatognathic system? Probably, the answer to these questions may come from the study of a new sensorymodality known as osseoperception, which involves a rearrangement of sensory and motor areas of the brain cortex (neuroplasticity).

Effect of a biteer bolus on oral, pharyngeal and esophageal transit of healthy subjetts

Context During swallowing, boluses stimulate sensory receptors of the oral, pharyngeal, laryngeal, and esophageal regions. Sweet and tasteless foods are more acceptable for swallowing than bitter foods. A bitter bolus is unpleasant for most subjects. Our hypothesis was that the ingestion of a bitter bolus might alter the oral behavior, pharyngeal and esophageal transit when compared to a sweet bolus. Objective To evaluate whether the bitter taste of a liquid bolus causes alteration on oral, pharyngeal and/or esophageal transit in normal subjects in comparison with sweet bolus.' Method Scintigraphic evaluation of oral, pharyngeal and esophageal transit was performed in 43 asymptomatic subjects, 22 women and 21 men, ages 23-71 years, without problems with the ingestion of liquid and solid foods, and without digestive, cardiac or neurologic diseases. Each subject swallowed in random sequence and at room temperature 5 mL of a liquid bolus with bitter taste, prepared with 50 mL of water with 2 g of leaves of Peumus boldus, heated until boiling (boldus tea), and 5 mL of a liquid bolus with sweet taste, prepared with 50 mL of water with 3 g of sucrose, both labeled with 37 MBq of technetium phytate (Tc99m). Results There was no difference between the bitter bolus and the sweet bolus in mouth, pharynx and esophageal transit and clearance duration and in the amount of residues. Conclusion A bitter bolus, considered an unpleasant bolus, does not alter the duration of oral, pharyngeal and esophageal phases of swallowing, when compared with a sweet bolus, considered a pleasant bolus. .

Contexto Durante a deglutição o bolo estimula os receptores sensoriais da boca, faringe, laringe e esôfago. Os alimentos doces e sem gosto são mais aceitáveis para a deglutição do que os alimentos amargos, que tem gosto desagradável para a maioria dos indivíduos. A hipótese destes autores era que a ingestão de um bolo amargo pode alterar o trânsito oral, faríngeo e esofágico. Objetivo Avaliar se o gosto amargo de um bolo líquido provoca alteração do trânsito oral, faringeo e/ou esofágico de pessoas normais. Método Avaliação cintilográfica dos trânsitos oral, faringeo e esofágico foi realizada em 43 indivíduos assintomáticos, 22 mulheres e 21 homens, com idades entre 23-71 anos, sem problemas com a ingestão de alimentos líquidos e sólidos, sem doença digestiva, cardíaca ou neurológica. Cada indivíduo ingeriu, em sequência aleatória e na temperatura ambiente, 5 mL de um bolo líquido com sabor amargo, preparado com 2 g de folhas de Peumus boldus em 50 mL de água, aquecidas até a temperatura de fervura (chá de boldo), e 5 mL de um bolo líquido com sabor doce, preparado com 3 g de sacarose em 50 mL de água, ambos marcados com 37 MBq de tecnécio fitato (Tc99m). Resultados Não houve diferença entre o bolo amargo e o bolo doce na duração do trânsito pela boca, faringe e esôfago, e na quantidade de resíduos. Conclusão Um bolo amargo, considerado de sabor desagradável, não altera a duração das fases oral, faríngea e esofágica da deglutição, quando comparado com um bolo doce, considerado como sabor agradável. .

Aleitamento materno e sua influência nas habilidades orais de crianças / Influence of breastfeeding on children's oral skills / Lactancia materna y su influencia en las habilidades orales del niño

OBJETIVO: Avaliar a influência de hábitos orais e do aleitamento materno sobre as habilidades orais de crianças. MÉTODOS: Estudo transversal que avaliou as habilidades orais de 125 crianças nascidas a termo, aos nove meses de idade, pertencentes à macrorregião centro-oeste do estado do Rio Grande do Sul, no período de agosto de 2010 a março de 2011. As variáveis estudadas incluíram avaliação das habilidades orais e informações sobre o aleitamento materno e a introdução da alimentação complementar. Análise de regressão logística simples e múltipla foi utilizada na análise dos resultados. RESULTADOS: O aleitamento materno influenciou positivamente a aquisição das habilidades orais de sucção das crianças aos nove meses de idade (OR 3,1; IC95% 1,2;8,3) e o hábito de usar a chupeta influenciou negativamente tais habilidades (OR 0,1; IC95% 0,03;0,6). CONCLUSÕES: O aleitamento materno contribuiu para o amadurecimento orofacial, pois melhorou a habilidade oral de sucção. O uso da chupeta mostrou alterar o funcionamento do sistema estomatognático. Os pais devem ser esclarecidos e recomendados a evitar o uso de chupetas durante a infância.

OBJECTIVE: The objective of this study was to investigate the influence of oral habits and breastfeeding on the oral skills of children. METHODS: Cross-sectional study evaluated the oral skills of 125 nine-month-old-children born at term, belonging to Macro-Midwest region of Rio Grande do Sul between August 2010 and March 2011. Variables included evaluating oral skills and information on breastfeeding and weaning. The results were analyzed using simple and multiple logistic regression. RESULTS: Breastfeeding positively influenced the acquisition of oral skills sucking at nine months of age (OR 3.1, 95%CI 1.2;8.3) and using a pacifier had a negative effect (OR 0.1, 95%CI 0.03;0.6). CONCLUSIONS: It was found that breastfeeding contributed to mature orofacial as it improved the ability of oral suction. Pacifier use was shown to affect the functioning of the stomatognathic system. This should be made clear to parents and the use of pacifiers during infancy should be avoided.

OBJETIVO: Evaluar la influencia de hábitos orales y de la lactanciamaterna sobre las habilidades orales de los niños MÉTODOS: Estudio transversal que evaluó las habilidades orales de 125 niños nacidos a término, a los nueve meses de edad, pertenecientes a la macro región centro oeste del Estado de Rio Grande do Sul, Brasil, en el período de agosto de 2010 a marzo de 2011. Las variables estudiadas incluyeron evaluación de las habilidades orales e informaciones sobre la lactancia materna y la introducción de la alimentación complementaria. Los resultados se analizaron utilizando regresión logística simple y múltiple. RESULTADOS: La lactancia materna influenció positivamente en la adquisición de habilidades orales de succión de los niños a los nueve meses de edad (OR=3,1; IC95% 1,2;8,3), mientras que el hábito de usar el chupete influenció negativamente tales habilidades (OR=0,1; IC95% 0,03;0,6). CONCLUSIONES: La lactancia materna contribuyó para la maduración orofacial, ya que mejoró la habilidad oral de succión. El uso del chupete mostró alterar el funcionamiento del sistema estomatognático. Los padres deben ser informados y recomendados para que eviten el uso de chupetes durante la infancia.

The varying clinical presentations of peripheral ossifying fibroma: a report of three cases / As diversas apresentações de fibroma ossificante periférico: relato de três casos

PURPOSE: Gingival growths are one of the most frequently encountered lesions in the oral cavity. Most of these lesions are innocuous, but some do have malignant potential. Different lesions with similar clinical presentations make it difficult to arrive at a correct diagnosis. One of the infrequently occurring gingival lesions is peripheral ossifying fibroma (POF). Lesions with histological features similar to POF have been given various names, adding to the confusion. We report the varied clinicopathological features of 3 cases of POF, discuss the contentious nomenclature and investigate the possible etiopathogenesis of this disease. CASE DESCRIPTION: Three cases of gingival growths (POF) are reported. Two of the lesions occurred in the maxillary anterior region, while the third occurred in the mandibular posterior region. Two of the cases showed radiographic evidence of bone loss. An excision biopsy was performed in all three cases. CONCLUSION: Because the rate of recurrence for peripheral ossifying fibroma is 8% to 20%, close postoperative monitoring is required. It is also necessary to use consistent and specific nomenclature in the literature to avoid confusion and the loss of important data.

OBJETIVO: Crescimentos gengivais são uma das doenças mais frequentemente encontradas na cavidade oral. A maioria dessas lesões são inócuas, mas alguns têm potencial maligno. Lesões diferentes com apresentações clínicas semelhantes tornam difícil um diagnóstico correto. Uma das lesões gengivais que ocorre raramente é o fibroma ossificante periférico (FOP). Lesões com características histológicas semelhantes ao FOP têm nomenclatura diferente, aumentando a confusão. Este artigo relata as características clinico-patológicos de 3 casos de fibroma ossificante periférico. DESCRIÇÃO DO CASO: Três casos de FOP são relatados. Duas das lesões ocorreram na região anterior da maxila, enquanto a terceira localizava-se na região posterior da mandíbula. Dois dos casos apresentaram evidências radiográficas de perda óssea. Biópsia excisional foi realizada em todos os três casos. CONCLUSÃO: Como a taxa de recorrência para FOP é de 8% a 20%, o monitoramento pós-operatório é necessário. Deve-se utilizar nomenclatura consistente e específica na literatura para evitar confusão e perda de dados importantes.

The relationship between the oral and pharyngeal phases of swallowing

OBJECTIVE: This study was designed to investigate a possible relationship between the duration of the oral and pharyngeal phases of swallowing. INTRODUCTION: The oral and pharyngeal phases of swallowing are independent from each other but may be related. METHODS: We used videofluoroscopy to evaluate 30 healthy volunteers between 29 and 77 years of age who swallowed 5- and 10-ml liquid and paste boluses in duplicate. The duration of the oral phase, pharyngeal transit, and pharyngeal clearance were measured. RESULTS: There were no differences in oral or pharyngeal transit times between the liquid and paste boluses or between the volumes of 5 and 10 ml (p>0.40). The pharyngeal clearance time for the paste bolus (0.48 ± 0.27 s) was longer than for the liquid bolus (0.38 ± 0.11 s, p = 0.03) with no difference between the volumes of 5 and 10 ml. There was no significant correlation between the oral transit time and the duration of pharyngeal transit for the liquid (5 ml, Spearman's coefficient p: -0.14; 10 ml, p: 0.18) or the paste (5 ml, p: 0.08; 10 ml, p: 0.10). The correlation between the oral transit time and the pharyngeal clearance time was not significant for the liquid bolus (5 ml, p: 0.31; 10 ml, p: 0.18), but it was significant for both the 5 ml (p: 0.71) and 10 ml (p: 0.64) paste boluses. DISCUSSION: The relationship between the oral and pharyngeal phases of swallowing can be affected by bolus consistency. CONCLUSION: There is a correlation between the duration of oral transit and the duration of pharyngeal clearance during the swallowing of paste boluses.

[Evaluation of maximum mouth opening after bilateral sagittal split osteotomy in patients with mandibular prognathism]

Mandibular prognathism is one of the most common skeletal disorders in Iranian population and so mandibular setback surgery is one of the most common surgeries in Oral and Mxilllofacial area. Ramus sagittal osteotomy is one of the surgeries which is done for the purpose of mandibular setback or advancement. The purpose of this study was to evaluate the progress of maximum mouth opening [MMO] after bilateral sagittal split osteotomy [BSSO] surgery in patients with mandibular prognathism. In this study, 36 patient's undergone BSSO surgery with Hunsck technique in order to correct manibular prognathism were taken into consideration. In all patients, fixation was done with three titanium screw in each side. Maximum mouth opening was measured before surgery and within 1, 3, 6 months after surgery. Repeated measurement was performed for data analysis [alpha = 0.05]. In the patients 81.32% of maximum mouth opening was gained after one mouth, 92.1/5 after three months and nearly total recovery [98.94%] after 6 months of surgery. The results confirm the concept that limitation in MMO is not a long lasting complication in bilateral sagittal split osteotomy surgery in patients with mandibular prognathism and it would approximatey be as same as before surgery after six months

Relation between oral stereognosis and masticatory efficiency in complete denture wearers: an in vivo study

Aim: The purpose of the present study was to evaluate the possible association between the oral stereognostic ability and masticatory efficiency at the time of denture insertion and after 6 months in complete denture wearers. Methods: Sixty edentulous patients were selected. The study was conducted in two parts. First, on the day of denture fit-in oral stereognostic ability test was conducted,followed by masticatory efficiency was carried out. The patients were recalled for check up after 6months and the same test was performed again. Data were tabulated and analyzed statistically by paired t-test and Pearson’s correlation coefficient. Results: There was weak correlation between oral stereognosis and masticatory efficiency. Many opinions have been presented in the literature in the past regarding oral stereognosis. The issue whether oral stereognosis also helps inpatients’ adaptation towards complete denture prosthesis is still ambiguous. No consensus has been reached. This study is further an attempt to understand the basic physiology of oral stereognosis and whether there is any possible relation between oral stereognosis and masticatory efficiency.Conclusions: Within the limitation of this study, it can be concluded that oral stereognostic ability improves with time, which might be due to adaptation to the denture. As adaptation towardsdenture improves masticatory efficiency improves as well. This study showed that there might bea weak association between oral stereognosis and masticatory efficiency.

Oral and perioral physiological changes with ageing

Ageing is the accumulation of changes over time. Ageing in humans is a multidimensional process including physical and psychosocial changes. Therefore, the management of the oral problems in elderly patients does not depend on the development of new technical skills, but rather on the overall knowledge of age-related and disease-related changes. Moreover, the dentist should be aware of the different modification necessary in the practice to prevent, diagnose and manage different oral conditions in the geriatric patient. Thus, the aim of this article is to gather the oral changes including salivary gland and saliva, tongue and oral sensation, lips, perioral tissues with ageing to enhance dentist's overall knowledge associated with these changes

Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no Sul do Brasil / Clinical-epidemiologic characteristics of patients with oral cavity and oropharynx cancer in a Private Ambulatory in South Brazil

Objetivo: Definir o perfil clínico e epidemiológico dos pacientes com diagnóstico de câncer de boca e orofaringe, atendidos em clínica de cirurgia de Cabeça e Pescoço. Métodos: Foram avaliados os prontuários dos pacientes com diagnóstico de carcinoma de boca e orofaringe atendidos no período de 2002 a 2006, em clínica decirurgia de Cabeça e Pescoço. Foram incluídos no estudo os prontuários de pacientes que foram submetidos, após o estadiamento da doença, a alguma modalidade de tratamento. Resultados: Entre os 28 casos incluídos no estudo,88,8% eram do gênero masculino, 85,7% eram caucasianos e a faixa etária mais acometida foi entre 51 e 60anos. A queixa de “ferida na boca” esteve presente em 88,8% dos casos de carcinoma de boca e odinofagia em80% dos casos de carcinoma de orofaringe. O tabagismo esteve presente em 92,8% e o etilismo em 85,7% dos pacientes. O sítio mais acometido na cavidade oral foi a língua (50%) e, na orofaringe, a amigdala e o palato mole (ambos com 40%). A maior parte dos pacientes foi submetida a tratamento cirúrgico radical (77,7%) com ou sem radioterapia adjuvante. O diagnóstico histopatológico, em aproximadamente 96% dos casos, indicou carcinoma espinocelular. Conclusões: Especial atenção dos profissionais de saúde, principalmente médicos e odontólogos, deve serdirecionada aos pacientes com idade maior que 50 anos, tabagistas e etilistas, com queixa de lesão na cavidade oral ou odinofagia persistente, com o objetivo de diagnósticosprecoces e maiores índices de tratamentos curativos, com menores taxas de morbidade e mortalidade.

Objective: It mains evaluate clinical and epidemiological factors of patients with oral cavity and oropharynx cancer that were trated in a head and neck surgeryclinic. Methods: The patients’ records that were taken care from 2002 to 2006 in head and neck surgery clinic andpatients with mouth and oropharynx carcinoma were evaluated. Results: Among 28 patients, 88,8% were men, 85,7% were caucasian, the average age was from 51 to 60, the complain about hurt in mouth was in 88,8% of the patients with oral cavity cancer and the odinofagia in 80% of the patients with oropharynx cancer.92,8% used tosmoke and 85,7% used to drink alcoholic drinks. The tongue was the most stricken part in oral cavity (50%), tonsil and soft palate (both 40%) in oropharynx. In the diagnose most of the patients were in advanced clinicalstaging cancer (III and IV) and infiltrating ulcer in both situations. Most of the patients were submitted to a radical the surgery treatment (77.7%) with or without adjuvant radiation therapy or chemotherapy. In almost 96% of the cases the histopathology diagnosis indicated squamous cell carcinoma. Conclusion: Special attention from the health professionals, mainly physicians and dentists, must be givento patients older than 50 years, smokers and alcoholic drunker, that complain about persistent oral hurt or odinofagiain an appointment to have a precocious diagnoses and higher ways of curative treatments, with lesser evidence of morbidity and mortality.

Electromyographic evaluation of mastication and swallowing in elderly individuals with mandibular fixed implant-supported prostheses

This study evaluated the effect of implant-supported oral rehabilitation in the mandible on the electromyographic activity during mastication and swallowing in edentulous elderly individuals. Fifteen patients aged more than 60 years were evaluated, being 10 females and 5 males. All patients were edentulous, wore removable complete dentures on both dental arches, and had the mandibular dentures replaced by implant-supported prostheses. All patients were submitted to electromyographic evaluation of the masseter, superior orbicularis oris muscles, and the submental muscles, before surgery and 3, 6 and 18 months postoperatively, using foods of different textures. The results obtained at the different periods were analyzed statistically by Kruskal-Wallis non-parametric test. Statistical analysis showed that only the masseter muscle had a significant loss in electromyographic activity (p<0.001), with a tendency of similar response for the submental muscles. Moreover, there was an increase in the activity of the orbicularis oris muscle during rubber chewing after treatment, yet without statistically significant difference. Mandibular fixed implant-supported prostheses in elderly individuals revealed a decrease in electromyographic amplitude for the masseter muscles during swallowing, which may indicate adaptation to new conditions of stability provided by fixation of the complete denture in the mandibular arch.

El aparato dentario, su forma y función con dientes naturales, artificiales y mixtos / The dental apparatus, its form and function with natural artificial and mixed teeth

En el siglo XX, diversos autores acordaron denominar la forma de la cavidad bucal en seres humanos como una figura ovalada, terminología que no concuerda, por referirse este fonema a un gráfico plano. Entonces, se decidió buscar nuevos vocablos para la forma de la misma; conjuntamente, se estudió y se determinó el volumen que aún no estaba establecido. Finalmente, se acordó que la cavidad bucal es un cuerpo cuadridimensional cambiante, con superficie, volumen, espesor, límites, anexos y un tiempo individual de concavidad interna, comprobándose que la forma es esferoidal y de un volumen apropiado para establecer el tamaño del bolo alimenticio.

Desenvolvimento do sistema sensório motor oral e motor global em lactentes pré-termo / Sensory oral motor and global motor development of preterm infants

TEMA: avaliação do desenvolvimento de lactentes nascidos pré-termo. OBJETIVO: avaliar associação entre a idade gestacional (IG) de lactentes nascidos pré-termo com o desenvolvimento motor global e com sinais precoces de alteração do desenvolvimento do sistema sensório motor oral, verificando uma possível associação entre eles. MÉTODO: estudo exploratório que avaliou o desenvolvimento de 55 lactentes com idade cronológica corrigida entre quatro e cinco meses, nascidos pré-termo no Instituto Materno Infantil Professor Fernando Figueira (IMIP) e acompanhados no Ambulatório de Egressos do Programa Mãe Canguru, no período de março a agosto de 2004. A avaliação do desenvolvimento do sistema sensório motor oral foi realizada através de indicadores pré-selecionados e a do desenvolvimento motor global através da Alberta Infant Motor Scale (AIMS). RESULTADOS: os lactentes com menor IG ao nascer (29 a 34 semanas) apresentaram uma mediana mais elevada do índice de sinais de risco na avaliação do desenvolvimento sensório motor oral, quando comparados com os nascidos com maior IG (35 a 36 semanas). Em relação ao desenvolvimento motor, os lactentes com menor IG ao nascer apresentaram um maior percentual de escore da AIMS abaixo do percentil 10 (26 por cento), quando comparado com os nascidos com maior IG (4 por cento) (p = 0,009). A mediana do índice dos sinais de risco para o desenvolvimento sensório motor oral foi significantemente maior entre os lactentes com escore total da AIMS inferior ao percentil 25, quando comparada com os que apresentaram escore igual ou maior que o percentil 25. CONCLUSÃO: a idade gestacional dos lactentes ao nascer influenciou o desenvolvimento do sistema sensório motor oral e motor global em detrimento dos RN com menor IG. Esses achados sugerem uma possível associação entre ambos aspectos do desenvolvimento infantil.

BACKGROUND: development assessment of preterm infants. AIM: to evaluate the association between the gestational ages (GA) of premature infants with the global motor development as well as with early signs of sensory oral motor development delay, and to verify a possible association between them. METHOD: an exploratory study that assessed the development of 55 infants with corrected chronological ages between four to five months, born preterm at the Instituto Materno Infantil Professor Fernando Figueira (IMIP) and who were followed at the Kangaroo Mother Program Clinic between March and August of 2004. The assessment of the sensory oral motor development was performed through pre-selected indicators and of the global motor development through the Alberta Infant Motor Scale (AIMS). RESULTS: infants with lower GA (29 to 34 weeks) presented a higher median of risk signs in the sensory oral motor development assessment when compared to those with higher GA (35 to 36 weeks). Regarding the global motor development, infants born with lower GA presented a higher number of scores in the AIMS below percentile 10 (26 percent) when compared to those with a higher GA (4 percent) (p=0.009). The median index of the risk signs for the sensory oral motor development were significantly higher among infants with total AIMS scores below percentile 25 when compared to those with scores equal to or above percentile 25. CONCLUSION: the gestational age of infants at birth influenced the sensory oral motor and global motor development - infants with lower gestational ages presented worse performances. These findings suggest a possible association between both aspects of infant development.

Amamentação de prematuros com menos de 1500 gramas: funcionamento motor-oral e apego / Breastfeeding of premature babies with less than 1500g: oral motor functioning and attachment

TEMA: amamentação de pré-termo. OBJETIVO: descrever a amamentação em bebês pré-termo de muito baixo peso e associações com disfunções orais e apego mãe-bebê. MÉTODO: estudo transversal com 48 bebês. Foram realizadas entrevista com as mães, avaliação oral e dos sinais de apego. Foi feita análise descritiva e Teste Exato de Fischer. RESULTADOS: as variáveis que se associaram estatisticamente à adequação da sucção nutritiva foram: postura no seio, preensão do mamilo, coordenação da sucção, respiração e deglutição, força e sua sustentação, ritmo e alerta. Doze díades tiveram suspeita de alteração do apego. CONCLUSÃO: componentes do sistema oral estão associados à qualidade da alimentação destes prematuros. Isto sugere que a avaliação precoce da amamentação pode detectar dificuldades que a colocam em risco.