Mechanical stress distribution over the palate by different pacifiers assessed by finite element analysis and clinical data.

The mechanical behavior of each type of pacifier on rigid structures and their various impacts on orofacial growth have yet to be discovered. The study aimed to evaluate the stress distribution over a child's palate by three types of pacifiers using finite element analysis and clinical and laboratory data. Modulus of elasticity was obtained from 30 specimens comprising 10 of each conventional (A), orthodontic (B), and breast-shaped (C) pacifiers. Tongue strength was assessed in eight 3-year-old children (kPa). A hemi-maxilla model was obtained from 2- to 3-year-old skull tomography, and the images of pacifiers A, B, and C were captured using 3D scanning. The Hypermesh® program generated a mesh of 6-node tetrahedral elements for applying forces in the X, Y, and Z directions to enable a nonlinear analysis. Pacifier B exhibited the highest values for distributed stress on the palate, followed by pacifier A. Pacifier B stimulated the maxilla forward and sideways. In contrast, pacifier A promoted a forward and upward load, favoring a more atresic palate. Pacifiers A and B tended to rotate in the sagittal plane, generating tensions in the anterior incisors and favoring the open bite. Pacifier C exhibited lateral expansion by stress induction over the mid-palatal suture with less influence on incisor inclination. Pacifiers showed different detrimental stress distributions on the palate. This information can be helpful for improving recommendations given to parents.

Impact of gastroplasty on salivary characteristics, dental health status and oral sensory aspects: A controlled clinical study.

BACKGROUND: Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion. OBJECTIVES: To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study. METHODS: Seventy-three adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n = 34) followed-up during a 6-months dietary programme, and Gastroplasty group (GG; n = 39) evaluated immediately before, 3 and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the four basic tastes were assessed. Two-way mixed model and sign test were applied. RESULTS: Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p < .001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p < .05). CONCLUSION: After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.

Clustering profiles of demographic and clinical characteristics and the oral health impact of individuals with temporomandibular disorders.

OBJECTIVE: To identify profiles of demographic, clinical, and oral health impact characteristics of individuals with temporomandibular disorder (TMD). METHODS: Four hundred ninety-six TMD patients (260 females) and 30 young controls were included. Sociodemographic, clinical, and Oral Health Impact Profile (OHIP-14) data were gathered and analyzed by Cluster, ANOVA, and regression analyses. RESULTS: Three clusters were identified: "Pain and depression symptoms" with participants with higher pain, depression, and OHIP-14 scores (59% females); "Chronic diseases" included older participants with current chronic diseases and medical treatment; "Healthier individuals" included younger individuals with lower chronic diseases, pain, and depression frequencies, whose OHIP-14 scores did not differ from controls (p = 0.079). OHIP-14 scores were predicted by age, pain, and depression. CONCLUSION: Distinct profiles of individuals with TMD were identified, emphasizing the complex interactions between coping ability, general health, and psychosocial aspects that must be monitored.

Multidisciplinary Evaluation of Pacifier Removal on Oro-Dentofacial Structures: A Controlled Clinical Trial.

It is well recognized that pacifier habit leads to occlusal and orofacial functional changes in children. However, the effects of the interruption of prolonged pacifier habit on the development of the dento-facial complex has not yet been fully characterized. Thus, the aim of this study was to investigate the influence of pacifier removal on aspects of oro-dentofacial morphology and function in preschool children. For that, a pacifier group (n = 28) and a control group (n = 32) of 4-year-old children with and without pacifier habit, respectively, were followed up by a group of dentists and speech therapists at baseline, 6 and 12 months after habit removal. Bite force and lip pressure were assessed using digital systems, and the evaluation of breathing and speech functions was performed using validated protocols, together with the measurements of dental casts and facial anthropometry. The Two-way mixed model ANOVA was used in data analysis. After 12 months, a decrease in malocclusion frequency was observed in pacifier group. Additionally, a change over time was observed in facial, intermolar and palate depth measurements, as well in bite and lip forces and speech function scores, increasing in both groups (p < 0.01). The upper and lower intercanine widths and breathing scores differed between groups at baseline and changed over time reducing the differences. The presence of speech distortions was more frequent in the pacifier group at baseline and decreased over time (p < 0.05). The interruption of pacifier habit improved the maxillary and mandibular intercanine widths, as well as the breathing and speech functions, overcoming the oro-dentofacial changes found. Trial Registration: This clinical trial was registered in the Brazilian Clinical Trials Registry (ReBEC; http://www.ensaiosclinicos.gov.br/), protocol no. RBR-728MJ2.

Salivary Microbiological and Gingival Health Status Evaluation of Adolescents With Overweight and Obesity: A Cluster Analysis.

Given the high prevalence of obesity in children and adolescents, the investigation of early markers is of clinical importance to better manage this condition. Thus, the aim was to evaluate the cross-sectional relationship between salivary microbiota, gingival health status, and excess weight in adolescents. A total of 248 students (14-17 y; 119 girls) were included, free of caries lesions and periodontal pockets. Physical examination included measures of height, weight, and body fat percentage (%BF). Oral examination was performed to gather information on dental (DMFT index) and gingival health status. Unstimulated saliva was submitted to qPCR reactions to quantify Streptococcus mutans, Porphyromonas gingivalis, Bifidobacteria, and Streptococcus pneumoniae percentages and the NFKappaB expression. Two-way ANOVA was applied considering group (normal-weight/overweight/obesity) and sex factors, in addition to cluster analysis. Group effect was significant for %S. mutans (partial eta2 = 0.20; p < 0.001) and %Bifidobacteria (partial eta2 = 0.19; p < 0.001), with overweight and obesity groups showing the highest levels compared to normal-weight ones, with no significant sex effect. There was no difference in the frequency of gingivitis, P. gingivalis, and S. pneumoniae percentages or NFKappaB expression between groups. Cluster analysis generated three clusters according to body fat accumulation: "Higher %BF," "Moderate %BF," and "Lower %BF." "Higher %BF" cluster was characterized by higher body fat percentage and higher salivary %Bifidobacteria, while cluster "Lower %BF" was characterized by lower body fat percentage and lower frequency of gingivitis ("Moderate %BF" cluster was the contrast). According to nutritional status, a difference in salivary S. mutans and Bifidobacteria percentages was found, with overweight or obesity adolescents showing the highest percentages than normal-weight ones. Besides, a positive relationship between body fat accumulation and Bifidobacteria count was observed, indicating a possible interaction between oral bacteria communities and weight gain.

Salivary uric acid is a predictive marker of body fat percentage in adolescents.

As saliva showed to be a noninvasive source of markers useful to monitor clinical status, the hypothesis tested was that saliva may provide reliable markers able to predict the body fat accumulation in young subjects. The salivary characteristics of 248 adolescent scholars (119 girls; 14-17 years) of flow rate, pH, phosphorus, urea, and calcium concentrations were assessed in stimulated saliva (colorimetric automated technique). The concentrations of cholesterol, 7-ketocholesterol, 25-hydroxyvitamin D2 and D3, and uric acid (UA) were measured with high-performance liquid chromatography in saliva collected at home (12-hour fast). Physical examination included height, weight, and body fat percentage (%BF) measured using bioelectric impedance to classify groups in below/above the %BF cutoff. Data were evaluated using 2-way analysis of variance and multiple linear regression. No significant difference was found in the levels of 25-hydroxyvitamin D2 and D3, cholesterol, 7-ketocholesterol, phosphorus, calcium, and urea between groups above and below %BF cutoff, and the variation in salivary flow was small. Significant sex and group effects were observed for salivary UA, which was increased in adolecents with higher %BF and in males (compared to females), without sex group interaction (power = 99.8%). Sex showed a significant effect on salivary urea, with lower levels in females. A predictive model was obtained, with salivary UA and sex explaining the variation of %BF (P < .001; power = 84%). Salivary UA showed to be an important marker of body fat accumulation in adolescents, demonstrating the clinical relevance of saliva to detect early changes and to monitor the nutritional status using a noninvasive and accurate method.

Low-level laser therapy and anesthetic infiltration for orofacial pain in patients with fibromyalgia: a randomized clinical trial

Background: To compare the analgesic effect of anesthetic infiltration of lidocaine 2% and low-level laser therapy (LLLT) by GaAlAs into tender points of patients with orofacial pain and fibromyalgia (FM). Material and Methods: A randomized clinical trial was performed with adults (N=66) that were allocated into two groups (1:1): Group A received LLLT irradiation by Diode Laser GaAlAs (780nm) with expositions twice a week during six weeks and Group B was treated with anesthetic infiltration of lidocaine 2% without vasoconstrictor once a week for four weeks. The pain assessment included the Visual Analogic Scale (VAS) and tenderness to palpation. Results: No dropout and adverse effect was observed during the study. The pain decreased significantly in each group after the treatment (p=0.0001, β=1.0), even though no statistical difference was found between both treatments (p=0.46, β= 0.82). The presence of tender points decreased after both treatments, with responsively in some types of masticatory muscles (p<0.05) except posterior temporalis muscle. The patients' perception showed that both treatments were effective and a few patients reported that the treatment did not improve welfare. Conclusions: The LLLT by GaAlAs and anesthetic infiltration of lidocaine 2% were equally effective to control orofacial pain in FM individuals (AU)

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Chewing in adolescents with overweight and obesity: An exploratory study with behavioral approach.

Physiological and behavioral aspects of masticatory function may have an impact on nutritional status, which has been little studied. The aim was to perform a comprehensive evaluation of objective, subjective and behavioral aspects of masticatory function in 231 adolescents, aged 14-17 years and compare these parameters between normal-weight (n = 115) and adolescents with overweight/obesity (n = 116). Objective aspects were examined by the Oro-facial Myofunctional Evaluation-expanded protocol (OMES-e), determining the masticatory type, chewing time/frequency, abnormal movements, and other; masticatory performance (color changeable chewing gum) and bite force were also explored. The subjective and behavioral evaluations were assessed using the Quality of Mastication Function Questionnaire, which explores the masticatory behavior and frequency/intensity of difficulty in chewing different types of foods. Results were submitted to normality tests, Chi-square, unpaired t-test and Mann-Whitney. A multiple linear regression model was used to evaluate which of the variables under study contributed to the variation in Percent Body Fat (α = 0.05). The results showed that OMES-e total score differed significantly between groups, that is, individuals with overweight showed more changes in oro-facial myofunctional aspects than normal-weight ones. Unilateral mastication was more frequent among females with overweight/obesity. They also showed greater difficulty on Habits and Fruit domains, reporting the need of adding sauce to the meal to facilitate swallowing and peeling and cutting fruit (apples) in small pieces in order to better chew them. OMES-e total score also showed a significant relationship with Percent Body Fat. Masticatory performance evaluated by chewing gum and bite force did not differ between groups. This study showed that adolescents with excess weight presented changes in masticatory behavior and greater difficulty in performing the masticatory function comparing to normal-weight ones.

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.

Abordagem ortodôntica na correção da classe III com mordida aberta anterior com osteotomia sagital mandibular e mentoplastia – caso clínico / Orthodontic approach in class III correction associated to open bite with sagittal mandibular osteotomy and mentoplasty – case report

O presente trabalho tem a finalidade de relatar um caso orto-cirúrgico de uma paciente com má oclusão do tipo Classe III associada a uma mordida aberta anterior. O plano de tratamento foi estabelecido em quatro fases, a pré-cirúrgica, a transcirúrgica, a pós-cirúrgica e a fase de contenção. Após o diagnóstico, todas as metas do tratamento foram estabelecidas e discutidas de maneira conjunta entre o ortodontista e o cirurgião bucomaxilofacial. Na fase pré-cirúrgica foram feitos todos os procedimentos para a descompensação dentária em ambos os maxilares. O procedimento cirúrgico consistiu na rotação anti-horária da mandíbula por meio da osteotomia sagital do ramo mandibular juntamente com mentoplastia. Na fase transoperatória foi conseguida a intercuspidação dentária com obtenção de um trespasse vertical e horizontal adequados pelo ato cirúrgico e por procedimentos fisioterápicos até que fosse retomada a função ideal do sistema estomatognático. Após esta fase, a paciente retornou à clínica ortodôntica para que fosse submetida aos procedimentos de finalização. Foi colocada uma contenção superior e inferior.

The present study aims to report an ortho-surgical case of a patient with Class III malocclusion associated with an anterior open bite. The treatment plan was established in four phases, the pre-surgical, trans-surgical, post-surgical and the retention phase. After the diagnosis, all treatment goals were established and discussed jointly between the orthodontist and maxillofacial surgeon. At pre-surgical phase all procedures for dental decompensation were performed in both jaws. The surgical procedure consisted on a counterclockwise rotation of the mandible by sagittal osteotomy of the mandibular ramus with mentoplasty. At transoperative dental intercuspation was achieved through vertical and horizontal overlap suitable for surgery and physiotherapy procedures until this resume optimal function of the stomatognathic system. After this phase, the patient returned to the clinic to complete the procedure. An upper and lower retainer was placed.

Alterações nas dimensões dos arcos dentários em pacientes com classe II, primeira divisão, tratados com AEB / Changes in dental arch dimensions in patients with class II, division 1, malocclusion treated with headgear

O objetivo deste estudo foi avaliar as possíveis alterações nas larguras intercaninos e intermolares, e no comprimento dos arcos dentários, em modelos de gesso, de pacientes submetidos ao tratamento ortodôntico com aparelho extrabucal (AEB). Para isso, foram selecionados 12 pares de modelos em gesso de pacientes com classe II, primeira divisão, antes e após o tratamento com AEB, totalizando 24 pares de modelos. As medidas da distância intermolares e intercaninos foram obtidas por meio de um paquímetro digital com precisão de 0,000 mm. Os resultados demonstraram aumento estatisticamente significante nas distâncias intermolares superiores. Não ocorreram diferenças estatisticamente significantes nas distâncias intercaninos e nos comprimentos dos arcos dentários. Concluiu-se que no tratamento ortodôntico com AEB em pacientes classe II, primeira divisão, na dentição mista, pode-se esperar um aumento significativo nas distâncias intermolares superiores...

The aim of this study was to evaluate possible changes in the intermolar distance, intercanine distance and arch length, through dental casts, of patients undergoing orthodontic treatment with headgear. To that end, we selected 12 pairs of dental casts of patients with class II, division 1 before and after treatment with headgear, totaling 24 pairs of dental casts. The measures of intermolar and intercanine distances were performed on casts with digital calipers accurate to 0.000 mm. The results showed a statistically significant increase in the upper intermolar distances. There were no statistically significant differences in the intercanine distances and dental arches lengths. It was concluded that orthodontic treatment with headgear in class II, division 1 patients, in mixed dentition we can expect a significant increase in the upper intermolar distances...