Chewing Problems Research Articles

The relationship between oral health and dental care usage behavior and health-related quality of life (EQ-5D) in women who have experienced pregnancy and childbirth

Objectives: This study analyzed raw data from the 8th National Health and Nutrition Examination Survey (2019-2021) to assess the impact of oral health problems and dental care usage patterns of women who have experienced pregnancy and childbirth. Methods: Out of the 2,389 participants with pregnancy and childbirth experience, 1,301 were included in the final analysis. Multiple regression analysis was conducted using to determine the influencing factors on EQ-5D. Results: Factors influencing EQ5D include general characteristics (age, family income (5 quintile), status of basic living subsistence, education level), oral health problems (chewing problems, complaints of chewing discomfort, speaking problems) (p<0.001). Conclusions: The oral health problems and dental care usage patterns of women who experience pregnancy and childbirth have a significant impact on their health-related quality of life. This study provides basic data for women’s ongoing oral care.

Impact of dental caries and Self-perceived oral health on daily lives of children and mothers in rural Egypt: a household survey

BackgroundThe present study assessed the impact of oral health on the daily lives of children and mothers living in a rural area in Northwestern Egypt.MethodsA cross-sectional household survey including children between 6 and 12 years old and their mothers was conducted in rural Egypt, 2019–2020. Data were collected using clinical examination and interview-based questionnaires of children and mothers. Three binary logistic regression models were used to assess the relationship between the dependent variables (oral health impact (yes, no) on avoiding smiling, chewing problems, and missing school (children) and avoiding social events (mothers)), and the explanatory variables: oral health (clinically-assessed caries experience and self-reported oral health) controlling for sociodemographic profile (child age and sex, mother’s education), daily toothbrushing and village of residence.ResultsA total of 211 households with 355 children and 211 mothers were included (91.5% response rate). About 54% of the children were girls, mean (SD) age = 8.7 (2.05) years and 82.3% did not brush their teeth daily. Mother’s mean (SD) age was 31.70 (5.45) years. Because of dental problems, 31.3% of children reported chewing difficulties, 31% avoided smiling compared to 76.3% and 43.6% of mothers. Also, 30.4% of children missed school and 76.8% of mothers reported reduced participation in social activities. In children, the number of decayed anterior teeth was associated with significantly higher odds of avoiding smiling (AOR = 1.22, 95%CI: 1.03, 1.44). In mothers, a greater number of posterior missing teeth was associated with significantly higher odds of chewing difficulties (AOR = 1.21, 95%CI: 1.01, 1.45), and a greater number of all missing teeth was associated with significantly higher odds of reduced participation in social events (AOR = 1.30, 95%CI: 1.30, 1.57). Good/ very good reported oral health in children and mothers was associated with lower odds of avoiding smiling and chewing problems (p < 0.05).ConclusionDecayed anterior teeth in children have a negative impact on smiling whereas missing teeth in mothers affect the ability to chew food and socialize. The psychological, functional, and social impacts of caries in this rural setting needs to be mitigated by improving oral health literacy and access to care.

Association between Self-Perception of Chewing, Chewing Behavior, and the Presence of Gastrointestinal Symptoms in Candidates for Bariatric Surgery.

Given the changes in the digestive tract post-bariatric surgery, adapting to a new pattern of eating behavior becomes crucial, with special attention to the specifics of chewing mechanics. This study aimed to investigate the association between self-perception of chewing, chewing behavior, and the presence of gastrointestinal symptoms in preoperative patients undergoing bariatric surgery. Sixty adult candidates for bariatric surgery at a public hospital in Belém (Brazil) were analyzed. Participants predominantly exhibited unilateral chewing patterns (91.6%), a fast chewing rhythm (73.3%), a large food bolus (80%), liquid intake during meals (36.7%), and 41.7% reported that chewing could cause some issue. Significant associations were found between the perception of causing problems and chewing scarcity (p = 0.006), diarrhea (p = 0.004), absence of slow chewing (p = 0.048), and frequent cutting of food with front teeth (p = 0.034). These findings reveal a relationship between the perception of chewing problems and chewing scarcity, presence of diarrhea, and fast chewing.

The effect of early childhood caries on chewing function and tolerated food texture levels in preschool children.

The early form of caries can affect solid food consumption. The aim of the study was to evaluate the effect of oral health status on chewing performance, and tolerated food texture among preschool children suffering from early childhood caries (ECC). A cross-sectional study was conducted with a sample of 109 children aged between 3 and 6 years, who were allocated to three groups (severe-ECC (s-ECC), ECC and control) on the basis of their caries. Chewing function was evaluated by using the 'Karaduman Chewing Performance Scale (KCPS)' and the Turkish version of the 'Mastication Observation and Evaluation instrument (T-MOE)', and the tolerated food texture was determined by the 'International Dysphagia Diet Standardization Initiative (IDDSI)'. Carious lesions, oral hygiene and gingival health status were evaluated by using the 'decayed, missing, filled tooth/surface indices (dmft/s)', 'plaque and gingival indices'; respectively. A total of 56 children (51.4%) had s-ECC, 39 (35.8%) had ECC and 14 (12.8%) had no caries (control group). KCPS showed that 26 (86.7%) children suffering from s-ECC were at level 1, and 11 (100%) children were at level 2. Seven (100%) children with s-ECC had IDDSI level-5. All children with healthy oral status had IDSSI level-7. Compared to the ECC and control groups, the s-ECC group had significantly lower scores from the T-MOE total and subscale scores (p < .001). The evaluation of chewing performance during routine dental examinations of children with ECC (especially s-ECC) may considerably contribute to the early diagnosis of chewing problems and the provision of necessary oral rehabilitation.

The relationship between the severity of intellectual and developmental disabilities (IDDs) in adults with IDDs and eating and drinking problems and nutritional status.

Adults with intellectual and developmental disabilities (IDDs) experience eating, drinking and swallowing problems, such as chewing problems, choking, gagging, coughing during eating, aspiration and rumination syndrome, which may lead to poor nutritional status. This study aimed to determine the relationship between IDD levels, eating, drinking and swallowing problems and nutritional status in adults with IDDs. The sample consisted of 71 participants (37 men and 34 women) with a mean age of 22.5±7years (range 18-60years). Professionals classified intellectual disability as mild, moderate or severe. The Screening Tool of Feeding Problems scale was applied to the caregivers of adults with IDDs to identify eating, drinking and swallowing problems. Dietary intake was assessed using a 24-h dietary recall and a food and nutrition photograph catalogue. The researchers measured body weight, height and middle upper arm circumference. Body mass index was calculated. Four body mass index categories were determined: underweight (<18.5kg/m2 ), normal weight (18.5-24.9kg/m2 ), overweight (25.0-29.9kg/m2 ) and obese (≥30kg/m2 ). Chi-squared tests were used to detect the relationship between IDD levels and eating and drinking problems, and analysis of variance tests were conducted to detect the relationship between IDD levels with anthropometric measurements and dietary intake. Participants had mild (42.3%; n=30), moderate (29.6%; n=21) or severe IDD (28.2%; n=20). They were underweight (12.7%; n=9), normal weight (59.2%; n=42) or overweight and/or obese (28.2%; n=20). Participants with severe IDD had significantly higher Screening Tool of Feeding Problems 'nutrition-related behaviour' and 'eating and drinking skill deficit problem' sub-scale scores than those with mild IDD. However, the groups had no significant difference in 'food refusal and selectivity' sub-scale scores. Participants with severe IDD also had anorexia prevalence similar to those with mild IDD. The groups did not significantly differ in anthropometric measurements, daily energy intake and macronutrient and micronutrient intake. While adults with severe IDD had more eating and drinking skill deficits (e.g. chewing problems and independent eating difficulties) and nutrition-related behaviour problems than those with mild IDD, the eating, drinking and swallowing problems, which may critically affect their food intake, were similar to adults with mild IDD. The anthropometric measurements and energy and nutrient intakes of adults with severe IDD were not significantly different from those with mild IDD consistently. Findings indicate that nutritional deficiencies and nutritional behaviour problems may be avoidable in adults with IDDs.

Nutritional assessment and nutritional status of centenarians (based on the materials of the study “Centenary citizen” in Moscow)

BACKGROUND: Malnutrition and micro- and macronutrient deficiencies are common in people aged 95 years and older. For timely detection of nutritional disorders, it is crucial to regularly examine centenarians and, if necessary, correct an individual patient management plan. A well-balanced diet is one of the fundamental factors for the normal functioning of the human body throughout its life. With age, for various reasons, the risk of malnutrition increases, however, the nutritional status of centenarians is currently not fully understood due to the difficulties of diagnosis.&#x0D; AIM: To evaluate nutritional status and its impact on life expectancy in patients aged 95 years and older, to identify the main determinants that affect the development of malnutrition, and to assess their impact on three-year survival of centenarians.&#x0D; MATERIALS AND METHODS: Analyzed the results of a Mini Nutritional Assessment, general and biochemical blood tests (including such parameters as hemoglobin levels, iron levels, total protein, albumin, vitamin B12, vitamin D, folic acid) in non-institutionalized people aged 95 and older living in Moscow. All studies were conducted at home in the presence of relatives and/or social workers after signing a voluntary informed consent.&#x0D; RESULTS: The study included 82 people, mean age (98.31.89) years; 87.8% were women. Of all the study participants, 56.1% (n=46) were at risk of developing malnutrition, and 11% (n=9) had malnutrition syndrome. Among the 64 participants who took the blood test, anemia was diagnosed in 71.9% (n=46), with macrocytic in 10.9% (n=5), normocytic in 84.8% (n=39), and microcytic in 4.3% (n=2) of patients. Hypoalbuminemia was identified in 16.9% (n=11 of 65) of participants. Of the 50 people who were screened for vitamin D levels, vitamin D deficiency was found in 98% (n=49 out of 50). The following factors influenced survival: a Mini Nutritional Assessment score of more than 24 reduces the risk of 3-year death by 72% (odds ratio (OR) 0.28, confidence interval (CI) 0.10.8), anemia increases the adverse risk by 3 times (OR=3.1, CI 1.18.9). The main clinical conditions associated with a higher risk of developing malnutrition were anemia (OR=3.1, CI 1.18.9) and chewing problems (OR=2.8, CI 0.97.8).&#x0D; CONCLUSIONS: Conducting a nutrition assessment and drawing up a program for the prevention of malnutrition syndrome in centenarians will improve the quality of life and increase life expectancy.

Machine learning-based identification and related features of depression in patients with diabetes mellitus based on the Korea National Health and Nutrition Examination Survey: A cross-sectional study.

Patients with diabetes mellitus (DM) are twice as likely as nondiabetic individuals to develop depression, which is a prevalent but often undiagnosed psychiatric comorbidity. Patients with DM who are depressed have poor glycemic control, worse quality of life, increased risk of diabetic complications, and higher mortality rate. The present study aimed to develop machine learning (ML) models that identify depression in patients with DM, determine the best performing model by evaluating multiple ML algorithms, and investigate features related to depression. We developed six ML models, including random forest, K-nearest neighbor, support vector machine (SVM), Adaptive Boosting, light gradient-boosting machine, and Extreme Gradient Boosting, based on the Korea National Health and Nutrition Examination Survey. The results showed that the SVM model performed well, with a cross-validated area under the receiver operating characteristic curve of 0.835 (95% confidence interval [CI] = 0.730-0.901). Thirteen features were related to depression in patients with DM. Permutation feature importance showed that the most important feature was subjective health status, followed by level of general stress awareness; stress recognition rate; average monthly income; triglyceride (mg/dL) level; activity restriction status; European quality of life (EuroQoL): usual activity and lying in a sickbed in the past 1 month; EuroQoL: pain / discomfort, self-care, and physical discomfort in the last 2 weeks; and EuroQoL: mobility and chewing problems. The current findings may offer clinicians a better understanding of the relationship between DM and depression using ML approaches and may be an initial step toward developing a more predictive model for the early detection of depressive symptoms in patients with DM.

Evaluating the effect of different physical pretreatments and cooking methods on nutritional (starch digestibility) and physicochemical properties of white rice grains (Fajr cultivar)

The effects of physical pretreatments including steaming, dry heating and a combination thereof (performed at different times) were evaluated on the content of resistant starch (RS), slowly digestible starch (SDS), and rapidly digestible starch (RDS), morphology, crystalline structure, and some other physicochemical properties of uncooked Iranian rice grains (Fajr cultivar). The grains were then subjected to cooking by various methods (i.e., boiling, rinsing, and steam-cooking) to investigate the effect of cooking on the nutritional properties obtained after applying physical pretreatments. Generally, reaction constant (k), hydrolysis index (HI), and estimated glycemic index (eGI) decreased after pretreatments. Physical pretreatments increased R1047/1022. Pretreated and cooked grains had significantly higher RS content (5–20%) than non-treated cooked samples. Morphology and crystalline structure were affected by pretreatments. Cooking by rinsing method is suggested for patients with type 2 diabetes mellitus because of lowering the HI (30%) and eGI (18%). Steam-cooking method is recommended for preparing a dietary rice meal due to the higher RS and SDS content. Pretreatment by steaming and cooking by boiling are suitable for people suffering from chewing problems. In conclusion, applying physical pretreatments and choosing appropriate cooking method can increase RS content, decrease eGI, and hence improve nutritional characteristics of rice grains.

Myasthenia-like paraneoplastic syndrome with multiple cranial nerve tumor infiltration: A case report and literature review.

Approximately 0.001% of patients with cancer have paraneoplastic nerve system syndrome, which can affect the central nervous system, neuromuscular junction, or peripheral nervous system. Although myasthenia gravis (MG) may exist as a thymic paraneoplastic syndrome (PNPS), its association with primary lung cancer remains unknown. A 55-year-old female presented with slurred speech, weakness in chewing, sporadic difficulty in swallowing, and weakness in both lower limbs for half a year. Based on cerebrospinal fluid and electromyography findings, we present the case of a female patient diagnosed with overlapping multicranial nerve tumor infiltration and MG-like neurological PNPS secondary to lung adenocarcinoma. The patient received intrathecal injections of pemetrexed and neurotrophic (vitamin B) therapy before ceasing chemoradiotherapy and chose cabozantinib on her own. Weakness of the proximal limbs, choking cough, and chewing problems did not improve significantly. Although it is unclear why MG coexists with lung cancer, it is probable that MG is a paraneoplastic condition. Cerebrospinal fluid testing should be carried out along with electrophysiological, serological, and pharmacological procedures pertinent to the diagnosis of MG to thoroughly examine if people simultaneously experience MG-like PNPS and tumor growth. Starting immunotherapy and anticancer medication at the same time that tumor development and MG-like syndrome are discovered is crucial.

Association of Glycated Hemoglobin Level with Self-Reported Chewing Problems in Elderly Community-Dwelling Individuals in Japan.

Chewing problems are associated with increased mortality, geriatric syndromes and poor activities of daily living. Starting in 2018, in Japan, a self-reported questionnaire investigating chewing status was implemented in the annual health checkup program. Considering the bidirectional association between hyperglycemia and poor oral health, it is hypothesized that people with self-reported chewing problems will have relatively poor glycemic profiles. We investigated the metabolic characteristics of elderly community dwellers with self-reported chewing problems, as well as the association between the problems and HbA1c levels. This was a retrospective, cross-sectional study. We reviewed the data of 1018 adults ≥ 65 years of age who had undergone an annual health checkup at Nihon University Hospital during the period from January 2019 through December 2019. The presence of chewing problems was investigated using a self-reported questionnaire constructed based on guidance provided by the Japanese government. In the 1018 participants, the overall prevalence of chewing problems was 10.4%. Participants with chewing problems showed significantly higher levels and worse categories of HbA1c than those without such problems (HbA1c < 6.0%, 42.5% vs 54.8%; HbA1c 6.0-6.9%, 41.5% vs 37.0%; HbA1c ≥ 7.0%, 16.0% vs 8.2%, p = 0.008). Participants with HbA1c ≥ 7.0% have a significantly increased risk of chewing problems as compared to those with HbA1c < 6.0% (odds ratio 2.76, p = 0.002), even after adjusting for the effects of age, sex, body mass index, eating behaviors, and history of diabetes mellitus. HbA1c ≥ 7.0% is associated with self-reported chewing problems in elderly Japanese community-dwellers. We thus recommend a proactive assessment of oral conditions for this population.

Consensus recommendations on chewing, swallowing and gastrointestinal problems in Phelan-McDermid syndrome

Gastrointestinal (GI) problems are common in Phelan-McDermid syndrome (PMS). Chewing and swallowing difficulties, dental problems, reflux disease, cyclic vomiting, constipation, incontinence, diarrhoea, and nutritional deficiencies have been most frequently reported. Therefore, this review summarises current findings on GI problems and addresses the fundamental questions, which were based on parental surveys, of how frequent GI problems occur in PMS, what GI problems occur, what consequences (e.g., nutritional deficiencies) GI problems cause for individuals with PMS, and how GI problems can be treated in individuals with PMS. Our findings show that gastrointestinal problems have a detrimental effect on the health of people with PMS and are a significant burden for their families. Therefore, we advise evaluation for these problems and formulate care recommendations.

Characterisation of community-dwelling older adults with poor appetite

PurposeA poor appetite affects up to 27% of community-dwelling older adults in Europe and is an early predictor of malnutrition. Little is known about the factors associated with poor appetite. The present study, therefore, aims to characterise older adults with poor appetite.MethodsAs part of the European JPI project APPETITE, data from 850 participants, aged ≥ 70 years of the Longitudinal Ageing Study Amsterdam (LASA) from 2015/16 were analysed. Appetite during the last week was assessed with a five-point scale and dichotomised into "normal" and "poor". Binary logistic regression was used to examine associations between 25 characteristics from 5 domains—physiological, emotional, cognitive, social, and lifestyle—and appetite. First, domain-specific models were calculated using stepwise backward selection. Second, all variables contributing to poor appetite were combined in a multi-domain model.ResultsThe prevalence of self-reported poor appetite was 15.6%. Fourteen parameters from all five single-domain models contributed to poor appetite and were entered into the multi-domain model. Here, female sex (total prevalence: 56.1%, odds ratio: 1.95 [95% confidence interval 1.10–3.44]), self-reported chewing problems (2.4%, 5.69 [1.88–17.20]), any unintended weight loss in the last 6 months (6.7%, 3.07 [1.36–6.94]), polypharmacy defined as ≥ 5 medications in the past 2 weeks (38.4%, 1.87 [1.04–3.39]), and depressive symptoms (Centre for Epidemiologic Studies Depression Scale without appetite item) (1.12 [1.04–1.21]) were associated with an increased likelihood of having poor appetite.ConclusionAccording to this analysis, older people with the characteristics described above are more likely to have a poor appetite.

Oral health, frailty and physical activity levels: is there a link?

Introduction. Oral frailty is associated with decreased quality of life and general health in older adults.Objective: to assess the relationship between oral frailty, physical frailty and physical functioning decline.Methods: An epidemiological cross-sectional Eucalyptus study of adults aged 65 years and older (n=396). The main study parameters: oral health status, chronic diseases, a comprehensive geriatric assessment, complete blood count.Results: 75.5% (n=299) of participants had less than half teeth. 87% of them used removable/fixed dentures or implants. Despite the high frequency of denture use, 9.4% (n=37) of study participants reported difficulties in pronunciation of words and 19.2% (n=76) complained of pain/discomfort when chewing food due to oral health/teeth/dentures. After adjusting for sex, age, cognitive decline, number of remaining teeth, denture/implant use, nutritional status and stroke/TIA, heart failure, chewing or speech problems due to problems of the oral cavity associated with teeth / oral mucosa / dentures were associated with low grip strength with OR (95% CI) 2.738 (1.306–5.737) and 2.494 (1.045– 5.952) respectively and frailty with OR (95% CI) 2.513 (1.083–5.829) in the group of study participants with difficulty in pronunciation of words. The association between chewing difficulty and frailty was significant after adjusting for sex, age, cognitive decline, number of remaining teeth, denture/implant use, nutritional status, and stroke/TIA with OR (95% CI) 2.002 (1.020–3.931), but disappeared after adjusting for heart failure.Conclusion: Chewing or pronunciation difficulties due to oral health problems were associated with an increased risk of frailty, and low levels of physical functioning. All patients with frailty and low physical function should be consulted by a prosthodontist.

Pain, discomfort, and functional impairment after extraction of primary teeth in children with palatally displaced canines – a randomized control trial comparing extraction of the primary canine versus extraction of the primary canine and the primary first molar

Objective To assess pain, discomfort, and functional impairment in children experiencing extraction of primary canine or primary canine and primary first molar as an interceptive treatment for palatally displaced permanent canines. Material and methods Twenty-eight children, aged 9.5–14 years with displaced permanent maxillary canines were randomly assigned for extraction of the primary canine only or the primary canine and the primary first molar. Pain and discomfort were rated on visual analogue scales, and influence on daily activities was assessed by a questionnaire that has been previously tested for reliability and validity. Differences between groups were assessed by independent samples t-tests, Mann–Whitney U-tests or the Fisher's exact test. Results Tooth extraction was associated with low levels of pain and discomfort on a group level. Extraction of both the canine and the first molar was associated with significantly more pain and discomfort than was the extraction of the canine only. Extractions were associated with chewing problems among one-third to half of the children, otherwise, few children reported any jaw impairment after extraction. Conclusion Primary canines and first molars can be extracted in a way that is associated with relatively low levels of pain and discomfort during and after the procedures. Double extractions induced more pain and discomfort than single extractions, which should be accounted for in the treatment planning.

Knowledge, Attitude, and Practices regarding Oral Health among Patients Visiting a Medical College

Introduction: Poor oral health affects quality of life. Experience of pain, eating, and chewing problems; embarrassment about shape of teeth or about missing, discoloured or damaged teeth can adversely affect people's daily lives and well-being. Objective: To assess knowledge, attitude, and practices regarding oral health among patients visiting a medical college. Methods: A cross-sectional descriptive study was conducted at Nobel Medical College, after obtaining ethical clearance from the institutional review committee. Convenience sampling technique was utilised for data collection from 2021 March to 2021 June. Total of 250 patients visiting Department of Community and Public Health Dentistry and Department of Periodontics were included. Data on the oral health knowledge, attitude, and practices, were collected by means of a self-administered closed-ended questionnaire. Prior written informed consent was taken from all the study participants. Descriptive statistics were used for data analysis. Results: Total of 250 outpatients participated in this study out of which 167 (66.8%) were males and 83 (33.2%) were females. Majority, 170 (68%) brushed their teeth for &lt;3 minutes, and only 25 (10%) subjects used interdental aids. More than half of respondents were aware about the role of tobacco in oral cancer and its impact on general health. Majority (88, 35%) yielded sources of information about oral health from radio and television. Conclusions: The knowledge and attitude regarding oral health in selected population was low. Hence, to promote good oral health and education about correct oral hygiene practices, there is need for conducting oral health education programs at periodic intervals.

Development a new chewing problem directory and its validation for Korean elders

ObjectivesThis study aimed to develop a new chewing problem directory (CPD) and validate it with oral health indicators such as total occlusion force, number of natural and rehabilitated teeth (NRT), NRT posterior, natural teeth, natural teeth posterior, and dental status among Korean elders.BackgroundChewing problem is the main oral health problem in elders. However, there has been no validated tool using both subjective and objective assessment of chewing problem.Subjects and methodsA total of 537 participants aged 65 years or more were randomly assigned into 2 subsamples: developing sample (n = 260) for developing and internally validating the new CPD as the 1st stage and confirmation sample (n = 277) for confirming validation of CPD as the 2nd stage. CPD was developed using three subjective questionnaires (general eating, chewing nuts, and chewing meat problem) and objective NRT. Periodontitis, age, sex, education, smoking, alcohol drinking, metabolic syndrome, and frailty were considered as confounders. Following the development of CPD, CPD was validated using multiple multivariable logistic regression after controlling for confounders in confirmation sample and total sample.ResultsThe Cronbach’s alpha value for three subjective questionnaires of CPD was 0.87. Among oral health indicators, NRT (0–28) showed the highest impact association with subjective chewing problem score (partial r = − 0.276). The chewing problem from the new CPD was associated with all items of oral health indicators. The prevalence of chewing problems by CPD was 57.7% in developing sample. Elders with NRT ≤ 24, compared with those with NRT ≥ 25, showed the highest impact on chewing problems by new CPD (Odds Ratio = 7.3 in the confirmation sample and 5.04 in the total sample, p < 0.05) among oral health indicators.ConclusionThis new CPD was developed as a valid tool to evaluate the chewing problem for Korean elders in dental clinics and community-based settings.

Spinal Muscular Atrophy - Is Newborn Screening Too Late for Children with Two SMN2 Copies?

Prompt treatment after genetic NBS for SMA substantially improves outcome in infantile SMA. However, deficiency of SMN-protein can cause damage of motor neurons even prior to birth. To describe the neurological status at the time of NBS and the reversibility of neurological deficits in a cohort of patients with only two copies of the SMN2 gene. We present motor, respiratory, and bulbar outcomes of 21 SMA patients identified in newborn screening projects in Germany. Inclusion criteria was initiation of SMN targeted medication at less than 6 weeks of age and a minimum age of 9 months at last examination. Twelve patients (57%) developed completely normally, reaching motor milestones in time and having no bulbar or respiratory problems. Three children (14.5%) caught up after initial delay in motor development. Six patients (29%) developed proximal weakness despite early treatment: Three of them (14.5%) achieved the ability to walk with assistance and the other three (14.5%) showed an SMA type 2 phenotype at the age of 16-30 months. One patient (4.8%) had respiratory problems. Three children (14.5%) had mild chewing problems and two individuals (9.5%) needed feeding via gastrotube. Initial CHOP-INTEND values below 30 could be indicative of a less favourable outcome, whereas values above 50 could indicate a good outcome, however in-depth statistic due to the small case number is not predictive. More than 70% of SMA patients with two SMN2 copies can achieve independent ambulation with immediate initiation of therapy. However, caregivers and paediatricians must be informed about the possibility of less favourable outcomes when discussing therapeutic strategies.

Evaluation of chewing ability in cerebrovascular accident and Parkinson’s disease

Purpose: Chewing problems are a major and prevalent issue in populations with neurological pathologies including cerebrovascular accident (CVA) and Parkinson’s disease (PD). We measured habitual solid chewing performance in patients with CVA or PD and compared it to that of normal older adults to identify differences in chewing ability between groups.Methods: Measures of habitual solid chewing in 32 patients with CVA, in 35 patients with PD, and in 217 normal older adults were compared. Data on the chewing duration, frequency, and rate were collected using a solid chewing task (SCT). We also analyzed the relationships between dentures, number of teeth, and SCT outcomes.Results: The chewing duration in the PD group was significantly longer than the normal group (p&lt;0.05). Chewing frequency and rate were not significantly different among the three groups. Results can be explained by rigidity and bradykinesia in orofacial structures in the PD group. No significant differences between the PD and CVA groups may be partly explained by the diverse location and size of the CVA lesion compared to the PD. Dentures and the number of teeth were not significantly correlated with SCT outcomes.Conclusions: Chewing impairment remains the area of development for research and rehabilitation, and SCT may help to assess oropharyngeal dysphagia and to identify therapeutic interventions.

Assessment of nutritional status of elderly population living at high altitude regions of India utilizing Mini Nutritional Assessment (MNA) methodology

Background: Malnutrition is associated with increased risk of morbidity and mortality amongst elderly population. There is lack of scientific evidence on the staus of malnutrition amongst elderly population residing at high altitude regions of Uttarakhand, India. Background: Malnutrition is associated with increased risk of morbidity and mortality amongst elderly population. Lack of scientific evidence exists on the status of malnutrition amongst elderly population residing at high altitude regions of Uttarakhand, India. Materials and methods: A community based cross-sectional study was conducted in high altitude regions of District Nainital. A total of 980 elderly subjects were selected from 30 clusters identified using population proportionate to size sampling method. Nutritional status of the elderly population was assessed using Mini Nutritional Assessment (MNA) tool. Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0. Results: The results of MNA revealed that 14.3% of the elderly subjects were malnourished. High prevalence of malnutrition was found among subjects who were illiterate (74.5%), financially dependent (75.2%), belonged to low monthly income (43.3%) had poor appetite (71.6%) and chewing problems (63.1%); (p&lt;0.0001). Conclusions: High prevalence of malnutrition was present amongst the elderly population in India. There is a need for timely assessment of malnutrition for maintenance of nutritional status and prevention of chronic diseases. Materials and methods: A community based cross-sectional study was conducted in high altitude regions of District Nainital. A total of 980 elderly subjects were selected from 30 clusters identified using population proportionate to size sampling method. Nutritional status of the elderly population was assessed using Mini Nutritional Assessment (MNA) tool. Data was entered in MS Excel 2007 and analyzed using SPSS version 20.0. Results: The results of MNA revealed that 14.3% of the elderly subjects were malnourished. High prevalence of malnutrition was found among subjects who were illiterate (74.5%), financially dependent (75.2%), belonged to low monthly income (43.3%) had poor appetite (71.6%) and chewing problems (63.1%); (p&lt;0.0001). Conclusions: High prevalence of malnutrition was present amongst the elderly population in India. There is a need for timely assessment of malnutrition for maintenance of nutritional status and prevention of chronic diseases.

Is scoliosis related to mastication muscle asymmetry and temporomandibular disorders? A cross-sectional study

ObjectivePatients with adolescent idiopathic scoliosis (AIS) may face motor control problems and health disability barriers during mandibular movements and chewing. However, studies investigating the extent of these disadvantages, and possible associated factors are quite limited in patients with AIS. This study was conducted to gain a deeper perspective on the effect of AIS on temporomandibular disorders (TMD) and to contribute to the small amount of data on this subject. MethodsTwenty-nine patients with AIS and 29 age- and sex-matched asymptomatic controls participated in this cross-sectional study. Cobb's method was used to measure scoliosis curves. In both groups, the volume of the masseter muscle was determined on magnetic resonance imaging, and Helkimo and Fonseca anamnestic indexes were used to evaluate temporomandibular joint (TMJ). ResultsIt was observed that the TMD symptoms were higher in the AIS group (22.6- Helkimo and 1.2 - Fonseca) than the asymptomatic group (13.6 - Helkimo and 0.7 - Fonseca). There was no significant asymmetry in masseter volume in patients with AIS, however the volume of the masseter muscles was smaller in the AIS group (R = 14.6/L = 13.6) compared to the control group (R = 16.1/L = 16.2). ConclusionsThe study results indicate that spinal curvatures affect the anatomical, biomechanical, and kinesiological features of the masticatory system, and individuals with AIS may experience more chewing problems than asymptomatic individuals. Examining musculoskeletal properties of masticatory system can provide information about the limitation of the TMJ in patients with AIS.