Stomatognathic Function Research Articles

A Prospective Randomized Control Trial of Lingual Frenuloplasty with Myofunctional Therapy in Patients with Maxillofacial Deformity in a Polish Cohort.

Introduction: There are few publications concerning ankyloglossia in mixed-aged groups utilizing myofunctional therapy and frenuloplasty in patients undergoing orthodontic treatment and maxillofacial surgery. While it is well known that ankyloglossia is mainly diagnosed in babies, research on functional and structural disorders in different age groups is less common. Thus, there is a high need for specific information about the influence and effectiveness of frenuloplasty with myofunctional therapy on the stomatognathic function and final treatment outcome for a wider variety of patients, especially those with maxillofacial deformities. Aim: This paper aims to evaluate the impact of lingual frenuloplasty as an adjunct to myofunctional therapy for the treatment of ankyloglossia in children and adults with maxillofacial deformity. Methods: Prospective randomized control trial with 155 subjects. Methods were based on visual observation and examination of the oral cavity. There were two groups: myofunctional therapy vs. myofunctional therapy and lingual frenuloplasty. Patients were randomized based on order of entry into the study. χ2 test, Kruskal-Wallis, ANOVA, Student's t-test and others were used for statistical analyses. Results: The presented protocol with myofunctional therapy and surgical procedures proved to be significantly more effective in improving tongue mobility and stomatognathic functions such as swallowing, breathing, and oral resting postures as compared to the reference group who underwent myofunctional therapy only. Conclusions: Lingual frenuloplasty with myofunctional therapy is highly effective in restoring the equilibrium of the orofacial muscles and the skeleton, which is often disturbed and may lead to unstable functional effects among patients considering orthodontic and orthognathic treatments for maxillofacial deformities.

Computerized Axiographic Findings in a Cohort of Migraine Patients: A Cross-Sectional Study.

The objective of this work was to investigate the association between the function of the stomatognathic system and migraine presence through an instrumental functional analysis in a group of diagnosed migraine patients and a control group. This study included 50 individuals in each group. A jaw-tracking analysis was performed using Cadiax 4. Tracings of the following movements were recorded: open/close, protrusion/retrusion, mediotrusion, speech, bruxing, and mastication. The tracings were evaluated for their quantity, quality, transversal characteristics, speed, curvature pattern, and condylar stability. Statistically significant differences between the groups were established for several aspects of the evaluation. Migraineurs presented with (a) higher values of mandibular lateral translation in protrusion/retrusion (p = 0.001), open/close (p = 0.031), and mastication (p = 0.016); (b) transient velocity losses in open/close (p = 0.001) and protrusive movements (p = 0.018); (c) a compromised condylar stability for protrusion/retrusion (p = 0.001) and mediotrusion (p = 0.003); (d) a compromised quality for protrusion/retrusion (p < 0.001) and mediotrusion (p = 0.003); and (e) a more frequent "figure-eight" curvature in open/close (p = 0.012). The importance of the stomatognathic function in migraine pathogenesis and treatment should be considered by using a patient-centered and interdisciplinary approach.

Myofunctional Speech Therapy for Facial Rejuvenation and Orofacial Function Improvement: A Systematic Review.

This review aims to reveal the effectiveness of myofunctional speech therapy on facial rejuvenation and/or improvement of orofacial function. A systematic review of four medical electronic databases (Medline, Google Scholar, SciELO, and LILACS) was conducted between January and March 2023. The research question was defined using the PICO model: Population (P): adult subjects with signs of physiological aging of facial skin. Intervention (I): aesthetic speech therapy (facial exercises and/or myofunctional therapy). Control (C): absence of treatment. Outcome (O): facial rejuvenation. Through the search process, a total of 472 potentially relevant articles were identified. A total of 21 studies were included in the review. Most of the studies required the participants to perform exercises learned during the weekly session on a daily basis. The subjects underwent an integrated treatment with facial exercises and worked on the stomatognathic functions for different durations. Many differences were found in the evaluation tools used to investigate the starting situation and the effects obtained following the treatment. At the diagnostic level, there was no concordance in the choice of the most appropriate scales and assessment tools, but great heterogeneity was observed. Indeed, forty-eight percent of the studies collected objective data through the use of various instruments (oral devices, electromyographs, cutometers, muscle ultrasound scans, and laser scans of the face). The observed improvements included not only a reduction in wrinkles and frown lines but also decreased muscle tension and slackness, enhanced facial symmetry and lip competence, improved skin elasticity, and restored stomatognathic function. These changes led to myofunctional restoration and facial rejuvenation, resulting in increased satisfaction with self-image and proprioception.

Orthodontic pain is related to oral health-related quality of life in orthodontic patients.

Orthodontic pain (OP) is a subjective experience induced by prolonged force on the teeth in fixed orthodontic treatment. OP acts as a predictor of aspects related to oral health-related quality of life (OHRQOL). It is important to understand the extent of the impact of OP on a patient's daily life, especially on stomatognathic function and social impact. To assess the correlation between OP and OHRQOL in fixed orthodontic treatment patients. The comparative pain rating scale is used to assess pain intensity, while the oral health impact profile-14 (OHIP-14) assesses the impact of OP severity on OHRQOL of 57 patients undergoing fixed orthodontic treatment in the early stages of treatment (1-3 months of treatment) at the Dental Hospital, Universitas Airlangga. Gender, age, and malocclusion classifications were also analyzed for their influence. The data were analyzed using Spearman correlation and two-way analysis of variance (ANOVA). In the initial phase of treatment, most of the patients (53%) experienced mild OP and moderate OP (39%), and OP was reduced over a week. The overall OHRQOL score was 17.4 ± 8, which indicates a negative impact on OHRQOL. There were also positive correlation dimensions of OHRQOL, which include the dimensions of physical limitations, psychological discomfort, and psychological limitations (r > 0.50). There was a significant difference between age groups in OP perception and OHRQOL (P < 0.05). There was a positive correlation between OP intensity and OHRQOL experienced by fixed orthodontic patients at the Dental Hospital, Universitas Airlangga.

Surgical growth modulation for mandibular retrognathism: A case report

A case of 18-year-old female presented with retrognathic mandible having skeletal class II malocclusion, exhibiting convex profile, deep mentolabial sulcus, class II molar, and canine relation bilaterally with proclined maxillary incisors, increased overjet and 100% deep bite. The case had a severe ABO discrepancy index. The leveling and alignment of dental arches were achieved by sequential archwire placement using 0.022” MBT PEA. After leveling and alignment stage, the case was assessed for surgical growth modulation using intra-oral distractors. After necessary planning the case was operated for bilateral sagittal split osteotomy and placement of intra-oral distractors. A standardized protocol was followed for the activation of distractors. Two weeks post distraction the case was reassessed for skeletal changes achieved, followed by settling of occlusion and removal of intra-oral distractors. Skeletal class I bases with improvement in vertical proportions was observed on completion of treatment. This case report suggests that in a patient with mandibular retrognathism and nearly exhausted growth potential, orthodontic treatment in conjunction with meticulously planned and executed mandibular distraction osteogenesis may be effective in achieving aesthetic enhancement and improved stomatognathic function.

The effect of orthodontic treatment with and without tooth extraction on stomatognathic function

Extraction commonly used in orthodontic treatment with crowding teeth. However, the total functional effect caused by extrac-tion and orthodontic treatment remains unclear. This study is aimed to explain the effect of orthodontic treatment with and with-out extraction procedures on dental morphology and masticatory function. The study was conducted using a cross-sectional study design, consisting of pre- and post-treatment groups (25 cases of extraction and 22 cases of non-extraction); and the long-itudinal study consisted of 23 extraction cases and 3 non-extraction cases. Morphological and functional recording was carried out with several assessments, including irregularity index values, masticatory efficiency, number of occlusal contacts, and EMG analysis. Cross sectional, irregularity index showed a significant decrease in malocclusion (p&lt;0.005). There was no significant change in masticatory efficiency. The occlusal contacts of extraction cases (A and C) tend to increase. The activity of the tem-poral (T) muscle was greater than that of the masseter (M) on EMG analysis. Almost all the results from the longitudinal stu-dies support the results from the cross-sectional studies. Results showed functional data immediately after extraction and amidst dynamic treatment decreased with occlusion instability. Both extraction and non-extraction cases improved morphologically and functionally after orthodontic treatment. It can be concluded that extraction of 4 premolars is not always associated with a negative impact on stomatognathic function when proper orthodontic treatment is performed after extraction.

Effect of masticatory movements on head and trunk sways, and sitting and foot pressure distributions during sitting position.

The purpose of this study was to test the hypothesis in healthy subjects that masticatory movements affect head and trunk sways, and sitting and foot pressure distributions during sitting position. A total of 30 healthy male subjects with an average age of 25.3 years (range, 22-32 years) were evaluated. The CONFORMatTM and MatScanTM system were used to analyze changes in sitting pressure distribution (center of sitting pressure: COSP) and changes in foot pressure distribution (center of foot pressure: COFP) respectively, and the 3-dimensional motion analysis system was used to analyze changes in head and trunk postures while subjects remained sitting position with rest position, centric occlusion, and chewing. The total trajectory length of COSP/COFP, COSP/COFP area, and head and trunk sway values were compared between the three conditions to evaluate whether masticatory movement affected the stability of head and trunk sways, and sitting and foot pressure distributions. Total trajectory length of COSP and COSP area during chewing were significantly shorter and smaller respectively than it was in rest position and centric occlusion (p < 0.016). Head sway value during chewing was significantly larger than it was in rest position and centric occlusion (p < 0.016). Masticatory movements affect sitting pressure distribution and head movements during sitting position.

Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients.

To assess the diagnostic and therapeutic approaches in pediatric mandibular fractures with regards to fracture pattern and localization. This retrospective study included patients under the age of 17 years that presented to the Department of Oral and Maxillofacial Surgery at Charité-Universitätsmedizin Berlin with mandibular fractures over an 11-year long period (2010-2020). Medical records were analyzed for age, gender, injury mechanism, clinical presentation, imaging modalities, fracture pattern, and fracture management. Statistical analyses included descriptive statistics, normality testing, and Mann-Whitney U tests. A total of 91 pediatric patients (23 females and 68 males) presented with mandibular fractures. The majority of mandibular fractures occurred in patients aged 13-16 years (67.0%, n = 61). The main causes were activities of daily life (34.1%), followed by assault (25.3%). Malocclusion and pain upon mandibular joint compression were documented in 72.5% and 51.7% of patients, respectively. The most frequently applied radiological diagnostic tool was a panoramic X-ray (49.5%). The main fracture patterns were single (42.9%) and double fractures (48.4%). An age-adapted surgical approach using open reduction and internal fixation (ORIF) was the most frequent management (61.5%). A conservative approach was favored in cases of condylar head fractures. Resorbable plates were used in eight cases of ORIF (8.8%). Treatment regimens should be carefully selected based on the unique anatomy of the pediatric patient with regards to centers of growth and dentition phase, to restore stomatognathic function and to maintain adequate skeletal growth and eruption of teeth. This study illustrates the challenges of mandibular fracture management in the pediatric patient. Hofmann E, Koerdt S, Heiland M, et al. Pediatric Maxillofacial Trauma: Insights into Diagnosis and Treatment of Mandibular Fractures in Pediatric Patients. Int J Clin Pediatr Dent 2023;16(3):499-509.

EWING'S SARCOMA IN THE PREMAXILLA OF A PEDIATRIC PATIENT: A CASE REPORT

In August 2019, a 5-year-old female pediatric patient was diagnosed with primary non-metastatic Ewing sarcoma. She began chemotherapy treatment in September 2019, ending in November 2019. Subsequently, she was referred to a head and neck specialist, where a tumor was observed in the upper anterior alveolar edge. A biopsy was performed which confirmed Ewing´s sarcoma and showed an infiltrate in the entire premaxilla without posterior or midface involvement. Surgery for tumor resection was performed in March 2020, with a conclusive biopsy of small and round cell malignant neoplasm, consistent with Ewing´s sarcoma, the surgical margins were compromised, thus requiring complementary radiotherapy treatment. The rehabilitation was performed with a polypropylene obturator prosthesis in the premaxilla region. The patient returned for a check-up, without complaints, and was able to express herself in an intelligible manner, with her stomatognathic functions in balance. In August 2019, a 5-year-old female pediatric patient was diagnosed with primary non-metastatic Ewing sarcoma. She began chemotherapy treatment in September 2019, ending in November 2019. Subsequently, she was referred to a head and neck specialist, where a tumor was observed in the upper anterior alveolar edge. A biopsy was performed which confirmed Ewing´s sarcoma and showed an infiltrate in the entire premaxilla without posterior or midface involvement. Surgery for tumor resection was performed in March 2020, with a conclusive biopsy of small and round cell malignant neoplasm, consistent with Ewing´s sarcoma, the surgical margins were compromised, thus requiring complementary radiotherapy treatment. The rehabilitation was performed with a polypropylene obturator prosthesis in the premaxilla region. The patient returned for a check-up, without complaints, and was able to express herself in an intelligible manner, with her stomatognathic functions in balance.

Initial therapeutic approaches for orofacial myofascial pain: three pilot studies

ABSTRACT Objective Myofascial pain diminishes the stomatognathic function and hinders clinical diagnosis. Therefore, initial pain reduction is crucial before definitive treatment. Here, the clinical validity of non-pharmaceutical therapies, including the Aqualizer® splint, physiotherapy, and dry-needle acupuncture was comparatively assessed. Methods Myofascial pain patients (n = 28; 20–65 years old) were examined through a visual analog scale, and intra- and extra-oral muscle palpation. Mandibular maximum opening and neck mobility were also evaluated. Changes in parameters through time were analyzed via the Kruskal-Wallis test, while the Friedman test and dot-plots were used for comparative therapies assessment. General patient improvement was represented via an isometric Principal Component. Results The Aqualizer® and physiotherapy resulted in improvement of all parameters except for mouth opening. Acupuncture improved extra-oral muscle pain and neck mobility. Conclusion The Aqualizer®, physiotherapy, and oral acupuncture are effective initial pain therapies. Among all, physiotherapy provided the greatest benefits, followed by the Aqualizer®.

An Overview of Mouth Breathing Syndrome and its Effect on Dental Development

Mouth breathing syndrome is a major harmful oral condition in children that causes them to switch from exclusively nasal breathing to mouth breathing or mixed breathing. It frequently happens as a result of an obstruction of the upper airway, which forces all or part of the air to enter through the mouth. Serious morphological and quality-of-life alterations are brought on by it. There are a number of causes for mouth breathing, but allergic rhinitis may be the most widespread, affecting more children. The second reason for this breathing pattern is palatine tonsils and adenoids. This multifactorial condition jeopardizes the balance of stomatognathic functions such as chewing, swallowing, breathing, and phonation, as well as creating conditions that influence the individual's development. Uncontrolled mouth breathing can have an adverse impact on the dentofacial system's health as well as aberrant dental and maxillofacial development. Based on the cause of mouth breathing, mouth breathers may demonstrate various dental development patterns, malocclusions, and maxillofacial development consequences. Furthermore, breathing through the mouth might harm dental health and raise the risk of periodontal and caries disorders. Because mouth breathers have several problems, a thorough and interdisciplinary clinical assessment is required to identify this syndrome early and reduce its negative effects on dentofacial development. This review finds that a multidisciplinary approach to these issues needs to make significant progress.

Speech therapy rehabilitation in Tapia´s syndrome: case report

Tapia’s syndrome is charaterized by damage to the recurrent laryngeal nerve (branch of the Xth) and the hypoglossal nerve (XIIth), and in some cases, the accessory nerve (XIth) may also be affected. The cause is usually trauma to the point where the hypoglossal and vagus intersect. This results in lingual hemiparesis, vocal fold paralysis and dysphagia. Objective: to present the results of speech therapy in a case that evolved with Tapia´s Syndrome after the excision of a tumour in the parapharyngeal space. Case report: male patient, 71 years old, submitted to excision of a Schwannoma in the vagus nerve, with parotid invasion. Evolved with: dysarthria; severe dysphagia; lack of flow control; dysphonia; facial paralysis and dyspnoea. Six months after surgery, thyroplasty and botulinum toxin injections were performed in the cricopharyngeal muscle and salivary glands, which ensured a temporary improvement in voice and control of salivary flow. Results: The rehabilitation process consisted of stimulating the mobility of the muscles responsible for facial mimicry, reintegration of stomatognathic functions, swallowing and voice. After two years of speech therapy, the patient showed improvement in the mobility of the facial mimic muscles, a slight improvement in the vocal pattern, in addition to an improvement in the breathing pattern. Conclusion: despite the limitations and functional complexities encountered in the postoperative period, there was evidence of improvement in the patient’s quality of life after performing clinical procedures combined with the therapeutic process.

EMG-assisted forward dynamics simulation of subject-specific mandible musculoskeletal system

Assessment of mandibular dynamics is essential for examining stomatognathic functions, and many kinds of stomatognathic diseases, such as temporomandibular joint (TMJ) disorder and jaw tumors, require individual diagnosis and rehabilitation treatments. Musculoskeletal models of the mandible system provide an efficient tool for fulfilling these tasks, but most existing models are generic, without direct correlation to subject-specific data. For this reason, the objective of this study was to establish a subject-specific mandible modeling framework based on clinical measurements, including medical imaging, jaw kinematics, and electromyographic (EMG) acquisition. First, a non-rigid iterative closest point method was performed to register muscle insertion sites. A flexible multibody approach was introduced to describe the large deformation behavior of jaw muscles. The EMG signals of the temporalis and masseter muscles were then utilized to determine their active forces. Meanwhile, a feedback loop for tracking desired mandibular kinematics was presented to calculate the activations of jaw opening and pterygoid muscles. The subject-specific muscle forces and TMJ joint loading during jaw opening–closing movements were then calculated based on forward–inverse coupling dynamics procedure. As a validation of the proposed framework, the mandible trajectories of seven healthy subjects were predicted and compared with experimental data. The results demonstrated unintentional movement of the head–neck complex together with the activation patterns of jaw opening and lateral pterygoid muscles for different people. The proposed framework combines musculoskeletal modeling with dental biomechanical testing, providing an efficient method of predicting and understanding the dynamics of subject-specific mandible systems.

Oropharyngeal Geometry of Maxilectomized Patients Rehabilitated with Palatal Obturators in the Trans-surgical Period: Repercussions on the Voice

Patients undergoing maxillectomies may present alterations in the stomatognathic functions involved in oral communication. Rehabilitative treatment should favor the rescue of these functions, through surgical flaps, obturator prostheses or both. The present study aims to present the impact of the use of the palatal obturator on the oropharyngeal geometry and on the voice of patients undergoing maxillectomies, after adaptation to trans-surgical palatine obturators (TPO). Twelve patients treated at a Cancer Hospital, submitted to maxillectomy and rehabilitated during surgery were evaluated. The oropharyngeal geometry was measured by acoustic pharyngometry and the vocal parameters were evaluated through auditory-perceptual and acoustic analyses. The comparison between the results with and without TPO was analyzed using the Wilcoxon test and the correlation between oropharyngeal measurements and acoustic parameters using Spearman's correlation coefficient, all with a significance level of 5%. There was a decrease in the following oropharyngeal measurements with the use of TPO: length of the pharyngeal cavity and vocal tract, volume of the oral cavity, pharyngeal and vocal tract and area of ​​the oropharyngeal junction. There was no difference in the length of the oral cavity and in the glottic area between situations with and without TPO. In the vocal evaluation, changes in intelligibility and resonance were observed in the situation without TPO and, in only one case, mild hypernasality was detected in the situation with TPO. It is concluded that the use of TPO brought the oropharyngeal measurements closer to normal values ​​and provided an improvement in speech intelligibility and vocal resonance in maxilectomized individuals.

Morphological comparison of masseter muscle fibres in the mandibular rest and open positions using diffusion tensor imaging.

The masseter muscle has a complicated multipennate internal structure and exhibits functional differentiation when performing various stomatognathic functions. It is important to understand the internal structural changes of the muscle during functioning to elucidate characteristic muscle disorders such as local myalgia. Diffusion tensor imaging (DTI) may be useful for investigating the internal structural features of muscle. To evaluate the features of masseter muscle fibres in human participants using DTI fibre tractography, and to elucidate the structural differences in the masseter muscle between the mandibular rest and open positions. Five healthy men (age 31±7years) underwent DTI and T1-weighted MRI of the right masseter muscle in the mandibular rest and open positions. MR images were used as a reference for muscle layer segmentation (superficial, intermediate, and deep). DTI fibre tractography of the masseter muscle was performed and the orientation of the DTI fibres was analysed in each layer using coordinates based on the Frankfurt horizontal plane. The DTI fibre orientation of the deep layer significantly changed between the mandibular rest and open positions in the frontal plane (p<0.05, Wilcoxon rank sum test). However, no significant change was found in the superficial and intermediate layers. DTI fibre tractography confirmed regional differences in the orientation change of the masseter muscle fibres between different mandibular positions. The results may support the existence of functional partitioning inside the masseter muscle and suggest that DTI may be useful for the evaluation of muscle fibres in multipennate muscles.

Impact of Maximum Tongue Pressure in Patients with Jaw Deformities Who Underwent Orthognathic Surgery.

Malocclusion and morphological abnormalities of the jawbone often affect the stomatognathic function and long-term postoperative stability in patients with jaw deformities. There are few reports on the effect of maximum tongue pressure (MTP) in these patients. We investigated the relationship between the MTP and jawbone morphology and the effect of the MTP on surgery in 42 patients with jaw deformity who underwent surgical orthodontic treatment at Hiroshima University Hospital. The MTP was measured using a tongue pressure measurement device; the average value was considered as the MTP. Based on the MTP measured before surgery, patients were classified into the high- or the low-MTP group. The clinical findings and results of the cephalometric analysis were compared. Posterior movement of the mandible in the high-MTP group was significantly lower than that in the low-MTP group. The ANB angle, overjet, and overbite in the high-MTP group were significantly smaller than those in the low-MTP group. On the other hand, there was no difference between the two groups in the measured values, indicating a labial inclination of the anterior teeth (U1 to SN, U1 to FH, IMPA, and FMIA). MTP has been suggested to affect mandibular prognathism in patients with jaw deformities.

Medical-Dental Collaboration and Interprofessional Training for Maxillofacial Diseases at Tohoku University Hospital.

The Tohoku University Hospital has been a clinical and research facility for all the related departments of Tohoku University. Medical-dental and interprofessional collaboration has resulted in special treatment teams, made up of members of departments such as the center for head and neck cancer, the center for dysphagia, and the cleft lip and palate center. Those treatment teams held conferences, case study meetings, reading sessions, and in-hospital seminars. The purpose of this study was to evaluate the outcomes of various medical-dental and the interprofessional collaboration at Tohoku University Hospital and training program to equip hospital dentists in higher medical institutions. The attainment targets are the acquisition of basic medical skills and knowledge under the guidance of supervising doctors. As a result, the hospital dentists could acquire their own specialized knowledge and skills certificated by each academic society. The smooth team treatment has been achieved, and the number of cases discussed by cancer boards and center for dysphagia has increased year by year due to the efficiency of their clinical pathways. On the dental care side as well, the wearing rates of maxillofacial prosthetic devices such as maxillofacial prostheses and palatal augmentation prostheses (PAP) have improved, which have contributed to improving patient's stomatognathic function. Tohoku University Hospital has been practicing collaboration between medical and dental professionals and it has produced mutual benefits. Our interprofessional training system based on the medical-dental collaboration could develop professionals who have acquired cross-disciplinary knowledge and skills from experienced doctors.

Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing.

ABSTRACTAims and objectivesPersistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing.Materials and methodsA cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant.ResultsOut of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01).ConclusionChildren with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication.Clinical significanceChildren with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD.How to cite this articleKalaskar R, Bhaje P, Kalaskar A, et al. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Mouth Breathing. Int J Clin Pediatr Dent 2021;14(5):604–609.

Visualization of mandibular movement relative to the maxilla during mastication in mice: integration of kinematic analysis and reconstruction of a three-dimensional model of the maxillofacial structure

BackgroundMastication is one of the most fundamental functions for the conservation of human life. To clarify the pathogenetic mechanism of various oral dysfunctions, the demand for devices for evaluating stomatognathic function has been increasing. The aim of the present study was to develop a system to reconstruct and visualize 3-dimensional (3D) mandibular movements relative to the maxilla, including dynamic transition of occlusal contacts between the upper and lower dentitions during mastication in mice.MethodsFirst, mandibular movements with six degrees of freedom were measured using a motion capture system comprising two high-speed cameras and four reflective markers. Second, 3D models of maxillofacial structure were reconstructed from micro-computed tomography images. Movement trajectories of anatomical landmark points on the mandible were then reproduced by integrating the kinematic data of mandibular movements with the anatomical data of maxillofacial structures. Lastly, 3D surface images of the upper dentition with the surrounding maxillofacial structures were transferred to each of the motion capture images to reproduce mandibular movements relative to the maxilla. We also performed electromyography (EMG) of masticatory muscles associated with mandibular movements.ResultsThe developed system could reproduce the 3D movement trajectories of arbitrary points on the mandible, such as incisor, molars and condylar points with high accuracy and could visualize dynamic transitions of occlusal contacts between upper and lower teeth associated with mandibular movements.ConclusionsThe proposed system has potential to elucidate the mechanisms underlying motor coordination of masticatory muscles and to clarify their roles during mastication by taking advantage of the capability to record EMG data synchronously with mandibular movements. Such insights will enhance our understanding of the pathogenesis and diagnosis of oral motor disorders by allowing comparisons between normal mice and genetically modified mice with oral behavioral dysfunctions.

Effect of oral exercises and photobiomodulation therapy in the rehabilitation of patients with mandible fractures: randomized double-blind clinical trial.

Mandible fractures compromise stomatognathic functions, requiring rehabilitation. Evaluate the effectiveness of photobiomodulation (PBM) associated with oral exercises for rehabilitation of patients with mandible fractures. In this randomized clinical trial, we compared PBM with PBM sham in 14 adults with mandibular fractures who underwent surgical intervention. The sessions were performed 24h and 48h after surgical procedure, and weekly for 4weeks after hospital discharge. Both groups performed oral exercises after each PBM session. Restriction of food consistencies, mandibular mobility, pain, and facial sensitivity measured before and after the surgical procedure were the outcomes evaluated, one and 3months after surgery. Maximum interincisal distances (MID), exercise pain, and restriction of food consistencies were also evaluated during each week of intervention. Both groups showed normal MID (> 35mm) and food consistencies consumed 1month after the surgical procedure, with no significant differences between them. Individuals in the PBM group had less pain response to exercise during all the weeks of intervention than the sham group (p < 0.05). The patients presented a reduction in the painful response in MID and mandibular laterality movements 1month after surgery compared to the preoperative period. In contrast, there was an improvement in laterality in the sham group only 3months postoperatively and persistent pain in MID. There was no significant difference in facial sensitivity within and between groups during follow-up. The performance of oral exercises associated with PBM effectively facilitated the early rehabilitation of oral functions, with significant gains in pain management.