Journal of oral rehabilitation最新文献

Background: Acute stroke often causes complications such as aspiration pneumonia, which can be prevented through oral hygiene. However, evidence supporting individualised oral care remains limited. We developed a multidisciplinary oral function management protocol and evaluated its benefits in patients with acute stroke, including its impact on aspiration pneumonia.

Methods: In this prospective multicentre cohort study, data from 1616 patients with acute stroke admitted to participating hospitals between 31 July 2017, and 27 January 2021 were analysed. Hospitals implemented our oral function management program (Protocol group) or provided conventional oral care (control group). To minimise confounding by baseline severity, propensity scores were estimated using stroke severity and initial complications; patients were matched 1:1 using nearest-neighbour matching with a calliper of 0.2, resulting in 313 matched pairs (n = 626). Primary outcome was the incidence of aspiration pneumonia; secondary outcomes were hospital stay length and oral function improvement.

Results: No significant differences in aspiration pneumonia onset rates were detected between the protocol and control groups (p = 0.7639). Compared to controls, the protocol group showed significant improvements in oral hygiene (p < 0.0001), tongue mobility (p = 0.0292), and FOIS scores (p = 0.0005). Time from admission to discharge evaluation (p < 0.0001) and total length of hospital stay (p = 0.0018) were significantly reduced. Compared to administration of conventional oral care, implementation of this Protocol facilitated earlier oral management and feeding/swallowing rehabilitation, potentially reducing hospital stays and enhancing oral functions.

Conclusion: The protocol may enhance oral functionality and reduce hospitalisation duration by systematising multidisciplinary oral management and swallowing rehabilitation, alongside supporting conventional pneumonia prevention strategies.

Objective: To evaluate the efficacy of education and self-management (ED and SM) interventions delivered by a health care provider, either alone or in combination with other non-surgical interventions for improving pain, function, or health-related quality of life (HRQoL) in adults with temporomandibular disorders (TMDs).

Design: Systematic review with meta-analysis.

Literature search: Six databases were searched up to March 2025.

Study selection criteria: Randomized clinical trials (RCTs) comparing the efficacy of ED and SM with any non-surgical other interventions such as splints, manual therapy, electrotherapy or multimodal approaches in adults with TMDs. Eligible studies had to report outcomes on pain, function or HRQoL.

Data synthesis: Risk of bias was assessed using the Cochrane RoB-1 tool. Pooled treatment effects were calculated using random-effects models with standardized mean differences. Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

Results: Forty-seven RCTs (n = 3238 participants; 77% female; mean age: 34.4 ± 7.3 years) were included, and none had a low risk of bias. ED and SM interventions were generally delivered as standardized programs and often served as control conditions. Based on very low-certainty evidence, other non-surgical interventions may be more effective than ED and SM alone for short-term pain reduction (SMD = 0.67, 95% CI: 0.13-1.20, 6 studies, 323 patients) or HRQoL improvement (SMD = 0.61, 95% CI: 0.20-1.01, 2 studies, 124 patients). When combined with ED and SM, non-surgical interventions may also result in moderate additional HRQoL improvements (SMD = 0.50, 95% CI: 0.18-0.82, 3 studies, 154 patients). Other comparisons-such as ED and SM alone versus ED and SM combined with other non-surgical interventions-showed comparable effects between groups on pain, function and HRQoL over the short-, medium- and long-term. However, the certainty of evidence supporting these findings remains low to very low.

Conclusion: The certainty of evidence supporting ED and SM interventions for TMDs is very low to low across all outcomes. While some short-term clinically relevant benefits may favour other non-surgical treatments, no consistent superiority or inferiority of ED and SM was found. Combining ED and SM with other interventions did not consistently improve outcomes. High-quality trials are needed to determine the effectiveness of ED and SM and their optimal delivery in TMD care.

Prospero: CRD42024529862.

Background: Bruxism is a masticatory muscle activity that may occur during sleep (SB) or wakefulness (AB) and is not classified as a movement or sleep disorder. Clear aligner therapy, widely adopted as a removable and aesthetic orthodontic alternative, modifies occlusal contacts and mandibular dynamics, which may influence the occurrence or perception of bruxism behaviours.

Objective: To systematically review the association between clear aligner therapy and bruxism (SB, AW and mixed/self-reported), with a focus on evaluating its role as neutral, protective or a potential risk factor.

Methods: A systematic search of electronic databases and grey literature was conducted through April 2025, with included studies that identified bruxism using validated instrumental methods (portable electromyography for SB, or smartphone-based ecological momentary assessment for AB), subjective questionnaires on behaviours and related symptoms. Risk of bias was assessed using the Joanna Briggs Institute tool, and evidence quality was evaluated with GRADE.

Results: Eleven studies evaluated 818 patients (72.8% female). Most studies suggested a neutral effect of clear aligners on bruxism. For SB, aligners often reduced tonic contractions but showed inconsistent effects on higher phasic activity and no changes on overall SB index. AB was generally unaffected, though one study reported reduced self-reported parafunctions with altered muscle recruitment. Mixed/self-reported bruxism outcomes were conflicting: some studies indicated improvements in clenching and TMJ pain, while others found a higher prevalence of bruxism symptoms during aligner therapy. Methodological heterogeneity and risk of bias were notable, precluding that no meta-analysis was possible. GRADE certainty for randomised studies was moderate and very low for non-randomised studies.

Conclusion: Current evidence on the relationship between clear aligner therapy and bruxism remains limited and heterogeneous. Most studies suggest a neutral effect, with occasional reductions in tonic contractions or symptom improvement, but also reports of increased phasic activity or self-reported bruxism. Overall, aligners cannot yet be classified as protective or harmful, highlighting the need for standardised, high-quality studies to clarify their role in bruxism management.

Background: Low tongue posture (LTP) results from nasal obstruction and impaired oral muscle function. However, the relationship between nasal obstruction-independent LTP and oral muscle function remains unclear.

Objective: In this study, we aimed to comprehensively examine the relationship between nasal obstruction-independent LTP and oral muscle function by evaluating LTP, nasal ventilation conditions, and oral muscle function based on the cross-sectional area of the muscle-fat tissue surrounding the oral cavity.

Methods: Participants included 28 children (LTP group: mean age: 8.71 years) with LTP and 24 children (control group: mean age: 8.89 years) without LTP. Nasal airway ventilation conditions were evaluated using nasal fluid analysis of the cone beam computed tomography (CBCT) data. Oral muscle function was assessed by measuring the cross-sectional area of muscle-fat in the upper and lower lips, upper and lower oral vermilions, and tongue using CBCT data.

Results: Compared with the control group, the LTP group exhibited higher nasal airway pressure and reduced muscle cross-sectional areas in the lower lip, lower orbicularis oris, and tongue. The LTP group without nasal obstruction had significantly smaller muscle cross-sectional areas of the lower lip and tongue than the group without LTP. The group without LTP but with nasal obstruction had a significantly larger tongue muscle cross-sectional area than the LTP group.

Conclusion: LTP can involve nasal obstruction and reduced muscle components in the lower lip, orbicularis oris, and especially the tongue, being related to lower muscle function. The findings could help improve the management of LTP-associated disorders.

Background: Tongue function is critical for essential activities such as feeding and sleep. In particular, tongue protrusion plays a key role in maintaining airway patency during sleep. However, standardised protocols for measuring tongue protrusion are lacking, and the reliability of tongue function assessments in children remains underexplored.

Objectives: To assess the intra- and inter-rater reliability of a novel tongue protrusion measurement method using a 3D-printed stand, alongside established tongue measurements.

Methods: Fifty-six children aged 4 to 17 years underwent two successive visits with the same rater and a third visit with a different rater, each spaced 1-4 weeks apart. Tongue protrusion strength (pProt) and endurance (eProt), elevation strength (pElev) and endurance (eElev), and tongue pressure during swallowing (pSwal) were assessed using the Iowa Oral Performance Instrument (IOPI). An adjustable 3D-printed stand was developed and used to standardise the protrusion task. Tongue mobility was assessed using the Motricité Bucco-Linguo-Faciale tongue subscore (MBLF-t), and mobility restriction due to the frenulum was measured with the Tongue Range of Motion Ratio (TRMR). Reliability was analysed using intraclass correlation coefficients (ICCs).

Results: pProt showed good intra-rater reliability and moderate inter-rater reliability, while eProt demonstrated excellent intra-rater and good inter-rater reliability. All other outcomes exhibited at least good intra- and inter-rater reliability, except for pElev, which showed slightly lower inter-rater reliability (ICC = 0.73).

Conclusion: This study highlights the reliability of tongue function assessments, including a novel IOPI-based protrusion measurement method, supporting their use in future research and clinical practice.

Trial registration: ClinicalTrials.gov ID: NCT06166680.

Background and objectives: Bruxism involves involuntary jaw activities like clenching or grinding, linked to changes in temporomandibular joint disorder (TMJ) vibrations, but its independent role is debated. This study used joint vibration analysis (JVA), a non-invasive method, to analyse TMJ vibrations in individuals with potential bruxism.

Methods: Adults (N = 195), aged 18-45, were included in this retrospective study divided into two groups: those with possible bruxism and TMD features (n = 175) and asymptomatic controls (n = 20). The classification was based on clinical examination and self-report, without differentiating sleep and awake bruxism. TMJ function was evaluated with JVA, assessing peak frequency, median frequency, vibration amplitude, and vibrational energy. Statistical analyses included independent t-tests, Mann-Whitney U tests, Spearman correlation and regression (α = 0.05).

Results: Participants with possible bruxism showed higher peak frequency (42.3 ± 5.6 Hz vs. 38.7 ± 4.2 Hz, p = 0.023), median frequency (28.9 ± 4.8 Hz vs. 25.6 ± 3.9 Hz, p = 0.015), vibration amplitude (6.5 ± 1.2 mm/s vs. 4.9 ± 1.0 mm/s, p < 0.001) and vibrational energy (12.7 ± 3.4 μJ vs. 9.2 ± 2.8 μJ, p < 0.001) than controls. Bruxism severity correlated with higher JVA parameters, explaining about 35% of the variance in vibration amplitude and 30% in energy (p < 0.001). Effect sizes ranged from moderate to large (Cohen's d = 0.73-1.35). These results reflect patterns in a mixed bruxism-TMD group, not bruxism-specific effects.

Conclusions: Findings show higher TMJ vibrational parameters in those possibly bruxing, many with TMD features. JVA helps characterise TMJ patterns but should not be used alone for bruxism diagnosis without imaging or TMD controls.

Trial registration: ClinicalTrials.gov.tr: NCT07070141.

Background: There are various tests to assess the individual performance of mastication. However, it has remained unknown how individuals used adaptive (e.g., 'increasing time to chew') and maladaptive (e.g., 'avoiding eating the food') strategies to chew and whether aging/cognitive impairment plays a key role in the use of these strategies during eating.

Objective: The study aims to develop the Masticatory Adaptation Experience Questionnaire (MAEQ) and investigate age-related factors of masticatory adaptation.

Methods: The study consists of two subsets: Set 1 included 125 healthy younger (YA, 20-50 years) and older (OA, over 50 years) adults, and Set 2 included 40 older patients with cognitive impairment (CI). Based on Set 1, internal consistency, test-retest reliability, and content and criterion-related validity were assessed. Eating difficulty was assessed using a food-specific questionnaire. The MAEQ mean score and scores for each adaptive/maladaptive strategy were compared between YAs and OAs, as well as between CIs and OAs.

Results: The MAEQ, a questionnaire assessing the frequency of using adaptive/maladaptive strategies to eat, shows good reliability and validity in older adults. Compared to young adults, older adults used multiple adaptive and maladaptive strategies concurrently when they had greater eating difficulty. In contrast, cognitively-impaired patients maladaptively avoid eating foods when having greater eating difficulty.

Conclusion: The MAEQ is a valid tool for assessing the use of adaptive/maladaptive strategies during mastication in older individuals. Age and cognitive impairment may play a key role in the use of the strategies.

Background: Anterior disc displacement without reduction (ADDwoR) is a prevalent temporomandibular joint disorder (TMD) and a significant source of orofacial pain. Despite its frequency, there is a lack of comprehensive reviews that establish standardised, evidence-based treatment strategies specifically for pain management in this condition.

Methods: This systematic review compared the efficacy of conservative versus surgical treatments for pain alleviation in ADDwoR. A literature search was conducted in PubMed, ScienceDirect and MEDLINE, supplemented by additional resources, following PICOS criteria. Twenty studies were selected and categorised to address the following: (1) the difference in pain relief between conservative and surgical treatments and (2) the effectiveness of surgical treatment after conservative treatment failure. Studies on combination therapies were also included. Methodological quality was assessed using the Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale. Data were synthesised through a qualitative narrative synthesis.

Results: The synthesised evidence indicates no significant difference in pain relief between conservative and surgical treatments for ADDwoR. Notably, arthrocentesis and various combination therapies demonstrated considerable therapeutic potential.

Conclusion: Conservative and surgical treatments are comparable in their efficacy for pain relief in ADDwoR. Based on these findings, a standardised treatment model is proposed to improve pain management. The promising results of arthrocentesis and combination therapies highlight important directions for future research and the development of innovative treatment strategies.

Background: Recent studies have focused on oral frailty and hypofunction, and their relationship with swallowing function and dysphagia. These play especially important roles in patients with dysphagia in medical-dental cooperation at acute hospitals.

Objective: This study aimed to assess oral frailty, in terms of nutritional intake by evaluating oral and swallowing functions simultaneously, in patients consulting at an acute hospital.

Methods: This cross-sectional study was conducted at the Center for Dysphagia of Tohoku University Hospital and involved a comprehensive survey of 183 patients. Their oral function and oral status were evaluated, which included factors such as poor oral hygiene, oral dryness, tongue-lip motor function, tongue pressure, and masticatory performance. Additionally, swallowing status was evaluated using various methods, including a questionnaire related to swallowing, Hyodo-Komagane score, modified water-swallowing, and repetitive saliva swallowing tests. This thorough approach ensured the validity and reliability of our findings.

Results: Approximately 60% of patients had head and neck tumours, degenerative diseases, and muscular diseases. Therefore, a high prevalence of oral hypofunction was observed. Furthermore, since 41.5% of patients had limited tongue movement, a characteristic correlation existed between the oral diadochokinesis and Hyodo-Komagane score.

Conclusion: These results suggest that oral dryness score, oral diadochokinesis, and tongue pressure are associated with oral hypofunction and dysphagia. Additionally, patients with hypofunction and decreased tongue pressure may have hypopharyngeal residuals. The medical-dental cooperation in an acute hospital allows for the simultaneous assessment of oral and swallowing functions. This suggests a potential to contribute to the practice of safe oral intake and appropriate rehabilitation.