Journal of oral rehabilitation最新文献

Background: While maximum isometric pressure (MIP) is widely used in clinical and research settings, reduced lingual swallow pressure (LSP) has been observed in patients with dysphagia and in older healthy adults. However, limited evidence exists on the test-retest reliability of LSP across different bolus consistencies.

Objective: This study assessed the test-retest reliability of LSP measurements in both younger and older adults with healthy swallowing function to identify factors influencing oral swallowing pressure.

Methods: Participants 18-40 years (younger) and 60+ years (older) were assessed across four separate sessions. Bolus types included trials of saliva, thin, mildly thick and extremely thick water, randomised across study visits. Two-way mixed effects models with absolute agreement were used to calculate intraclass correlation coefficients (ICCs) and evaluate test-retest reliability of LSP for each swallow type (regular or effortful) and bolus type. Linear mixed effects regression modelling was used to examine the factors influencing LSP.

Results: A total of 51 participants were included. Test-retest reliability for LSP ranged from good to excellent across both groups (ICC = 0.79-0.98). Reliability was non-significantly higher in the older group (ICC = 0.96) and during effortful swallows (ICC = 0.94). Effort level significantly influenced LSP estimates, with effortful swallows producing about 1.83 times more lingual pressure than regular swallows. There were no significant effects of age, sex, or bolus type on LSP.

Conclusion: These findings suggest that LSP measurements are reliable across measurement time points in nondysphagic participants, regardless of age, effort level, or bolus type. Only swallow effort level significantly influenced LSP estimates.

Background: Infrared thermography is an objective method for investigating muscle functioning, enabling inferences about physiology and therapeutics. This noninvasive and non-ionising imaging diagnostic method allows real-time visualisation of the vascular and musculoskeletal systems through skin microcirculation dynamics. It transforms information about the human body's thermal radiation, captured via infrared radiation, into an analysable image.

Objective: To describe the thermographic behaviour of the orbicularis oris muscle during sustained contraction and chewing tasks.

Methods: The study included 56 healthy women aged 18-52 years, who underwent thermographic evaluations before, during, and after performing sustained contraction and chewing tasks. The orbicularis oris muscle was analysed qualitatively and quantitatively using anatomical thermal areas and Student's t-test to compare mean temperature data.

Results: Qualitative analysis revealed temperature changes during the provocative tasks. A comparison of mean temperatures showed a significant temperature increase, corroborating the qualitative findings. The mean temperature variation per task was as follows: 0.57°C during lip compression, 0.20°C during lip protrusion, 0.57°C while chewing peanuts, 0.43°C while chewing crackers, and 0.37°C while chewing a bread roll. There was a decrease in mean temperature during the intervals between tasks, though insufficient to return to baseline levels, indicating a cumulative temperature effect between tasks.

Conclusion: The orbicularis oris muscle temperature increased during the provocative tasks. The 2-min interval between tasks was insufficient for the resting temperature to return to baseline levels. These findings confirm that thermography is an effective method for identifying such temperature changes.

Background: From the perspective of site specificity, inducing muscle activity across a large area of the tongue through diversified tongue resistance training (TRT) may be an effective approach to improve tongue pressure (TP) and function. However, the distribution of muscle activity within the tongue during different TRT exercises remains unclear.

Objectives: To examine the hypothesis that muscle activity distribution within the tongue varies with TRT direction using muscle functional magnetic resonance imaging (mfMRI), and to clarify the relationship between these distributions and functional outcomes.

Methods: Twenty young volunteers were randomly assigned to either an elevation or a lateral 4 week TRT group. We performed mfMRI before (at rest) and immediately following each training task, before and after 4 weeks of TRT, and we measured maximal elevation, lateral TP, and oral diadochokinesis (ODK). A linear mixed-effects model was used to analyse the functional outcomes.

Results: After TRT, mfMRI revealed that elevation exercise activated the anterior tongue, including the origin of the genioglossus. Conversely, lateral exercise induced significant activity across a wider area extending to the tongue root. Post-training maximal elevation TP and overall ODK values were significantly higher in the elevation training group. No significant differences between groups were observed in post-training lateral TP.

Conclusions: TRT direction changes the pattern of muscle activity in the tongue. This finding reveals qualitative aspects of TRT that cannot be evaluated by post-training TP alone, offering a new perspective for designing more effective rehabilitation programs.

Trial registration: ClinicalTrials.gov identifier: UMIN000047658.

Background: The long-term influence of mandibular atrophy on masticatory function, patient-reported outcomes, and prosthetic maintenance in users of implant-retained overdentures remains unclear.

Objective: To assess the impact of mandibular bone atrophy on masticatory function, quality of life, patient satisfaction, and prosthetic maintenance over a five-year period.

Methods: Twenty-four fully edentulous patients were rehabilitated with mandibular overdentures retained by two narrow-diameter implants and divided into two groups according to mandibular bone height: atrophic mandible (AM) and non-atrophic mandible (NAM). Masticatory performance (MP) and swallowing threshold (ST) were assessed, while quality of life and satisfaction were evaluated using the Dental Impact on Daily Living (DIDL) questionnaire. Prosthetic maintenance events were recorded over 5 years. Multilevel mixed-effects regression evaluated temporal trends and group differences, and chi-square tests were used for prosthetic events.

Results: Four participants were lost to follow-up, resulting in 10 individuals per group at 5 years. The AM group showed significant reductions in MP_X50 (-9.66%; p = 0.00) and ST_X50 (-1.9%; p = 0.01); and increase in ST_ME5.6 (+43.32%; p = 0.01). The eating/chewing domain of the DIDL was significantly lower in the AM group (0.35 ± 0.72) compared to the NAM group (0.73 ± 0.47). Although overall prosthetic maintenance did not differ significantly, the AM group exhibited a higher frequency of Equator dislodgement (9.24%; p = 0.00) and attachment replacement (6.02%; p = 0.00).

Conclusion: Mandibular atrophy adversely affected masticatory function, patient-reported chewing satisfaction, and the frequency of specific prosthetic complications over 5 years.

Background: Age-related decline in swallowing function (dysphagia) increases the risk of aspiration pneumonia and reduces quality of life in older adults. However, the efficacy of swallowing-targeted interventions in aging remains unclear.

Objective: This study aimed to systematically review the interventions for age-related dysphagia in aged rodent models and evaluate their effectiveness through a meta-analysis.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched MEDLINE, Embase, and Cochrane Library (January 2024) for studies on interventions for swallowing decline in aged rodents. Seventeen studies were included, of which eight contributed to the meta-analysis.

Results: Interventions included progressive resistance tongue exercise, neuromuscular electrical stimulation (NMES), treadmill running, and pharmacological manipulation. The meta-analysis showed that tongue exercise significantly increased in both young (standardised mean difference [SMD] = 3.659; 95% confidence interval [CI]: 2.011-5.308) and aged rodents (SMD = 3.274; 95% CI: 2.682-3.867). Beyond force, tongue exercise improved endurance, induced region-specific myosin heavy chain shifts, and elicited neural and mitochondrial metabolic adaptations. NMES increased fatigue resistance, promoted a shift toward fatigue-resistant fibre isoforms, and partially restored neuromuscular junction integrity. Treadmill running improved endurance and fatigue resistance, with region-dependent effects on fibre composition. Pharmacological interventions had limited impact.

Conclusion: Robust evidence shows that progressive resistance tongue exercise can mitigate age-related decline in swallowing, whereas evidence for NMES, treadmill running, and pharmacological interventions remains limited. These findings underscore the translational potential of exercise-based therapies and highlight the need for age-tailored strategies.

Objective: To compare clinical examination findings, functional limitations, and psychological profiles between patients with subclinical temporomandibular disorders (TMD) and those with self-reported painful TMD.

Materials and methods: This cross-sectional study investigated 98 subclinical TMD patients and 262 self-reported painful TMD patients attending a specialised orofacial pain clinic. Subclinical TMD was defined as positive palpation findings without muscle or joint pain complaints. Self-reported painful TMD required both pain complaints and positive clinical findings. Validated questionnaires assessed jaw functional limitations (JFLS-20), depression (PHQ-9), stress (SPST-20), and oral behaviours (OBC). Statistical analysis used Mann-Whitney U tests and chi-square tests with Bonferroni correction.

Results: Self-reported painful TMD patients were significantly older (median age 39 vs. 31 years, p = 0.003), showed greater jaw functional limitations (JFLS global score: 1.88 vs. 0.75, p < 0.001), and higher depression scores (PHQ-9: 1.0 vs. 0.0, p < 0.001). Sleep bruxism frequency differed significantly between groups (p < 0.001), with subclinical patients more commonly reporting frequent sleep bruxism. No significant differences were found in stress levels, overall oral behaviours, or daytime clenching frequency.

Conclusions: Patients with self-reported painful TMD demonstrate distinct clinical profiles characterised by greater functional impairment and psychological distress compared to subclinical cases.

Clinical relevance: These findings suggest different phenotypes within the TMD spectrum that may require tailored clinical approaches. Longitudinal studies are needed to determine whether subclinical TMD represents an early stage or a distinct entity.

Background: Studies on painful temporomandibular disorders (TMDs) and somatic symptoms in Southeast Asian migraine patients are lacking.

Objectives: This study investigated the prevalence of TMD pain and somatic symptoms in migraine patients, examining their relationships with pain characteristics, psychological distress, and quality of life (QOL). Additionally, it identified factors associated with moderate-to-severe distress, low QOL, and poor general health.

Methods: Participants were recruited from a neurology clinic, where migraines were diagnosed based on the ICHD-3 criteria. A trained interviewer administered a questionnaire comprising sociodemographics, migraine-specific information, the DC/TMD TMD pain screener (TPS), Graded Chronic Pain Scale (GCPS), Patient Health Questionnaires (PHQ-15/PHQ-4), and WHOQOL-BREF. Data were analysed employing Chi-square/Mann-Whitney U tests, Spearman's correlation, and logistic regression analysis (α = 0.05).

Results: Among the 106 participants (mean age 45.3 years [SD = 14.0]), 31.1% experienced TMD pain, while 37.7% exhibited medium-to-high somatic symptoms. Individuals with comorbid migraine-TMD pain had a higher somatic symptom burden, distress, and poorer psychological/environmental QOL. Those with medium-to-high somatic symptoms reported more frequent migraines, greater pain intensity/disability, higher TMD pain propensity, elevated distress, and worse QOL in all domains. Somatic symptoms, but not TMD pain, were negatively and moderately correlated with general health, physical, and psychological QOL (rs = -0.41 to -0.53). Somatic symptoms (OR 1.34) and poor general health (OR 3.06) increased the odds of moderate-to-severe distress and low overall QOL, respectively.

Conclusions: To effectively manage migraine patients, screening for TMDs and addressing somatic symptoms and general health are essential for reducing psychological distress and enhancing overall QOL.

Background: Chronic apical periodontitis (CAP) remains among the most challenging endodontic conditions due to persistent infection and inflammatory destruction in the periapical region. In contemporary endodontic terminology (AAE 2015), CAP typically corresponds to apical periodontitis with radiographic apical radiolucency, which may present with or without symptoms.

Objective: This study evaluates the effect of a novel bioceramic sealer, iRoot SP, on periodontal clinical parameters and masticatory function in patients with chronic apical periodontitis (CAP) compared with the traditional AH-Plus sealer.

Methods: In a single-center randomised controlled trial, 108 patients with single-tooth CAP were randomly allocated in a 1:1 ratio to the iRoot SP group or the AH-Plus group. Standardised root canal treatments were performed according to a strict protocol. Primary outcome measures included immediate obturation quality, clinical efficacy at one week, postoperative pain, periodontal parameters (probing depth, sulcular bleeding, gingival and plaque indices), and masticatory efficiency assessed preoperatively and at follow-up intervals of one week, three months, and six months.

Results: The iRoot SP group achieved a significantly higher adequate filling rate (96.3% vs. 85.2%, p < 0.05) and overall clinical effectiveness (98.2% vs. 83.3%, p < 0.01). Moreover, postoperative pain was markedly lower (3.7% vs. 18.5%, p < 0.05). Superior improvements in periodontal metrics and masticatory function were consistently observed at all follow-up points (all p < 0.001).

Conclusion: The innovative iRoot SP sealer enhances root canal obturation quality and clinical outcomes while reducing postoperative discomfort and promoting periodontal and functional recovery in CAP. These results underscore its potential as a superior alternative in endodontic therapy.

Background: Obesity is associated with periodontal disease, which compromises chewing by reducing masticatory efficiency. However, little is known about periodontal health and the use of removable prostheses in obese older adults.

Objective: To evaluate the effects of removable partial denture (RPD) insertion on periodontal condition, maximum bite force (MBF), and oral health-related quality of life (OHRQoL) in obese and normal-weight older adults.

Material and methods: Edentulous older adults in the maxilla and partially edentulous in the mandible were assigned to obese (71.9 ± 5.0 years; n = 12, 6 women and 6 men) and normal-weight (69.9 ± 6.7 years; n = 6 women and 6 men) groups. Periodontal parameters (probing depth, clinical attachment loss, gingival recession, bleeding on probing) were measured with William's probe, and plaque was assessed with the modified O'Leary index. MBF was recorded with pressure sensors, and OHRQoL was evaluated with the OHIP-14. Periodontal parameters and MBF were measured before and 3, 6, 9, and 12 months after RPD insertion, while OHRQoL was measured before, and after 6 and 12 months. Data were analysed by repeated-measures ANOVA with Bonferroni post hoc tests (α = 0.05).

Results: Obese individuals showed higher bleeding on probing (p = 0.02) and greater MBF (p = 0.002) at all time points. MBF increased in both groups after 3 months, while OHRQoL remained lower in obese individuals (p = 0.01). Both groups showed significant plaque reduction after RPD insertion (p < 0.05).

Conclusion: Obese older adults wearing RPDs exhibit greater periodontal impairment and poorer OHRQoL, despite similar improvements in MBF and plaque reduction. These findings underscore the need for closer periodontal monitoring and targeted oral health strategies for obese older adults receiving RPDs.

Trial registration: Brazilian Registry of Clinical Trials: ReBEC #U1111-1228-7273.