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Effects of gum chewing on glycaemic control in women with gestational diabetes mellitus: A randomized controlled trial. Impact of chewing on hyperglycaemia in women with GDM.
Yerlikaya-Schatten, G, Trimmal, L, Rosicky, I, Husslein, P, Schatten, C, Eppel, D, Eppel, W, Tura, A, Göbl, CS
European journal of obstetrics, gynecology, and reproductive biology. 2020;:61-65
Abstract
BACKGROUND The amount of chewing might be relevant in reducing hyperglycaemia in diabetic patients. The study assessed the impact of enhanced chewing on glycaemic control in women with gestational diabetes mellitus (GDM). METHODS As an open-label, mono-centre randomized controlled trial, 59 women with recent diagnosis of GDM were included. They received either routine care or additional chewing gum intervention. SMBG was performed for five days. RESULTS No significant impact on mean values of postprandial glucose levels were observed. The estimated mean differences (intervention vs. control group) were: 4.9 mg/dl, 98.4 %CI -7.2-17.1 (breakfast); -4.5 mg/dl, 98.4 %CI -15.1-6.0 (lunch); -3.8 mg/dl, 98.4 %CI -15.9 to 8.4 (dinner). OGTT levels at 60 and 120 min. were associated with glucose levels after breakfast. CONCLUSION In conclusion, no significant differences in blood glucose levels were observed between the groups and therefore major effects of chewing on hyperglycaemia in women with GDM could be excluded. TRIAL REGISTRATION ClinicalTrials.gov; NCT03961542, Date of registration: 20.01.2019. Retrospectively registered.
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Effects of Neuromuscular Electrical Stimulation Synchronized with Chewing Exercises on Bite Force and Masseter Muscle Thickness in Community-Dwelling Older Adults in South Korea: A Randomized Controlled Trial.
Park, JS, Jung, YJ, Kim, MJ
International journal of environmental research and public health. 2020;(13)
Abstract
This study is aimed at investigating the effects of synchronized neuromuscular electrical stimulation (NMES) and chewing exercises on bite force and the masseter muscle thickness in community-dwelling older adults. Material and methods: Forty older adults were enrolled in South Korea and randomly assigned to either an experimental or control group. The experimental group performed chewing exercises using the No-Sick Exerciser equipment synchronized with NMES applied to the bilateral masseter muscles, while the control group performed only chewing exercises. Both groups received interventions for 20 min/day, 5 days/week, for 6 weeks. Bite force was measured using the OCCLUZER device, and masseter muscle thickness was measured using a portable ultrasound. Results: Both groups showed a significant increase in bite force and masseter muscle thickness compared to baseline measurements (p < 0.05). The experimental group showed a significantly higher increase in bite force and masseter muscle thickness than the control group after combined intervention (p < 0.05). Conclusion: This study demonstrates that NMES synchronized with chewing exercises is more efficient in increasing bite force and masseter muscle thickness than chewing exercises alone in community-dwelling older adults.
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Effect of implant-supported mandibular overdentures versus reline on masticatory performance and salivary flow rates in very old adults-A randomized clinical trial.
Maniewicz, S, Duvernay, E, Srinivasan, M, Perneger, T, Schimmel, M, Müller, F
Clinical oral implants research. 2019;(1):59-67
Abstract
PURPOSE To compare the masticatory efficiency (ME), maximum voluntary bite force (MBF), masseter muscle thickness (MMT), and salivary flow rates (SFR) in completely edentulous dependent elders treated either with a conversion of their existing mandibular complete removable dental prostheses (CRDPs) into a two-implant overdenture (IOD) or a conventional reline of the CRDP. MATERIAL AND METHODS Participants were randomly allocated into intervention (IG) and control (CG) groups. The IG received two implants in the mandibular canine regions, and their CRDPs were transformed into IODs. The CG received a conventional reline of their mandibular CRDPs. Outcomes were recorded at each recall visit (baseline, immediately, 3 months, 12 months after intervention, and subsequently on an annual basis). Statistical analyses used mixed linear regression models (level of significance: p < 0.05). RESULTS The IG comprised 16 participants (age = 85.0 ± 6.2 years), while the CG comprised 16 (age = 84.8 ± 5.4 years), with a mean follow-up of 2.7 ± 2.2 years (range: 3 months-7 years). A significant increase of MBF in the IG was observed with an overall gain of 80 N (p < 0.001) compared with the reline group. There were no significant long-term changes in SFR, MMT, or ME within/between groups. CONCLUSION Since dependent elders with mandibular IODs present a significant gain in MBF, but no relative increase in SFR, MMT, and ME, it seems that this increased capacity of MBF is not exploited by the elders during their habitual chewing.
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Improvement in Food Intolerance Resulting from Roux-En-Y Gastric Bypass after Speech Therapy Intervention in Chewing.
Rossi, DC, Soares, AN, Silva, KRS, Britto, ATBO, Bosco, AA
Obesity surgery. 2019;(10):3195-3201
Abstract
INTRODUCTION Food intolerance is expected during the postoperative period following gastric bypass and may be associated with inadequate chewing. OBJECTIVE To evaluate chewing before and after speech therapy intervention in subjects undergoing Roux-en-Y gastric bypass who present with food intolerance. MATERIALS AND METHODS This was a randomized controlled trial, approved by the Brazilian Ethics and Research Committee under n. 438,600. The study population was allocated into two groups: the study group (SG), who received speech therapy intervention, and the control group (CG), who did not receive any intervention, in six visits at 7, 15, 30, 60, and 90 days (v7, v15, v30, v60, and v90) after the initial visit (v0). During v0 and v90, a chewing evaluation was performed according to the MBGR protocol adapted. The significance level adopted was 5%. RESULTS A total of 30 females (88%) and 4 males (12%) were analyzed. The SG had 18 subjects, and the CG had 16, with mean ages of 50.17 ± 12.28 years and 45.69 ± 9.78 years, respectively. The postoperative time ranged from 4 to19 months. In the SG, a marked improvement in the number of episodes of food intolerance was observed (p < 0.001), an improvement in the intake of cereals and meats (p = 0.004 and p < 0.001, respectively), and an improvement in chewing capacity and swallowing (p = 0.002 and p = 0.011, respectively). CONCLUSION Speech therapy intervention in chewing led to a marked improvement of food acceptance and food intolerance resulting from Roux-en-Y gastric bypass.
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Administration of low-level laser on muscles of mastication following the induction of initial fatigue: protocol for a randomized, controlled, clinical trial.
de Brito Bitencourt, G, Gonçalves, MLL, Kobayashi, FY, Motta, LJ, Silva, DFTD, Politti, F, Paulino Feliciano, L, Mesquita-Ferrari, RA, Fernandes, KPS, Bussadori, SK
Medicine. 2018;(26):e11340
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Abstract
BACKGROUND Orofacial pain encompasses painful conditions, such as temporomandibular disorder (TMD). Multidisciplinary health teams seek to control such musculoskeletal disorders to improve the quality and functional capacity of the muscles of mastication. The aim of the proposed study is to evaluate the effect of low-level laser therapy as a form of treatment for the prevention of initial fatigue of the muscles of mastication (masseter and anterior temporal muscles) as well as the recovery of these muscles after induced exhaustion (caused by isometric contraction) in young adults. METHODS The participants will be 78 healthy male and female volunteers between 18 and 34 years of age. The volunteers will be randomly allocated to a laser group (n = 26), sham group (n = 26), and control group (n = 26). All participants will be submitted to a clinical evaluation to record mandibular movements, bite force, muscle sensitivity to palpation, and initial muscle fatigue. Initial fatigue will be induced by isometric contraction of the jaws. Maximum voluntary contraction will be performed to record the time until initial exhaustion of the masseter muscle (determined by electromyography). The groups will then be submitted to the interventions: active laser therapy (wavelength: 780 nm; fluence: 134 J/cm; power: 50 mW; irradiance: 1.675 W/cm; exposure time: 80 seconds per point) on 3 points of the masseter and 1 point on the anterior temporal muscles on each side; sham laser (placebo effect); or no intervention (control). Maximum voluntary contraction will be performed again after the interventions to record the time until initial exhaustion of the masseter muscle (determined by electromyography). Differences in individual time until exhaustion between the pre- and postintervention evaluations will be measured to determine the effect of low-level laser therapy. DISCUSSION Although studies have been made with the use of low-level laser therapy in TMDs and on the effect of photobiomodulation on fatigue, this the first study to test this therapy in the prevention of fatigue in this region. The clinical relevance lies in the fact that longer dental procedures could take place if the patients are less prone to fatigue.
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One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants.
Paleari, AG, Oliveira Junior, NM, Marin, DOM, Rodriguez, LS, Arioli Filho, JN, Pero, AC, Compagnoni, MA
Journal of applied oral science : revista FOB. 2018;:e20160628
Abstract
OBJECTIVE There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. MATERIAL AND METHODS Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). RESULTS Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p<0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p<0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p<0.05). CONCLUSION MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant.
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Prospective evaluation of relationships between radiotherapy dose to masticatory apparatus and trismus.
Hague, C, Beasley, W, Garcez, K, Lee, LW, McPartlin, A, McWilliam, A, Ryder, D, Sykes, AJ, Thomson, D, van Herk, M, et al
Acta oncologica (Stockholm, Sweden). 2018;(8):1038-1042
Abstract
AIMS: This feasibility study aimed to identify relationships between radiation doses to the masticatory apparatus as a combined block or as individual subunits with changes in trismus following radiotherapy. MATERIAL AND METHODS Twenty patients from a single center were recruited prospectively as part of a randomized trial comparing proactive exercises in the management of trismus. Patients with stage III/IV oral cavity or oropharyngeal squamous cell cancers received intensity-modulated radiotherapy with concurrent systemic therapy. All patients had trismus prior to radiotherapy. Maximal inter-incisor distance (MID) was measured pre- and 6 months from the start of radiotherapy. Bilateral muscles of mastication: medial and lateral pterygoids (MP and LP), masseters (M), temporalis (T), temporomandibular joint (TMJ) were contoured on CT images. The block comprised all muscles excluding the TMJ below the orbital floor. Mean dose, equivalent uniform dose (EUD) and V35-V60 Gy were compared with change in MID. RESULTS In six patients, the MID deteriorated at 6 months from the start of radiotherapy compared with 14 whose MID improved. No significant association was observed between age, gender, smoking, alcohol status, exercise compliance, cisplatin, tumor site, stage, V35-V60 Gy or EUD with change in MID. A clinical outlier was excluded. Without the outlier (n = 19), a significant association was seen between mean dose and change in MID at 6 months for the ipsilateral block (p = .01), LP (p = .04) and M (p < .01). All patients where trismus deteriorated at 6 months received mean doses >40 Gy to the block. CONCLUSION Higher mean radiation doses to the ipsilateral block, LP and M were significantly associated with deterioration in trismus. Limiting dose to these structures to ≤40 Gy for tumors not invading the masticatory muscles may improve treatment-related sequelae. The ipsilateral block, LP and M should be studied further as possible alternative avoidance structures in radiotherapy treatment planning.
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Adaptation to new complete dentures-is the neuromuscular system outcome-oriented or effort-oriented?
Eberhard, L, Oh, K, Eiffler, C, Rammelsberg, P, Kappel, S, Schindler, HJ, Giannakopoulos, NN
Clinical oral investigations. 2018;(6):2309-2317
Abstract
OBJECTIVE The aim of this study was to observe the adaptation strategy of the stomatognathic system during the adaptation of complete dentures, comprising masticatory parameters and subjective measures. Our hypothesis was that with new dentures, masticatory performance would increase while the effort of the system is kept constant. MATERIAL AND METHODS Thirty-two patients received standardized new complete dentures. Masticatory performance tests were conducted with old dentures (T1), immediately after incorporation of new dentures (T2) and after an adaptation period of 3 months (T3). Patients habitually chewed the silicone-based artificial test food Optocal. The comminuted test food was analyzed and mean particle sizes (x50) were calculated. Simultaneously, surface EMGs of the anterior temporalis and masseter muscles were recorded. Specific (SMW) and total muscle work (TMW) were determined. Patients filled in the OHIP-49 questionnaire. Test conditions were compared using repeated-measures ANOVA with SPSS 22 (SPSS Inc.) RESULTS Masticatory performance increased (P = 0.016) between old (x50 = 4.99 ± 0.28) and adapted new dentures (x50 = 4.80 ± 0.33). TMW deteriorated (P = 0.004) at T2 (from TMW1 = 119.77 ± 56.49 to TMW2 = 92.12 46.27), and increased again (P = 0.028) at T3 (TMW3 = 107.66 ± 44.65). OHIP scores decreased significantly in all subscales (P < 0.001…P = 0.046); the total score was reduced (P < 0.001) from 56.24 ± 29.05 (T1) to 34.66 ± 24.74 (T3). CONCLUSION In complete denture wearers, masticatory performance improves over an adaptation period. Muscle work initially decreased before reaching its original level again after adaptation. Subjective parameters overestimated the functional improvements. CLINICAL SIGNIFICANCE The subjective evaluation does not adequately reflect functional improvements. The assessment of function requires an adaptation period.
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Impact of prosthodontic rehabilitation on the masticatory performance of partially dentate older patients: Can it predict nutritional state? Results from a RCT.
Wallace, S, Samietz, S, Abbas, M, McKenna, G, Woodside, JV, Schimmel, M
Journal of dentistry. 2018;:66-71
Abstract
OBJECTIVES With a decreased number of teeth, a reduction in chewing function can contribute to changes in food choices and ultimately impact on overall nutritional status. This study compared the impact of two tooth replacement strategies for partially dentate older patients on masticatory performance and nutritional status. METHODS Patients aged 65 years and older were randomly allocated to two different treatment groups. For the RPDP-group (removable partial dental prostheses) each participant was restored to complete dental arches with cobalt-chromium removable prostheses. For the SDA-group (shortened dental arch), participants were restored to 10 occluding pairs of natural and replacement teeth using adhesive bridgework. Masticatory performance was assessed with a colour-mixing ability test. Each patient provided haematological samples that were screened for biochemical markers of nutritional status. Patients were also assessed using the Mini Nutritional Assessment (MNA). RESULTS Eighty-nine patients completed the test for masticatory performance and provided blood samples and MNA scores at baseline (BL) and after 12 months (12m). Masticatory performance (p<0.001) and MNA (p<0.05) increased significantly in both groups, but no significant between group differences were noted. A mixed picture was observed for nutrition biomarkers. Mixed-effect linear regression models did not demonstrate that nutritional status could be predicted from masticatory performance. CONCLUSIONS These results indicate that prosthodontic rehabilitation according to the principles of the SDA is equivalent to RPDPs in terms of restoration of chewing capacity for partially dentate older patients. However, masticatory performance may only have minor associations with nutritional status for this patient group. CLINICAL SIGNIFICANCE Replacing teeth with either RPDPs or SDA provides a prerequisite for efficient chewing. Further research is required to determine the impact of oral rehabilitation coupled with nutritional counselling for this patient population.
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Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial.
Prado, DGA, Berretin-Felix, G, Migliorucci, RR, Bueno, MDRS, Rosa, RR, Polizel, M, Teixeira, IF, Gavião, MBD
Journal of applied oral science : revista FOB. 2018;:e20170164
Abstract
OBJECTIVES The esthetic and functional results of orthognathic surgery of severe dentofacial deformities are predictable, however there are differences regarding the effects on stomatognathic system. The aim was to investigate the effects of orofacial myofunctional therapy (OMT) on the masticatory function in individuals with dentofacial deformity submitted to orthognathic surgery (OGS). MATERIAL AND METHODS Forty-eight individuals (18-40 years) were evaluated, 14 undergoing OMT (treated group-TG), 10 without this treatment (untreated group-UTG) and 24 in a control group with normal occlusion; for clinical aspects the data of an individual was missed (n=46). Chewing was performed using the Expanded protocol of orofacial myofunctional evaluation with scores (OMES-E). Muscle tone and mobility were also analyzed before (P0), three (P1) and six months (P2) after OGS. Surface electromyography of the masseter and temporalis muscles was performed, considering the parameters amplitude and duration of act and cycle, and the number of masticatory cycles. The OMT consisted of ten therapeutic sessions along the postoperative period. The results were compared using parametric and non-parametric tests. RESULTS TG showed higher scores in P1 and P2 than P0; for the masticatory type the scores in P2 were significantly higher than P0. In addition, the proportion of individuals with adequate tone of lower lip and adequate tongue mobility for TG increased significantly from P1 and P2 in relation to P0. The EMG results showed a decrease in act and cycle duration in P2 in relation to P0 and P1 for the TG; furthermore the values were close to controls. An increase in the number of cycles from P0 to P2 was also observed, indicating faster chewing, which may be attributed to an improvement of balanced occlusion associated with OMT. CONCLUSION There were positive effects of OMT on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.