To determine whether chewing side preference is related to handedness and lateral asymmetry of occlusal characteristics, muscular force and temporomandibular disorders (TMD) in a dentate population. One hundred and seventeen dentate adults participated in this cross-sectional study. Static and dynamic occlusal characteristics were determined at the maximal intercuspal position and at the lateral excursions by scanning interocclusal records and analysing them using image software. Unilateral maximum bite force and finger-thumb grip force were measured by means of a gnathodynamometer. TMD were assessed according to the Research Diagnostic Criteria for TMD. Chewing side preference and masticatory laterality were determined by observing the jaw's movement while each subject chewed silicone. Asymmetry or side difference of the variables was calculated. Correlation between side difference variables and masticatory laterality was studied using Spearman correlation coefficient. Fifty-nine subjects chewed on the right, 15 on the left and 43 chewed on both sides. There was no relationship between preferred chewing side and handedness, lateral asymmetry of TMD or side difference in finger-thumb grip force. Significant and positive correlations were observed between masticatory laterality and side differences in bite force and side differences in occlusal contact area at intercuspal position (P<0.01). Chewing side preference in a dentate population is related to lateral asymmetry of bite force and asymmetry of occlusal contact area at the intercuspal position but not to handedness.
Objective: To determine the variation in prevalence of temporomandibular disorders (TMD), other side effects, and technical complications during 5 years of sleep apnea treatment with a mandibular advancement device. Materials and Methods: Forty patients diagnosed with obstructive sleep apnea received an adjustable appliance at 70% of the maximum protrusion. The protrusion was then progressively increased. TMD (diagnosed according to the Research Diagnostic Criteria for TMD), overjet, overbite, occlusal contacts, subjective side effects, and technical complications were recorded before and a mean of 14, 21, and 58 months after treatment and analyzed by the Wilcoxon test (P < .05). Results: Fifteen patients still used the oral appliance at the 5-year follow-up, and no significant variation in TMD prevalence was observed. Subjective side effects were common, and a significant reduction was found in overjet, overbite, and in the number of occlusal contacts. Furthermore, the patients made a mean of 2.5 unscheduled dental visits per year and a mean of 0.8 appliance repairs/relines per year by a dental technician. The most frequent unscheduled visits were needed during the first year and were a result of acrylic breakage on the lateral telescopic attachment, poor retention, and other adjustments to improve comfort. Conclusions: Five-year oral appliance treatment does not affect TMD prevalence but is associated with permanent occlusal changes in most sleep apnea patients during the first 2 years. Patients seek several unscheduled visits, mainly because of technical complications.
1 April 2014 in The Journal of Prosthetic Dentistry
Denture-related mucosal lesions have been broadly studied. However, no consensus has been reached regarding the risk factors associated with these lesions, and few studies have used multivariable analysis to determine the relative significance of different risks. The purpose of this study was to determine the relationship between systemic, local, and denture factors on the risk of denture-related oral mucosal lesions in an elderly population by using multivariable analysis. Eighty-four elderly denture wearers recruited from geriatric residences and day care centers participated in this cross-sectional study. All data were obtained by means of a questionnaire-interview, a physical examination, and complementary tests. Bivariate relationship and multiple logistic regression analyses were performed (α=.05). Angular cheilitis (34%), traumatic ulcers (15%), and denture stomatitis (14%) were the 3 most common lesions, and the prevalence of at least 1 denture-related mucosal lesion was 54%. The presence of denture stomatitis was related to low saliva pH, never having smoked, and regular sugar consumption. Angular cheilitis was associated with age, complete edentulism, the presence of oral Candida, a lack of denture stability, and a reduced occlusal vertical dimension. The presence of traumatic ulcers was related to a resorbed residual alveolar ridge. The presence of at least 1 lesion was associated with poor masticatory efficiency, being resident in a care facility, oral Candida, and a lack of denture stability. Several systemic, local, and denture-related characteristics are independent risk factors for denture-related mucosal lesions in an elderly population.
Masticatory performance is the outcome of a complex interplay of several factors. This study was carried out to determine the relationship between masticatory performance and several muscular‐related and occlusion‐related factors in a population with a full or near‐full complement of natural teeth. One‐hundred dentate young adults participated in this cross‐sectional study. Maximum muscular force with jaw, hand, tongue, and cheek were measured by means of a gnatodynamometer. Occlusal contact area and number of teeth in contact were determined in the maximal intercuspal position and in a 1.5‐mm right and left lateral excursion by means of interocclusal registrations that were scanned and analysed using image software. Masticatory performance was determined by sieving the Optosil particles resulting from 20 chewing cycles. Stepwise multiple linear regression analysis showed that the maximum bite force in the region of the first molar had the best correlation with masticatory performance and explained 36% of its variation. Static occlusion characteristics such as occlusal contact area, the lack of lateral crossbite and the number of anterior teeth in contact explained an additional 9% of the variation in masticatory performance. These findings suggest that variables related to dynamic occlusion or tongue or cheek force do not enhance the prediction of masticatory performance.
Summary: The aim of this cross‐sectional study was to determine the preferred chewing side and whether chewing side preference is related to peripheral, functional or postural lateral preferences. One hundred and forty‐six adults with natural dentition performed three masticatory assays, each consisting of five trials of chewing three pieces of silicon placed into a latex bag for 20 cycles, either freestyle or unilaterally on the right‐ or left‐hand side. Occlusal contact area in the intercuspal position, maximum bite force, masticatory performance and cycle duration were measured and the lateral asymmetry of these variables was calculated. Laterality tests were performed to determine handedness, footedness, earedness and eyedness as functional preferences, and hand‐clasping, arm‐folding and leg‐crossing as postural lateral preferences. The preferred chewing side was determined using three different methods: assessment of the first chewing cycle for each trial, calculation of the asymmetry index from all cycles and application of a visual analogue scale. Bivariate relationship and multiple linear regression analyses were performed. Among unilateral chewers, 77% of them preferred the right side for chewing. The factors most closely related to the preferred chewing side were asymmetry of bite force, asymmetry of masticatory performance and earedness, which explained up to 16% of the variance. Although several functional or postural lateral preferences seem to be related to the preferred chewing side, peripheral factors such as asymmetry of bite force and of masticatory performance are the most closely related to the preferred chewing side in adults with natural dentition.