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Dynamic mechanics in the pig mandibular symphysis.

During mastication, various biomechanical events occur at the mammalian jaw symphysis. Previously, these events have been studied in the static environment, or by direct recording of surface bone strains. Thus far, however, it has not been possible to demonstrate directly the forces and torques passing through the symphysis in association with dynamically changing muscle tensions. Therefore, we modified a previously published dynamic pig jaw model to predict the forces and torques at the symphysis, and related these to simulated masticatory muscle tensions, and bite, joint and food bolus forces. An artificial rigid joint was modelled at the symphysis, allowing measurements of the tri-axial forces and torques passing through it. The model successfully confirmed three previously postulated loading patterns at the symphysis. Dorsoventral shear occurred when the lower teeth hit the artificial food bolus. It was associated with balancing-side jaw adductor forces, and reaction forces from the working-side bite point. Medial transverse bending occurred during jaw opening, and was associated with bilateral tensions in the lateral pterygoid. Lateral transverse bending (wishboning) occurred at the late stage of the power stroke, and was associated with the actions of the deep and superficial masseters. The largest predicted force was dorsoventral shear force, and the largest torque was a 'wishboning' torque about the superoinferior axis. We suggest that dynamic modelling offers a new and powerful method for studying jaw biomechanics, especially when the parameters involved are difficult or impossible to measure in vivo.

Animals↗

Reinforcement of surgical adhesive strips.

Surgical adhesive strips are often used for closure of some wounds or to minimize tension on sutures after closures. The package insert of the type most commonly used (Steri-Strip), indicates that the application of compound tincture of benzoin, U.S.P. (CTB) increases strip adhesion. The increase in adhesive power by CTB was compared with a preparation containing gum mastic (Mastisol). The study clearly demonstrated that the latter preparation provided a markedly more adhesive strength than that obtained with CTB.

Adhesiveness↗

Esophageal solid bolus transit: studies using concurrent videofluoroscopy and manometry.

OBJECTIVE: Our aim was to assess the efficacy and mechanism of solid bolus transit through the esophagus. METHODS: Eight healthy volunteers were studied with concurrent manometry and videofluoroscopy while swallowing 5 ml liquid barium, a 5-6 mm diameter bread ball, and 4 g chewed bread in both a supine and upright posture. As many as four successive swallows were performed until clearance was achieved. RESULTS: The esophageal clearance of liquid barium was 100% with the first swallow. Clearance of the unchewed bread ball occurred with the first swallow in only 6.7% of trials in the upright posture and 5.9% in the supine posture. After four swallows, clearance was 100% and 52.9% in the upright and supine postures, respectively. Chewed bread was more readily cleared than unchewed bread, with 100% clearance after two swallows in the upright posture and 91% clearance after four swallows in the supine posture. The most common locus of bread stasis was at the aortic arch and carina. The bread boluses were noted to move more effectively when localized in the head as opposed to the tail of the bolus composite. Nonocclusive contractions often occurred at the bolus tail despite the increased peristaltic amplitude seen with the chewed bread. Failed peristalsis, a frequent cause for solid clearance failure, was observed during 30% of all bread swallows. This usually occurred distal to the stopping point of the bolus, suggesting it to be the result rather than the cause of impaired transit. CONCLUSIONS: Although infrequently perceived by these normal subjects and in contradistinction to liquid clearance, bread is rarely cleared from the esophagus with a single swallow. Mastication and an upright posture facilitate the esophageal transport of solids. Bolus composition and impaired bolus transit alter the amplitude and conductance of peristalsis. Manometric data pertaining to liquid clearance through the esophagus do not readily apply to bread.

Adult↗

Spontaneous buccolinguofacial dyskinesia in the elderly.

Buccolinguofacial dyskinesia consists of repetitive, non-rhythmic abnormal movements which occur at the speed of normal voluntary movement. To the observer they do not suggests a normal activity of mastication or phonation. This type of dyskinesia was evidenced in 88 patients out of a total of 240 elderly examined. It is more frequent in females than in males. Incidence does not increase with age. Frequency is highly variable individually. Every subject seems to have a comparatively stable frequency of his own. Dyskinesia is reduced or suppressed by neuroleptics, whereas stereotyped movements of the limbs are not affected. Individualization of bucolinguofacial dyskinesia from other abnormal movements should consequently rest on both its clinical features and its pharmacological sensitivity.

Age Factors↗

Rehabilitation with dental prosthesis can increase cerebral regional blood volume.

Treatment with denture for edentulous people is highly important for maintaining quality of life. However, its effect on the brain is unknown. In this experimental study, we hypothesized that dental prosthesis can recover not only the physical condition of mastication system but also the regional brain activity. We evaluated functional brain imaging of edentulous subjects fixed by dental implant prosthesis with clenching tasks by multi-channel near-infrared optical topography. Results revealed a significantly (P<0.001; paired t-test) increased cerebral regional blood volume during maximum voluntary clenching task by implant-retained prosthesis. There were no statistically significant differences between patients with and without prosthesis in the latency to the maximum regional blood volume after the task. Conclusively, clenching can be effective for increasing cerebral blood volume; accordingly maintenance of normal chewing might prevent the brain from degenerating.

Bite Force↗

Masticatory function in patients with xerostomia.

The effects of reduced salivary output in patients suffering from xerostomia on masticatory function has not been previously studied. This study compares masticatory performance and kinematic activity of patients suffering from xerostomia with age-, sex-, and number of occluding pairs-matched healthy controls. Masticatory function was evaluated by assessment of chewing motion and muscle activity during chewing an artificial food (CutterSil), chewing gum and swallowing a bolus of almond. Chewing motion was recorded with the Optotrak computer system. Bilateral muscle activity of both masseter and anterior temporalis was recorded using surface electrodes. Results of this study revealed significant differences between patients and controls in their ability to process food and masticatory muscle activity. The majority of patients could not break down the artificial food, others had a larger median particle size than the controls. A significant difference was also observed in the number of chewing cycles required to swallow almonds, the patients required more than twice as many chews as the controls, P < 0.001. The right masseter muscle displayed significantly less activity for the patient than the controls. These findings suggest that patients with xerostomia exhibit reduced ability to process food. The observed decline in masticatory performance is probably due to reduced activity of the muscles of mastication.

Aged↗

Influence of age and dental status on chewing behaviour studied by EMG recordings during consumption of various food samples.

OBJECTIVE: To evaluate the effects of age and dental status on chewing performance in humans. DESIGN: Electromyography recordings (EMG) were made during chewing of six foods (rice, beef, cheese, crispy bread, apple, and peanuts) to compare the masticatory patterns of four subject groups with different ages and dental status. SUBJECTS: Nineteen elders (mean age 67.2 years) classified into three categories according to their number of opposing post-canine teeth pairs (i.e. functional units) and a control group of 10 young adults (mean age 26.5 years) with a high number of functional units. MAIN OUTCOME MEASURES: Number of chewing cycles, chewing time, total muscle activity and muscle activity per chew, burst and inter-burst durations, maximum and mean voltages from EMG recordings. RESULTS: Time-related EMG parameters increased from young subjects to elderly subjects with high, middle and low dental status. Parameters related to EMG voltages per chew decreased in the same order among the different groups of subjects. These tendencies were observed for all the studied products. Subjects with weak muscle contraction may compensate for their poor chewing performance by lengthening both chewing cycle and sequence duration. Additional alterations in the chewing patterns were observed when age effect was associated with a dental status degradation in terms of number of functional units. CONCLUSION: Impairment in mastication for the elderly is due to both ageing and decreasing number of functional pairs of post-canine teeth.

Adult↗

Symptoms of craniomandibular disorders in elderly Brazilian wearers of complete dentures.

OBJECTIVE: Investigate the incidence of symptoms of craniomandibular disorder in elderly Brazilian wearers of full dentures. DESIGN: In this cross-sectional study, a questionnaire based on Helkimo's anamnestic index was applied to a group of 65-year-olds or older individuals who wear a set of full dentures. SETTING: Interviews were carried out at the dental clinics of the University of Taubaté and the University of Vale do Paraíba, Brazil. SUBJECTS: From a total of 384 patients, 84 elderly wearers of full dentures were interviewed. MAIN OUTCOME MEASURES: The questionnaire identified the most commonly related symptoms of craniomandibular disorders. RESULTS: The patient's average age was 73.5 years (ranging from 65 to 89 years), 81% of them females. Only 5% reported pain when opening their mouths, and the same percentage complained of temporomandibular joint luxation and a sensation of tired muscles during mastication. Similar rates were found for pain in the temporomandibular joint area (6%), pain in the temporal muscle area (7%), difficulty to move the mandible in the morning (4%) and pain during excursive (protrusive and lateral) movements (8%). The highest rates were found for pain in the masseter muscle area (39%) and articular noises (24%). CONCLUSION: The incidence of craniomandibular disorder symptoms was low in this group of elderly wearers of full dentures, except for pain in the masseter (39%) and articular noises (24%).

Aged↗

Sensory and motor deficits in the elderly: impact on oral health.

Hearing, vision, orthopedic, and speech disorders are the most common impairments in the elderly. Older adults experience other sensory impairments such as olfactory and gustatory dysfunction, as well as oral motor problems including difficulty with mastication, speech, and swallowing. These disorders can directly affect oral health and can impair dental treatment. Therefore, it is imperative that dental health practitioners be cognizant of these conditions and aware of the impact these conditions and their treatments can have on oral health and function. Dental professionals may need to use different communication techniques for patients with vision or hearing losses. Accommodations in the dental office and by dental professionals will help older patients who have sensory and/or motor impairments to preserve their oral health and function and receive dental treatments in a safe and efficacious manner. This paper reviews the most common causes of sensory and motor impairments and their implications for oral health care with treatment modification guidelines for the older patient.

Aged↗

Tongue piercing: case report and review of current practice.

Although oral piercing has been an uncommon practice in the Western world, the insertion of metal objects into intra-oral and peri-oral pierced sites is growing in popularity. Tongue piercing is one such practice whereby a metal barbell is inserted into the tongue after piercing with a 14-16 gauge needle. Pain, swelling and infection are the most serious consequences associated with this procedure. Other adverse outcomes include mucosal or gingival trauma, chipped or fractured teeth, increased salivary flow, calculus build-up, and interference with speech, mastication and swallowing. This article presents a case report on tongue piercing and highlights the procedure involved. Special attention is given to complications and dental implications associated with such an unusual practice.

Adult↗

Complete denture success for patients and dentists.

The huge prevalence of tooth decay and the gradual ageing of populations in the developed world have combined to produce a steady increase in the need for complete denture treatment. To achieve successful treatment, it is vital to consider a number of issues throughout the denture process. Before treatment even begins, the patient's motivation for denture treatment and emotional attitude towards dentures must be evaluated. Patients will thereby gain realistic expectations of what can and cannot be achieved, and dentists will understand what the patient really wants. Afterwards, the dentist must work with the patient to help achieve success in difficult areas such as neuromuscular control, mastication and speech. By learning to handle patient complaints positively, dentists can educate patients to solve their own problems in future. Finally, patients must be informed that continued success depends on regular denture maintenance at home combined with periodic consultation with the dentist.

Attitude to Health↗

A comparison of unrefined wheat and rice diets in the management of duodenal ulcer.

Twenty-one chronic duodenal ulcer patients in a rice-eating area were put on to an unrefined wheat diet and twenty-one continued on their previous rice diet. After 5 years only 14% of the first group had had relapses compared with 81% of the second group. A similar 5-year relapse rate (80%) was obtained in a group of thirty patients from another area with a more varied rice diet. The author attributes this difference to the increased mastication required by the unrefined wheat diet, which is associated with an increase in saliva, lower stomach acidity and reduced bile output.

Adult↗

Comment: gating effects and constraints on the central pattern generators for rhythmic movements.

Respiration, mastication, and locomotion are compared in terms of the contributions of events occurring at the motoneuron membrane and at premotoneuronal levels for the production of phasic gain changes of afferent effects. Data are presented which suggest that an inhibitory mechanism operating on limb motoneurons can prevent disruption of the locomotor pattern by proprioceptive input and that Ia inhibitory interneurons contribute to this rhythmic inhibition of both flexor and extensor motoneurons. Renshaw cell rhythmic activity during locomotion is described and discussed in terms of its possible role in gating of inputs to motoneurons.

Animals↗

Inactivation of amino acid receptors in medullary reticular formation modulates and suppresses ingestion and rejection responses in the awake rat.

The lateral medullary reticular formation (RF) is the source of many preoromotor neurons and is essential for generation of ingestive consummatory responses. Although the neurochemistry mediating these responses is poorly understood, studies of fictive mastication suggest that both excitatory and inhibitory amino acid receptors play important roles in the generation of these ororhythmic behaviors. We tested the hypothesis that amino acid receptors modulate the expression of ingestion and rejection responses elicited by natural stimuli in awake rats. Licking responses were elicited by either intraoral (IO) gustatory stimuli or sucrose presented in a bottle. Oral rejection responses (gaping) were elicited by IO delivery of quinine hydrochloride. Bilateral microinjection of the N-methyl-D-aspartate (NMDA) receptor antagonist d-[(3)-2-carboxypiperazin-4-yl]-propyl-1-phosphonic acid (D-CPP) suppressed licking and gape responses recorded electromyographically from a subset of orolingual muscles. Likewise, infusion of the non-NMDA receptor antagonist 6-cyano-7-nitroquinoxaline-2,3-dione (CNQX) significantly reduced licking and gape responses but was accompanied by spontaneous gasping responses. Rats still actively probed the bottle, indicating an intact appetitive response. Neither D-CPP nor CNQX differentially affected ingestion or rejection, suggesting that the switch from one behavior to the other does not simply rely on one glutamate receptor subtype. Nevertheless, a glutamate receptor-mediated switch from consummatory behavior to gasps after CNQX infusions suggests a multifunctional substrate for coordinating the jaw and tongue in different behaviors. Bilateral infusions of the GABA(A) receptor antagonist bicuculline or the glycine receptor antagonist strychnine enhanced the amplitude of IO stimulation-induced oral responses. These data suggest that the neural substrate underlying ingestive consummatory responses is under tonic inhibition. Release of this inhibition may be one mechanism by which aversive oral stimuli produce large-amplitude mouth openings associated with the rejection response.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

Muscimol infusions in the brain stem reticular formation reversibly block ingestion in the awake rat.

Previous studies have localized a central pattern generator for mastication to the midline pontomedullary reticular formation (RF) based on cortically induced ororhythmic movements. The present study determined whether this same substrate mediated licking responses evoked by more natural stimuli. Licking in the awake rat was initiated either through an appetitive response to sucrose presented in a bottle or by intraoral (IO) infusions. Oral rejection responses also were obtained by IO infusions of quinine hydrochloride. Small volumes of the GABA(A) agonist muscimol bilaterally infused into the lateral medullary RF significantly reduced licking and oral rejection responses measured electromyographically from the anterior digastric and geniohyoid muscles. Other than the decrement or absence of ororhythmic activity, rats appeared normal and actively approached and probed the water bottle. The suppression was reversible and returned to baseline within 3 h. In contrast, midline infusions of muscimol did not affect licking or rejection responses. We postulate that the lateral medullary RF is an essential final common path for ingestive consummatory responses.

Administration, Oral↗

Firing patterns of human genioglossus motor units during voluntary tongue movement.

The tongue participates in a range of complex oromotor behaviors, including mastication, swallowing, respiration, and speech. Previous electromyographic studies of the human tongue have focused on respiratory-related tongue muscle activities and their role in maintaining upper airway patency. Remarkably, the activities of human hypoglossal motor units have not been studied during the execution of voluntary maneuvers. We recorded single motor unit activity using tungsten microelectrodes in the genioglossus muscle of 10 healthy human subjects performing both slow tongue protrusions and a static holding maneuver. Displacement of the tongue was detected by an isotonic transducer coupled to the lingual surface through a customized lever arm. For protrusion trials, the firing rate at recruitment was 13.1 +/- 3 Hz and increased steeply to an average of 24 +/- 6 Hz, often with very modest increases in tongue protrusion. For the static holding task, the average firing rate was 16.1 +/- 4 Hz, which is surprisingly high relative to limb motor units. The average coefficient of variation of interspike intervals was approximately 20% (range, 10-28%). These are the first recordings of their type obtained in human subjects and provide an initial glimpse into the voluntary control of hypoglossal motoneurons during tongue movements presumably instigated by activity in the motor cortex.

Action Potentials↗

Behavior of jaw muscle spindle afferents during cortically induced rhythmic jaw movements in the anesthetized rabbit.

The regulation by muscle spindles of jaw-closing muscle activity during mastication was evaluated in anesthetized rabbits. Simultaneous records were made of the discharges of muscle spindle units in the mesencephalic trigeminal nucleus, masseter and digastric muscle activity (electromyogram [EMG]), and jaw-movement parameters during cortically induced rhythmic jaw movements. One of three test strips of polyurethane foam, each of a different hardness, was inserted between the opposing molars during the jaw movements. The induced rhythmic jaw movements were crescent shaped and were divided into three phases: jaw-opening, jaw-closing, and power. The firing rate of muscle spindle units during each phase increased after strip application, with a tendency for the spindle discharge to be continuous throughout the entire chewing cycle. However, although the firing rate did not change during the jaw-opening and jaw-closing phases when the strip hardness was altered, the firing rate during the power phase increased in a hardness-dependent manner. In addition, the integrated EMG activity, the duration of the masseteric bursts, and the minimum gape increased with strip hardness. Spindle discharge during the power phase correlated with jaw-closing muscle activity, implying that the change in jaw-closing muscle activity associated with strip hardness was caused by increased spindle discharge produced through insertion of a test strip. The increased firing rate during the other two phases may be involved in a long-latency spindle feedback. This could contribute to matching the spatiotemporal pattern of the central pattern generator to that of the moving jaw.

Afferent Pathways↗

Unilateral masticatory function changes the proteoglycan content of mandibular condylar cartilage in rabbit.

Unilateral masticatory function was induced in 10-day-old rabbits by grinding the right side molars out of occlusion under general anesthesia. The grinding procedure was repeated twice a week thereafter. They were killed at the ages of 25 and 35 days. Rabbits of the same age with uninterfered occlusions served as controls. The changes in articular cartilage of the mandibular condyle were studied biochemically and histochemically. There was a significant decrease in the proteoglycan content of the condylar cartilage in both groups of animals subjected to molar grinding compared to the animals with untouched occlusions. Especially the amount of aggregating proteoglycans was reduced. The condylar cartilage matrix synthesis is sensitive to loading produced by masticatory function during growth. The mechanical properties of the articular cartilage after a period of unilateral mastication will be impaired and it is possible that this makes the joint cartilage more susceptible to pathological events.

Adaptation, Physiological↗