Changes in masticatory performance
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Individuals with moderate to severe periodontitis have worse masticatory performance and oral health-related quality of life compared to those with healthier periodontal conditions. The study found a 32% difference in chewing ability between those with reduced alveolar bone height versus the control group. Loss of periodontal structures, even mildly, can impair masticatory performance and negatively impact quality of life by affecting chewing ability and comfort. Assessing masticatory and oral health-related quality of life can help clinicians determine the best treatment approach for each individual.
Changes in masticatory performance
- 1. Tania de Freitas Borges et al. J Periodontol • March 2013
- 2. The loss of periodontal supporting structures attributable to periodontitis can negatively affect the sensory function of periodontal tissues and lead to development of alternative strategies to deal with the less stable mechanical support of the teeth, ultimately causing specific chewing dysfunctions. Individuals with moderate to- severe periodontitis experience a change in their food chewing ability, which affects the final product of masticatory function.
- 3. A multidimensional approach, measuring not only masticatory function but also physical, psychologic, and social limiting factors, can be performed by using questionnaires intended to analyze the oral health– related quality of life (OHRQoL). Considering the potential association between periodontal disease and reduction of masticatory performance and OHRQoL, this study aimed to evaluate the effect of periodontal disease on chewing ability and OHRQoL.
- 4. The participants in the present study were 24 dentate volunteers, comprising 10 females and 14 males, 23 to 76 years old (mean age, 50.1 years). Selection criteria did not include age, sex, race, or social status. The participants were divided into the following two groups: control group and test group. For this categorization, the alveolar bone height–to– tooth length (AB/T) ratio was calculated. Participants with an AB/T ratio >50% were included in the control group, and those with an AB/T ratio <50% were placed in the test group. Each group consisted of 12 individuals (n = 12), comprising five females and seven males. Considering the above categorization, all individuals in the test group were expected to have moderate-to-severe generalized periodontitis.
- 5. The inclusion and exclusion criteria were determined by screening, which provided data regarding the participants’ personal information, medical and dental history, any existing parafunctional habits, and potential symptoms of temporomandibular dysfunction. Individuals were excluded from the study if they presented with some of the following criteria during screening: 1) splinting of teeth after orthodontic treatment 2) fixed prostheses with >1 element 3)dental implants
- 6. 4) partial removable dentures 5)endodontic lesions 6) absence of >4 pairs of teeth in occlusion and absence of all pairs of molars from any hemiarch. 7) use of any medication that could interfere in muscle activity, such as antihistamines, sedatives, homeopathic medicinal products, or central nervous system depressors 8) treatments that could directly or indirectly interfere in muscle activity during the period in which the study was performed, such as speech therapy and otorhinolaryngologic treatments.
- 7. Alveolar Bone Height The alveolar bone height measurement was performed in digital panoramic radiography through a computer-customized system. For this study, reference points were used. 1) The root apex (A) is the most apical part of the root. In upper multiroot teeth, the vestibular root was used as a reference point for the proximal and the palatine root for the opposite proximal. 2) The alveolar crest (AC) is the portion located on the surface of the most coronal root. When >1 crest image of the alveolar bone was observed, the most apical part was used. 3) The highest part of the crown (C) is the midpoint of the incisal margin for the incisors and the cusp in the most coronal position for premolars and molars.
- 9. Dental Mobility An electronic mobility testing device was used to measure the degree of mobility of the abutment teeth. To standardize data collection, a fixing device was used for the mobility testing device, so that the patient would not have to change head position. Participants were instructed to place their chin on the supporting platform with the rod positioned at a 90 angle in the centre of the vestibular face of each tooth. A dental cotton roll was placed between the teeth of the hemiarch opposite of the register to standardize the disocclusion of the teeth. After fixing the rod at the given position, the mobility reading was performed. All measurements were conducted by the same clinician (TFB) to avoid variability between examiners.
- 10. Masticatory Performance In this study, chewing material called a biocapsule was used that contains beads to analyze the masticatory performance. The beads were obtained by an ionotropic gelification method of solids at the following concentrations: a 2% aqueous pectin dispersion, 18.65% starch, 20.5% lactose, 18.65% saccharose, 40.2% microcrystallized cellulose, and 0.016% fuchsin. The beads remained in solution for 10 minutes. They were then dried until their weights remained constant and coated with 5% cationic methacrylate polymer in a mixed solvent of 10% acetone in absolute ethanol. Subsequently, 250-mg beads were placed inside polyvinyl acetate capsules, with a 0.40-mm wall thickness, a 7-mm internal diameter, and an 8-mm external diameter. The biocapsules were welded using radiofrequency and were kept hermetically sealed throughout the clinical trial. They were characterized as inert and biocompatible.
- 11. OHRQoL For analysis of quality of life, the Oral Health Impact Profile (OHIP) questionnaire was used to measure individuals’ perceptions regarding the social impact of the oral disorder on their well-being. It consists of 48 questions. The study applied the OHIP-14 questionnaire, which comprises 14 questions divided into the following seven groups: 1) functional limitation; 2) physical pain; 3) psychologic discomfort; 4) physical disability; 5) psychologic disability; 6) social disability; and 7) handicap. The answers were recorded on a Likert scale with values ranging from 0 to 4. The individual’s quality of life improves with a decrease in the Likert scale value.
- 12. The control group presented the best masticatory performance indicator. The data showed that there was a statistically significant difference of masticatory performance between the two groups. Masticatory performance had a positive correlation with the AB/T mean of the posterior sextants. In the study, the impact of periodontitis on quality of life was higher in the physical pain subscale, and feeling uncomfortable while eating was a question of great relevance. The third highest impact on quality of life was the physical disability subscale, which is the only subscale to display masticatory efficiency.
- 13. Masticatory performance, which was evaluated based on chewing hard artificial foods, was found to be worse for individuals with reduced alveolar bone height. A difference of 32% was found between the test and control groups regarding grinding of food, which was analyzed by having participants chew the biocapsule for 10 seconds. However, it is necessary to analyze the results with caution. Individuals with generalized periodontitis may have the indication of extracting all the teeth followed by oral rehabilitation with full denture prostheses.
- 14. A study with a masticatory performance test observed a reduction in masticatory performance of individuals rehabilitated with conventional dentures (69%) and individuals rehabilitated with fixed mandibular implant-supported prostheses (39%) compared with individuals with a natural dentition. Therefore, one should consider the possibility of periodontal disease control and patient guidance based on the advantages of not extracting teeth, including maintenance of the periodontal proprioception that can influence neuromuscular control of chewing. In this study, even individuals with mild loss of periodontal supporting structure have potential changes in their masticatory performance.
- 15. Individuals with better periodontal conditions are more likely to have a better quality of life. This is supported by the study, which demonstrates a correlation between the quality of life and both the supporting alveolar bone loss and tooth mobility. Bernabe´ and Marcenes showed that, despite the influence of sociodemographic factors as well as other concomitant oral conditions, periodontal disease was associated with quality of life in individuals with generalized periodontitis and those with localized periodontitis. Despite the reduction in masticatory performance and quality of life observed in this study, chewing ability is more favourable than that found following some oral rehabilitations procedures, such as complete dentures or implant-supported prostheses.
- 16. It can be stated that loss of periodontal structures can negatively affect the masticatory performance and OHRQoL. Even mild reductions in alveolar bone height may impair masticatory performance. The assessment of quality of life and masticatory performance related to periodontal support can assist clinicians in providing the most appropriate intervention care tailored to meet individual needs.