Factors associated with masticatory performance among preschool children

Mastication and oral myofunctional status in excess weight children and adolescents: A cross-sectional observational study

BACKGROUND

Masticatory function seems to play a role in the aetiology of obesity. However, literature on the association between oral myofunctional status and overweight and obesity in children and adolescents is scarce and contrasting.

OBJECTIVE

To compare masticatory performance, orofacial myofunctional status and tongue strength and endurance between children and adolescents with overweight and obesity and those with normal weight.

METHODS

Thirty children and adolescents with overweight and obesity and 30 subjects with normal weight matched for age and sex were recruited. All subjects were evaluated with the Test of Masticating and Swallowing Solids in Children (TOMASS-C) for masticatory performance and with the Italian Orofacial Myofunctional Evaluation with Scores (I-OMES) for the orofacial myofunctional status. Anterior and posterior maximum tongue pressures and tongue endurance were measured. Parents-reported (PRO) duration of meals was recorded. Data were compared between the groups through the paired samples t-test or the Wilcoxon signed-rank test.

RESULTS

Children and adolescents with overweight showed significantly lower number of bites (p = .033), lower I-OMES scores (p < .05), and shorter meal duration (p = .005) compared to their peers with normal weight. No significant differences were found between the two groups for the number of swallows, the number of masticatory cycles and the total time of the TOMASS-C, and none of the tongue pressure measurements.

CONCLUSIONS

Eating in children and adolescents with overweight and obesity is characterised by a larger bolus sizes and shorter PRO meal duration. Additionally, overweight and obesity seem to be associated with poorer orofacial skills and structures in the paediatric population.

The effect of early childhood caries on chewing function and tolerated food texture levels in preschool children

BACKGROUND

The early form of caries can affect solid food consumption.

OBJECTIVE

The aim of the study was to evaluate the effect of oral health status on chewing performance, and tolerated food texture among preschool children suffering from early childhood caries (ECC).

METHODS

A cross-sectional study was conducted with a sample of 109 children aged between 3 and 6 years, who were allocated to three groups (severe-ECC (s-ECC), ECC and control) on the basis of their caries. Chewing function was evaluated by using the 'Karaduman Chewing Performance Scale (KCPS)' and the Turkish version of the 'Mastication Observation and Evaluation instrument (T-MOE)', and the tolerated food texture was determined by the 'International Dysphagia Diet Standardization Initiative (IDDSI)'. Carious lesions, oral hygiene and gingival health status were evaluated by using the 'decayed, missing, filled tooth/surface indices (dmft/s)', 'plaque and gingival indices'; respectively.

RESULTS

A total of 56 children (51.4%) had s-ECC, 39 (35.8%) had ECC and 14 (12.8%) had no caries (control group). KCPS showed that 26 (86.7%) children suffering from s-ECC were at level 1, and 11 (100%) children were at level 2. Seven (100%) children with s-ECC had IDDSI level-5. All children with healthy oral status had IDSSI level-7. Compared to the ECC and control groups, the s-ECC group had significantly lower scores from the T-MOE total and subscale scores (p < .001).

CONCLUSION

The evaluation of chewing performance during routine dental examinations of children with ECC (especially s-ECC) may considerably contribute to the early diagnosis of chewing problems and the provision of necessary oral rehabilitation.

Investigation of Malocclusion and Associated Factors in Preschoolers: A Cross-Sectional Questionnaire Study

This study aims to describe the prevalence of malocclusion and identify associated factors in preschool children. Completed in 2022-2023, this cross-sectional study included 523 children aged 26 to 80 months in municipal schools in Salvador. An oral examination was carried out on the children, and a questionnaire was self-administered by the parents. Descriptive analyses and multivariate logistic regression (the backward method, p-value ≤ 0.05, 95% CI) were conducted. The majority of children were female (51.82%), over 54 months old (52.2%), Black or mixed race (90.63%), and not affected by COVID-19 (92.35%). The prevalence of malocclusion was 43.21%, with open bite as the most common condition. There was a significant association between malocclusion and screen time (OR: 1.34; p: 0.116; CI: 1.0-1.94), physical/psychological aggression (OR: 2.55; p: 0.031; CI: 1.0-5.98), consumption of ultra-processed foods (OR: 1.77; p: 0.003; CI: 1.22-2.57), digital suction (OR: 3.1; p: 0.001; CI: 1.56-6.16), and the habit of biting objects (OR: 1.56; p: 0.121; CI: 1.0-2.73). The promotion of comprehensive health in early childhood and psychosocial interventions are recommended, aiming to reduce screen time, aggression, consumption of ultra-processed foods, thumb sucking, and the habit of biting objects to prevent malocclusion.

Association between occlusal features and masticatory function in Hong Kong preschool children: a survey with one-year longitudinal follow-up

BACKGROUND

Mastication is important for breaking down food, aiding swallowing and nutrients absorption, and is therefore fundamental to a child's development. Studies have shown poor masticatory function to be associated with younger age and presence of caries. However, studies of the association between masticatory function and malocclusion yielded contradictory results. The aim of this study is therefore to investigate the association between three-dimensional occlusal features with masticatory function, among preschool children in Hong Kong.

METHODS

Self-administered questionnaires on masticatory function in three domains, namely general chewing difficulty, requiring help when eating different food types and increased preference for soft food were completed by parents. Information on non-nutritive sucking habits and basic demographics were also collected in the questionnaire. Clinical examinations were conducted to record three-dimensional occlusal features and presence of caries. Baseline investigations and one-year follow-ups were undertaken for 1,566 and 996 preschool children. Association of poor masticatory function with occlusal features, sucking habits and caries was investigated using chi-squared tests. Binomial logistic regressions were then carried out incorporating any significant factors identified. Longitudinal analysis of the one-year follow-up data was carried out to investigate whether improved occlusal features, sucking habits and caries resulted in better masticatory function.

RESULTS

In the cross-sectional study, the first domain of general chewing difficulty was associated with caries and thumb/digit sucking. The second domain of requiring help when eating different food types was associated with the male sex, younger age, caries and pacifier use. The last domain of increased preference for soft foods was associated with caries and thumb/digit sucking. Occlusal features, including abnormal overjet and unilateral permanent molars not in contact, were significantly associated with poor masticatory function in the bivariate analyses, but were not significant in the logistic regressions. In the longitudinal analysis, general chewing difficulty was found to improve in those of older age and those with resolved anterior crossbite. Less help was required to eat meat in those with fewer caries. Similarly, less help was required to eat food containing bones in those with reduced pacifier use. Preferences for eating soft foods was reduced in those who developed a normal overjet.

CONCLUSIONS

The study identified significant relationships between masticatory difficulties and factors associated with age, gender, active caries, and non-nutritive oral habits such as thumb/digit sucking and pacifier use. Younger children and males required more assistance with certain food types. Active caries and thumb/digit sucking habits contributed to general masticatory difficulties and preference for soft foods. The one-year follow-up indicated that improvement in masticatory function varies across age cohorts and were associated with improved occlusal features, such as resolution of anterior crossbite and normalized overjet, reduced pacifier use, and a decrease in the number of decayed teeth.

The effect of a soft diet on molar dentin formation during the occlusal establishment period

OBJECTIVE

This study intends to investigate the effect of a soft food diet on molar dentin formation during the occlusal establishment period. It can provide dietary guidance for infants to strengthen their dental structure.

DESIGN

60 BALB/c mice were used to obtain mandibles during lactation (P0.5, P7.5, P15.5, P21.5) and occlusal establishment (P27.5, P33.5, P60.5). The mice were randomly divided into soft or hard diet groups after weaning at day 21.5. Hematoxylin-eosin and aniline blue staining were used to observe the morphology and number of odontoblasts and the amount of molar dentin formation. Immunohistochemistry was performed to observe the proliferation and apoptosis of odontoblasts. The in vivo fluorescence double-labeling was applied to evaluate the rate of molar dentin formation.

RESULTS

The soft diet group had poorer periodontal membrane development but more cervical dentin deposition. Alterations in morphology and the number of odontoblasts showed a stronger correlation with age rather than food hardness. There are no significant differences in proliferative and apoptotic behavior of dentin-forming cells between the two groups. Rather, it affected the rate of dentin deposition. The rate of dentin deposition was high in the soft diet group from P21.5 to P27.5, but it was surpassed by the hard diet group within P27.5-P33.5, and the difference between the two groups disappeared at P33.5-P60.5.

CONCLUSIONS

A soft diet promotes molar early cervical dentin formation. This advantage is caused by an enhanced odontoblast secretion rate rather than affecting the morphology, number, proliferation, or apoptosis of odontoblasts.

Does malocclusion affect ingestion: a systematic review

OBJECTIVES

The multifactorial aspect of malocclusions and their consequences on ingestion function is rarely described in the literature. The aims of this review are (i) to investigate the relationship between oral ingestion and malocclusion and (ii) to gather malocclusion tools that could help screen subjects at risk of malocclusion-related ingestion disorders.

MATERIAL AND METHODS

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria have been documented in a protocol published in the Prospective International Register of Systematic Reviews (PROSPERO) under the registration number CRD42023395840. The bibliographic search involved the PubMed®, Cochrane and PROSPERO databases.

RESULTS

A total of 29 articles published between 2007 and 2023 were retained by the search criteria for the qualitative synthesis. Twenty of the studies found that the severity of malocclusion has a negative impact on oral ingestion. This review highlights that malocclusion and ingestion impairments are associated but it is not possible to determine causality due to the observational approach of many of the studies.

CONCLUSION

Malocclusion has a negative impact on ingestion function. During orthodontic consultations, particular interest should be directed towards chewing, biting, and swallowing disorders, which can affect patients' nutritional status. This review offers arguments for designing further studies assessing the extent to which malocclusions may affect nutritional status.

CLINICAL RELEVANCE

Orthodontic treatment should focus on improving patients' ingestion.

Association of masticatory efficiency with deep carious lesions in children

PURPOSE

Masticatory efficiency is defined as an individual ability to grind and pulverize food material, and can be influenced by many factors. This research aimed to investigate the association between masticatory efficiency and deep carious lesion.

METHODS

The research included 48 children (24 male, 24 female) aged from 3 to 14 years. Participants were allocated to two groups; children with no or with only incipient carious lesions were included in the first group (ICDAS levels 0, 1, or 2), and children with bilateral deep carious lesions that are ICDAS levels 4, 5, and 6 were included in the second group. Information on dental parameters (dental status, ICDAS level of each carious lesion), and level of pain (Wong-Baker scale) were collected from each participant. Participants chewed Optosil® test food for 20 masticatory cycles, and chewed particles were analyzed by the optical scanning method.

RESULTS

There is a significant difference in masticatory efficiency variables (number of chewed particles, minimal and maximal Feret diameter, Sauter mean diameter, a mean and total surface of particles) between groups. A positive significant correlation is observed between WBS level and time needed for masticatory performance in a group of children with deep carious lesions.

CONCLUSION

Deep carious lesions in children are associated with a decrease in masticatory efficiency. Moreover, children with carious lesions that provoke a higher level of pain take more time for masticatory cycles.

The Effect of Caries on the Chewing Ability of Children: A Scoping Review

Childhood caries might have several effects on the children's general health and growth, including chewing ability. This study aims to identify the evidences found regarding the effect of caries on the chewing ability of children through a scoping review. A scoping review literature search was performed in three databases (Scopus, PUBMED, and Web of Science) without restricting the publicized year. The selected articles were using human as its subjects and aiming to analyze the effects of caries on mastication ability in children. Ten articles matched the inclusion criteria of this review. All the articles suggested a deleterious effect of caries on masticatory performance, maximum bite force, swallowing threshold, and even masticatory behavior. Two of them stated that the effect was reversible by giving dental treatment. This scoping review concludes a negative effect of caries on the children's chewing ability.

Food consumption and masticatory performance of normal weight, overweight and obese children aged 7 to 12 years old

Childhood obesity is a significant public health problem. Studies show that obese children are more likely to become obese adults. In an attempt to ascertain the factors associated with childhood obesity, research has shown that this condition is associated with changes in food consumption and masticatory performance. The aim of this study was thus to evaluate food consumption and masticatory performance in normal weight, overweight and obese children aged 7 - 12 years. A cross-sectional study was carried out with 92 children aged 7 - 12 years, of both sexes, from a public school in a Brazilian municipality. The children were divided into the following groups: normal weight (n = 48), overweight (n = 26) and obese (n = 18). Anthropometric parameters, food consumption, food consistency preference, and masticatory performance were evaluated. Pearson's chi-square test was used to compare categorical variables. To compare numerical variables, the one-way ANOVA test was applied. For variables not conforming to a normal distribution, the Kruskal-Wallis test was used. The level of statistical significance was set at p ≤ 0.05. Our results show that the children with obesity consumed fewer fresh foods (median = 3, IQI = 4.00-2.00, p = 0.026), consumed more ultra-processed foods (median = 4, IQI = 4.00-2.00, p = 0.011), performed fewer mastication sequences (median = 2, IQI = 3.00-2.00, p = 0.007), and ate faster (median = 58.50, IQI = 69.00-48.00, p = 0.026) compared to children of normal weight. We conclude that children with obesity exhibit differences in food consumption and masticatory performance compared to children of normal weight.

Masticatory function after comprehensive dental treatment in children with severe early childhood caries

BACKGROUND

Parents are frequently concerned that their child's mastication may be compromised after comprehensive dental treatment.

AIM

To evaluate changes in masticatory function and food preferences after dental treatment in children with early childhood caries.

DESIGN

This prospective study assessed masticatory function with the (1) mixing ability test using duo-coloured chewing gum and (2) the number of chews/g and time taken to eat six food items before and 3 months after dental treatment. A dental examination and a food preference questionnaire were also completed.

RESULTS

Twenty-five children (age: 4.9 ± 0.5 years, baseline dmft/child: 11.4 ± 4.9) completed the study. The mean number of restorations/child, total extractions/child, and posterior extractions/child was 5.1 ± 2.9, 6.4 ± 5.2, and 3.6 ± 2.3, respectively. The number of chews/g of cereal (p = .014) and popcorn (p = .003) significantly increased after dental treatment. The number of chews/g and duration taken for cereal (chews/g: r = 0.795, p = .000, duration: r = 0.794, p = .000) and peanuts (chews/g: r = 0.459, p = .032) were significantly associated with more extractions. There was no change in mastication function for the other foods, mixing ability score, and child's food preferences after dental treatment.

CONCLUSIONS

An increased number of chews/g is needed for certain hard foods after dental treatment, which was associated with an increased number of total and posterior extractions.

Effect of malocclusion on jaw motor function and chewing in children: a systematic review

Objective

To investigate the effects of dental/skeletal malocclusion and orthodontic treatment on four main objective parameters of chewing and jaw function (maximum occlusal bite force [MOBF], masticatory muscle electromyography [EMG], jaw kinematics, and chewing efficiency/performance) in healthy children.

Materials and methods

Systematic searches were conducted in MEDLINE (OVID), Embase, and the Web of Science Core Collection. Studies that examined the four parameters in healthy children with malocclusions were included. The quality of studies and overall evidence were assessed using the Joanna Briggs Institute and GRADE tools, respectively.

Results

The searches identified 8192 studies; 57 were finally included. The quality of included studies was high in nine studies, moderate in twenty-three studies, and low in twenty-five studies. During the primary dentition, children with malocclusions showed similar MOBF and lower chewing efficiency compared to control subjects. During mixed/permanent dentition, children with malocclusion showed lower MOBF and EMG activity and chewing efficiency compared to control subjects. The jaw kinematics of children with unilateral posterior crossbite showed a larger jaw opening angle and a higher frequency of reverse chewing cycles compared to crossbite-free children. There was a low to moderate level of evidence on the effects of orthodontic treatment in restoring normal jaw function.

Conclusions

Based on the limitations of the studies included, it is not entirely possible to either support or deny the influence of dental/skeletal malocclusion traits on MOBF, EMG, jaw kinematics, and masticatory performance in healthy children. Furthermore, well-designed longitudinal studies may be needed to determine whether orthodontic treatments can improve chewing function in general.

Clinical relevance

Comprehensive orthodontic treatment, which includes evaluation and restoration of function, may or may not mitigate the effects of malocclusion and restore normal chewing function.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00784-021-04356-y.

Children who have more toothache-related behaviors have worse masticatory performance

Inadequate masticatory function can be linked to oral problems and result in functional limitation. In children, this function is extremely important for their development, and therefore efforts are made to keep it adequate. To evaluate whether dental pain-related behaviors are associated with masticatory performance (MP). A cross-sectional study was conducted with a sample of 123 children from 3 to 5 years old. Toothache was evaluated using the Dental Discomfort Questionnaire. Anthropometric data, predominant type of breathing, presence of malocclusion, number of posterior teeth cavitated by dental caries, and masticatory units were collected. MP was measured by the median size of the crushed particles (X₅₀ ) after 20 cycles of chewing the Optocal test material and was calculated with the Rosin-Rammler equation. Data analysis involved a description of variable frequencies, as well as simple and multiple linear regression, and a confidence level set at 95%. The mean scores of dental pain-related behaviors were 1.14 (±1.90) points, and the mean X₅₀ value was 3.96 mm (±1.34). In the multiple linear regression, a larger median size of the particles remained associated with a higher score of dental pain-related behaviors (β = +.81, p = .01); mouth breathing (β = +.22, p = .01); and a smaller number of masticatory units (β = -.22, p = .02). Greater dental pain-related behavior scores are associated with worse MP, regardless of the presence of associations with predominantly oral breathing and fewer chewing units.

Pediatric dentists can determine chewing performance level in children

OBJECTIVES

The current study was aimed to verify whether pediatric dentists could determine chewing performance level in children by using Karaduman Chewing Performance Scale (KCPS).

MATERIALS AND METHODS

Typical developing children and children with cerebral palsy (CP) who were referred to pediatric dentistry above the age of 2 years were included in the study. The chewing performance level was scored according to KCPS. One experienced physical therapist and three pediatric dentists independently assessed the chewing videos of the children and scored each child's chewing function. The correlation between the KCPS scores of the physical therapist and the pediatric dentists was used for reliability. The agreement between the scorings of the physical therapist and pediatric dentists was assessed using Fleiss kappa statistics.

RESULTS

Fifty-four typical developing children and 43 children with CP were included. A strong positive correlation between the KCPS scoring of the physical therapist and pediatric dentists was found (r=0.911-0.939, p<0.001). An excellent agreement in the KCPS scoring between the physical therapist and the 1st and 3rd dentists (p<0.001, κ 0.754-0.763), and a good agreement in the KCPS scoring between the physical therapist and the 2nd dentist was detected (p<0.001, κ 0.687).

CONCLUSIONS

The study results show that the KCPS is reliable for pediatric dentists in determining the chewing performance level in children. Therefore, it could be suggested that pediatric dentists could use the KCPS in their clinical settings and research studies.

CLINICAL RELEVANCE

The study may have clinical implications in the evaluation of children with chewing difficulty in dental practice.

CLINICAL TRIAL NUMBER

NCT04407455.

3D Facial morphology in children affected by spinal muscular atrophy type 2 (SMAII)

OBJECTIVES

The main objective of this study was to assess the three-dimensional facial characteristics of children affected by spinal muscular atrophy (SMA), a severe muscular disorder characterized by hypotonia, areflexia, weakness, and respiratory impairment.

MATERIALS/METHODS

Stereophotogrammetric facial scans from 22 SMA type II patients aged 2-7 years were obtained. Data were analysed using both inter-landmark distances and principal component analysis and compared with data collected from matched control subjects.

RESULTS

Patients had wider transverse facial diameters, but smaller biocular width. Middle and lower anterior face heights were increased, whereas the mandibular ramus was shorter, with a reduced posterior-to-anterior face height ratio. Facial width-to-length ratio was reduced. In the sagittal plane, mandibular body length, and facial divergence were increased, whereas the gonial angles were decreased. In the horizontal plane, lower facial convexity was greater in patients, whereas mandibular convexity was smaller. Patients had smaller and down-slanted eye fissures, with a larger and more vertically developed nose.

LIMITATIONS

This study assessed a relatively small number of patients, due to the rare frequency of SMA type II.

CONCLUSIONS/IMPLICATIONS

SMA type II children possess peculiar facial alterations that may be due to the altered muscular activity. As feeding problems may derive also by malocclusion and masticatory muscular alterations, a detailed assessment of the craniofacial individual alterations should be considered in the standards of care of these patients.

Mastication in children and adolescents with overweight or obesity: a systematic review

ABSTRACT Studies have shown that changes in mastication are related to overweight in children and adolescents as these changes influence the increase in food consumption. The objective of this article was to characterize, through a systematic review, the mastication in children and adolescents with overweight or obesity. For this, two independent authors performed a systematic review of the electronic databases: Medical Literature Analysis and Retrieval System Online, Scopus, Cumulative Index to Nursing and Allied Health, Web of Science and Latin American and Caribbean Literature in Health Sciences. Masticatory characteristics were considered as primary outcomes; the methods of analyzing mastication, the physical characteristics of the foods/materials used in the analyses and the fasting time were considered as secondary outcomes. This review was prepared in accordance with the items of the preferential reports for systematic analysis and meta-analysis. The systematic review protocol was submitted to the International Prospective Registry of Systematic Reviews. Nine articles were included in this review. The reviewed articles suggest that children and/or adolescents with overweight or obese present masticatory damages because they have worse masticatory performance and altered orofacial myofunctional characteristics.

Natural food mastication capability in preschool children according to their oral condition: A preliminary study

This study investigated, for the first time, the masticatory capability of preschool children using natural foods, and the impact of an early oral health alteration (early childhood caries: ECC) on the granulometry of ready-to-swallow food boluses. Thirteen children with ECC were compared to 13 preschool children with a healthy oral condition. Oral health criteria and NOT-S scores (Nordic Orofacial dysfunction Test-Screening) were recorded. For each child, number of masticatory cycles (Nc), chewing time (Ti), and frequency (Fq = Nc/Ti) were recorded during mastication of raw carrot (CAR), cheese (CHS) and breakfast cereals (CER) samples. Food boluses were collected by stopping children at their food-dependent individual swallowing threshold (Nc), and the median food bolus particle size value (D50) was calculated. Correlations were sought between oral health and masticatory criteria. In the ECC group, mean Fq values were significantly decreased for all three foods (p ≤ .001) and mean D50 values were significantly increased (p ≤ .001) compared to the control group (i.e., D50 CAR = 4,384 μm ± 929 vs. 2,960 μm ± 627). These alterations were related to the extent of ECC. The NOT-S mean global score was significantly increased in children with ECC (2.62 ± 1.37 vs. 1 ± 0.91 in the control group, p ≤ .01), due to "Mastication and swallowing" domain impairment. This study gives granulometric normative values for three foods in preschool children and shows the impact of ECC on D50 values. The progression of children's masticatory capability after dental treatment, and the impact of such modifications of sensory input on future eating habits should be explored.

The influence of malocclusion, sucking habits and dental caries in the masticatory function of preschool children

The aim of this study was to evaluate the association of malocclusion, nutritive and non-nutritive sucking habits and dental caries in the masticatory function of preschool children. A cross-sectional study was conducted with a sample of 384 children aged 3-5 years. A single examiner calibrated for oral clinical examinations performed all the evaluations (kappa > 0.82). Presence of malocclusion was recorded using Foster and Hamilton criteria. The number of masticatory units and of posterior teeth cavitated by dental caries was also recorded. The parents answered a questionnaire in the form of an interview, addressing questions about the child's nutritive and non-nutritive sucking habits. The masticatory function was evaluated using Optocal test material, and was based on the median particle size in the masticatory performance, on the swallowing threshold, and on the number of masticatory cycles during the swallowing threshold. Data analysis involved simple and multiple linear regression analyses, and the confidence level adopted was 95%. The sample consisted of 206 children in the malocclusion group and 178 in the non-malocclusion group. In the multiple regression analysis, the masticatory performance was associated with age (p = 0.025), bottle feeding (p = 0.004), presence of malocclusion (p = 0.048) and number of cavitated posterior teeth (p = 0.030). The swallowing threshold was associated with age (p = 0.025), bottle feeding (p = 0.001) and posterior malocclusion (p = 0.017). The number of masticatory cycles during the swallowing threshold was associated with the number of cavitated posterior teeth (p = 0.001). In conclusion, posterior malocclusion, bottle feeding and dental caries may interfere in the masticatory function of preschool children.

Evaluation of the Association between Menstrual Cycle Irregularity and Dental Pain or Chewing Discomfort in Women before Menopause

This study was performed to assess the relationship between menstrual irregularity and dental pain or chewing discomfort in women before menopause, using nationally representative data. This study analyzed 4595 participants who were ≥19 years or older, and did not have missing values for outcome variables from the Korean National Health and Nutrition Examination Survey. Tooth pain was considered present if the participant felt throbbing discomfort, pain, or sensitivity when eating hot or cold food or drinking hot or cold beverages. Self-reported oral chewing discomfort was obtained. Adjusted odds ratios and their 95% confidence intervals for tooth pain in the individuals with menstrual cycle irregularity were 1.30 (1.05, 1.62) after adjustment for age, body mass index, drinking, smoking, income, exercise, stress, metabolic syndrome, and the frequency of tooth brushing. Adjusted odds ratios and their 95% confidence intervals for chewing discomfort in the individuals with menstrual cycle irregularity were 1.33 (1.03, 1.72) after adjustment. The association between menstrual irregularity and dental pain or chewing discomfort in women before menopause was proven—after adjusting for confounding factors—by multiple logistic regression analyses. Menstrual cycle irregularity may be considered a potential risk indicator for dental pain or chewing discomfort in Korean women before menopause.

Masticatory behavior for different solid foods in preschool children according to their oral state

Gradual introduction of solid foods in early childhood takes part in the maturation of mastication. The impact of any oral state alteration on food oral processing development is poorly documented for this age group. This study investigated the masticatory behavior in 3 to 6 year-old children with or without early childhood caries (ECC) for three solid foods of different textures. Twenty-one children with healthy oral state and 23 children with severe ECC were observed during complete mastication of calibrated samples of raw carrot, cheese and breakfast cereals. Food refusals and kinematic parameters (Ti: chewing time, Nc: number of cycles and Fq: chewing frequency) were used to assess children masticatory behavior. Oral Health-related Quality of Life and orofacial dysfunctions were evaluated using, respectively the early childhood oral health impact scale (ECOHIS) and the Nordic orofacial dysfunction test screening (NOT-S). Children suffering from ECC exhibited significantly higher ECOHIS and NOT-S scores, in particular for the mastication domain. Accordingly, lower chewing frequencies values were recorded in children with ECC (i.e., carrot Fq: 1.21 ± 0.20 vs 1.35 ± 0.22, p ≤ 0.01), as well as more frequent refusals for carrots. Kinematic parameters were shown to be repeatable in all children for successive samples of the same food, and tended to vary depending on the proposed food. Some masticatory behavior regulation according to food properties could already be present in preschool children. Children with ECC developed alternative behavioral strategies to overcome feeding difficulties. Further studies should investigate food bolus properties according to oral health, as well as nutritional issues. PRACTICAL APPLICATIONS: During childhood, the way solid foods are processed in the oral cavity to be safely swallowed and then digested in available nutrients, is poorly documented. In this study, preschool children have been shown to repeatedly adapt their masticatory behavior to a given food. The collection of various food boli as recorded at the moment of swallowing could then be considered in further food bolus properties research investigations. Moreover, this study suggested that children with altered dentition modified their masticatory kinematic parameters and developed alternative strategies, including food or texture selection, to overcome their feeding difficulties. The development of a mastication evaluation protocol could help medical professionals to detect children masticatory deficiencies and then propose diet adaptations. Considering the importance of food diversity in mastication development and maturation, food industries may consider to develop a range of texture adapted foods for young children, especially designed to gradually rehabilitate the masticatory function.

A new masticatory performance assessment method for infants: A feasibility study

This study evaluated the feasibility of assessing masticatory performance in infants and toddlers. Four groups of healthy children (n = 97, 42 girls and 55 boys) participated in the study: two study groups (SG) followed at 6, 8, and 10 months old (MO) or at 12, 15, and 18 MO, and two control groups (CG) of respectively 10 and 18 MO children. Masticatory performance was determined from children's ability to comminute a model gel during videotaped lab measurements. The gel was inserted in a mesh feeder and offered to the child for a 60s oral processing duration, then gel particles were collected from the feeder and photographed. Resulting gel breakdown was assessed from the characterization of the area and number of formed particles. Children strategy to orally process the gel (sucking vs. biting/chewing) was evaluated from video recordings. Children's compliance (acceptance of the feeder in the mouth for the expected duration) was average (51%) overall. It decreased from 1 year of age and was higher in SG than in CG. The number and area of gel particles formed under oral processing increased significantly with age, demonstrating an increase in children masticatory performance as they grew up. Median particles area was positively associated with sucking behavior and negatively associated with biting/chewing. The association with teeth emergence was not significant. In conclusion, the proposed method is relevant for quantifying the development of early masticatory performance in children who accept to hold the feeder in their mouth. PRACTICAL APPLICATIONS: In this article, a method to easily quantify masticatory performance in young children aged 6-18 MO was evaluated. The method is based on a feeder and could be used for collecting boluses, as an alternative to the chew-and-spit method when it is unfeasible. Children's compliance to the method and the impact of previous study participation on compliance to the protocol are detailed, giving thus a rationale for an optimal application of this method in future experiments. Finally, the determination of masticatory performance as a function of age thanks to this method could contribute to the understanding of food oral processing and food texture acceptance in childhood in future studies.

Association of feeding behavior with jaw bone metabolism and tongue pressure

In recent decades, the eating habits of children and adolescents have undergone many changes due to the diversification of lifestyles worldwide. Reduced masticatory function in growing animals results in changes in the mandible, including a decrease in bone mass. However, the influence of different eating behaviors on jaw bone metabolism (e.g., the palatal palate) during the growth period is not fully understood. In addition, recent clinical studies reported that masticatory performance is positively related to tongue pressure in adults, but no consensus has been reached regarding whether tongue pressure is related to masticatory performance in children. This review summarizes current findings related to these issues, focusing on the influence of different feeding behaviors on jaw bone metabolism, including the development of tongue pressure. Consumption of a soft diet had a negative impact on jaw bone metabolism in the maxilla and mandible of rats; however, mastication of a hard diet recovered the collapsed equilibrium of bone turnover caused by a soft diet during growth. Tongue pressure is closely associated with an increase in masticatory performance in children. Peak maximum tongue pressure is reached earlier in women than in men. Before reaching adulthood, women require intervention to increase their peak tongue pressure.

Comparison of masticatory performance and tongue pressure between children and young adults

The aims of the present study were to evaluate whether there are significant differences in masticatory performance by gender and dental stage. We also determined the factors directly associated with the masticatory performance in children, and those directly associated with masticatory performance in young adults. The study included 180 subjects, ranging in age from 6 to 12 years or 20 to 33 years. The subjects were divided into three groups according to the Hellman developmental stage (III A, III B, or VA); the groups were the subdivided according to gender. The body mass index (BMI), maximum tongue pressure, and sum of decayed, missing, and filled teeth (DMFT) were determined in all subjects. To investigate masticatory performance, the total number and maximum projected area of chewed particles of the jelly materials were measured. Masticatory performance had the highest values at Stage VA in both males and females. Regarding the maximum tongue pressure in females, Stage III B had the highest value of all stages. Multiple regression analysis showed that masticatory performance was associated with DMFT index, maximum tongue pressure, and BMI in children. Among young adults, masticatory performance was associated with DMFT index and maximum tongue pressure. Better masticatory performance is directly associated with better dental status, a higher BMI, and tongue pressure in schoolchildren. Additionally, masticatory performance was well-correlated with tongue pressure in young adults, although maximum tongue pressure reached its peak before Stage VA in females. We suggest that females need training with respect to tongue pressure, by the mixed dentition stage.

Common risk indicators for oral diseases and obesity in 12-year-olds: a South Pacific cross sectional study

BACKGROUND

Despite the increasing need to prevent obesity and oral diseases in adolescents worldwide, few studies have investigated the link existing between these conditions and their common risk factors. This study aims to evaluate the oral health and weight status of New Caledonian Children (aged 6,9,12 years) and to identify, amongst 12-year-olds, risk indicators that may characterize the groups of children affected by oral diseases, obesity or both diseases.

METHODS

This survey evaluated in 2011-2012 the oral health and stature-weight status and related risk indicators in a national representative sample of 6, 9 and 12 years-old children in New Caledonia. Dental status, chewing efficiency, height, weight and waist circumference were clinically recorded at school. The body mass index (BMI) and the waist to height ratio (WtHR) were calculated. For BMI the WHO Cut-offs were used. Twelve years-old participants responded to a questionnaire concerning socio-demographic and behavioural variables. For statistical analysis, the Clinical Oral and Global Health Index (COGHI) was developed and used. Twelve years-old children were categorised into four groups; Oral Diseases (ODG), Obesity (OG), Obesity and Oral Diseases (ODOG) and a Healthy Group (HG). A multivariate analysis was conducted using mixed-effects multinomial logistic regression models.

RESULTS

Prevalence of overweight and obesity was greatly increasing from 6 years (respectively 10.8% [8.8;13.3] and 7.8% [6.0;9.9]) to 12 years (respectively 22.2% [19.9;24.7] and 20.5% [18.2;22.9]) and one third of the 12-yr-olds had an excess of abdominal adiposity. At age 12, 36.6% of the children were healthy (HG), 27.3% had oral diseases (ODG), 19.7% were obese (OG) and 16.5% had both conditions (ODOG). Geographical location, ethnicity, tooth-brushing frequency and masticatory disability were significant risk factors for the OG, ODOG and ODG groups. Ethnicity and masticatory impairment were common risk indicators for the association of oral diseases and obesity.

CONCLUSIONS

In NC health promotion programs should be specifically addressed towards Native populations who are particularly exposed to oral diseases and obesity, integrating a multiple risk factors approach, in order to prevent the onset of chronic diseases in adulthood. The impact of masticatory ability on children's weight status is a major issue for future research.

Influence of masticatory function, dental caries and socioeconomic status on the body mass index of preschool children

OBJECTIVE

The objective of this study was to determine the influence of masticatory function, dental caries and socioeconomic status on the body mass index (BMI) of preschool children.

METHODS

A cross-sectional study was conducted with a sample of 285 children aged three to five years allocated to three groups based on the BMI: underweight, ideal weight and overweight/obesity. Socioeconomic status was determined based on the responses of parents/caregivers to a specific form. Cavitated lesions were diagnosed using the criteria of the International Caries Detection and Assessment System. Masticatory function was assessed based on masticatory performance (MP) and the swallowing threshold (ST), which were evaluated based on the results of a test food. Data analysis involved the employment of the Kruskal-Wallis, Mann-Whitney and chi-square tests as well as simple and multiple linear regression analyses.

RESULTS

In the final multiple regression model, BMI was influenced by monthly household income (β=0.234; 95%CI: 1.014 to 1.647), number of cavitated teeth (β=-0.180; 95%CI: -0.293 to -0.054) and X50 of the ST (β=0.304; 95%CI: 0.213-0.498).

CONCLUSION

Children whose food test resulted in large particles and those from families with a higher monthly income had a higher BMI. Children with a greater number of teeth with cavitated dental caries had a lower BMI.