Vibratory stimulus to the masseter muscle impairs the oral fine motor control during biting tasks

Food Hardness Modulates Behavior, Cognition, and Brain Activation: A Systematic Review of Animal and Human Studies

Food hardness is one of the dietary features that may impact brain functions. We performed a systematic review to evaluate the effect of food hardness (hard food versus soft food diet) on behavior, cognition, and brain activation in animals and humans (PROSPERO ID: CRD42021254204). The search was conducted on 29 June 2022 using Medline (Ovid), Embase, and Web of Science databases. Data were extracted, tabulated by food hardness as an intervention, and summarized by qualitative synthesis. The SYRCLE and JBI tools were used to assess the risk of bias (RoB) of individual studies. Of the 5427 studies identified, 18 animal studies and 6 human studies met the inclusion criteria and were included. The RoB assessment indicated that 61% of animal studies had unclear risks, 11% had moderate risks, and 28% had low risks. All human studies were deemed to have a low risk of bias. The majority (48%) of the animal studies showed that a hard food diet improved behavioral task performance compared to soft food diets (8%). However, 44% of studies also showed no differential effects of food hardness on behavioral tests. It was also evident that certain regions of the brain were activated in response to changes in food hardness in humans, with a positive association between chewing hard food, cognition performance, and brain function. However, variations in the methodologies of the included studies hindered the meta-analysis execution. In conclusion, our findings highlight the beneficial effects of dietary food hardness on behavior, cognition, and brain function in both animals and humans, however, this effect may depend on several factors that require further understanding of the causality.

Subjective and objective evaluation of masticatory function in patients with bimaxillary implant-supported prostheses

BACKGROUND

People perform poorly in masticatory function tests despite well-functioning prostheses. However, it is unclear whether there is an agreement between subjective and objective measures of mastication.

OBJECTIVES

To investigate the association between subjective and objective measures of masticatory function in patients with bimaxillary implant-supported prostheses.

MATERIALS AND METHODS

An experimental group (n = 25, age = 70.6 ± 7.5 years, eight women) with bimaxillary implant-supported fixed prostheses and a control group (n = 25, age = 69.0 ± 5.3, 13 women) with natural dentition were recruited. The participants in the experimental group were included if they had been using the prosthesis for at least a year and had no obvious complaints with their prostheses. The control group was people with natural dentition and without any prostheses or complaints related to the masticatory system. The masticatory function was evaluated objectively with food comminution and mixing ability tests, and subjectively with jaw function limitation scale (JLFS) and oral health impact profile (OHIP).

RESULTS

The experimental group performed poorly in both objective tests (p < .001). However, there was no significant differences between the two groups in total JFLS (p = .114) and OHIP (p = .312) scores. Though, there were certain positive correlations between the food comminution test and JFLS subdomains in the control group, and a positive correlation between food comminution test and specific subdomains of OHIP in the experimental group indicating poor correlation between the subjective and objective measures.

CONCLUSION

Although patients with implant prostheses show poor masticatory performance, there is no agreement in the objective and subjective measures of mastication.

Effect of Apical Microsurgery on Force Regulation of Incisor Teeth during Unpredictable Force Control Task

BACKGROUND

Apical microsurgery (AMS) involves removal of the root-end which can affect the force regulation of teeth.

OBJECTIVE

To investigate the force regulation of incisor teeth treated with AMS during the unpredictable force control task in comparison to their contralateral teeth with complete root apices, in humans.

METHODS

Fifteen eligible participants (8 women and 7 men; mean age 52.9 ± SD 4.4 years) performed a standardized unpredictable force control task which involved pulling and holding a force transducer with AMS-treated incisors and its contralateral control teeth (n =30 teeth). A series of four load masses: 100, 200, 50, and 300 gm were attached to the force transducer through a string in an unpredictable manner. The force profile obtained was divided into initial and later time-segments. The peak force and peak force rate during the initial time-segment, and the holding force and coefficient of variability during the later time-segments were calculated and compared by the repeated measures analysis of variance.

RESULTS

During the initial time-segment, the peak force and peak force rate were significantly lower in the AMS-treated teeth than in the controls (P = 0.001, P = 0.013, respectively). However, during the later time-segment, no significant differences in the holding force nor the coefficient of variability were observed between the AMS-treated teeth and their controls (P = 0.755, P = 0.213, respectively).

CONCLUSION

In contrast to incisors with complete normal root apices, AMS-treated incisors do not show robust changes in force regulation.

Cognitive changes and neural correlates after oral rehabilitation procedures in older adults: a protocol for an interventional study

BACKGROUND

Epidemiological studies show an association between masticatory function and cognitive impairment. This has further strengthened the notion that tooth loss and impaired masticatory function may be risk factors for dementia and cognitive decline. Animal experiments have indicated a causal relationship and several possible mechanisms have been discussed. This evidence is, however, lacking in humans. Therefore, in the current interventional study, we aim to investigate the effect of rehabilitation of masticatory function on cognition in older adults.

METHODS

Eighty patients indicated for prosthodontic rehabilitation will be randomly assigned to an experimental or a control group. Participants will conduct neuropsychological assessments, masticatory performance tests, saliva tests, optional magnetic resonance imaging, and answer questionnaires on oral health impact profiles and hospital anxiety and depression scale before, 3 months, and 1 year after oral rehabilitation. The difference between the two groups is that the control group will be tested an additional time, (at an interval of about 3 months) before the onset of the oral rehabilitation procedure. The primary outcome is a change in measures of episodic memory performance.

DISCUSSION

Although tooth loss and masticatory function are widespread in older people, it is still an underexplored modifiable risk factor potentially contributing to the development of cognitive impairment. If rehabilitation of masticatory function shows positive effects on the neurocognitive function, this will have great implications on future health care for patients with impaired masticatory status. The present project may provide a new avenue for the prevention of cognitive decline in older individuals.

TRIAL REGISTRATION

The protocol for the study was retrospectively registered in ClinicalTrials.gov Identifier: NCT04458207, dated 02-07-2020.

The effect of occlusal splints on the mechanical stress on teeth as measured by intraoral sensors

PURPOSE

Whether it is possible to prevent mechanical stress on teeth via an occlusal splint remains to be clarified. This study aimed to assess the same by simultaneously recording the occlusal pressure and strain on the teeth in humans.

METHODS

Eleven participants (five women and six men; mean age 25.7 years) were enrolled in this study. Hard and soft oral appliances were fabricated for the maxillary arch of each participant. The strain on the four target teeth (right maxillary and mandibular first premolars, and first molars) and occlusal pressure were concurrently measured, while the participants performed maximum voluntary teeth clenching under each condition (hard, soft, or no occlusal splint).

RESULTS

Compared to the absence of an occlusal splint, hard occlusal splints generated less strain on molar teeth but more strain on premolar teeth, while soft occlusal splints did not lower the strain on all target teeth significantly.

CONCLUSION

Considering the limitations of this study, hard occlusal splints should be used for the protection of molar teeth but for premolar teeth caution is required and depends on the case. On the other hand, soft occlusal splints may not have any benefit for the protection of either type of teeth for patients exhibiting excessive occlusal pressure.

Oral Fine Motor Control of Teeth Treated with Endodontic Microsurgery: A Single-Blinded Case-control Study

INTRODUCTION

Periodontal mechanoreceptors (PMRs) are refined neural receptors present in abundance at the root apex and have a pivotal role in oral fine motor control. This case-control study aimed to evaluate the oral fine motor control of teeth treated with endodontic microsurgery (EMS) in comparison with the control teeth using a standardized behavioral biting task.

METHODS

Fourteen eligible participants performed 5 trials of an oral fine motor control task that involved holding and splitting half of a peanut positioned on a force transducer with their EMS treated tooth and its contralateral control incisor tooth (28 teeth in total). The outcome variables were the mean food holding force, intra- and intertrial variability of the holding force, food splitting force, splitting duration, and the frequency of the stepwise splitting phase. The data were analyzed with parametric and nonparametric tests.

RESULTS

The results showed no statistically significant differences in the holding force, inter- and intratrial variability of the holding force, splitting force, or splitting duration between the teeth treated with EMS and the control (P > .05). However, there was a significantly higher frequency of stepwise ramp increase during the splitting phase with EMS treated teeth compared with the control (48% and 37%, respectively; P < .05).

CONCLUSIONS

EMS treated teeth showed similar force regulation and oral fine motor control as the contralateral control. The findings of this study suggest that EMS treatment does not perturb the sensory information of PMRs and maintains the force regulation and oral fine motor control of the teeth.

Motor control strategies during unpredictable force control tasks in humans

BACKGROUND

There are fundamental similarities and differences between the jaw and hand motor systems. However, it is unclear how the two systems respond to unpredictable task demands.

OBJECTIVE

To investigate and compare the force control of the jaw motor system (OMS) and the hand motor system (HMS) during unpredictable load changes.

METHODS

Seventeen healthy adults (24.0 ± 4.3 years) performed two standardised force control tasks (OMS and HMS). During the OMS, the participants asked to bite and pull a force transducer with the front teeth. While during HMS they pinched and pulled the same force transducer with their index and thumb fingers. Series of loads were added to a string attached to the transducer in an unpredictable (sequential and non-sequential) manner. The entire force profile during the task was divided into "initial" and "latter" segments. The force control was analysed and compared between the OMS and HMS in terms of peak force during the initial segment and holding force and force variability during the latter segment.

RESULTS

The peak force, holding force and force variability were higher for the OMS than the HMS (P < .001). However, there were no differences in the peak force, holding force or force variability between the sequential and non-sequential load changes (P > .05).

CONCLUSIONS

The results showed that unpredictable load changes did not affect the force control during the motor control task. This study suggests that both the motor systems are optimised in performing simple motor control tasks and are rather resilient to motor unpredictability.

Effect of food hardness on chewing behavior in children

Objective

To investigate the effects of food hardness on chewing behavior in children compared with adults.

Materials and methods

Healthy children (3–17 years) were equally divided into five groups based on their dental eruption stages. Each participant ate soft and hard viscoelastic test food models (3 each), while the three-dimensional jaw movements and electromyographic (EMG) activity of the bilateral masseter muscles were recorded. The data from the children were compared with a control group of healthy adults (18–35 years). The data were analyzed with nonparametric tests.

Results

There was no significant difference in the number of chewing cycles and the duration of the chewing sequence between children groups and adults. Children with primary dentition (3–5 years) showed shorter lateral jaw movement and higher muscle activity at the end of the chewing sequence, compared with adults. Further, children’s age-groups (3–14 years) failed to adapt their jaw muscle activity to food hardness. However, at the late-permanent dentition stage (15–17 years), children were capable of performing adult-like chewing behavior.

Conclusions

Overall, it seems that children as young as 3-year-old are quite competent in performing basic chewing function similar to adults. Yet, there are differences in the anticipation or adaption of jaw muscle activity and jaw kinematics to food hardness.

Clinical relevance

The study may have clinical implication in the diagnosis and management of children with chewing impairment associated with dental malocclusions and other orofacial dysfunctions.

Effects of Chronic and Experimental Acute Masseter Pain on Precision Biting Behavior in Humans

Chronic pain in the orofacial region is common worldwide. Pain seems to affect the jaw motor control. Hence, temporomandibular disorders (TMD) are often accompanied by pain upon chewing, restricted mouth opening and impaired maximal bite forces. However, little is known on the effects of pain, in particular the effects of chronic jaw muscle pain on precision biting. The aim of the study was to investigate the effect of chronic and acute jaw muscle pain on oral motor control during precision biting in humans. Eighteen patients with chronic masseter muscle pain and 18 healthy participants completed the experiment. All participants were examined according to the Diagnostic Criteria for TMD. Experimental acute pain was induced by bilateral, simultaneous sterile hypertonic saline infusions into the healthy masseter muscles. A standardized hold and split biting task was used to assess the precision biting. The data was analyzed with non-parametric statistical tests. The results showed no significant differences in the hold forces, split forces, durations of split or peak split rates within or between the pain and pain-free conditions. The mean split rate increased significantly compared to baseline values both in the chronic patients and the pain-free condition. However, this increase was not evident in the experimental acute pain condition. Further, there were no significant differences in the mean split rates between the conditions. The data suggest that jaw muscle pain does not seem to alter precision biting in humans, however, the possibility that a nociceptive modulation of spindle afferent activity might have occurred but compensated for cannot be ruled out.

Multimodal Sensory Stimulation of the Masseter Muscle Reduced Precision but Not Accuracy of Jaw-Opening Movements

A functional integration between the trigeminal and craniocervical sensorimotor systems has been demonstrated, with simultaneous jaw and head–neck movements during jaw opening–closing. We previously showed that pain induction in the masseter muscle increased the relative contribution of the neck component of integrated jaw–neck movements. Induced pain or manipulation of proprioception by vibration did not affect accuracy during a jaw-opening task in men. It is not known how multimodal sensory stimulation, with a combination of pain induction and vibration, affects jaw-opening accuracy and precision. The aim was to investigate how jaw–neck movements, and specifically accuracy and precision of jaw-opening, are affected during concomitant nociceptive and proprioceptive stimulation of the masseter muscle. Twenty-one healthy men performed jaw-opening to a target position, defined as 75% of individual maximum jaw opening, during control (Ctr), vibration of masseter muscles (Vib), pain induction in the masseter (Pain), and concomitant vibration and pain induction in the masseter muscle (VibPain). Simultaneous jaw and head movements were recorded with an optoelectronic system and amplitudes calculated for each jaw opening–closing cycle. Accuracy of jaw movements was defined as the achievement of the target position. Precision of jaw movements was defined as the cycle-to-cycle variability from the mean of cycles 2–10 (coefficient of variation, CV). Differences between the trials were analyzed with Friedman’s test, Dunn’s test, and Benjamini–Hochberg correction. There were no significant differences between the trials for jaw movement amplitudes. For head movements, amplitudes for cycles 2–10 were larger during Pain compared to Ctr and Vib (both p = 0.034), and larger during VibPain compared to Ctr (p = 0.034) and Vib (p = 0.035). There were no differences in accuracy of jaw movements between the trials. For precision of jaw movements, the cycle-to-cycle variability was larger during VibPain compared to Ctr (p = 0.027) and Vib (p = 0.018). For integrated jaw–neck motor strategy, there was a difference between pain and non-pain trials, but no differences between unimodal and multimodal stimulation trials. For achievement of jaw-opening to a target position, the results show no effect on accuracy, but a reduced precision of jaw movements during combined proprioceptive and nociceptive multimodal stimulation.

Behavioral learning and skill acquisition during a natural yet novel biting task

OBJECTIVE

To investigate the effect of short-term training on behavioral learning and skill acquisition during a natural yet novel biting task.

METHODS

Thirty (18 women) healthy volunteers in the age range of 18-32 years were divided into a naive (n = 17) and expert (n = 13) groups based on the self-reported familiarity to perform a complex behavioral biting task. The volunteers participated in a single experimental session divided into three sets with three series, each with ten trials of a standardized biting task. The task was to position, split and retrieve a sunflower seed from its shell without crushing the seed. The two consecutive sets were separated by fifteen minutes of short-term training. During the short-term training, the participants repeatedly performed the biting task for about fifteen minutes. A five-point grading system was devised to determine the performance and video registrations were made to determine the duration of the task.

RESULTS

There was a significant main effect of training on the task performance scores (P < .001). The performance scores of the naive group before training was significantly lower than all the sets of the expert group (P < .010). The performance scores of the naive group were also significantly better after training than before (P = .001). However, the expert group took significantly shorter time to complete the task than the naive group.

CONCLUSION

The results of the present study show a significant effect of training on the performance of a complex behavioral biting task. Training resulted in improved performance scores and a subtle decrease in the duration of the task.