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Michalakis K, Papagiannaki M, Hirayama H, Tsouknidas A. Mini-review: Pathways of postural disturbances tracing to the stomatognathic system. Neurosci Lett 2024; 836:137889. [PMID: 38964707 DOI: 10.1016/j.neulet.2024.137889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/06/2024]
Abstract
Postural alignment is strongly shaped by inborn anatomical and nonvolitional neural factors, whereas postural stability is dynamic in nature and driven by both automatic and volitional sensorimotor processes. The sensory and motor systems responsible for these functions are tightly integrated with the central nervous system, several vital structures of which are in close proximity to the stomatognathic system. Interventions in the oral cavity have therefore been stipulated to provide sensory feedback, which may then be translated into motor function. Since the early 90 s, numerous intervention studies have provided evidence of this correlation, with traditional views advocating that causative factors are mainly indirect. Dynamic postural responses were thus predominantly considered manifestations of head displacement, with most studies identifying potential connections along active and passive muscular interactions. The consideration however, that neuromuscular adaptations of whole-body dynamics might extend beyond biomechanical responses and involve direct pathways as well, has led to a recent paradigm shift, challenging conventional perspectives. Among the suggested pathways are central projections of trigeminal afferents, providing inputs for the oculomotor system, as well as active and passive muscular interactions. Further intervention studies indicate a sensory integration of the stomatognathic system to proprioception, likely through neural networks that work in concert with visual cues and the vestibular organs. Building on this accumulating pool of evidence, a timely perspective is provided on a critical yet underexplored aspect of neurophysiology: the intricate interplay between the cranio-cervico-mandibular system and the broader framework of body posture.
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Affiliation(s)
- K Michalakis
- Laboratory of Applied Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA; Center for Multiscale and Translational Mechanobiology, Boston University, Boston, MA, USA.
| | - M Papagiannaki
- Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece
| | - H Hirayama
- Laboratory of Applied Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA
| | - A Tsouknidas
- Laboratory of Applied Biomechanics, Department of Restorative Sciences & Biomaterials, Henry M. Goldman School of Dental Medicine, Boston University, Boston MA-02111, USA; Laboratory for Biomaterials and Computational Mechanics, Department of Mechanical Engineering, University of Western Macedonia, University Campus ZEP, 50100 Kozani, Greece.
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Deshmukh A, Poovani SK, Thumati P. An observational analysis to evaluate the influence of occlusion on body posture and plantar pressure - An in vivo study. J Indian Prosthodont Soc 2024; 24:273-278. [PMID: 38946511 PMCID: PMC11321483 DOI: 10.4103/jips.jips_497_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024] Open
Abstract
AIM The aim of this study is to evaluate the influence of occlusion on body posture and plantar arch pressure. SETTINGS AND DESIGN An Observational analysis to Analyze the Influence of Occlusion on Plantar Pressure and Body Posture. MATERIALS AND METHODS A total of 30 asymptomatic subjects were selected for the study including 18 females and 12 males from age group 22 years to 28 years with a mean age of 24.83 years. Each subject underwent evaluation of occlusion at MIP using a Digital Occlusal analyzer (T-Scan III). At this point, the subjects were made to stand on a mat scan which consisted of a large postural platform sensor and a computer that displayed the plantar pressure data. The computer connected to the T Scan displayed the occlusal pressure analysis. This was followed by an evaluation of body posture using a posture grid where the photographs were taken and an evaluation of the frontal and lateral photos was done using the APECS - posture analysis app. STATISTICAL ANALYSIS USED Statistical package for social sciences (SPSS) for windows version 22.0 Released 2013, Armonk, N Y: IBM Corp., was used to perform Statistical Analysis. A chi-square test was applied for qualitative variables to find the association. Paired t-test was applied to compare the changes in the quantitative parameters in eye-open and eye-closed conditions. The level of significance was set at 5%. RESULTS As observed from the results, occlusion for 40% of the subjects, where n = 12, was dominant on the right side. Occlusion for 23.3% of subjects, where n = 7, was dominant on the left side. Whereas, for 36.7% of subjects, where n = 11, the pressure distribution was almost equal on both sides. The inclination of body posture for 23.3% of subjects, where n = 7, was towards the right side. The inclination of body posture for 50% of subjects, where n = 11, was towards the left side. And, the inclination of body posture for 26.7% of subjects, where n = 8, was neutral i.e., balanced on the right and left side. Plantar pressure for 6.7% of subjects, where n = 2, was dominant on the right side. Plantar pressure for 36.7% of subjects, where n = 11, was dominant on the left side. Whereas, for 56.7% of subjects, where n = 17, the plantar pressure distribution was almost equal on both sides. CONCLUSION On correlating the three parameters, it was found that occlusion for most of the subjects dominated on the right side, while body posture and plantar pressure dominated on the contralateral i.e., left side.
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Affiliation(s)
- Aishwarya Deshmukh
- Department of Prosthodontics and Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Shwetha Kumari Poovani
- Department of Prosthodontics and Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
| | - Prafulla Thumati
- Department of Orofacial Pain, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
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Giraudeau A, Nicol C, Macchi R, Coyle T, Mesure S, Berdha K, Orthlieb JD, Barthèlemy J. Impact of occlusal proprioception on static postural balance. Heliyon 2023; 9:e20309. [PMID: 37800066 PMCID: PMC10550569 DOI: 10.1016/j.heliyon.2023.e20309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
Conflicting results on the effects of occlusal proprioceptive information on standing sway have been reported in the literature, partly due to the heterogeneity of the occlusal criterion studied and the experimental protocol used. In this study, occlusal functions, different mandibular positions and visual conditions were used to investigate the involvement of occlusal proprioception information in static postural balance. Postural adjustments of 26 healthy young adults, divided into Class I malocclusion and Class I normocclusion groups, were studied in upright position, in five mandibular positions (1 free, 2 centric and 2 eccentric), with and without vision. Due to different reported test durations, postural parameters were examined for the first and last halves of the 51.2 s acquisition time. A permutation ANOVA with 4 factors was used: group, mandibular position, vision, time window. Mean length of CoP displacement was shorter with vision (ES = 0.30) and more affected by vision loss in the free than in the intercuspal mandibular position (ES = 0.76 vs. 0.39), which has more tooth contacts. The malocclusion group was more affected by vision loss (ES = 0.64). Unexpectedly, with vision, the mean length was smaller in one eccentric occlusion side compared to the other (ES = 0.51), but independent of the left or right side, and more affected by vision loss (ES = 1.04 vs. ES = 0.71). The first-time window of the acquisition time, i.e. 25.6 s, was sufficient to demonstrate the impact of dental occlusion, except for the sway area. Comparison of the two visual conditions was informative. With vision, the weight of occlusal proprioception was not strictly related to occlusal characteristics (number of teeth in contact; centered or eccentric mandibular position), and it was asymmetrical. Without vision, the lack of difference between groups and mandibular positions suggested a sensory reweighting, probably to limit postural disturbance.
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Affiliation(s)
- Anne Giraudeau
- Aix Marseille Univ, School of Dentistry, Marseille, France
- Aix Marseille Univ, CNRS, ISM, Marseille, France
| | | | - Robin Macchi
- Aix Marseille Univ, CNRS, ISM, Marseille, France
- SEP-EA 7370, INSEP, Paris, France
| | - Thelma Coyle
- Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Serge Mesure
- Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Kelly Berdha
- Aix Marseille Univ, School of Dentistry, Marseille, France
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Belhassen S, Mat Q, Ferret C, Clavel R, Renaud B, Cabaraux P. Post-Traumatic Craniocervical Disorders From a Postural Control Perspective: A Narrative Review. BRAIN & NEUROREHABILITATION 2023; 16:e15. [PMID: 37554255 PMCID: PMC10404808 DOI: 10.12786/bn.2023.16.e15] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 08/10/2023] Open
Abstract
Mild traumatic brain injury (mTBI) and whiplash injury (WI) may lead to long-term disabling consequences known as post-concussive syndrome (PCS) and whiplash-associated disorders (WADs). PCS and WAD patients commonly complain of conditions encompassing dizziness, vertigo, headache, neck pain, visual complaints, anxiety, and neurocognitive dysfunctions. A proper medical work-up is a priority in order to rule out any acute treatable consequences. However investigations may remain poorly conclusive. Gathered in the head and neck structures, the ocular sensorimotor, the vestibular, and the cervical proprioceptive systems, all involved in postural control, may be damaged by mTBI or WI. Their dysfunctions are associated with a wide range of functional disorders including symptoms reported by PCS and WAD patients. In addition, the stomatognathic system needs to be specifically assessed particularly when associated to WI. Evidence for considering the post-traumatic impairment of these systems in PCS and WAD-related symptoms is still lacking but seems promising. Furthermore, few studies have considered the assessment and/or treatment of these widely interconnected systems from a comprehensive perspective. We argue that further research focusing on consequences of mTBI and WI on the systems involved in the postural control are necessary in order to bring new perspective of treatment.
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Affiliation(s)
- Serge Belhassen
- Groupe d'Etudes, de Recherche, d'Information et de Formation sur les Activités Posturo-Cinétiques (Gerifap), Juvignac, France
| | - Quentin Mat
- Department of Otorhinolaryngology, Centre Hospitalier Universitaire (CHU) Charleroi, Charleroi, Belgium
| | - Claude Ferret
- Departments of Oral Health Sciences and Otorhinolaryngology, Centre Hospitalier Universitaire (CHU) de Montpellier, Montpellier, France
| | - Robert Clavel
- Groupe d'Etudes, de Recherche, d'Information et de Formation sur les Activités Posturo-Cinétiques (Gerifap), Juvignac, France
| | - Bernard Renaud
- Groupe d'Etudes, de Recherche, d'Information et de Formation sur les Activités Posturo-Cinétiques (Gerifap), Juvignac, France
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Associations of Masticatory Muscles Asymmetry and Oral Health with Postural Control and Leg Injuries of Elite Junior Soccer Players. J Hum Kinet 2022; 84:21-31. [DOI: 10.2478/hukin-2022-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abstract
The influence of asymmetry between masticatory muscles on postural control is still under debate and only few studies examined the impact of oral health on injury risk.
The present study investigated the relationships between masticatory muscles asymmetry, oral health, postural control and the prevalence of (non-contact or traumatic) leg injuries in a sample of 144 male elite junior soccer players. sEMG of the masseter and temporal muscles was performed during maximum teeth clenching, postural control was tested by measuring sway velocity during the unipedal stance with eyes closed, while oral health and the number of leg injuries were assessed using a questionnaire. The time-1 assessment was repeated in a subgroup of 69 players after one year. Pearson and partial correlation coefficients and adjusted odds ratios (OR) were used to assess associations. Asymmetry between the masseter and temporalis muscles (AMTM, quantified as anteroposterior coefficient, APC) was associated with higher sway velocity on the dominant leg (using time-1 data partial r = -0.24, p = 0.004, using longitudinal data partial r = -0.40, p = 0.005). Higher prevalence of two or more leg injuries throughout a competitive season was associated with poor oral health (adjusted OR (95%CI) using time-1 data = 2.14 (1.02–4.46), using longitudinal data = 4.47 (1.25–15.96)). These results indicate that AMTM has a negative influence on the sway velocity of the dominant leg only, possibly because frequent balancing exercises on the non-dominant leg may counteract negative influences of AMTM. The association of oral health with leg injuries underlines the need for oral health promotion and monitoring strategies in sports.
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Diéguez-Pérez M, Fernández-Molina A, Burgueño-Torres L. Influence of occlusion and mandibular position on foot support and head posture in adult patients. Cranio 2022:1-8. [PMID: 36334277 DOI: 10.1080/08869634.2022.2140245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study postural changes, taking into account different mandibular positions and the cephalic and plantar body segments. METHODS A cross-sectional, descriptive, clinical, and observational study was carried out on 76 patients, (mean age 28.79 years), in whom body posture and plantar support were evaluated in the maximum mandibular intercuspal position and the mandibular rest position without dental contact. RESULTS When the mandibular position was altered, 71.01% of the patients showed changes in the bipupillary line (p = 0.008), while those who did not show such changes did, however, show changes in plantar support. More than 85% of the sample experienced alterations in the plantar plane when the mandibular position was changed, with statistically significant results (p < 0.001). CONCLUSION There is a positive relationship between the different segments in body posture. In the sample, changes in plantar support with respect to the different mandibular positions were noticeable.
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Affiliation(s)
- Montserrat Diéguez-Pérez
- Department of Preclinical Dentistry, Faculty of Biomedical Sciences and Health Sciences, European University of Madrid, Madrid, Spain
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Aurora Fernández-Molina
- Department of Preclinical Dentistry, Faculty of Biomedical Sciences and Health Sciences, European University of Madrid, Madrid, Spain
| | - Laura Burgueño-Torres
- Department of Preclinical Dentistry, Faculty of Biomedical Sciences and Health Sciences, European University of Madrid, Madrid, Spain
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Experimental Analysis of the Use of Cranial Electromyography in Athletes and Clinical Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137975. [PMID: 35805630 PMCID: PMC9266171 DOI: 10.3390/ijerph19137975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 06/23/2022] [Accepted: 06/26/2022] [Indexed: 02/04/2023]
Abstract
Background: Cranial surface electromyography is assumed to analyze the correlation between the stomatognathic apparatus and the muscular system and its implications on the physical status of professional athletes. The purpose of this paper is to evaluate surface cranial electromyography as an aid in the diagnosis and treatment of occlusal and muscular disorders in professional athletes. Methods: A sample of 25 athletes (mean age 23 years, 20 men and 5 women) underwent electromyographic recording; among them, 13 had a sports injury condition (symptomatic athletes), while 12 were in perfect physical condition (asymptomatic athletes). At odontostomatological examination, 6 showed cranio-mandibular disorders (dysfunctional athletes), while 19 showed no disorders (functional athletes). The treatment plan to resolve the symptoms of the dysfunctional athletes was chosen based on the electromyographic data. One month after the start of therapy with an occlusal splint, a follow-up was performed, and the results were compared with the initial data. Results: Statistical analysis showed that the chosen therapy following the use of electromyography was effective in 72% of cases, while 28% of patients did not respond to therapy (p = 0.028). Conclusions: The use of cranial electromyography in competitive athletes is a valuable tool in therapeutic choice aimed at balancing occlusal loads and improving the patient’s global tonic postural attitude, resulting in positive feedback in the qualitative assessment of sports performance.
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Cheng CH, Atsuta I, Koyano K, Ayukawa Y. Hypothetical Model of How a Clinical Remount Procedure Benefits Patients with Existing Dentures: A Narrative Literature Review. Healthcare (Basel) 2022; 10:healthcare10061067. [PMID: 35742118 PMCID: PMC9222819 DOI: 10.3390/healthcare10061067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
The clinical remount procedure, which involves remounting the dentures on an articulator with interocclusal records, can effectively reduce occlusal discrepancies. This procedure can be applied not only to new dentures but also to those already in service; however, research in this field is still scarce. This narrative review aims to establish a hypothetical mechanism and possible indications and contraindications for this technique as a basis for further research. Current studies have revealed a high prevalence of malocclusion in delivered dentures. Performing a clinical remount on these existing dentures would enhance the oral function of the denture wearer and would enable effective and accurate correction of the accumulated errors in the jaw relationship in a stable working environment. This technique should be performed if a patient has poor masticatory function or occlusion-related complaints. However, performing a clinical remount on dentures with an excessive anterior–posterior discrepancy between the centric relation and the maximal intercuspal position or on dentures with extremely low occlusal vertical dimension, is considered less effective. The clinical remount procedure remains an essential skill both for fabricating quality dentures and maintaining those already in service.
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Affiliation(s)
- Chi-Hsiang Cheng
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka 8128582, Japan; (C.-H.C.); (K.K.); (Y.A.)
| | - Ikiru Atsuta
- Division of Advanced Dental Devices and Therapeutics, Faculty of Dental Science, Kyushu University, Fukuoka 8128582, Japan
- Correspondence: ; Tel.: +81-92-642-6441
| | - Kiyoshi Koyano
- Division of Advanced Dental Devices and Therapeutics, Faculty of Dental Science, Kyushu University, Fukuoka 8128582, Japan
| | - Yasunori Ayukawa
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University, Fukuoka 8128582, Japan; (C.-H.C.); (K.K.); (Y.A.)
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Freire DBDL, Celeste RK, Arús NA, Vizzotto MB, Silveira HLDD. [Dental imaging procedures in the Unified Health System and the expansion of secondary care: series between 2000-2016]. CIENCIA & SAUDE COLETIVA 2021; 26:4727-4736. [PMID: 34730658 DOI: 10.1590/1413-812320212610.15172020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 08/13/2020] [Indexed: 11/22/2022] Open
Abstract
The scope of this paper was to analyze the time series of dental procedures performed between 2000 and 2016 in the Brazilian Unified Health System (SUS). The data were obtained from the Outpatient Information System of the SUS (SIA-SUS). The influence of the 2004 National Oral Health Policy of Ordinance No. 600/2006 (which instituted the financing of Dental Specialty Centers - CEOs), and Ordinance No. 1,234/2013 (Financial incentive for the Program for Enhancement of Quality and Access - PMAQ-CEO) were analyzed. Descriptive analyses of the initial and final years of the time series were presented, assessing trends and seasonality in seven types of imaging procedures. The time series of rates of periapical/bitewing radiographic exams revealed a trend of moderate increase and was the only area in which the impact of the financial implementation policy of the CEOs was observed, though not of the PMAQ-CEO. Extraoral imaging exams, such as panoramic radiography, facial CT/TMJ and TMJ MRI revealed a strong upward trend, despite the very low rates. The conclusion reached is that between 2000 and 2016, the policy of expansion of secondary care increased the use of periapical/bitewing imaging exams.
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Affiliation(s)
- Danielle Bianca de Lima Freire
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS Brasil.
| | - Roger Keller Celeste
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS Brasil.
| | - Nádia Assein Arús
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS Brasil.
| | - Mariana Boessio Vizzotto
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS Brasil.
| | - Heraldo Luis Dias da Silveira
- Programa de Pós-Graduação em Odontologia, Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul. R. Ramiro Barcelos 2492, Santa Cecília. 90035-004 Porto Alegre RS Brasil.
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The Significance of Posterior Occlusal Support of Teeth and Removable Prostheses in Oral Functions and Standing Motion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136776. [PMID: 34202488 PMCID: PMC8297000 DOI: 10.3390/ijerph18136776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/16/2021] [Accepted: 06/21/2021] [Indexed: 01/19/2023]
Abstract
The purpose of this study was to evaluate the effect of posterior occlusal support of natural teeth and artificial teeth on oral functions and standing motion. Patients who had been treated with removable prostheses were enrolled as the subjects. Their systemic conditions (body mass index (BMI) and skeletal muscle mass index (SMI)) were recorded. The subjects were classified into two groups according to a modified Eichner index: B1-3 (with posterior occlusal support) and B4C (without posterior occlusal support). Maximum occlusal force (MOF), masticatory performance (MP), and standing motion (sway and strength) were evaluated for cases with and without removable prostheses. There were no significant differences in BMI and SMI between the B1-3 group and the B4C group. The subjects with removable prostheses demonstrated significantly higher values in MOF, MP, and sway and strength than the subjects without removable prostheses. The comparison of oral functions between the B1-3 group and the B4C group revealed that the positive effect of posterior occlusal support of natural teeth and removable prostheses and the significant positive effects of posterior occlusal support on standing motion were partly observed in these comparisons. Posterior occlusal support of natural teeth and even of removable prostheses may contribute to the enhancement of oral functions and standing motion.
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Shi M, Liu X, Zhang C, Zhang H, Liu Q, Wang D, Liu X, Li J, Wang M. Effect of dental malocclusion on cerebellar neuron activation via the dorsomedial part of the principal sensory trigeminal nucleus. Eur J Oral Sci 2021; 129:e12788. [PMID: 33945647 PMCID: PMC8453929 DOI: 10.1111/eos.12788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Occlusion has been proposed to play a role for body posture and balance, both of which are mediated mainly by the cerebellum. The dorsomedial part of the principal sensory trigeminal nucleus (Vpdm) has direct projection to the cerebellum. The experimental unilateral anterior crossbite (UAC) has an impact on the motor nuclei in the brain stem via trigeminal mesencephalic nucleus (Vme). The current aim was to explore whether UAC has an impact on Vpdm‐cerebellum circuit. The inferior alveolar nerve was injected into cholera toxin B subunit (CTb), the cerebellum was injected into fluoro‐gold (FG), and the Vpdm was injected into biotinylated dextran amine (BDA) to identify the activation of Vpdm‐cerebellum circuit by UAC. Data indicated that there were more neuronal nuclei (NeuN)/CTb/FG triple‐labelled neurons and NeuN/CTb/vesicular glutamate transporter 1(VGLUT1) triple‐labelled neurons in the Vpdm, and more NeuN/BDA/ VGLUT1 triple‐labelled neurons in the cerebellum of rats with UAC than in control rats. The VGLUT1 expression in the Vpdm and cerebellum in the UAC group was higher than that in control rats. These findings indicate an excitatory impact of UAC on the Vpdm‐cerebellum pathway and support the role of occlusion for body posture and balance.
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Affiliation(s)
- Minghong Shi
- School of Stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Department of Oral Anatomy and Physiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Xin Liu
- Department of Oral Anatomy and Physiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China.,Department of Stomatology, The 960th Hospital of People's Liberation Army, Jinan, China
| | - Chunkui Zhang
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, The Fourth Military Medical University, Xi'an, China
| | - Hongyun Zhang
- Department of Oral Anatomy and Physiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Qian Liu
- Department of Oral Anatomy and Physiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Dongmei Wang
- School of Stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Xiaodong Liu
- Department of Oral Anatomy and Physiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
| | - Jinlian Li
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, The Fourth Military Medical University, Xi'an, China
| | - Meiqing Wang
- School of Stomatology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Department of Oral Anatomy and Physiology, School of Stomatology, The Fourth Military Medical University, Xi'an, China
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Maurer-Grubinger C, Adjami F, Avaniadi I, Christian W, Doerry C, Fay V, Fisch V, Gerez A, Goecke J, Kaya U, Keller J, Krüger D, Pflaum J, Porsch L, Wischnewski C, Scharnweber B, Sosnov P, Oremek G, Groneberg DA, Ohlendorf D. Symmetrical dental occlusion blocking - changes of body sway and weight distribution in healthy subjects across 4 age decades. J Occup Med Toxicol 2021; 16:7. [PMID: 33639978 PMCID: PMC7912460 DOI: 10.1186/s12995-021-00296-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/16/2021] [Indexed: 12/19/2022] Open
Abstract
Objectives Symmetrical dental occlusion blocking is used in dentistry as a quick diagnostic tool to test for potential influences of the craniomandibular system on body sway and weight distribution. This study presents the changes of body sway and pressure distribution in healthy subjects, free of a temporomandibular dysfunction (TMD). Immediate effects between occlusal blocking and rest position on body sway and body weight distribution in general, as well as for both genders and for four age decades will be evaluated. Materials and methods 725 (396f/329 m) subjects (neither subjective signs of TMD nor acute/chronic complaints in the musculoskeletal system) volunteered (21 to 60 years) while both genders were divided into four age groups according to decades. A pressure measuring platform was used. Body sway and weight distribution were recorded in two dental occlusion conditions (a) in rest position and (b) symmetrical blocking (bicuspid region) by cotton rolls. Results Both, the frontal sway and the sagittal sway reduced by 0.67 mm (t(724) = − 3.9 (p < 0.001)) and by 0.33 mm (t(724) = − 3.4 (p < 0.001)). The relative pressure under the left forefoot increased by 0.33% (t(724) = 2.88 (p < 0.001)) and the relative pressure overall under the forefoot increased by 0.67% (t(724) = − 3.4 (p < 0.001)). Gender-specific, age-specific and BMI-specific reactions could not be identified. Conclusions Subjects, free of any TMD and with no complaints of the musculoskeletal system, show small changes of the body sway and weight distribution when biting symmetrically on a cotton roll. These changes are independent of age, gender or body mass index (BMI). Due to the relative large sample size, the presented results can also be seen as norm values when body sway is used as an additional assessment of a TMD.
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Affiliation(s)
- C Maurer-Grubinger
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - F Adjami
- Department of Orthodontics, School of Dentistry "Carolinum", Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 29, 60590, Frankfurt/Main, Germany
| | - I Avaniadi
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - W Christian
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - C Doerry
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - V Fay
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - V Fisch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - A Gerez
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - J Goecke
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - U Kaya
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - J Keller
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - D Krüger
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany.,Department of Orthodontics, School of Dentistry "Carolinum", Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 29, 60590, Frankfurt/Main, Germany
| | - J Pflaum
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - L Porsch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - C Wischnewski
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - B Scharnweber
- Department of Orthodontics, School of Dentistry "Carolinum", Goethe-University Frankfurt am Main, Theodor-Stern-Kai 7, Building 29, 60590, Frankfurt/Main, Germany
| | - P Sosnov
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - G Oremek
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - D A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany
| | - D Ohlendorf
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main, Theodor-Stern-Kai 7, Building 9A, 60590, Frankfurt/Main, Germany.
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Development of a Wearable Mouth Guard Device for Monitoring Teeth Clenching during Exercise. SENSORS 2021; 21:s21041503. [PMID: 33671506 PMCID: PMC7926888 DOI: 10.3390/s21041503] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
Teeth clenching during exercise is important for sports performance and health. Recently, several mouth guard (MG)-type wearable devices for exercise were studied because they do not disrupt the exercise. In this study, we developed a wearable MG device with force sensors on both sides of the maxillary first molars to monitor teeth clenching. The force sensor output increased linearly up to 70 N. In four simple occlusion tests, the trends exhibited by the outputs of the MG sensor were consistent with those of an electromyogram (EMG), and the MG device featured sufficient temporal resolution to measure the timing of teeth clenching. When the jaw moved, the MG sensor outputs depended on the sensor position. The MG sensor output from the teeth-grinding test agreed with the video-motion analysis results. It was comparatively difficult to use the EMG because it contained a significant noise level. Finally, the usefulness of the MG sensor was confirmed through an exercise tolerance test. This study indicated that the developed wearable MG device is useful for monitoring clenching timing and duration, and the degree of clenching during exercise, which can contribute to explaining the relationship between teeth clenching and sports performance.
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Klostermann I, Kirschneck C, Lippold C, Chhatwani S. Relationship between back posture and early orthodontic treatment in children. Head Face Med 2021; 17:4. [PMID: 33546715 PMCID: PMC7863507 DOI: 10.1186/s13005-021-00255-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background The purpose of this study was to analyze the relationship between body posture and sagittal dental overjet in children before and after early orthodontic treatment with removable functional orthodontic appliances. Methods Angle Class II patients (mean age 8.2 ± 1.2 years; 29 males and 25 females) with a distinctly enlarged overjet (> 9 mm) were retrospectively examined regarding body posture parameters before and after early orthodontic treatment. In addition, changes in overjet were investigated with the aid of plaster models. Forms of transverse dysgnathism (crossbite, lateral malocclusions) and open bite cases were excluded. Body posture parameters kyphosis, lordosis, surface rotation, pelvic tilt, pelvic torsion and trunk imbalance were analyzed by means of rasterstereographical photogrammetry to determine, if the orthodontic overjet correction is associated with specific changes in posture patterns. Results In nearly all patients an overjet correction and an improvement regarding all body posture and back parameters could be noted after early orthodontic treatment. Overjet reduction (− 3.9 mm ± 2.1 mm) and pelvic torsion (− 1.28° ± 0,44°) were significantly (p < 0.05) and moderately correlated (R = 0.338) with no significant associations found for the other posture and back parameters (p > 0.05). Conclusion Overjet reduction during early orthodontic treatment may be associated with a detectable effect on pelvic torsion.
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Affiliation(s)
- Isa Klostermann
- Department of Orthodontics, University of Muenster, Waldeyerstraße 30, 48149, Muenster, Germany
| | - Christian Kirschneck
- Department of Orthodontics, University Medical Centre of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Carsten Lippold
- Department of Orthodontics, University of Muenster, Waldeyerstraße 30, 48149, Muenster, Germany.
| | - Sachin Chhatwani
- Department of Orthodontics, School of Dentistry, Faculty of Health, Witten/Herdecke University, Alfred-Herrhausen Str. 45, 58455, Witten, Germany
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Relationship between Unilateral Posterior Crossbite and Human Static Body Posture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155303. [PMID: 32717988 PMCID: PMC7432746 DOI: 10.3390/ijerph17155303] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
Background: We compared photogrammetry-assessed body posture between young adults with and without unilateral posterior crossbite (UPCB). Assessments were controlled by vision, mandibular position and sitting/standing position. In addition, we aimed to determine the relationship between UPCB laterality and the direction of body posture using photogrammetry and a static postural platform. Methods: Adults with natural dentition, with and without UPCB, were enrolled. Static body posture was assessed by photogrammetry based on horizontal acromial alignment and horizontal anterior-superior iliac spine (ASIS) alignment. Frontal photographs were taken with participants asked to open or close their eyes and hold their jaws at rest, at an intercuspal position, and at left or right lateral positions. Distribution of foot pressure was recorded using a static postural platform at different visual input and mandibular positions. General linear models with repeated measures were used to assess the effect of the various within- and between-subject factors. Results: In total, 36 adults (left UPCB = 12; Right UPCB = 6; controls = 18) participated. There were significant differences between the control and UPCB groups in horizontal alignment at the acromion (p = 0.035) and ASIS (p = 0.026) levels when controlled by visual input and mandibular position. No significant differences in horizontal alignment or foot pressure distribution were observed by laterality in the UPCB group. Conclusion: The presence of UPCB affects static body posture, but the side of crossbite is not related to the direction of effect on static body posture.
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Militi A, Cicciù M, Sambataro S, Bocchieri S, Cervino G, De Stefano R, Fiorillo L. Dental occlusion and sport performance. ACTA ACUST UNITED AC 2020; 69:112-118. [PMID: 32181617 DOI: 10.23736/s0026-4970.20.04350-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION In recent years, interest has been given to the relationship between dental occlusion and athletes' performance. A correct occlusion allows for a correct position of the mandible in space and could be reached by wearing a splint made by a dentist. Achieving this condition appears to be an advantage for all athletes, and especially for those who have TMJ dysfunction. The purpose of the study was to investigate the hypothesis and common belief that correcting the occlusion or the use of a splint could improve an athlete's performance. EVIDENCE ACQUISITION A search on electronic database has been performed and obtained 141 results; then, following the application of the inclusion criteria, only 11 articles were selected. EVIDENCE SYNTHESIS A good occlusion seems to be an advantage for the athletes. CONCLUSIONS The use of an occlusal splint should be evaluated in different sports, because the occlusion and TMJ conditions of the athletes are different and the efforts in which they are subjected could not be generalized because the sports have various rules and characteristics that involves the stomatognathic system differently.
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Affiliation(s)
- Angela Militi
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Marco Cicciù
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Sergio Sambataro
- Section of Orthodontics, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Salvatore Bocchieri
- Section of Orthodontics, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Rosa De Stefano
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy -
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17
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Amaricai E, Onofrei RR, Suciu O, Marcauteanu C, Stoica ET, Negruțiu ML, David VL, Sinescu C. Do different dental conditions influence the static plantar pressure and stabilometry in young adults? PLoS One 2020; 15:e0228816. [PMID: 32045439 PMCID: PMC7012393 DOI: 10.1371/journal.pone.0228816] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/23/2020] [Indexed: 11/18/2022] Open
Abstract
Background Posture is influenced by many factors and dental occlusion seems to have its role on postural stabilization. Our rationale to perform the study was to find out if there are differences of static plantar pressure and stabilometric parameters depending on different dental conditions. Methods The observational study consisted in plantar pressure assessment and stabilometric analysis of 95 right-handed healthy volunteer subjects (mean age 22.94 ± 2.52 years) by using the PoData system. Each subject followed four measurements with open eyes: mandibular postural position, maximum intercuspation, biting on cotton rolls and maximum mouth opening. Plantar pressure was recorded on 1st and 5th metatarsal heads and heel, and was expressed as percentage of weight distribution on each foot. The recorded centre of pressure (CoP) parameters were: CoP path length, 90%confidence ellipse area and maximum CoP speed. Statistical analysis used repeated-measures ANOVA with Bonferroni posthoc analysis and Friedman test. Results Loading on the left 5th metatarsal head was significantly higher in maximum mouth opening condition when compared to maximum intercuspation and to biting on cotton rolls. The left heel loading was significantly lower in the maximum mouth opening in comparison to maximum intercuspation. The CoP path length and maximum CoP speed were significantly higher in maximum mouth opening compared to the other three conditions. Confidence ellipse area had significantly lower values in maximum intercuspation and in the biting on cotton rolls conditions compared to the mandibular postural position, and in maximum intercuspation compared to maximum mouth opening. Conclusion In young adults with an optimum functional occlusion the static plantar pressure is influenced by the maximum mouth opening. An improved postural stability was recorded in maximum intercuspation (a condition used during swallowing) in comparison to mandibular postural position (a condition that allows relaxation of the masticatory muscles after functional moments).
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Affiliation(s)
- Elena Amaricai
- Department of Rehabilitation, Physical Medicine and Rheumatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Ramona Onofrei
- Department of Rehabilitation, Physical Medicine and Rheumatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- * E-mail:
| | - Oana Suciu
- Department of Rehabilitation, Physical Medicine and Rheumatology, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Corina Marcauteanu
- Department of Occlusiology, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Eniko Tunde Stoica
- Department of Occlusiology, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Meda Lavinia Negruțiu
- Dental Materials and Dental Prosthesis Department, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Laurentiu David
- Department of Pediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Cosmin Sinescu
- Dental Materials and Dental Prosthesis Department, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Julià-Sánchez S, Álvarez-Herms J, Cirer-Sastre R, Corbi F, Burtscher M. The Influence of Dental Occlusion on Dynamic Balance and Muscular Tone. Front Physiol 2020; 10:1626. [PMID: 32082183 PMCID: PMC7005008 DOI: 10.3389/fphys.2019.01626] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/24/2019] [Indexed: 12/18/2022] Open
Abstract
Excellent postural control is essential to improve the physical performance of athletes. Stability of the body during motor tasks depends on different physiological systems. The influence of dental occlusion on body balance has been widely investigated in the past few years. It has been suggested that this relationship is strengthened by disturbing environments for balance control (i.e., unstable platform, fatigue, development tasks.). Moreover, dental occlusion may influence the muscle tone of both masticatory and postural muscles, which are involved in the preservation of balance. Therefore, we attempted to determine whether (i) there are differences in dynamic balance assessed by the modified star excursion balance test between opposed dental occlusion conditions (dental contact: intercuspal position/no dental contact: cotton rolls mandibular position) and (ii) dental occlusion influences the biomechanical and viscoelastic properties of the masticatory and postural muscles assessed with MyotonPRO®. Thirty physically active subjects were recruited for the study. The main findings were the following: (i) the Star Excursion Balance Test composite score was significantly higher for measurements made in cotton rolls mandibular position (p < 0.001) and also in subjects showing a correct occlusion (p = 0.04), and (ii) the biomechanic and viscolelastic properties of selected muscles showed different trend according to the presence of malocclusal traits. It is concluded that dental occlusion conditioned both dynamic stability and the biomechanic and viscoelastic properties of the analyzed muscles.
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Affiliation(s)
- Sonia Julià-Sánchez
- Faculty of Physical Activity and Sport Sciences, European University, Madrid, Spain
| | - Jesús Álvarez-Herms
- Faculty of Physical Activity and Sport Sciences, European University, Madrid, Spain
| | - Rafel Cirer-Sastre
- Institut Nacional d'Educació Física de Catalunya, Universitat de Lleida, Lleida, Spain
| | - Francisco Corbi
- Institut Nacional d'Educació Física de Catalunya, Universitat de Lleida, Lleida, Spain
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
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Tripodi D, Fulco D, Beraldi A, Ripari P, Izzi G, D’Ercole S. Custom-Made Mouthguards: Electromyographic Analysis of Masticatory Muscles and Cardiopulmonary Tests in Athletes of Different Sports. Health (London) 2019. [DOI: 10.4236/health.2019.114038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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