Assessment Tools for Masticatory Function in Periodontitis Patients: A Scoping Review

AIMS

The aim of this scoping review was to map the available evidence on assessment tools for masticatory function for periodontitis patients. It also aimed to examine the methodology of masticatory function assessment and to identify the elements of subjective masticatory function evaluation for periodontitis patients reported in the literature.

METHODS

A scoping review was conducted following the methodological guidance for the conduct of scoping reviews. Embase, MEDLINE, Web of Science, and Scopus were systematically searched for published studies in English reporting objective or subjective masticatory function assessment in periodontitis patients.

RESULTS

Forty-five studies were included in the analysis. The identified assessment tools for masticatory function were summarized using the terminology described by the recent consensus. Heterogeneity was observed in the approach of assessment, the type(s) and design of assessment tools, and the methods of measurement employed. Most studies utilized only one assessment tool. Seven studies reported composite objective assessment and five studies utilized assessment tools for both objective and subjective masticatory function. Items from the included instruments for subjective masticatory function were analyzed and categorized into seven potentially clinically relevant elements of subjective masticatory function evaluation. Unclear reporting on validation status was found in all included instruments for subjective masticatory function.

CONCLUSION

Variable methodologies have been reported to assess masticatory function in periodontitis patients. Future research is needed to discern the clinical utility of these assessment tools for masticatory function in periodontitis patients.

Evaluation of the thickness of masticatory muscles in patients with chronic periodontitis by ultrasonography

OBJECTIVES

Periodontitis is one of the most common chronic inflammatory diseases. It causes changes in the biting abilities of individuals. However, periodontal treatment has positive effects on masticatory function. The aim of this study is to determine the effect of periodontitis and periodontal treatment on masticatory abilities by measuring masseter and temporal muscle thicknesses with ultrasonography before and after periodontal treatment in chronic periodontitis patients.

METHODS

The patients included in the study were determined by clinical and radiological examination. The thickness of the masseter and temporal muscles of the patients were measured by ultrasonography. Periodontal measurements and treatments of the patients were completed by a single physician. IBM SPSS 20.0 (IBM Corp., Armonk, NY) statistical program was used for statistical analysis.

RESULTS

A statistically significant difference was found between the values of periodontal measurements before and after treatment (p<0.05). In the ultrasonography measurements of the thickness of masseter and anterior temporal muscles, a statistically significant increase was observed in both rest and contraction values at all time intervals (p<0.05). Muscle thicknesses of male patients were higher than female patients.

CONCLUSIONS

Periodontitis negatively affects the masticatory performance of individuals. Chronic periodontitis patients should be referred for periodontal treatment without wasting time.

Periodontal status is associated with oral function in community-dwelling older adults, independent of dentition status

OBJECTIVE

To determine whether periodontal status is associated with oral function, including masticatory performance and occlusal force, among community-dwelling older adults.

BACKGROUND

Although a potential association between periodontal status and oral function has been reported, variations in the root surface area (RSA) of each tooth have not been considered.

METHODS

We used data from a population-based study involving community-dwelling older adults. The RSA with periodontal ligament (RSA-PL), which quantifies the RSA attached to the periodontal ligament and alveolar bone, was calculated based on full-mouth periodontal examination. Masticatory performance was assessed using spectrophotometric measurement of the color (a* value) of color-changing chewing gum. The bilateral maximal occlusal force (MOF) was measured using a pressure-sensitive sheet and dedicated software. The associations of the RSA-PL, a quantitative marker of periodontal tissue support, with the a* value and MOF were assessed using linear regression models.

RESULTS

The analyses included data from 250 adults [60.8% women; age, mean (standard deviation) 82.5 (5.0) years]. On average, the study participants had an RSA-PL of 26.3 cm² , a* value of 25.0, and an MOF value of 555.1 N. After adjustments for potential confounders, including dentition status, age, sex, dental visit regularity, smoking status, physical activity level, depressive symptoms, a history of stroke or diabetes mellitus, and body mass index, the RSA-PL was found to be associated with the a* value [coefficient (per 1 cm² increase): 0.16, 95% confidence interval (CI) 0.10-0.22)] and MOF (coefficient: 9.2, 95% CI 5.3-13.1).

CONCLUSION

This study demonstrated that greater amounts of remaining tooth-supporting structures, indicated by higher RSA-PL values, were associated with better masticatory performance and a higher occlusal force among community-dwelling older adults.

Deterioration of periodontal status affects declines in masticatory performance: The Suita study

AIM

We aimed to clarify the association between deterioration of periodontal status and masticatory performance in a longitudinal follow-up study of a general urban population.

MATERIALS AND METHODS

This study investigated 663 participants in the Suita study with no changes in the number of functional teeth or occlusal support areas during a 5-year follow-up period. Participants were classified into three groups according to changes in periodontal status during the survey period: a recovered group; a stable group; and a deteriorated group. Rate of masticatory performance change was calculated by subtracting the value at baseline from the value at follow-up and dividing the resulting value by the baseline value.

RESULTS

Median rates of masticatory performance change were -11.7% in the recovered group, -19.2% in the stable group, and -30.8% in the deteriorated group, and these values were significantly different (p < .001). Multiple regression analysis revealed periodontal status group (recovered group: reference; stable group: p = .029; deteriorated group: p = .006) as an independent variable was significantly associated with the rate of masticatory performance change.

CONCLUSION

The present results suggest that deterioration of periodontal status increases the risk of age-related declines in masticatory performance.

Influence of Micronutrient Intake, Sociodemographic, and Behavioral Factors on Periodontal Status of Adults Assisted by a Public Health Care System in Brazil: A Cross-Sectional Multivariate Analysis

The lack of access to a balanced diet, rich in vitamins and minerals, can predispose people to inflammatory diseases such as obesity, diabetes mellitus, and periodontitis. We aimed to evaluate the relationship between micronutrient intake, sociodemographic behavioral characteristics, and periodontal health in adults assisted by a public health care system. Participants (n = 450) answered a food frequency questionnaire and were submitted to anthropometric and oral clinical examinations. Principal component analysis was used to summarize the number of components emerging from 17-micronutrient intake. Subsequently, cluster analysis was employed. The prevalence of at least one periodontal pocket ≥ 4 mm was 67.4%. Three clusters were identified according to periodontal status. Cluster 1 "poor periodontal status" was characterized by older individuals (n = 202; 85% females) with poor periodontal status, lower education level, mainly smokers with non-transmissible chronic diseases (NTCD), with lower energy, omega-3, fiber, Zn, K, Cu, and vitamin C intake. Cluster 3 "healthy periodontal status" included younger individuals (n = 54) with the healthiest periodontal status, a higher education level, without NTCD, and with higher energy, omega-3, fiber, Zn, calcium, retinol, and riboflavin intake. Cluster 2 was labeled as "intermediate periodontal status". Micronutrient ingestion was associated with periodontal status and may be considered in health promotion actions for low-income populations.

The effects of perioperative oral management on perioperative serum albumin levels in patients treated surgically under general anesthesia: A multicenter retrospective analysis in Japan

The purpose of the present study was to investigate the efficacy of perioperative oral managements (POMs) on perioperative nutritional conditions in patients undergoing surgery with general anesthesia. Medical records were retrospectively reviewed and the effects of POMs were investigated based on a large number of cases using a multicenter analysis. The profile of serum albumin levels was assessed and compared between patients with and without POMs using the multivariate analysis. Seventeen Eleven thousand and one hundred sixty patients (4,873 males and 6,287 females) were reviewed. Of these, 2710 patients (24.3%) had undergone POMs. The results of a multivariate analysis revealed the significant positive effect of POMs on perioperative serum albumin level (change between at admission and discharge, (Estimate: 0.022, standard error: 0.012, P < .0001). Patient gender, age, surgical site, performance status, the American Society of Anesthesiologists (ASA) physical status classification, operation time, amount of blood loss, and serum albumin level at admission were also significant predictors. Adjusted multivariate analysis of the effects of POMs on perioperative change of serum albumin level in all subjects reveled the significance of POMs intervention (estimate: 0.022, standard error: 0.012, P < .0001). These results suggest that POMs exerts significant positive effects on perioperative serum albumin levels in patients underwent surgery under general anesthesia.

Application of masticatory control in dental treatment for elderly individuals

Taiwan transitioned to an aged society in 2018. Appropriate dental treatment is important for elderly individuals. Previously, reconstruction of the dentition was thought to help regain chewing function. However, concerns of the elderly population, such as decline in learning ability and saliva secretion, complicate dental reconstruction. Overlooking the special needs of elderly individuals may lead to impaired chewing function, resulting in nutritional imbalances and increased burden on the digestive tract, causing more health disorders. For the elderly population, treatment must be aimed at restoring as much chewing function as possible with minimal changes. Additionally, regular oral hygiene care, proper design of fixed partial dentures, and implant placement greatly reduce the difficulty in adapting to a new prosthesis. These measures allow us to provide better quality of life for elderly individuals.

Masticatory satisfaction, ability, and performance in partially dentate patients after periodontal therapy

Abstract Introduction Understanding the effects of periodontal therapy is essential in performance and satisfaction of partially dentate patients. Objective To assess the effect of subgingival periodontal treatment in performance and masticatory satisfaction and ability as reported by partially dentate patients with untreated chronic periodontitis. Materials and method Patients were given nonsurgical periodontal treatment and masticatory satisfaction, ability, and performance were evaluated before and after treatment. Performance was assessed based on sieving chewed standardized chewable material, while satisfaction and ability were analyzed using a questionnaire based on OHIP-EDENT. Result Mean numbers of functional tooth units were 10.36 ± 1.43 anterior and 6.73 ± 0.79 posterior teeth. Masticatory performance did not vary significantly (p = 0.075), and mean particle sizes before and after treatment were 4.23 ± 1.84 mm and 3.90 ± 0.75 mm, respectively. Overall satisfaction and ability scores after treatment were higher (p > 0.05) compared with scores prior to the periodontal intervention. Conclusion Periodontal treatment improves masticatory satisfaction and ability with no effect on performance.

Which variables should be controlled when measuring the granulometry of a chewed bolus? A systematic review

The distribution of food particles in a chewed bolus characterizes the food destruction after food oral processing (FOP). Previous reviews report that it could be affected by a lot of parameters as the number of chewing strokes, the dental status, but the conditions for producing reproducible data allowing inter-studies comparison have not been clearly described yet. This systematic review aims to identify the variables that can affect bolus granulometry determination, and to calculate their relative weights in the median particle size (D₅₀ ) variations. The systematic review focuses on granulometry expressed as D50 of the most used foods (peanuts, carrots, and almonds) and materials (Optosil and Optocal). Based on 58 studies, 5 variables among 60 being extracted could explain the D₅₀ variations. Conceptual differences between the conditions for FOP should be considered. After Chewing-test, the bolus is collected after a predefined number of strokes and its granulometry characterizes the effects of the dental and muscular apparatus on food destruction, while after Mastication-test the bolus is collected at the swallowing threshold, and its granulometry reflects the outcome of the abilities of the subject to adapt his/her mastication behavior to food texture. Experimental conditions related either to physical sieving or image analysis used to analyze the collected boluses impact the D₅₀ values. Finally, when type of test, sieving conditions, type of food or material, number of chewing strokes, and the oral status of the subjects are controlled, mean D₅₀ values are reproducible and could be used for inter-studies comparisons. PRACTICAL APPLICATIONS: This review provides tables that could be useful to control mean D₅₀ variations in further research.

Determining chewing efficiency using a solid test food and considering all phases of mastication

OBJECTIVES

Following chewing a solid food, the median particle size, X₅₀, is determined after N chewing cycles, by curve-fitting of the particle size distribution. Reduction of X₅₀ with N is traditionally followed from N ≥ 15-20 cycles when using the artificial test food Optosil^®, because of initially unreliable values of X₅₀. The aims of the study were (i) to enable testing at small N-values by using initial particles of appropriate size, shape and amount, and (ii) to compare measures of chewing ability, i.e. chewing efficiency (N needed to halve the initial particle size, N(1/2-Xo)) and chewing performance (X₅₀ at a particular N-value, X_50,N).

DESIGN

8 subjects with a natural dentition chewed 4 types of samples of Optosil particles: (1) 8 cubes of 8 mm, border size relative to bin size (traditional test), (2) 9 half-cubes of 9.6 mm, mid-size; similar sample volume, (3) 4 half-cubes of 9.6 mm, and 2 half-cubes of 9.6 mm; reduced particle number and sample volume. All samples were tested with 4 N-values. Curve-fitting with a 2nd order polynomial function yielded log(X₅₀)-log(N) relationships, after which N(1/2-Xo) and X_50,N were obtained.

CONCLUSIONS

Reliable X₅₀-values are obtained for all N-values when using half-cubes with a mid-size relative to bin sizes. By using 2 or 4 half-cubes, determination of N(1/2-Xo) or X_50,N needs less chewing cycles than traditionally. Chewing efficiency is preferable over chewing performance because of a comparison of inter-subject chewing ability at the same stage of food comminution and constant intra-subject and inter-subject ratios between and within samples respectively.

Lack of agreement between objective and subjective measures in the evaluation of masticatory function: A preliminary study

The evaluation of mastication is important to understand the masticatory behavior and diagnose feeding difficulties. The objective of this preliminary study was to verify if there is agreement between objective and subjective validated methods of chewing evaluation in a convenience sample which consisted of 32 adolescents (mean 15.5years), complete permanent dentition and free of tooth decay. The Quality of Masticatory Function Questionnaire with the Food-Mastication, Habits, Meat, Fruit and Vegetables domains was used in the subjective evaluation. The objective aspects consisted of maximum bite force (BF) and masticatory performance (MP) by mastication of cubes of test-material and sieving to determine the median particle size (X₅₀) and distribution in the sieves ("b"), and by the colorimetric method using colorchangeable chewing gum. Data were submitted to exploratory analysis, normality test and correlation tests (Pearson/Spearman). The correlation between BF and X₅₀ (r=-0.43; p=0.02) and between BF and MP chewing gum (r=0.53; p=0.002) was significant with large effect size. The MP evaluated by chewing gum correlated with X₅₀ (r=-0.34; p=0.055), but not with "b" (r=-0.06; p=0.73), while "b" correlated only with X₅₀ (r=0.52, p=0.002). No significant correlation was observed between the objective measures and the total score of the subjective evaluation; only a negative correlation was observed between "b" and Meat domain (r=-0.40; p=0.023). The objective methods showed moderate correlation with each other and no agreement between the objective and subjective methods was observed in this sample of healthy adolescents, emphasizing the importance of both aspects in the evaluation of masticatory function.

The effect of periodontal status and occlusal support on masticatory performance: the Suita study

AIM

In this study, we investigated the effect of differences in periodontal status in the masticatory performance of dentate subjects with the same occlusal supporting area.

MATERIALS AND METHODS

The subjects of the analysis were classified into those of Eichner A1-3 (n = 1094) and Eichner B1-4 (n = 529). Subjects' periodontal status was evaluated on the basis of the Community Periodontal Index (CPI). The number of functional teeth and occlusal support were investigated, the latter on the basis of the Eichner Index. Furthermore, masticatory performance was investigated by means of test gummy jelly. For each group, periodontal status was classified in two different ways, either with/without moderate periodontitis (CPI Code ≤2/≥3) or with/without severe periodontitis (CPI Code ≤3/4), and masticatory performance was compared between the various groups.

RESULTS

In subjects who were Eichner A1 and B3, masticatory performance was significantly lower in subjects with moderate periodontitis compared with those without, and in subjects with severe periodontitis compared with those without.

CONCLUSION

Periodontal disease affects masticatory performance not only if occlusion is established by natural dentition with no tooth loss but also if occlusal support has decreased.

Masticatory performance and taste perception in patients submitted to cancer treatment

The aim of this study was to analyse mastication and the sense of taste in 39 patients submitted to cancer treatment in different areas of the body and to compare these variables with those of 44 control individuals within the same age range. The following aspects were assessed: dental status (DMFT); stimulated and non-stimulated salivary flow; sense of taste (salty, sweet, bitter and sour); and masticatory performance (MP), through the calculation of X(50). Logistic regression models were established to test the association between the independent variables and cancer treatment. Cancer patients had lesser stimulated salivary flow, a smaller number of teeth and occlusal units, worse MP, higher salty, sweet and sour taste scores and a lower bitter taste score (P < 0·05). A significant positive correlation was found between MP and the DMFT index in both groups (P < 0·05), meaning that a lower DMFT index value denoted a smaller X(50) value (better masticatory performance). The logistic regression model revealed that patients who had undergone cancer treatment had a greater probability of exhibiting a smaller number of teeth, higher salty and smaller bitter taste scores (P < 0·05). It was concluded that patients who were submitted to cancer treatment presented oral physiology alterations when compared with control subjects at the same age range.