The "Interdisciplinary Orofacial Examination Protocol for Children and Adolescents": a resource for the interdisciplinary assessment of the stomatognatic system

The Interdisciplinary Orofacial Examination Protocol for Children and Adolescents (Protocolo de exploración interdisciplinaria orofacial para niños y adolescents, Barcelona, 2008) is very useful in providing a fast, initial, expedient detection of possible morphological and functional disorders, and to guide the patient toward the appropriate professionals. With this tool it is possible to detect the risk factors which can negatively affect morphological and functional harmony and guide patients toward the necessary treatment as early as possible. This Protocol, developed by 4 orthodontists, 1 ENT and 3 speech language therapists, also contributes to the unification of concepts and nomenclature used by distinct specialists, thus making professional understanding easier and more dynamic.

A one-page orofacial myofunctional assessment form: a proposal

The author presents her own proposal of a one-page orofacial myofunctional assessment and for each item on the list a brief rationale is provided. The protocol is an easy but comprehensive form that can be faxed or emailed to referral sources as needed. As science provides more objective assessment and evaluation tools, this one-page form can be easily modified.

The reliability of the Neonatal Oral-Motor Assessment Scale

OBJECTIVES

Sucking problems in preterm infants can be specified by means of visual observation. The Neonatal Oral-Motor Assessment Scale (NOMAS) is the visual observation method most commonly used to assess the non-nutritive sucking (NNS) and nutritive sucking (NS) skills of infants up to approximately 8 weeks postterm. During the first 2 min of a regular feeding the infant's sucking skill is assessed, either immediately or on video. Although NOMAS has been used since 1993, little is known about the method's reliability. The aim of our study was to determine the test-retest and inter-rater reliability of NOMAS.

METHODS

The 75 infants included in this study were born at 26-36 weeks postmenstrual age (PMA). Four observers participated in the study. They were trained and certified to administer NOMAS in the Netherlands by M.M. Palmer between 2000 and 2002.

RESULTS

We found the test-retest agreement of NOMAS to be 'fair' to 'almost perfect' (Cohen's kappa [kappa] between 0.33 and 0.94), whereas the inter-rater agreement with respect to the diagnosis was 'moderate' to 'substantial' (Cohen's kappa, between 0.40 and 0.65). As a diagnostic tool, however, the current version of NOMAS cannot be used for both full-term and preterm infants. For a measuring instrument such as NOMAS, one should aim at reliability coefficients for inter-rater and test-retest agreement of at least 0.8. A Cohen's kappa of 0.6 or less we find unacceptable. Nonetheless, by observing sucking and swallowing according to a protocol much useful information can be gathered about the development of an infant's sucking skills. For instance, whether the infant is able to co-ordinate sucking and swallowing, whether the infant can maintain sucking, swallowing and breathing during the continuous phase and whether the infant is able to suck rhythmically with equally long bursts. In addition, NOMAS offers useful aids for intervention.

CONCLUSIONS

NOMAS should be re-adjusted in order to improve inter-rater agreement, and at the same time current insights into the development of sucking and swallowing should be incorporated in the method.

Newborn rats' first suckling experience: taste differentiation and suckling plasticity

The present study examined responsiveness of newborn rats to a surrogate nipple providing fluids with basic tastes (sweet, sour, bitter and salty) and assessed the effects of this first gustatory experience on subsequent responding to the nipple itself (empty nipple) or the nipple providing water. Responsiveness (attachment to and ingestion from a surrogate nipple providing saccharin, saline, quinine or ammonium chloride) was compared with that toward a nipple providing water. Compared to water, saline and quinine significantly reduced attachment to and ingestion from the nipple, while saccharin and milk significantly increased attachment behavior. Ammonium chloride increased attachment but not ingestive behavior. Suckling experience with saline, quinine and ammonium chloride attenuated both attachment and ingestive behaviors when subjects were tested 1 h later with an empty surrogate nipple or a nipple providing water. Experience with saccharin and milk (but not water) increased both measures. The data suggest that in newborn rats, as early as a few hours after birth, mechanisms of gustatory detection have control over suckling behavior. Initial experience with the tastants available from the nipple in the first suckling episode may alter further responsiveness to the nipple itself, mediated perhaps by mechanisms of appetitive and aversive conditioning.

Relation of oral yeast infection in Brazilian infants and use of a pacifier

The frequency of oral yeast ingestion and its relationship with sucking and feeding habits was described in children from one to 18 months of age. Yeasts were detected in 58.3 percent of children and the most prevalent species were Candida parapsilosis and Candida albicans. The use of a pacifier was positively associated with the frequency of yeast infection and with the levels of these microorganisms in the mouth. No relationship was detected between the prevalence of yeast and breast-feeding or bottle-feeding habits. The results suggest that use of a pacifier is an important local factor in the colonization and proliferation of yeast in the oral cavity.