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Saliva is a non-invasive source of biomarkers useful in the study of different pathophysiological conditions. The qualitative and quantitative study of saliva, as well as the assessment of oral health, can be particularly useful for a better understanding of obesity due to its importance in the food oral perception and ingestion.To evaluate the effect of treatment of morbid obesity (dietary counselling versus gastroplasty) on salivary characteristics, oral sensory perception and dental health in a controlled study.Seventy-three adults (60 females; 19-59 years) with morbid obesity were divided in: Control group (CG; n = 34) followed-up during a 6-months dietary programme, and Gastroplasty group (GG; n = 39) evaluated immediately before, 3 and 6 months after gastroplasty. Dietary habits, Oral Health Impact Profile and xerostomia complaints were investigated by interview. The clinical examination included anthropometric and caries experience evaluation. Salivary flow rate, buffering capacity, total protein and alpha-amylase levels, and sensitivity for the four basic tastes were assessed. Two-way mixed model and sign test were applied.Physical and clinical aspects did not differ between groups in the beginning of the study, and GG showed a rapid weight loss after surgery (p .001). An improvement in most of the dietary aspects was observed, especially in the GG. A worsening in the dental health status was observed over time in both groups, with an increase in the number of filled and decayed teeth. CG showed a better oral health-related quality of life, while xerostomia complains increased in GG after gastroplasty. Salivary flow rate remained stable in both groups, but a decrease in buffering capacity, total protein and alpha-amylase activity was observed in GG after 6-months; taste sensitivity increased from baseline to 6-months in GG (p .05).After 6-months of follow-up, patients undergoing gastroplasty presented an improvement in dietary habits and taste sensitivity. However, changes in saliva composition and a worsening in dental health status and xerostomia complaints were also observed.

STUDY OBJECTIVES: The aim was to identify predictive factors for sleep bruxism (SB) severity among polysomnographic parameters, salivary cortisol levels, temporomandibular disorders, age, and sex. METHODS: Young adults (19–30 years) were screened for self-/roommate reports of teeth grinding/clenching during sleep associated with clinical signs of tooth wear. Individuals positive for both conditions were administered a polysomnographic exam to provide a definite diagnosis of SB (n = 28). Healthy participants without SB signs/symptoms were also included (n = 15). The Research Diagnostic Criteria for Temporomandibular Disorders was applied to determine functional, muscular, and articular domains of the Temporomandibular Index. Cortisol awakening levels were measured in saliva. Principal component analysis was used to extract the latent components emerging from polysomnographic results, and 2 regression models were adjusted to predict the number and duration of bruxism episodes. RESULTS: Principal component analysis resulted in 4 components—C1: %N1, total sleep time, sleep efficiency, arousals/microarousals; C2: %N2, %N3; C3: periodic limb movements and apneas; C4: %REM and REM latency. The number of SB episodes/h was predicted by increasing muscular scores and C2 (decrease in %N2 and increase in %N3) (adjusted R(2) = 45%; P =.001). The total time of SB episodes was predicted by decreased articular and increased functional scores, age, and female sex (adjusted R(2) = 36%; P = 0.010). Salivary cortisol levels were not associated with SB severity and did not differ between groups. CONCLUSIONS: The findings showed that SB severity was predicted by muscular and functional scores, female sex, and distinct polysomnographic patterns, contributing to the deeper knowledge of the underlying pathophysiology of SB severity; additionally, the findings can help to formulate health approaches that are specific to the patient and will better assist in treating this condition. CITATION: Rosar JV, Marquezin MCS, Pizzolato AS, et al. Identifying predictive factors for sleep bruxism severity using clinical and polysomnographic parameters: a principal component analysis. J Clin Sleep Med. 2021;17(5):949–956.

The relationship between oral health and nutritional aspects are complex, especially in individuals with chronic diseases and comorbidities, such as morbid obesity. Thus, the aim of the present study was to identify oral health and nutritional-related patterns in 113 individuals, aged 19–68 years (92 females), seeking treatment for morbid obesity. Sociodemographic variables and medical records were examined, in addition to the consumption of fruit, vegetables, candies, and processed foods. Measures of body mass index, neck, waist and hip, caries experience (DMFT index), Community Periodontal Index (CPI index), and salivary physicochemical aspects were gathered. Aspects of oral health-related quality of life and symptoms of dry mouth were evaluated by means of Oral Health Impact Profile (OHIP-14) and Xerostomia Inventory-XI questionnaires. K-means cluster analysis and, subsequently, comparisons between clusters (one-way ANOVA) were performed (α = 5%). Three clusters were generated: Cluster 1 (labeled “Young”; n = 77) was characterized by younger participants with higher BMI, who reported the use of distractors while eating, the smallest number of meals/day, and who consumed sweetened drinks and processed food the day before. Cluster 2 (labeled “Diabetic individuals”; n = 12) was characterized by older participants with the highest proportion of diabetic participants (100% were diabetic; 73% insulin users), lower BMI, higher DMFT index and OHIP-14 and xerostomia scores, and who reported having consumed fruit and vegetables the day before. Finally, Cluster 3 (labeled “Poor periodontal health”; n = 24) was characterized by participants with the worse periodontal condition (higher CPI), and lower salivary flow, pH, and buffer capacity. Cluster 1 and 2 were the groups that showed higher demand for nutritional and dietetic counseling, because of the poor eating behavior and higher serum glucose levels, respectively. On the other hand, Cluster 2 and 3 showed the higher demand for oral rehabilitation and dental treatment because of the loss of teeth and worse periodontal condition, respectively, besides the need for dietetic counseling. This sample of individuals with morbid obesity showed very unique oral-health and nutritional characteristics and special needs patterns that should be identified to adjust or change unhealthy habits, thus improving the assistance of this condition.

State of Sao Paulo Research Foundation (FAPESP, SP, Brazil) 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 15.5 years), 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 (X-50) 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 X-50 (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 X-50 (r = 0.34 p = 0.055), but not with "b" (r = -0.06 p = 0.73), while "b" correlated only with X-50 (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. Univ Campinas UNICAMP, Dept Pediat Dent, Campinas, SP, Brazil Univ Fed Sao Paulo UNIFESP, Dept Pharmaceut Sci, Sao Paulo, Brazil Fed Univ Lavras UFLA, Dept Hlth Sci, Lavras, Brazil Univ Fed Sao Paulo UNIFESP, Dept Speech Therapy, Sao Paulo, Brazil Univ Fed Sao Paulo UNIFESP, Dept Pharmaceut Sci, Sao Paulo, Brazil Univ Fed Sao Paulo UNIFESP, Dept Speech Therapy, Sao Paulo, Brazil FAPESP: 2014/24804-4 Web of Science

Objective: To better understand the relationship between malocclusion and masticatory and salivary functions in the primary dentition, the aim was to evaluate the differences in masticatory performance (MP), facial morphology (FM), maximal bite force (BF) and salivary parameters in 65 preschool children with normal occlusion (n = 22), functional posterior crossbite (n = 20) and anterior open bite (n = 23), and to explore the relationship between these variables. Material and Methods: MP, FM and BF were assessed by sieving method, anthropometry and gnatodynamometer, respectively. Stimulated (SS) and unstimulated (US) saliva flow and composition were measured by automated colorimetric technique. Data were analyzed using ANOVA/Kruskal-Wallis, t-test/Wilcoxon and Pearson/Spearman correlation test. The relationship between SS flow rate and the independent variables were assessed using multiple linear regression. Results: The lower face dimension was smaller in crossbite-group, and a decreased BF in the crossbite-side of the dental arch was observed. BF correlated positively with intergonial width in open bite group. In malocclusion groups, better MP correlated with byzigomatic and intergonial widths. US flow rate was lower in crossbite-group and total protein concentration differed between SS and US saliva only in the crossbite-group, being lower in US. Amylase activity was higher in SS than US in all groups. SS flow rate related positively with age and negatively with the presence of malocclusion. Conclusion: In young subjects, significant correlations were found between masticatory parameters and facial dimensions; in addition, some important masticatory and salivary parameters differed between children with different morphological occlusions, hence the importance of the early assessment of these parameters.KEYWORDS Bite Force; Dental Occlusion; Masticatory System; Primary Dentition.

Purpose This study evaluated the association between excess weight and quality of life (QoL), symptoms of anxiety, caries experience and socio-economic factors in a representative sample of 8- to 10-year-old children from three public schools of Piracicaba (SP, Brazil). Materials and methods The Autoquestionnaire Qualite de Vie Enfant Image was applied to explore family and social relations, activities, health, body functions and separation domains, and, by means of the Multidimensional Anxiety Scale for Children, symptoms of anxiety were screened. Clinical examination was performed using DMFT/dmft indexes to assess oral health and caries experience. Medical and nutritional history, parents' schooling, monthly income and ownership of household goods and services were also evaluated. Results Of the 313 subjects included, four subjects were underweight, 188 normal weight, 67 overweight and 54 presented obesity (38.7% with excess weight). Measures of QoL, anxiety scores and caries experience did not differ between groups. The regression model showed a significant association between excess weight and the ownership of household goods and services (OR = 5.4/CI = 1.6-18.3). Conclusions High prevalence of excess weight was observed among prepubertal children, emphasizing the need for continued health programmes to limit risk factors for obesity. QoL, anxiety scores and caries experience did not differ between subjects with different body weights, although children from public schools with higher ownership of goods and services were more likely to present excess weight.

Asthma is a chronic inflammatory disease, in which disturbances in breathing, masticatory and swallowing functions may impact the eating behavior. The aim of the study was to evaluate the impact of asthma on taste sensitivity, masticatory behavior and feeding problems in children. The sample consisted of 91 children (6-7y) divided into two groups: asthma (n=46) and control group (n=45). Interviews were held with parents/guardians and clinical examinations were performed to gather information on medical, dental and feeding aspects. The gustatory sensitivity for sucrose and urea (sweet and bitter, respectively) were measured by staircase method designed for this age-range. The respiratory and masticatory functions were evaluated using the Orofacial Myofunctional Evaluation with Scores-expanded (OMES-e) protocol. Feeding problems were assessed using the Montreal Children's Hospital Feeding Scale, exploring oral motor, sensory, appetite, maternal concerns, child's behavior, and strategy aspects after transcultural adaptation to Brazilian Portuguese. The two groups were homogeneous relative to sociodemographic characteristics and nutritional status. Although the total OMES-e scores did not differ between groups, the frequency of changes in food incision and escape were different (p=0.007 and p=0.0011, respectively). The Asthma group required more time and higher number of masticatory cycles to eat the test-food (p0.05). The gustatory thresholds for sweet and bitter were different, with asthmatic children requiring significantly higher concentrations to perceive the taste (p0.001). The frequency of children classified by their parents according to feeding difficulties also differed between groups (p=0.001; Fisher's exact test). Asthmatic children showed remarkable changes in taste, chewing and eating behaviors, thereby pointing out the eating problems they may experience, which should be considered when designing and implementing therapeutic interventions.

As sucking habits and eating behavior may be interrelated and also associated with taste, body composition, and sociodemographic factors, the objective was to perform an exploratory analysis to identify groups of children with a high degree of association between intragroup subjects, providing explanation and interpretation of the data. The study initially included 352 prepubertal children (197 girls; 7- to 11-year-old), from whom information about sociodemographic characteristics, duration of breastfeeding, past bottle-feeding and non-nutritive sucking habits, taste sensitivity, body mass index (BMI), and consistency of food ingested were collected. Salivary concentrations of amylase and total protein were also determined. Data were submitted to cluster analysis (hierarchical analysis, K-means, and silhouette plot), one-way ANOVA and correlation tests. Cluster analysis included 159 children, generating three reliable and meaningful clusters: Cluster 1 (labeled "good tasters"), was characterized by older children and higher taste sensitivity; Cluster 2 ("softer food consistency") by longer bottle-feeding duration and children who eat food with lower consistency, and Cluster 3 ("breastfed") by longer breastfeeding duration (silhouette coefficient = 0.61). Cluster 3 also showed the higher percentage of normal-weight children, normal delivery, maternal schooling, and lower rate of past non-nutritional sucking habit. No correlation was found between salivary amylase and total protein concentrations, taste sensitivity and BMI, although taste sensitivity showed to be higher among girls (p = 0.002; power = 88%). The study identified three clusters, highlighting the relationship between nutritional sucking habits, consistency of food ingested, and sociodemographic characteristics. Most importantly, a close relation between bottle-feeding and consumption of soft food consistency was observed.

Objective The aim was to evaluate the relationship between orofacial function, dentofacial morphology, and bite force in young subjects. Subjects and Methods Three hundred and sixteen subjects were divided according to dentition stage (early, intermediate, and late mixed and permanent dentition). Orofacial function was screened using the Nordic Orofacial Test-Screening (NOT-S). Orthodontic treatment need, bite force, lateral and frontal craniofacial dimensions and presence of sleep bruxism were also assessed. The results were submitted to descriptive statistics, normality and correlation tests, analysis of variance, and multiple linear regression to test the relationship between NOT-S scores and the studied independent variables. Results The variance of NOT-S scores between groups was not significant. The evaluation of the variables that significantly contributed to NOT-S scores variation showed that age and presence of bruxism related to higher NOT-S total scores, while the increase in overbite measurement and presence of closed lip posture related to lower scores. Bite force did not show a significant relationship with scores of orofacial dysfunction. No significant correlations between craniofacial dimensions and NOT-S scores were observed. Conclusion Age and sleep bruxism were related to higher NOT-S scores, while the increase in overbite measurement and closed lip posture contributed to lower scores of orofacial dysfunction.

a b s t r a c t Objectives: Few studies have evaluated the relationship between morphological and functional characteristics of the masticatory apparatus in young subjects. Thus, the aim of this study was to evaluate masticatory performance (MP), maximal bite force (BF), orthodontic treatment need and orofacial dysfunction in children and adolescents. Design: The sample consisted of 316 subjects of both genders, with an age range 6–16 years divided into 4 groups: early mixed, intermediate mixed, late mixed and permanent dentition. MP was evaluated by the individual’s ability to comminute a chewable test material in order to determine median particle size (X50) and distribution of particles in different sieves (‘‘b’’). BF was determined using a digital gnatodynamometer with fork strength of 10 mm. Orofacial function and orthodontic treatment need were screened using the Nordic Orofacial Test-Screening (NOT-S) protocol and Index of Orthodontic Treatment Need (IOTN), respectively. The results were submitted to descriptive statistics, normality test, analysis of variance and stepwise multiple linear regression to test relationship between MP and studied independent variables. Results: Variance of X50 and b between groups was statistically significant. But evaluation of variables that significantly contributed to MP variation showed that age, body mass index (BMI), BF and the presence of sleep bruxism were negatively related to X50 and the NOT-S clinical exam scores showed a positive relationship with X50. Conclusion: In the studied sample, age, BMI, BF and the presence of sleep bruxism were related to better MP; but the increase in NOT-S scores was significantly related to poorer MP.

Objectives: Mastication is an essential function that prepares the food for swallowing and digestion and may be related to nutritional status. Thus, the aims of this study were to evaluate the masticatory parameters in overweight and obese children and the relation between bite force and anthropometric evaluation, food consistency, breast/bottle-feeding, and occlusion. Materials and methods: The sample consisted of 204 children of both genders, age range 8–10 years, divided into normal weight, overweight, and obese. Unilateral bite force was measured using a digital gnatodynamometer with 10mm force fork. Anthropometric and nutritional evaluation involved the measurements of body mass index and skeletal muscle mass using bioelectric impedance analysis. Occlusion was evaluated as regards orthodontic treatment need and food consistency was analysed using a structured questionnaire. In addition, the time of breast- and bottle-feeding was investigated. The results were submitted to chi-square and correlation tests, analysis of variance, and multiple linear regression to determine the relation between bite force and the independent variables under study ( α = 0.05). Results: Statistical analysis showed that the time of breast- and bottle-feeding and food consistency did not differ among groups. The regression model showed that body mass index, orthodontic treatment need, and body skeletal muscle mass contributed significantly to the variation in bite force. Conclusions: Breast- and bottle-feeding behaviour and food consistency did not differ in normal-weight, overweight, and obese children. However, bite force was dependent on body skeletal muscle mass, body mass index, and orthodontic treatment need.

The objective of this case report was to describe the oral rehabilitation of a five-year-old boy patient diagnosed with amelogenesis imperfecta (AI) in the primary dentition. AI is a group of hereditary disorders that affects the enamel structure. The patient was brought to the dental clinic complaining of tooth hypersensitivity during meals. The medical history and clinical examination were used to arrive at the diagnosis of AI. The treatment was oral rehabilitation of the primary molars with stainless steel crowns and resin-filled celluloid forms. The main objectives of the selected treatment were to enhance the esthetics, restore masticatory function, and eliminate the teeth sensitivity. The child was monitored in the pediatric dentistry clinic at four-month intervals until the mixed dentition stage. Treatment not only restored function and esthetic, but also showed a positive psychological impact and thereby improved perceived quality of life. The preventive, psychological, and curative measures of a young child with AI were successful. This result can encourage the clinicians to seek a cost-effective technique such as stainless steel crowns, and resin-filled celluloid forms to reestablish the oral functions and improve the child’s psychosocial development.