Prevalence of Malocclusions and Associated Factors inBrazilian Children and Adolescents with CerebralPalsy: A Multi-Institutional Study

Background. To assess the prevalence and factors associated with malocclusions in children and adolescents with cerebral palsy (CP). Methods. The study included 134 subjects with CP aged 2–18 years enrolled in six rehabilitation institutions and their caregivers, which provided demographic, systemic, and behavioral data. A calibrated researcher held oral examinations with record of the following malocclusion indexes, DAI and DMFT. Poisson regression analysis was used (α < 0.05). Results. About 85.8% (n = 115) of patients had malocclusion. In deciduous and mixed dentition (n = 99), increased overjet (75.8%), open bite (51.5%), posterior cross bite (19.2%), and anterior cross bite (3.0%) were identified. Increased overjet was associated with the age group of 2–5 years and mild communication impairment. Anterior open bite was more common in children who underwent tongue interposition, lip interposition, and pacifier sucking. Communication skills, mouth breathing, and tongue interposition were associated with posterior cross bite. Severe malocclusions (DAI > 30) were observed in 88.6% of patients with permanent dentition (n = 35) and were associated with liquid diet consistency and finger sucking. Conclusion. The prevalence of malocclusion in individuals with CP was high and associated with demographic, behavioral, and systemic factors.

Effects of diet consistency on mandibular growth. A review

This article is a review that focuses on the diet consistency and how this affects mandibular morphology. Various published studies focused on the relationship between mastication and growth of the mandible because it is considered that mandibular growth is dependent on the loads exerted by the function of the masticatory muscles. Moreover it has been pointed out that the increase of orthodontic anomalies is due to the modern softer diet. Even in rats, soft diet is one of the factors causing malocclusions. All of the studies have been experimental, mainly in rodents, since this research is impossible to be applied on humans in a short period of time. Most experimental studies suggested that occlusal loading affects bone mass, bone amount, bone density, the length and the width of the bone, the degree of mineralization, the genetic expression, the collagen immunoreaction and the chondrocytes action on the cartilage. It is stated that bone volumes and thickness of the mandible of rats fed with soft diet were smaller when compared to animals fed with hard diet. Also the mandibles and condyles were smaller and less dense in the rats of soft diet as compared to controls. Furthermore the length and the width of the condyle in the soft diet group of animals were smaller as compared to the condyle of the hard diet group of animals. Soft diets affect also the degree of mineralization, and the action of the chondrocytes on the cartilage.

POST-BARIATRIC SURGERY NUTRITIONAL REQUIREMENTS – Part 1 (Nutritional Therapy in the evolution of diet and Dumping Syndrome)

Bariatric surgery is a form of treatment for morbid obesity (Body Mass Index – BMI – ≥ 40 Kg/m2) and, in patients with comorbidities such as diabetes mellitus from a BMI ≥ 35 Kg/m2. Bariatric diet protocols are defined by each surgical team and may vary in the progression of dietary consistency. However, they all share common nutritional goals such as: – Maximize weight loss and absorption of essential nutrients – Maintain adequate hydration – Avoid vomiting and dumping syndrome Nutritional guidance is based on a diet with minimal calories and high in essential nutrients, ensuring healing and minimizing loss of lean mass. The diet should reduce reflux, early satiety and dumping syndrome, at the same time increasing the expected weight loss for each period and, later, the maintenance of the acquired weight. Women who become pregnant should be monitored for adequate weight gain and specific supplementation, meeting the needs of the mother and fetus. Diet stage and progression The progression of diet consistency is based on post-surgical recommendation protocols. To improve the results, patients and family members already receive, in the preoperative period, a structured postoperative diet, with examples of menus and recommendations regarding the type of food, preparations, volume, in addition to basic notions of dietary technique.

Cerebral palsy: association between nutritional status and occurrence of oropharyngeal dysphagia

ABSTRACT Objective: to verify the association between nutritional status and the occurrence of oropharyngeal dysphagia in individuals with cerebral palsy. Methods: a cross-sectional, quantitative study with people aged between two and 20 years. Neuromotor impairment, occurrence and degree of dysphagia, anthropometry, food consumption, feeding route, diet fractionation and consistency were evaluated. Swallowing evaluation was performed by a skilled speech-language-hearing therapist, through the Clinical Evaluation Protocol of Pediatric Dysphagia (PAD-PED, Portuguese acronym).The statistical analysis was performed adopting p<0.05%. Results: 40 subjects with a median of 8.7 (5.45-14.5) years, 65% of whom were males. Concerning neuromotor impairment, 72.5% were classified at levels IV and V. The prevalence of dysphagia was 70%, the feeding route being predominantly oral (77.5%) with a normal diet consistency (55%). In the growth curves, all of them were classified within an adequate height for their age. As for weight, body mass index and skinfolds, 82.5%, 85% and 62.5% were eutrophic, respectively. Statistically significant association was found between dysphagia and body mass index (p=0.018). The mean daily caloric and proteic intake was 1427.29±338.62 kcal and 56.86±17.57 grams, respectively. Statistically significant association was found between the feeding route and the amount of protein ingested daily (p=0.041). Conclusion: most subjects presented oropharyngeal dysphagia and more severe motor impairment; they were fed orally with a normal diet consistency. It was observed that the greater the difficulty in swallowing, the greater the impairment of nutritional status.

Consistency in fruit preferences across the geographical range of the frugivorous bats Artibeus , Carollia and Sturnira (Chiroptera)

The frugivorous phyllostomid bat genera Artibeus , Carollia and Sturnira are important seed dispersers in the Neotropics, and exhibit supposed preferences for fruits of the genus Ficus , Piper and Solanum , respectively. We performed a quantified literature review to test the hypothesis that interactions with plants are consistent throughout the bats´ geographic ranges. Through an extensive literature review we obtained a total of 4,448 records of fruit consumption from 180 publications. To test which fruits were most frequently consumed across the Neotropical region and in each of its component countries these data were organized by bat species and country. In general, considering the 176 botanical genera eaten by these bats, the results showed a high consumption frequency of Ficus (24.0%) by Artibeus , Piper (38.7%) by Carollia and Solanum (31.0%) by Sturnira . Additionally, our findings support the hypothesis of diet consistency throughout the geographic range of these genera. We suggest that this consistency is related to the wide distribution of the study groups (both bats and plants), the phenology of the zoochoric species consumed, the spatial fidelity of bats and the foraging patterns of the different bat species.

Evaluation of Temporomandibular Joint Total Replacement with Alloplastic Prosthesis: Observational Study of 27 Patients

Background Temporomandibular joint (TMJ) total replacement with alloplastic prostheses has been performed since 1960s. Research in these last two decades has achieved important improvement in the development of biomaterials, design, adaptation, and fixation of the prosthesis components. Objective To evaluate total TMJ replacement with alloplastic prostheses. Methods We studied 27 patients, between 19 and 73 years old, who had total TMJ uni- or bilateral replacement surgery with custom-made alloplastic prostheses manufactured by TMJ Concepts, Inc. (Ventura, CA) between 1996 and 2011. The general data and preoperative measurements were taken from medical records. Subjective data related to pain, diet consistency, and current quality of life were collected with a questionnaire answered by the patients; measures of maximum interincisal opening and lateral mandibular movements were obtained from direct examination. Results We found significant difference ( p < 0.05) comparing pre- to postoperative results about improvement in mouth opening, pain relief, and satisfaction with the surgery and diet consistency. Conclusion The results of this study show that total alloplastic TMJ prostheses are an efficient, safe, and stable long-term solution for patients who need TMJ total replacement.