journal club on masticatory performance in chronic periodontitis

1. Tania de Freitas Borges et al.
J Periodontol • March 2013

2.  The loss of periodontal supporting structures
attributable to periodontitis can negatively affect the
sensory function of periodontal tissues and lead to
development of alternative strategies to deal with the
less stable mechanical support of the teeth,
ultimately causing specific chewing dysfunctions.
 Individuals with moderate to- severe periodontitis
experience a change in their food chewing ability,
which affects the final product of masticatory
function.

3.  A multidimensional approach, measuring not only
masticatory function but also physical, psychologic,
and social limiting factors, can be performed by using
questionnaires intended to analyze the oral health–
related quality of life (OHRQoL).
 Considering the potential association between
periodontal disease and reduction of masticatory
performance and OHRQoL, this study aimed to
evaluate the effect of periodontal disease on chewing
ability and OHRQoL.

4.  The participants in the present study were 24 dentate volunteers,
comprising 10 females and 14 males, 23 to 76 years old (mean age,
50.1 years).
 Selection criteria did not include age, sex, race, or social status. The
participants were divided into the following two groups: control group
and test group. For this categorization, the alveolar bone height–to–
tooth length (AB/T) ratio was calculated.
 Participants with an AB/T ratio >50% were included in the control group,
and those with an AB/T ratio <50% were placed in the test group.
 Each group consisted of 12 individuals (n = 12), comprising five females
and seven males. Considering the above categorization, all individuals in
the test group were expected to have moderate-to-severe generalized
periodontitis.

5.  The inclusion and exclusion criteria were determined by
screening, which provided data regarding the participants’
personal information, medical and dental history, any
existing parafunctional habits, and potential symptoms of
temporomandibular dysfunction.
Individuals were excluded from the study if they presented
with some of the following criteria during screening:
 1) splinting of teeth after orthodontic treatment
 2) fixed prostheses with >1 element
 3)dental implants

6.  4) partial removable dentures
 5)endodontic lesions
 6) absence of >4 pairs of teeth in occlusion and absence of all
pairs of molars from any hemiarch.
 7) use of any medication that could interfere in muscle activity,
such as antihistamines, sedatives, homeopathic medicinal
products, or central nervous system depressors
 8) treatments that could directly or indirectly interfere in muscle
activity during the period in which the study was performed,
such as speech therapy and otorhinolaryngologic treatments.

7. Alveolar Bone Height
 The alveolar bone height measurement was performed in digital
panoramic radiography through a computer-customized system.
 For this study, reference points were used. 1) The root apex (A) is the
most apical part of the root. In upper multiroot teeth, the vestibular root
was used as a reference point for the proximal and the palatine root for
the opposite proximal.
 2) The alveolar crest (AC) is the portion located on the surface of the
most coronal root. When >1 crest image of the alveolar bone was
observed, the most apical part was used.
 3) The highest part of the crown (C) is the midpoint of the incisal margin
for the incisors and the cusp in the most coronal position for premolars
and molars.

9. Dental Mobility
 An electronic mobility testing device was used to measure the degree of
mobility of the abutment teeth. To standardize data collection, a fixing
device was used for the mobility testing device, so that the patient would
not have to change head position.
 Participants were instructed to place their chin on the supporting
platform with the rod positioned at a 90 angle in the centre of the
vestibular face of each tooth.
 A dental cotton roll was placed between the teeth of the hemiarch
opposite of the register to standardize the disocclusion of the teeth.
After fixing the rod at the given position, the mobility reading was
performed. All measurements were conducted by the same clinician
(TFB) to avoid variability between examiners.

10. Masticatory Performance
 In this study, chewing material called a biocapsule was used that
contains beads to analyze the masticatory performance.
 The beads were obtained by an ionotropic gelification method of solids
at the following concentrations: a 2% aqueous pectin dispersion, 18.65%
starch, 20.5% lactose, 18.65% saccharose, 40.2% microcrystallized
cellulose, and 0.016% fuchsin. The beads remained in solution for 10
minutes.
 They were then dried until their weights remained constant and coated
with 5% cationic methacrylate polymer in a mixed solvent of 10% acetone
in absolute ethanol.
 Subsequently, 250-mg beads were placed inside polyvinyl acetate
capsules, with a 0.40-mm wall thickness, a 7-mm internal diameter, and
an 8-mm external diameter. The biocapsules were welded using
radiofrequency and were kept hermetically sealed throughout the clinical
trial. They were characterized as inert and biocompatible.

11. OHRQoL
 For analysis of quality of life, the Oral Health Impact Profile (OHIP)
questionnaire was used to measure individuals’ perceptions regarding
the social impact of the oral disorder on their well-being. It consists of
48 questions.
 The study applied the OHIP-14 questionnaire, which comprises 14
questions divided into the following seven groups: 1) functional
limitation; 2) physical pain; 3) psychologic discomfort; 4) physical
disability; 5) psychologic disability; 6) social disability; and 7) handicap.
 The answers were recorded on a Likert scale with values ranging from 0
to 4. The individual’s quality of life improves with a decrease in the
Likert scale value.

12.  The control group presented the best masticatory performance
indicator. The data showed that there was a statistically
significant difference of masticatory performance between the
two groups.
 Masticatory performance had a positive correlation with the AB/T
mean of the posterior sextants.
 In the study, the impact of periodontitis on quality of life was
higher in the physical pain subscale, and feeling uncomfortable
while eating was a question of great relevance.
 The third highest impact on quality of life was the physical
disability subscale, which is the only subscale to display
masticatory efficiency.

13.  Masticatory performance, which was evaluated based on
chewing hard artificial foods, was found to be worse for
individuals with reduced alveolar bone height.
 A difference of 32% was found between the test and
control groups regarding grinding of food, which was
analyzed by having participants chew the biocapsule for
10 seconds.
 However, it is necessary to analyze the results with
caution. Individuals with generalized periodontitis may
have the indication of extracting all the teeth followed by
oral rehabilitation with full denture prostheses.

14.  A study with a masticatory performance test observed a
reduction in masticatory performance of individuals rehabilitated
with conventional dentures (69%) and individuals rehabilitated
with fixed mandibular implant-supported prostheses (39%)
compared with individuals with a natural dentition.
 Therefore, one should consider the possibility of periodontal
disease control and patient guidance based on the advantages of
not extracting teeth, including maintenance of the periodontal
proprioception that can influence neuromuscular control of
chewing.
 In this study, even individuals with mild loss of periodontal
supporting structure have potential changes in their masticatory
performance.

15.  Individuals with better periodontal conditions are more likely to
have a better quality of life. This is supported by the study,
which demonstrates a correlation between the quality of life and
both the supporting alveolar bone loss and tooth mobility.
 Bernabe´ and Marcenes showed that, despite the influence of
sociodemographic factors as well as other concomitant oral
conditions, periodontal disease was associated with quality of
life in individuals with generalized periodontitis and those with
localized periodontitis.
 Despite the reduction in masticatory performance and quality of
life observed in this study, chewing ability is more favourable
than that found following some oral rehabilitations procedures,
such as complete dentures or implant-supported prostheses.

16.  It can be stated that loss of periodontal structures can
negatively affect the masticatory performance and OHRQoL.
Even mild reductions in alveolar bone height may impair
masticatory performance.
 The assessment of quality of life and masticatory
performance related to periodontal support can assist
clinicians in providing the most appropriate intervention care
tailored to meet individual needs.