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BACKGROUND & AIMS: Debate still exists about the impact of dental implant-supported prostheses on nutritional status of partially and complete edentulous patients. This review aims to answer the focused question: "Do complete and partial edentulous patients, using implant-supported prostheses, present better nutritional and masticatory functions when compared to those using conventional rehabilitations?". A possible cause-effect relationship between masticatory improvements and nutritional gain was also evaluated. METHODS: Literature search included 6 databases (PubMed/Medline, Embase, LILACS, Scopus, Web of Science, and The Cochrane Library - CENTRAL), grey literature (Google Scholar, Proquest Dissertations and Thesis and Open Grey databases) and manual search (last update June 2020), without language, publication time and follow-up restrictions. We included only studies evaluating both masticatory and nutritional outcomes. The PICO question comprised complete and partial edentulous patients (Population), submitted to implant-supported prostheses (Intervention), in comparison to conventional dental prosthetic rehabilitation, evaluating masticatory function and nutrition parameters (outcomes). Risk of bias was assessed by using Cochrane Collaboration's tool (randomized clinical trials), Joanna Briggs Institute critical appraisal checklist (paired clinical trials), and Meta-Analysis of Statistics Assessment and Review Instrument" (JBI - MAStARI) critical appraisal tools (cohort studies). All meta-analyses were conducted at 5% level of significance. This report followed the PRISMA guidelines. (Review registration PROSPERO - CRD42019135744). RESULTS: We identified 1199 articles while searching databases. Fourteen articles met eligibility criteria, including 817 prostheses installed in 660 patients (mean age = 66.8 years-old). Patients wearing implant overdentures (IOD) presented better masticatory function in comparison to conventional complete denture (CD) wearers (p < 0.05). However, bioavailability of several nutrients remained within the same range, except for serum folate that was lower in IOD patients after 6 (mean difference 3.51 nmol/L; p = 0.01) and 12 months of rehabilitation (mean difference 3.69 nmol/L; p = 0.003). When comparing the effects of CD and IOD rehabilitations along time (for the same patient), serum albumin and vitamin B12 levels also decreased for both groups after 12 months-follow-up, but still within the reference range. The additional retention of the implants did not interfere in body weight, but reduced the risk of malnutrition (using the Mini Nutritional Assessment). Implant-supported partial prostheses also improved mastication in comparison to the conventional ones, increasing short-term daily intake of carbohydrates, protein, calcium, fiber, and iron, whereas decreasing the consumption of cholesterol. However, no long-term changes on bioavailability of most nutrients were observed, expect for a slight increase in ferritin and cholinesterase, and a small reduction in folate and Vitamin A. CONCLUSION: Current evidence indicates significant masticatory improvements for dental fixed implant-supported prostheses in comparison to conventional removable prostheses. However, bioavailability remained stable for most of the nutrients, especially for complete edentulous patients. These results indicate the importance of a multidisciplinary approach during oral rehabilitation (nutrient specialist), in order to enhance food choices and promote health benefits to the patients.

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A large number of methodological procedures and experimental conditions are reported to describe the masticatory process. However, similar terms are sometimes employed to describe different methodologies. Standardisation of terms is essential to allow comparisons among different studies. This article was aimed to provide a consensus concerning the terms, definitions and technical methods generally reported when evaluating masticatory function objectively and subjectively. The consensus is based on the results from discussions and consultations among world-leading researchers in the related research areas. Advantages, limitations and relevance of each method are also discussed. The present consensus provides a revised framework of standardised terms to improve the consistent use of masticatory terminology and facilitate further investigations on masticatory function analysis. In addition, this article also outlines various methods used to evaluate the masticatory process and their advantages and disadvantages in order to help researchers to design their experiments.

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The use of smartphones during meals may possibly influence the number of ingested calories. We evaluated the influence of smartphones' distraction during eating on caloric intake. Physical (masticatory parameters, sex and body mass index - BMI); environmental (with or without distraction) and psychological (stress levels) variables were evaluated as confounding factors. Sixty-two adults were recruited for experimental snack tests performed on four different days. At baseline, we evaluated masticatory performance, swallowing threshold, masticatory frequency and body mass index (BMI). In the following three sessions, volunteers were presented a snack test in which participants ate under three experimental conditions: no distraction, using their smartphones, or reading a printed text. At the end of each session, total and nutritional compound stratified caloric intake was measured. Three-way mixed model ANOVA was used to test the effect of experimental condition on the total, carbohydrate and lipid caloric intakes. Hierarchical multiple linear regression models were used to estimate the influence of confounding factors on the total caloric intake. We found an effect of the condition (no distraction, smartphone or reading) on the total caloric (p = .007) and lipid intake (p = .002). When eating without distraction, the mean caloric intake was 535 (±164) kcal, in comparison to 591 (±203) kcal using smartphone (p = .05) and 622 (±226) kcal (p = .002) reading a text (no significant difference between distracters). Eating with distracters increased approximately 15% caloric ingestion. An interaction condition*sex effect was observed on lipid intake (p = .020). Energy intake was found to be dependent on sex and age, in which older men ingested more calories. Smartphone use during a meal increased caloric and lipid intake, depending on sex and age in young adults with complete dentition.

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The present study aimed to compare the main objective parameters of mastication among individuals with different body mass indexes. One hundred and sixty participants matched for gender and age were divided in the following groups according to their body mass index (BMI): Obese group (30 ≤ BMI < 35), Overweight group (25 ≤ BMI < 30), normal range group (18.5 ≤ BMI < 25) and underweight group (17 ≤ BMI < 18.5). Each group was composed by forty subjects. The maximum bite force, the masticatory performance, chewing rate and three variables related to swallowing (number of chewing cycles, chewing time, and median particle size) were assessed in all groups. The oral conditions, including the number of teeth, number of occlusal units and salivary flow (unstimulated and stimulated) were also evaluated. Regardless of the BMI, males had a larger bite force and better masticatory and swallowing performances than females. They also chewed faster than females. Individuals of the obese group had the largest median particles sizes (both after 20 chewing cycles and at the moment of swallowing), which indicates a less good masticatory performance. The median particle sizes were negatively correlated with the number of teeth and number of occlusal units in the obese group. We did not observe large differences in masticatory performance and swallowing variables among the four weight groups, although there was a tendency that individuals of the obese group swallowed larger particles. The results of this study do not support the existence of an "obese chewing style".

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In a previous study, we evaluated the influence of periodontal treatment and physiological parameters on the subjective perception of mastication using the Oral Impact on Daily Performance Questionnaire (OIDP). In this study, we investigated the influence of periodontal treatment on the objective measures of masticatory performance in the same study sample. Patients with chronic periodontitis (n = 28) were examined on two occasions with a 45-day interval. Electrical activity of the masticatory muscles and maximum bite force were determined. In addition, masticatory performance was assessed using silicone impression blocks as test material. The median particle size of the chewed blocks was determined employing a sieving method. The number of teeth and the probing depth were also recorded. The probing depth was significantly reduced following treatment (P < 0.001). The median particle size of the chewed material was also reduced, which indicates a significant improvement in masticatory performance after treatment (P < 0.001). Bite force and muscle activity were significantly correlated both before and after treatment (P < 0.05). There was a negative correlation between masticatory performance and number of teeth (P < 0.05); moreover, individuals with a lower number of teeth exhibited poorer masticatory performance (P = 0.01). Periodontal treatment had a positive influence on masticatory performance 45 days after conservative treatment.

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OBJECTIVE: Assess the influence of salivary flow on physiological parameters of the stomatognathic system in patients who take beta-blockers or anxiolytic medications. DESIGN: Sixty patients were divided into three groups based on the following criteria: Group 1, control (n=20; no use of medication); Group 2, use of antihypertensive beta-blockers (n=20); and Group 3, use of benzodiazepine anxiolytics (n=20). Salivary flow was assessed by determining stimulated and non-stimulated flow/minute. The quantification of the sense of taste was determined on a visual analogue scale (VAS) using solutions of 0.9% NaCl (salty), 50% sucrose (sweet), 20% unsweetened coffee (bitter) and 4.2% vinegar (sour). The DMFT index (number of decayed/missing/filled teeth) was determined by a calibrated examination, following the criteria of the World Health Organization (WHO). Masticatory performance was assessed with an Optosil comminution test and Rosim-Ramler equation. RESULTS: The results did not reveal a significant correlation between salivary flow and masticatory performance (p>0.05). We observed significant decreased non-stimulated salivary flow for Group 2 (p=0.05) when compared to controls. However, taste perception was not influenced by salivary secretion amongst groups. Furthermore, we observed a significant negative correlation between non-stimulated salivary flow and DMFT in Group 1 (p=0.02; r=-0.52). CONCLUSIONS: Patients under beta-blockers therapy presented reduced non-stimulated salivary flow when compared to controls, without influencing the sense of taste or masticatory performance. The use of anxiolytics did not affect salivary flow and taste perception in the studied sample.

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Purpose: To compare the masticatory performance and satisfaction levels of subjects with normal dentition and subjects with implant-supported overdentures with two types of attachments (ball and bar-clip retention systems). Methods: The sample comprised 24 subjects, 12 edentulous patients and 12 dentate subjects. The denture wearers received two dental implants and new maxillary and mandibular dentures. Three months after the first surgical phase, the mandibular dentures were connected to the implants by a gold ball attachment. Two months later new mandibular overdentures were made with a bar-clip attachment. Satisfaction levels (modified OHIP-EDENT and verbal rating scale) and masticatory performance (chewing for 40 masticatory cycles) were measured with the old dentures, with the unattached new dentures, and with the new dentures with ball and bar-clip attachments. Data were analyzed by Friedman and chi-square tests. Results: Both masticatory performance and satisfaction levels significantly improved after implant treatment. No significant differences were observed between the overdentures with ball and bar attachments. However, the masticatory performance after treatment was still significantly lower than the performance of the healthy subjects. Conclusion: The rehabilitation of edentulous patients with overdenture with ball or bar-clip attachment improves both satisfaction and masticatory performance, but the outcomes levels are not equal as those found for dentate subjects.

Objetivo: Comparar o nível de satisfação e a performance mastigatória dos indivíduos com dentição normal e pacientes reabilitados com uma sobredentadura suportada por implantes com dois tipos de conectores diferentes, sistema de retenção bola e barra. Metodologia: Vinte e quatro indivíduos participaram do estudo, sendo 12 pacientes desdentados e 12 indivíduos dentados totais. Os desdentados receberam dois implantes e novas dentaduras, superiores e inferiores. Três meses depois da primeira fase cirúrgica, a dentadura inferior foi conectada aos implantes através do sistema bola. Dois meses depois, uma nova sobredentadura inferior foi realizada, porém desta vez conectado através do sistema barra-clipe. O nível de satisfação (OHIP-EDENT adaptado e escala verbal de medição) e a performance mastigatória (mastigação por 40 ciclos mastigatórios) foram medidos em vários momentos do tratamento, com as dentaduras antigas, novas não conectadas por implantes, e depois de ter conectado a sobredentadura pelo sistema bola e barra-clipe. O teste de Friedman e o teste qui-quadrado foram aplicados para analisar os resultados.Resultados: O nível de satisfação e a performance mastigatória melhoraram significativamente após a reabilitação com os implantes. Nenhuma diferença foi observada entre as sobredentaduras com sistema bola e barra-clipe. Entretanto, a performance mastigatória ainda permaneceu significativamente menor que a performance dos indivíduos dentados. Conclusão: A reabilitação de pacientes edêntulos reabilitados com sobredentadura com bola ou barra-clipe melhora tanto o nível de satisfação quanto a performance mastigatória, porém ainda abaixo do nível dos indivíduos com dentição normal.

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Ultrasonography has been used to determine the association between muscle thickness, temporomandibular dysfuntion (TMD), facial morphology, and bite force. The aim of this study was to evaluate signs and symptoms (SS) of TMD using the craniomandibular index (CMI), masseter and anterior temporalis thickness, facial dimensions, and bite force in adolescents (12-18 years of age): 20 (10 males and 10 females) with SSTMD and 20 without (control, matched for age and gender). Ultrasonography was carried out using Just-Vision 200, and bite force measured with a pressure transducer. The measurements undertaken on the cephalograms included anterior (n-gn, n-Me, sp-gn) and posterior (S-tgo) facial dimensions, jaw inclination (NSL/ML), vertical jaw relationship (NL/ML), gonial angle (ML/RL), and overbite and overjet. The data were analysed with analysis of variance, Pearson's and Spearman's correlation and multiple regression. The SSTMD group showed a smaller bite force than the controls (P < 0.05). In the control group, bite force was negatively correlated with jaw inclination and overbite. There were negative correlations between anterior temporalis thickness and anterior facial dimensions; and positive correlations for masseter and anterior temporalis and posterior dimensions. In the SSTMD group, there were positive correlations for masseter and bite force, and anterior and posterior dimensions. Negative correlations were found for the masseter and temporalis muscles and jaw inclination and vertical jaw relationship. Multiple regression analysis showed that in the control group the overjet and jaw inclination contributed 50 per cent to the variance in bite force. In the SSTMD group, the dimensions of the masseter muscles during contraction contributed 39 per cent to the variance. The correlations between CMI and the craniofacial variables were more significant in the SSTMD group. The findings indicate that muscle thickness influences facial dimensions and bite force in adolescents with SSTMD.

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INTRODUCTION: The production of sufficient saliva is indispensable for good chewing. Recent research has demonstrated that salivary flow rate has little influence on the swallowing threshold. OBJECTIVES: The hypothesis examined in the present study was that adding fluids to foods will influence chewing physiology. MATERIALS AND METHODS: Twenty subjects chewed on melba toast, cake, carrot, peanut and Gouda cheese. They also chewed on these foods after addition of different volumes of water or alpha-amylase solution. Jaw muscle activity, number of chewing cycles until swallowing and chewing cycle duration were measured. Repeated measures analysis of variance was applied to test the null hypothesis that there would be no statistically significant difference among the results obtained for the various food types and fluids. Subsequently, contrasts were determined to study the levels of intra-subjects factors (food type and fluid volume). Linear regression was used to determine the changes in muscle activity and cycle duration as a function of the chewing cycles. RESULTS: Fluid addition significantly decreased muscle activity and swallowing threshold for melba, cake and peanut (p<0.05). The effect of alpha-amylase in the solutions was similar to that of water (p>0.05). Doubling the volume of tap water had a greater effect. CONCLUSIONS: Fluid addition facilitated chewing of dry foods (melba, cake), but did not influence the chewing of fatty (cheese) and wet products (carrot). This study is relevant to improve patients' life quality and the management of chewing and feeding disorders caused by hyposalivation.

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Mastication is a complex process that involves activities of the facial muscles, the elevator and suprahyoidal muscles, and the tongue. These activities result in patterns of rhythmic mandibular movements, food manipulation, and the crushing of food between the teeth. Saliva facilitates mastication by moistening food particles, making a bolus, and assisting swallowing, whereas food consistency modifies masticatory forces, the mandibular jaw movements, the duration of the mastication cycle, and the number of cycles preceding the first swallow. Jaw elevator EMG activity research shows a clear relation between muscular activity and food properties. The teeth, masticatory muscles, and temporomandibular joints are also important because together they form the mechanism by which the food particles are fragmented. Hard and dry foods require more chewing cycles and a longer time in the mouth until swallowing for sufficient breakdown to take place and for enough saliva to be added to form a coherent bolus safe enough for swallowing. Product characteristics, the amount of saliva, dentition, and bite force affect the chewing performance. This study presents an update and synopsis of the effects of saliva, food, dentition, muscle force, and temporomandibular disorders on the masticatory process.

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The production of sufficient saliva is indispensable for good chewing. Recent research has demonstrated that salivary flow rate has little influence on the swallowing threshold. We examined the hypothesis that adding fluid to a food will influence the chewing process. Twenty healthy subjects chewed on melba toast, breakfast cake, carrot, peanut and Gouda cheese. In addition they chewed on these foods after we added different volumes of tap water or a solution of alpha-amylase. We measured jaw muscle activity and the number of cycles until swallowing. Furthermore, we obtained visual analogue scale (VAS) scores for texture and sound attributes for all foods and fluid conditions. The additional fluids significantly lowered muscle activity and swallowing threshold for melba, cake and peanut. The effect of alpha-amylase in the solutions was rather limited. Doubling the volume of tap water had a larger effect. Several texture and sound attributes of melba, cake and peanut were also significantly affected by the additional fluids. For melba, cake, and peanut we observed significant correlations between the physiology parameters and several attributes for the various fluid conditions. This indicates that the added fluid affects both the physiology (muscle activity and number of cycles) and the sensory perception of a number of texture and sound attributes. Adding fluid facilitates the chewing of dry foods (melba, cake), but does not influence the chewing of fatty (cheese) and wet products (carrot).

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We determined the salivary flow rate in 16 healthy subjects in rest and while chewing artificial and natural foods (Parafilm, Melba toast with and without margarine, and three different volumes of breakfast cake and cheese). We also determined the duration of a chewing cycle, the number of chewing cycles until swallowing, and the time until swallowing. The physical characteristics of the foods were quantified from force-deformation experiments. The flow rates of the saliva as obtained without stimulation, with Parafilm stimulation, and with chewing on the various foods were significantly correlated. An increase in chewing cycle duration, number of chewing cycles until swallowing, and time until swallowing was observed as a function of the volume of the food. More chewing cycles were required for Melba toast than for an equal volume of cake or cheese. This may be caused by the low water and fat percentage of the Melba toast. The number of chewing cycles and the time until swallowing significantly decreased when the Melba toast was buttered. The decrease may be caused by facilitation in bolus formation and lubrication of the food due to buttering the toast. The number of chewing cycles until swallowing was not correlated to the salivary flow rate.

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