Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance

Programa de Doctorat Medicina i Recerca Translacional

Detalles Bibliográficos
Autor: Riera-Punet, Nina
Tipo de recurso: tesis doctoral
Estado:Versión publicada
Fecha de publicación:2019
País:España
Institución:CBUC, CESCA
Repositorio:TDR. Tesis Doctorales en Red
OAI Identifier:oai:www.tdx.cat:10803/667061
Acceso en línea:http://hdl.handle.net/10803/667061
Access Level:acceso abierto
Palabra clave:Esclerosi lateral amiotròfica
Esclerosis lateral amiotrófica
Amyotrophic lateral sclerosis
Masticació
Masticación
Mastication
Ciències de la Salut
616
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repository_id_str
dc.title.none.fl_str_mv Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
title Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
spellingShingle Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
Riera-Punet, Nina
Esclerosi lateral amiotròfica
Esclerosis lateral amiotrófica
Amyotrophic lateral sclerosis
Masticació
Masticación
Mastication
Ciències de la Salut
616
title_short Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
title_full Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
title_fullStr Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
title_full_unstemmed Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
title_sort Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral appliance
dc.creator.none.fl_str_mv Riera-Punet, Nina
author Riera-Punet, Nina
author_facet Riera-Punet, Nina
author_role author
dc.contributor.none.fl_str_mv Martínez Gomis, Jordi
Peraire Ardèvol, Maria
Martínez Gomis, Jordi
Universitat de Barcelona. Facultat de Medicina i Ciències de la Salut
dc.subject.none.fl_str_mv Esclerosi lateral amiotròfica
Esclerosis lateral amiotrófica
Amyotrophic lateral sclerosis
Masticació
Masticación
Mastication
Ciències de la Salut
616
topic Esclerosi lateral amiotròfica
Esclerosis lateral amiotrófica
Amyotrophic lateral sclerosis
Masticació
Masticación
Mastication
Ciències de la Salut
616
description Programa de Doctorat Medicina i Recerca Translacional
publishDate 2019
dc.date.none.fl_str_mv 2019
2019
2019
dc.type.none.fl_str_mv info:eu-repo/semantics/doctoralThesis
info:eu-repo/semantics/publishedVersion
format doctoralThesis
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10803/667061
url http://hdl.handle.net/10803/667061
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 178 p.
application/pdf
application/pdf
dc.publisher.none.fl_str_mv Universitat de Barcelona
publisher.none.fl_str_mv Universitat de Barcelona
dc.source.none.fl_str_mv TDX (Tesis Doctorals en Xarxa)
reponame:TDR. Tesis Doctorales en Red
instname:CBUC, CESCA
instname_str CBUC, CESCA
reponame_str TDR. Tesis Doctorales en Red
collection TDR. Tesis Doctorales en Red
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869424953229574144
spelling Alterations in the masticatory system in patients with amyotrophic lateral sclerosis and its management with an oral applianceRiera-Punet, NinaEsclerosi lateral amiotròficaEsclerosis lateral amiotróficaAmyotrophic lateral sclerosisMasticacióMasticaciónMasticationCiències de la Salut616Programa de Doctorat Medicina i Recerca TranslacionalINTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterised by progressive degeneration of the lower (LMN) and upper motor neurons (UMN) in the spinal cord and brain, causing muscle atrophy, muscle weakness, and spasticity. AIMS: With the present thesis we aimed to investigate the alterations and functional limitations of the masticatory system in patients with ALS. The thesis comprises three articles. METHODS: The first two studies assessed a total of 153 ALS patients and 23 control subjects. In study I, the Diagnostic Criteria for Temporomandibular Disorders protocol (DC/TMD) and a specific questionnaire to assess aspects of masticatory dysfunction and frequency of self-injury of the oral mucosa were applied to all participants. Maximum bite force and maximum finger-thumb grip force were determined. In study II, all participants answered using the 8- item Jaw Functional Limitation Scale (JFLS-8). Patients with ALS were grouped by neurologic examination as follows: non- bulbar ALS, bulbar UMN-predominant ALS; bulbar LMN-predominant ALS; and bulbar balanced (UMN + LMN) ALS. Study III included eleven patients with ALS who sought oral treatment because of oral self-biting or TMD-related symptoms. A custom complete-coverage acrylic resin device was fabricated and fitted to each participant. A follow-up visit was planned for 3 months after the placement of the oral appliance, at which point the patients would rate the degree of improvement or worsening of the chief complaint and their degree of satisfaction with the treatment. RESULTS: Study I showed that maximum unassisted and assisted mouth opening, protrusion, left laterotrusion, and finger-thumb grip force were significantly reduced in both spinal- and bulbar-onset patients compared to the control group; however, bite force was reduced only in bulbar-onset patients. ALS patients with tube feeding had the greatest reduction in maximum bite force and mandibular opening. There was no relationship between TMD and ALS. Oral self-injury due to biting was more frequent in the ALS group than in the control group and in the bulbar-onset group compared to the spinal- and respiratory-onset groups. Of the ALS patients in the study, 10% sought dental treatment related to the condition. Thus, in study II, patients with non-bulbar ALS had similar mandibular limitations to healthy participants. Only patients with balanced UMN and LMN bulbar manifestations reported greater difficulties in chewing soft food or in jaw mobility compared to the non-bulbar ALS group. Patients with bulbar involvement also had greater difficulties in chewing tough food or chicken and in swallowing and talking compared to the non-bulbar group, regardless of whether UMN or LMN predominant. Participants in study III reported a mean of 61% improvement of the chief complaint and a mean of 84% satisfaction with the treatment. The mean rate of compliance was 62% of the recommended time and only a few adverse effects were reported. CONCLUSIONS: Patients with ALS showed a reduction in finger-thumb grip force that was twice as great as the reduction in bite force. The maximum range of mandibular movement was also reduced, especially in bulbar-onset patients. ALS patients did not have a higher prevalence of TMD, but did have more traumatic mucosal injury than controls. Bulbar involvement in patients with ALS is associated with functional limitation of the masticatory system. However, balanced bulbar UMN and LMN involvement is associated with the worst impairments, affecting soft food chewing and opening the jaw widely. Patients with ALS were highly satisfied with the use of an oral appliance to manage oral self-biting or TMD-related symptoms. Adherence to this treatment was high and no major adverse effects were observed. The dentist should be an integral part of the multidisciplinary team to manage ALS patients.INTRODUCCIÓN: La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa caracterizada por la degeneración progresiva de las neuronas motoras inferiores (MNI) y superiores (MNS). OBJETIVOS: El objetivo principal de esta tesis ha sido investigar las alteraciones y limitaciones funcionales del sistema masticatorio en pacientes con ELA. La tesis se ha basado en la integración de tres artículos. MATERIAL Y MÉTODOS: Los dos primeros estudios evaluaron 153 pacientes con ELA y 23 sujetos control. En el primer estudio se aplicó el protocolo de criterios diagnósticos para trastornos temporomandibulares (DC/TMD) y un cuestionario para evaluar aspectos de la disfunción masticatoria y la frecuencia de lesiones orales traumáticas por mordisqueo involuntario. Se determinó la fuerza de mordida y la fuerza muscular entre los dedos pulgar e índice. En el segundo estudio se utilizó la escala de limitación funcional de la mandíbula (JFLS-8). El tercer estudio incluyó a once pacientes con ELA a los que se les colocó un dispositivo intraoral y se valoró el grado de satisfacción y la mejoría en su calidad de vida con el tratamiento. RESULTADOS: En el primer estudio los pacientes con ELA presentaron una reducción en los movimientos mandibulares, en la fuerza de mordida y en la fuerza muscular entre los dedos pulgar e índice. En el segundo estudio, los pacientes con ELA bulbar informaron mayores dificultades para masticar y movilidad mandibular reducida en comparación con el grupo de ELA sin afectación bulbar. Los participantes del tercer estudio informaron una media de un 61% de mejoría con respecto al motivo de consulta y una media del 84% de satisfacción con el dispositivo intraoral. CONCLUSIONES: Los pacientes con ELA presentaron una reducción en la fuerza muscular entre los dedos pulgar e índice y en la fuerza de mordida, un rango de movimiento mandibular reducido y mayor frecuencia de lesiones orales traumáticas por mordisqueo involuntario. La afectación bulbar en estos pacientes está asociada a una limitación funcional del sistema masticatorio. La satisfacción de los pacientes con ELA con un dispositivo oral para controlar las lesiones orales traumáticas por mordisqueo involuntario o los síntomas relacionados con TMD fue alta.Universitat de BarcelonaMartínez Gomis, JordiPeraire Ardèvol, MariaMartínez Gomis, JordiUniversitat de Barcelona. Facultat de Medicina i Ciències de la Salut201920192019info:eu-repo/semantics/doctoralThesisinfo:eu-repo/semantics/publishedVersion178 p.application/pdfapplication/pdfhttp://hdl.handle.net/10803/667061TDX (Tesis Doctorals en Xarxa)reponame:TDR. Tesis Doctorales en Redinstname:CBUC, CESCAInglésADVERTIMENT. L'accés als continguts d'aquesta tesi doctoral i la seva utilització ha de respectar els drets de la persona autora. Pot ser utilitzada per a consulta o estudi personal, així com en activitats o materials d'investigació i docència en els termes establerts a l'art. 32 del Text Refós de la Llei de Propietat Intel·lectual (RDL 1/1996). Per altres utilitzacions es requereix l'autorització prèvia i expressa de la persona autora. En qualsevol cas, en la utilització dels seus continguts caldrà indicar de forma clara el nom i cognoms de la persona autora i el títol de la tesi doctoral. No s'autoritza la seva reproducció o altres formes d'explotació efectuades amb finalitats de lucre ni la seva comunicació pública des d'un lloc aliè al servei TDX. Tampoc s'autoritza la presentació del seu contingut en una finestra o marc aliè a TDX (framing). Aquesta reserva de drets afecta tant als continguts de la tesi com als seus resums i índexs.info:eu-repo/semantics/openAccessoai:www.tdx.cat:10803/6670612026-06-14T12:46:07Z
score 15.300724

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