Masticatory performance in patients with myasthenia gravis

Oral function in patients with myasthenia gravis

Myasthenia Gravis (MG) is characterised by muscle weakness and increased fatigability. The aim of this pilot study was to investigate if patients with MG demonstrate different functional chewing patterns and report more complaints related to mastication as compared with healthy controls. Twelve patients (median 60 years Q1–Q3: 46–70) with generalised MG and nine healthy controls (median 57 years Q1–Q3: 55–63) participated. All participants underwent dental and oral examination and were asked to fill in a questionnaire concerning oral health. Static maximum bite force was measured with a bite force transducer, electromyography in the masseter, temporalis, and suprahyoid muscles were recorded, and jaw movement was tracked, during a 5-minute gum chewing test. The patients had more oral complaints (oral health impact profile total score 22.6 vs 7.5 P < 0.01) and had lower peak bite force than controls (18.8kgf (11.1;26.4) (95% CI) vs 29.5 kgf (21.6; 37.4) (P = 0.04)). In contrast, fatigability of the masticatory muscles, as defined by number of chewing cycles during the gum-chewing test, did not differ between patients and controls (P = 0.10). In conclusion, patients had more oral complaints and lower bite force than controls, but did not show significantly different functional chewing patterns. Future studies should aim at integrating measurement of peak force into functional tests. Attention should be given to oral complaints of patients with MG.

Thymoma associated myasthenia gravis with atypical presentation of lipomatous tongue atrophy: a case report

A 28-year-old female patient came to the outpatient dental clinic for multiple teeth extractions and full mouth rehabilitation suffer from myasthenia gravis (MG) primary presentation as tongue atrophy and facial muscles weakness and the symptoms became worries, the patient unable to speak as well and change her voice and complaining of dysphagia and dysarthria. Oral symptoms, treatment schedule and protocol, the selection, prescription and impacts of medications, and prevention of myasthenic crisis are all important; aspects should be considered by dentists and oral health care providers. Weakness of facial and oropharyngeal muscle is considered very popular at disease onset and therefore oral health providers are often the first medical professionals to observe these patients. Myasthenic patients seek particular approach and consultation in order to ensure ideal and proper dental management.

Functional limitation of the masticatory system in patients with bulbar involvement in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) with bulbar dysfunction affects the motor neurons responsible for controlling the muscles in the jaw, face, soft palate, pharynx, larynx and tongue. This cross-sectional study aimed to determine the functional limitation of the jaw in patients with ALS and bulbar dysfunction who had upper motor neuron (UMN), lower motor neuron (LMN) or balanced involvement. One hundred and fifty-three patients with ALS and 23 controls were included. 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. Jaw limitation between the different groups was compared using the Kruskal-Wallis test. 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. No significant differences were found between the groups in smiling and yawning difficulties. 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 in chewing soft food and in opening the jaw widely.

Dentistry and the myasthenia gravis patient: a review of the current state of the art

Myasthenia gravis (MG) is a chronic neuromuscular disease characterized by muscular weakness and fatigability. Dental management of patients diagnosed with MG presents a challenge to the oral health care provider. The purpose of this article was to review the etiology, pathogenesis, diagnosis, and clinical signs and symptoms associated with MG, highlighting the role of the oral health care provider in the process of diagnosis and management of the oral and dental complications that might be associated with the disease, while avoiding myasthenic crisis. A discussion of the recent approaches to treatment of the disease and current research on MG is presented.

Confiabilidade da eficiência mastigatória com beads e correlação com a atividade muscular

TEMA: a avaliação da eficiência mastigatória pela análise colorimétrica com beads, pode ser um método promissor, mas não há relatos sobre a sua confiabilidade. OBJETIVO: investigar a confiabiabilidade das beads para teste de eficiência mastigatória e a correlação com a atividade eletromiográfica dos músculos masseter e temporal anterior. MÉTODO: participaram dezenove sujeitos adultos jovens, nove do gênero masculino e dez do feminino com idades entre dezoito e vinte-oito anos, com dentição completa, sem histórico de desordem temporomandibular, trauma, cirurgia na região de cabeça e pescoço, tratamento ortodôntico ou fonoaudiológico. O teste de eficiência mastigatória foi realizado com beads nas condições: mastigação habitual, mastigação unilateral direita e esquerda, com duração de 20 segundos. Simultaneamente, foi realizada a eletromiografia. A atividade em máxima intercuspidação habitual dos dentes também foi registrada. A quantidade de fucsina liberada após a mastigação foi medida usando o espectrofotômetro Beckman DU-7 UV-Visible (Beckman Inc., Palo Alto, CA, USA). RESULTADOS: houve alta confiabilidade do teste de eficiência mastigatória (r = 0,86, p < 0,01) e correlação significante com a atividade eletromiográfica (r = 0,76, p < 0,01). Também houve correlações positivas quando as provas foram analisadas separadamente. CONCLUSÃO: o teste de eficiência mastigatória realizado com beads mostrou-se um método confiável e correlacionado positivamente à atividade eletromiográfica dos músculos temporal anterior e músculos masseter.

Dental management of patients with myasthenia gravis: A literature review

Myasthenia gravis is a chronic neuromuscular disease characterized by muscular weakness and fatigability. Dental management of patients diagnosed with myasthenia gravis presents a challenge to the dental profession. A MEDLINE search of the English medical (limited to provision in dental care) and dental literature on myasthenia gravis and dental management published between 1975 and 2004 was conducted. In the dental literature, 12 articles were found, and only a few focused on myasthenia gravis and dental care. The purpose of this article was to review and summarize the clinical signs and symptoms associated with myasthenia gravis, highlighting the role of the dental profession in the process of the diagnosis and management of the oral and dental complications that might be associated with the disease, while avoiding myasthenic crisis.