Anatomical, functional, physiological and behavioural aspects of the development of mastication in early childhood

Adverse childhood experiences and fertility intention among college students in China: moderated mediation effects of resilience and attachment

Background

The declining fertility rates and aging are becoming major demographic and public health challenges. According to the life course theory, an individual’s current fertility intention is shaped by past experiences, with adverse childhood experiences (ACEs) known to have long-term effects on adult physiology, psychology, and society. Existing literature indicates that attachment styles and resilience are important factors in shaping psychological responses to ACEs and may play a role in influencing fertility intentions over time. We aim to investigate how ACEs influences fertility intentions and to identify mechanisms that could inform early intervention strategies.

Methods

We draw a large-scale design at a comprehensive university in eastern China between September 2022 and October 2023. Validated questionnaires assess ACEs, attachment, resilience, and fertility intentions. Latent class analysis identified three distinct ACEs profiles and logistic regression explored the relationship between ACEs and fertility intention. Mediation and moderation models were then tested using the PROCESS in SPSS, with attachment being a mediator and resilience playing a moderating role in the relationship between ACEs and fertility intention.

Results

A total of valid 15,969 samples were included, among which 36.5% of adult students intended to have children. Latent class analysis divided ACEs into Severe Adversity (3.53%), Predominant Neglect (3.39%), and Minimal Adversity (93.07%). Logistic analysis indicates that, compared with Minimal Adversity, Severe Adversity(β =-0.45, P <0.01) and Predominant Neglect(β =-0.29, P =  0.02) significantly lower fertility intentions. Mediation analysis found that ACEs influence fertility intentions through attachment anxiety and avoidance, with different mediation effects depending on adversity patterns. “Severe Adversity” showed full mediation, while “Predominant Neglect” exhibited partial mediation. Higher ACE exposure was linked to greater attachment insecurity, which in turn lowered fertility intentions. Additionally, resilience moderated these pathways, buffering the negative impact of ACEs on attachment.

Conclusions

This study highlights the impact of ACEs on fertility intentions, with attachment and resilience playing key roles. While resilience buffers ACEs’ effects on attachment, it does not directly influence fertility intention, suggesting that strengthening interpersonal relationships is better than resilience alone. Interventions should focus on fostering secure attachment patterns to support positive reproductive decision-making.

Clinical trial

Not applicable.

Time-course changes in videofluoroscopic findings during developmental and aging stages in mice

Videofluoroscopic swallow study methodology in mice has recently been established; however, details of developmental and age-related changes remain unclear. This study aimed to reveal the changes in swallowing associated with the entire lifespan of mice using the videofluoroscopic swallow study methodology. We tested six age groups of male C57BL/6J mice (4, 8, 16, 54, 77, and 104 weeks old; n  = 5 for each group, respectively). The videofluoroscopic swallow study analyzed the bolus area, pharyngeal transit time, interswallow interval, lick-swallow ratio, and lick rate. Significant age differences were found in the bolus area and lick rate. The bolus area increased significantly as the mice grew older. There was a significant increase in the lick rate from 4 to 8 weeks ( P  < 0.001) and then a significant decrease from 8 to 104 weeks ( P  < 0.01). No significant difference was observed between the various stages in the lick-swallow ratio, interswallow interval, or pharyngeal transit time. There was a significant positive correlation between the body weight and bolus area. This study revealed the detailed changes in swallowing at each life stage from swallowing maturation to old age in the mice. Our research may serve as a guide for future studies on swallowing in humans.

Pre-chewing of infant food - expectations towards an old, traditional feeding habit for potential allergy prevention

Premastication is a traditional feeding method whereby solids are pre-chewed by the mother or sometimes by other relatives and then given to the infant along with the oral microbiota. The aim of this study was to assess if premastication is known or performed among the German population as well as to evaluate the expectations regarding this feeding method, particularly in the context of allergy prevention. Two surveys about premastication were conducted. For the survey of the "general population (GP)" 10,000 participants (18 to 65 years old) were randomly selected from the official population register of Berlin. The survey of the "selected population (SP)" was conducted by the patient organization German Allergy and Asthma Association (DAAB). 526 people from the GP and 220 participants from the SP completed the questionnaire. 15.3% (n=114) of all respondents had previously heard of premastication, 1.5% (n=7/455) of the people with children reported that they have performed premastication for their child. 42.8% (n=225) of the GP as well as 36.4% (n=80) of the SP could imagine performing premastication for their future child or grandchild. 59.3% (n=312) of the GP stated that they at least partially think premastication may help to prevent the development of allergies.Premastication appears to be barely known and practiced among the German population. However, a considerable proportion of participants would consider giving pre-chewed food to their infant. A high rate of respondents, especially among the GP, believed that premastication may have a positive impact on the prevention of allergies.

Quantitative Comparison of Age-Related Development of Oral Functions During Growing Age

OBJECTIVES

This cross-sectional study aimed to investigate the age-related development of five major oral functions-tongue pressure, lip pressure, masticatory efficiency, bite force, and occlusal contact area-in subjects aged 5-20 years.

MATERIAL AND METHODS

Ninety-two subjects were divided into four age groups: 5-8, 9-12, 13-16, and 17-20 years. Oral functions were evaluated using standardized methods, including Chew Check Gum for assessing masticatory efficiency, Dental Prescale II for measuring occlusal force and contact area, JMS tongue pressure measuring device for evaluating tongue pressure, and Ripple-Kun for measuring lip pressure.

RESULTS

Occlusal contact area, maximum bite force, tongue pressure, and masticatory efficiency gradually increased with age, whereas lip pressure remained stable. The occlusal contact area temporarily decreased between 5 and 12 years of age, likely due to the replacement of erupting lateral teeth. Some differences were observed between males and females; however, overall trends in oral function parameters were similar. Spearman's rank correlation analyses revealed significant positive correlations between age and occlusal contact area, bite force, tongue pressure, and masticatory efficiency.

CONCLUSIONS

Oral function parameters exhibited different age-related development patterns. Occlusal contact area, maximum bite force, tongue pressure, and masticatory efficiency gradually increased with age. Interestingly, the occlusal contact area tended to reduce temporarily between 5 and 12 years of age due to the replacement of erupting lateral teeth. Conversely, lip pressure was almost stable during this period. Our findings provide valuable insights into the developmental patterns of oral functions during the growing years.

Early Influences on Development of Sensory Perception and Eating Habits

Infancy and early childhood are important periods for the development of food choices and eating preferences that are tracked into adult life, influencing weight gain, body composition, and metabolism and ultimately affecting the balance between health and disease. In this narrative review, we discuss studies focused on the effects of fetal programming and early food experiences, highlighting recent advances in the discovery of factors that contribute to the development of food preferences and eating behavior. Food preference can be influenced by early direct contact with flavors, textures, and aromas, as well as by environmental adversities during early development. Evidence suggests that exposure to intrauterine growth restriction is associated with increased preferences for highly palatable foods, such as those rich in carbohydrates and fats, over the life course. Early flavor experiences, whether from amniotic fluid or human milk, may also shape the development of food preferences. Finally, children are more likely to accept textures that they are able to manipulate, and early exposure to a range of textures facilitates the acceptance of foods of various textures later on. Improving dietary habits during gestation (fetal) and postnatal periods is of critical importance for the establishment of positive eating habits and healthy growth in infants and should be an important focus of primary prevention efforts.

Timing of food pieces introduction and neurodevelopment: findings from a nationwide birth cohort

BACKGROUND

While complementary feeding can be challenging, little emphasis has been placed on the introduction to food texture/pieces, especially in terms of neurodevelopmental outcomes. This study aims to determine the association between the timing of introduction to food pieces during infancy and neurodevelopment in early childhood. We hypothesized that late introduction to food texture/pieces relates to unfavorable neurodevelopmental outcomes.

METHODS

Families (n = 18329) were recruited from the general population during the nationwide ELFE (Étude Longitudinale Française depuis l'Enfance) birth cohort in France, and 8511 were selected for a complete case analysis. Age at introduction to food pieces was determined based on repeated assessments during the first year. A range of neurodevelopmental outcomes among children were assessed using validated instruments, i.e. composite scores at 1 and 3.5 years, and a score for language acquisition at 2 years. Risk for developmental delay at 3.5 years was defined based on a developmental quotient (DQ) below 90 according to the child's chronological age and the respective composite score at this age. We used linear regression modelling to evaluate associations between age at introduction to food pieces and the standardised neurodevelopmental scores, while logistic regression models were used in the analyses according to the risk for developmental delay.

RESULTS

Our findings highlight consistent associations between late introduction to food pieces (i.e., after 10 months, compared to early (before 8 months)) and lower estimates of standardised neurodevelopmental scores at ages 1, 2 and 3.5 years (-0.35 [-0.40; -0.30], -0.15 [-0.20; -0.10] and - 0.18 [-0.23; -0.13], respectively). Infants introduced to pieces late were also more likely to be at risk for developmental delay according to DQ < 90 (OR [95%CI] = 1.62 [1.36; 1.94]).

CONCLUSIONS

This study shows that late introduction to food pieces (> 10 months) is related to lower neurodevelopmental scores. Given the challenges that complementary feeding may pose, concerted efforts are required to enhance our understanding of the sensory aspects of early diets and to ultimately provide guidance.

The test of masticating and swallowing solids (ToMaSS): An investigation of applicability and clinical utility in children with orofacial myofunctional disorders

BACKGROUND

Orofacial myofunctional disorders (OMD) are often associated with limitations of oral ingestion of solid food. The Test of Masticating and Swallowing Solids (ToMaSS) is a simple diagnostic tool to assess and quantify oropharyngeal efficiency while eating a standardised cracker.

OBJECTIVES

The objective of this study was to investigate the applicability and clinical utility of the ToMaSS in children with OMD.

METHODS

In this case-control study, data were collected from 18 children between 4 and 11 years with confirmed OMD. Inter-rater reliability and age effects on the ToMaSS parameters were investigated and the specific performance profile of the OMD children was identified.

RESULTS

Inter-rater reliability was excellent for the ToMaSS parameters 'bites' (ICC = .999), 'masticatory cycles' (ICC = .961), 'time'(ICC≧ .999) and good for 'number of swallows' (ICC = .810). 'Masticatory cycles' and 'time' decreased as a function of age with a significant difference in the 'number of masticatory cycles' between the youngest (4-6 years) and oldest (10-14 years) participants (p = .006, Z = -2.739). Deviations from normative data in at least one of the four ToMaSS parameters were found in 90% of the OMD children with 'bites', and 'masticatory cycles' predominantly corresponding to the performances expected in typically-developing children in younger age groups.

CONCLUSIONS

The ToMaSS is a reliable diagnostic instrument and clinically useful to detect limited efficiency of oral solid bolus intake and specific impairments in chewing function and duration of food intake in children with OMD. Our data suggest that OMD is associated with delayed development of efficient solid bolus preparation.

Food oral processing and eating behavior from infancy to childhood: evidence on the role of food texture in the development of healthy eating behavior

Eating behaviors develop in early life and refine during childhood, shaping long-term food choice and dietary habits, which underpin optimum growth and health. The development of Food Oral Processing (FOP) is of major importance in the establishment of eating behaviors at two scale levels: for the initial acceptance of food texture and for the longer-term development of eating behaviors associated to food intake. To date, both processes have been studied as independent topics and the current review proposes a parallel vision on their development from the onset of complementary feeding to later childhood. Individual factors affecting these FOP-related behaviors as they relate to food texture acceptance are discussed, alongside examples of interventions aiming at modifying them. Opportunity to better consider food textures when designing foods for children is addressed. Altogether, the review demonstrates the critical role of food texture in the development of a child's FOP skills, eating habits, and dietary patterns. These scientific knowledges need to be considered for the development of healthier eating behavior. We identify research gaps that need to be addressed and highlight the need to design foods that can support the development of healthy oral processing and eating behaviors among infants and children.

Potential of 3D printing in development of foods for special medical purpose: A review

Nutritional management has emerged as an effective strategy to mitigate the risks of malnutrition and disease-related mortality among patients. The emergence of novel food types, particularly foods for special medical purposes (FSMPs), has garnered increasing attention from researchers and businesses. 3D printing (3DP) technology, alternatively known as food additive manufacturing, has gained popularity among novel food developers due to its distinct capabilities in tailoring nutrition, appearance, texture, and enhancing overall edible quality. This review examines current market trends, product forms, and unique characteristics of FSMPs, highlighting the progress made in applying 3DP to the development of functional foods and drugs. Despite its potential medical benefits, there are limited instances of direct utilization of 3DP in the production of such specialized food type. Currently, the FSMP market faces several challenges, including limited product diversity, inadequate formula design, and a lack of product appeal. 3DP offers significant advantages in catering to the unique needs of special patients, encompassing both physiological medical benefits and enhanced sensory as well as psychological eating experiences. It holds great promise in promoting precision medicine and personalized home-based FSMPs preparations. This review will delve into the development strategies and feasibility of 3DP in creating specialized medical food for patients with unique conditions and across different age groups. Additionally, it explores the potential challenges of applying 3DP to the FSMP sector, such as regulatory frameworks, patient acceptance, cost of 3D-printed FSMPs, and the improvement of 3DP.

Pediatric Dysphagia

Pediatric dysphagia is a common condition encountered in clinical practice. We review the physiology and development of swallow, presentation, epidemiology, and etiology of dysphagia. Additionally, comorbidities, associated conditions, and medical management of dysphagia are discussed.

Influence of changing dentition on food texture preferences and perception of eating difficulty in Australian children

The transition from primary to permanent dentition is an important phase in children's oral development, yet its impact on texture perception and food acceptance are less explored. This study aimed to investigate how changing dentition and tooth loss influence texture preferences and perception of eating difficulty among children aged 5 to 12 years. Children (n = 475) completed a forced-choice questionnaire featuring drawings of six food pairs, each available in hard or soft texture, and reported whether they had started losing primary teeth and the number of tooth gaps present. They also tasted four samples: chocolate snacks (cake and biscuits) and cheddar cheese (grated and cubes), evaluating their perceived eating difficulty and liking for each sample. Analysis of questionnaire responses showed a general preference for softer food textures among children, with a 36% probability of choosing hard foods. Preferences were not related to child's dental state, including primary teeth loss (p = .13) or number of tooth gaps (p = .45). In the taste test, chocolate biscuits and cheese cubes were perceived as significantly more difficult to eat than chocolate cake and grated cheese, respectively (both p < .0001). Children with more than two tooth gaps reported greater eating difficulty for chocolate biscuits and cheese cubes compared to children with fewer or no tooth gaps. This study demonstrated that children's texture preferences for hardness of foods remained consistent during dentition change, while their perception of eating difficulty could vary based on their dental state at specific points in time.

Food texture experiences across nine age groups in Indian infants from urban areas

The introduction of complementary food plays a fundamental role in dietary behaviours later in life. Little is known about the influences of age on food texture acceptance in young Indian children. Thus, the objective of this cross-sectional study was to describe the relationship between age and food texture experiences in young children aged 4-36 months in India from urban areas using a parental-reported survey. This study relies on a face-to-face parent survey, which was conducted comprising 306 children categorised into 9 age groups. Questions focussed on food texture experience considering 16 textures were analysed. Textures such as dissolvable, sticky, and soupy/liquidy were already accepted by more than half of 4-5-month-old infants. In India, soupy/liquidy is a more common base texture than pureed. Indeed, pureed was found to be introduced to a majority of infants only from 8 to 9 months onwards. Food textures such as rubbery, slippery, and foods with skin were more likely rejected by the youngest children. With increasing age, the refusal probability of food textures decreased. Our survey showed food texture experiences in Indian children aged from 4 to 36 months. It provides useful insights for parents and healthcare professionals by contributing to the understanding of texture acceptance during the transition to complementary foods.

Functional adaptation of the infant craniofacial system to mechanical loadings arising from masticatory forces

The morphology and biomechanics of infant crania undergo significant changes between the pre- and post-weaning phases due to increasing loading of the masticatory system. The aims of this study were to characterize the changes in muscle forces, bite forces and the pattern of mechanical strain and stress arising from the aforementioned forces across crania in the first 48 months of life using imaging and finite element methods. A total of 51 head computed tomography scans of normal individuals were collected and analysed from a larger database of 217 individuals. The estimated mean muscle forces of temporalis, masseter and medial pterygoid increase from 30.9 to 87.0 N, 25.6 to 69.6 N and 23.1 to 58.9 N, respectively (0-48 months). Maximum bite force increases from 90.5 to 184.2 N (3-48 months). There is a change in the pattern of strain and stress from the calvaria to the face during postnatal development. Overall, this study highlights the changes in the mechanics of the craniofacial system during normal development. It further raises questions as to how and what level of changes in the mechanical forces during the development can alter the morphology of the craniofacial system.

Association between occlusal features and masticatory function in Hong Kong preschool children: a survey with one-year longitudinal follow-up

BACKGROUND

Mastication is important for breaking down food, aiding swallowing and nutrients absorption, and is therefore fundamental to a child's development. Studies have shown poor masticatory function to be associated with younger age and presence of caries. However, studies of the association between masticatory function and malocclusion yielded contradictory results. The aim of this study is therefore to investigate the association between three-dimensional occlusal features with masticatory function, among preschool children in Hong Kong.

METHODS

Self-administered questionnaires on masticatory function in three domains, namely general chewing difficulty, requiring help when eating different food types and increased preference for soft food were completed by parents. Information on non-nutritive sucking habits and basic demographics were also collected in the questionnaire. Clinical examinations were conducted to record three-dimensional occlusal features and presence of caries. Baseline investigations and one-year follow-ups were undertaken for 1,566 and 996 preschool children. Association of poor masticatory function with occlusal features, sucking habits and caries was investigated using chi-squared tests. Binomial logistic regressions were then carried out incorporating any significant factors identified. Longitudinal analysis of the one-year follow-up data was carried out to investigate whether improved occlusal features, sucking habits and caries resulted in better masticatory function.

RESULTS

In the cross-sectional study, the first domain of general chewing difficulty was associated with caries and thumb/digit sucking. The second domain of requiring help when eating different food types was associated with the male sex, younger age, caries and pacifier use. The last domain of increased preference for soft foods was associated with caries and thumb/digit sucking. Occlusal features, including abnormal overjet and unilateral permanent molars not in contact, were significantly associated with poor masticatory function in the bivariate analyses, but were not significant in the logistic regressions. In the longitudinal analysis, general chewing difficulty was found to improve in those of older age and those with resolved anterior crossbite. Less help was required to eat meat in those with fewer caries. Similarly, less help was required to eat food containing bones in those with reduced pacifier use. Preferences for eating soft foods was reduced in those who developed a normal overjet.

CONCLUSIONS

The study identified significant relationships between masticatory difficulties and factors associated with age, gender, active caries, and non-nutritive oral habits such as thumb/digit sucking and pacifier use. Younger children and males required more assistance with certain food types. Active caries and thumb/digit sucking habits contributed to general masticatory difficulties and preference for soft foods. The one-year follow-up indicated that improvement in masticatory function varies across age cohorts and were associated with improved occlusal features, such as resolution of anterior crossbite and normalized overjet, reduced pacifier use, and a decrease in the number of decayed teeth.

The effect of a soft diet on molar dentin formation during the occlusal establishment period

OBJECTIVE

This study intends to investigate the effect of a soft food diet on molar dentin formation during the occlusal establishment period. It can provide dietary guidance for infants to strengthen their dental structure.

DESIGN

60 BALB/c mice were used to obtain mandibles during lactation (P0.5, P7.5, P15.5, P21.5) and occlusal establishment (P27.5, P33.5, P60.5). The mice were randomly divided into soft or hard diet groups after weaning at day 21.5. Hematoxylin-eosin and aniline blue staining were used to observe the morphology and number of odontoblasts and the amount of molar dentin formation. Immunohistochemistry was performed to observe the proliferation and apoptosis of odontoblasts. The in vivo fluorescence double-labeling was applied to evaluate the rate of molar dentin formation.

RESULTS

The soft diet group had poorer periodontal membrane development but more cervical dentin deposition. Alterations in morphology and the number of odontoblasts showed a stronger correlation with age rather than food hardness. There are no significant differences in proliferative and apoptotic behavior of dentin-forming cells between the two groups. Rather, it affected the rate of dentin deposition. The rate of dentin deposition was high in the soft diet group from P21.5 to P27.5, but it was surpassed by the hard diet group within P27.5-P33.5, and the difference between the two groups disappeared at P33.5-P60.5.

CONCLUSIONS

A soft diet promotes molar early cervical dentin formation. This advantage is caused by an enhanced odontoblast secretion rate rather than affecting the morphology, number, proliferation, or apoptosis of odontoblasts.

Chewing skills in two and three year old children: Gender and age comparisons on an adapted version of the test of mastication and swallowing (TOMASS-C)

PURPOSE

Few assessment tools objectively measure chewing skills in the paediatric population. There is a need for assessment tools that use consistent foods so comparisons can be made between typically developing children and children with paediatric feeding disorders, and to measure the efficacy of treatment. The Test of Masticating and Swallowing Solids for adults (TOMASS) and children (TOMASS-C) are assessments that use a cracker as a consistent measure to assess chewing skills. Normative data exist for children over 4 years, however, no data are available for younger children. This study investigated age and gender-related differences in mastication skills in typically developing children aged 2-3 years when eating a cracker.

METHOD

Thirty participants aged 2;0-3;10 were assessed using an adapted version of the TOMASS-C. Participants were required to eat a single Arnott's Salada cracker, and the number of bites, masticatory cycles, swallows, and duration of time to finish the cracker were measured.

RESULT

Two-year-old children used more masticatory cycles and took longer to finish the cracker than 3-year-old children. There were no significant effects of age on the number of swallows and number of bites, and no significant differences between boys and girls.

CONCLUSION

This study provides preliminary normative data for chewing skills in children aged 2 and 3 years and confirms that the TOMASS-C is sensitive to developmental changes in mastication within this younger age range. These results expand our understanding of oral motor and chewing development in children.

Medication adherence and pharmaceutical design strategies for pediatric patients: An overview

Medication adherence in pediatric patients is a key factor in drug development and dosage form design. High medication adherence is not only important to achieve the expected treatment effects but can also effectively reduce medical costs. It is an ongoing task to accurately identify differences in medication adherence between children and adults and analyze the factors related to pediatric medication adherence. This is necessary to guide the development of pediatric drugs. This review focuses on factors that influence pediatric medication adherence as well as pharmaceutical design strategies to improve adherence. Current new dosage forms, new technologies, and new devices are comprehensively summarized in terms of their advantages and limitations.

Taking shape: A geometric morphometric analysis of the immature human palate in relation to dental eruption and growth

BACKGROUND

The immature human palate functions in suckling and swallowing but transitions to participate in mastication and sound production as the individual grows and matures. Functional alterations manifest as changes in the morphology of the palate and may result from dental eruption. The aim of this study was to analyse the effect of dental eruption on morphological changes of the palate in immature individuals using geometric morphometrics.

METHODS

Crania from 72 individuals were sourced from the Raymond A. Dart Collection of Human Skeletons, University of the Witwatersrand. Age groups corresponding to the eruption of the deciduous (birth - 5 years), mixed (6-12 years) and permanent dentition (13-20 years) respectively were used. Fourteen osteological landmarks were digitised across the oral surface of the palate and were converted into linear distances and 3D wireframes. Data analysis focused on alterations in shape and size relative to the state of the dentition.

RESULTS

A significant increase in the geometric mean, length and width was observed between the different states of the dentition. The palate shape was long and narrow in the permanent dentition group, resulting in a more acute angle anteriorly and a protruded orale. A protrusion of the staphylion and deeper palatal dome and change in the horizontal alignment of the alveolar region were also observed in the permanent dentition group.

CONCLUSION

The subtle changes identified in the growing palate during different stages of the dentition may assist forensic scientists during detailed case analysis.

Association of masticatory efficiency with deep carious lesions in children

PURPOSE

Masticatory efficiency is defined as an individual ability to grind and pulverize food material, and can be influenced by many factors. This research aimed to investigate the association between masticatory efficiency and deep carious lesion.

METHODS

The research included 48 children (24 male, 24 female) aged from 3 to 14 years. Participants were allocated to two groups; children with no or with only incipient carious lesions were included in the first group (ICDAS levels 0, 1, or 2), and children with bilateral deep carious lesions that are ICDAS levels 4, 5, and 6 were included in the second group. Information on dental parameters (dental status, ICDAS level of each carious lesion), and level of pain (Wong-Baker scale) were collected from each participant. Participants chewed Optosil® test food for 20 masticatory cycles, and chewed particles were analyzed by the optical scanning method.

RESULTS

There is a significant difference in masticatory efficiency variables (number of chewed particles, minimal and maximal Feret diameter, Sauter mean diameter, a mean and total surface of particles) between groups. A positive significant correlation is observed between WBS level and time needed for masticatory performance in a group of children with deep carious lesions.

CONCLUSION

Deep carious lesions in children are associated with a decrease in masticatory efficiency. Moreover, children with carious lesions that provoke a higher level of pain take more time for masticatory cycles.

The Effect of Caries on the Chewing Ability of Children: A Scoping Review

Childhood caries might have several effects on the children's general health and growth, including chewing ability. This study aims to identify the evidences found regarding the effect of caries on the chewing ability of children through a scoping review. A scoping review literature search was performed in three databases (Scopus, PUBMED, and Web of Science) without restricting the publicized year. The selected articles were using human as its subjects and aiming to analyze the effects of caries on mastication ability in children. Ten articles matched the inclusion criteria of this review. All the articles suggested a deleterious effect of caries on masticatory performance, maximum bite force, swallowing threshold, and even masticatory behavior. Two of them stated that the effect was reversible by giving dental treatment. This scoping review concludes a negative effect of caries on the children's chewing ability.

Nutrient density and oral processing properties of common commercial complementary porridge samples used in southern Africa: Effect on energy and protein intakes among children aged 6-24 months

Child malnutrition is an endemic public health problem in Africa. Infants are supposed to receive complementary foods from about 6 months onwards, as breastmilk alone no longer provide adequate nutrients. Commercially available complementary foods (CACFs) form an important part of baby foods in developing countries. However, systematic evidence on whether they really meet optimal quality specifications for infant feeding is limited. Some CACFs commonly used in Southern Africa and other parts of the world were investigated to establish if they meet optimal quality standards for protein and energy content, viscosity, and oral texture. For the energy content, most CACFs for 6-24-month-old children both in the dry and ready-to-eat forms (range: 372.0-1816.0 kJ/100 g), were below Codex Alimentarius guidelines. The protein density of all CACFs (0.48-1.3 g/100 kJ) conformed with Codex Alimentarius requirements, but some (33%) were below the minimum World Health Organization (World Health Organization. Regional Office for Europe (2019a). Commercial foods for infants and young children in the WHO European region) target of 0.7 g/100 kJ. Most CACFs had high viscosity values even at high shear rate of 50 s-1 , and were too thick or thick, sticky, grainy, and slimy, which may limit nutrient intake in infants, potentially causing child malnutrition. There is a need to improve the oral viscosity and sensory texture of CACFs for better nutrient intake by infants.

Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder

This study evaluates the masticatory efficiency in patients with craniofacial disorders (CD) compared to controls (C). A total of 119 participants (7-21 years), divided into CD group (n = 42, mean age 13.45 ± 5.2 years) and C group (n = 77, mean age 14.3 ± 3.27 years) under an orthodontic treatment were included. Masticatory efficiency was assessed using a standard food model test. The masticated food was examined according to its number of particles (n) and area (mm²), wherein a higher number of particles alongside a smaller area was an indication of better masticatory efficiency. Additionally, the influence of cleft formation, chewing side, dentition stage, age and sex were evaluated. Patients with CD chewed the standardized food in fewer particles (n_CD = 61.76 vs. n_C = 84.58), with a significantly higher amount of area than the controls (A_CD = 192.91 mm² vs. A_C = 146.84 mm²; p = 0.04). In conclusion, patients with CD showed a significantly decreased mastication efficiency compared to healthy patients. Factors such as stage of cleft formation, chewing side, dentition stage and age showed an influence on masticatory efficiency, whereas no gender effect on the masticatory efficiency of CD patients was found.

Can lingual spurs alter the oral health-related quality of life during anterior open bite interceptive treatment? A systematic review

INTRODUCTION

The use of lingual spurs has been described as one efficient option, with great stability of results, but with scarce information of toleration for use in the mixed and permanent dentition phases.

OBJECTIVE

The purpose of this study was to assess the impact of lingual spurs on the oral health-related quality of life of children and/or adolescents during anterior open bite treatment.

METHODS

The review was recorded in the PROSPERO database. Eight electronic databases and partial gray literature were searched, without restrictions until march 2022. A manual search was also performed in the references of the included articles. Studies assessing the impact of lingual spurs on the oral health-related quality of life were included. Risk of bias was assessed using JBI or ROBINS-I tool, according to the study design. The level of evidence was assessed through GRADE.

RESULTS

Five studies met the eligibility criteria. Two non-randomized clinical trials had a serious risk of bias. Of the case-series studies, two had a low risk of bias and the other, a moderate risk of bias. The certainty of the evidence was classified as very low for all the evaluated results. In general, the studies reported an initial negative impact with the use of lingual spurs, however this was transitory in nature. A quantitative analysis was not performed due to the great heterogeneity between the studies.

CONCLUSION

Current evidence, although limited, suggests that lingual spurs have an initial transient negative impact during interceptive treatment. Additional well-conducted randomized clinical trials are needed.

Comprehensive Dental Treatment under General Anesthesia Improves Mastication Capability in Children with Early Childhood Caries-A One-Year Follow-Up Study

BACKGROUND

Using the granulometry of ready-to-swallow food boluses, this study investigated the evolution of masticatory capability of children with Early Childhood Caries (ECC) after comprehensive dental treatment under general anesthesia (GA).

METHODS

Sixteen children with ECC were assessed before and over one year after dental treatment under GA, in comparison with 12 children with a Healthy Oral State (HOS). Oral health criteria, quality of life, body mass index, and frequency of orofacial dysfunctions were recorded. Masticatory kinematic parameters and median food bolus particle size (D50) at swallowing were assessed while masticating raw carrot (CAR), cheese (CHS), and breakfast cereals (CER). The impact of posterior teeth extractions was analyzed.

RESULTS

Quality of life and orofacial functions improved after dental treatment. Chewing frequency for all three foods increased without reaching the values of children with HOS, while D50 values for CAR and CHS decreased. After one year, children with posterior teeth extractions exhibited higher D50 values for CAR and CHS than children with only conservative treatment. One third of children with ECC were overweight or obese.

CONCLUSIONS

Comprehensive dental treatment improved children's mastication, and their BMI subsequently increased. Links between mastication and nutrition should be investigated further in children.

A review on children's oral texture perception and preferences in foods

Texture properties of foods are particular drivers for food acceptance and rejection in children. The texture preferences follow the developmental progression of the child and these changes modulate the present and future food habits. This paper reviews the development and factors influencing texture preferences in children and the methods in food texture research with children. The child's acceptance of more complex food textures is age-dependent. The progression is indorsed by the development of oral processing skills at an early age and bolstered by repeated exposures to foods with varying textures. Children generally reject foods containing pieces or bits (i.e., geometrical textural properties); however, the impact of mechanical textural properties on food acceptance is less clear. Child characteristics such as food neophobia, picky eating, and tactile over-responsivity, negatively affect the acceptance of more diverse food textures. Depending on the child's age, the prevailing methods of characterizing food texture preferences in children include observational techniques and self-reported questionnaires. Despite knowledge of children's development of masticatory skills, learning, and cognitive abilities, the relationships of these changes to food texture acceptance and the recommended test methodology for evaluating product texture acceptance in this period of life are still limited.

Macroglossia and less advanced dystrophic change in the tongue muscle of the Duchenne muscular dystrophy rat

Background

Duchenne muscular dystrophy (DMD) is an X-linked muscle disease caused by a complete lack of dystrophin, which stabilizes the plasma membrane of myofibers. The orofacial function is affected in an advanced stage of DMD and this often leads to an eating disorder such as dysphagia. Dysphagia is caused by multiple etiologies including decreased mastication and swallowing. Therefore, preventing the functional declines of mastication and swallowing in DMD is important to improve the patient’s quality of life. In the present study, using a rat model of DMD we generated previously, we performed analyses on the masseter and tongue muscles, both are required for proper eating function.

Methods

Age-related changes of the masseter and tongue muscle of DMD rats were analyzed morphometrically, histologically, and immunohistochemically. Also, transcription of cellular senescent markers, and utrophin (Utrn), a functional analog of dystrophin, was examined.

Results

The masseter muscle of DMD rats showed progressive dystrophic changes as observed in their hindlimb muscle, accompanied by increased transcription of p16 and p19. On the other hand, the tongue of DMD rats showed macroglossia due to hypertrophy of myofibers with less dystrophic changes. Proliferative activity was preserved in the satellite cells from the tongue muscle but was perturbed severely in those from the masseter muscle. While Utrn transcription was increased in the masseter muscle of DMD rats compared to WT rats, probably due to a compensatory mechanism, its level in the tongue muscle was comparable between WT and DMD rats and was similar to that in the masseter muscle of DMD rats.

Conclusions

Muscular dystrophy is less advanced in the tongue muscle compared to the masseter muscle in the DMD rat.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13395-022-00307-7.

A dynamic in vitro oral mastication system to study the oral processing behavior of soft foods

A bolus-oriented artificial oral mastication system was developed to simulate the dynamics of food mastication in the human mouth. The system consists of a chewing unit, a bolus forming unit, and provisions for the dynamic incorporation of saliva during mastication. The system performance was validated with in vivo trials (n = 25) considering time-dependent changes in particle size, textural attributes and rheological behavior of the bolus. Idli, a fermented and steamed black gram-rice-based Indian food was considered the model soft food for all trials measured in triplicates. The mastication dynamics were evaluated by analyzing bolus properties during every 3 s of mastication. Large strain shear rheology tests revealed that the viscosity of the sample decreased over time. Results of in vivo trials follow close trends in particle size and rheological behavior and have no significant change in correlation with in vitro mastication results. Similar observations were made in the half softening time of idli during mastication as determined using the relative change in hardness (hardness ratio (H_t/H₀)) values fitted to the Weibull model. Also, a model to simulate the time-dependent changes in bolus adhesiveness was developed.

Real-world evidence of the impact of obesity on residual teeth in the Japanese population: A cross-sectional study

BACKGROUND

Tooth loss is associated with nutritional status and significantly affects quality of life, particularly in older individuals. To date, several studies reveal that a high BMI is associated with tooth loss. However, there is a lack of large-scale studies that examined the impact of obesity on residual teeth with respect to age and tooth positions.

OBJECTIVE

We assessed the impact of obesity on the number and position of residual teeth by age groups using large scale of Japanese database.

METHODS

This was a cross-sectional study of 706150 subjects that were included in the database that combined the data from health insurance claims and health check-up, those lacking information about BMI, HbA1c level, smoking status, and the number of residual teeth were excluded. Thus, a total of 233517 aged 20-74 years were included. Subjects were classified into 4 categories based on BMI, and the number of teeth was compared between age-groups. The percentage of subjects with residual teeth in each position was compared between groups with obesity (BMI ≥25.0 kg/m2) and non-obesity. Logistic regression analysis was performed to clarify whether obesity predicts having <24 teeth.

RESULTS

Higher BMI was associated with fewer teeth over 40s (P for trend <0.0001 when <70s). Obesity was associated with the reduction of residual teeth in the maxillary; specifically, the molars were affected over the age 30. Smoking status further affected tooth loss at positions that were not affected by obesity alone. After adjusting for age, sex, smoking status, and HbA1c ≥6.5%, obesity remained an independent predictive factor for having <24 teeth (ORs: 1.35, 95% CIs: 1.30-1.40).

CONCLUSIONS

We found that an increase in BMI was associated with a decrease in the number of residual teeth from younger ages independently of smoking status and diabetes in the large scale of Japanese database.

"Baby-led weaning" - Progress in infant feeding or risky trend?

Baby-led weaning (BLW), proposed as a new form of complementary feeding, has emerged as a real trend phenomenon in the media. Infants are seated at the family table from the age of 6 months, facing the foods they grab and bring to their mouth: they decide which foods they want to eat and what amount. The consumption of mashed foods and the use of a spoon are totally discouraged. BLW is increasingly used in nurseries and centers of young children. A bibliographic search carried out between 2000 and 2021 found 423 articles, of which 38 were selected. The clinical studies selected are 11 cross-sectional observational studies and two randomized controlled studies. BLW promotes breastfeeding, the early introduction of morsels, the respect of the child's appetite, the use of unprocessed foods, and the choice of "homemade" and friendliness. These benefits can nonetheless be reached with usual complementary feeding (SCF), according to current recommendations. Other benefits are claimed without scientific evidence such as easier achievement of dietary complementary feeding and an optimal growth with prevention of excess weight gain. BLW has some obvious downsides. The infant may not get enough energy, iron, zinc, vitamins, and other nutrients, or too much protein, saturated fat, salt, or sugar. The risk of choking, which must be distinguished from the physiological gagging reflex, has not been ruled out by scientific studies. Currently, the Nutrition Committee of the French Pediatric Society considers that the data published to date in terms of benefits and risks of BLW do not lend themselves to advice for this practice in preference over SCF carried out according to current recommendations.

Beyond language: The unspoken sensory-motor representation of the tongue in non-primates, non-human and human primates

The English idiom "on the tip of my tongue" commonly acknowledges that something is known, but it cannot be immediately brought to mind. This phrase accurately describes sensorimotor functions of the tongue, which are fundamental for many tongue-related behaviors (e.g., speech), but often neglected by scientific research. Here, we review a wide range of studies conducted on non-primates, non-human and human primates with the aim of providing a comprehensive description of the cortical representation of the tongue's somatosensory inputs and motor outputs across different phylogenetic domains. First, we summarize how the properties of passive non-noxious mechanical stimuli are encoded in the putative somatosensory tongue area, which has a conserved location in the ventral portion of the somatosensory cortex across mammals. Second, we review how complex self-generated actions involving the tongue are represented in more anterior regions of the putative somato-motor tongue area. Finally, we describe multisensory response properties of the primate and non-primate tongue area by also defining how the cytoarchitecture of this area is affected by experience and deafferentation.

Study of Orofacial Function in Preschool Children Born Prematurely

Children born prematurely often exhibit orofacial dysfunction. We conducted Nordic Orofacial Test Screening and analyzed chewing and swallowing functions of 243 children aged 3−5 years, consisting of 142 and 101 children born full-term and preterm, respectively, to evaluate the orofacial function of preschool premature children. Categorical variables were analyzed using chi-square test for a comparison. The univariate analysis of variance was used to analyze the effects of birth weight, gestational age, intubation at birth, use of nasal continuous positive airway pressure support after birth, and use of nasogastric tube on the chewing and swallowing functions of children born prematurely. In this survey, term-born children had a higher incidence of bad oral habits, grinding teeth while sleeping, and abnormal gulping compared to preterm-born children. Preterm-born children had a higher incidence of choking, decreased mouth opening (<30 mm), abnormal dental arch form, abnormal palatal vault, and dysarthria compared to term-born children.

Examining the Role of Food Form on Children's Self-Regulation of Energy Intake

Increasing childhood obesity rates in both the United States and worldwide demonstrate a need for better prevention and intervention strategies. However, little is understood about what factors influence children's ability to sense and respond to hunger and fullness cues, a critical component of self-regulation of energy intake and maintenance of a healthy body weight. Research in adults suggests that food form may influence self-regulation of energy intake. More specifically, beverages are not as satiating as solid foods when matched for factors such as energy content, energy density, and volume and therefore elicit poorer energy intake self-regulation. However, much less is known about the impact of food form on children's ability to regulate their energy intake. This report describes a study that will examine the relationship between biological, cognitive, and psychological factors and children's appetite self-regulation (ASR). In this registered report, we will examine the influence of food form on children's short-term energy compensation, a proxy indicator of energy intake self-regulation. The study will employ a within-subjects, crossover design in which children (n = 78) ages 4.5-6 years will attend five laboratory visits, each ~1 week apart. During each visit, children will be presented with one of five possible preload conditions: apple slices, apple sauce, apple juice, apple juice sweetened with non-nutritive sweetener (NNS), or no preload. The order of preload conditions will be pseudorandomized and counterbalanced across participants. Following consumption of the preload (or no preload), children will consume a standardized ad libitum test meal of common foods for this age group. We hypothesize that children will demonstrate poorer short-term energy compensation (greater meal intake) in response to the liquid and semi-solid preloads compared to the solid preload. Understanding how energy in various forms affects children's ability to self-regulate intake has implications for dietary recommendations and will help identify those who are most at-risk for poor intake regulation and the development of obesity.

The Ogival Palate: A New Risk Marker of Sudden Unexpected Death in Infancy?

OBJECTIVE

Ogival palate (i.e., a narrow and high-arched palate) is usually described in obstructive breath disorder but has been found in infants unexpectedly deceased. We studied the association between ogival palate and sudden unexpected death in infancy (SUDI) on the basis of a computed tomography (CT) evaluation.

METHODS

We conducted a monocentric case-control study of children under 2 years of age who died of SUDI, for which a head CT scan and an autopsy were performed between 2011 and 2018. Each case was matched by sex and age (± 30 days) to two controls selected among living children in the same center who benefited from a cranio-encephalic CT scan. Four parameters of the hard palate were measured by CT: height, width, length, and sagittal angle; the height/width ratio was calculated. The presence of an ogival palate was also subjectively evaluated by the radiologists, independently from the measurements. Standardized odds ratios (OR) were calculated using conditional logistic regression models, all expressed for +1 standard deviation (SD).

RESULTS

Thirty-two deceased children were matched to 64 living control children. Mean ages were 5.0 and 5.3 months, respectively. Twenty-eight cases were considered to have died as a result of SIDS. The mean heights of the hard palate were significantly higher in the deceased children [4.1 (± 0.7) millimeters (mm)] than in the living children [3.2 (± 0.6) mm], with OR (+1SD) = 4.30 (95% confidence interval [CI], 2.04-9.06, P = 0.0001). The mean widths of the hard palate were 21.0 (± 1.9) mm and 23.2 (± 2.1) mm, respectively, with OR = 0.15 (95% CI, 0.06-0.40, P = 0.0001). The mean sagittal angles were significantly more acute in deceased children [134.5° (± 9.3)] than in living children [142.9° (± 8.1)], with OR = 0.28 (95% CI, 0.14-0.56, P = 0.0003). The mean height/width ratios were 19.8 (± 3.7) and 14.1 (± 3.3), respectively, with OR = 6.10 (95% CI, 2.50-14.9, P = 0.0001). The hard palate was subjectively considered as ogival in 59.4% (19/32) of the cases versus 12.5% (8/64) of the controls.

CONCLUSION

Radiological features of the ogival palate were strongly associated with SUDI. This observation still needs to be confirmed and the corresponding clinical features must be identified.

Health-related marketing messages on product labels of commercial infant and toddler food packaging in Australia: a cross-sectional audit

Background

Proper nutrition in early childhood is essential to ensure optimal growth and development. Use of ‘better-for-you’ features on food packaging position products as healthier for children. This study aims to systematically explore the use of better-for-you labelling on infant and toddler food packaging.

Methods

A cross-sectional audit of health and nutrition claims, text and images used as ‘better-for-you’ features present on infant and toddler food packaging. Data on infant and toddler food packaging were collected from five large grocery stores in Adelaide, Australia in 2019. The content of 282 unique commercial products (n=215 infant foods, n=67 toddler foods) were analysed for explicit and implicit features positioning them as better-for-you, including health and nutrition claims as well as text and images representing ‘natural.’

Results

At least one feature of better-for-you positioning was identified on all food packaging coded. All products had characteristics coded as ‘natural’. Almost one-fifth (17%) of the products included statements in addition to mandatory allergen labelling that their products were ‘free from’ certain allergens, or gluten. One-third of the labels had statements related to enhancing development of taste, oro-motor skills and other aspects of childhood development. Of the fruit and vegetable-based infant foods displaying a sugar statement suggesting a low sugar content, 85% were sweetened with fruit puree.

Conclusions

The use of better-for-you features on infant and toddler food packaging is common and pervasive. Allergen-free and developmental claims are being used to position infant and toddler foods as better-for-you. Regulation of toddler food products separately from adult food is required, as is tighter regulation of the appropriate use of sugar and fruit puree statements on infant and toddler food packaging.

Food texture experiences across age groups in 4- to 36-month-old children in the United States

The question of what to feed becomes a new challenge as an infant reaches the transition to complementary foods. Limited information is available that provides a texture progression map for complementary food introduction. Thus, the objective of this study was to determine the relationship between age and food texture experiences (FTE) in young children aged 4-36 months in the United States. A parent-reported survey was fielded with 328 children categorized into five age groups (AGs): 4-8 months (AG1), 9-12 months (AG2), 13-18 months (AG3), 19-24 months (AG4), and 25-36 months (AG5). The present study analyzed four questions focused on FTE, with statistical analyses including probit and logit models, and analysis of variance. Results showed that all 16 food textures were tried at least once (>50%) by AG3. The question answered by participants, "How well does your child manage a specific texture," showed that significant differences existed among AGs for the management of 10 food textures (including chewy, hard, soft), whereas teething alone had no effect. The most refused textures by the children were AG1-crispy (27%), AG2-leafy (23%), AG3-leafy (40%), AG4-tough meat (52%), and AG5-leafy (51%). With increasing AG, the refusal probability of nine food textures, including chewy, leafy, and rubbery, also increased (p < .05). The refusal probability of cold food temperatures decreased with increasing age (p < .05). This study observed FTE in children across AGs and provides useful information to parents and practitioners as they introduce food textures into children's diets.

Children who have more toothache-related behaviors have worse masticatory performance

Inadequate masticatory function can be linked to oral problems and result in functional limitation. In children, this function is extremely important for their development, and therefore efforts are made to keep it adequate. To evaluate whether dental pain-related behaviors are associated with masticatory performance (MP). A cross-sectional study was conducted with a sample of 123 children from 3 to 5 years old. Toothache was evaluated using the Dental Discomfort Questionnaire. Anthropometric data, predominant type of breathing, presence of malocclusion, number of posterior teeth cavitated by dental caries, and masticatory units were collected. MP was measured by the median size of the crushed particles (X₅₀ ) after 20 cycles of chewing the Optocal test material and was calculated with the Rosin-Rammler equation. Data analysis involved a description of variable frequencies, as well as simple and multiple linear regression, and a confidence level set at 95%. The mean scores of dental pain-related behaviors were 1.14 (±1.90) points, and the mean X₅₀ value was 3.96 mm (±1.34). In the multiple linear regression, a larger median size of the particles remained associated with a higher score of dental pain-related behaviors (β = +.81, p = .01); mouth breathing (β = +.22, p = .01); and a smaller number of masticatory units (β = -.22, p = .02). Greater dental pain-related behavior scores are associated with worse MP, regardless of the presence of associations with predominantly oral breathing and fewer chewing units.

Growth of Neanderthal infants from Krapina (120-130 ka), Croatia

Modern humans have a slow and extended period of childhood growth, but to what extent this ontogenetic pathway was present in Neanderthals is debated. Dental development, linked to the duration of somatic growth across modern primates, is the main source for information about growth and development in a variety of fossil primates, including humans. Studies of Neanderthal permanent teeth report a pace of development either similar to recent humans or relatively accelerated. Neanderthal milk teeth, which form and emerge before permanent teeth, provide an opportunity to determine which pattern was present at birth. Here we present a comparative study of the prenatal and early postnatal growth of five milk teeth from three Neanderthals (120 000-130 000 years ago) using virtual histology. Results reveal regions of their milk teeth formed quickly before birth and over a relatively short period of time after birth. Tooth emergence commenced towards the earliest end of the eruption schedules displayed by extant human children. Advanced dental development is consistent with expectations for Neanderthal infant feeding.

Texture Consumption Patterns of 8- to 12-Month-Old Infants: A Reflection of Typical Feeding Development

Purpose The lack of age-appropriate expectations for the acquisition of feeding skills and consumption of textured food in early childhood inhibits early and accurate identification of developmental delay in feeding and pediatric feeding disorder. The objective of this study was to describe texture intake patterns in a cohort of typically developing infants between 8 and 12 months of age, with the aim of informing future research to establish targets for feeding skill acquisition. Method Using cross-sectional methodology, we studied the presence of liquid and solid textures and drinking methods in the diet, consumption patterns by texture and drinking methods, and caloric intake by texture via caregiver questionnaire and 3-day dietary intake record in 63 healthy infants between 8 and 12 months of age. Descriptive statistics and a one-way analysis of variance were conducted to compare the effect of age on texture intake patterns. Results Findings reveal rapid advancement of intake patterns for texture overall and for energy intake by texture between 8 and 12 months of age. Whereas liquids continue to provide a large proportion of total energy through this time, solids contribute an equal proportion of energy by 12 months of age. Conclusions This study describes texture intake patterns in a cohort of typically developing infants between 8 and 12 months of age by examining the presence of texture and drinking methods, liquid and solid consumption patterns, and energy intake by texture. When applied to data from a future population sample, findings will provide a threshold for age expectations for typical and disordered feeding development to aid in the detection of developmental delay in feeding and pediatric feeding disorder. What Is Known: Expectations regarding early feeding development have been focused on nutrition parameters. Lack of standardized, age-appropriate expectations for texture progression in infancy and early childhood inhibits early and accurate identification and treatment of pediatric feeding disorder. What Is New: We have described changes in dietary composition by texture and drinking method in healthy infants. Together with nutritional composition, this study describes a more comprehensive assessment of infant feeding, particularly to clinicians who need to diagnose feeding skill deficits. Supplemental Material https://doi.org/10.23641/asha.16879615.

Determination of Chewing Count from Video Recordings Using Discrete Wavelet Decomposition and Low Pass Filtration

Several studies have shown the importance of proper chewing and the effect of chewing speed on the human health in terms of caloric intake and even cognitive functions. This study aims at designing algorithms for determining the chew count from video recordings of subjects consuming food items. A novel algorithm based on image and signal processing techniques has been developed to continuously capture the area of interest from the video clips, determine facial landmarks, generate the chewing signal, and process the signal with two methods: low pass filter, and discrete wavelet decomposition. Peak detection was used to determine the chew count from the output of the processed chewing signal. The system was tested using recordings from 100 subjects at three different chewing speeds (i.e., slow, normal, and fast) without any constraints on gender, skin color, facial hair, or ambience. The low pass filter algorithm achieved the best mean absolute percentage error of 6.48%, 7.76%, and 8.38% for the slow, normal, and fast chewing speeds, respectively. The performance was also evaluated using the Bland-Altman plot, which showed that most of the points lie within the lines of agreement. However, the algorithm needs improvement for faster chewing, but it surpasses the performance of the relevant literature. This research provides a reliable and accurate method for determining the chew count. The proposed methods facilitate the study of the chewing behavior in natural settings without any cumbersome hardware that may affect the results. This work can facilitate research into chewing behavior while using smart devices.

In vitro models of gut digestion across childhood: current developments, challenges and future trends

The human digestion is a multi-step and multi-compartment process essential for human health, at the heart of many issues raised by academics, the medical world and industrials from the food, nutrition and pharma fields. In the first years of life, major dietary changes occur and are concomitant with an evolution of the whole child digestive tract anatomy and physiology, including colonization of gut microbiota. All these phenomena are influenced by child exposure to environmental compounds, such as drugs (especially antibiotics) and food pollutants, but also childhood infections. Due to obvious ethical, regulatory and technical limitations, in vivo approaches in animal and human are more and more restricted to favor complementary in vitro approaches. This review summarizes current knowledge on the evolution of child gut physiology from birth to 3 years old regarding physicochemical, mechanical and microbial parameters. Then, all the available in vitro models of the child digestive tract are described, ranging from the simplest static mono-compartmental systems to the most sophisticated dynamic and multi-compartmental models, and mimicking from the oral phase to the colon compartment. Lastly, we detail the main applications of child gut models in nutritional, pharmaceutical and microbiological studies and discuss the limitations and challenges facing this field of research.

Association of obesity, diabetes, and physical frailty with dental and tongue-lip motor dysfunctions in patients with metabolic disease

OBJECTIVE

This study aimed to reveal the clinical features associated with decreased dental (or shearing/crushing) and tongue-lip motor functions in patients with metabolic diseases.

METHODS

One thousand patients with metabolic diseases including diabetes, dyslipidemia, hypertension, and hyperuricemia were recruited. Dental function was assessed with a gummy jelly test, wherein glucose elution from a chewed gummy jelly was measured. Tongue-lip motor function was measured as repeatedly pronounced syllables per second. The association of clinical variables with the two functions was analyzed using multivariate linear regression models.

RESULTS

The mean measurement of dental function was 202 ± 73 mg/dL, and that of tongue-lip motor function was 5.5 ± 1.0 times/s. Clinical variables independently associated with dental function (mg/dL) were age (adjusted regression coefficient β = -9.8 per standard deviation [SD]), smoking (β = -14.4 and -25.9 for past and current smoking, respectively), body mass index (BMI) 25-30 and ≥30 versus 20-25 kg/m² (β = -14.7 and -23.1, respectively), diabetes (β = -11.9), hemoglobin A1c level ≥64 mmol/mol (β = -14.6), gait speed (β = 6.2 per SD), and handgrip strength (β = 7.5 and 7.7 per SD for males and females, respectively) (all P < 0.05). Clinical variables independently associated with tongue-lip motor function (times/s) were age (β = -0.31 per SD), BMI ≥ 30 versus 20-25 kg/m² (β = -0.24), diabetes (β = -0.22), dyslipidemia (β = 0.16), gait speed (β = 0.12 per SD), and handgrip strength (β = 0.18 and 0.13 per SD for males and females, respectively) (all P < 0.05).

CONCLUSIONS

Obesity, diabetes, physical frailty, and old age were shared risk factors for decreased dental and tongue-lip motor functions in patients with metabolic diseases.

Determinants of masticatory performance assessed by mixing ability tests

STATEMENT OF PROBLEM

Studies determining the main predictors of masticatory performance by using mixing ability tests are sparse.

PURPOSE

The purpose of this clinical study was to identify potential determinants of masticatory performance assessed by analyzing a patient's masticatory ability using bicolored chewing gum and visual, quantitative, and interactive methods.

MATERIAL AND METHODS

Nondental participants attending healthcare centers were consecutively recruited in Granada, Spain. The inclusion criteria were older than18 years and resident in the coverage area of the reference healthcare centers for at least the previous 6 months. The participants were excluded if they had received dental treatment in the previous 6 months or they were unable to communicate. The masticatory performance was determined by using 2-colored chewing gum (Kiss 3 white and blue; Smint) that was masticated for a total of 20 strokes. The masticated gum was crushed between 2 transparent glass slides, creating a 1-mm-thick specimen that was subsequently scanned. The mixed-color area was calculated as a percentage by using Photoshop as described by Schimmel et al and designated as the gold standard method. In addition, all images made were analyzed by using the Web application the Chewing Performance Calculator. In addition, the masticated bolus was inspected visually, and mastication performance was classified as being poor, moderate, or good. Sociodemographic data, as well as data on behaviors, medical and nutritional status, health-related quality of life, saliva, and general oral health, were collected for all participants to identify the main determinants of masticatory performance.

RESULTS

One hundred thirty-seven participants were enrolled. The masticatory performance values obtained using both methods (gold standard method and Chewing Performance Calculator) were significantly greater for well masticated gum (P<.001), which had been visually classified as being poorly masticated (69.1% for gold standard method and 43.5% for Chewing Performance Calculator), moderately masticated (89.7% for gold standard method and 67.3% for Chewing Performance Calculator), and well masticated (97.3% for gold standard method and 80.3% for Chewing Performance Calculator). The bivariate analyses revealed that masticatory performance was significantly higher in younger people (<65 years) (P=.008), who also had a higher basal salivary flow rate (P<.001), were nondenture users (P=.002), and had more standing teeth and occlusal units (P<.001). However, the multiple regression analyses showed that the number of occlusal units was the only significant predictor of masticatory performance. In addition, the mean masticatory performance (95% confidence interval: 47.7% to 56.8%) was found to be greatly improved (by 1.2% to 2.2%), with each occlusal unit, in accordance with the Chewing Performance Calculator and between 0.8% and 1.8% according to the gold standard method; the basal masticatory performance was calculated as 72.1% to 81.2% (95% confidence interval).

CONCLUSIONS

The number of occlusal units is one of the main predictors of masticatory performance when a 2-color bolus is used to test mixing ability.

Food Oral Processing-An Industry Perspective

We illustrate how scientific understanding of Food Oral Processing enables food product development with specific benefits for several target populations. in vivo, in vitro, and in silico approaches are discussed in the context of their ability to quantify oral processing from the molecular to the macroscopic scale. Based on this understanding, food structures with enhanced performance in terms of hedonic and nutritional properties as well as appropriateness for age and certain medical conditions can be developed. We also discuss current gaps and highlight development opportunities from an industry perspective.

Pediatric dentists can determine chewing performance level in children

OBJECTIVES

The current study was aimed to verify whether pediatric dentists could determine chewing performance level in children by using Karaduman Chewing Performance Scale (KCPS).

MATERIALS AND METHODS

Typical developing children and children with cerebral palsy (CP) who were referred to pediatric dentistry above the age of 2 years were included in the study. The chewing performance level was scored according to KCPS. One experienced physical therapist and three pediatric dentists independently assessed the chewing videos of the children and scored each child's chewing function. The correlation between the KCPS scores of the physical therapist and the pediatric dentists was used for reliability. The agreement between the scorings of the physical therapist and pediatric dentists was assessed using Fleiss kappa statistics.

RESULTS

Fifty-four typical developing children and 43 children with CP were included. A strong positive correlation between the KCPS scoring of the physical therapist and pediatric dentists was found (r=0.911-0.939, p<0.001). An excellent agreement in the KCPS scoring between the physical therapist and the 1st and 3rd dentists (p<0.001, κ 0.754-0.763), and a good agreement in the KCPS scoring between the physical therapist and the 2nd dentist was detected (p<0.001, κ 0.687).

CONCLUSIONS

The study results show that the KCPS is reliable for pediatric dentists in determining the chewing performance level in children. Therefore, it could be suggested that pediatric dentists could use the KCPS in their clinical settings and research studies.

CLINICAL RELEVANCE

The study may have clinical implications in the evaluation of children with chewing difficulty in dental practice.

CLINICAL TRIAL NUMBER

NCT04407455.

Factors Associated With Food Texture Acceptance in 4- to 36-Month-Old French Children: Findings From a Survey Study

Food texture plays an important role in food acceptance by young children, especially during the complementary feeding period. The factors driving infant acceptance of a variety of food textures are not well-known. This study summarizes maternal reports of children's ability to eat foods of different textures (here: acceptance) and associated factors. Mothers of 4- to 36-month-old children (n = 2,999) answered an online survey listing 188 food-texture combinations representing three texture levels: purees (T1), soft small pieces (T2), hard/large pieces, and double textures (T3). For each offered combination, they reported whether it was spat out or eaten with or without difficulty by the child. A global food texture acceptance score (TextAcc) was calculated for each child as an indicator of their ability to eat the offered textured foods. The results were computed by age class from 4-5 to 30-36 months. The ability to eat foods without difficulty increased with age and was ranked as follows: T1> T2 > T3 at all ages. TextAcc was positively associated with exposure to T2 (in the age classes between 6 and 18 months old) and T3 (6-29 months) and negatively associated with exposure to T1 (9-36 months). Children's developmental characteristics, as well as maternal feeding practices and feelings with regard to the introduction of solids, were associated with texture acceptance either directly or indirectly by modulating exposure. Children's ability to eat with their fingers, gagging frequency, and to a lesser extent, dentition as well as maternal feelings with regard to the introduction of solids were the major factors associated with acceptance. This survey provides a detailed description of the development of food texture acceptance over the complementary feeding period, confirms the importance of exposure to a variety of textures and identifies a number of additional person-related associated factors.

Risk Factors of Composite Attachment Loss in Orthodontic Patients during Orthodontic Clear Aligner Therapy: A Prospective Study

BACKGROUND

The composite attachment loss during orthodontic clear aligner therapy is an adverse event that commonly happens in our daily practice. However, there is a lack of related statistical analysis and studies analyzing the related risk factors. Therefore, the aim of this study is to assess the incidence of attachment loss during orthodontic clear aligner therapy and to identify rick factors that may predict such event.

MATERIALS AND METHODS

The demographics and clinical variables of 94 patients undergoing clear aligner therapy (27 males and 67 females; average age: 27.60 ± 0.86 years) were recorded. Both patient-related and tooth-related attachment loss was recorded. The chi-squared test and logistic regressive analysis were applied to identify the potential risk factors. SPSS for Mac (version 23.0, IBM, USA) was used for statistical analyses. P < 0.05 was considered statistically significant.

RESULTS

Our study suggested that the risk factors for attachment loss include frequent aligner removal (≥ 5 times a day) (losing rate = 60.0%, P = 0.005), aligner wear time less than 18 hours a day (losing rate = 50.8%, P = 0.014), eating without aligners inserted (losing rate = 47.9%, P = 0.034), utilizing aligner tray seaters (losing rate = 48.2%, P = 0.006), and unilateral mastication (losing rate = 52.1%, P = 0.002). The multivariable logistic regression analysis indicates that aligner wear time less than 18 hours a day (P = 0.020, B = 0.925), using aligner tray seaters (P = 0.007, B = 1.168), and unilateral mastication (P = 0.034, B = -0.458) were considered independent factors that can predict the composite attachment loss in orthodontic clear aligner therapy.

CONCLUSION

Wearing aligner less than 18 hours a day, using aligner tray seaters, and unilateral mastication may contribute to increased incidence of composite attachment loss during orthodontic clear aligner therapy.