Chewing-side Preference is Involved in Differential Cortical Activation Patterns during Tongue Movements after Bilateral Gum-chewing: a Functional Magnetic Resonance Imaging Study

Does Orthodontic Treatment Change the Preferred Chewing Side of Patients with Malocclusion?

Whether orthodontic treatment can change the preferred chewing side (PCS) is unknown. This study examined (1) if the PCS changes after orthodontic treatment and (2) which factors contribute to this change. Two hundred fifty patients who visited the orthodontic clinic at Tokyo Medical and Dental University Hospital between 2017 and 2020 were included in the study. Mandibular kinesiograph (MKG) was taken at pre- and post-treatment, and PCS was determined. Patients who showed a change in PCS to the opposite side and those who showed no change in PCS at post-treatment were pooled into the PCS-changed and PCS-unchanged groups, respectively. The demographic, clinical, and cephalometric parameters were compared between the groups. Significant factors associated with changes in were of age < 20 years at the beginning of orthodontic treatment (odds ratio (OR), 2.00), maximum lateral mandibular movement to PCS ≥ 10.0 mm at pre-treatment (OR, 6.51), and change in occlusal canting of ≥1.0° (OR, 2.72). The predicted probability of change in PCS was 13.2%, 36.0%, and 67.5% for no factor, one factor, and two factors associated with PCS change, respectively. Orthodontic treatment may change PCS due to patient age, maximum lateral mandibular movement to PCS, and change in occlusal canting.

Functional quantification of oral motor cortex at rest and during tasks using activity phase ratio: A zero-setting vector functional near-infrared spectroscopy study

Oral frailty associated with oral hypokinesia may cause dementia. Functional near-infrared spectroscopy (fNIRS) can be used while the participants are in seating position with few restrictions. Thus, it is useful for assessing brain function, particularly oral motor activity. However, methods for identifying oral motor cortex (OMC) activation via the scalp have not been established. The current study aimed to detect OMC activation, an indicator of activity phase ratio (APR), which reflects increased oxygen consumption (0 &lt; [deoxyhemoglobin (ΔDeoxyHb) or 0 &lt; {[ΔDeoxyHb- oxyhemoglobin (ΔOxyHb)/√2]}, via fNIRS to accurately identify local brain activity. The APR, calculated via zero-set vector analysis, is a novel index for quantifying brain function both temporally and spatially at rest and during tasks. In total, 14 healthy participants performed bite tasks for 3 s per side for 10 times while in the sitting position. Then, time-series data on concentration changes in ΔOxyHb and ΔDeoxyHb were obtained via fNIRS. The anatomical location of the OMC was determined using a pooled data set of three-dimensional magnetic resonance images collected in advance from 40 healthy adults. In the zero-set vector analysis, the average change in ΔOxyHb and ΔDeoxyHb concentrations was utilized to calculate the APR percentage in 140 trials. The significant regions (z-score of ≥2.0) of the APR and ΔOxyHb in the task were compared. During the bite task, the APR significantly increased within the estimated OMC region (56–84 mm lateral to Cz and 4–20 mm anterior to Cz) in both the right and left hemispheres. By contrast, the ΔOxyHb concentrations increased on the bite side alone beyond the OMC region. The mean APR at rest for 2 s before the task showed 59.5%–62.2% in the left and right OMCs. The average APR for 3 s during the task showed 75.3% for the left OMC and 75.7% for the right OMC during the left bite task, and 65.9% for the left OMC and 80.9% for the right OMC during the right bite task. Interestingly, the average increase in APR for the left and right OMCs for the left bite task and the right bite task was 13.9% and 13.7%, respectively, showing almost a close match. The time course of the APR was more limited to the bite task segment than that of ΔOxyHb or ΔDexyHb concentration, and it increased in the OMC. Hence, the APR can quantitatively monitor both the resting and active states of the OMC in the left and right hemispheres. Using the zero-set vector-based fNIRS, the APR can be a valid indicator of oral motor function and bite force.

Distinctive Cortical Articulatory Representation in Cleft Lip and Palate: A Preliminary Functional Magnetic Resonance Imaging Study

Objective:

To investigate cortical representation of articulation of the bilabial plosive in patients with cleft lip and palate.

Design:

We examined cortical representation for /pa/-articulation in cleft lip and palate patients using blood oxygenation level–dependent functional magnetic resonance imaging.

Subjects:

Data from four postsurgical adult cleft lip and palate patients were compared with those from six healthy volunteers.

Results:

Activation foci were found in the bilateral primary sensorimotor cortex in all cleft lip and palate patients, as in the controls. The sensorimotor cortex ipsilateral to the side of cleft lip and palate showed greater activation in unilateral cleft lip and palate patients, whereas the sensorimotor cortex contralateral to the side on which cheiloplasty had been performed earlier showed greater activation in a bilateral cleft lip and palate patient.

Conclusions:

The results suggest that there may be an ipsilateral dominance in cortical representation during bilabial articulation to the side of the cleft in the upper lip.

Influence of Human Jaw Movement on Cerebral Blood Flow

Temporal changes in cerebral blood flow induced by jaw movement have yet to be investigated. To assess the influence of pattern and intensity of muscle contraction during jaw movement on task-induced change in cerebral blood flow, we performed bilateral transcranial Doppler ultrasound examination during clenching, gum chewing, and tooth tapping in healthy volunteers. A random-effects model analysis revealed a significant increase in middle cerebral artery blood flow velocity during clenching (high muscle activity) and gum chewing (moderate muscle activity), compared with the preceding rest period; however, such an increase was not detected during tooth tapping (low muscle activity). Cerebral blood flow was greater on the working side during the intensive isometric contraction of the masseter muscle in clenching. These results suggest that task-induced change in cerebral blood flow during jaw movement is influenced by the change in peripheral circulation evoked by muscle contraction.

Mastication as a Stress-Coping Behavior

Exposure to chronic stress induces various physical and mental effects that may ultimately lead to disease. Stress-related disease has become a global health problem. Mastication (chewing) is an effective behavior for coping with stress, likely due to the alterations chewing causes in the activity of the hypothalamic-pituitary-adrenal axis and autonomic nervous system. Mastication under stressful conditions attenuates stress-induced increases in plasma corticosterone and catecholamines, as well as the expression of stress-related substances, such as neurotrophic factors and nitric oxide. Further, chewing reduces stress-induced changes in central nervous system morphology, especially in the hippocampus and hypothalamus. In rodents, chewing or biting on wooden sticks during exposure to various stressors reduces stress-induced gastric ulcer formation and attenuates spatial cognitive dysfunction, anxiety-like behavior, and bone loss. In humans, some studies demonstrate that chewing gum during exposure to stress decreases plasma and salivary cortisol levels and reduces mental stress, although other studies report no such effect. Here, we discuss the neuronal mechanisms that underline the interactions between masticatory function and stress-coping behaviors in animals and humans.

Chewing gum benefits sustained attention in the absence of task degradation

OBJECTIVES

The present study examined the effect of chewing gum on sustained attention and associated changes in subjective alertness.

METHODS

In a within-participants design, 20 participants completed an extended version of the sustained attention response task (SART: Robertson et al., 1997), both with and without chewing gum. Self-rated measures of alertness, contentedness, and calmness were taken before and after the SART.

RESULTS

Chewing gum was associated with improved attentional task performance. This finding was not contingent upon a general decrease in attentional performance and was apparent at all stages of the task. Subjective measures of alertness, contentedness, and calmness were higher following the chewing of gum. Changes in sustained attention co-varied with subjective alertness.

DISCUSSION

The effects of chewing gum on attention and alertness are consistent with past literature and were not contingent on declines in attention. Additionally, we found evidence that gum-induced changes in self-rated alertness and attention are related. We found no support for the proposition that chewing gum can impair attention due to the division of resources.

Stress and chewing affect blood flow and oxygen levels in the rat brain

OBJECTIVE

Mastication, including chewing, would be of great importance not only for food intake, but also for the mental, physical and physiological functioning of the body. Our study showed that mastication, especially chewing, suppresses the stress response and was regarded as a biological response to defend against various stresses. Although mastication altered brain function during stress, the underlying mechanisms have not been elucidated.

METHODS

The effects of chewing during restraint stress on blood flow and oxygen partial pressure (PO(2)) levels in the rat amygdala and hypothalamus were measured using laser Doppler flowmetry and O(2)-selective electrodes.

RESULTS

Amygdaloidal and hypothalamic blood flow were not affected by restraint stress, but PO(2) levels were significantly reduced by restraint stress for 180 min compared to unrestrained control rats. The decrease in amygdaloidal and hypothalamic PO(2) levels during restraint stress was reduced after chewing for 30 min.

CONCLUSION

These results suggested that it is possible to evaluate hypothalamic and amygdaloidal blood flow and PO(2) levels in rat brains during restraint stress. Restraint stress reduced cerebral PO(2) levels. In addition, chewing would lead to increased blood flow and to recover cerebral PO(2) levels.

Comparison of Brain Activation via Tooth Stimulation

The aim of this study was to evaluate the sensation of each tooth type at the cortical level. The tactical sensation from teeth plays an important role in controlling the masticatory system. However, the role of each tooth type has not been determined. Functional near-infrared spectroscopy (fNIRS) was used to detect changes in cerebral blood flow in the somatosensory cortex of 12 healthy volunteers. Painless vibrotactile stimuli were applied to 8 teeth (left maxillary and mandibular incisors, canines, 1st premolars, or 1st molars). The somatosensory cortex was activated during stimulation of all teeth. A comparison of cortical activation revealed significantly greater activation during stimulation of the maxillary and mandibular first molars. However, no significant differences were seen between any other teeth. These results indicate that the first molar is the most sensitive tooth type at the cortical level, and provide basic data on the relationship between input from individual tooth type and brain activation. These data could be useful for understanding the neural mechanisms of individual tooth types.

Improving the sensitivity of EEG-fMRI studies of epileptic activity by modelling eye blinks, swallowing and other video-EEG detected physiological confounds

RATIONALE

To improve the sensitivity and specificity of simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI) it is prudent to devise modelling strategies explaining the residual variance. The purpose of this study is to investigate the potential value of including additional regressors for physiological activities, derived from video-EEG, in the modelling of haemodynamic patterns linked to interictal epileptiform discharges (IEDs) using simultaneously recorded video-EEG-fMRI.

METHODS

Ten patients with IED (focal epilepsy: 6, idiopathic generalized epilepsy (IGE):4) were studied. BOLD-sensitive fMRI images were acquired on a 3T MRI scanner. 64-channel EEG was recorded using MR-compatible system. A custom made, dual-video-camera system synchronised with EEG was used to record video simultaneously. IEDs and physiological activities were identified and labelled on video-EEG using Brain Analyzer2. fMRI time-series data were pre-processed and analysed using SPM5 software. Two general linear models (GLM) were created; GLM1: IEDs were convolved with the canonical haemodynamic response function and its derivatives. Realignment parameters and pulse regressors were included in the design matrix as confounds, GLM2: GLM1 and additional regressors identified on video-EEG including: eye blinks, hand or foot movement, chewing and swallowing were also included in the design matrix. SPM [F] maps (p<0.05, corrected for family wise error and p<0.001, uncorrected) were generated for both models. We compared the resulting blood oxygen level dependent (BOLD) maps for cluster size, statistical significance and degree of concordance with the irritative zone.

RESULTS

BOLD changes relating to physiological activities were generally seen in expected brain areas. In patients with focal epilepsy, the extent and Z-score of the IED-related global maximum BOLD clusters increased in 4/6 patients and additional IED-related BOLD clusters were observed in 3/6 patients for GLM2. Also, the degree of concordance of IED-related maps with irritative zone improved for one patient for GLM2 and was unchanged for the other cases. In patients with IGE, the size and statistical significance for global maximum and other BOLD clusters increased in 2/4 patients. We conclude that the inclusion of additional regressors, derived from video based information, in the design matrix explains a greater amount of variance and can reveal additional IED-related BOLD clusters which may be part of the epileptic networks.

Increased occlusal vertical dimension induces cortical plasticity in the rat face primary motor cortex

Previous studies have demonstrated that functional plasticity in the primary motor cortex (M1) is related to motor-skill learning and changes in the environment. Increased occlusal vertical dimension (iOVD) may modulate mastication, such as in the masticatory cycle, and the firing properties of jaw-muscle spindles. However, little is known about the changes in motor representation within the face primary motor cortex (face-M1) after iOVD. The purpose of the present study was to determine the effect of iOVD on the face-M1 using intracortical microstimulation (ICMS). In an iOVD group, the maxillary molars were built-up by 2mm with acrylic. The electromyographic (EMG) activities from the left (LAD) and right (RAD) anterior digastric (AD), masseter and genioglossus (GG) muscles elicited by ICMS within the right face-M1 were recorded 1, 2 and 8 weeks after iOVD. IOVD was associated with a significant increase in the number of sites within the face-M1 from which ICMS evoked LAD and/or GG EMG activities, as well as a lateral shift in the center of gravity of the RAD and LAD muscles at 1 and 2 weeks, but not at 8 weeks. These findings suggest that a time-dependent neuroplastic change within the rat face-M1 occurs in association with iOVD. This may be related to the animal's ability to adapt to a change in the oral environment.

The cerebral representation of temporomandibular joint occlusion and its alternation by occlusal splints

Occlusal splints are a common and effective therapy for temporomandibular joint disorder. Latest hypotheses on the impact of occlusal splints suggest an altered cerebral control on the occlusion movements after using a splint. However, the impact of using a splint during chewing on its cerebral representation is quite unknown. We used functional magnetic resonance imaging (fMRI) to investigate brain activities during occlusal function in centric occlusion on natural teeth or on occlusal splints in fifteen healthy subjects. Comparisons between conditions revealed an increased activation for the bilateral occlusion without a splint in bilateral primary and secondary sensorimotor areas, the putamen, inferior parietal and prefrontal cortex (left dorsal and bilateral orbital) and anterior insular. In contrast, using a splint increased activation in the bilateral prefrontal lobe (bilateral BA 10), bilateral temporo-parietal (BA 39), occipital and cerebellar hemispheres. An additionally applied individually based evaluation of representation sites in regions of interest demonstrated that the somatotopic representation for both conditions in the pre- and postcentral gyri did not significantly differ. Furthermore, this analysis confirmed the decreasing effect of the splint on bilateral primary and secondary motor and somatosensory cortical activation. In contrast to the decreasing effect on sensorimotor areas, an increased level of activity in the fronto-parieto-occipital and cerebellar network might be associated with the therapeutic effect of occlusal splints.

Changes in cortical activation in craniomandibular disorders during splint therapy - a single subject fMRI study

There is some controversial discussion within the therapy of craniomandibular disorders (CMDs) about the mode of action of occlusal splints. Here we present a case report on one CMD-patient measuring cerebral activation changes with functional magnetic resonance imaging (fMRI) before and after therapy with a stabilization splint. Wearing the Michigan splint for 11 nights and partially days resulted in substantial pain relief and changes in occlusal movement performance. Cerebral activation during occlusion was decreased after therapy (PRE-POST) in bilateral sensorimotor regions but also additional areas such as left posterior insula, right superior temporal cortex and bilateral occipital lobe. During the first usage of the splint in the scanner (PRE) increased activation in the left dorsolateral prefrontal lobe (BA 9) was observed. After splint training occlusion with the splint compared to without a splint increasingly involved the left superior parietal lobe (BA 7, POST). Whereas BA 9 might be associated with increasing working memory load due to the manipulation with an unusual object, the BA 7 activation in the POST session might document increased sensorimotor interaction after getting used to the splint. Our findings indicate that wearing an occlusion splint triggers activation in parietal sensorimotor integration areas, also observed after long periods of sensorimotor training. These additional recourses might improve coordination and physiological handling of the masticatory system.

Somatosensory processing of the tongue in humans

We review research on somatosensory (tactile) processing of the tongue based on data obtained using non-invasive neurophysiological and neuroimaging methods. Technical difficulties in stimulating the tongue, due to the noise elicited by the stimulator, the fixation of the stimulator, and the vomiting reflex, have necessitated the development of specialized devices. In this article, we show the brain activity relating to somatosensory processing of the tongue evoked by such devices. More recently, the postero-lateral part of the tongue has been stimulated, and the brain response compared with that on stimulation of the antero-lateral part of the tongue. It is likely that a difference existed in somatosensory processing of the tongue, particularly around primary somatosensory cortex, Brodmann area 40, and the anterior cingulate cortex.

fMRI study of brain activity elicited by oral parafunctional movements

Parafunctional masticatory activity, such as the tooth clenching and grinding that is associated with bruxism, is encountered by clinicians in many disciplines, including dentistry, neurology and psychiatry. Despite this, little is known about the neurological basis for these activities. To identify the brain network engaged in such complex oromotor activity, functional magnetic resonance imaging (fMRI) was used to elucidate the brain activation patterns of 20 individuals (10 males and 10 females, mean s.d. age of 26.3+/-4.1 years) with (parafunctional, PFx group, 5M/5F) and without (normal functional, NFx group, 5 M/5F) self-reported parafunctional grinding and clenching habits during clenching and grinding tasks. Subject group classification was based on: (i) self-reported history, (ii) clinical examination, (iii) evaluation of dental casts and (iv) positive responses to the temporomandibular disorder (TMD) History Questionnaire [Dworkinand LeResche, Journal of Craniomandibular Disorders, (1992) 6:301]. While subjects performed these oromotor tasks, each wore a custom-designed oral appliance minimizing head motion during imaging. Mean per cent signal changes showed significant between group differences in motor cortical (supplementary motor area, sensorimotor cortex and rolandic operculum) and subcortical (caudate) regions. Supplementary motor area data suggest that motor planning and initiation, particularly during the act of clenching, are less prominent in individuals with oromotor parafunctional behaviours. The overall extent of activated areas was reduced in subjects with self-reported parafunctional masticatory activity compared with the controls. This study's methodology and findings provide an initial step in understanding the neurological basis of parafunctional masticatory activities that are relevant for therapeutic research applications of temporomandibular joint and muscle disorders and associated comorbidities.

Representation of the speech effectors in the human motor cortex: somatotopy or overlap?

Somatotopy within the orofacial region of the human motor cortex has been a central concept in interpreting the results of neuroimaging and transcranial magnetic stimulation studies of normal and disordered speech. Yet, somatotopy has been challenged by studies showing overlap among the effectors within the homunculus. In order to address this dichotomy, we performed four voxel-based meta-analyses of 54 functional neuroimaging studies of non-speech tasks involving respiration, lip movement, tongue movement, and swallowing, respectively. While the centers of mass of the clusters supported the classic homuncular view of the motor cortex, there was significant variability in the locations of the activation-coordinates among studies, resulting in an overlapping arrangement. This "somatotopy with overlap" might reflect the intrinsic functional interconnectedness of the oral effectors for speech production.

Negative BOLD during tongue movement: a functional magnetic resonance imaging study

The aim of this functional magnetic resonance imaging (fMRI) study was to evaluate negative blood oxygen level-dependent (BOLD) signals during voluntary tongue movement. Deactivated (Negative BOLD) regions included the posterior parietal cortex (PPC), precuneus, and middle temporal gyrus. Activated (Positive BOLD) regions included the primary somatosensory-motor area (SMI), inferior parietal lobule, medial frontal gyrus, superior temporal gyrus, insula, lentiform nucleus, and thalamus. The results were not consistent with previous studies involving unilateral hand and finger movements showing the deactivation of motor-related cortical areas including the ipsilateral MI. The areas of Negative BOLD in the PPC and precuneus might reflect specific neural networks relating to voluntary tongue movement.

Influence of voluntary control of masticatory side and rhythm on cerebral hemodynamics

The aim of this study was to investigate the influence on cerebral hemodynamics of voluntary control of masticatory side and rhythm during gum chewing. Blood flow velocity in the middle cerebral artery was measured using transcranial Doppler ultrasonography to evaluate cerebral circulation in healthy volunteers. Heart rate and masseter muscle activity were recorded simultaneously. Volunteers performed three tasks: (1) free gum chewing, (2) gum chewing in which mastication was limited to the right side, and (3) gum chewing in which mastication was limited to the right side and rhythm was set at 1.0 Hz. Changes in cerebral circulation during pre-task, on-task, and post-task periods were analyzed using random effects model, and differences in cerebral circulation and muscle activity between tasks were analyzed using the Friedman test. In all tasks, on-task cerebral circulation was greater than pre-task. Muscle activity and masticatory rhythm varied between tasks, whereas the rate of increase in cerebral circulation did not differ significantly among tasks. These results suggest that cerebral circulation is activated during gum chewing, irrespective of voluntary control of masticatory side and rhythm.

Relationship between chewing side preference and handedness and lateral asymmetry of peripheral factors

OBJECTIVE

To determine whether chewing side preference is related to handedness and lateral asymmetry of occlusal characteristics, muscular force and temporomandibular disorders (TMD) in a dentate population.

DESIGN

One hundred and seventeen dentate adults participated in this cross-sectional study. Static and dynamic occlusal characteristics were determined at the maximal intercuspal position and at the lateral excursions by scanning interocclusal records and analysing them using image software. Unilateral maximum bite force and finger-thumb grip force were measured by means of a gnathodynamometer. TMD were assessed according to the Research Diagnostic Criteria for TMD. Chewing side preference and masticatory laterality were determined by observing the jaw's movement while each subject chewed silicone. Asymmetry or side difference of the variables was calculated. Correlation between side difference variables and masticatory laterality was studied using Spearman correlation coefficient.

RESULTS

Fifty-nine subjects chewed on the right, 15 on the left and 43 chewed on both sides. There was no relationship between preferred chewing side and handedness, lateral asymmetry of TMD or side difference in finger-thumb grip force. Significant and positive correlations were observed between masticatory laterality and side differences in bite force and side differences in occlusal contact area at intercuspal position (P<0.01).

CONCLUSIONS

Chewing side preference in a dentate population is related to lateral asymmetry of bite force and asymmetry of occlusal contact area at the intercuspal position but not to handedness.

Functional magnetic resonance imaging of brain activity during chewing and occlusion by natural teeth and occlusal splints

Brain imaging based on functional magnetic resonance (fMRI) is a useful tool for examination of neuronal networks and cerebral structures subserving visiospatial function. The purpose of this study was to compare the brain activity during chewing and occlusal function in centric occlusion on natural teeth or on occlusal splints. Four tasks were performed by 13 healthy, fully dentate subjects (21-32 years old, 6 female and 7 male): occlusal tap-tap movements in centric occlusion by natural teeth, after application of a maxillary occlusal splint and chewing movements on left and right sided rubberdam strips. In order to reveal which areas of the brain were more strongly activated, conjunction analyses between the different tasks were performed for each subject and for the average values of brain signal activity of all subjects. Whilst several known foci of activity were subtracted, differences of significant activity rested in areas of the sensorimotor cortex. Mainly ipsitaterality of hemispheres concerned the left and right sided chewing, whereas the conjunction between tap-tap movements on natural teeth and splint occlusion indicated only one weak, but significant activation foci. The study confirms fMRT as one of the most useful developing methods to clear up neuro-cortical effectiveness of occlusion and occlusal therapy.

Laterality of swallowing in healthy subjects by AP projection using videofluoroscopy

Although anteroposterior projections in videofluoroscopic examination of swallowing (VF) provide clinically important information, the laterality of swallowing in healthy subjects has not been examined fully to date. One hundred sixty-seven healthy volunteers were prospectively studied. The subjects were asked to swallow 5 ml of barium solution three times while X-ray images were taken that showed the pathway of the solution from the pharynx into the esophagus to assess the laterality of swallowing. We classified patterns of swallowing into three types according to passage in the pharyngoesophageal segment as indicated by width: RD (right-side-dominant flow), LD (left-side-dominant flow), and NL (no laterality in flow). Fifty-eight percent of the subjects were classified as NL, 35% as LD, and 7% as RD. The ratio of types in women was NL:LD:RD = 7:2:1. There were no significant differences among the groups according to age. Although classifications in young men (age = 20-30 years) tended to be the same as in women regardless of age, ratios of LD tended to increase with age; 71% of elderly adults (age = 51-75 years) were classified as LD. These results demonstrate laterality in normal swallowing and will be helpful in determining treatment strategies for the patients with dysphagia.