Objetivo: Tendo em vista as divergências de informações quanto à avaliação da função mastigatória quanto aos aspectos investigados e a forma de avaliação dos mesmos, bem como a necessidade de padronização para fins de comparação, sentiu-se a necessidade de se elaborar uma proposta de avaliação clínica da função mastigatória. Material e Método: Foi elaborado um questionário e encaminhado via endereço eletrônico para fonoaudiólogos de vários locais do país. Este continha questões sobre a formação e atuação dos profissionais e informações sobre os aspectos investigados na história clínica da função mastigatória e na avaliação desta função quanto aos aspectos morfofuncionais investigados e forma de avaliação da mesma, além da verificação de outras funções orais. Foram respondidos e analisados 70 questionários, utilizados na elaboração da proposta de avaliação, além da análise da literatura e da experiência dos fonoaudiólogos do Laboratório de Fisiologia do HRAC/USP. Resultados: A partir das análises realizadas, um protocolo de avaliação da função mastigatória foi proposto, contemplando os seguintes aspectos: alimentos testados, quantidade do mesmo, preensão, movimento mandibular, lado inicial da função, tipo mastigatório, participação da musculatura perioral, postura dos lábios, presença de tremor, contração de masseteres, coordenação dos movimentos, escape anterior de alimento, amassamento com a língua, movimento de cabeça, local de trituração do alimento, respiração durante a mastigação, ruídos nas ATMs, tempo mastigatório, número de ciclos mastigatórios, formação do bolo, presença de tosse ou engasgo e dor durante a mastigação, além do teste de eficiência mastigatória. Considerações Finais: Este trabalho, que propõe um protocolo para a avaliação clínica da mastigação, irá contribuir com a Fonoaudiologia, de modo a trazer critérios para a avaliação desta função. / Objective: According to the divergences of informations in the evaluation of the masticatory function as for the investigated aspects and the form of evaluation of them, as well as the need of standardization for comparison of the patients' masticatory function; it was necessary to elaborate a proposal of clinical evaluation of the masticatory function. Material and Method: A questionnaire was elaborated and sent by e-mail for some Speech Pathologists from several places from Brazil. This questionnaire had some questions about the formation and the professionals' performance and informations about the aspects that were investigated in the clinical history of the masticatory function and in the evaluation of this function as for the morphologic and functional aspects that were investigated and the form of evaluation of the masticatory function, besides the verification of other oral functions. Seventy questionnaires were answered and analyzed and they were used for the elaboration of the proposal of evaluation besides the analysis of the literature and experience of the Speech Pathologists of the Laboratory of Physiology at HRAC/USP. Results: From the analyses it was proposed the elaboration of a protocol of evaluation of the masticatory function, contemplating the following aspects: the test foods, the amount of the test foods, the teeth that bite the food, the mandibular movement, the initial side of the masticatory function, the masticatory laterality, the participation of the perioral muscles, the labial posture, if exists tremor, the contraction of muscles masseteres, the coordination of the mandibular movements, if there is a leak of food from the mouth, the trituration of the food with the tongue, the head's movement, the place of the trituration of the food, the breathing during the mastication, the noises in ATMs, the duration of masticatory function, the number of masticatory cycles, the formation of the bolus, if there is cough or choking and pain during the mastication, besides the test of masticatory efficiency. Final considerations: It was verified the lack of standardization of the evaluation of the masticatory function related to the aspects to be investigated, as well as the form of evaluation of them. For this reason, this work proposes a protocol for the clinical evaluation of the mastication and it will contribute with the Speech Pathology to bring criteria for the evaluation of the masticatory function.

Objetivo: Tendo em vista as divergências de informações quanto à avaliação da função mastigatória quanto aos aspectos investigados e a forma de avaliação dos mesmos, bem como a necessidade de padronização para fins de comparação, sentiu-se a necessidade de se elaborar uma proposta de avaliação clínica da função mastigatória. Material e Método: Foi elaborado um questionário e encaminhado via endereço eletrônico para fonoaudiólogos de vários locais do país. Este continha questões sobre a formação e atuação dos profissionais e informações sobre os aspectos investigados na história clínica da função mastigatória e na avaliação desta função quanto aos aspectos morfofuncionais investigados e forma de avaliação da mesma, além da verificação de outras funções orais. Foram respondidos e analisados 70 questionários, utilizados na elaboração da proposta de avaliação, além da análise da literatura e da experiência dos fonoaudiólogos do Laboratório de Fisiologia do HRAC/USP. Resultados: A partir das análises realizadas, um protocolo de avaliação da função mastigatória foi proposto, contemplando os seguintes aspectos: alimentos testados, quantidade do mesmo, preensão, movimento mandibular, lado inicial da função, tipo mastigatório, participação da musculatura perioral, postura dos lábios, presença de tremor, contração de masseteres, coordenação dos movimentos, escape anterior de alimento, amassamento com a língua, movimento de cabeça, local de trituração do alimento, respiração durante a mastigação, ruídos nas ATMs, tempo mastigatório, número de ciclos mastigatórios, formação do bolo, presença de tosse ou engasgo e dor durante a mastigação, além do teste de eficiência mastigatória. Considerações Finais: Este trabalho, que propõe um protocolo para a avaliação clínica da mastigação, irá contribuir com a Fonoaudiologia, de modo a trazer critérios para a avaliação desta função. / Objective: According to the divergences of informations in the evaluation of the masticatory function as for the investigated aspects and the form of evaluation of them, as well as the need of standardization for comparison of the patients' masticatory function; it was necessary to elaborate a proposal of clinical evaluation of the masticatory function. Material and Method: A questionnaire was elaborated and sent by e-mail for some Speech Pathologists from several places from Brazil. This questionnaire had some questions about the formation and the professionals' performance and informations about the aspects that were investigated in the clinical history of the masticatory function and in the evaluation of this function as for the morphologic and functional aspects that were investigated and the form of evaluation of the masticatory function, besides the verification of other oral functions. Seventy questionnaires were answered and analyzed and they were used for the elaboration of the proposal of evaluation besides the analysis of the literature and experience of the Speech Pathologists of the Laboratory of Physiology at HRAC/USP. Results: From the analyses it was proposed the elaboration of a protocol of evaluation of the masticatory function, contemplating the following aspects: the test foods, the amount of the test foods, the teeth that bite the food, the mandibular movement, the initial side of the masticatory function, the masticatory laterality, the participation of the perioral muscles, the labial posture, if exists tremor, the contraction of muscles masseteres, the coordination of the mandibular movements, if there is a leak of food from the mouth, the trituration of the food with the tongue, the head's movement, the place of the trituration of the food, the breathing during the mastication, the noises in ATMs, the duration of masticatory function, the number of masticatory cycles, the formation of the bolus, if there is cough or choking and pain during the mastication, besides the test of masticatory efficiency. Final considerations: It was verified the lack of standardization of the evaluation of the masticatory function related to the aspects to be investigated, as well as the form of evaluation of them. For this reason, this work proposes a protocol for the clinical evaluation of the mastication and it will contribute with the Speech Pathology to bring criteria for the evaluation of the masticatory function.

The temporomandibular disorder (TMD) has been widely discussed, however, controversy still exists about the relationship between trait anxiety and his effect on masticatory functions, as well as electromyography of masticatory muscles and cervical posture. Objective. Evaluate the trait anxiety and masticatory function of subjects with TMD. Casuistic and Methods. Were evaluated 61 young adults of both sexes, aged between 18 and 30 years. The TMD diagnosis was based on clinical criteria Instrument Research Diagnostic Criteria (RDC / TMD) and the subjects were then divided into DTM symptomatic and control groups, trait anxiety was assessed using the Scale of the State-Trait Anxiety (STAI) and the electromyography records were collected in rest (R) position, maximal voluntary contraction (MVC) and habitual mastication (MH) of masseter and temporal, bite force (FM) was measured by a force transducer and the evaluation of masticatory performance was performed by the geometric mean diameter (GMD) of a artificial food chewed particles. For radiological analysis of complex craniocervical were used radiographs (sagittal plane) and measured three angles and two distances: high cervical angle (HCA), low cervical angle (LCA), the atlas plane angle (APA); distance translation of the odontoid (Tz C2/C7): occipital distance - atlas (DOA). Results. Of the 61 selected subjects, only 27 completed all phases of the study, 15 were symptomatic TMD group (5 men and 10 women) with a mean age of 21.7 ± 3.51 years and 12 controls (4 men and 8 women) aged mean of 19.8 ± 2.48. DTM symptomatic group presented the higher scores on trait anxiety (p = 0.036), mean values of electromyography (EMG) of masticatory muscles, bite force and masticatory performance did not differ between the control and DTM symptomatic groups, the correlation between mean values of EMG, FM and PM each other and with the cervical posture showed a moderate negative correlation between the distance of anterior translation of the head (Tz C2-C7) and electromyographic activity of the masseter (p = 0.005 and r = - 0.67) and anterior temporal (p = 0.01 and r = - 0.63) during mastication. Conclusion. In the sample studied, increased trait anxiety is related to symptomatic TMD patients, masticatory function did not differ symptomatic subjects with TMD and controls and electrical activity in muscles of mastication masseter and anterior temporal had an inverse relationship with the anterior translation head. / A disfunção temporomandibular (DTM) tem sido amplamente discutida na literatura, no entanto, ainda há controvérsia sobre sua relação com o traço ansioso e repercussão nas funções mastigatórias, assim como, da eletromiografia mastigatória e postura cervical. Objetivo. Avaliar o traço ansioso e a função mastigatória de indivíduos com DTM. Casuística e Métodos. Foram avaliados 61 indivíduos adultos jovens, de ambos os sexos, com faixa etária entre 18 e 30 anos. O diagnóstico de DTM foi baseado nos critérios clínicos do instrumento Research Diagnostic Criteria (RDC/DTM) e os indivíduos foram então divididos em grupo DTM sintomática e Controle, a ansiedade traço foi avaliada por meio da Escala de Ansiedade Traço-Estado (IDATE) e foram colhidos registros de eletromiografia de superfície em repouso (R), contração voluntária máxima (CVM) e mastigação habitual (MH) de masseter e temporal, a força de mordida (FM) mensurada por meio de um transdutor de força e a avaliação da performance mastigatória foi realizada pelo diâmetro geométrico médio(DGM) das partículas de um alimento artificial mastigado. Para a análise radiológica do complexo craniocervical, foram utilizadas radiografias de perfil (plano sagital) e mensurados três ângulos e duas distâncias: ângulo cervical alto (ACA); ângulo cervical baixo (ACB); ângulo do plano do atlas (APA); distância de translação do odontóide (Tz C2/C7): distância occipital atlas (DOA). Resultados. Dos 61 sujeitos selecionados, apenas 27 concluíram todas as etapas da pesquisa, sendo 15 no grupo DTM sintomática (5 homens e 10 mulheres) com idade média de 21,7 ±3,51 anos e 12 controles (4 homens e 8 mulheres) idade média de 19,8 ± 2,48. Foram verificados maiores escores de ansiedade traço no grupo DTM sintomática (p=0,036), os valores médios da eletromiografia (EMG) dos músculos mastigatórios, da força de mordida e da performance mastigatória não apresentaram diferença entre os grupos controle e DTM, a correlação entre os valores médios de EMG, FM e PM entre si e com a postura cervical demonstrou uma correlação moderada negativa entre a distância de translação anterior da cabeça (Tz C2-C7) e a atividade eletromiográfica dos músculos masseter (p = 0,005 e r = - 0,67 ) e temporal anterior (p = 0,01 e r = - 0,63) durante a mastigação habitual. Conclusão: Na amostra avaliada, o traço ansioso aumentado está relacionado a indivíduos com DTM sintomática, a função mastigatória não diferiu sujeitos com DTM sintomática e controles e a atividade elétrica em mastigação habitual dos músculos masseter e temporal anterior tiveram uma relação inversamente proporcional com a translação anterior da cabeça.

Doctor Scientiae (Odontology) - DSc(Odont) / The primary function of the jaws and teeth in mammals is chewing and swallowing. In man there are additional functions of speech, non-verbal communication and cosmetic appeal. Chewing is a complex operation requiring both adequate skeletal structures, and a well co-ordinated muscle system. There is considerable variation in both these components of chewing within which adequate function appears to be possible, at least for a modern refined diet. For example, the dental arches may not conform to the modal arrangement and teeth may be missing, yet adequate function remains (Slagter et al 1993). There are unfortunately no baseline requirements for an adequate dentition nor the minimal chewing performance necessary to avoid indigestion. A common rule of thumb when replacing missing posterior teeth is that the extent of the prosthesis can be reduced to the premolars without seriously affecting chewing (Kayser, 1984). This arbitrary estimation has not been defined by a minimum area for functioning posterior occlusal surfaces. The same lack of quantifiable measurement is a feature of assessing orthodontic treatment goals and outcomes (Omar, McEwen and Ogston 1987). The clinical rules for correcting malocclusions, usually, have more to do with the restoration of modal tooth, arch and skeletal relationships, than with the restoration of function; if restoration of function is a concern of treatment, it is not measurable in the same way that tooth positions can be assessed on plaster casts or angles measured on a radiograph. Muscle tenderness and limited movement are both features of temporomandibular dysfunction. The boundary between normal subjects, who may have some signs of dysfunction and patients, who may not have distinctly more severe signs cannot always be made (Widmar 1992). By some definitions based on the morphology of the joint structures, even symptomless individuals could be categorised as abnormal. One of the difficulties in assessing functional incapacity of a patient with muscle pain is the absence of the same baseline data needed to assess malocclusion, or the handicap due to reduced occlusal area. It is encouraging to find that a simple test, such as measuring maximum opening, is a useful indicator of treatment progress in temporomandibular dysfunction. This sign, although simple and of limited diagnostic use, reflects the poverty of useful tests for masticatory function.