Körperliche Gesundheit und maximale Leistungsfähigkeit gelten im Spitzensport als oberste Priorität. So können akute Schmerzen im Mund-, Kiefer-, Gesichtsbereich sowie funktionelle Beschwerdebilder zu Ausfällen, mangelnder Regeneration und Leistungseinbußen führen. Obwohl eine entsprechende Beachtung im Profisport von zahlreichen internationalen Organisationen wie FDI, IOC und UEFA gefordert wird, belegen Studien, dass Leistungssportler unterschiedlichste Defizite des Mungesundheitszustandes aufweisen. Insgesamt gibt es nur wenig verfügbare Daten, daher war es ein Ziel der Dissertation zu Grunde liegenden Studie, klinische Daten zu oralen Entzündungen, Karieserfahrung, craniomandibulären Dysfunktioen sowie Erosionen (orofaszialer Gesundheitsstatus) von jungen Spitzensportlern in Deutschland zu erheben und diese im Vergleich zu einer Kontrollgruppe einzuordnen. Ein weiterer Fokus lag auf der Erfassung des Mundgesundheitsverhaltens dieser speziellen Kohorte um eine Einschätzung der Bedeutung diese Faktor auf den vorliegenden Mundgesundheitszustand zu ermöglichen.:1. Einführung in das Thema 1.1. Einleitung 1.2. Mundgesundheitszustand bei Sportlern 1.3. Auswirkungen der Mundgesundheit auf die sportliche Performance 1.3.1. Allgemeines 1.3.2. Einschränkungen durch akute Beschwerden 1.3.3. Systemischer Einfluss 1.4. Auswirkungen des Leistungssports auf die Mundgesundheit 1.4.1. Allgemeines 1.4.2. Verändertes Mundgesundheitsverhalten 1.4.3. Vermehrte Mundtrockenheit 1.4.4. Spezielle Ernährungsgewohnheiten 1.4.5. Systemischer Einfluss 1.5. Fragestellung der vorliegenden Studie 2. Publikationsmanuskript 3. Zusammenfassung der Arbeit 4. Literatur 5. Wissenschaftliche Präsentation 6. Darstellung des eigenen Beitrages 7. Erklärung über die eigenständige Abfassung der Arbeit 8. Lebenslauf 9. Danksagung

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Neuralgia pós-herpética trigeminal (NPH), neuralgia idiopática do trigêmeo (NIT) e síndrome da ardência bucal (SAB) são doenças neuropáticas da face, caracterizadas por dor na ausência de sinais que evidenciem a causas. Este estudo teve por objetivos determinar as características sensitivas, olfativas, gustativas e salivares em doentes com NPH, NIT e SAB comparados a controles. Foram avaliados 20 doentes de cada grupo, diagnosticados de acordo com critérios da International Association for the Study of Pain (IASP), e 60 indivíduos saudáveis, através de um protocolo sistematizado que incluiu os seguintes testes quantitativos sensitivos: limiares térmicos (frio e calor), limiares mecânicos tácteis, limiares dolorosos de superfície, limiares gustativos (doce, azedo, salgado e amargo), limiares olfativos e fluxo salivar. Os testes foram realizados no território de inervação trigeminal. Os dados foram analisados através dos testes estatísticos ANOVA 1 fator, Tukey, Kruskal-Wallis e Dunn, e o nível de significância foi de 5%. Os limiares térmicos de frio foram diferentes (maiores) somente no ramo mandibular dos doentes com NPH (p=0,001) e os limiares térmicos de calor foram diferentes (maiores) em todos os ramos trigeminais nos doentes com NPH e SAB (p=0,001); a sensibilidade mecânica táctil estava alterada no ramo mandibular de doentes com NPH (p=0,001) e em todos os ramos trigeminais dos doentes com SAB (p= 0,001; p=0,004 e p=0,001); os limiares gustativos salgado e doce, além do limiar olfativo, foram maiores em todos os doentes quando comparados aos controles (p=0,004; p=0,001 e p=0,0389); o sabor ácido obteve os menores limiares e não foram encontradas diferenças para a identificação do sabor amargo ou na avaliação salivar quantitativa (p=0,1694 e p=0,001). Este estudo apresentou evidências de anormalidades sensitivas nos doentes com dor neuropática trigeminal, tanto somestésicas como gustativas e olfativas. A sensibilidade somatosensitiva apresentou-se mais alterada nos doentes com NPH e SAB quando comparados a NIT e aos controles. Mecanismos periféricos e centrais relacionados à percepção e modulação sensitiva podem estar envolvidos na fisiopatologia dos achados aqui observados / Trigeminal postherpetic neuralgia (PHN), idiopathic trigeminal neuralgia (ITN) and burning mouth syndrome (BMS) are painful neuropathies with no clear signs about their causes. The objectives of this study were to determine somatosensory, olfactory, gustative and salivary characteristics of patients with PHN, ITN and BMS compared to controls. Twenty patients from each group, diagnosed according to the criteria from the International Association for the Study of Pain (IASP), and 60 healthy controls were evaluated with a systematized quantitative approach which included thermal (cold and warm), mechanical (tactile), pain, gustative (sweet, sour, salty and bitter) and olfactory thresholds, and quantitative salivary flow evaluation. Data were analyzed with ANOVA 1 factor, Tukey, Kruskal-Wallis and Dunn tests with a level of significance of 5%. Thermal thresholds for cold were different (higher) only in the mandibular branch of patients with PHN (p=0.001) and warm thresholds were higher in all trigeminal branches of PHN and BMS (p=0,001); tactile mechanical sensitivity was altered at the mandibular branch of PHN (p=0,001) and in all trigeminal branches of BMS (p= 0,001; p=0,004 e p=0,001). The salty, sweet and olfactory thresholds were higher in all studied groups (p=0,004; p=0,001 e p=0,0389); the sour threshold was lower and there were no differences in bitter taste or salivary flow (p=0,1694 e p=0,001). This study showed evidences of somatosensory, gustative and olfactory abnormalities in patients with neuropathic orofacial pain. Somatosensory findings were discrete in ITN and more common in PHN and BMS. Peripheral and central mechanisms of perception and modulation could be involved in the physiopathology of these findings

L'objectiu principal de la investigació va ser estudiar els efectes ocasionats per un hàbit de respiració oral en les diferents estructures orofacials i analitzar la relació entre respiració oral i deglució atípica. Per a això, es van definir les estructures que poden sofrir alteració per la inspiració oral i que són objecte d'estudi. La selecció de la mostra es va realitzar a partir de la revisió de 762 històries clíniques dels pacients que van iniciar tractament en el Servei de Logopèdia de l'Hospital de Nens de Barcelona. Es van descartar 389 nens que no s'ajustaven als nostres criteris de selecció, quedant 373 per a la realització de la investigació (309 amb respiració oral i 64 amb respiració nasal). Es va utilitzar per a la recollida de dades un protocol d'evolució i un protocol de trastorns miofuncionals. L'anàlisi dels resultats es va realitzar a través d'una metodologia correlacional que ens va permetre comptabilitzar les diferències estructurals i funcionals entre els nens amb respiració oral i nasal. Es van obtenir estadístics Chi-quadrat i V de Cramer a partir de taules de contingències. Els resultats obtinguts mostren diferències significatives en la majoria de les estructures orofacials entre els respiradores orals i nasals. I reflecteixen relació entre respiració oral i deglució atípica. / El objetivo principal de la investigación fue estudiar los efectos ocasionados por un hábito de respiración oral en las diferentes estructuras orofaciales y analizar la relación entre respiración oral y deglución atípica.Para ello, se definieron las estructuras que pueden sufrir alteración por la inspiración oral y que son objeto de estudio.La selección de la muestra se realizó a partir de la revisión de 762 historias clínicas de los pacientes que iniciaron tratamiento en el Servicio de Logopedia del Hospital de Nens de Barcelona.Se descartaron 389 niños que no se ajustaban a nuestros criterios de selección, quedando 373 para la realización de la investigación (309 con respiración oral y 64 con respiración nasal).Se utilizó para la recogida de datos un protocolo de evolución y un protocolo de trastornos miofuncionales.El análisis de los resultados se realizó a través de una metodología correlacional que nos permitió contabilizar las diferencias estructurales y funcionales entre los niños con respiración oral y nasal. Se obtuvieron estadísticos Chi-cuadrado y V de Cramer a partir de tablas de contingencias.Los resultados obtenidos muestran diferencias significativas en la mayoría de las estructuras orofaciales entre los respiradores orales y nasales. Y reflejan relación entre respiración oral y deglución atípica. / The main objective of the research was to study the effects caused by a habit of oral respiration on different orofacial structures and analyze the relationship between oral respiration and atypical swallowing. Thereby, there were defined structures that may suffer alteration by the oral inspiration and which are under consideration. The sample selection was made after reviewing medical history of 762 patients who started treatment within the Logopedia Service at "Hospital de Nens" in Barcelona. It ruled that 389 children did not meet our criteria for selection, leaving 373 for conducting the research (309 to 64 with oral respiration and nasal respiration). A development protocol and a miofunctional disorder protocol were both used for data collection.The analysis of the results was conducted through a correlational methodology that allowed us to account for structural and functional differences between children with oral and nasal respiration. We obtained Chi-square statistical and V of Cramer from contingency tables. The results show significant differences in most orofacial structures between oral and nasal respirators. And they reflect a relationship between oral respiration and atypical swallowing.

Clefts of orofacial komplex are the most common birth development defects. One of them is Pierre Robin sequence, which is characterized by presence of micrognathia, glossoptosis and upper airway obstruction. Because of these symptoms, isolated cleft palate "U" or "V" shaped can be part of the diagnose. Other clinical manifestations are feeding difficulties, obstructive sleep apnea syndrome and / or gastroesophageal reflux disease. The aim of the treatment is to secure the airway and the child's thriving after birth by using conservative or invasive treatment methods. Choosing of methods and procedures should be established by multidisciplinary cooperation. The other part of diploma thesis is trying to find out, which clinical manifestation are the most common in patients from the Czech Republic compare to foreign patients and the differences in management of the treatment. Furthermore we are trying to investigate, whether there is higher percentage of patients with delayed neuromotor development among PRS patients, which are under physical therapy. The last part is trying to find out the relationship between the poor posture and PRS diagnose in children age 4 - 6 years.

Made available in DSpace on 2016-06-02T20:19:23Z (GMT). No. of bitstreams: 1 5759.pdf: 1614441 bytes, checksum: e8cb545f5a6d49747c6cc09da7ab4c40 (MD5) Previous issue date: 2014-02-21 / Universidade Federal de Sao Carlos / The prevalence of temporomandibular disorders (TMD) signs and symptoms on general population is around 40% and physical therapist actuation has been more and more important to the treatment of the dysfunction. In this context, three different studies on this area were developed, which are explained on this dissertation. The first one is an observational longitudinal study with the following objectives: (1) to verify clinical symptoms and jaw functionality in college students with TMD according to the level of anxiety and depression (A/D) evaluated in two different moments, and (2) to evaluate the correlation between A/D, clinical variables and muscle activity. The results showed that although college students A/D levels changed over the academic semester, no difference in TMD signs and symptoms was observed in subjects with either high or low levels of A/D. Furthermore, the significant correlation between A/D and functional impairment, as well as between A/D and maximum mouth opening without pain in low A/D condition suggests an association between these factors, being important a better investigation. In order to better explore the physiotherapy techniques and overcome the lack of a review study, which addressed the effectiveness of MT in these patients, the second survey was conducted. This study was a systematic review to evaluate the isolated effects of MT in reducing painful symptoms and reduced mouth opening. The review included 12 randomized controlled trials, most of them of high methodological quality that addressed myofascial release, cervical spine manipulation techniques and mixed protocols. They have shown from low to high clinical evidence that MTTM reduces symptoms of pain, increase pressure pain threshold and maximum mouth opening of subjects with TMJ impairment, depending on the applied technique. A third study was conducted in parallel with the other two, which was based on biomechanical and neuroanatomical relationships between the cervical spine, head and the temporomandibular joint. It is a pilot clinical trial that aimed to verify the effects of a rehabilitate program of MT and exercises, designed to cervical function on subjects with TMD. It was evaluated clinical signs, functionality and pressure pain threshold of masseters and temporalis, taking into account the sample´s baseline. The results showed that treatment focused on the cervical spine was effective in increasing maximum mouth opening, as well as to reduce hypersensitivity of the masticatory muscles and functionality of the stomatognathic system in individuals with myofascial and mixed TMD. However, further studies are needed for more accurate conclusions. In general, the studies described on the present dissertation indicate the importance of standardizing TMD patient s assessment, and classifying them according to the type of the disorder. Furthermore, future studies should consider the level of functional impairment and use it as inclusion criterion to increase internal validity. Finally, the number of studies found in the systematic review and the reduced number of included studies show that there is a lot of information about the topic, but a small portion of it follows a methodological rigor, being in fact is reliable. It is important that further clinical trials include a comparison group (control, placebo, conventional treatment or another treatment) so that the effect of the technique is indeed evident. In case of manual therapy clinical trials, the simulation of therapy, which represents the placebo effect of the technique, is increasingly necessary. / A prevalência dos sinais e sintomas de disfunção temporomandibular (DTM) na população geral é em torno de 40% e a atuação da fisioterapia tem sido cada vez mais importante no tratamento dessa disfunção. Neste contexto, foram desenvolvidos os três primeiros estudos dessa nova linha de pesquisa, que compõem esta dissertação. O primeiro trata-se de um estudo transversal com os seguintes objetivos: (1) avaliar a variabilidade de sinais clínicos e de funcionalidade mandibular em estudantes universitários em função do nível de ansiedade e depressão (A/D) avaliados em dois momentos distintos e (2) verificar a correlação entre os níveis de A/D e variáveis clínicas da DTM e eletromiográficas dos músculos mastigatórios. Os resultados mostraram que apesar da amostra ter apresentado variação no nível de A/D no período avaliado, não houve diferença significativa nos sinais e sintomas de DTM. Além disso, houve correlação entre os valores de A/D e o comprometimento funcional, bem como entre os valores de A/D e a abertura máxima sem dor na situação de menor A/D sugerindo a existência de associação entre esses fatores, que precisa ser melhor investigada. A fim de explorar melhor as técnicas terapêuticas, e suprir a falta de um estudo de revisão que abordasse a efetividade do uso exclusivo da TM nesses pacientes, o segundo estudo foi elaborado em forma de revisão sistemática com o objetivo de avaliar o efeito isolado da TM na melhora dos sintomas dolorosos e de limitação da abertura da boca. A revisão incluiu 12 estudos randomizados controlados, sendo a maioria de alta qualidade metodológica e que abordaram técnicas de liberação miofascial, manipulação vertebral e protocolos mistos. Os estudos mostraram que há de baixa a alta evidência clínica de que a TM melhora os sintomas de dor, limiar de dor à pressão e máxima abertura da boca de sujeitos com comprometimento das estruturas da ATM, dependendo da técnica aplicada. Baseado na relação biomecânica e neuroanatômica entre a coluna cervical, a cabeça e a ATM, foi desenvolvido um terceiro estudo em paralelo com os demais. Trata-se de um ensaio clínico piloto com o objetivo de verificar o efeito de um programa de TM e exercícios voltados para a reabilitação da função cervical sobre sinais clínicos, funcionalidade e limiar de dor à pressão em sujeitos com DTM, a partir do registro da linha de base dos sujeitos. Os resultados mostraram que o tratamento com foco na coluna cervical foi eficiente em aumentar a máxima abertura da boca bem como em diminuir a hipersensibilidade dos músculos mastigatórios e a funcionalidade do sistema estomatognático em sujeitos com DTM, porém, futuros estudos são necessários para conclusões mais precisas. De maneira geral, os estudos descritos na presente dissertação apontam a importância da padronização da avaliação dos sujeitos com DTM, e classificação dos mesmos de acordo com a origem. Além disso, futuros estudos devem considerar o grau de comprometimento funcional que os sujeitos apresentam e usá-lo como critério de inclusão para aumentar a validade interna dos mesmos. Por fim, o número de estudos encontrados na revisão sistemática e o reduzido número de estudos incluídos mostra que existe muita informação sobre o assunto, porém uma pequena parcela dela segue um maior rigor metodológico, e portanto é mais confiável. É muito importante que os próximos ensaios clínicos incluam um grupo de comparação (controle, placebo, tratamento convencional ou outro tipo de tratamento) para que a efetividade da técnica seja de fato evidenciada. Ao se tratar de terapia manual, a simulação da terapia, que representa o efeito placebo da técnica se vê cada vez mais necessária.

The thesis deals with the impact of orofacial cleft (cleft lip and palate) on family psychosomatics within the psycho-social-ethical framework. It summarises the history, classification and treatment of cleft disorders, followed by an analysis of real-life problems occuring in the process of taking care of a baby with orofacial cleft, specifies terms frequently used when discussing orofacial cleft as a stigma: stigma and stigmatisation, norm and normality, beauty and ugliness.The phenomena of fear and pain, difficulty in communication with the child{\crq}s and the parents{\crq} immediate social surroundings and, the barriers between experts and the parents are dealt with in the thesis. The thesis focuses on orofacial cleft anomalies in connection with Christian ethics. It analyses the relation of abortion and orofacial disorders and the role of hope in the process of taking care and upbringing of a child suffering from this disorder.

Neuralgia pós-herpética trigeminal (NPH), neuralgia idiopática do trigêmeo (NIT) e síndrome da ardência bucal (SAB) são doenças neuropáticas da face, caracterizadas por dor na ausência de sinais que evidenciem a causas. Este estudo teve por objetivos determinar as características sensitivas, olfativas, gustativas e salivares em doentes com NPH, NIT e SAB comparados a controles. Foram avaliados 20 doentes de cada grupo, diagnosticados de acordo com critérios da International Association for the Study of Pain (IASP), e 60 indivíduos saudáveis, através de um protocolo sistematizado que incluiu os seguintes testes quantitativos sensitivos: limiares térmicos (frio e calor), limiares mecânicos tácteis, limiares dolorosos de superfície, limiares gustativos (doce, azedo, salgado e amargo), limiares olfativos e fluxo salivar. Os testes foram realizados no território de inervação trigeminal. Os dados foram analisados através dos testes estatísticos ANOVA 1 fator, Tukey, Kruskal-Wallis e Dunn, e o nível de significância foi de 5%. Os limiares térmicos de frio foram diferentes (maiores) somente no ramo mandibular dos doentes com NPH (p=0,001) e os limiares térmicos de calor foram diferentes (maiores) em todos os ramos trigeminais nos doentes com NPH e SAB (p=0,001); a sensibilidade mecânica táctil estava alterada no ramo mandibular de doentes com NPH (p=0,001) e em todos os ramos trigeminais dos doentes com SAB (p= 0,001; p=0,004 e p=0,001); os limiares gustativos salgado e doce, além do limiar olfativo, foram maiores em todos os doentes quando comparados aos controles (p=0,004; p=0,001 e p=0,0389); o sabor ácido obteve os menores limiares e não foram encontradas diferenças para a identificação do sabor amargo ou na avaliação salivar quantitativa (p=0,1694 e p=0,001). Este estudo apresentou evidências de anormalidades sensitivas nos doentes com dor neuropática trigeminal, tanto somestésicas como gustativas e olfativas. A sensibilidade somatosensitiva apresentou-se mais alterada nos doentes com NPH e SAB quando comparados a NIT e aos controles. Mecanismos periféricos e centrais relacionados à percepção e modulação sensitiva podem estar envolvidos na fisiopatologia dos achados aqui observados / Trigeminal postherpetic neuralgia (PHN), idiopathic trigeminal neuralgia (ITN) and burning mouth syndrome (BMS) are painful neuropathies with no clear signs about their causes. The objectives of this study were to determine somatosensory, olfactory, gustative and salivary characteristics of patients with PHN, ITN and BMS compared to controls. Twenty patients from each group, diagnosed according to the criteria from the International Association for the Study of Pain (IASP), and 60 healthy controls were evaluated with a systematized quantitative approach which included thermal (cold and warm), mechanical (tactile), pain, gustative (sweet, sour, salty and bitter) and olfactory thresholds, and quantitative salivary flow evaluation. Data were analyzed with ANOVA 1 factor, Tukey, Kruskal-Wallis and Dunn tests with a level of significance of 5%. Thermal thresholds for cold were different (higher) only in the mandibular branch of patients with PHN (p=0.001) and warm thresholds were higher in all trigeminal branches of PHN and BMS (p=0,001); tactile mechanical sensitivity was altered at the mandibular branch of PHN (p=0,001) and in all trigeminal branches of BMS (p= 0,001; p=0,004 e p=0,001). The salty, sweet and olfactory thresholds were higher in all studied groups (p=0,004; p=0,001 e p=0,0389); the sour threshold was lower and there were no differences in bitter taste or salivary flow (p=0,1694 e p=0,001). This study showed evidences of somatosensory, gustative and olfactory abnormalities in patients with neuropathic orofacial pain. Somatosensory findings were discrete in ITN and more common in PHN and BMS. Peripheral and central mechanisms of perception and modulation could be involved in the physiopathology of these findings

The topic of this diploma thesis is an analysis of interdisciplinary approach to children with orofacial clefts. The first chapter deals with theoretical base and defines terminology - communication, communication disabilites. It also defines anatomy and physiology of nasal cavity and oral cavity. The second chapter relates to issues of orofacial clefts. It describes classification, etiology, symptomatology, prevention, aestetic and psychosocial impacts and orofacial cleft children care. The third chapter deals with occurence of communication disabilites of children with orofacial clefts. It focuses on the definition of palatholaly, velopharyngeal inadequacy and it describes various linguistic levels and speech therapy and intervention. The fourth chapter is empiric and it deals with analysis of interdisciplinary approach to children with orofacial clefts. In research processes there were used scientific literature analysis, anamnestic data analysis and available specialized materials analysis. Based on all of these materials six case studies were created. Main goal of this empiric chapter was to analyze interdisciplinary approach to children with orofacial clefts. Partial goals were to analyze whether information provided by experts and doctors to parents of newborn children with orofacial cleft...

The present study explored the effect of the birth of a child with a cleft lip and palate on family functioning within the context of family systems theory. Five families, each with a child who was born with a cleft lip and palate, were included in the study. The five couples were all married and they were the biological parents of their children whose ages ranged from two months to five years. All five sets of parents were initially interviewed together and then had separate individual interviews where the Family Assessment Measure-III was administered. The results reflected each family's distinctive patterns of interaction and how they adapted to the birth of a child with an orofacial cleft. Factors found to affect family functioning included: External support systems, individual coping skills, family rules and boundaries, open communication and cohesion among family members. / Psychology / M. A. (Psychology)