There is no established quantitative, objective method to differentiate individuals with good masticatory function from those lacking this attribute. The aim of this study was to specify a normal range of median particle size values for masticated raw carrots collected just before being swallowed. The masticatory normative indicator (MNI) value thus obtained was based on seven studies carried out by different investigators using different methods for measuring particle size in carrot boluses. A simple mathematical transformation of variables and the choice of an interval of +/-1.96 times the standard deviation gave 4.0 mm as the upper limit of normal median particle size for carrots in a population of young persons with good oral health. This value identifies boluses that may be considered as resulting from impaired mastication, as illustrated in healthy individuals with experimentally hampered mastication, denture wearers, and individuals presenting with obesity or Down syndrome.
The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health. Orofacial dysfunction is on account of poor neuromotor control, muscle weakness, dental anomalies, dysmorphology and intercurrent illness. In particular, feeding and swallowing are impaired. The aim of this first article was to summarize the orofacial difficulties encountered by persons with Down's syndrome at all stages of life and to explain their aetiology. Indicators are proposed for the identification of masticatory problems within this population and reduced masticatory efficiency is discussed in relation to repercussions on oral and general health and on the social integration of persons with Down's syndrome. A second article will describe techniques for preventing, treating and compensating for masticatory dysfunction in this population.
The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health; orofacial dysfunction results and feeding and swallowing are impaired. These problems have been described in an earlier article. Different techniques are proposed for the prevention of the development of orofacial dysfunction in Down's syndrome. In particular, early myofunctional therapy coupled with appliance wear has been shown to be successful over the long term when multidisciplinary management is possible. Functional or conventional orthodontic treatment may be successful for older children when performed concurrently with the use of appropriate behaviour management techniques. More recently, techniques for the compensation of masticatory dysfunction in adults have been proposed, although further research is necessary to confirm their efficacy. The aim of this second article was to review techniques for the prevention, treatment and compensation of orofacial dysfunction in persons with Down's syndrome from birth to adulthood.
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