Oral function in amyotrophic lateral sclerosis patients: A matched case–control study

Abstract

Background & aims: Patients with amyotrophic lateral sclerosis (ALS) develop swallowing difficulties with the progression of the disease. The present study aimed at comparing oral function and body composition between ALS patients and healthy controls, and at evaluating which parameters are the most discriminant between both groups. Methods: We included ALS patients at the start of their multidisciplinary follow-up at the Geneva University Hospitals and healthy age-, gender-, and dental status-matched adults. We assessed the severity of the disease through the ALS Functional Rating Scale and the swallowing difficulties through the EAT-10 score. We performed an intraoral examination of the dental status, and measured chewing performance, bite, lip and tongue force, saliva weight, and body composition. Group comparisons were performed with t-tests or ManneWhitney tests as appropriate. Linear discriminant analysis was used to determine the most discriminant parameters between groups. Results: Twenty-six ALS patients (bulbar onset: n ¼ 7, median (IQR) ALS Functional Rating Scale: 37 (11)) were included. The ALS patients had a significantly lower chewing performance (p < 0.001), lip force (p < 0.001), tongue force (p ¼ 0.002), saliva weight (p < 0.004) and fat-free mass index (p < 0.001) as compared to the healthy individuals, and a higher EAT-10 score (p < 0.001). In ALS patients, a low chewing performance was correlated with a low bite (r ¼ À0.45, p < 0.05)) and tongue force (r ¼ À0.59, p < 0.05). The most discriminant parameters between both groups, by order of importance, were chewing performance, fat-free mass index and saliva weight and allowed the calculation of a discriminant function. Conclusion: Compared to healthy controls, ALS patients have significant alterations of oral function and body composition. The most discriminant parameters between both groups were chewing performance, fat-free mass index and saliva volume. It remains to be demonstrated whether oral parameters predict outcome. Clinical Trial registry: clinicaltrials.gov, identifier: NCT 01772888.

Correlation of weight and body composition with disease progression rate in patients with amyotrophic lateral sclerosis

“…Investigation of body composition may offer insights to address this issue. Previous studies with small sample sizes 18 , 19 found that ALS patients have a lower BMI and FFM than healthy controls, but no significant difference in body composition was found among patients and controls in this study. The inconsistent results might be explained by the different disease duration of patients and the demographic differences of controls.…”

A conceptual model of oro‐facial health with an emphasis on function

“…Symptoms of genetic syndromes such as Down syndrome, or haematological and autoimmune diseases are often evident in the oro‐facial system as well. Further, a direct effect on the oral cavity was demonstrated for stroke and amyotrophic lateral sclerosis patients who lose much of their sensory and motor abilities and hence show impaired bolus control and swallowing disorders, leading to frequent feeding problems, low oral health–related quality of life and aspiration pneumonia 60,61 …”

Intervención odontológica en el manejo de la esclerosis lateral amiotrófica.

“…Nagely-Jalith Mejía-Chuquispuma 1,2,a , Ivo Luna-Mazzola 1,2,a , Laura Ricardina Ramírez-Sotelo 3,b Estimado Editor: La esclerosis lateral amiotrófica (ELA) es un trastorno neurodegenerativo que afecta las motoneuronas en la corteza motora, el tronco encefálico y la médula espinal (1). Si bien las manifestaciones clínicas de esta enfermedad son variadas y dependen del sitio de inicio de los síntomas, pueden causar parálisis muscular progresiva y ser de naturaleza terminal e invalidante (2).…”

“…Si bien las manifestaciones clínicas de esta enfermedad son variadas y dependen del sitio de inicio de los síntomas, pueden causar parálisis muscular progresiva y ser de naturaleza terminal e invalidante (2). A pesar que la ELA tiene una incidencia global baja (1,9 a 4,5/100.000 personas por año) (3), los intentos por mejorar la calidad de vida de los pacientes que la padecen son muy valorados; por ello, en los últimos años se han realizado estudios con la finalidad de describir las manifestaciones orales generadas por esta enfermedad y cómo manejarlas (1)(2)(3)(4)(5). La presente carta tiene por objetivo justificar el rol del odontólogo como parte del equipo multidisciplinario para el manejo de pacientes con ELA.…”

“…Sin embargo, en estadios avanzados de casi todos los casos se produce el compromiso de esta región (2,4). Así, una de las repercusiones de la ELA en el sistema estomatognático es la disminución de la función masticatoria, la cual incluye características como la fuerza de mordida, movilidad mandibular, rendimiento masticatorio y capacidad de coordinación de los labios y la lengua (1,4). Tres estudios han encontrado que la ELA, principalmente de inicio bulbar, se asocia a una reducción significativa de una o más de estas características, lo cual explica por qué los pacientes con este tipo de inicio presentan mayores dificultades en la deglución y fonación (1,4,5).…”