Orofacial Motor Functions and Temporomandibular Disorders in Patients With Sjögren's Syndrome

Abstract

Objective. Sjögren's syndrome (SS) induces difficulty in chewing and swallowing due to low salivary flow. However, these symptoms may be associated with other factors, such as orofacial myofunctional disorders and temporomandibular disorder (TMD), which have not been comprehensively assessed in this population. The aims of this study were to investigate orofacial muscles and functions as well as the presence of TMD in patients with SS compared with a group without SS and to analyze whether the patients' experience of limitations in orofacial functioning is associated with the orofacial functional status and muscle pain related to TMD.Methods. Women with SS based on the 2002 American-European Consensus Group criteria and volunteers paired by age and sex were compared. The examinations included the orofacial myofunctional evaluation with scores (OMES) protocol, tongue and lip strength measures, and electromyography of the masticatory muscles. TMD investigations included clinical examination, self-report of symptoms, and assessment according to the Jaw Functional Limitation Scale.Results. Patients with SS present with impaired muscle and orofacial functions based on lower scores of all categories of OMES (P < 0.0001), tongue strength (P = 0.0003-0.0004), and masticatory muscle activity (P = 0.0002-0.007), as well as worse TMD signs and symptoms (P < 0.05) and jaw functional limitation (P < 0.0001-0.0003).Conclusion. Patients' experiences with limitation in mastication and swallowing were associated with orofacial myofunctional status and muscle pain related to TMD. Those disorders should be monitored along with disease control and must be addressed in the clinical evaluation to prevent nutritional and metabolic comorbidities in patients with SS.

Quantitative Measurement of Swallowing Performance Using Iowa Oral Performance Instrument: A Systematic Review and Meta-Analysis

“…An initial screening of the titles and abstracts identified 47 studies. After reading the full texts, 33 studies [ 44 , 45 , 46 , 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] were included, thus eliminating 14 studies [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 78 ] that did not meet the inclusion/exclusion criteria. The summary of the search strategy is depicted in Figure 2 .…”

“…Impaired swallowing performance was associated to many pathologies and conditions. In particular, among the 19 studies [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] with a case-control design, participants included patients with head and neck cancer in 3 studies (21.4%) [ 71 , 72 , 76 ], with muscular dystrophies in 4 studies (28.5%) [ 70 , 73 , 74 , 75 ], and dysphagic [ 77 ], post-extubated [ 49 ], unilateral cleft-lip-palate [ 50 ], Parkinson’s disease [ 51 ], chronic temporo-mandibular disorders (TMD) [ 52 ], sleep breathing disorders [ 53 ], and post-stroke [ 54 ] subjects in 1 study (7.1%), respectively. Among the 5 case-control studies with a cross-sectional design, older adults [ 55 ], patients with mouth breathing behavior [ 56 ], motor speech disorders and sound disorders [ 57 ], Sjogren syndrome [ 58 ], and Down syndrome [ 59 ] were included in only 1 study (20%).…”

“…Moreover, the sample in 1 out of 14 intervention studies (7.1%) was totally composed of HC without any reported pathologies [ 44 ]. In these 14 intervention studies [ 40 , 41 , 42 , 43 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ], some sessions of tongue exercises were applied in order to evaluate the effect of oral musculature training on the swallowing performance. In particular, in 1 study (7.1%) [ 60 ], patients were treated with tongue-to-palate resistance training (TPRT), consisting of separately pressing the anterior and posterior region of the tongue strongly against the palate, and conventional dysphagia therapy, whereas the control group performed only conventional dysphagia therapy, including thermal tactile stimulation, facial massage, and various maneuvers.…”

“…The Newcastle–Ottawa quality assessment scale was also applied to studies with a cross-sectional design: a low risk of bias was found in three studies [ 56 , 58 , 59 ]. Two studies instead [ 55 , 57 ] resulted in being at an intermediate risk of bias because of inadequate information about “Selection”, “Comparability”, and “Exposure” domains.…”

“…For the case-control analyses, 21 [ 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 65 , 67 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] studies (63.64%) reported at least one of the outcome variables in the HC and patients’ groups. Specifically, 19 studies [ 49 , 50 , 51 , 53 , 54 , 55 , 56 , 57 , 59 , 65 , 67 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ] (57.57%) reported MIP values, 4 studies [ 51 , 52 , 54 , 74 ] (12.12%) reported LSP values, 9 studies [ 36 , 40 , 45 , 61 , 62 ,…”