Validation of the MBGR orofacial myofunctional assessment protocol for adults with temporomandibular disorders with disc displacement with reduction

Bueno, Mariana da Rocha Salles; Rosa, Raquel Rodrigues; Genaro, Katia Flores; Berretin-Felix, Giédre

doi:10.1590/2317-1782/20202019132

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• CoDAS 32 (4) • 2020 • https://doi.org/10.1590/2317-1782/20202019132 linkcopy

Validation of the MBGR orofacial myofunctional assessment protocol for adults with temporomandibular disorders with disc displacement with reduction

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose This study aimed at validating the MBGR Orofacial Myofunctional Assessment Protocol (MBGR Protocol) for adults with Temporal Mandibular Disorders (TMD).

Methods The study sample was composed of 30 adults: 15 with TMD (disc displacement with reduction according to the Research Diagnostic Criteria for Temporomandibular Disorders) and 15 control individuals. The validation process encompassed the content, criterion, and construct of the protocol, as well as its inter- and intra-rater agreement levels and sensitivity and specificity values, considering a 5% statistical significance level.

Results The following validities were confirmed: of content, as the MBGR Protocol covers all functional issues present in patients with TMD; of criterion, with significant correlations between the MBGR and Orofacial Myofunctional Evaluation with Scores (OMES) protocols; of construct, differentiating individuals with and without Orofacial Myofunctional Disorders (OMD) as for pain on palpation and mandible range of motion, with significant correlation between the MBGR clinical evaluation and that using a digital algometer, as well as confirmation of the instrumental assessment for the breathing mode classification. Agreement ranged from poor to very good and from reasonable to very good for the inter- and intra-rater power analyses, respectively. High sensitivity and specificity values were observed.

Conclusion The MBGR Protocol proved to be valid for use in adults presented with TMD with disc displacement with reduction and controls, covering all aspects that enable the analysis of OMD in these individuals.

Keywords
Temporomandibular Joint; Stomatognathic System; Speech, Language and Hearing Sciences; Protocols; Validation Studies

Author (year)	Sample	Myofunctional Assessment Procedures	Results /Identified OMD	Level of evidence
Ferreira et al.⁽⁵⁾	- 81 adults	- Clinical evaluation of mastication and deglutition (OMES)	- Changes in mastication behavior	3
	- Aged 18-41 years	- Clinical evaluation of mastication and deglutition (OMES)	- Higher chewing frequency
	- Groups divided according to TMD and occlusion	- Mastication time and frequency	- Higher chewing frequency
Melchior et al.⁽¹⁴⁾	- 1 woman with TMD	- Orofacial myofunctional evaluation with scores (OMES)	- Speech with mandibular deviation and lisp	5
	- Aged 35 years		- Preferred unilateral mastication on the right side
			- Atypical deglutition
		- Electromyography	- Changes in orofacial mobility
			- Muscle imbalance
			- Post-treatment improvement
Ferreira et al.⁽¹⁵⁾	- 44 subjects of both genders	- Orofacial myofunctional evaluation with scores (OMES)	- Worsening of the general myofunctional, tongue and mandibular mobility status	3
	- Aged 21 years on average	- Orofacial myofunctional evaluation with scores (OMES)
	- Group with mild TMD (n=23)	- Evaluation of mandibular kinematics during unilateral mastication
	- Control group (n=21)		- Reduced masticatory stability
Ferreira et al.⁽¹⁶⁾	- 30 adult women	- Orofacial myofunctional evaluation with scores (OMES)	- Worsening of global myofunctional status (appearance and posture of lips and tongue, lips and mandible mobility, and deglutition)	3
	- Group with moderate TMD (n = 20)	- Measurement of masseter oxygen saturation during unilateral mastication
	- Control group (n = 10)		- Lower oxygen extraction capacity
Melchior et al.⁽¹⁷⁾	- 5 women	- Orofacial myofunctional evaluation with scores (OMES) before and after orofacial myofunctional therapy	- Improvement of orofacial functions after orofacial myofunctional therapy	3
	- Aged 50-61 years
	- After low-intensity laser therapy
Rodrigues et al.⁽¹⁸⁾	- 52 individuals of both genders	- Clinical and electromyographic evaluation of mastication	- Larger number of mastication strokes and longer mastication time	3
	- Aged 18-60 years	- Clinical and electromyographic evaluation of mastication	- Greater electromyographic activity of the masticatory muscles
	- TMD group (n = 27)	- Analysis of mastication efficiency	- No impairment of mastication efficiency
	- Control group (n = 25)	- Analysis of mastication efficiency	- No impairment of mastication efficiency
Ferreira et al.⁽¹⁹⁾	- 76 adults	- Orofacial myofunctional evaluation with scores (OMES)	- Changes in appearance/posture, mobility, mastication, and deglutition	3
	- Group with chronic TMD (n = 46)	- Orofacial myofunctional evaluation with scores (OMES)	- Higher frequency of unilateral mastication
	- Control group (n = 30)	- Electromyography	- Longer mastication time
Weber et al.⁽²⁰⁾	- 70 women	- Clinical evaluation of mastication and deglutition (OMES)	- Chronic unilateral mastication	3
	- TMD group (n = 34)	- Cephalometric analysis of the position of the mandible and hyoid bone	- Changes of lip and tongue posture during deglutition
	- Control group (n = 36)		- Lower position of the hyoid bone in relation to mandible
Maffei et al.⁽²¹⁾	- 10 adults	- Videofluoroscopic evaluation of mastication and deglutition	- Preferred unilateral mastication with the presence of compensatory tongue movements	4
	- Both genders
	- TMD group		- Signs of oropharyngeal dysphagia
Stuginski-Barbosa et al.⁽²²⁾	-60 women	- Clinical assessment of deglutition	- Atypical deglutition	3
	- Group with myofascial pain syndrome
	- Control group
Busanello-Stella et al.⁽²³⁾	- 16 adults of both genders	- Clinical evaluation of mastication, intra- and extra-oral aspects, sensitivity, tension and mobility	- Unilateral mastication	4
	- Aged 19-51 years
	- Group with bruxism and orofacial pain
Matos and Sekito⁽²⁴⁾	- 44 individuals of both genders	- Visual clinical examination of the habitual position of the lips and tongue	- Almost half of the individuals presented altered habitual tongue posture	4
	- Aged 43 years on average)		- Pain on palpation
	- TMD group	- Pain on palpation	- Absence of pain/tongue posture relationship
Felício et al.⁽²⁵⁾	- 40 women (adolescents, adults and elderly)	Clinical evaluation of mastication and deglutition	- Preferred unilateral mastication	3
	- TMD group		- Atypical deglutition
	- Control group		- Atypical deglutition
Pereira et al.⁽²⁶⁾	- 135 adults	- Mastication performance evaluation	- Inefficient mastication	3
	- Both genders	- Mastication performance evaluation	- Reduced bite force
	- TMD group (n = 15)	- Bite force
	- Control group (n = 120)	- Bite force

MBGR
OMES	Lips	Tongue	Palate	Breathing	Deglutition	Mastication
Lips	-0.46**
Tongue		-1**
Palate			-0.47**
Breathing				-0.69**
Deglutition					-0.45**
Mastication						-0.48**

MBGR items	Maximum score	CG	SG	p-value	W statistics
Extraoral examination	28	7	7	0.458	214.5
Intraoral examination	58	7	7	0.933	230
Tonus	06	3	3	0.262	205.5
Pain on palpation	10	4	8	0.0002*	144
Mobility
Lips	16	0	0	-	-
Tongue	16	0	0	0.237	256
Mandible	13	0	2	0.0014*	156.5
Functions
• Breathing	04	0	0	-	-
Mastication	10	1	1	0.798	226.5
• Deglutition	39	4	4	0.983	233.5
• Speech	44	1	1	1	232
Total score	244	31	38	0.056	186

Pain on palpation	PPT
Pain on palpation	Right TMJ	Left TMJ	Right Masseter	Left Masseter	Right Temporal	Left Temporal
Right TMJ	-0.43**
Left TMJ		-0.58**
Right Masseter			-0.51**
Left Masseter				-0.61**
Right Temporal					-0.48**
Left Temporal						-0.55**

MBGR items	Weighted Kappa		Standard error		Agreement (%)		Strength of agreement
MBGR items	Inter	Intra	Inter	Intra	Inter	Intra	Inter	Intra
Extraoral examination	0.94	0.65	0.027	0.172	86.67	50.00	a	b
Intraoral examination	0.74	0.55	0.085	0.2	70.00	50.00	b	c
• Tongue	1.00	0.74	0	0.165	100.00	50.00	a	b
• Hard palate	0.20	0.80	0.152	0.118	83.33	83.33	e	b
• Teeth and occlusion	0.96	-	0.026	-	86.67	100.00	a	-
Mobility	0.51	0.74	0.097	0.096	46.67	83.33	c	b
• Lips	0.06	-	0.051	-	80.00	100.00	e	-
• Tongue	0.84	0.57	0.091	0.353	83.33	83.33	a	c
• Mandible	0.64	0.86	0.115	0.155	63.33	83.33	b	a
Function	0.96	0.54	0.016	0.15	83.33	16.67	a	c
• Breathing	0.79	0.29	0.202	0.157	93.33	16.67	b	d
• Mastication	0.95	0.46	0.036	0.338	90.00	50.00	a	c
• Deglutition	1.00	0.97	0	0.018	100.00	83.33	a	a
• Speech	1.00	0.93	0	0.054	100.00	66.67	a	a

Rated aspect	Cutoff point
Rated aspect	Median (%)	Percentile (%)
Sensitivity	71.43	50.00
Specificity	75.00	79.17

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[TFN100] ^**
p<0.01.

[2] Correlation strength: Moderate for lips, palate, breathing, and mastication; strong for the tongue