Clinical diagnosis of hyposalivation in hospitalized patients.

Berti-Couto Sde A1, Couto-Souza PH, Jacobs R, Nackaerts O, Rubira-Bullen IR, Westphalen FH, Moysés SJ, Ignácio SA, Costa MB, Tolazzi AL.J Appl Oral Sci. 2012 Mar-Apr;20(2):157-61.

Fonte: Oral Science


OBJECTIVE: The aim of this study was to evaluate the effectiveness of clinical criteria for the diagnosis of hyposalivation in hospitalized patients.

MATERIAL AND METHODS: A clinical study was carried out on 145 subjects (48 males; 97 females; aged 20 to 90 years). Each subject was clinically examined, in the morning and in the afternoon, along 1 day. A focused anamnesis allowed identifying symptoms of hyposalivation, like xerostomia complaints (considered as a reference symptom), chewing difficulty, dysphagia and increased frequency of liquid intake. Afterwards, dryness of the mucosa of the cheeks and floor of the mouth, as well as salivary secretion during parotid gland stimulation were assessed during oral examination.

RESULTS: Results obtained with Chi-square tests showed that 71 patients (48.9%) presented xerostomia complaints, with a significant correlation with all hyposalivation symptoms (p <0.05). Furthermore, xerostomia was also significantly correlated with all data obtained during oral examination in both periods of evaluation (p<0.05).

CONCLUSION: Clinical diagnosis of hyposalivation in hospitalized patients is feasible and can provide an immediate and appropriate therapy avoiding further problems and improving their quality of life.



Dysphagia in the Elderly

Review articleSmukalla SM, et al. Curr Treat Options Gastroenterol. 2017

Fonte: Pharmaceutical Journal


OPINION STATEMENT: Dysphagia is a common problem in the elderly population with an especially high prevalence in hospitalized and institutionalized patients. If inadequately addressed, dysphagia leads to significant morbidity and contributes to decreased quality of life. Dysphagia can be categorized as emanating from either an oropharyngeal or esophageal process. A disproportionate number of elderly patients suffer from oropharyngeal dysphagia with a multifactorial etiology. Historically, treatment options have been limited and included mostly supportive care with a focus on dietary modification, food avoidance, and swallow rehabilitation. Nascent technologies such as the functional luminal imaging probe (FLIP) and advances in esophageal manometry are improving our understanding of the pathophysiology of oropharyngeal dysphagia. Recent developments in the treatment of specific causes of oropharyngeal dysphagia, including endoscopic balloon dilations for upper esophageal sphincter (UES) dysfunction, show promise and are expected to enhance with further research. Esophageal dysphagia is also common in the elderly and more commonly due to an identifiable cause. The full breadth of treatment options is frequently unavailable to elderly patients due to comorbidities and overall functional status. However, the increasing availability of less invasive solutions to specific esophageal pathologies has augmented the number of treatment options available to this population, where an individualized approach to patient care is paramount. This review focuses on the evaluation and management of dysphagia in the elderly and delineates how standard and novel therapeutics are contributing to more nuanced and personalized management.



Imagem: Pinterest

CATAO, Maria Helena Chaves de Vasconcelos; OLIVEIRA, Polyana Sarmento de; COSTA, Roniery de Oliveira and CARNEIRO, Vanda Sanderana Macêdo. 

Rev. CEFAC [online]. 2013, vol.15, n.6 [cited 2017-08-17], pp.1601-1608. 

OBEJTIVO: avaliar a eficácia do laser de baixa intensidade no tratamento da dor em pacientes com desordens temporomandibulares. 

MÉTODO:consistiu de um ensaio clínico randomizado divididos em dois grupos: Grupo 1: laser AsGaAl, Grupo 2: laser InGaAlP, do qual participaram 20 pacientes entre 19 e 35 anos de idade, com diagnóstico de sinais e sintomas de DTM. Os pacientes tinham a amplitude de movimento para abertura máxima da boca e lateralidade registados no início e no final do tratamento a laser. O Laser foi aplicado em quatro pontos pré-auriculares, totalizando 12 sessões três vezes por semana, durante um mês. Dor dos pacientes foi registrado com base na utilização da escala analógica visual (EAV) e também por exame físico dos pontos álgicos. 

RESULTADOS: observou-se redução significante (p<0,028) do nível de dor em ambos os grupos, porém no G1 a significância foi maior. A evolução do limiar de sensibilidade muscular evidenciou diferença estatisticamente significante (p<0,05) para G1 e G2. A laserterapia no Grupo 1 melhorou a abertura bucal em média de 4,643 mm, enquanto no Grupo 2, a média foi de 3,71 mm por paciente. 

CONCLUSÃO: houve eficácia em ambos os lasers no controle da dor e abertura bucal dos pacientes.


Mudança funcional no padrão de deglutição por meio da realização de exercícios orofaciais

Irina Claudia Fernandes Alves
Claudia Regina Furquim de Andrade

Imagem: Pinterest 


O objetivo desta pesquisa foi verificar se há melhora funcional do padrão de deglutição em indivíduos identificados com risco para disfagia orofaríngea após quatro semanas da realização de exercícios orofaríngeos específicos com intensidade e duração pré-determinados.
Esta pesquisa é de caráter longitudinal de efeito funcional, determinado por medidas comparativas inicial e final. A população-alvo foi constituída de indivíduos adultos e idosos selecionados por 24 meses. Foi incluído para esta pesquisa um total de 68 indivíduos. Foi realizada avalição clínica da deglutição e observados sinais clínicos para disfagia. Os indivíduos foram divididos em dois grupos de acordo com o nivelamento inicial na escala ASHA NOMS. No Grupo 1 (G1) – ASHA NOMS, inicial de níveis 1 e 2; Grupo 2 (G2) – ASHA NOMS, inicial de níveis 3, 4 e 5. Todos os indivíduos realizaram um protocolo de exercícios por quatro semanas. O protocolo conta com sessões presenciais e continuidade das atividades em ambiente domiciliar. Ao final, foi realizada nova mensuração do desempenho de deglutição.
Para o grupo G2 houve melhora estatisticamente significante. Para o G1, a relação não foi significante, apesar de mudança intensa na escala ASHA NOMS, porém, neste grupo, temos um número reduzido de indivíduos devido à gravidade do perfil.
O programa se mostrou efetivo, pois, após as quatro sessões de exercícios, houve melhora importante no padrão de deglutição, demonstrada pela escala funcional.


Swallowing Function After Continuous Neuromuscular Electrical Stimulation of the Submandibular Region Evaluated by High-Resolution Manometry

Jungheim, M., Schubert, C., Miller, S. et al. Dysphagia (2017) 32: 501.

Fonte imagem:


Although neuromuscular electrical stimulation (NMES) is increasingly used in dysphagia therapy, patient responses to NMES are inconsistent and conflicting results have been reported. This, together with a lack of information about the effects of NEMS on the swallowing process, has led to an ongoing debate about its impact on swallowing function. In order to address this, we set out to (i) collect baseline information on the physiological effects of NMES on the complex pharyngeal phase of swallowing and (ii) to compare two different stimulation protocols. In doing so, we provide information useful for evaluating the therapeutic effectiveness of NMES on the swallowing process. In a prospective study, 29 healthy participants performed water swallows after receiving continuous NMES for 10 min. The stimulus was applied in the submandibular region using one of two different stimulation protocols: low-frequency stimulation (LFS) and mid-frequency stimulation (MFS). Swallowing parameters of the pharynx and UES were measured using high-resolution manometry. Maximum tongue base pressure increased by 8.4% following stimulation with the MFS protocol. Changes in UES function were not found. LFS stimulation did not result in any significant changes in the parameters examined. The MFS protocol enhances tongue base retraction during swallowing in healthy volunteers. The magnitude of the effect, however, was small, possibly due to the ability of healthy subjects to compensate for external influences, such as NMES, and may actually prove to be much greater in patients with diminished tongue base retraction. Thus, further studies are needed to determine whether a similar effect is also achievable in dysphagic patients with impaired bolus propulsion, possibly allowing MFS stimulation of the tongue base region to be used as an additional treatment tool.

Acesse o periódico 

Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia.


Kim HD, et al.

J Oral Rehabil. 2017.

Tongue function can affect both the oral and pharyngeal stages of the swallowing process, and proper tongue strength is vital for safe oropharyngeal swallowing. This trial investigated the effect of tongue-to-palate resistance training (TPRT) on tongue strength and oropharyngeal swallowing function in stroke with dysphagia patients. This trial was performed using a 4-week, two-group, pre-post-design. Participants were allocated to the experimental group (n = 18) or the control group (n = 17). The experimental group performed TPRT for 4 weeks (5 days per week) and traditional dysphagia therapy, whereas the control group performed traditional dysphagia therapy on the same schedule. Tongue strength was measured using the Iowa Oral Performance Instrument. Swallowing function was measured using the videofluoroscopic dysphagia scale (VDS) and penetration-aspiration scale (PAS) based on a videofluoroscopic swallowing study. Experimental group showed more improved in the tongue strength (both anterior and posterior regions, P = 0·009, 0·015). In addition, the experimental group showed more improved scores on the oral and pharyngeal phase of VDS (P = 0·029, 0·007), but not on the PAS (P = 0·471), compared with the control group. This study demonstrated the effectiveness of TPRT in increasing tongue muscle strength and improving swallowing function in patients with post-stroke dysphagia. Therefore, we recommend TPRT as an easy and simple rehabilitation strategy for improving swallowing in patients with dysphagia.

© 2016 John Wiley & Sons Ltd.


Effect of phototherapy (low-level laser therapy and light-emitting diode therapy) on exercise performance and markers of exercise recovery: a systematic review with meta-analysis

Leal-Junior, E.C.P., Vanin, A.A., Miranda, E.F. et al. Lasers Med Sci (2015) 30: 925. doi:10.1007/s10103-013-1465-4


Recent studies have explored if phototherapy with low-level laser therapy (LLLT) or narrow-band light-emitting diode therapy (LEDT) can modulate activity-induced skeletal muscle fatigue or subsequently protect against muscle injury. We performed a systematic review with meta-analysis to investigate the effects of phototherapy applied before, during and after exercises. A literature search was performed in Pubmed/Medline database for randomized controlled trials (RCTs) published from 2000 through 2012. Trial quality was assessed with the ten-item PEDro scale. Main outcome measures were selected as: number of repetitions and time until exhaustion for muscle performance, and creatine kinase (CK) activity to evaluate risk for exercise-induced muscle damage. The literature search resulted in 16 RCTs, and three articles were excluded due to poor quality assessment scores. From 13 RCTs with acceptable methodological quality (≥6 of 10 items), 12 RCTs irradiated phototherapy before exercise, and 10 RCTs reported significant improvement for the main outcome measures related to performance. The time until exhaustion increased significantly compared to placebo by 4.12 s (95% CI 1.21-7.02, p < 0.005) and the number of repetitions increased by 5.47 (95% CI 2.35-8.59, p < 0.0006) after phototherapy. Heterogeneity in trial design and results precluded meta-analyses for biochemical markers, but a quantitative analysis showed positive results in 13 out of 16 comparisons. The most significant and consistent results were found with red or infrared wavelengths and phototherapy application before exercises, power outputs between 50 and 200 mW and doses of 5 and 6 J per point (spot). We conclude that phototherapy (with lasers and LEDs) improves muscular performance and accelerate recovery mainly when applied before exercise.