Chewing Problem

Temporomandibular Disorders (TMD) encompass various conditions that affect the temporomandibular joint and associated tissues, often causing or being associated with other symptoms such as jaw pain, myofascial pain, neck pain, and headaches. TMDs are classified according to the DC/TMD instrument in which the joint and pain axes are evaluated. However, there is no evaluation of mandibular function, and TMDs can result in a decrease in jaw strength and resistance. This leads to an increase in the chewing fatigue. Reliable and time-effective diagnostic methods for evaluating masticatory function are crucial in the clinical setting because of the high prevalence of TMD. Chewing efficiency is essential for food preparation and nutrient absorption, and muscle fatigue is a common problem affecting chewing ability. Despite this, there is a lack of validated tests to evaluate chewing fatigue in patients with TMD, which makes its consideration unnoticed in clinical practice. The modified six-minute functional chewing test (F-6MMT) was proposed as a tool to evaluate chewing ability and fatigue in patients with TMD. This test is an adaptation of a previously designed test in which subjects with mitochondrial pathology were evaluated; however, the subjects were not instructed to perform functional chewing during the test. In this version, modifications are added so that the test is as functional as possible, allowing chewing to be evaluated in a standardized way, and cut-off points established between healthy subjects and subjects with TMD in terms of chewing capacity in general and fatigue in particular. This study will follow standardized reporting guidelines and recruit participants from diverse clinical settings.

Various structural and functional problems in neural, sensory and perceptual, cardiovascular, pulmonary, gastrointestinal, endocrine, and musculoskeletal systems occur in geriatrics not associated with a specific disease. One of the problems observed in geriatrics is chewing and swallowing disorders. Failure to detect changes in chewing and swallowing performance in elderly individuals at an early stage may lead to chewing and swallowing disorders and serious complications in later stages. Therefore, it is necessary to comprehensively and systematically address the possible factors affecting chewing and swallowing performance in geriatric individuals. The first aim of the study is to analyze the factors affecting chewing and swallowing performance in geriatric individuals within the scope of the International Classification of Functioning, Disability, and Health (ICF). The second aim of the study is to create a dysphagia risk prediction model for geriatric individuals based on the results of the analyses to be conducted. In the study, the dependent variables, chewing performance, will be evaluated with the Chewing and Swallowing Test of Solids, and swallowing performance will be assessed with the Repetitive Saliva Swallowing Test and Dysphagia Limit. Independent variables affecting chewing and swallowing performance have been considered within the scope of the ICF, and all possible factors determined for both geriatrics and swallowing have been listed, and the evaluation parameters and assessment tools have been decided. The evaluation parameters have been categorized under ICF headings such as personal factors, body structures, body functions, activity and participation, and environmental factors, and the evaluations to be conducted have been divided into two groups: geriatric and physiotherapy evaluations. The geriatric evaluations are part of routine geriatric assessment and do not include any specific evaluation for the study. Physiotherapy evaluations will be applied in a certain order to use time efficiently and will take approximately 35-45 minutes. Through geriatric and physiotherapy evaluations, a holistic assessment of participants within the scope of ICF will be ensured.