What are the management options for impaired buccal mastication?

Management Options for Impaired Buccal Mastication

The management of impaired buccal mastication should focus on identifying and treating the underlying cause while implementing appropriate dietary modifications and rehabilitation techniques to improve masticatory function and prevent complications such as malnutrition and aspiration.

Causes of Impaired Buccal Mastication

Impaired buccal mastication (chewing difficulty) can result from various conditions:

1. Dental causes:

   • Missing teeth or poor dentition
   • Ill-fitting dentures
   • Dental trauma 1
   • Malocclusion 2

2. Neurological causes:

   • Trigeminal nerve dysfunction (CN V) affecting masticatory muscles 1
   • Facial nerve weakness (CN VII) 1
   • Progressive neurological diseases (ALS, Parkinson's, dementia) 1
   • Stroke 1

3. Musculoskeletal causes:

   • Temporomandibular disorders 1
   • Masticatory muscle weakness 1
   • Age-related sarcopenia affecting oral musculature 1, 3

4. Other causes:

   • Head and neck cancers 1
   • Xerostomia (dry mouth) 1
   • Medication side effects 1

Diagnostic Approach

1. Clinical assessment:

   • Evaluate dental status (missing teeth, occlusion problems)
   • Assess masticatory muscle strength and coordination
   • Check for signs of temporomandibular disorders
   • Evaluate tongue mobility and strength

2. Imaging studies (when appropriate):

   • For suspected trigeminal nerve issues: MRI head and orbit/face/neck without and with IV contrast (rated 8/9 - usually appropriate) 1
   • For suspected dental trauma: Intraoral radiographs 1

3. Functional assessment:

   • Observe chewing pattern and efficiency
   • Evaluate for signs of dysphagia (often co-occurs with masticatory problems) 1
   • Screen for nutritional deficiencies 4

Management Strategies

1. Dental Interventions

• Restore dentition:

  • Repair damaged teeth
  • Replace missing teeth with appropriate prosthetics
  • Adjust ill-fitting dentures
  • Consider dental implants for improved masticatory function 5

• Treat dental trauma based on specific injury type:

  • For lateral luxation: Ensure proper occlusion and refer to dentist 1
  • For extrusive luxation: Gentle repositioning or extraction for severe cases 1

2. Management of Temporomandibular Disorders

• Conservative approaches:
  • Early diagnosis and reassurance
  • Simple physiotherapy exercises
  • Night splints (commonly prescribed by dentists) 1
  • Avoid excessive jaw movement during dental procedures 6

3. Neurological Management

• For trigeminal neuralgia:

  • Carbamazepine as first-line medication
  • Consider neurosurgery for poorly controlled cases 1

• For neuropathic pain following trauma or dental procedures:

  • Manage as other neuropathic pain conditions 1

4. Dietary Modifications

• Food consistency adaptations:
  • Progress from soft to more challenging textures as function improves
  • Ensure adequate nutrition despite modified diet 4
  • Monitor for signs of malnutrition in patients with chronic mastication problems 1

5. Rehabilitation Techniques

• Masticatory muscle exercises:

  • Targeted exercises to strengthen masticatory muscles
  • Coordination exercises for improved chewing efficiency

• Swallowing therapy (when dysphagia co-exists):

  • Referral to speech-language pathologist for comprehensive evaluation 1
  • Combined videofluoroscopic swallow study if both oropharyngeal and esophageal dysphagia are suspected 1

6. Special Considerations

• For elderly patients:

  • Screen for "Dysmasema" - persistent masticatory dysfunction related to aging and systemic factors 3
  • Monitor nutritional status closely 1, 4

• For patients with cognitive impairment:

  • Use visual aids, plain language, and multimodal presentation of information
  • Provide corrective feedback and repetition to improve understanding 1
  • Consider decision-making capacity and need for surrogate decision-makers 1

• For patients with Down syndrome:

  • Early identification of masticatory problems
  • Address specific orofacial dysfunction related to neuromotor control and muscle weakness 7

Monitoring and Follow-up

• Regular dental check-ups (at least every 6 months)
• Nutritional assessment
• Adjustment of interventions based on progress
• Monitoring for complications (malnutrition, aspiration)

Prevention

• Maintain good oral hygiene
• Regular dental care
• Early intervention for dental problems
• Proper denture care when applicable 6

By addressing the underlying cause of impaired buccal mastication and implementing appropriate interventions, patients can experience improved masticatory function, better nutrition, and enhanced quality of life.