Children with Unilateral Molar-Incisor Hypomineralization May Exhibit Contralateral Muscle Hyperactivity

Children with Unilateral Molar-Incisor Hypomineralization May Exhibit Contralateral Muscle Hyperactivity | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Children with Unilateral Molar-Incisor Hypomineralization May Exhibit Contralateral Muscle Hyperactivity Ligia Maria Napolitano Gonçalves, Kelly Fernanda Molena, Milena Rodrigues Carvalho, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4385637/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objectives This study aimed to assess unilateral molar-incisor hypomineralization (MIH) on the stomatognathic system in children, investigating if greater impairment exists on the affected side in terms of postural and masticatory activities and occlusal force contacts. Materials and Methods Fourteen children with unilateral MIH (mean age: 7.92 years) were included in this cross-sectional split-mouth observational study. Electromyography (EMG) evaluated masseter and temporal muscle activity during various jaw postures and habitual chewing. Occlusal force contacts were measured using T-SCAN®. The analyses compared the side with MIH to the side without the defect. Statistical analysis employed the Shapiro-Wilk test, Wilcoxon signed-rank test, and paired t-test. Results Muscle hyperactivity was observed on the unaffected side, indicating greater voluntary contraction compared to the affected side for the temporal muscle at rest (p = 0.01) and masseter muscle in right laterality (p = 0.02). No significant difference was found in occlusal force between the sides analyzed. Conclusions Children with MIH exhibit compromised stomatognathic system functionality, with enamel defects potentially disrupting balance and leading to functional limitations. Clinical Relevance: Children with unilateral MIH may present muscle hyperactivity on the unaffected side, suggesting enamel defects could lead to stomatognathic system imbalances with clinical implications for dentists. Molar incisor hypomineralization Masticatory Muscles Surface Electromyography Occlusal Force Masticatory Force INTRODUCTION Molar-incisor hypomineralization (MIH) is a qualitative enamel defect of a systemic origin, typically affecting first permanent molars and sometimes incisors [ 1 – 3 ]. Its global prevalence varies considerably, with an estimated average of around 12.8%, reaching approximately 28.7% in Brazil [ 4 – 6 ]. MIH can significantly impact the oral health and quality of life of children and adolescents [ 7 – 10 ]. Clinical consequences associated with MIH include hypersensitivity [ 2 , 11 – 13 ], difficulty in achieving anesthesia [ 14 , 15 ], and negative aesthetic impacts [ 16 – 18 ]. Fractures after tooth eruption and rapid caries progression in newly erupted first permanent molars may occur [ 19 ], predisposing the patient to chewing preference and leading to stomatognathic system alterations [ 20 ]. Lesions in different dental groups can cause stomatognathic system alterations, potentially progressing to temporomandibular dysfunctions [ 20 ]. In bilateral enamel defects, these alterations can be severe enough to considerably interfere with masticatory functions and may compromise the stomatognathic system [ 20 ]. Since MIH clinically presents heterogeneously and asymmetrically in most cases [ 10 ], even affecting only one first permanent molar, there was interest in discovering the behavior of each side of the child's dental arch. Therefore, the objective of this study was to determine whether children with unilateral MIH would present modifications in the stomatognathic system on the affected side compared to the unaffected side regarding postural and dynamic muscle activities, occlusal distribution, and bite forces, compared to the side unaffected by this enamel alteration. MATERIALS AND METHODS This cross-sectional split-mouth observational study was approved by the Ethics Committee of the School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil (process # 12161019.2.0000.5419), adhering to the Helsinki Declaration for Human Studies. Informed consent was obtained from the guardians of the children involved. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Setting and participants Children were recruited from the School of Dentistry of Ribeirão Preto, University of São Paulo (FORP/USP), from July 2020 to July 2022, from the "Dental Enamel Clinic" offered at FORP/USP. The analysis of the stomatognathic system was conducted at the Electromyography Laboratory of the Department of Basic and Oral Biology at FORP/USP. Two examiners were trained and calibrated by a reference examiner to diagnose MIH based on criteria described by Ghanim and colleagues [ 21 ]. Inter- and intra-examiner agreement was assessed using unweighted Kappa coefficients (κ ≥ 0.8). Inclusion criteria were children aged 6 to 12 years, of both sexes, with at least one permanent first molar showing indices consistent with mild MIH (codes 21 – white or creamy opacities and 22 – yellow or brown opacities [ 21 ]), or severe MIH (code 3 – enamel post-eruptive breakdown [ 21 ]), with unilateral MIH, meaning only one side affected by MIH and the other side showing no enamel defects. Exclusion criteria were children under medical treatment using corticosteroids, muscle relaxants, and immunosuppressants, with a medical history of surgical intervention within 12 months before the study onset, using anti-inflammatory or analgesic drugs that could interfere with neuromuscular physiology, who underwent oral or facial surgical interventions altering facial and occlusal patterns (orthodontic treatment) or both, who had restorations or fissure sealants placed before diagnosis, and temporomandibular disorders (TMD) found during clinical examination. Sample size calculation was based on Carvalho et al. [ 20 ], using the standard deviation estimate of the difference detected in electromyography data (primary outcome), with a test power of 80% and significance level of 95%, considering an estimated loss of 20%, resulting in a required sample of 13 matched children. Measurements Children with unilateral MIH underwent the following examinations: surface electromyography (EMG) and T-SCAN with molar bite force assessment. The child was positioned according to a pre-established protocol [ 20 , 22 , 23 ], and all tests were conducted by a trained technician. Sensor placement followed the guidelines of the Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles (SENIAM) and adhered to protocols established in the literature [ 24 , 25 ] to ensure precise muscle localization as required. EMG measures muscle activity of the masseter and temporal muscles on both sides of the jaw under various postural conditions: mandibular rest (4s), maximum protrusion with dental contact (5s), maximum right and left lateral movements with dental contact (5s), and maximum voluntary dental clenching with Parafilm M® (5s), with the latter used to normalize all data [ 20 , 23 , 26 ]. Parafilm M® dental clenching was utilized to standardize all EMG data collection, following SENIAM guidelines. Parafilm M®, an inert material used in this study, consisted of a folded paraffin sheet (Parafilm M®, Pechinery Plastic Packaging, Batavia, IL, USA) placed between the occlusal surfaces of the upper and lower first molars on both sides of the dental arch (18x17x4mm, weight 245mg). Dynamic assessments of habitual and non-habitual chewing efficiency in children involved analyzing EMG signals from the masseter and temporal muscles on both sides, recorded in microvolts per second (µV) [ 27 ]. Non-habitual chewing involved the utilization of Parafilm M® for 4 seconds to standardize data under dynamic conditions, following the guidelines outlined by SENIAM. For habitual chewing, EMG signals from chewing cycles of the masseter and temporal muscles on both sides were recorded. This was conducted during habitual chewing of two food types—hard (such as peanuts and M&M's) and soft (such as Bis-Lacta® sandwich cookies)—with each chewing session lasting 10 seconds. Children were informed about the food type to be chewed before the examination, emphasizing that they were not required to swallow them; they had the option to discard them in a designated container if they chose not to consume them. The T-Scan® III Occlusal Analysis System (Tekscan, Inc., South Boston, MA, USA) enabled the analysis of occlusal surface interrelationships in terms of percentage force between the upper and lower arches [ 28 , 29 ]. A positioning guide, into which the sensor was inserted, was carefully placed in the child's oral cavity. This guide, with a central marking, was positioned to be centered and snugly fit between the mesial surfaces of the upper central incisors to standardize examination collection. The obtained data were subsequently analyzed and stored by the T-SCAN software, which demonstrated the maximum occlusal force contacts as a percentage for each child, both for the upper and lower arches individually, as well as for each tooth in contact with its antagonist. It's worth noting that teeth without occlusal contacts were recorded as 0% contact. Statistical methods The data were tabulated, normalized, and then subjected to statistical analysis using Jamovi software (Version 2.3), with a significance level of 95%. Normality was assessed using the Shapiro-Wilk test (p < 0.05), and the non-parametric Two-tailed Wilcoxon signed-rank test was used to compare the medians/quartiles of values obtained from the unaffected sides with those affected by MIH. Data from T-SCAN examinations (occlusal force distribution) were compared using the paired t-test. RESULTS The study involved 14 children (seven of each gender), with a mean age of 7.92 years (SD = 1.9), and a mean BMI of 18.36 (SD = 3.64), with the clinical presentations of MIH described in Table 1 . Table 1. Description of the research sample with the following data: Sex, age, BMI, side, and severity of MIH. M: Male, F: Female, BMI: Body Mass Index, MIH: Molar Incisor Hypomineralization Sex Age BMI Affected size MIH severity M 11 27.28 Right Mild M 6 20.80 Left Mild F 6 20.20 Left Mild F 7 18.20 Left Severe M 8 12.80 Left Mild M 8 15.70 Left Severe M 7 22.91 Right Mild F 8 14.08 Right Mild M 12 18.03 Left Severe F 6 17.33 Left Severe M 6 16.18 Left Severe F 8 18.07 Left Severe F 8 17.50 Left Severe F 10 18.00 Left Severe The EMG activities of the masseter and temporal muscles, on the ipsilateral (I) and contralateral (C) sides, with means and standard deviations, under Rest, Right and Left Lateral movements, Protrusion, for rigid or dry foods, and for soft foods are summarized in Table 2 . Overall, it was noted that the contralateral side had higher EMG activity compared to the ipsilateral side, for both the masseter and temporal muscles, except in the masseter's rest condition, which was similar on both sides (I and C), and in the consistent and soft foods conditions, where the temporal muscle had lower activity on the contralateral side. There was a significant difference for the masseters at rest, and for the temporals in the right lateral movement, with both showing higher activity on the contralateral side. Table 2. Description of static mandibular tasks (rest, right and left lateral movements, protrusion) and dynamic tasks (chewing hard and soft foods), of the masseter and temporal muscles, on the ipsilateral (I) side with MIH and contralateral (C) side without MIH, Minimum (Min), Maximum (Max), Mean (Standard Deviation), Mean, 25th percentile, 75th percentile, p - value . Percentile Mandibular tasks Muscles Groups Mi Ma Mean (SD) Median 25th 75th p-value Rest (RMS) Masseter I 0.02 0.22 0.09 (0.07) 0.06 0.04 0.14 0.39 C 0.02 0.29 0.09 (0.08) 0.05 0.04 0.29 Temporal I 0.06 1.04 0.23 (0.30) 0.11 0.09 0.18 0.01* C 0.06 1.51 0.59 (0.45) 0.55 0.24 0.85 Right laterality (RMS) Masseter I 0.04 0.93 0.22 (0.24) 0.17 0.05 0.28 0.02* C 0.04 1.61 0.47 (0.47) 0.26 0.13 0.68 Temporal I 0.06 0.96 0.23 (0.24) 0.23 0.10 0.25 0.40 C 0.07 1.51 0.39 (0.78) 0.18 0.09 0.22 Left laterality (RMS) Masseter I 0.02 1.50 0.27 (0.37) 0.19 0.07 0.28 0.27 C 0.03 3.56 0.61 (0.91) 0.27 0.17 0.74 Temporal I 0.06 1.09 0.24 (0.26) 0.15 0.12 0.25 0.06 C 0.07 1.70 0.32 (0.44) 0.15 0.09 0.36 Protrusion (RMS) Masseter I 0.04 2.05 0.40 (0.53) 0.20 0.13 0.39 0.36 C 0.06 5.46 0.96 (1.71) 0.28 0.12 0.55 Temporal I 0.07 1.05 0.21 (0.25) 0.13 0.10 0.19 0.06 C 0.06 2.06 0.43 (0.61) 0.20 0.08 0.41 Hard food (µV) Masseter I 0.19 3.31 1.07 (0.98) 0.68 0.52 0.96 0.50 C 0.28 4.94 1.28 (1.36) 0.65 0.53 0.96 Temporal I 0.26 4.37 0.98 (1.04) 0.66 0.52 0.10 0.50 C 0.23 3.25 0.82 (0.78) 0.56 0.44 0.86 Soft food (µV) Masseter I 0.19 3.30 1.01 (1.05) 0.54 0.34 1.36 0.30 C 0.13 7.14 1.35 (1.78) 0.74 0.52 1.40 Temporal I 0.32 4.61 1.02 (1.12) 0.61 0.47 1.11 0.43 C 0.35 2.38 0.94 (0.62) 0.76 0.47 1.12 In the description of Overall Occlusal Force (Table 3) , the mean on the contralateral side (53.2) was higher than the ipsilateral side (46.8), while the standard deviation was the same (15.3). In the Upper Occlusal Force, the mean and standard deviation on the contralateral side were higher (20.7–14.0) than on the ipsilateral side (19.9–11.9). In the Lower Occlusal Force, the mean and standard deviation on the contralateral side were higher (25.1–15.7) than on the ipsilateral side (20.7–10.0). Thus, it was generally observed that the contralateral side exhibited greater Maximum Occlusal Force in all positions. Table 3. Description of overall, upper, and lower occlusal force on the ipsilateral (I) side with MIH and contralateral (C) side without MIH, with values of Mean (Standard Deviation), Median, and p-value . T-SCAN Mean (SD) Median p-value Maximum Occlusal Force I 25.2 (12.4) 23.6 0.86 C 25.5 (15.6) 19.7 Overall Occlusal Force I 46.8 (15.3) 47.5 0.45 C 53.2 (15.3) 52.5 Upper Occlusal Force I 19.9 (11.9) 15.9 0.85 C 20.7 (14.0) 19.5 Lower Occlusal Force I 20.7 (10.0) 22.9 0.31 C 25.1(15.7) 21.0 DISCUSSION Individuals with MIH experience clinical conditions that have a direct impact on their oral health and quality of life [ 2 , 7 – 10 ]. The qualitative defect in this dental enamel is noted during mineralization, resulting in the enamel of softened consistency that easily fractures under chewing forces, starting from its eruption in the oral cavity [ 19 , 30 ]. This leads to dentin hypersensitivity [ 2 , 11 – 13 ], caries [ 31 , 32 ], aesthetic problems in anterior teeth [ 16 – 18 ] and may impact the quality of life [ 11 – 13 ]. Given these facts, it was raised the possibility that such problems could interfere with the functioning of the stomatognathic system in individuals with unilateral MIH. In a recent study by Carvalho et al. [ 20 ], it was observed that children with MIH exhibited hyperactivity of the masticatory muscles compared to children without MIH. However, no severity of the teeth affected by the defect was observed, and children could also present bilateral MIH in any of the molars. Thus, the present study aimed to elucidate how muscular activity and occlusal forces behaved on the affected and unaffected sides of children with unilateral MIH. The EMG is considered a gold standard instrument for evaluating myoelectric activity in any muscle of the human body [ 33 ]. In the context of this specific study, the right and left masseter, and temporal muscles of children with unilateral MIH were analyzed in static and dynamic conditions. Thus, under static conditions, higher EMG activities were observed in the contralateral muscles without MIH, suggesting an imbalance in these conditions. It is known that hypomineralized enamel has a higher organic content and deficiency in the quality of mineral content [ 2 , 34 , 35 ]. Enamel with MIH contains only 20% mineral content and is characterized by high porosity and lower surface hardness [ 36 ]. Therefore, it is suggested that increased use of the contralateral side may be explained by dentin hypersensitivity associated with possible pain, combined with the fragile characteristics in the composition of MIH enamel, such as less dense interprismatic structure and accentuated interprismatic spaces [ 34 , 35 ]. This leads individuals to utilize the opposite side of the defect, for this possible sensitivity to be alleviated or even unnoticed. The analysis of dynamic conditions, chewing hard and soft food, also revealed higher EMG activity in the masseter muscles on the contralateral side without MIH, while the temporal muscles showed higher activity on the ipsilateral side. This suggests a possible compensation in the chewing act by the contralateral masseter muscles, so that the teeth with MIH could be spared from this masticatory impact, as they are more sensitive to chewing force due to their compromised enamel structure, a fact previously explained by the positioning of enamel prisms and their porosities causing dental hypersensitivity and pain [ 37 , 38 ]. These results are consistent with other studies that have demonstrated the presence of EMG activity in skeletal striated muscles when exposed to continuous stress, leading to increased myoelectric activity [ 20 , 39 , 40 ]. With the assistance of the T-SCAN, it was possible to visualize the percentage distribution of occlusal contact points and force during the individual's occlusion in both sides [ 41 – 43 ]. Additionally, it can be synchronized with EMG, allowing simultaneous acquisition of information about occlusal function and muscular activity of the masticatory muscles [ 44 , 45 ]. In this study, it was confirmed that EMG activities correspond to the results of maximum occlusal force in the T-SCAN, noting that the contralateral side without MIH had a higher percentage of force compared to the ipsilateral side with MIH. This fact can be explained by the difficulty in sensing mechanical stimuli, from tooth brushing to chewing soft or hard foods, which can cause painful sensations in teeth affected by the defect [ 11 , 37 ]. Patients with MIH may have a higher risk of dental caries [ 46 , 47 ]. This can be facilitated by the fact that painful hypersensitivity may prefer a soft or mushy diet, which does not require as much chewing force, as seen in the results of occlusal forces in the T-SCAN device, in addition to the accumulation of dental biofilm in enamel defects [ 20 , 48 , 49 ]. It is imperative to underscore that the greater the efficiency of the stomatognathic system, the heightened the individual's capacity to exert a notable biting force [ 22 , 26 , 39 ]. In the analysis of data from children with MIH, there was no significant difference in occlusal forces between the two sides. Thus, it is suggested that this may have possibly occurred due to the severity of the disease not being severe enough to resist using the affected side. When this enamel anomaly presents a higher degree of hypersensitivity or fracture, children tend not to use the affected side, but rather the other side for comfort in both biting and chewing [ 20 , 49 ]. In this study, children with unilateral defects with MIH, both mild and severe, were evaluated through a convenience sample. Studies with longer follow-up periods and larger sample sizes are needed to increase understanding of possible alterations in the stomatognathic system in children with MIH. Nonetheless, the research results highlighted that child with unilateral MIH showed evidence of involvement of the stomatognathic system. This was manifested by observing increased muscle activity on the unaffected contralateral side. The data obtained in this study suggest that since children with unilateral MIH exhibited greater muscle activity on the side opposite the defect, indicating increased use of this side, it may lead to significant muscular alterations in these children over the long term. CONCLUSIONS This study suggests that children affected by unilateral MIH demonstrated dysfunction in the stomatognathic system, characterized by pronounced muscle hyperactivity in the masseter and temporal muscles on the contralateral side. This condition may result in an overload that may affect the normal functionality of this system. Declarations Ethical approval All procedures performed in studies involving human participants were following the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Conflict of interests The authors have no conflicts of interest to declare that are relevant to the content of this article. Funding This study was funded by the National Council for Scientific and Technological Development ( CNPq ) Number: 405914/2021-0. Availability of data and materials We declare for the purposes of verification that the data presented in this manuscript, and defined after completion, will be made openly available in a public repository that issues datasets with DOIs. The authors confirm that the data supporting the conclusions of this study will be available digitally after publication of the Study, and that the data supporting the results of this study are available upon request to the corresponding author. Authors contributions All authors participated in designing the protocol. First, LMNG, FKC and SCHR designed the study. LMNG, FKC, AMQ and FWGPS selected the patients from study. LMNG, SCHR and SS collected the data. FKC and SCHR did statistical analysis. All authors then participated in synthesizing the data. LMNG, KFM, FKC and AMQ wrote the first draft of the paper. FKC, FWGPS, AMQ, SCHR and SS provided critical guidance on the analysis and overall direction of the study. 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Published 2020 Oct 26. 10.3389/fneur.2020.560363 Chun YP, Tan C, Villanueva O et al (2024) Overexpression of ameloblastin in secretory ameloblasts results in demarcated, hypomineralized opacities in enamel. Front Physiol 14:1233391. Published 2024 Jan 11. 10.3389/fphys.2023.1233391 Elhennawy K, Manton DJ, Crombie F et al (2017) Structural, mechanical and chemical evaluation of molar-incisor hypomineralization-affected enamel: A systematic review. Arch Oral Biol 83:272–281. 10.1016/j.archoralbio.2017.08.008 Fearne J, Anderson P, Davis GR (2004) 3D X-ray microscopic study of the extent of variations in enamel density in first permanent molars with idiopathic enamel hypomineralisation. Br Dent J 196(10):634–625. 10.1038/sj.bdj.4811282 Santos PS, Vitali FC, Fonseca-Souza G et al (2024) Dentin hypersensitivity and toothache among patients diagnosed with Molar-Incisor Hypomineralization: A systematic review and meta-analysis. J Dent . Published online April 4, 2024. 10.1016/j.jdent.2024.104981 Chan YL, Ngan NM (2010) Degraded prism sheaths in the transition region of hypomineralized teeth. J Dent 38(3):237–244 Gonçalves LMN, Palinkas M, Hallak JEC, Marques Ju´nior W, Vasconcelos PB, Frota NPR et al (2018) Alterations in the stomatognathic system due to amyotrophic lateral sclerosis. J Appl Oral Sci 26: e20170408. https://doi.org/10.1590/1678-7757-2017-0408 PMID: 29898176 Luijcks R, Hermens HJ, Bodar L, Vossen CJ, Van Os J, Lousberg R (2014) Experimentally induced stress validated by EMG activity. PLoS One 9(4):e95215. Published 2014 Apr 15. 10.1371/journal.pone.0095215 Abutayyem H, Annamma M, Desai L, Alam VB (2023) MK Evaluation of occlusal bite force distribution by T-Scan in orthodontic patients with different occlusal characteristics: a cross sectional-observational study. BMC Oral Health 23(1):888. Published 2023 Nov 20. 10.1186/s12903-023-03544-4 Prabahar T, Gupta N, Chowdhary N, Sonnahalli NK, Chowdhary R, Reddy VR (2021) Comparative Evaluation of Occlusal Bite Force in Relation to the Muscle Activity in the Mixed Dentition Children of Age Group 9–12 Years: A T-scan Analysis. Int J Clin Pediatr Dent 14(Suppl 1):S29–S34. 10.5005/jp-journals-10005-2019 Shopova D, Bozhkova T, Yordanova S, Yordanova M (2022) Case Report: Digital analysis of occlusion with T-Scan Novus in occlusal splint treatment for a patient with bruxism. F1000Res 10:915. Published 2022 Jan 13. 10.12688/f1000research.72951.2 Chen YJ, Yao CC, Chang ZC et al (2023) Occlusal function and electromyographic activity of masticatory muscles in skeletal Class III patients with different patterns of mandibular asymmetry. J Oral Rehabil 50(4):276–285. 10.1111/joor.13412 Thumati P, Kerstein RB, Thumati RP (2017) Disclusion time reduction therapy in treating occluso-muscular pains. J Indian Prosthodont Soc 17(1):95–98. 10.4103/0972-4052.194948 Villani FA, Aiuto R, Dioguardi M et al (2023) Caries prevalence and molar incisor hypomineralisation (MIH) in children. Is there an association? A systematic review. Eur J Paediatr Dent 24(4):312–320. 10.23804/ejpd.2023.1985 Salem MB, Chouchene F, Masmoudi F, Baaziz A, Maatouk F, Ghedira H (2023) Are Molar-Incisor Hypomineralization and Hypomineralized Second Primary Molars Predictive of Dental Caries? A Systematic Review. Eur J Dent 17(1):7–15. 10.1055/s-0042-1749360 Rizzardi KF, Rizzardi RF, Crescente CL, Tognetti VM, de Sousa ET, Parisotto ™ (2023) Relationship between cariogenic bacteria and molar incisor hypomineralization in Brazilian schoolchildren. Transl Pediatr 12(11):2001–2009. 10.21037/tp-23-48 Kumai T (1993) Difference in chewing patterns between involved and opposite sides in patients with unilateral temporomandibular joint and myofascial pain-dysfunction. Arch Oral Biol 38(6):467–478. 10.1016/0003-9969(93)90182-l Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4385637","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":302032901,"identity":"f307a23a-2e40-41e7-a2cd-5245534f7408","order_by":0,"name":"Ligia Maria Napolitano Gonçalves","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Ligia","middleName":"Maria Napolitano","lastName":"Gonçalves","suffix":""},{"id":302032902,"identity":"753b460f-b14a-46ea-9992-71f31f0f8b86","order_by":1,"name":"Kelly Fernanda Molena","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Kelly","middleName":"Fernanda","lastName":"Molena","suffix":""},{"id":302032903,"identity":"7e1a82dc-55a3-4ef0-983c-d088028104ba","order_by":2,"name":"Milena Rodrigues Carvalho","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Milena","middleName":"Rodrigues","lastName":"Carvalho","suffix":""},{"id":302032904,"identity":"25cfc0bb-2cab-422d-a1e4-5bec30c25c32","order_by":3,"name":"Simone Cecilio Hallak Regalo","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"Cecilio Hallak","lastName":"Regalo","suffix":""},{"id":302032905,"identity":"464b58bf-f245-488e-8acc-9c9eafd6a933","order_by":4,"name":"Selma Siéssere","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Selma","middleName":"","lastName":"Siéssere","suffix":""},{"id":302032906,"identity":"e1522e79-b9d5-47f1-815a-589088598216","order_by":5,"name":"Francisco Wanderley Garcia de Paula-Silva","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Francisco","middleName":"Wanderley Garcia","lastName":"de Paula-Silva","suffix":""},{"id":302032907,"identity":"1bf30c70-5c20-4919-82d2-45257dc3a20f","order_by":6,"name":"Alexandra Mussolino de Queiroz","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYNACAyBmb3wA47IRqYXnsAEpWkBAIplILfzTDm+T+FBwT05+5mPGx5U7GBLnz25ge1yBz+zbaWWSMwyKjRlnJzMbnj3DkLjhzgF2wzP4rLmdYybNY5CQ2Cydf0yysQ2oRSKBTbIBjw55kJY/QC1tkofZwFrmzyCgxQCkhQGopUeCGaKl4QYBLYa304otewwSjCV4gH5pPCNhvOHOwXZDfFrkbidvvPHjT4KcfPthxoeNO2xk589uPvYQnxYGSDxCAWODBDAQGQloQNMCJCQIaRgFo2AUjIKRBgA5U0lP+JoZkwAAAABJRU5ErkJggg==","orcid":"","institution":"University of São Paulo","correspondingAuthor":true,"prefix":"","firstName":"Alexandra","middleName":"Mussolino","lastName":"de Queiroz","suffix":""},{"id":302032908,"identity":"f110cbd9-fabc-457f-a024-d553ee55ef9f","order_by":7,"name":"Fabrício Kitazono de Carvalho","email":"","orcid":"","institution":"University of São Paulo","correspondingAuthor":false,"prefix":"","firstName":"Fabrício","middleName":"Kitazono","lastName":"de Carvalho","suffix":""}],"badges":[],"createdAt":"2024-05-08 00:39:44","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4385637/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4385637/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57552487,"identity":"9bb2621d-e2e3-4b4d-b02a-1e318c748248","added_by":"auto","created_at":"2024-06-01 18:53:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":676892,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4385637/v1/6e694715-e63a-4794-a6f5-08a2d2202fd0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Children with Unilateral Molar-Incisor Hypomineralization May Exhibit Contralateral Muscle Hyperactivity","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMolar-incisor hypomineralization (MIH) is a qualitative enamel defect of a systemic origin, typically affecting first permanent molars and sometimes incisors [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Its global prevalence varies considerably, with an estimated average of around 12.8%, reaching approximately 28.7% in Brazil [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. MIH can significantly impact the oral health and quality of life of children and adolescents [\u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinical consequences associated with MIH include hypersensitivity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], difficulty in achieving anesthesia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], and negative aesthetic impacts [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Fractures after tooth eruption and rapid caries progression in newly erupted first permanent molars may occur [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], predisposing the patient to chewing preference and leading to stomatognathic system alterations [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLesions in different dental groups can cause stomatognathic system alterations, potentially progressing to temporomandibular dysfunctions [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In bilateral enamel defects, these alterations can be severe enough to considerably interfere with masticatory functions and may compromise the stomatognathic system [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Since MIH clinically presents heterogeneously and asymmetrically in most cases [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], even affecting only one first permanent molar, there was interest in discovering the behavior of each side of the child's dental arch.\u003c/p\u003e \u003cp\u003eTherefore, the objective of this study was to determine whether children with unilateral MIH would present modifications in the stomatognathic system on the affected side compared to the unaffected side regarding postural and dynamic muscle activities, occlusal distribution, and bite forces, compared to the side unaffected by this enamel alteration.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cp\u003e This cross-sectional split-mouth observational study was approved by the Ethics Committee of the School of Dentistry of Ribeir\u0026atilde;o Preto, University of S\u0026atilde;o Paulo, Brazil (process # 12161019.2.0000.5419), adhering to the Helsinki Declaration for Human Studies. Informed consent was obtained from the guardians of the children involved. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSetting and participants\u003c/h2\u003e \u003cp\u003eChildren were recruited from the School of Dentistry of Ribeir\u0026atilde;o Preto, University of S\u0026atilde;o Paulo (FORP/USP), from July 2020 to July 2022, from the \"Dental Enamel Clinic\" offered at FORP/USP. The analysis of the stomatognathic system was conducted at the Electromyography Laboratory of the Department of Basic and Oral Biology at FORP/USP. Two examiners were trained and calibrated by a reference examiner to diagnose MIH based on criteria described by Ghanim and colleagues [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Inter- and intra-examiner agreement was assessed using unweighted Kappa coefficients (κ\u0026thinsp;\u0026ge;\u0026thinsp;0.8).\u003c/p\u003e \u003cp\u003eInclusion criteria were children aged 6 to 12 years, of both sexes, with at least one permanent first molar showing indices consistent with mild MIH (codes 21 \u0026ndash; white or creamy opacities and 22 \u0026ndash; yellow or brown opacities [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]), or severe MIH (code 3 \u0026ndash; enamel post-eruptive breakdown [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]), with unilateral MIH, meaning only one side affected by MIH and the other side showing no enamel defects.\u003c/p\u003e \u003cp\u003eExclusion criteria were children under medical treatment using corticosteroids, muscle relaxants, and immunosuppressants, with a medical history of surgical intervention within 12 months before the study onset, using anti-inflammatory or analgesic drugs that could interfere with neuromuscular physiology, who underwent oral or facial surgical interventions altering facial and occlusal patterns (orthodontic treatment) or both, who had restorations or fissure sealants placed before diagnosis, and temporomandibular disorders (TMD) found during clinical examination.\u003c/p\u003e \u003cp\u003eSample size calculation was based on Carvalho et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], using the standard deviation estimate of the difference detected in electromyography data (primary outcome), with a test power of 80% and significance level of 95%, considering an estimated loss of 20%, resulting in a required sample of 13 matched children.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasurements\u003c/h2\u003e \u003cp\u003eChildren with unilateral MIH underwent the following examinations: surface electromyography (EMG) and T-SCAN with molar bite force assessment. The child was positioned according to a pre-established protocol [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], and all tests were conducted by a trained technician. Sensor placement followed the guidelines of the Surface ElectroMyoGraphy for the Non-Invasive Assessment of Muscles (SENIAM) and adhered to protocols established in the literature [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] to ensure precise muscle localization as required.\u003c/p\u003e \u003cp\u003eEMG measures muscle activity of the masseter and temporal muscles on both sides of the jaw under various postural conditions: mandibular rest (4s), maximum protrusion with dental contact (5s), maximum right and left lateral movements with dental contact (5s), and maximum voluntary dental clenching with Parafilm M\u0026reg; (5s), with the latter used to normalize all data [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Parafilm M\u0026reg; dental clenching was utilized to standardize all EMG data collection, following SENIAM guidelines. Parafilm M\u0026reg;, an inert material used in this study, consisted of a folded paraffin sheet (Parafilm M\u0026reg;, Pechinery Plastic Packaging, Batavia, IL, USA) placed between the occlusal surfaces of the upper and lower first molars on both sides of the dental arch (18x17x4mm, weight 245mg).\u003c/p\u003e \u003cp\u003eDynamic assessments of habitual and non-habitual chewing efficiency in children involved analyzing EMG signals from the masseter and temporal muscles on both sides, recorded in microvolts per second (\u0026micro;V) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Non-habitual chewing involved the utilization of Parafilm M\u0026reg; for 4 seconds to standardize data under dynamic conditions, following the guidelines outlined by SENIAM. For habitual chewing, EMG signals from chewing cycles of the masseter and temporal muscles on both sides were recorded. This was conducted during habitual chewing of two food types\u0026mdash;hard (such as peanuts and M\u0026amp;M's) and soft (such as Bis-Lacta\u0026reg; sandwich cookies)\u0026mdash;with each chewing session lasting 10 seconds. Children were informed about the food type to be chewed before the examination, emphasizing that they were not required to swallow them; they had the option to discard them in a designated container if they chose not to consume them.\u003c/p\u003e \u003cp\u003eThe T-Scan\u0026reg; III Occlusal Analysis System (Tekscan, Inc., South Boston, MA, USA) enabled the analysis of occlusal surface interrelationships in terms of percentage force between the upper and lower arches [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A positioning guide, into which the sensor was inserted, was carefully placed in the child's oral cavity. This guide, with a central marking, was positioned to be centered and snugly fit between the mesial surfaces of the upper central incisors to standardize examination collection. The obtained data were subsequently analyzed and stored by the T-SCAN software, which demonstrated the maximum occlusal force contacts as a percentage for each child, both for the upper and lower arches individually, as well as for each tooth in contact with its antagonist. It's worth noting that teeth without occlusal contacts were recorded as 0% contact.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical methods\u003c/h2\u003e \u003cp\u003eThe data were tabulated, normalized, and then subjected to statistical analysis using Jamovi software (Version 2.3), with a significance level of 95%. Normality was assessed using the Shapiro-Wilk test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the non-parametric Two-tailed Wilcoxon signed-rank test was used to compare the medians/quartiles of values obtained from the unaffected sides with those affected by MIH. Data from T-SCAN examinations (occlusal force distribution) were compared using the paired t-test.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe study involved 14 children (seven of each gender), with a mean age of 7.92 years (SD = 1.9), and a mean BMI of 18.36 (SD = 3.64), with the clinical presentations of MIH described in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDescription of the research sample with the following data: Sex, age, BMI, side, and severity of MIH. M: Male, F: Female, BMI: Body Mass Index, MIH: Molar Incisor Hypomineralization\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"473\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAffected size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMIH severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 27.28\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 20.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 20.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 18.20\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 12.80\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 15.70\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 22.91\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 14.08\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 18.03\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 17.33\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 16.18\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 18.07\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 17.50\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.856236786469344%\" valign=\"bottom\"\u003e\n \u003cp\u003eF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.742071881606766%\" valign=\"bottom\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.913319238900634%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 18.00\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.272727272727273%\" valign=\"bottom\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.21564482029598%\" valign=\"top\"\u003e\n \u003cp\u003eSevere\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe EMG activities of the masseter and temporal muscles, on the ipsilateral (I) and contralateral (C) sides, with means and standard deviations, under Rest, Right and Left Lateral movements, Protrusion, for rigid or dry foods, and for soft foods are summarized in \u003cstrong\u003eTable 2\u003c/strong\u003e. Overall, it was noted that the contralateral side had higher EMG activity compared to the ipsilateral side, for both the masseter and temporal muscles, except in the masseter\u0026apos;s rest condition, which was similar on both sides (I and C), and in the consistent and soft foods conditions, where the temporal muscle had lower activity on the contralateral side. There was a significant difference for the masseters at rest, and for the temporals in the right lateral movement, with both showing higher activity on the contralateral side.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eDescription of static mandibular tasks (rest, right and left lateral movements, protrusion) and dynamic tasks (chewing hard and soft foods), of the masseter and temporal muscles, on the ipsilateral (I) side with MIH and contralateral (C) side without MIH, Minimum (Min), Maximum (Max), Mean (Standard Deviation), Mean, 25th percentile, 75th percentile, \u003cem\u003ep\u003c/em\u003e-\u003cem\u003evalue\u003c/em\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"725\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"74.89655172413794%\" colspan=\"7\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.551724137931036%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMandibular tasks\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMuscles\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMa\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e25th\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e75th\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep-value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRest (RMS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMasseter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 (0.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.09 (0.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.638157894736842%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.019736842105264%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.388157894736842%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.223684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.348684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.197368421052632%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.01*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.59 (0.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight laterality (RMS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMasseter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e0.22 (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.02*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.47 (0.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.638157894736842%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.019736842105264%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.388157894736842%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.223684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e0.23 (0.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.348684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.197368421052632%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.40\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e1.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.39 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft laterality\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(RMS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMasseter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e0.27 (0.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e3.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.61 (0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.638157894736842%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.019736842105264%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.388157894736842%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.223684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e0.24 (0.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.348684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.197368421052632%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e1.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.32 (0.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProtrusion (RMS)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMasseter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e0.40 (0.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e5.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.96 (1.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.638157894736842%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.019736842105264%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.388157894736842%\" valign=\"top\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.223684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e0.21 (0.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.348684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.197368421052632%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.43 (0.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eHard food (\u0026micro;V)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMasseter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e3.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e1.07 (0.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e4.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e1.28 (1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.638157894736842%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.019736842105264%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.388157894736842%\" valign=\"top\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.223684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e0.98 (1.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.348684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.197368421052632%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e3.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.82 (0.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"16.137931034482758%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSoft food (\u0026micro;V)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.275862068965518%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eMasseter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.241379310344827%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.0344827586206895%\" valign=\"top\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.896551724137931%\" valign=\"top\"\u003e\n \u003cp\u003e3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.793103448275861%\" valign=\"top\"\u003e\n \u003cp\u003e1.01 (1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.517241379310345%\" valign=\"top\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.275862068965518%\" valign=\"top\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.551724137931034%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e7.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e1.35 (1.78)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.638157894736842%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTemporal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.019736842105264%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.388157894736842%\" valign=\"top\"\u003e\n \u003cp\u003e0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.223684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e4.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.44736842105263%\" valign=\"top\"\u003e\n \u003cp\u003e1.02 (1.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.348684210526315%\" valign=\"top\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.868421052631579%\" valign=\"top\"\u003e\n \u003cp\u003e1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.197368421052632%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.660831509846828%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.159737417943107%\" valign=\"top\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.940919037199125%\" valign=\"top\"\u003e\n \u003cp\u003e2.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.88183807439825%\" valign=\"top\"\u003e\n \u003cp\u003e0.94 (0.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.098468271334792%\" valign=\"top\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.12910284463895%\" valign=\"top\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn the description of Overall Occlusal Force \u003cstrong\u003e(Table 3)\u003c/strong\u003e, the mean on the contralateral side (53.2) was higher than the ipsilateral side (46.8), while the standard deviation was the same (15.3). In the Upper Occlusal Force, the mean and standard deviation on the contralateral side were higher (20.7\u0026ndash;14.0) than on the ipsilateral side (19.9\u0026ndash;11.9). In the Lower Occlusal Force, the mean and standard deviation on the contralateral side were higher (25.1\u0026ndash;15.7) than on the ipsilateral side (20.7\u0026ndash;10.0). Thus, it was generally observed that the contralateral side exhibited greater\u0026nbsp;Maximum Occlusal Force in all positions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eDescription of overall, upper, and lower occlusal force on the ipsilateral (I) side with MIH and contralateral (C) side without MIH, with values of Mean (Standard Deviation), Median, and\u0026nbsp;\u003cem\u003ep-value\u003c/em\u003e.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"501\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.75249500998004%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eT-SCAN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780439121756487%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.75049900199601%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.157684630738522%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.55888223552894%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.75249500998004%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaximum Occlusal Force\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780439121756487%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.75049900199601%\" valign=\"top\"\u003e\n \u003cp\u003e25.2 (12.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.157684630738522%\" valign=\"top\"\u003e\n \u003cp\u003e23.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.55888223552894%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.56272401433692%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.44444444444444%\" valign=\"top\"\u003e\n \u003cp\u003e25.5 (15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.992831541218635%\" valign=\"top\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.75249500998004%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Occlusal Force\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780439121756487%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.75049900199601%\" valign=\"top\"\u003e\n \u003cp\u003e46.8 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.157684630738522%\" valign=\"top\"\u003e\n \u003cp\u003e47.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.55888223552894%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.56272401433692%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.44444444444444%\" valign=\"top\"\u003e\n \u003cp\u003e53.2 (15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.992831541218635%\" valign=\"top\"\u003e\n \u003cp\u003e52.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.75249500998004%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper Occlusal Force\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780439121756487%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.75049900199601%\" valign=\"top\"\u003e\n \u003cp\u003e19.9 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.157684630738522%\" valign=\"top\"\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.55888223552894%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.56272401433692%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.44444444444444%\" valign=\"top\"\u003e\n \u003cp\u003e20.7 (14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.992831541218635%\" valign=\"top\"\u003e\n \u003cp\u003e19.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.75249500998004%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower Occlusal Force\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.780439121756487%\" valign=\"top\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.75049900199601%\" valign=\"top\"\u003e\n \u003cp\u003e20.7 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.157684630738522%\" valign=\"top\"\u003e\n \u003cp\u003e22.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.55888223552894%\" rowspan=\"2\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.56272401433692%\" valign=\"top\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.44444444444444%\" valign=\"top\"\u003e\n \u003cp\u003e25.1(15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.992831541218635%\" valign=\"top\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIndividuals with MIH experience clinical conditions that have a direct impact on their oral health and quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR8 CR9\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The qualitative defect in this dental enamel is noted during mineralization, resulting in the enamel of softened consistency that easily fractures under chewing forces, starting from its eruption in the oral cavity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This leads to dentin hypersensitivity [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], caries [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], aesthetic problems in anterior teeth [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and may impact the quality of life [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Given these facts, it was raised the possibility that such problems could interfere with the functioning of the stomatognathic system in individuals with unilateral MIH.\u003c/p\u003e \u003cp\u003eIn a recent study by Carvalho et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], it was observed that children with MIH exhibited hyperactivity of the masticatory muscles compared to children without MIH. However, no severity of the teeth affected by the defect was observed, and children could also present bilateral MIH in any of the molars. Thus, the present study aimed to elucidate how muscular activity and occlusal forces behaved on the affected and unaffected sides of children with unilateral MIH.\u003c/p\u003e \u003cp\u003eThe EMG is considered a gold standard instrument for evaluating myoelectric activity in any muscle of the human body [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In the context of this specific study, the right and left masseter, and temporal muscles of children with unilateral MIH were analyzed in static and dynamic conditions. Thus, under static conditions, higher EMG activities were observed in the contralateral muscles without MIH, suggesting an imbalance in these conditions. It is known that hypomineralized enamel has a higher organic content and deficiency in the quality of mineral content [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Enamel with MIH contains only 20% mineral content and is characterized by high porosity and lower surface hardness [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Therefore, it is suggested that increased use of the contralateral side may be explained by dentin hypersensitivity associated with possible pain, combined with the fragile characteristics in the composition of MIH enamel, such as less dense interprismatic structure and accentuated interprismatic spaces [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This leads individuals to utilize the opposite side of the defect, for this possible sensitivity to be alleviated or even unnoticed.\u003c/p\u003e \u003cp\u003eThe analysis of dynamic conditions, chewing hard and soft food, also revealed higher EMG activity in the masseter muscles on the contralateral side without MIH, while the temporal muscles showed higher activity on the ipsilateral side. This suggests a possible compensation in the chewing act by the contralateral masseter muscles, so that the teeth with MIH could be spared from this masticatory impact, as they are more sensitive to chewing force due to their compromised enamel structure, a fact previously explained by the positioning of enamel prisms and their porosities causing dental hypersensitivity and pain [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These results are consistent with other studies that have demonstrated the presence of EMG activity in skeletal striated muscles when exposed to continuous stress, leading to increased myoelectric activity [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the assistance of the T-SCAN, it was possible to visualize the percentage distribution of occlusal contact points and force during the individual's occlusion in both sides [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Additionally, it can be synchronized with EMG, allowing simultaneous acquisition of information about occlusal function and muscular activity of the masticatory muscles [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. In this study, it was confirmed that EMG activities correspond to the results of maximum occlusal force in the T-SCAN, noting that the contralateral side without MIH had a higher percentage of force compared to the ipsilateral side with MIH. This fact can be explained by the difficulty in sensing mechanical stimuli, from tooth brushing to chewing soft or hard foods, which can cause painful sensations in teeth affected by the defect [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with MIH may have a higher risk of dental caries [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. This can be facilitated by the fact that painful hypersensitivity may prefer a soft or mushy diet, which does not require as much chewing force, as seen in the results of occlusal forces in the T-SCAN device, in addition to the accumulation of dental biofilm in enamel defects [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is imperative to underscore that the greater the efficiency of the stomatognathic system, the heightened the individual's capacity to exert a notable biting force [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In the analysis of data from children with MIH, there was no significant difference in occlusal forces between the two sides. Thus, it is suggested that this may have possibly occurred due to the severity of the disease not being severe enough to resist using the affected side. When this enamel anomaly presents a higher degree of hypersensitivity or fracture, children tend not to use the affected side, but rather the other side for comfort in both biting and chewing [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this study, children with unilateral defects with MIH, both mild and severe, were evaluated through a convenience sample. Studies with longer follow-up periods and larger sample sizes are needed to increase understanding of possible alterations in the stomatognathic system in children with MIH. Nonetheless, the research results highlighted that child with unilateral MIH showed evidence of involvement of the stomatognathic system. This was manifested by observing increased muscle activity on the unaffected contralateral side. The data obtained in this study suggest that since children with unilateral MIH exhibited greater muscle activity on the side opposite the defect, indicating increased use of this side, it may lead to significant muscular alterations in these children over the long term.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study suggests that children affected by unilateral MIH demonstrated dysfunction in the stomatognathic system, characterized by pronounced muscle hyperactivity in the masseter and temporal muscles on the contralateral side. This condition may result in an overload that may affect the normal functionality of this system.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures performed in studies involving human participants were following the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicts of interest to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the\u0026nbsp;National Council for Scientific and Technological Development (\u003cstrong\u003eCNPq\u003c/strong\u003e) Number: 405914/2021-0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare for the purposes of verification that the data presented in this manuscript, and defined after completion, will be made openly available in a public repository that issues datasets with DOIs. The authors confirm that the data supporting the conclusions of this study will be available digitally after publication of the Study, and that the data supporting the results of this study are available upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors participated in designing the protocol. First, LMNG, FKC and SCHR designed the study. LMNG, FKC, AMQ and FWGPS selected the patients from study. LMNG, SCHR and SS collected the data. FKC and SCHR did statistical analysis. All authors then participated in synthesizing the data. LMNG, KFM, FKC and AMQ wrote the first draft of the paper. FKC, FWGPS, AMQ, SCHR and SS provided critical guidance on the analysis and overall direction of the study. All authors critically revised successive drafts of the paper and approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eLima LJS, Ramos-Jorge ML, Soares MEC (2021) Prenatal, perinatal and postnatal events associated with hypomineralized second primary molar: a systematic review with meta-analysis. Clin Oral Investig 25(12):6501\u0026ndash;6516. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00784-021-04146-6\u003c/span\u003e\u003cspan address=\"10.1007/s00784-021-04146-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFagrell TG, Dietz W, J\u0026auml;levik B, Nor\u0026eacute;n JG (2010) Chemical, mechanical and morphological properties of hypomineralized enamel of permanent first molars. 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Published 2022 Jan 13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.12688/f1000research.72951.2\u003c/span\u003e\u003cspan address=\"10.12688/f1000research.72951.2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen YJ, Yao CC, Chang ZC et al (2023) Occlusal function and electromyographic activity of masticatory muscles in skeletal Class III patients with different patterns of mandibular asymmetry. J Oral Rehabil 50(4):276\u0026ndash;285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/joor.13412\u003c/span\u003e\u003cspan address=\"10.1111/joor.13412\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThumati P, Kerstein RB, Thumati RP (2017) Disclusion time reduction therapy in treating occluso-muscular pains. 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Arch Oral Biol 38(6):467\u0026ndash;478. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0003-9969(93)90182-l\u003c/span\u003e\u003cspan address=\"10.1016/0003-9969(93)90182-l\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Molar incisor hypomineralization, Masticatory Muscles, Surface Electromyography, Occlusal Force, Masticatory Force","lastPublishedDoi":"10.21203/rs.3.rs-4385637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4385637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aimed to assess unilateral molar-incisor hypomineralization (MIH) on the stomatognathic system in children, investigating if greater impairment exists on the affected side in terms of postural and masticatory activities and occlusal force contacts.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eFourteen children with unilateral MIH (mean age: 7.92 years) were included in this cross-sectional split-mouth observational study. Electromyography (EMG) evaluated masseter and temporal muscle activity during various jaw postures and habitual chewing. Occlusal force contacts were measured using T-SCAN\u0026reg;. The analyses compared the side with MIH to the side without the defect. Statistical analysis employed the Shapiro-Wilk test, Wilcoxon signed-rank test, and paired t-test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMuscle hyperactivity was observed on the unaffected side, indicating greater voluntary contraction compared to the affected side for the temporal muscle at rest (p\u0026thinsp;=\u0026thinsp;0.01) and masseter muscle in right laterality (p\u0026thinsp;=\u0026thinsp;0.02). No significant difference was found in occlusal force between the sides analyzed.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eChildren with MIH exhibit compromised stomatognathic system functionality, with enamel defects potentially disrupting balance and leading to functional limitations.\u003c/p\u003e\u003ch2\u003eClinical Relevance:\u003c/h2\u003e \u003cp\u003eChildren with unilateral MIH may present muscle hyperactivity on the unaffected side, suggesting enamel defects could lead to stomatognathic system imbalances with clinical implications for dentists.\u003c/p\u003e","manuscriptTitle":"Children with Unilateral Molar-Incisor Hypomineralization May Exhibit Contralateral Muscle Hyperactivity","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 09:32:58","doi":"10.21203/rs.3.rs-4385637/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"29f5b7fa-0687-4981-9977-4798ea965293","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-06T06:06:17+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-14 09:32:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4385637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4385637","identity":"rs-4385637","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}