The purpose of this study is to evaluate whether jaw ROM exercise with a hot pack and massage improve biting disorder. This study was designed as an open study of jaw ROM exercise of DMD patients. Patients and methods Twenty patients with DMD, 16-29 years old, who were admitted to five hospitals were registered in this study. They were not able to sit up without support, did not receive respiratory Inhibitors,research,lifescience,medical care during the daytime, had biting disorder, but they ate per os, and did not undergo tube feeding. Two patients stopped the jaw ROM exercise after 4 months

of training, because of cardiac insufficiency. We analyzed the data of 18 patients (21.3 ± 4.1 years old male) excluding data of these two patients. When biting, the jaw joint becomes the fulcrum, and the masseter, temporal muscle, and the medial pterygoid muscle are involved. Among these muscles for biting, the massetter is Inhibitors,research,lifescience,medical easy to intervene from the body surface (Fig. 1-a). Figure 1. Jaw ROM exercise. The jaw ROM exercise consisted of therapist-assisted training (2 times a week) and self-training (before

each meal). In the therapist-assisted training, the therapist warmed the masseter of the patient with a hot pack and then massaged the masseter to enhance the effect of the jaw ROM exercise. Inhibitors,research,lifescience,medical To Selleck Belnacasan prepare a hot pack, silica gel was placed in a cloth bag and warmed in hot water of 80°C℃ approximately for 10 min. The warmed bag was covered with a dry towel to protect the skin of the

patient from burning, and wrapped in a plastic bag to maintain temperature. The hot pack was placed on the cheek of the masseter Inhibitors,research,lifescience,medical muscle region for 15 minutes and supported with the hands so as not to drop (Fig.1-b). Next, immediately after applying a hot pack, the masseter was massaged from the top to the bottom with both hands 24 times per minute to the degree that the patient did not feel pain (Fig.1-c). Immediately after the massage, the therapist asked the patient to perform Inhibitors,research,lifescience,medical the jaw ROM exercise repeatedly at his own pace for five minutes. When the patient CYTH4 opened his mouth, the therapist placed a hand under the patient’s chin and applied a mild resistance (Fig. 1-d). In the self-training, the patient performed the jaw ROM exercise in 10 cycles, before each meal three times every day. The therapist-assisted training and self-training were continued for six months. Outcomes were evaluated by measuring the greatest occlusal force and the distance between an incisor of the top and that of the bottom at the maximum degree of opening the mouth. In the greatest occlusal force measurement, we used a bite pressure meter (Occlusal Force Meter GM10 (Nagano Keiki)). Each patient was asked to bite the sensor part of the bite pressure meter with the greatest force (Fig. 2-1a). The target tooth for the occlusal force measurement was the first molar.