The patient told us, “I do not get tired from biting, and I can eat more kinds of food than before.” Discussion This is the first report on the increase of the occlusal force of DMD patients. The jaw ROM exercise gave the DMD patients a feeling of satisfaction with their appetite. This means that the applicability of jaw ROM exercise was confirmed subjectively and objectively. Occlusal force increases up to approximately 20 years of age in healthy persons. In the natural history of DMD, occlusal force does not increase in patients in their teens or older (2). On the basis of this

finding, we did Inhibitors,research,lifescience,medical not compare the training effect between the groups of patients with and without the jaw ROM exercise, but we compared the effect in terms of the time course. The occlusal force of DMD patients is markedly lower than that in healthy persons of the same age (5). Muscles Ponatinib manufacturer contributing to the occlusion of the mouth are the masseter, temporal muscle, and medial pterygoid Inhibitors,research,lifescience,medical muscle. The masseter acts mainly to generate occlusal force. The factors causing the degradation of occlusal force are muscle atrophy,

Inhibitors,research,lifescience,medical muscle and soft tissue consolidation (7, 10), and malocclusion (11, 12). Among these factors, we consider that the effect of the jaw ROM exercise is mainly on the amelioration of the consolidation of the masseter and soft tissue. In this study, we applied a hot pack on Inhibitors,research,lifescience,medical the cheek of the masseter muscle region and massaged the masseter

before the jaw ROM exercise. These actions were useful to reduce the consolidation of the masseter and soft tissue. The hot pack enhances hypodermal blood flow by warming the body surface and increases the intramuscular temperature in a deep part of hypodermal tissue (13). It is confirmed that the temperature of the muscle depends on hypodermal Inhibitors,research,lifescience,medical thickness (14). In the case of DMD, the hypodermal tissue is thin, and the temperature of the masseter increases sufficiently to increase the blood flow in the masseter and soft tissue. Then, the extensibility of the masseter and soft tissue increases (15, 16), and the muscle softens (17, 18). The masseteric massage performed immediately after a hot pack application also increased the extensibility of the masseter and soft tissue around the muscle (15, 16). The increase in the extensibility of the masseter augmented muscle force: as a result, the greatest occlusal force mafosfamide increases. The self-training served to maintain the effect. In animal experiments, it was observed that there is a muscle force augmentation effect when we let an animal exercise after a hot pack application (13, 19). It is considered that the heat shock protein increased muscle protection from heat load other than blood flow improvement, which contributes to muscle force augmentation (20, 21). In DMD, a similar muscle protection may have been provided by a hot pack.