Sleepiness, occlusion, dental arch and palatal dimensions in children attention deficit hyperactivity disorder (ADHD)

Oro-facial function and quality of life in children and adolescents with large horizontal maxillary overjet-A case-control study

BACKGROUND

Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro-facial function (OF) and malocclusion have great impact on psychological well-being and quality of life (QoL).

OBJECTIVES

The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well-being in children and adolescents with large overjet.

METHODS

The study was a case-control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9-14 years old. OF was examined by use of Nordic Orofacial Test-Screening (NOT-S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well-being were examined using KIDSCREEN-10 and Strengths and Difficulties Questionnaire.

RESULTS

The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT-S score (p < .001) and reduced BF (p = .011), numbers of contacts (p < .001) and CE (p = .005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p = .007), hyperactivity (p = .043) and total difficulties score (p = .009) were found in the study group.

CONCLUSION

The study group showed higher NOT-S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well-being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group.

Specific dento-craniofacial characteristics in non-syndromic children can predispose to sleep-disordered breathing

AIM

To ascertain and illustrate specific clinical dento-craniofacial characteristics associated with sleep-disordered breathing (SDB) in non-syndromic children.

METHODS

Narrative review of literature on SDB, dental occlusion and craniofacial morphology retrieved through online literature database search for these terms. The review focused on clinical examples and graphical illustrations in order to ascertain the association between dento-craniofacial characteristics and SDB. Only publications concerning healthy non-syndromic children without any somatic or psychological diagnosis were included.

RESULTS

Dento-craniofacial characteristics such as anterior open bite, large overjet, cross bite and facial appearance such as convex profile due to mandibular retrognathia and inclination, narrow and high palate can predispose to SDB in non-syndromic children. Furthermore, extended head posture, mouth breathing and general adenoidal face may be symptoms or predisposing factors to SDB in non-syndromic children.

CONCLUSION

Dento-craniofacial characteristics as anterior open bite, large overjet due to mandibular retrognathia, cross bite, and narrow and high palate can predispose to SDB in non-syndromic children. Facial characteristics predisposing to SDB can be a convex facial profile, extended head posture, mouth breathing and general adenoidal face. Interdisciplinary collaboration between medical doctors and dentists can prove valuable in diagnostics, prevention and treatment of SDB in non-syndromic children.

A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder

OBJECTIVE

Children and adults with ADHD often report sleep disturbances that may form part of the etiology and/or symptomatology of ADHD. We review the evidence for sleep changes in children with ADHD.

METHODS

Systematic review with narrative synthesis assessing sleep and circadian function in children aged 5 to 13 years old with a diagnosis of ADHD.

RESULTS

148 studies were included for review, incorporating data from 42,353 children. We found that sleep disturbances in ADHD are common and that they may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may impact sleep.

CONCLUSION

Sleep disturbance may represent a clinically important feature of ADHD in children, which might be therapeutically targeted in a useful way. There are a number of important gaps in the literature. We set out a manifesto for future research in the area of sleep, circadian rhythms, and ADHD.

Sleep-disordered breathing and malocclusion in children and adolescents-a systematic review

BACKGROUND

Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB.

OBJECTIVES

The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls.

METHODS

Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence.

RESULTS

The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low.

CONCLUSION

No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.

Three-dimensional analysis of upper airway and craniofacial morphology in orthodontic adolescents with Attention Deficit Hyperactivity Disorder (ADHD): A comparative retrospective study

PURPOSE

The aim of this study is to evaluate craniofacial characteristics and upper airway morphology in adolescents with Attention Deficit Disorder with Hyperactivity (ADHD) compared to controls (CON).

MATERIALS AND METHODS

Records from July 2014 to May 2018 of patients who were seeking orthodontic treatment at a single institute and had full pre-treatment orthodontic records including cone-beam computed tomography (CBCT) were reviewed. Comprehensive cephalometric variables were measured to determine craniofacial morphology. Upper airway volume (UAV), minimum cross-sectional area (MCA), and linear measurements were calculated at multiple planes.

RESULTS

A total of 87 adolescents (ADHD, 29; CON, 58) were included in the study. Overall, UAV and MCA in ADHA group were smaller than CON. Statistical significance was evident in airway widths at planes A (P=0.002), C (P=0.042), and D (P<0.001), and airway area at plane D (lower hypopharynx) (P<0.001), with the ADHD group showing narrower widths and area compared to CON. The most common skeletal classification in the ADHD group was sequenced as Class II, Class I then Class III, with percentages of (58.6%), (31%) and (10.3%), respectively. No significant differences were found between the groups for any of the skeletal, dental, and soft tissue cephalometric variables.

CONCLUSIONS

ADHD affected adolescents have similar craniofacial characteristics, but narrower upper airway dimensions compared to controls. Further investigations with larger samples are warranted to further elucidate the relationship between SDB and ADHD.

The prevalence of malocclusion is higher in schoolchildren with signs of hyperactivity

INTRODUCTION

Attention deficit-hyperactivity disorder is a behavioral disorder characterized by a lack of focus, impulsive behavior, and or excessive activity. This research aimed to evaluate the association between signs of attention deficit-hyperactivity disorder and malocclusion in schoolchildren.

METHODS

A cross-sectional study was conducted with a representative sample of 633 children aged 7-12 years. The children were clinically examined for malocclusion using the Dental Aesthetic Index. The predominant breathing pattern was also determined. Parents answered a questionnaire addressing socioeconomic characteristics and the presence of nonnutritive sucking habits. The Swanson, Nolan, and Pelham Scale-IV was filled out by both parents and teachers to compare behavioral patterns. The children were submitted to a neuropsychological evaluation using the Raven's Colored Progressive Matrix Test. Data analysis involved the chi-square test and Poisson regression analysis.

RESULTS

The prevalence of malocclusion was 42% higher among children with signs of hyperactivity reported by both parents and teachers (prevalence ratio [PR], 1.42; 95% confidence interval [CI], 1.11-1.81; P = 0.004). In the final Poisson regression model, the prevalence of malocclusion was lower among schoolchildren aged 11 and 12 years (PR, 0.62; 95% CI. 0.52-0.73; P <0.001) and higher among those who used a pacifier for at least 4 years (PR, 1.25; 95% CI, 1.02-1.54; P = 0.029) as well as those classified as mouth breathers (PR, 1.28; 95% CI, 1.09-1.51; P = 0.003).

CONCLUSIONS

The prevalence of malocclusion was higher among children with signs of hyperactivity independently of age, pacifier use, and mouth breathing.

Attention-Deficit Hyperactivity Disorder Symptoms in A Group of Children Receiving Orthodontic Treatment in Turkey

Objective

Children with attention-deficit hyperactivity disorder (ADHD) are known to have several oral health problems, particularly traumatic dental injuries, decayed or filled teeth, and poor oral hygiene. The objective of the present study was to determine the ADHD symptoms in a group of patients with malocclusion and receiving orthodontic treatment.

Methods

A total of 88 subjects with a diagnosis of malocclusion between aged 8 and 17 years were included in the study. Socio-demographic characteristics, breastfeeding history, oral habits, and dental trauma history of the subjects were acquired by a detailed questionnaire. Subjects and their parents completed questionnaires addressing ADHD, other psychiatric problems, and dental health impact on the quality of life. During the orthodontic examination, the Index of Complexity, Outcome, and Need was applied to confirm the diagnosis of malocclusion.

Results

Parent-reported psychiatric complaint occurred in almost half of the patients (n=38, 43.2%); the most frequent psychiatric complaints were inattention (n=22, 25%), opposition (n=13, 14.8%), and hyperactivity (n=11, 12.5%). The estimated ADHD prevalence according to parent measure was 15.9% (n=14). Self-report measures revealed that 18.4% (n=16) had behavioral symptoms. The most affected quality of life domain was psychological discomfort.

Conclusion

The findings indicate that ADHD prevalence in children with malocclusion is high. The orthodontists should have a keen eye on behavioral problems.