Open-mouth posture and maxillary arch width in young children: a three-year evaluation

The Association Between Transverse Maxillary Deficiency and Septal Deviation in Adults with Obstructive Sleep Apnea

OBJECTIVES

Recent evidence suggests that environmental factors impact craniofacial development. Specifically, the height and width of the maxilla may impact the degree of septal deviation. We sought to determine the relationship between transverse maxillary deficiency and severity of septal deviation.

METHODS

A prospective cohort of adult sleep surgery patients were evaluated by standardized CT imaging. Primary outcomes evaluated the relationship of a narrow, high-arched palate (the palatal height to width ratio) with the degree of septal deviation at the level of the 1st premolar and 1st molar. Secondary outcome evaluated the relationship of the palatal height-to-width ratio and nasal obstruction. Both adjusted and unadjusted linear regression were performed, including correction for multiple hypothesis testing.

RESULTS

Ninety-three patients were included. On average, the cohort was middle aged (54.7 ± 12.7 years), obese (BMI 30.1 ± 4.5 kg/m2), predominantly male (74.2%), White (73.1%), and with severe obstructive sleep apnea (OSA) (AHI 30.0 ± 18.7 events/h). A moderate correlation was observed between both the relative and absolute inter-premolar palatal height and the degree of septal deviation at the inter-molar region. No significant correlation was observed between palatal dimensions and NOSE score.

CONCLUSION

This study found that transverse maxillary deficiency is moderately associated with greater degree of septal deviation among a sample of OSA patients. This contributes to the concept that craniofacial development impacts the nasal airway, promoting a comprehensive evaluation of both endonasal and extranasal structures.

LEVEL OF EVIDENCE

4 Laryngoscope, 134:2464-2470, 2024.

Comparison of the short-term effects of tooth-bone-borne and tooth-borne rapid maxillary expansion in older adolescents

PURPOSE

To compare the short-term effects of tooth-bone-borne and tooth-borne rapid maxillary expansion (RME) devices on dentofacial structures in older adolescents.

METHODS

The retrospective study reviewed pre- and posttreatment lateral and posteroanterior cephalometric images and orthodontic model records of patients who underwent maxillary expansion. Two groups were formed, in which the same upper jaw expansion protocol was applied with two different maxillary expansion devices: the first group consisted of 15 individuals treated with tooth-bone-borne (hybrid) RME (HRME; 9 girls and 6 boys; mean age, 16.9 ± 0.42 years) and the second group consisted of 15 individuals treated with tooth-borne (conventional) RME (CRME; 8 girls and 7 boys; mean age, 16.74 ± 0.54 years). Cephalometric and orthodontic model measurements were conducted on the records taken before and after treatment.

RESULTS

Significant skeletal and dental expansions were observed in both groups (p < 0.05). However, the increase in nasal width measurements in the HRME group (2.24 ± 0.61 mm) was significantly higher than the increase in the CRME group (1.12 ± 0.25 mm; p < 0.01). Buccal tipping of the premolars was significantly less in the HRME group (0.46 ± 0.35°) than in the CRME group (2.46 ± 0.63°; p < 0.01). The amount of tipping of the molars was higher in the HRME group (4.76 ± 0.88°) compared to the CRME group (2.9 ± 1.03°; p < 0.01).

CONCLUSION

Although the HRME device increase the nasal width in older adolescents to a greater extent, more dental side effects were seen at the maxillary first molars.

Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3-6 years

BACKGROUND

Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children.

METHODS

A total of 503 Japanese children (258 boys and 245 girls aged 3-6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion.

RESULTS

62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related.

CONCLUSIONS

Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.

The role of craniofacial maldevelopment in the modern OSA epidemic: a scoping review

STUDY OBJECTIVES

There is increasing recognition that environmental factors affect human craniofacial development and our risk for disease. A scoping review of the literature was performed looking at environmental influences on craniofacial development to better understand this relationship and investigate what further study is needed to determine how this relationship may impact obstructive sleep apnea.

METHODS

A comprehensive literature search was performed using the Ovid Medline database from inception to May, 2020 with relevance to craniofacial development in 5 clinically-oriented variables: diet, secular change, breastfeeding/non-nutritive sucking habits (NNSH), nasal obstruction/mouth breathing, and masticatory muscle function. The Oxford Centre for Evidence-Based Medicine Levels of Evidence (LoE) was used to assess studies based on study design.

RESULTS

18,196 articles were initially identified, of which 260 studies were fully reviewed and 97 articles excluded. The remaining 163 articles were categorized as follows: Secular change (n = 16), Diet (n = 33), Breastfeeding/NNSH (n = 28), Nasal obstruction/Mouth breathing (n = 57), and Masticatory muscle function (n = 35). 93% of included studies reported a significant association between craniofacial morphology and environmental factors. The majority of studies were characterized as low LoE studies with 90% of studies being LoE 4 or 5.

CONCLUSIONS

The studies in this review suggest that environmental factors are associated with changes in craniofacial development. However, most studies were heterogeneous and low-level studies, making strong conclusions about these relationships difficult. Future rigorous studies are needed to further our understanding of environmental influences on craniofacial development and OSA risk.

Prevalence of an incompetent lip seal during growth periods throughout Japan: a large-scale, survey-based, cross-sectional study

BACKGROUND

Systemic and local factors may lead to disruption of craniofacial growth and development, causing an imbalance between the orofacial skeleton, muscle and soft tissue, dental occlusion, and the dental arch during growth periods. We aimed to reveal whether the prevalence of incompetent lip seal (ILS) varies with age and region, as well as to clarify the factors related to an ILS, in a national, large-scale epidemiological study.

METHODS

We surveyed 3399 children, from 3 to 12 years of age, visiting 66 pediatric dental clinics throughout Japan. For this survey, we employed a questionnaire consisting of 44 questions regarding daily health conditions and lifestyle habits. We evaluated the differences in ILS prevalence by age and region (using a Cochran-Armitage test for trend and a Kruskal-Wallis test), and the relationship between ILS and factors investigated in the questionnaire (using Spearman's rank correlation coefficient).

RESULTS

We observed that 30.7% of Japanese children exhibited an ILS and that the ILS rate increased with age (p < 0.001). There were no regional differences in the rate of ILS in Japanese children (p = 0.506). We revealed that 12 of 44 survey items exhibited a statistically significant correlation with ILS (p < 0.001), using Spearman's rank correlation coefficient. These items involved orofacial morphology, mouth breathing, and possibly, allergic rhinitis.

CONCLUSION

The rate of ILS seems to increase with age in children, throughout Japan. Therefore, this disorder may not self-correct during the growth periods in these children. Guidelines are required for pediatric dentists to recognize ILS among children aged 3-12 years.

Relationship between occlusal findings and orofacial myofunctional status in primary and mixed dentition: part IV: interrelation between space conditions and orofacial dysfunctions

AIM

The aim of this study was to provide basic representative data on the prevalence of malocclusions involving space deficiency in both primary and early mixed dentition and to examine the relationship between these malocclusions and orofacial dysfunctions. The results should be viewed from an orthodontic prevention and early treatment perspective.

SUBJECTS AND METHODS

Orthodontic findings in the maxilla and mandible as well as the myofunctional status of 766 children in primary dentition and 2,209 children in mixed dentition were examined clinically in a cross-sectional study. The following parameters from each jaw were subjected to orthodontic analysis: crowding in the anterior and posterior regions of the maxilla and mandible in primary and mixed dentitions, deviations from normal maxillary arch forms in the primary dentition, deviations from normal anterior maxillary arch width in mixed dentition and maxillary apical base morphology in mixed dentition. Static and dynamic orofacial dysfunctions were documented with reference to specific parameters and clinical tests.

RESULTS

Crowding was observed in every tenth child in primary dentition (10.8%) and in every second child in mixed dentition (49.7%). Habitual open mouth posture, visceral swallowing, articulation disorders and oral habits were statistically significantly more frequent in children in primary dentition presenting a narrow maxillary arch. Reduced anterior maxillary arch width (compression) was statistically more frequent in children in early mixed dentitions with habitual open mouth posture. A narrow maxillary apical base correlated positively with all the orofacial dysfunctions analyzed.

CONCLUSIONS

Deviations from a regular arch form become apparent very early during dentition development and coexist with specific orofacial dysfunctions. They are thus important indicators for the early detection of functional abnormalities, causing deviations from normal dentition development. In children with orofacial dysfunctions the development of a narrow maxillary dental arch should be prevented by myofunctional therapy and by educating the parents. Interceptive orthodontic measures to treat a narrow maxillary arch in primary and early mixed dentition should also focus on eliminating functional disturbing factors, such as orofacial dysfunctions. Interdisciplinary cooperation with specialists in other fields of medicine, e.g. otorhinolaryngology and speech therapy, is essential to achieve this goal.

Comparative cephalometric study between nasal and predominantly mouth breathers

Aim

to evaluate the possible correlation between the respiratory pattern in determining the craniofacial dimensions, using as baseline the Tweed-Merrifield's cephalometric analysis, added to angle SN-GoGn and to Y axis angle.

Methodology

The selected sample to this study comprised 50 teleradiographies taken in lateral and natural positions of the head in young female patients at the age of 9 to 12 years, presenting mean age of 10 years and 5 months and Class 1 malocclusion. After diagnosis of respiratory pattern, the sample was divided into two groups: control group, 25 teleradiographies of nasal breathers in lateral and natural positions of the head; experimental group, 25 teleradiographies of predominantly mouth breathers in lateral and natural positions of the head.

Results

The results were submitted to descriptive analysis (mean and standard deviation), test F and “t” Student test with significance level of 5%. There was no significant difference between the group with nasal breathing and the group with predominantly mouth breathing for any of the studied variables.

Estudo cefalométrico comparativo entre respiradores nasais e predominantemente bucais

OBJETIVO: avaliar a possível influência do padrão respiratório na determinação das dimensões craniofaciais, tendo como base a análise cefalométrica de Tweed-Merrifield, acrescidas do ângulo SN-GoGn e do ângulo do eixo Y. METODOLOGIA: A amostra selecionada para o presente estudo constou de 50 telerradiografias, tomadas em norma lateral e posição natural de cabeça, de jovens do sexo feminino, na faixa etária de 9 a 12 anos (idade média de 10 anos e 5 meses) com maloclusão de Classe I. Após o diagnóstico do padrão respiratório, dividiu-se a amostra em dois grupos, assim constituídos: grupo controle - 25 telerradiografias de respiradores nasais e grupo experimental - 25 telerradiografias de respiradores predominantemente bucais. RESULTADOS: foram submetidos à análise descritiva (média e desvio padrão), teste F e teste "t" de Student com nível de significância de 5%, através dos quais foi possível constatar não existir diferença significativa entre os grupos com respiração nasal quando comparado com o grupo de respiração predominantemente bucal para nenhumas das grandezas estudadas.

Perennial rhinitis in the under 4s: a difficult problem to treat safely and effectively? A comparison of intranasal fluticasone propionate and ketotifen in the treatment of 2-4-year-old children with perennial rhinitis

To compare the safety and efficacy of fluticasone propionate aqueous nasal spray (FPANS) and oral ketotifen in children aged 2-4 years with perennial rhinitis. A randomized, multicentre, double-blind, double dummy, placebo-controlled study. Paediatric patients between the ages of 2-4 years with perennial rhinitis. Rhinitis symptoms score (parent-rated), clinical evaluation of symptoms (investigator-rated) and adverse event profiles during the treatment period. Patients treated with FPANS had a significant reduction in both the total night-time rhinitis symptom assessment for weeks 4-6 (p-value 0.036), and the total daytime rhinitis symptom score over the same period (p-value 0.049). Generally, except for nasal itching/rubbing over weeks 1-3, the patients taking FPANS had lower recorded symptom scores for all individual symptoms measured. Nasal blockage, in particular, was significantly reduced over the 4-6 week period (p-value 0.027). The overall investigator-rated clinical evaluation showed substantial improvement or improvement in nine of 12 of the children taking FPANS compared with four of 14 taking ketotifen. Finally, there were no reports of serious adverse events, the incidence of drug-related adverse events was low and there was no statistical difference between the groups. FPANS may be an appropriate treatment to control the symptoms of rhinitis in children between 2 and 4 years old.

Electromyographic analysis of trapezius and sternocleidomastoideus muscles during nasal and oral inspiration in nasal- and mouth-breathing children

The purpose of this study was to evaluate sternocleidomastoideus (SCM) and trapezius (superior fibers) muscle activity patterns in mouth-breathing children, and to compare them with nasal-breathing children. Forty-six children, of both sexes, ranging from 8 to 12 years old, were evaluated through electromyography. The selected children were divided into two groups; Group I, was made up of 26 mouth-breathing children and Group II of 20 nasal-breathing children. Electromyographic recordings were obtained through surface electrodes in the SCM and trapezius muscles, bilaterally, during oral and nasal inspiration. Root-mean-square (RMS) data expressed in microvolts (microV), were analyzed using the Kruskall-Wallis statistical test. From the results obtained, we concluded that there was a significant difference in the muscle activity between the groups, with higher activity during nasal inspiration in the mouth-breathing group. During oral inspiration, there was no significant difference between groups. Within the groups, only the mouth-breathing group showed higher activity during nasal inspiration.

Transversal dental arch dimensions in 9-year-old children born in the 1960s and the 1980s

The transversal arch dimension has been studied in 2 different cohorts of 9-year-old children, a group of 119 (56 girls and 63 boys) from Norway and a group of 133 (72 girls and 61 boys) from Sweden. Half of the children in each group were born in the 1960s and half in the 1980s. The maxillary and mandibular transversal dimensions did not differ between the 1960s groups and the 1980s groups when the maxilla and the mandible were studied separately. When the intermaxillary relationship was assessed, a significant reduction in the intermaxillary difference was found in the boys born in the 1980s compared with the boys born in the 1960s. This was confirmed with different measurement points. In the girls, the mesial drift of the first permanent molars, because of a greater prevalence of caries in the 1960s groups, masked this effect. When the mesial drift of the first permanent molars in the girls born in the 1960s was considered, the transversal intermaxillary difference showed the same secular pattern as in the boys. When the mesial drift of the first permanent molars was considered, the intermaxillary difference in the 1960s groups resembled that found in an American sample of northwest European ancestry born in the 1940s to a greater extent compared with the children born in the 1980s.

A lip seal study of Japanese children with malocclusion

The purpose of this study was to clarify the relationship between lip seal and malocclusion in Japanese children. Fifty-three patients aged 7 to 14 years (mean 10.24 +/- 1.93) were selected randomly, and compared with 20 subjects with normal occlusion aged 7 to 14 years (mean 10.50 +/- 2.56). The subjects were divided into a good lip seal group and poor lip seal group by observing the distance between the upper and lower lip at rest. The variables that were analyzed for morphological evaluation included model analysis and cephalometric analysis. Noted for functional evaluation were tongue position, the size of the tonsils and adenoids and the oral muscle force measured by button pulling. In the evaluation of the degree of lip seal, there was no statistical difference between subjects with malocclusion and those with normal occlusion. Within the group with malocclusions, however, there were significant differences in overbite (p < 0.01), overjet (p < 0.01), and oral muscle force by button pulling (p < 0.05) between the good lip seal and poor lip seal groups. These results suggest that there is a need not only to correct malocclusion but also to be aware of lip sealing so that it may be improved in Japanese children.

Infant oral health and oral habits

Many oral diseases and conditions, including dental caries (cavities) and malocclusions, have their origins early in life. Prudent anticipatory guidance by the medical and dental professions can help prevent many of the more common oral health problems. This article provides information on the rationale for early dental examination and instructions for pediatric and family practitioners in scheduling and conducting an early oral intervention appointment. In addition, feeding practices, non-nutritive sucking, mouth breathing, and bruxing are discussed, including their effects on orofacial growth and development.

Magnetic resonance imaging procedures to study the concurrent anatomic development of vocal tract structures: preliminary results

The vocal tract structures undergo drastic anatomic restructuring during the course of development from infancy to adulthood. This study demonstrates the feasibility of using MRI to examine the growth processes of the vocal tract. This method affords precise and detailed visualization of the soft tissues in the oro-pharyngeal region, while also providing images of related bony and cartilaginous structures. Information on anatomic restructuring contributes to the understanding of how speech emerges and develops, and it also establishes normative information that can be used in the assessment of developmental anomalies. This paper describes the method used to measure and examine the concurrent anatomic development of the various vocal tract structures during early childhood. Preliminary results from two pediatric subjects indicate that there is synchrony of growth in the different structures-both soft and hard tissues-, and that such synchronous growth appears to persist during periods of growth spurts.