Association between atypical swallowing and malocclusions: a systematic review

The role of atypical deglutition in children and adolescents with moderate to severe obstructive sleep apnea syndrome

This cross-sectional study aimed to assess the prevalence of atypical deglutition (tongue thrust) in children diagnosed with moderate to severe obstructive sleep apnea syndrome (OSAS) and to explore its associations, particularly in relation to the type of dentition (mixed or permanent). The study was conducted over a 5 year period at a paediatric hospital in Paris, France. Children aged 6-18 years with moderate to severe OSAS (apnea-hypopnea index ≥5/h) underwent a comprehensive evaluation, including the recording of demographic data, symptoms of snoring and breathing issues, and otolaryngology examination. The swallowing pattern was assessed and orthodontic evaluations were performed. Cephalometric radiography and pharyngometry tests (pharyngeal collapsibility was computed) were conducted. The study found a high prevalence of atypical deglutition in children with mixed 74% [56-87] or permanent 38% [25-51] dentition. In children with mixed dentition and atypical deglutition, the pharyngeal compliance and lower facial dimensions were increased. In children with permanent dentition, atypical deglutition was associated with more severe OSAS and a lower hyoid bone position. Independent of the type of dentition, atypical deglutition was associated with an increase in the apnea-hypopnea index, an increase in the lower facial dimension, increased pharyngeal compliance, and a more caudal hyoid bone position. Atypical deglutition was strongly associated with increased pharyngeal collapsibility, more severe OSAS and altered facial measurements in children. The findings suggest that identifying atypical deglutition in children with OSAS could help to guide a personalised therapeutic approach, including myofunctional therapy.

Prevalence of malocclusions and parafunctional habits in pediatric patients with developmental dyslexia

Objective

The study aimed to assess the prevalence of dental malocclusion, orthodontic parameters, and parafunctional habits in children with developmental dyslexia (DD).

Methods

Forty pediatric patients (67.5% boys and 32.5% girls, mean age: 11.02 ± 2.53 years, range: 6-15 years) with DD were compared with 40 age- and sex-matched healthy participants for prevalence of dental malocclusion, orthodontic parameters, and parafunctional habits. Dental examinations were performed by an orthodontist.

Results

Pediatric patients with DD exhibited a significantly higher prevalence of Angle Class III malocclusion (22.5% vs. 5.0%, P = 0.024), deep bite (27.5% vs. 7.5%, P = 0.019), midline deviation (55.0% vs. 7.5%, P < 0.0001), midline diastemas (32.5% vs. 7.5%, P = 0.010), wear facets (92.5% vs. 15.0%, P < 0.0001), self-reported nocturnal teeth grinding (82.5% vs. 7.5%, P < 0.0001), nail biting (35.0% vs. 0.0%, P < 0.0001), and atypical swallowing (85.0% vs. 17.5%, P < 0.0001) compared to that in healthy controls.

Conclusions

Pediatric patients with DD showed a higher prevalence of Class III malocclusion, greater orthodontic vertical and transverse discrepancies, and incidence of parafunctional activities. Clinicians and dentists should be aware of the vulnerability of children with dyslexia for exhibiting malocclusion and encourage early assessment and multidisciplinary intervention.

Exploring the potential of rapid maxillary expansion and masticatory muscle activity in unilateral posterior crossbite

Background

This systematic review and meta-analysis aimed to evaluate if rapid maxillary expansion improves the activity of the masticatory muscles (masseter and temporal) in patients with unilateral posterior crossbite.

Material and Methods

Searches were performed in PubMed/MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, and grey literature. A manual search of orthodontic journals was also performed. Randomized clinical trials or longitudinal prospective studies were eligibles. Meta-analyses were conducted using R software with the "Meta" package, applying mean differences with a 95% confidence interval. Risk of bias was assessed using the Newcastle-Ottawa scale, and evidence certainty was evaluated using GRADE.

Results

Nine articles were included. Qualitative analysis showed that RME treatment in patients with unilateral posterior crossbite showed a positive correlation with improvement in masseter and temporalis muscle activity. Meta-analyses indicated a significant difference for all models of muscle activity after treatment with rapid maxillary expansion, except for the temporal muscle in the force exerted on the maximum voluntary clenching on cotton rolls. The studies showed low bias risk, and the evidence certainty for each analysis was generally low to very low.

Conclusions

This investigation demonstrated the benefits of R rapid maxillary expansion in treating unilateral posterior crossbite and its potential therapeutic effects on the masticatory muscles. Key words:Rapid maxillary expansion, masticatory muscles, unilateral posterior crossbite, systematic review, meta-analysis.

The Influence of the Tongue on the Development of Dental Malocclusion

The tongue supports the upper dental arch and encourages healthy dental arch development when it rests against the roof of the mouth. On the other hand, over time, malocclusion can result from incorrect tongue position, such as lying low in the mouth or thrusting forward during swallowing or speaking. As a muscular organ, the tongue applies forces to the jaws and teeth that may help with malocclusion or hinder it from aligning properly. The dentition and jaws grow and align according to the way the tongue, teeth, and surrounding structures interact. The tongue's morphogenetic function includes forming the arches and having an important impact on the maxillary complex's development. The tongue frequently assumes a balancing and compensatory function in subsequent phases, functioning more or less like a natural orthodontic bite. In adults, the tongue is able to compensate for problems like open bites, teeth that are out of alignment, or differences in the occlusal and sagittal planes of the spine. In this context, the tongue's ability to sustain occlusion during malocclusion can be considered a compensatory response. This is comparable to how lingual dysfunction may contribute to malocclusion or act as a potential source of recurring orthodontic instability. In order to diagnose and treat orthodontic issues, dental professionals must know the connection between tongue position and dental malocclusion. Malocclusion can be prevented or minimized with early intervention, such as myofunctional therapy to correct tongue position and habits, improving dental health and well-being overall.

Observation of factors associated with visceral swallowing pattern in 2-6 year old children: A cross-sectional study

Introduction

The association between the visceral swallowing pattern (VSP) and dentofacial abnormalities remains controversial. This cross-sectional study aimed to investigate the association between the VSP and various factors including type of birth, gender, tongue posture, lip incompetence, eruption of primary molars, habits and the presence of malocclusions in children with primary and early mixed dentition.

Material and method

A total of 219 children (102 boys and 117 girls) were evaluated using a combination of a questionnaire and a structured clinical examination by one pediatric specialist dentist. Kittel's method of tongue posture evaluation and the Payne technique for assessment of swallowing pattern were included in the clinical examination of myofunctional status. After checking for normality, normal and non-normal distributed data were analyzed using two-sample t-test and Mann-Whitney U test, respectively. Analysis of categorical variables was done using a chi-square test, and Bonferroni correction was used as correction for multiple comparisons.

Results

A total of 56.2 % of the study population had a VSP. The chi-square test indicated a statistically significant higher presence of VSP in male gender. Statistically significant associations were seen between the VSP and lip incompetency, pathologic resting tongue position, habits, anterior open bite and increased overjet. On the other hand, no statistically significant associations were found between VSP and children's age within the sample population, type of birth, uni- or bilateral crossbites, increased overbite, edge-to-edge anterior bite or completion of eruption of primary molars and/or permanent incisors.

Conclusions

The association between VSP and male gender, pathologic tongue posture, lip incompetency and habits and occlusal traits such as anterior open bite and increased anterior overjet is supported by the results of the present study.