3D evaluation of cranial and dentofacial morphological differences between individuals with mouth breathing and nasal breathing

INTRODUCTION

The present study aimed to identify the morphological differences in cranial and dentofacial structures between individuals with mouth-breathing and nasal-breathing.

MATERIALS AND METHODS

The study included 120 individuals, 60 each in the nasal breathing (NB) and mouth breathing (MB) groups. 3D stereophotogrammetry, lateral cephalometric radiographs, and intraoral examination results were recorded by the researchers to determine the morphological differences between the MB group and the NB group. The study utilized cephalometric radiographs for 2D hard tissue measurements and 3D stereophotogrammetric records for linear and angular measurements.

RESULTS

Statistically significant differences were found between the NB and MB groups' SNB angles (respectively, 79.3 ± 3.04, 76.6 ± 4.24, and p=0.002). Also, the NB group's SN-GoGn angle was lower than the MB group's (respectively, 31.5 ± 5.12, 36.0 ± 5.55, and p=0.002). Considering the Jarabak ratio, the NB group's Jarabak ratio was higher than the MB group (respectively,65.7 ± 4.16, 62.6 ± 4.10, and p=0.014). In 3D stereophotogrammetry measurements, increased Li-Me' was detected in the MB group than in NB group.

CONCLUSION

Mouth breathing results in significant morphological differences that affect the development of both soft tissues and skeletal structures. Orthodontists utilize these characteristic features observed in mouth-breathing anomalies for early diagnosis and consider referring their patients for medical treatment of mouth breathing.

The effects of adenoid hypertrophy and oral breathing on maxillofacial development: a review of the literature

According to modern epidemiological surveys, the prevalence of adenoid hypertrophy in children and adolescents ranges from 42% to 70%. Adenoid hypertrophy can lead to airway obstruction; thus forces a child to breathe through their mouth, thus affecting the normal development of the dental and maxillofacial area, and can lead to malocclusion. Long-term mouth breathing can cause sagittal, vertical and lateral changes in the maxillofacial area. In this article, we review the current research status relating to the association between adenoid hypertrophy, oral breathing and maxillofacial growth and development in children and adolescents. We also discuss the personalized formulation of treatment plans.

Evaluation of the breathing mode by infrared thermography

OBJECTIVES

To analyze breathing modes with infrared thermography.

METHODS

Cross-sectional observational exploratory study conducted in 20 female participants with a mean age of 26.0-years. The thermograms were made following the principles of the American Academy of Thermology and the Brazilian Thermology Society. The camera FLIR A315 (FLIR Inc., Santa Barbara, CA) was used for the tests. The recordings consisted of the participants breathing normally through the nose for 2min and simulating oral/oronasal breathing for another 2min. The thermograms were analyzed with the FLIR Tools software. An ellipse was placed between the nostrils and the lip commissures to obtain the mean temperatures. The collection was made by two independent researchers, and the normalized non-dimensional temperature was calculated.

RESULTS

The temperature in nasal breathing is higher than in oral/oronasal breathing both for inhaling and exhaling when measured in the region of the mouth. The exhaling temperatures were higher than the inhaling ones in oral/oronasal breathing (through the nose and the mouth) and nasal breathing (only through the nose). The temperature difference between exhaling and inhaling (ΔT) was greater in oral/oronasal breathing when measured in the region of the mouth.

CONCLUSION

The thermographic assessment of breathing modes may be made by comparing the mean temperatures of the mouth, using an ellipse.

LEVEL OF EVIDENCE

Study without consistently applied reference standards.

The Role of Montelukast Sodium in Children with Adenoid Hypertrophy - A Comparative Study

Background Adenoid Hypertrophy (AH) results in symptoms ranging from mild nasal obstruction to the dangerous obstructive sleep apnoea. Normally for such patients Adenoidectomy with or without Tonsillectomy is carried out. However complications like haemorrhage and recurrence of adenoid tissue are common. Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The present study is aimed at evaluating the effect of oral Montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH. Materials and Methods Sixty children aged between 6 and 12 years with adenoid hypertrophy were randomly divided into two groups of thirty each. The study group was prescribed Tablet Montelukast 5 mg daily for 12 weeks while the control group received matching placebo. A questionnaire based upon the severity of the symptoms as well as the Adenoid Nasopharynx ratio (A/N), as measured via X-ray Adenoids and the Nasal endoscopic scores done before and after treatment (at 3 months) in the two groups were taken into consideration . Results The Mann Whitney Test which was used found no distinction in snoring, sleep discomfort and mouth breathing between the two groups before the start of treatment. But a significant difference was indeed observed between the two groups after treatment in case of snoring (P < 0.006), sleep discomfort(P < 0.001) and mouth breathing (P < 0.001). Conclusion Oral Montelukast therapy is seen to be effective not only in the reduction of the size of adenoids but also in improvement of the overall symptoms and can thus be considered as a viable alternative .

Ineffectiveness of watchful waiting on mouth breathing in children with obstructive sleep apnea

OBJECTIVE

To investigate the effectiveness of watchful waiting on mouth breathing in children with OSA.

METHODS

Children in the Childhood Adenotonsillectomy Trial (CHAT) dataset were divided into two groups according to the treatment they received. One question in the OSA-18 Quality-of-Life Survey was chosen to evaluate the severity of mouth breathing.

RESULTS

In total, 392 children (adenotonsillectomy group, n = 197 and watchful waiting group, n = 195) were enrolled in the study. There was no significant correlation between the Apnea-Hypopnea Index (AHI) and the severity of mouth breathing, r=.09,p=.073. In watchful waiting group, there is no statistically significant difference of mouth breathing score (p = .555) between baseline and followup.

CONCLUSIONS

The watchful waiting of mouth breathing in children with less severe OSA is ineffective. More caution should be taken to choose watchful waiting for children with mild OSA but severe mouth breathing.

Mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped: device's efficacy confirmed with physical video observation

PURPOSE

This study aimed to design a device to monitor mouth puffing phenomena of patients with obstructive sleep apnea when mouth-taped and to employ video recording and computing algorithms to double-check and verify the efficacy of the device.

METHODS

A mouth puffing detector (MPD) was developed, and a video camera was set to record the patients' mouth puffing phenomena in order to make ensure the data obtained from the device was appropriate and valid. Ten patients were recruited and had polysomnography. A program written in Python was used to investigate the efficacy of the program's algorithms and the relationship between variables in polysomnography (sleep stage, apnea-hypopnea index or AHI, oxygen-related variables) and mouth puffing signals (MPSs). The video recording was used to validate the program. Bland-Altman plot, correlations, independent sample t-test, and ANOVA were analyzed by SPSS 24.0.

RESULTS

Patients were found to mouth puff when they sleep with their mouths taped. An MPD was able to detect the signals of mouth puffing. Mouth puffing signals were noted and categorized into four types of MPSs by our algorithms. MPSs were found to be significantly related to relative OSA indices. When all participants' data were divided into minutes, intermittent mouth puffing (IMP) was found to be significantly different from non-mouth puffing in AHI, oxygen desaturation index (ODI), and time of oxygen saturation under 90% (T90) (AHI: 0.75 vs. 0.31; ODI: 0.75 vs. 0.30; T90: 5.52 vs. 1.25; p < 0.001). Participants with severe OSA showed a higher IMP percentage compared to participants with mild to moderate OSA and the control group (severe: 38%, mild-to-moderate: 65%, control: 95%; p < 0.001).

CONCLUSIONS

This study established a simple way to detect mouth puffing phenomena when patients were mouth-taped during sleep, and the signals were classified into four types of MPSs. We propose that MPSs obtained from patients wearing the MPD can be used as a complement for clinicians to evaluate OSA.

Associations between skeletal discrepancies, breathing pattern, and upper airway obstruction in Class III malocclusions

OBJECTIVE

To verify the associations between sagittal and vertical skeletal discrepancies, changes in upper airways, and breathing pattern in children and adolescents with Angle Class III and Class III subdivision malocclusions.

METHODS

Eighty-five children and adolescents with a mean age of 9.5 ± 1.74 years were selected. Cephalometry assessed the sagittal relationship (AO-BO measurement), facial types (Ricketts VERT index), nasopharynx, and oropharynx. An otorhinolaryngologist analyzed the breathing pattern and upper airway obstruction during anamnesis, physical examination, anterior rhinoscopy, and nasofibroscopy. Medical records were also reviewed. For statistical analysis, ordinary one-way ANOVA, Kruskal-Wallis (Tukey's post-hoc), unpaired t-test, Pearson's correlation, chi-square, and Fisher's exact tests (p < 0.05) were used.

RESULTS

The nasopharyngeal cephalometric dimension and pharyngeal tonsil hypertrophy were associated, whereas the oropharyngeal cephalometric dimension and palatine tonsils hypertrophy were not. Sagittal discrepancies were associated with septum deviation, while facial type was associated with inferior turbinate and palatine tonsils hypertrophy. However, facial type was not associated with breathing pattern, septum deviation, and pharyngeal tonsils hypertrophy.

CONCLUSIONS

Sagittal discrepancies and type of malocclusion were not associated with breathing pattern and changes in upper airways, except for the severity of septum deviation and Class III malocclusions, which were associated with large sagittal discrepancies. Although the facial types analyzed presented signs of airway obstruction, the highest prevalence of inferior turbinate and palatine tonsils hypertrophy were found in patients with dolichofacial type.

Analysis of maxillary arch morphology and its relationship with upper airway in mouth breathing subjects with different sagittal growth patterns

OBJECTIVE

This three-dimensional cone beam computed tomography(CBCT) study assessed pharyngeal airway and maxillary arch in mouth breathing subjects with different skeletal classifications and analyzed the factors associated with the upper airway morphological variations in mouth breathing (MB) and nasal breathing (NB) subjects.

METHODS

One hundred and five subjects (52 MB and 53 NB children), divided into three skeletal groups: Class I (1° ≤ ANB° ≤ 5°), Class II (ANB° >5°), and Class III (ANB°<1°). An independent t-test and one-way ANOVA test were utilized in the group analysis of normal distributed data. The linear multiple regression test was applied to create a model for the airway volumes based on the maxillary arch parameters in different skeletal groups.

RESULTS

In three skeletal groups, NB individuals had greater oropharyngeal airway volume (OPV) and total pharyngeal airway volume (TPV) than MB. Maxillary arch parameters of intermolar width (IMW), intercanine width (ICW), and maxillary width of canines (MWC) were larger in NB participants than in MB subjects. In the MB group, we discovered that Class II individuals had lower NPV (nasopharyngeal airway volume) than Class I and Class III. MWC was lower in Class II subjects compared to Class I and Class III in both the NB and MB groups.

CONCLUSION

NB individuals had greater pharyngeal airway and maxillary arch parameters than MB subjects. Our model equation revealed that the inter-molar width (IMW) and palatal area (PA) parameters were the strongest predictors of total pharyngeal airway volume (TPV) in the skeletal Class II and Class I groups.

Reconstruction of nasal airway in patients of class IIId maxillary defect with vastus lateralis muscle-chimeric double skin paddle ALT flap

BACKGROUND

A reconstructive challenge in patients with class IIId maxillary defect is how to obliterate the defect and restore a patent nasal airway. The current strategy using the single anterolateral thigh (ALT) fasciocutaneous flap for reconstruction may result in permanent mouth breathing. As the ALT flap was a common option in reconstruction processes, this study aimed to evaluate the benefits of vastus lateralis (VL) muscle-chimeric double skin paddle ALT flap in simultaneous defect and nasal airway reconstruction.

METHODS

This study included 21 patients with class IIId maxillary defect who underwent free ALT flap reconstruction (n = 11, single ALT flap group; n = 10, VL muscle-chimeric double skin paddle ALT flap (chimeric ALT flap) group) at the China Medical University Hospital from August 2015 to September 2019. Associated parameters collected for analysis included gender, age, body mass index (BMI), operative time, hospitalization, clinical stage, preoperative treatment, flap/defect size, comorbidities, postoperative RT, mouth breathing and short/long term complications.

RESULTS

No significant differences were observed in age, BMI, hospitalization, clinical stage, preoperative treatment, defect size, comorbidities, and postoperative RT between the two groups; however, the chimeric ALT flap group as dominated by male patients (p = 0.009), and had longer operative times (12.1 h vs. 10.1 h, p = 0.002) and larger flap sizes (180 cm² vs. 96.7 cm², p = 0.013). Compared with the chimeric ALT flap group, the single ALT flap group suffered from permanent mouth breathing.

CONCLUSION

Nasal airway reconstruction should be considered in patients with class IIId maxillary defect. Compared to the single ALT flap, the chimeric ALT flap is a superior reconstructive option for patients with class IIId maxillary defect, although a longer surgical duration and larger flap size are required.

Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing

Objective

Rapid maxillary expansion (RME) has been extensively used in orthodontic practice for over a century, and it is claimed to benefit upper airway morphology. However, its effect in actually alleviating mouth breathing has remained unexplored. This systematic review was planned with an objective to provide a comprehensive synthesis of the effects of RME on upper airway volume and most importantly, its role in alleviating mouth breathing.

Methods

A literature search of electronic databases were done for the time period of 2000-2018. Randomized controlled trials (RCTs) and non-RCTs conducted on 8-15-year-old children who received bonded or banded RME and upper airway measured using three-dimensional (3D) imaging were included.

Results

Twelve studies (two RCTs, nine nonrandomized clinical trials, and one non-RCT) were included in this systematic review, and nine studies were included for meta-analysis. Among the evaluated parameters, nasal cavity volume showed a significant increase which was maintained even after the retention phase, whereas nasopharyngeal and oropharyngeal volume did not report a significant change.

Conclusion

Based on this systematic review, it can be concluded that RME causes a significant increase in nasal cavity volume, but its effect on nasopharyngeal and oropharyngeal volume is not statistically significant in majority of studies. This increase in volume may not be considered as an equivalent for enhancement of airway and function unless proven so. In order to establish its significance in the improvement of breathing, it is necessary to conduct more well-designed RCTs with samples actually comprising mouth breathers.

How to cite this article

Balasubramanian S, Kalaskar R, Kalaskar A. Rapid Maxillary Expansion and Upper Airway Volume: Systematic Review and Meta-analysis on the Role of Rapid Maxillary Expansion in Mouth Breathing. Int J Clin Pediatr Dent 2022;15(5):617-630.

A non-randomized concurrent controlled trial of myofunctional treatment in the mixed dentition children with functional mouth breathing assessed by cephalometric radiographs and study models

Objectives

This study aimed to examine the clinical effects of myofunctional treatment on children with functional mouth breathing by cephalometric radiographs and study models.

Methods

A total of 224 children (6–10 years old; 114 males and 110 females; SNA°: 82.24 ± 1.67°; ANB°: 2.79 ± 0.80°, 28° < SN-GoGn° < 37°) formed three groups: MB-M group (mouth breathers with myofunctional treatment,n = 75); MB-N group (mouth breathers with no treatment,n = 70); NB group (nasal breathers with no treatment, n = 79). A blind evaluation of cephalometric radiographs and study models was conducted at T1(pre-study) and T2 (post-study), respectively.

Results

Two hundred four children (MB-M:66, MB-N:68, NB:70) completed the present study. At T1, MB-M and MB-N groups, compared to their NB counterpart, had greater anterior lower facial height(P < 0.01) and overjet(P < 0.001) but shorter overbite and maxillary canines width (P < 0.001). At T2, the MB-N group exhibited a higher ANB angle, anterior lower facial height, and overjet, but shorter overbite and maxillary canines width (P < 0.001). From T1 to T2, the anterior lower facial height increased, overbite and the maxillary canines width further decreased in the MB-N group (P < 0.001). However, in the MB-M group, the incisors were retracted, overbite increased (P < 0.001), anterior lower facial height increased insignificantly (P > 0.05), and maxillary canines width increased slightly (P < 0.05). In the NB and MB-M groups, the mandible showed a normal tendency to grow forward, whereas, in the MB-N group, the mandible showed a tendency to grow downward (P < 0.001).

Conclusions

Mouth breathers demonstrated increased anterior facial height and overjet but reduced overbite and maxillary arch width, which improved significantly following myofunctional treatment.

Trial registration

TCTR: TCTR20220401001. Registered 1^stApril 2022-Retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03559-w.

Three-dimensional evaluation of hyoid bone position in nasal and mouth breathing subjects with skeletal Class I, and Class II

BACKGROUND

This retrospective study investigated the effect of breathing pattern, skeletal class (Class I, Class II), and age on the hyoid bone position (HBP) in normodivergent subjects.

METHODS

A total of 126 subjects (61 males, 65 females) aged 7-9 years and 10-12 years were scanned using cone-beam computed tomography (CBCT). All participants were classified according to the anteroposterior skeletal pattern into (Class I, Class II). Each skeletal group was further divided according to the breathing mode into mouth breathers (MB) and nasal breathers (NB). The HBP was measured accordingly. Independent sample t-test and Mann Whitney U test were used to detect significant differences between the groups, and binary logistic regression was used to identify MB predictive indicators.

RESULTS

The breathing mode and skeletal class affected the vertical HBP in subjects with 7-9 years, while they affected the anteroposterior HBP in subjects with 10-12 years. Regarding the age effect, hyoid bone was located more anteriorly in the older NB subjects, and hyoid bone was more inferiorly in the older age group. A regression equation of the significant variables was formulated, C3-Me (P: 001, OR: 2.27), and H-EB (P: 0.046, OR: 1.16) were positively correlated with occurrence of MB.

CONCLUSION

There were significantly different HBPs among subjects with different anteroposterior skeletal classes, breathing modes, and age cohorts. Moreover, C3-Me, and H-EB were significant predictors and correlated with increased likelihood of being MB subject.

Effects of mouth breathing on maxillofacial and airway development in children and adolescents with different cervical vertebral maturation stages: a cross-sectional study

Background

To examine the influence of mouth breathing on maxillofacial and airway development in children and adolescents with different cervical vertebral maturation stages.

Methods

Lateral cephalometric radiograph of a total of 120 children and adolescents, 64 girls and 56 boys (7–15 years old), diagnosed with mouth breathing were examined. Maxillofacial hard tissue, soft tissue and airway measurements were obtained using both manual and digital techniques. Independent samples t-test was performed to compare the difference between the measured indexes and the standard values.

Results

As for maxillofacial hard tissue, SNB (CS1–CS5), GoGn (CS1–CS5), ArGoNa (CS1–CS5), ArGo (CS1–CS2) and SNA (CS1–CS2) in mouth breathing children and adolescents were below the standard values (P < 0.05). NGoMe (CS1–CS5), SN-MP (CS1–CS4), SN-PP (CS1–CS4), PP-MP (CS1–CS3) and SN-GoGn (CS1–CS2) in mouth breathing children and adolescents were above the standard values (P < 0.05). As for maxillofacial soft tissue measurements, H angle (CS1–CS5), lower lip length (CS1–CS5), upper lip protrusion (CS1–CS5), upper lip length (CS1–CS4), lower lip protrusion (CS1–CS3), surface Angle (CS2–CS3) and nasolabial angle (CS2) in mouth breathing children and adolescents were above the standard values with statistically significance (P < 0.05). As for airway measurements, PAS (CS1, CS2, CS5) in mouth breathing children and adolescents was above the standard value with statistical significance (P < 0.05).

Conclusions

Mouth breathing had a real effect on maxillofacial and airway development, which differed among mouth breathing children and adolescents with different cervical vertebral maturation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02234-x.

Evaluation and Management of Snoring

Snoring can be harmless (primary) or a symptom of sleep-disordered breathing (secondary) and should alert the physician to evaluate the patient for risks thereof. Phenotypes of snoring and sleep-disordered breathing (SDB) are anatomic and nonanatomic and identifying these phenotypes and their interrelationships are critical to effective therapy. Mouth breathing alerts the physician to nasal airway obstruction, signals orofacial growth changes in children, and heralds the progression of SDB. Systematic evaluation to establish phenotypes includes assessing sleep habits, comorbidities, upper airway examination, polysomnography, and drug-induced sleep endoscopy. Strategies for treatment should be personalized and precise to the phenotype(s) to achieve the most benefit.

Three-dimensional image study of accelerated maxillary expansion in oral breathing kids

OBJECTIVE

To evaluate, by a three-dimensional study, the volumetric and integumentary effects of rapid maxillary expansion on the nose, in mouth breathing kids with maxillary hypoplasia, in the short term, assessing the possible interference of gender, growth and age on the results achieved.

METHODS

120 mouth breathing patients with maxilla hypoplasia were divided into an Experimental Group treated by rapid maxillary expansion (n = 104, 62 males and 42 females, mean age 10.1 years, SD = 2.10, ranging from 5.1 to 13.9 years); and Control Group, constituted by 16 patients (9 males and 7 females, mean age 9.3 years, SD = 2.1 years, ranging from 6.1 to 13.2 years). Patients in the experimental group underwent multislice computed tomography examinations at two different times: (T1) pre-expansion and (T2) post-expansion. The control group was submitted to the same tests at the same time intervals. Six soft tissue variables of the nose were studied, besides the volume and area of the nasal cavity, and the measurement and comparison of data between T1 and T2 were performed using the Dolphin Imaging 11.7 Premium software.

RESULTS

The experimental group showed significant mean increases in all soft tissue variables studied (p < 0.005), yet there were no significant changes in the control group. In the comparison between groups, only inclination of the nasal dorsum did not present any significant change.

CONCLUSION

Rapid maxillary expansion may alter the nasal shape and physiology, by anatomical changes in the nose soft tissues, making it an important aid in the treatment of mouth breathing in childhood.

LEVEL OF EVIDENCE

The soft tissues of the nose play an important role in nasal shape and physiology and facial esthetics, and since they are directly related to the nasal valves, they are fundamental for maintenance and stability of the nasal breathing pattern.

Nasal obstruction promotes alveolar bone destruction in the juvenile rat model

Background/purpose

Nasal obstruction leads to oral breathing and consequently hypoxia. The purpose of this study was to determine the influence of hypoxia on inflammatory response and the effect on alveolar bone development in a rat model in which mouth breathing was induced by nasal obstruction.

Materials and methods

Unilateral nasal obstruction was performed by injecting a Merocel sponge into the nasal cavity of 8-week-old Sprague Dawley (SD) rats. After 3 and 6 weeks of nasal obstruction, rats were sacrificed, the organs were weighed, and the changes in mandibular bone quality were examined by micro-computed tomography (μ-CT). The stereomicroscope was used for the morphological analysis of alveolar bone loss in response to nasal obstruction. Hematoxylin and Eosin (H&E) and immunohistochemical staining were employed to examine inflammation and bone remodeling induced by hypoxia.

Results

Nasal obstruction led to a delay in overall growth and organ development. The bone mineral density (BMD) and bone volume/total volume (BV/TV) of the mandible were reduced due to nasal obstruction, and the loss of the alveolar bone was confirmed morphologically. Our nasal obstruction method was observed to be successful in inducing hypoxia along with an increase in hypoxia-inducible factor 1-alpha (HIF-α). Oral hypoxia induced by nasal obstruction increased inflammatory response, and increased expression of receptor activator of nuclear factor kappa-Β ligand (RANKL) led to bone destruction.

Conclusion

This study demonstrated that nasal obstruction induced mouth breathing led to hypoxia in a rat model. Under hypoxic conditions, an increase in osteoclast differentiation induced by activation of the inflammatory pathway causes destructive changes in the alveolar bone.

Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Children with Mouth Breathing

Aims and objectives

Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing.

Materials and methods

A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of <0.05 was considered significant.

Results

Out of 100 children, 70 were males and 30 were females. On the CSHQ scale, the highest score was found on sleep-disordered breathing followed by sleep onset delay and daytime sleepiness. The commonest symptom of inattention was “failing to give close attention in school” (73%) whereas the commonest symptom of hyperactivity was “trouble waiting for his/her turn” (66%). Seven participants satisfied complete criteria for ADHD. Sleep duration and daytime sleepiness had a significant negative correlation with hyperactivity (p < 0.05). A positive correlation was observed between daytime sleepiness and inattention (p < 0.01).

Conclusion

Children with sleep disturbances or ADHD should be assessed for the presence of mouth breathing, as early identification and correction of mouth breathing may help to prevent unnecessary exposure to the medication.

Clinical significance

Children with ADHD or sleep disturbances should always be assessed for the presence of mouth breathing. Early identification and correction of mouth breathing may help in preventing unnecessary exposure to medication for treating ADHD.

How to cite this article

Kalaskar R, Bhaje P, Kalaskar A, et al. Sleep Difficulties and Symptoms of Attention-deficit Hyperactivity Disorder in Mouth Breathing. Int J Clin Pediatr Dent 2021;14(5):604–609.

[Symptoms, causes, and treatment options of geriatric nose]

With increasing age, structures of the internal and external nose change. Many elderly patients complain about rhinitis with nasal obstruction, endonasal crusting, epistaxis, intermittent rhinorrhea, and olfactory disorders. These symptoms are mainly caused by atrophy of the mucosa and the olfactory epithelium, but may also be an expression of drug side effects. Additionally, there are changes in the shape of the nose (continuous growth, altered elasticity of supporting structures) and in the dermis, which may develop tumors due to its sun-exposed position. These multiple internal and external changes of the nose can be summarized by the collective term "aging nose," whose treatment options are complex. These range from conservative (nasal care, medication changes, hemostatic measures) to surgical lines of therapy (septorhinoplasty, tumor excision, vascular ligation) and will require further scientific study in the future.

Evaluation of the Average Nasal and Nasopharyngeal Volume in 10-13-year-old Children: A Preliminary CBCT Study

Aim and objective

Mouth breathing is one of the most common deleterious habits prevalent in children which leads to various skeletal and dental malocclusions. Due to the close relationship between nasal and nasopharyngeal cavity volume and maxilla, transverse maxillary deficiency causes reduced nasal and nasopharyngeal cavity volume leading to mouth breathing. Therefore, knowledge of average nasal and nasopharyngeal cavity volume is essential to accurately diagnose mouth breathing and to evaluate underlying causative factors.

Materials and methods

Cone-beam computed tomographic scans of 60 children were taken and nasal cavity and nasopharyngeal volumes were calculated using Planmeca Romexis 5.2.0.R software. Average volumes were computed using predetermined landmarks and compared among gender.

Results

The nasal cavity and nasopharyngeal volume showed significant differences among the gender (p value < 0.001 and 0.018, respectively).

Conclusion and clinical significance

Knowledge of the average nasal and nasopharyngeal cavity volumes can be a useful diagnostic aid for mouth breathing patients and also assess the causative factors and treatment outcomes in these patients.

How to cite this article

Kalaskar R, Balasubramanian S, Kalaskar A. Evaluation of the Average Nasal and Nasopharyngeal Volume in 10–13-year-old Children: A Preliminary CBCT Study. Int J Clin Pediatr Dent 2021;14(2):187–191.

Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis

Background

Mouth breathing is closely related to the facial skeletal development and malocclusion. The purpose of this systematic review and meta-analysis was to assess the effect of mouth breathing on facial skeletal development and malocclusion in children.

Methods

An electronic search in PubMed, the Cochrane Library, Medline, Web of Science, EMBASE and Sigle through February 23rd, 2020, was conducted. Inclusion criteria were children under 18 years of age with maxillofacial deformities due to mouth breathing. The risk of bias in nonrandomized studies of interventions (ROBINS-I) tool for controlled clinical trials. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used for the quality assessment. The included indicators were SNA, SNB, ANB, SN-OP, SN-PP, PP-MP, SNGoGn, MP-H, 1-NA, 1. NA, 1. NB, 1-NB, Overjet, Overbite, SPAS, PAS, and C3-H. Data concerning the mean difference in mesial molar movement and extent of canine retraction were extracted for statistical analysis. The mean differences and 95% confidence intervals were analyzed for continuous data. Review Manager 5.3, was used to synthesize various parameters associated with the impact of mouth breathing on facial skeletal development and malocclusion.

Results

Following full-text evaluations for eligibility, 10 studies were included in the final quantitative synthesis. In Sagittal direction, SNA (MD: − 1.63, P < 0.0001), SNB (MD: − 1.96, P < 0.0001) in mouth-breathing children was lower than that in nasal-breathing children. ANB (MD: 0.90, P < 0.0001), 1. NA (MD: 1.96, P = 0.009), 1-NA (MD: 0.66, P = 0.004), and 1-NB (MD: 1.03, P < 0.0001) showed higher values in children with mouth breathing. In vertical direction, SN-PP (MD: 0.68, P = 0.0050), SN-OP (MD: 3.05, P < 0.0001), PP-MP (MD: 4.92, P < 0.0001) and SNGoGn (MD: 4.10, P < 0.0001) were higher in mouth-breathing individuals. In airway, SPAS (MD: − 3.48, P = 0.0009), PAS (MD: − 2.11, P < 0.0001), and C3-H (MD: − 1.34, P < 0.0001) were lower in mouth breathing group.

Conclusions

The results showed that the mandible and maxilla rotated backward and downward, and the occlusal plane was steep. In addition, mouth breathing presented a tendency of labial inclination of the upper anterior teeth. Airway stenosis was common in mouth-breathing children.

Trial registration crd-register@york.ac.uk, registration number CRD42019129198.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01458-7.

Do breastfed children have a lower chance of developing mouth breathing? A systematic review and meta-analysis

OBJECTIVE

Determine the association between breastfeeding and the development of mouth breathing in children.

MATERIALS AND METHODS

Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding.

RESULTS

The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18).

CONCLUSIONS

Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern.

CLINICAL RELEVANCE

The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding.

TRIAL REGISTRATION

PROSPERO registry: CRD42017062172.

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.

Influence of mouth breathing on atopic dermatitis risk and oral health in children: A population-based cross-sectional study

Background/purpose

Previous studies have suggested that mouth breathing has harmful effects on atopic dermatitis (AD) and oral health in children, but the evidence has been insufficient. To investigate the association of mouth breathing with AD and oral health in Korean schoolchildren aged 8–11 years.

Materials and methods

Cross-sectional data were obtained from March to April 2016. A questionnaire was used to investigate children's mouth breathing habits and personal/family histories related to allergic disease. Oral health status was determined through a clinical oral examination. Data were analyzed with multivariable logistic regression.

Results

In total, 1507 children were included. A moderate relationship was observed between mouth breathing and AD (adjusted odds ratio, 1.05; 95% confidence interval, 1.00–1.10; p-value, 0.035), whereas no association was found between mouth breathing and dental caries in children. Mouth breathing during sleep (MBS) was closely related to allergic diseases and other respiratory diseases. Furthermore, mouth breathing was associated with child's tonsillitis and was identified as a possible risk factor for class II dental malocclusion.

Conclusion

We confirmed the positive association between mouth breathing (especially during sleep) and allergic diseases, including the AD in school-aged children. The influence of mouth breathing on dental caries remains uncertain. An intervention trial is required to evaluate whether the prevention of mouth breathing can reduce the risk of allergic diseases.

Association Between Mouth Breathing and Asthma: a Systematic Review and Meta-analysis

PURPOSE OF REVIEW

This systematic review and meta-analysis evaluated the association between asthma and mouth breathing. We performed a systematic search in the PubMed, SCOPUS, Lilacs, Web of Science, Google Scholar and OpenThesis databases.

RECENT FINDINGS

Asthma is defined as a heterogeneous disease characterized by variable symptoms of wheezing, shortness of breath, chest oppression and/or cough, and limitation of expiratory airflow. Although several studies have examined the association between asthma and mouth breathing, there are no systematic reviews or meta-analyses that synthesize the available bodies of evidence. We used the odds ratio as a measure of the association between asthma and mouth breathing. Summary estimates were calculated using random-effects models, and the risk of bias was estimated using the Newcastle-Ottawa Scale for case-control studies and the National Institutes of Health tool for cross-sectional studies. Nine studies were included in the present systematic review. Data from 12,147 subjects were analyzed, of which 2083 were children and adolescents and 10,064 were adults. We found an association between mouth breathing and asthma in children and adolescents (OR 2.46, 95% CI 1.78-3.39) and in adults (OR 4.60, 95% CI 1.49-14.20). However, limitations were found in the methodological description of the included studies, as well as high heterogeneity among studies evaluating adult populations. This meta-analysis showed an association between mouth breathing and asthma in children, adolescents and adults, but the results should be interpreted with caution. Further studies with standardized criteria for the investigation of mouth breathing are needed.

Effect of mouth closure on upper airway obstruction in patients with obstructive sleep apnoea exhibiting mouth breathing: a drug-induced sleep endoscopy study

PURPOSE

Snoring and obstructive sleep apnoea (OSA) exhibit multifactorial aetiologies; mouth breathing increases airway obstruction and upper respiratory tract resistance. Of the many published studies, few have evaluated sleeping subjects. We explored how mouth breathing affected the upper respiratory tract anatomy and OSA during sleep.

METHODS

Eighteen patients with OSA, confirmed via full-night polysomnography, were enrolled in this study. We performed drug-induced sleep endoscopy (DISE) and defined obstruction sites before and after mouth closure using commercial mouth strips. We evaluated obstruction sites in two ways, i.e. by grading obstructions using our DISE grading system and measuring the affected areas. Patients who improved by at least one DISE grade were defined as responders. Areas were measured based on DISE videos analysed using ImageJ software. The apnoea-hypopnoea index (AHI) and body mass index (BMI) were recorded.

RESULTS

Based on the DISE grade, 40% (7/18) of patients showed obstruction site improvement. When assessed areally, the mean number of pixels improved significantly at both the retropalatal (p = 0.045) and retrolingual (p = 0.019) levels. However, DISE non-responders exhibited no areal improvements. Responders and non-responders did not differ significantly in terms of AHI or BMI (both p < 0.05).

CONCLUSIONS

Mouth closure improves or at least does not lead to further deterioration of the upper airway. Improvements were evident at the retropalatal and especially retrolingual levels. Neither the BMI nor the AHI differed between the two groups. However, responders tended to have a higher AHI than non-responders (39.4 vs. 32.8 events/h).

EEG signals during mouth breathing in a working memory task

Background: Continuous mouth breathing results not only morphological deformations but also poor learning outcomes. However, there were few studies that observed correlations between mouth breathing and cognition. This study aimed at investigating the changes in brain activity during mouth breathing while the participant simultaneously performed a cognitive task using electroencephalography (EEG).Methods: Twenty subjects participated in this study, and EEG electrodes (32 channels, 250-Hz sampling rate) were placed on their scalp. Brain waves during a resting state and n-back tasks (0-back and 2-back) and physiological parameters such as SpO2, ETCO2, and the airway respiratory rate were measured. The pre-processed EEG signals were analyzed based on their frequencies as delta waves (0.5 ∼ 4 Hz), theta waves (4 ∼ 8 Hz), alpha waves (8 ∼ 13 Hz), beta waves (13 ∼ 30 Hz) and gamma waves (30 ∼ 50 Hz) using fast Fourier transform (FFT).Results: When compared with nose breathing, theta and alpha powers were lower during mouth breathing at rest and alpha wave presented low power at 0-back and 2-back tasks. Furthermore, beta and gamma waves exhibited low powers at 2-back task. However, the behavioral results (accuracy and response time) have no significant difference between two breathing methods (mouth and nose). Mouth breathing showed different brain activity patterns, compared to nose breathing, and these changes are related to cognitive regions.Conclusion: The reason for this change seems to relate to the decreased oxygen saturation during mouth breathing, suggesting that when cognitive abilities are required, mouth breathing can act as one of the variables that cause different outcomes in brain activities.

Impact of adenotonsilectomy on nasal airflow and pulmonary blood pressure in mouth breathing children

INTRODUCTION

Adenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP.

METHODS

This is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF.

RESULTS

The mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm³/s (±112.21, p = 0.01); and 498.93 cm³/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm³/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = -0.459; p = 0.01) when we analyzed all the groups.

CONCLUSION

PASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.

Are pediatricians and otolaryngologists well prepared to identify early signs of vertical facial growth?

BACKGROUND

The prevalence of vertical facial growth is very high in the developed world. Most authors agree that mouth breathing is its main cause. Even though care is mainly conducted by odontologists, the professionals who first see these patients are pediatricians and otolaryngologists. The objective of this study is to analyze the ability of pediatricians and otolaryngologists to identify early signs of vertical facial growth among children.

METHODS

60 participant aged 4.1-13.7 years were analyzed subjectively by 9 otolaryngologists, 9 pediatricians and two specialists in dentofacial orthopedics. They were also assessed objectively with cephalometric analysis.

RESULTS

Otolaryngologists showed 34.78% sensitivity, 92.86% specificity and 48.33% efficiency. Pediatricians showed 13.04% sensitivity, 100% specificity and 33.33% efficiency. Using a linear regression model compared against the objective measurements we found a weak positive correlation both for otolaryngologists and pediatricians.

CONCLUSION

The sensitivity was very low for both groups. We believe it is of paramount importance to increase the awareness and the ability of otolaryngologists and pediatricians to recognize signs of disrupt facial growth.

Unilateral nasal obstruction alters sweet taste preference and sweet taste receptors in rat circumvallate papillae

Nasal obstruction causes mouth breathing, and affects the growth and development of craniofacial structures, muscle function in the stomatognathic system, and the taste perceptive system. However, the detailed mechanism underlying the effects of nasal obstruction on taste perception has not been fully elucidated. In this study, we investigated this mechanism using the two-bottle taste preference test, immunohistological analysis, and quantification of the mRNA expression of taste-related molecules in the circumvallate papillae. Neonatal male Wistar rats were divided randomly into control and experimental groups. Rats in the experimental group underwent unilateral nasal obstruction by cauterization of the external nostril at the age of 8 days. Arterial oxygen saturation (SpO₂) was recorded in awake rats using collar clip sensors. Taste preference for five basic taste solutions was evaluated. Immunohistochemical analysis and quantitative real-time polymerase chain reaction (RT-PCR) were conducted to evaluate the expressions of taste-related molecules in the taste cells of the circumvallate papillae. Body weights were similar between the two groups throughout the experimental period. The SpO₂ in the 7- to 12-week-old rats in the experimental group was significantly lower than that in the age-matched rats in the control group. In the two-bottle taste preference test, the sensitivities to sweet taste decreased in the experimental group. The mRNA expression of T1R2, T1R3, α-gustducin, and PLCβ2 was significantly lower in the experimental group than in the control group as determined by quantitative RT-PCR, and the immunohistochemical staining for α-gustducin and PLCβ2 was less prominent. These findings suggest that nasal obstruction may affect sweet taste perception via the reduced expression of taste-related molecules in the taste cells in rat circumvallate papillae.

Proposal for a screening questionnaire for detecting habitual mouth breathing, based on a mouth-breathing habit score

Background

When mouth breathing becomes habitual, it can cause sleep disorders and abnormal maxillofacial growth, thus early detection of habitual mouth breathing is important. We created a questionnaire for early detection of habitual mouth breathing using a score based on a spectrum of factors found to be characteristic of mouth breathers.

Methods

First, a draft 50-question questionnaire was given to 101 random dental clinic patients, classified by dental professionals into habitual mouth breathers (n = 28) and nose breathers (n = 73). The 10 questions that significantly differentiated mouth and nose breathers (p < 0.05) were identified from this questionnaire. These questions, regarding nasal obstruction, open mouth at rest, awareness of mouth breathing, gum swelling and dental staining of the front teeth, bad breath, maxillary protrusion, nasal obstruction in childhood, bottle-feeding, and history of asthma, formed the basis for a second questionnaire. This second survey was completed by another 242 participants, separately classified into mouth breathing (n = 26), suspected mouth breathing (n = 40), and nose breathing groups (n = 176).

Results

Receiver operating characteristic curve analysis of the resulting mouth breathing habit scores, representing the responses to the 10-question survey, showed moderate checklist diagnosability. Sensitivity of cut-off values was 61.5% (specificity 92.0%) for the mouth-breathing group, and 77.5% (specificity 56.3%) for the suspected mouth-breathing group.

Information was also obtained from visual assessment of maxillofacial characteristics. We found that the mouth-breathing and suspected mouth-breathing groups showed significantly high odds ratios for 7 items: discomfort while breathing and increased chin muscle tonus with lip closure, maxillary protrusion, tongue thrust, open mouth at rest, open bite, and childhood asthma. For 94.6% of the nose breathing group, ≥1 of these items applied.

Conclusions

These findings were then used together to create a sample screening form. We believe that screening of this kind can facilitate more accurate diagnosis of habitual mouth breathing and contribute to its early detection.

Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children

OBJECTIVES

The aim of the study was to investigate the prevalence of upper respiratory tract infections (URI) - as indicated by rhinosinusitis (RS), ear infections (EI), and antibiotic consumption - in a general pediatric population and evaluate the relationship between these conditions and habitual snoring and mouth breathing during sleep.

METHODS

A population-based cross-sectional study was performed in three medium-sized Polish cities from 2011 to 2015.

RESULTS

4837/6963 questionnaires (69.5%) were completed, returned and analyzed. Mean age of studied group was 7.07 ± 0.72 and 7.14 ± 0.73 in girls and boys, respectively. Habitual mouth breathing during sleep (MB) was reported in 907 (18.7%) children and habitual snoring (HS) in 290 (6.0%). 230/290 (79.3%) of children with HS were also MB. Both HS and MB were more prevalent in boys than in girls (p = 0.027 and p < 0.0001, respectively) and neither was associated with BMI (p = 0.11 and p = 0.07, respectively). Habitual snoring and habitual mouth breathing were highly associated with more frequent bouts of rhinosinusitis, ear infections, and antibiotic use (p < 0.0001 for each parameter).

CONCLUSIONS

Higher rates of rhinosinusitis, ear infections, and antibiotic consumption were similarly associated with HS and MB. MB is over three times more prevalent in the pediatric population relative to HS, therefore it might be considered as a risk factor for URI and may be included in history of URI.

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction?

Introduction

Imaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing.

Objective

The objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children.

Methods

This retrospective study included 25 mouth-breathing children aged 5–9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements.

Results

The intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p < 0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p < 0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction.

Conclusions

(1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.

Nasal patency and otorhinolaryngologic-orofacial features in children

INTRODUCTION

Nasal obstruction is a common symptom in childhood, related to rhinitis and pharyngeal tonsil hypertrophy. In the presence of nasal obstruction, nasal patency may be reduced, and nasal breathing is replaced by mouth breathing. Orofacial and otorhinolaryngologic changes are related to this breathing mode. Objective evaluation of upper airways may be obtained through nasal patency measurement.

OBJECTIVE

To compare nasal patency and otorhinolaryngologic-orofacial features in children.

METHODS

One hundred and twenty three children, 6-12 year-old, and of both sexes underwent speech therapy evaluation, according to Orofacial Myofunctional Evaluation protocol, clinical and endoscopic otorhinolaryngologic examination and nasal patency measurement, using the absolute and predicted (%) peak nasal inspiratory flow values.

RESULTS

Lower values of absolute and estimated peak nasal inspiratory flow values were found in children with restless sleep (p=0.006 and p=0.002), nasal obstruction report (p=0.027 and p=0.023), runny nose (p=0.004 and p=0.012), unsystematic lip closure during mastication (p=0.040 and p=0.026), masticatory speed reduced (p=0.006 and p=0.008) and altered solid food swallowing (p=0.006 and p=0.001). Absolute peak nasal inspiratory flow was lower in children with pale inferior turbinate (p=0.040), reduced hard palate width (p=0.037) and altered speech (p=0.004). Higher absolute values were found in children with increased tongue width (p=0.027) and, higher absolute and predicted (%) in children with mild everted lip (p=0.008 and p=0.000).

CONCLUSIONS

Nasal patency was lower in children with restless sleep, rhinitis signs and symptoms, hard palate width reduced and with changes in mastication, deglutition and speech functions. It is also emphasized that most of the children presented signs and symptom of allergic rhinitis.

Radiofrequency volumetric inferior turbinate reduction: long-term clinical results

The aim of our study was to assess long-term results of radiofrequency volumetric tissue reduction of inferior turbinates (RVTR). We performed a prospective long-term longitudinal evaluation of 305 patients affected by rhinitis (114 allergic and 191 non-allergic) who were unresponsive to medical treatment and underwent RVTR (January 2004 - December 2010). Subjects were followed for a mean period of 39.70 ± 19.41 months (range 24-60). Patients completed the NOSE-scale questionnaire pre- and post-operatively after 1 month and yearly for 5-years. Recurrence was assumed if the post-operative total NOSE score increased by at least 75% during follow-up and the patient restarted medical treatments. Estimation of relapse over time was performed by Kaplan-Meyer analyses. We documented overall good satisfaction of patients regarding the procedure, with a good rate of pain control and a low rate of complications. Post-operatively there was a significant improvement in nasal stuffiness, nasal obstruction and mouth breathing (p < 0.05). We observed a worsening trend for symptoms after 36 months with progressive increasing rate of recurrences that were significantly higher in allergic than non-allergic patients (p < 0.05). We also observed a slight worsening trend of global satisfaction of patients. Our study confirms the minor discomfort and low risk of side effects of RVTR. Our data showed good efficacy of the procedure in the majority of patients for at least 36 months after surgery, and in fact in this time period the cumulative probability to remain relapse-free was up to 0.8. In the following 2 years, we observed a worse temporal trend in term of recurrence rate, and in particular in allergic patients with a significant difference vs non-allergic individuals (p < 0.05).

Association between oral habits, mouth breathing and malocclusion

The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth. While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion. Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion. The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions. Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite. Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points. Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.

The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis

Background

Deformity in the dental arc and facial skeleton by adenoid hypertrophy due to chronic mouth breathing is a well-known process. Most of the related studies have been based on cephalometric analyses. The aim of this study is to detect the presence of skeletal deformities on the soft tissue by analyzing distances and angles on photographs.

Methods

Ninety-seven children having between 25 and 100 % of adenoids, ages 4–12 years (48 boys, 49 girls), and 90 cases having 0–25 % adenoid tissue, ages 4–12 years (54 boys, 36 girls), were studied by clinical history, physical examination (including endoscopy), and standardized clinical photographs. The children and parents were asked if any of the following were present in the children: snoring, sleep apnea, daytime sleepiness, poor school performance, mouth breathing during sleep, smoking parents, and restlessness during sleep.

Results

The assessment of linear and angular measurements on the clinical photographs showed, in the group having thicker adenoids compared with controls, a statistically significant increase in the distance between nasion and tip and nasion and subnasale and in the angle between Frankfort horizontal plane-gnathion-angulus mandible; there was also a statistically significant decrease in the distance between endocanthion and exocanthion and the angles between tragion-angulus mandible and gnathion and between nasion-angulus mandible and gnathion.

Conclusions

The analyses showed a significant increase in the anterior face height and increase in the angle between Frankfort horizontal plane-gnathion-angulus mandible and a retropositioned and posterior-rotated mandible due to thicker adenoids.

Trial registration

2010/140 Date: 04 January 2010.

The effect of mouth breathing on exercise induced fall in lung function in children with allergic asthma and rhinitis

OBJECTIVES

Exercise induced bronchospasm (EIB) represents a common feature of childhood asthma which is most commonly revealed during free running. On the other hand aerobic exercise shows significant beneficial effects in asthmatics especially on the reduction of the level of systemic inflammation and is recommended as part of its treatment. The aim of this study was to test how mandatory mouth breathing influences the exercise induced level of decrease in lung function according to the level of severity of allergic rhinitis (AR).

METHODS

Free 6-minute running test preceded and followed by spirometry done with and without a nose clip a day apart was conducted in 55 children with moderate persistent asthma and AR. Children were divided into two groups according to the severity of nasal symptoms.

RESULTS

There was a greater fall in forced expiratory volume in one second after exercise with a nose clip in children with less nasal symptoms than in children with more nasal symptoms (mean ± SD; -5.28 (7.91) vs. -0.08 (4.58), p = 0.0228) compared to testing without the nose clip (mean ± SD; LNS, -1.31 ± 3.89%, p = 0.2408; MNS, -1.47 ± 3.68%, p = 0.2883).

CONCLUSION

Our results show that regular mouth breathing due to nasal congestion may lessen the degree of EIB in patients with persistent AR and allergic asthma.

Maxillary dentoskeletal changes 1-year after adenotonsillectomy

OBJECTIVE

To measure the maxillary dentoskeletal and soft tissue changes of severely obstructed mouth breathing (MB) young children who had their mode of breathing normalized after adenotonsillectomy (T&A), in comparison with a matched group of severely obstructed untreated MB children (CG).

METHODS

Seventy patients who had an Ear, Nose, and Throat examination (ENT), including flexible nasal endoscopy, to confirm the severe obstruction of the upper airways and the indication of T&A composed the sample. Cephalograms and dental casts were available from the patient's orthodontic records. Treatment group (TG) and CG included 35 children each. Groups were matched by gender (24 males and 11 females in each group), age (TG, 6.7 ± 1.8 years; CG, 6.9 ± 2.3 years), tooth development (TG, 13 primary dentition, 22 mixed dentition; CG, 14 primary dentition, 21 mixed dentition), and skeletal maturation status. Records were taken at baseline (T0) and 1-year after T&A (T1) for TG; while CG records were taken with a 1-year interval. Dentoskeletal measurements were performed in the lateral cephalograms, and dental casts were used to assess the palatal volume and occlusal changes.

RESULTS

TG showed a significant increase (503.3 mm(3), P < 0.001) in the palatal volume (10% of change), while CG palatal volume was stable. No dimensional occlusal changes were detected between T0 and T1 in both groups. Significant downward (point A, 2.1 mm; ANS, 2.1 mm) and forward displacements (point A, 0.7 mm; ANS, 1 mm) of the anterior region of the maxilla were observed in the TG, but CG presented only significant downward displacement (point A, 1.8 mm; ANS, 1.4 mm). The maxillary posterior region (PNS, PTM, and Molar) displaced downward in both groups (P < 0.05), however no sagittal change was found. The palatal plane inclination was stable in both groups.

CONCLUSIONS

TG presented significant increase in the palatal volume and in the forward displacement of the maxilla. No other significant maxillary dentoskeletal changes were found.

Impact of genioplasty during puberty on the upper airways

AIM

Mouth breathing is a functional disorder that affects craniofacial and dento-alveolar growth and also upper airway (UA) anatomy. This is apparent mainly in dimensional abnormalities of the UA caused by hypertrophy of Waldeyer's ring and excessive vertical development of the lower part, giving rise to labial incompetence that perpetuates the functional disorder. The main aim of this study was to evaluate the development of the oropharyngeal structures in young hyperdivergent patients who had undergone functional genioplasty in the context of orthodontic treatment.

METHODS

This is a comparative retrospective study performed on 47 adolescents who were hyperdivergent, non-obese and exclusive or diurnal mouth breathers, treated at the Centre de soins, d'enseignement et de recherche dentaires (CSERD) in Montpellier, France. All were candidates for early genioplasty for vertical reduction, and were undergoing or at the end of treatment: 23 had been treated surgically (functional genioplasty), and 24 controls had received orthodontic treatment alone. Inter-group comparison of the changes in cephalometric measurements of the oro- and nasopharyngeal zones and maxillomandibular measurements was performed using covariance analysis (ANCOVA) to adjust for confounding factors.

RESULTS

Concerning the skeletal structures: in the sagittal dimension, genioplasty led to significantly greater projection of the symphysis in the surgical group than in the control group (P<0.001). However, the sagittal position of the hyoid bone was unchanged. Similarly, in the vertical dimension, the reduction in divergence of the bony base was significantly greater in the surgical group (P<0.001), but with no change in the vertical position of the hyoid bone. Concerning the upper airways: at the level of the nasopharynx, there was a significantly greater increase in the velopharyngeal space in the surgical group (P<0.033). The same observation can be made on the level of the oropharynx, where there was a significant increase in the linguopharyngeal space in the surgical group (P<0.05), which was not the case in the control group. The change in the depth of the pharynx did not differ significantly between the two groups.

CONCLUSION

Early genioplasty performed on adolescents during the growth phase helps to recalibrate the UA by encouraging spontaneous lip closure.

Montelukast in Adenoid Hypertrophy: Its Effect on Size and Symptoms

INTRODUCTION

Adenotonsillar hypertrophy (AH) is considered the most common cause of upper respiratory tract obstruction among children. It results in a spectrum of symptoms from mouth breathing, nasal obstruction, hyponasal speech, snoring, and obstructive sleep apnea (OSA) to growth failure and cardiovascular morbidity. Adenotonsillectomy is a typical strategy for patients with AH, but may lead to serious complications such as bleeding (4-5%) and postoperative respiratory compromise (27%), especially among young children, as well as recurrence of adenoid tissue (10-20%). Thus, non-surgical therapies have attracted considerable attention as an alternative strategy. The inflammatory mechanism proposed for AH has lead to the use of anti-inflammatory drugs to manage this condition. The present study aimed to evaluate the effect of chewable tablets of montelukast, a cysteinyl- leukotriene receptor antagonist, in children with AH.

MATERIALS AND METHODS

Sixty children between the ages of 4-12 years with >75% choanal obstruction on primary nasal endoscopy were recruited in this randomized, placebo-controlled trial and randomly divided into two groups. The study group was treated with montelukast 5 mg daily for 12 weeks while the control group received matching placebo for the same period of time. A questionnaire was completed by each child's parent/guardian to assess the severity of sleep discomfort, snoring, and mouth breathing before and after the intervention.

RESULTS

Adenoid size decreased in 76% of the study group compared with 3% of the placebo group after 12 weeks. A statically significant improvement was observed in the study group compared with the placebo group in terms of sleep discomfort, snoring, and mouth breathing. The symptoms average total score dropped from 7.7 to 3.3 in the study group, while in the placebo group the total score changed from 7.4 to 6.7.

CONCLUSION

Montelukast chewable tablets achieved a significant reduction in adenoid size and improved the related clinical symptoms of AH and can therefore be considered an effective alternative to surgical treatment in children with adenoid hypertrophy.

The effect of mouth breathing on chewing efficiency

OBJECTIVE

To examine the effect of mouth breathing on chewing efficiency by evaluating masticatory variables.

MATERIALS AND METHODS

Ten adult nasal breathers with normal occlusion and no temporomandibular dysfunction were selected. Subjects were instructed to bite the chewing gum on the habitual side. While breathing through the mouth and nose, the glucide elution from the chewing gum, number of chewing strokes, duration of chewing, and electromyography (EMG) activity of the masseter muscle were evaluated as variables of masticatory efficiency.

RESULTS

The durations required for the chewing of 30, 60, 90, 120, 180, and 250 strokes were significantly (P < .05) longer while breathing through the mouth. There was no significant difference in the glucide elution rate (%) for each chewing stroke between nose and mouth breathings. The glucide elution rates for 1- and 3-minute chewing were significantly (P < .05) lower while breathing through the mouth. However, there was no significant difference in the glucide elution rate for 5-minute chewing between nose and mouth breathings. While chewing for 1, 3, and 5 minutes, the chewing stroke and EMG activity of the masseter muscle were significantly (P < .05) lower during mouth breathing.

CONCLUSIONS

It takes a longer amount of time to complete chewing to obtain higher masticatory efficiency when breathing through the mouth. Therefore, mouth breathing will decrease the masticatory efficiency if the duration of chewing is restricted in everyday life.

Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing

BACKGROUND

Adenotonsillectomy (T&A) may not completely eliminate sleep-disordered breathing (SDB), and residual SDB can result in progressive worsening of abnormal breathing during sleep. Persistence of mouth breathing post-T&As plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth.

METHODS

Retrospective study on non-overweight and non-syndromic prepubertal children with SDB treated by T&A with pre- and post-surgery clinical and polysomnographic (PSG) evaluations including systematic monitoring of mouth breathing (initial cohort). All children with mouth breathing were then referred for myofunctional treatment (MFT), with clinical follow-up 6 months later and PSG 1 year post-surgery. Only a limited subgroup followed the recommendations to undergo MFT with subsequent PSG (follow-up subgroup).

RESULTS

Sixty-four prepubertal children meeting inclusion criteria for the initial cohort were investigated. There was significant symptomatic improvement in all children post-T&A, but 26 children had residual SDB with an AHI > 1.5 events/hour and 35 children (including the previous 26) had evidence of "mouth breathing" during sleep as defined [minimum of 44 % and a maximum of 100 % of total sleep time, mean 69 ± 11 % "mouth breather" subgroup and mean 4 ± 3.9 %, range 0 and 10.3 % "non-mouth breathers"]. Eighteen children (follow-up cohort), all in the "mouth breathing" group, were investigated at 1 year follow-up with only nine having undergone 6 months of MFT. The non- MFT subjects were significantly worse than the MFT-treated cohort. MFT led to normalization of clinical and PSG findings.

CONCLUSION

Assessment of mouth breathing during sleep should be systematically performed post-T&A and the persistence of mouth breathing should be treated with MFT.

Muscular and functional changes following adenotonsillectomy in children

BACKGROUND

It is recognized that adenotonsillar hypertrophy leads to muscular and functional changes in face, and that adenotonsillectomy is associated to improvement in this condition. However, the ideal interval one should wait until this spontaneous recovery is not well defined, neither if this recovery is expected to be complete or partial.

OBJECTIVE

To compare the muscular and functional changes in face of children prior and after adenotonsillectomy in a monthly evaluation.

METHODS

8 children aged from 4 to 6 years were prospectively studied. All patients underwent adenotonsillectomy, and were assessed before and monthly-after surgery up to 6 months, through the Protocol of Orofacial Myofunctional Evaluation with Scores (OMES).

RESULTS

There was a progressive improvement in OMES score in all measured parameters, including the "mobility" and "posture" sub-tests; this improvement was significant at the first month after surgery. The sub-test "function" was not affected by surgery. Improvement continued from the first to the sixth month after surgery, although it was not significant between these two periods. Additionally, all parameters remained altered after the final evaluation at six months. There was a significant correlation between the improvement in "mobility" sub-test and in total score of OMES.

CONCLUSION

We observed a partial recovery in facial muscular and functional changes following adenotonsillectomy, particularly during the first month after surgery. This improvement was especially observed in the "mobility" and "posture" sub-tests. We conclude that waiting for a spontaneous muscular and functional facial recovery during the first month post-operatively seems reasonable. Nevertheless, after this period, if the patient fails to achieve recovery, it may be advised that this child should undergo myofunctional therapy.

Radiographic adenoid evaluation: proposal of an objective parameter

Objective

The objective of the present study was to evaluate current radiographic parameters designed to investigate adenoid hypertrophy and nasopharyngeal obstruction, and to present an alternative radiographic assessment method.

Materials and Methods

In order to do so, children (4 to14 years old) who presented with nasal obstruction or oral breathing complaints were submitted to cavum radiographic examination. One hundred and twenty records were evaluated according to quantitative radiographic parameters, and data were correlated with a gold-standard videonasopharyngoscopic study, in relation to the percentage of choanal obstruction. Subsequently, a regression analysis was performed in order to create an original model so the percentage of the choanal obstruction could be predicted.

Results

The quantitative parameters demonstrated moderate, if not weak correlation with the real percentage of choanal obstruction. The regression model (110.119*A/N) demonstrated a satisfactory ability to "predict" the actual percentage of choanal obstruction.

Conclusion

Since current adenoid quantitative radiographic parameters present limitations, the model presented by the present study might be considered as an alternative assessment method in cases where videonasopharyngoscopic evaluation is unavailable.

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

BACKGROUND

Nasorespiratory function and its relation to craniofacial growth are of great interest because of the basic biological relationship between form and function, and the accumulating findings of the relationship between mode of breathing, craniofacial growth and orthodontic treatment.

OBJECTIVES

The aim of this study was to evaluate the effect of adenoid hypertrophy and sociodemographic variables on the occlusion of children.

METHODOLOGY

A total of 180 subjects aged 3-12 years were selected at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Ninety subjects had hypertrophied adenoids while 90 normal children served as the control group. Orthodontic examinations were carried out and impressions for study models taken. Occlusion was assessed in the anterior-posterior, transverse and vertical planes.

RESULTS

Class I relationship was the most prevalent occlusion in both adenoid and control subjects (55.6% and 72.2%, respectively). The occurrence of class II division 1 was significantly higher among adenoid than control subjects (P=0.003). Posterior crossbites occurred significantly more in adenoid subjects in the 9-12 years category. In the vertical plane, the occurrence of deep bite was significantly greater in male than female adenoid subjects. Age had a statistically significant but weak correlation with anterior open bite (r=0.37). Age and BMI also had significant though weak correlations with posterior crossbite in female adenoid subjects (r=0.39 and r=0.36, respectively). Regression analysis also showed that age had a significant effect on the occurrence of anterior open bite, while BMI had a significant effect on the occurrence of class II occlusion in adenoid subjects (P<0.05).

CONCLUSION

The presence of hypertrophied adenoids affects the occlusion in the three planes. Age and BMI have significant effects on the occurrence of anterior open bite and class II division 1 malocclusion respectively in adenoid subjects.

Are distinct etiologies of upper airway obstruction in mouth-breathing children associated with different cephalometric patterns?

OBJECTIVE

To test the null hypothesis that mouth-breathing (MB) children by distinct obstructive tissues present a similar cephalometric pattern.

METHODS

The sample included 226 prepubescent children (113 MB and 113 nasal breathing (NB) controls). An ENT clinical examination, including flexible nasal endoscopy, orthodontic clinical and cephalometric examinations, was performed on the MB population. MB children were grouped into three categories, according to the obstructive tissues: 1) adenoid group (AG), 2) tonsillar group (TG), and 3) adenotonsillar group (ATG). The NB controls were matched by gender, age, sagittal dental relationship and skeletal maturation status. Lateral cephalometric radiography provided the cephalometric pattern comparisons between the MB and NB groups.

RESULTS

MB cephalometric measurements were significantly different from those of NB children, exception in the SNB° (P=0.056). All comparisons between the three groups of MB children with the NB children showed a significant difference. Finally, even among the three groups of MB children, a significant difference was observed in the measurements of the SNB° (P<0.036), NSGn° (P<0.028) and PFH/TAFH ratio (posterior facial height/total anterior facial height) (P<0.012).

CONCLUSIONS

The cephalometric pattern of MB and NB children was not similar. Cephalometric measurements of the MB group differed according to the etiology of upper airway obstruction. Children with isolated hypertrophy of the palatine tonsils presented with a mandible that was positioned more forward and upward compared to children obstructed only by the enlarged adenoid.

Acoustic rhinometry in mouth breathing patients: a systematic review

INTRODUCTION

When there is a change in the physiological pattern of nasal breathing, mouth breathing may already be present. The diagnosis of mouth breathing is related to nasal patency. One way to access nasal patency is by acoustic rhinometry.

OBJECTIVE

To systematically review the effectiveness of acoustic rhinometry for the diagnosis of patients with mouth breathing.

METHODS

Electronic databases LILACS, MEDLINE via PubMed and Bireme, SciELO, Web of Science, Scopus, PsycInfo, CINAHL, and Science Direct, from August to December 2013, were consulted. 11,439 articles were found: 30 from LILACS, 54 from MEDLINE via Bireme, 5558 from MEDLINE via PubMed, 11 from SciELO, 2056 from Web of Science, 1734 from Scopus, 13 from PsycInfo, 1108 from CINAHL, and 875 from Science Direct. Of these, two articles were selected.

RESULTS

The heterogeneity in the use of equipment and materials for the assessment of respiratory mode in these studies reveals that there is not yet consensus in the assessment and diagnosis of patients with mouth breathing.

CONCLUSION

According to the articles, acoustic rhinometry has been used for almost twenty years, but controlled studies attesting to the efficacy of measuring the geometry of nasal cavities for complementary diagnosis of respiratory mode are warranted.

Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review

Rapid maxillary expansion (RME) is a widely used practice in orthodontics. Scientific evidence shows that RME can be helpful in modifying the breathing pattern in mouth-breathing patients. In order to promote the restoration of physiological breathing we have developed a rehabilitation program associated with RME in children. The aim of the study was a literature review and a model of orofacial rehabilitation in children with obstructive sleep apnea undergoing treatment with rapid maxillary expansion. Muscular training (local exercises and general ones) is the key factor of the program. It also includes hygienic and behavior instructions as well as other therapeutic procedures such as rhinosinusal washes, a postural re-education (Alexander technique) and, if necessary, a pharmacological treatment aimed to improve nasal obstruction. The program should be customized for each patient. If RME is supported by an adequate functional rehabilitation, the possibility to change the breathing pattern is considerably amplified. Awareness, motivation and collaboration of the child and their parents, as well as the cooperation among specialists, such as orthodontist, speech therapist, pediatrician and otolaryngologist, are necessary conditions to achieve the goal.

Articulation error of children with adenoid hypertrophy

PURPOSE

Adenoid hypertrophy is a physical alteration that may affect speech, and a speech disorder can have other negative effects on a child's life. Airway obstruction leads to constricted oral breathing and causes postural alterations of several oro-facial structures, including the mouth, tongue, and hyoid bone. The postural modifications may affect several aspects of speech production.

METHODS

In this study, we compared articulation errors in 19 children with adenoid hypertrophy (subject group) to those of 33 children with functional articulation disorders independent of anatomical problems (control group).

RESULTS

The mean age of the subject group was significantly higher (P=0.016). Substitution was more frequent in the subject group (P=0.003; odds ratio [OR], 1.80; 95% confidence interval [CI], 1.23-2.62), while omission was less frequent (P<0.001; OR, 0.43; 95% CI, 0.27-0.67). Articulation errors were significantly less frequent in the palatal affricative in the subject group (P=0.047; OR, 0.25; 95% CI, 0.07-0.92). The number of articulation errors in other consonants was not different between the two groups. Nasalization and aspiration were significantly more frequent in the subject group (P=0.007 and 0.014; OR, 14.77 and 0.014; 95% CI, [1.62-135.04] and NA, respectively). Otherwise, there were no differences between the two groups.

CONCLUSION

We identified the characteristics of articulation errors in children with adenoid hypertrophy, but our data did not show the relationship between adenoid hypertrophy and oral motor function that has been observed in previous studies. The association between adenoid hypertrophy and oral motor function remains doubtful.

Association between breastfeeding and breathing pattern in children: a sectional study

OBJECTIVE

to determine the prevalence of mouth breathing and to associate the history of breastfeeding with breathing patterns in children.

METHODS

this was an observational study with 252 children of both genders, aged 30 to 48 months, who participated in a dental care program for mothers and newborns. As an instrument of data collection, a semi-structured questionnaire was administered to the children's mothers assessing the form and duration of breastfeeding and the oral habits of non-nutritive sucking. To determine the breathing patterns that the children had developed, medical history and clinical examination were used. Statistical analysis was conducted to examine the effects of exposure on the primary outcome (mouth breathing), and the prevalence ratio was calculated with a 95% confidence interval.

RESULTS

of the total sample, 43.1% of the children were mouth breathers, 48.4% had been breastfed exclusively until six months of age or more, and 27.4% had non-nutritive sucking habits. Statistically significant associations were found for bottle-feeding (p<0.001) and oral habits of non-nutritive sucking (p=0.009), with an increased likelihood of children exhibiting a predominantly oral breathing pattern. A statistically significant association was also observed between a longer duration of exclusive breastfeeding and a nasal breathing pattern presented by children.

CONCLUSION

an increased duration of exclusive breastfeeding lowers the chances of children exhibiting a predominantly oral breathing pattern.