Prevalence and factors associated with anterior open bite in 2 to 5 year old children in Benin city, Nigeria

BACKGROUND

Anterior open bite is said to exist when there is an actual vertical gap between the upper and lower incisors with the teeth in centric occlusion. This could occur in the anterior or posterior region, and may be attributed to the supra eruption of the posterior teeth or the infra eruption of the anterior teeth and it is common in both adults and children.

OBJECTIVE

To evaluate the prevalence of anterior open bite (AOB) in 2 to 5 -year -old children and the aetiological factors responsible for it.

METHODS

The study group comprised 1031 children (429 boys and 602 girls) between the ages of 2 to 5-years, who were examined for the presence of AOB and the relationship with various oral habits.

RESULTS

AOB was present in 29 (2.8%) of the subjects. Sucking habits were observed in 267 (25.9%) children. Only 29(10.9%) of the children with sucking habits had an AOB which was asymmetric in 20 (7.5%) and symmetric in 9 (3.4%). The asymmetric AOB was significantly higher in children with thumb sucking habits than in finger suckers (P<0.05). There was no significant difference between frequency, duration of sucking habits and AOB. The 4-year olds showed a significant difference in the number of children with AOB (P<0.05). Sucking habits of 1-2 hours and duration of 24 to 60 months exhibited the highest prevalence of an AOB in 13 (44.8%) and 17 (58.6%)children respectively.

CONCLUSION

The prevalence of AOB in this study is 2.8%. Thumb sucking is the most important aetiological factor in the formation of an AOB in 2 to 5-year-old children.

Effect of restricted pacifier use in breastfeeding term infants for increasing duration of breastfeeding

BACKGROUND

To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.

OBJECTIVES

To assess the effect of unrestricted versus restricted pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (14 March 2012).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing unrestricted versus restricted pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data were checked for accuracy.

MAIN RESULTS

We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 0.99; 95% confidence interval (CI) 0.93 to 1.05), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.98 to 1.13), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).

AUTHORS' CONCLUSIONS

Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.

Is early use of pacifier a risk factor for diarrhea?

AIM

Non nutritive suckling has been always used by mothers for calming and comforting infants and young children. Previous studies have suggested that pacifiers may get contaminated but only three studies have shown a possible association between the use of pacifiers and diarrhea or enteric infections. The goal of this study was to investigate whether the early start of pacifier within the first month of life is a risk factor for diarrhea in early childhood.

METHODS

Case-control study. Subjects 12 to 36 month old were recruited. Cases were children with at least 1 episode of diarrhea per year of life.

RESULTS

Among cases (N.=63), those who had started using pacifier in the first month of life were 61.9%, while among controls (N.=78) they were 29.4%, OR 3.89, CI95% 1.92-7.85. Type and frequency of pacifier hygiene practices were not associated with diarrhea.

CONCLUSION

Our results suggest that the recommendation to postpone pacifier use after the first month of life not to interfere with the duration of breastfeeding, may have also the effect to reduce the risk of episodes of diarrhea in the first three years of life.

PURLs. Should breastfeeding babies be given pacifiers?

Tell breastfeeding moms who ask that question that pacifier use will not interfere.

Prevalence of malocclusion and related oral habits in 5- to 6-year-old children

PURPOSE

To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010.

MATERIALS AND METHODS

Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire.

RESULTS

In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%.

CONCLUSION

There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).

Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition

OBJECTIVE

Nutritional, immunological and psychological benefits of exclusive breastfeeding for the first 6 months of life are unequivocally recognized. However, mothers should also be aware of the importance of breastfeeding for promoting adequate oral development. This study evaluated the association between breastfeeding and non-nutritive sucking patterns and the prevalence of anterior open bite in primary dentition.

MATERIAL AND METHODS

Infant feeding and non-nutritive sucking were investigated in a 3-6 year-old sample of 1,377 children, from São Paulo city, Brazil. Children were grouped according to breastfeeding duration: G1--non-breastfed, G2--shorter than 6 months, G3--interruption between 6 and 12 months, and G4--longer than 12 months. Three calibrated dentists performed clinical examinations and classified overbite into 3 categories: normal, anterior open bite and deep bite. Chi-square tests (p<0.05) with odds ratio (OR) calculation were used for intergroup comparisons. The impact of breastfeeding and non-nutritive sucking on the prevalence of anterior open bite was analyzed using binary logistic regression.

RESULTS

The prevalence estimates of anterior open bite were: 31.9% (G1), 26.1% (G2), 22.1% (G3), and 6.2% (G4). G1 would have significantly more chances of having anterior open bite compared with G4; in the total sample (OR=7.1) and in the subgroup without history of non-nutritive sucking (OR=9.3). Prolonging breastfeeding for 12 months was associated with a 3.7 times lower chance of having anterior open bite. In each year of persistence with non-nutritive sucking habits, the chance of developing this malocclusion increased in 2.38 times.

CONCLUSIONS

Breastfeeding and non-nutritive sucking durations demonstrated opposite effects on the prediction of anterior open bite. Non-breastfed children presented significantly greater chances of having anterior open bite compared with those who were breastfed for periods longer than 12 months, demonstrating the beneficial influence of breastfeeding on dental occlusion.

Pacifier use versus no pacifier use in breastfeeding term infants for increasing duration of breastfeeding

BACKGROUND

To successfully initiate and maintain breastfeeding for a longer duration, the World Health Organization's Ten Steps to Successful Breastfeeding recommends total avoidance of artificial teats or pacifiers for breastfeeding infants. Offering the pacifier instead of the breast to calm the infant may lead to less frequent episodes of breastfeeding and as a consequence may reduce breast milk production and shorten duration of breastfeeding; however, this remains unclear.

OBJECTIVES

To assess the effect of pacifier use versus no pacifier use in healthy full-term newborns whose mothers have initiated breastfeeding and intend to exclusively breastfeed, on the duration of breastfeeding, other breastfeeding outcomes and infant health.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 December 2010).

SELECTION CRITERIA

Randomised and quasi-randomised controlled trials comparing pacifier use versus no pacifier use in healthy full-term newborns who have initiated breastfeeding regardless of whether they were born at home or in the hospital.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction.

MAIN RESULTS

We found three trials (involving 1915 babies) for inclusion in the review but have included only two trials (involving 1302 healthy full-term breastfeeding infants) in the analysis. Meta-analysis of the two combined studies showed that pacifier use in healthy breastfeeding infants had no significant effect on the proportion of infants exclusively breastfed at three months (risk ratio (RR) 1.00; 95% confidence interval (CI) 0.95 to 1.06), and at four months of age (RR 0.99; 95% CI 0.92 to 1.06) and also had no effect on the proportion of infants partially breastfed at three months (RR 1.00; 95% CI 0.97 to 1.02), and at 4 months of age (RR 1.01; 95% CI 0.98 to 1.03).

AUTHORS' CONCLUSIONS

Pacifier use in healthy term breastfeeding infants, started from birth or after lactation is established, did not significantly affect the prevalence or duration of exclusive and partial breastfeeding up to four months of age. However, evidence to assess the short-term breastfeeding difficulties faced by mothers and long-term effect of pacifiers on infants' health is lacking.

Influence of the mode of nutritive and non-nutritive sucking on the dimensions of primary dental arches

INTRODUCTION

Sucking is innate in both infants and young children. It is termed nutritive when referring to suckling from the breast or bottle-feeding and non-nutritive when applied to sucking of a digit or pacifier. Few studies have attempted to assess the impact of the type of sucking on the size of the dental arches. The aim of this study was to quantify the influence of the mode of nutritive suckling and non-nutritive sucking habits (NNSH) on the measurements of the dental arches.

PATIENTS AND METHODS

This was a transverse descriptive study involving 226 Senegalese children. The mode of feeding and the presence or not of a NNSH (digit or pacifier) were gathered from parents of all children using a structured questionnaire. Quantitative variables regarding intra- and inter-arch relationships were recorded using plaster moulds taken from the children. Statistical analyses were used to compare the different variables according to gender, the mode of feeding and the presence or not of a NNSH.

RESULTS

The subjects in the study (123 boys and 103 girls) were aged between 5 and 6years old. The children who had enjoyed mixed feeding (breast/bottle combination) had a great length of the anterior maxillary arch and a significantly greater depth of the palatal arch than children receiving breast-feeding alone. The children with antecedents or a current NNSH had a longer anterior maxillary arch than subjects with no NNSH (P=0.01). Regarding inter-arch relationships, the children with antecedents or a current digit-sucking habit had less overbite than their peers who had no NNSH (P=0.04).

CONCLUSION

The results of this study show that bottle-feeding, even partial, as well as NNSH are associated with changes in certain dimensions of the maxillary dental arch and in inter-arch relationships. Longitudinal studies are required to investigate further the nature of this association.

Association between sociodemographic factors and nutritive and non-nutritive sucking habits among Iranian girls

Prolonged duration of finger- and pacifier-sucking may be a risk factor for maldevelopment of orofacial structures and dental occlusion. This study assessed the prevalence of nutritive and non-nutritive sucking habits and their association with some contributing factors among 7-year-old girls in Mashhad, Islamic Republic of Iran. Based on a questionnaire to the parents of 436 schoolgirls, the rate of current or previous pacifier-sucking was 26.6% and of finger-sucking was 10.6%. Child's birth rank and number of siblings and parents' educational level were significantly related to ever pacifier-sucking but not to finger-sucking. The highest prevalence of ever pacifier-sucking was among children who had been breast- and bottle-fed but finger-sucking was more common among exclusively breastfed children.

Retention mucocele on the lower lip associated with inadequate use of pacifier

Mucocele forms because of salivary gland mucous extravasation or retention and is usually related to trauma in the area of the lower lips. Ruptured ducts release the mucous that accumulates into adjacent tissues, leading to swelling. This report describes a large mucocele involving the lower lip, which was produced in a child by incorrect use of a pacifier. A few important concepts are discussed to help clinicians in the diagnosis and treatment of this pathology.

Feeding and nonnutritive sucking habits and prevalence of open bite and crossbite in children/adolescents with Down syndrome

OBJECTIVE

To analyze the influence of breastfeeding, bottle feeding, and nonnutritive sucking habits on the prevalence of open bite and anterior/posterior crossbite in children with Down syndrome (DS).

MATERIALS AND METHODS

A cross-sectional study was carried out in 112 pairs of mothers/children with DS between 3 and 18 years of age at a maternal/children's hospital in Rio de Janeiro, Brazil. The children with DS were clinically examined for the presence of open bite as well as anterior and posterior crossbite. Information on breastfeeding, bottle feeding, and nonnutritive sucking habits was collected using a structured questionnaire. The control variables were age and mouth posture of children/adolescents and mother's schooling. Statistical analysis of the data was performed using the chi-square test and multiple logistic regression.

RESULTS

The prevalence of anterior open bite was 21%, anterior crossbite was 33%, and posterior crossbite was 31%. The use of bottle feeding for more than 24 months (prevalence ratio [PR] = 1.6) was associated with the occurrence of open bite. Having breastfed for less than 6 months (PR = 1.4) and pacifier sucking for more than 24 months (PR = 3.1) were associated with the prevalence of anterior crossbite. Finger sucking (PR = 2.9) and the use of bottle feeding for more than 24 months (PR = 2.6) were associated with posterior crossbite.

CONCLUSION

The prevalence of open bite and crossbite in children with DS was associated with the use of bottle feeding and pacifier sucking for more than 24 months, breastfeeding for less than 6 months, and finger sucking.

Pacifier-sucking and breast-feeding: a comparison between the 1960 s and the 1990 s

PURPOSE

Pacifiers and their forerunners have been condemned in past centuries, probably beginning in the 17(th) and 18(th) centuries when alcohol and opiates were incorporated as fillings in sucking rags in Great Britain. Nowadays, the modern pacifier is criticized for reducing breast-feeding time and encouraging weaning. The purpose of this study was to analyze if pacifier-sucking has been detrimental to breast-feeding in the past few decades.

METHODS

In the present study, 2 groups of young children born 30 years apart (1967 and 1995 to 1997) in the same geographic area were analyzed in the first 6 months of age regarding their sucking and feeding habits, including initial and prolonged pacifier-sucking and breast-feeding.

RESULTS

Findings do not support the commonly held opinion that pacifier-sucking reduces breast-feeding time. In the 30 years that separate the 2 groups, the pacifier-sucking habit increased by 32% and prolonged use of a pacifier increased. At the same time, breast-feeding at 6 months old has increased 20-fold in the contemporary group (born between 1995 and 1997) as compared with the 1967 group.

CONCLUSIONS

The results suggest that mothers might be unable to satisfy their child's sucking urge through breast-feeding alone, and that they use the pacifier as a supplement. Pacifier use does not negatively affect the prevalence of breast-feeding.

Risks and benefits of pacifiers

Physicians are often asked for guidance about pacifier use in children, especially regarding the benefits and risks, and when to appropriately wean a child. The benefits of pacifier use include analgesic effects, shorter hospital stays for preterm infants, and a reduction in the risk of sudden infant death syndrome. Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department (e.g., heel sticks, immunizations, venipuncture). The American Academy of Pediatrics recommends that parents consider offering pacifiers to infants one month and older at the onset of sleep to reduce the risk of sudden infant death syndrome. Potential complications of pacifier use, particularly with prolonged use, include a negative effect on breastfeeding, dental malocclusion, and otitis media. Adverse dental effects can be evident after two years of age, but mainly after four years. The American Academy of Family Physicians recommends that mothers be educated about pacifier use in the immediate postpartum period to avoid difficulties with breastfeeding. The American Academy of Pediatrics and the American Academy of Family Physicians recommend weaning children from pacifiers in the second six months of life to prevent otitis media. Pacifier use should not be actively discouraged and may be especially beneficial in the first six months of life.

[Prevalence and factors associated with non-nutritive sucking behavior. Cross sectional study among 5- to 6-year-old Senegalese children]

Sucking behaviours have been described in the literature under two facets i.e. nutritive and non nutritive. Nutritive sucking refers to breast feeding, bottle feeding or a combination of both. Non nutritive sucking habits are mentioned when children suck their thumb or another finger(s), a pacifier or any other object. Non nutritive sucking habits (NNSH) are suspected to potentially induce dentoalveolar anomalies and thus may constitute a public dental health problem. Anthropological and historical data suggest that non nutritive sucking habits are associated with modern pattern of life. The aim of this study is to investigate the prevalence and factors associated with NNSH in Senegalese children 5/6 years old. Data of this study were collected using a structured questionnaire administered by the investigators to mothers or caregivers of 443 children (231 boys and 212 girls) aged 5/6 years. Three types of data were collected: data on the social background of the children including place of residence (urban, suburban and rural) and the mother's occupation (workers, employee, executive, housewife), data regarding former and present sucking habits and information on the feeding pattern of the children when they were infants (breast feeding, bottle feeding or a combination of both). The results indicated a prevalence rate of 16.50% and 17.20% respectively for digit and pacifier sucking in this population. Also, a significant association was found between children's non nutritive sucking habits in one hand and the mothers' occupation and feeding pattern on the other hand. Breast fed children are less prone to develop a non nutritive sucking habit than bottle fed children. Longitudinal studies are necessary to verify the nature of these associations. The identification of factors associated with non nutritive sucking habits would permit to develop and target recommendations for the prevention of such habits.

Effects of breastfeeding and sucking habits on malocclusion in a birth cohort study

OBJECTIVE

To estimate the prevalence of malocclusion and to examine the effects of breastfeeding and non-nutritive sucking habits on dentition in six-year-old children.

METHODS

A cross-sectional study was carried out nested into a birth cohort conducted in Pelotas, Southern Brazil, in 1999. A sample of 359 children was dentally examined and their mothers interviewed. Anterior open bite and posterior cross bite were recorded using the Foster & Hamilton criteria. Information regarding breastfeeding and non-nutritive sucking habits was collected at birth, in the first, third, sixth and 12th months of life, and at six years of age. Control variables included maternal schooling and child's birthweight, cephalic perimeter, and sex. Data were analyzed by Poisson regression.

RESULTS

Prevalence of anterior open bite was 46.2%, and that of posterior cross bite was 18.2%. Non-nutritive sucking habits between 12 months and four years of age and digital sucking at age six years were the main risk factors for anterior open bite. Breastfeeding for less than nine months and regular use of pacifier between age 12 months and four years were risk factors for posterior cross bite. Interaction between duration of breastfeeding and the use of pacifier was identified for posterior cross bite.

CONCLUSIONS

Given that breastfeeding is a protective factor for other diseases of infancy, our findings indicate that the common risks approach is the most appropriate for the prevention of posterior cross bite in primary or initial mixed dentition.

Transverse features of subjects with sucking habits and facial hyperdivergency in the mixed dentition

INTRODUCTION

The aim of this study was to analyze the transverse characteristics of subjects with sucking habits and hyperdivergency in the mixed dentition.

METHODS

The test group consisted of 80 subjects with sucking habits and hyperdivergency in the intermediate mixed dentition, and it was compared with a control group of 185 subjects. The prevalence rate of posterior crossbite was recorded. Maxillary and mandibular intercanine and intermolar widths, and anterior and posterior transverse interarch discrepancies were measured on the dental casts. The statistical comparisons between the test and control groups were performed with independent sample t tests and chi-square tests (P <.05).

RESULTS

The prevalence rate of posterior crossbite in the test group was significantly greater (52%) than in the control group (14%) (P <.001). The test group had significantly smaller maxillary intermolar and intercanine widths and significantly greater posterior transverse discrepancy (P <.01). No significant differences were found for mandibular intermolar and intercanine widths or anterior transverse discrepancy.

CONCLUSIONS

Prolonged sucking habits and hyperdivergency in the mixed dentition were associated with narrow maxillary intermolar and intercanine widths, increased posterior transverse discrepancies, and increased prevalence of posterior crossbites.