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

Analysis of the Influence of Breastfeeding and Bottle-Feeding upon the Origin of Posterior Crossbites

(1) Introduction. An analysis was made of posterior crossbites in deciduous dentition and their relation to the type of feeding received by the child, with the objective of determining the influence of the way in which the child is fed in the early stages of life on the development of posterior crossbites. (2) Material and methods. A total of 1401 preschool children between 3 and 6 years of age from Seville (Spain) were included in the study. An intraoral exploration was carried out to assess the presence of crossbites (uni- or bilateral, and functional or not). The study was completed with a parent or legal guardian questionnaire exploring the type of feeding received by the child in the first stages of life, as well as the presence of bad oral habits and their duration. (3) Results. A total of 276 children (19.7%) presented posterior crossbite in occlusion. Uponn centering the midlines, 197 were maintained, indicating that 79 were due to premature contacts (functional crossbites). There were no significant differences in crossbites among the children who had received breastfeeding, though bottle-feeding was seen to favor crossbite. (4) Conclusions. No statistically significant relationship was found between posterior crossbites and breastfeeding, though an association between posterior crossbites and bottle-feeding was observed, with the number of crossbites increasing with the duration of bottle-feeding.

Influence of bad oral habits upon the development of posterior crossbite in a preschool population

BACKGROUND

A study is made of posterior crossbite in deciduous dentition and its possible association to extrinsic factors (bad oral habits).

METHODS

A total of 1168 Spanish children between 3 and 6 years of age were included in the study. Exploration of the oral cavity was performed to assess the presence of crossbite (uni- or bilateral and/or functional), and a questionnaire was administered to the parents or caregivers to determine the presence of bad oral habits and their duration.

RESULTS

In occlusion, 19.7% of the cases (n = 230) presented uni- or bilateral posterior crossbite. On adopting centric relation confronting the midlines, crossbite persisted in 165 children, indicating that 65 cases were due to premature contacts (functional crossbite). The identified favoring factors were pacifier use, thumb sucking, oral breathing and tongue thrusting or immature swallowing.

DISCUSSION

Most studies in the literature report a relationship between posterior crossbite and bad oral habits. The proportion of posterior crossbites identified in our study (16.6%) is consistent with the data published by authors such as Kobayashi, Limeira or Paolantonio, among others, but differs from the results of Zhifei Zhou, Peres or Germa. In coincidence with most studies, we recorded a statistically significant association between posterior crossbite and bad oral habits.

CONCLUSIONS

Bad oral habits favor the appearance of posterior crossbite, and the duration of the habit, its intensity (in the case of thumb sucking) and type (in the case of pacifier use) act as influencing factors. Functional study characterized the types of posterior crossbites and identified those attributable to premature contacts. This aspect has not been addressed by previous studies, and we consider the findings to be very interesting for analyzing and identifying the features of true crossbites.

Narrating the Genetic Landscape of Human Class I Occlusion: A Perspective-Infused Review

This review examines a prevalent condition with multifaceted etiology encompassing genetic, environmental, and oral behavioral factors. It stands as a significant ailment impacting oral functionality, aesthetics, and quality of life. Longitudinal studies indicate that malocclusion in primary dentition may progress to permanent malocclusion. Recognizing and managing malocclusion in primary dentition is gaining prominence. The World Health Organization ranks malocclusions as the third most widespread oral health issue globally. Angle's classification system is widely used to categorize malocclusions, with Class I occlusion considered the norm. However, its prevalence varies across populations due to genetic and examination disparities. Genetic factors, including variants in genes like MSX1, PAX9, and AXIN2, have been associated with an increased risk of Class I occlusion. This review aims to provide a comprehensive overview of clinical strategies for managing Class I occlusion and consolidate genetic insights from both human and murine populations. Additionally, genomic relationships among craniofacial genes will be assessed in individuals with Class I occlusion, along with a murine model, shedding light on phenotype-genotype associations of clinical relevance. The prevalence of Class I occlusion, its impact, and treatment approaches will be discussed, emphasizing the importance of early intervention. Additionally, the role of RNA alterations in skeletal Class I occlusion will be explored, focusing on variations in expression or structure that influence craniofacial development. Mouse models will be highlighted as crucial tools for investigating mandible size and prognathism and conducting QTL analysis to gain deeper genetic insights. This review amalgamates cellular, molecular, and clinical trait data to unravel correlations between malocclusion and Class I phenotypes.

In silico approach towards neuro-occlusal rehabilitation for the early correction of asymmetrical development in a unilateral crossbite patient

Neuro-occlusal rehabilitation (N.O.R.) is a discipline of the stomatognathic medicine that defends early treatments of functional malocclusions, such as unilateral crossbite, for the correction of craniofacial development, avoiding surgical procedures later in life. Nevertheless, N.O.R.'s advances have not been proved analytically yet due to the difficulties of evaluate the mechanical response after the treatment. This study aims to evaluate computationally the effect of N.O.R.'s treatments during childhood. Therefore, bilateral chewing and maximum intercuspation occlusion were modelled through a detailed finite element model of a paediatric craniofacial complex, before and after different selective grinding-alternatives. This model was subjected to the muscular forces derived from a musculoskeletal model and was validated by the occlusal contacts recorded experimentally. This approach yielded errors below 2% and reproduced successfully the occlusal, muscular, functional and mechanical imbalance before the therapies. Treatment strategies balanced the occlusal plane and reduced the periodontal overpressure (>4.7 kPa) and the mandibular over deformation (>0.002 ε) on the crossed side. Based on the principles of the mechanostat theory of bone remodelling and the pressure-tension theory of tooth movement, these findings could also demonstrate how N.O.R.'s treatments correct the malocclusion and the asymmetrical development of the craniofacial complex. Besides, N.O.R.'s treatments slightly modified the stress state and functions of the temporomandibular joints, facilitating the chewing by the unaccustomed side. These findings provide important biomechanical insights into the use of N.O.R.'s treatments for the correction of unilateral crossbite, but also encourage the application of computing methods in biomedical research and clinical practise.

Association between malocclusion in the mixed dentition with breastfeeding and past nonnutritive sucking habits in school-age children

OBJECTIVES

To evaluate the association between malocclusion characteristics in the mixed dentition stage, breastfeeding, and past nonnutritive sucking habits in school-age children.

MATERIALS AND METHODS

A total of 547 school children in the mixed dentition, in the age range between 7 and 13 years, were evaluated by means of questionnaire and clinical examination. Binomial and multinomial logistic regression models were used to evaluate the associations between breastfeeding and finger and pacifier sucking habits, the malocclusion characteristics of posterior crossbite, and excessive or deficient overjet and overbite.

RESULTS

Individuals who had nonnutritive sucking habits had 2.16 times greater chance of having anterior open bite (odds ratio [OR] 2.16; 95% confidence interval [CI], 1.07-4.33) and 2.39 times greater chance of having posterior crossbite (OR 2.39; 95% CI, 1.56-5.49). Children who were exclusively breastfed up to at least 6 months of age had a higher frequency of normality for overjet and overbite and the lowest posterior crossbite index. However, in adjusted analysis, breastfeeding showed no association with malocclusion characteristics in the mixed dentition stage.

CONCLUSIONS

Breastfeeding was not associated with the presence of malocclusion in the mixed dentition, whereas past nonnutritive sucking habits were associated with the occurrence of malocclusion.

Conformity between Pacifier Design and Palate Shape in Preterm and Term Infants Considering Age-Specific Palate Size, Facial Profile and Lip Thickness

This retrospective case-control study is the first to examine the spatial conformity between pacifiers and palates in 39 preterm infants (12 females, 27 males) and 34 term infants (19 females, 15 males), taking into account the facial-soft-tissue profile and thickness. The shape of 74 available pacifiers was spatially matched to the palate, and conformity was examined using width, height, and length measurements. In summary, the size concept of pacifiers is highly variable and does not follow a growth pattern, like infant palates do. Pacifiers are too undersized in width, length, and height to physiologically fit the palate structures from 0 to 14 months of age. There are two exceptions, but only for premature palates: the palatal depth index at 9−11 months of age, which has no clinical meaning, and the nipple length at <37 weeks of age, which bears a resemblance to the maternal nipple during non-nutritive sucking. It can be concluded that the age-size concept of the studied pacifiers does not correspond to any natural growth pattern. Physiologically aligned, pacifiers do not achieve the age-specific dimensions of the palate. The effects attributed to the products on oral health in term infants cannot be supposed.

Co-Sleeping as a Protector against Malocclusion in the Primary Dentition: A Cross-Sectional Study

Mothers practice co-sleeping and breastfeeding simultaneously, for convenience and to strengthen bonding. Due to the scarcity of studies analyzing the impact of co-sleeping on primary dentition, this study aimed to analyze the possible effects of co-sleeping on children’s occlusion. In this cross-sectional study, mothers of 221 children aged 2−5 years who had been breastfed for less than 6 months completed a questionnaire about non-nutritive sucking habits. The WHO (World Health Organization) and IOTN-AC indices (the Aesthetic Component of the Index of Orthodontic Treatment Need) were used to assess malocclusion. The type of sagittal (dental and skeletal), transverse and vertical malocclusion was recorded. The non-co-sleeping group showed significantly higher pacifier use (p < 0.05), digital sucking (p < 0.05) and atypical swallowing (p < 0.05) habits. The non-co-sleeping group showed significantly higher mean scores on the IOTN-AC (p < 0.05) and WHO (p < 0.01), a significantly higher presence of canine class II (p < 0.05), anterior open bite (p < 0.05), posterior crossbite (p < 0.05), overbite (p < 0.05), skeletal class II (p < 0.01) and protrusion (p < 0.05). In conclusion, children who practice co-sleeping appear to have a lower frequency and duration of non-nutritive sucking habits. Co-sleeping may contribute to a lower development of malocclusions in children who are weaned early (before six months of age).

Association between deleterious oral habits and asthma in children: a systematic review and meta-analysis

Deleterious oral habits (DOH) have been described as a common finding in pediatric series. Studies have investigated their association with local and systemic health problems. In this study, the association between DOH and asthma was investigated. PubMed, Scopus, Lilacs, Web of Science, Google Scholar, and OpenThesis were accessed to identify observational studies that evaluated the association between DOH (thumb sucking, pacifier use, onychophagia or nail biting, bottle feeding) and asthma in children aged 2-17 years. Information on DOH was obtained from the verbal report of the children's parents. Asthma diagnosis was performed by a physician or using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. We used a random-effects model to pool the results. The odds ratio (OR) was used as measure of association between DOH and asthma. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess risk of bias. The GRADE approach was used to assess the quality of evidence. Five studies were included and data from 18,733 children aged 2 to 13 years were analyzed. We found an association between bottle feeding and asthma (OR = 1.25; 95%CI 1.13-1.38; p < 0.001) with moderate level of certainty. Despite the association between pacifier use and asthma (OR = 1.11; 95%CI 1.00-1.24; p = 0.05), the quality of evidence was low. Only one study provided data on nail biting and thumb-sucking, and the individual results showed no association between these habits and asthma. This meta-analysis found an association between bottle feeding, pacifier use, and asthma in children.

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

STUDY OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Evaluation of mother's complementary feeding knowledge and occlusion

Aim:

Mothers' understanding of feeding methods and how they affect deciduous dentition were the focus of this study.

Materials and Methods:

This study looked at people from different parts of the population. In total, 230 moms of children aged 6 months to 5 years who completed an oral health questionnaire were included in the study. Mothers' awareness of feeding patterns and their impact on deciduous dentition were examined in the study.

Results:

Illiterate moms' children showed a significant difference in the quality of their occlusion compared to similarly raised children of literate mothers. Children who began supplementary feeding before the age of 6 months were more likely to have occlusion changes.

Conclusion:

Malocclusion prevalence was shown to be unrelated to meal behaviors. However, further research is required as there are just a few studies currently available.

Prevalence of malocclusion among children of the Kingdom of Saudi Arabia - A systematic review and meta-analysis

Objective

Systematic review and meta-analysis are of a great tool in assessment of malocclusion, which is major public health concern. This study aims to explore the prevalence of malocclusion among the children of the Kingdom of Saudi Arabia through a meta-analysis and systematic review.

Materials and methods

Registered with PROSPERO as CRD42020198427, an authentic and global scale database search using relevant MeSH (Medical Subject Headings) terms was performed. Literature search and articles screening done following PRISMA guidelines.

For the dichotomous variables, 95% confidence intervals (CIs) were set for statistical data analysis. The heterogeneity index between the studies was determined using indices Tau², Chi², df and I² and Test for overall effect as Z.

Results

A total of 7930 candidates were reported to have either one of the three malocclusions. Prevalence of Class I, Class II and Class III Malocclusions were found to be 66.51%, 17.70%, 15.79% respectively. Among the small subsample of these candidates, male children with Class I, Class II and Class III Malocclusion were 43.80%, 12.27% and 7.40% respectively whereas female children were 22.07%, 10.93 %, 3.52 % respectively.

Conclusions

According to the 26 studies included in the systematic review, there were 72% of the candidates with malocclusion in Saudi Arabia. Prevalence of Class I, Class II and Class III malocclusion were 66.51%, 17.70%, and 15.79% respectively. In both male and female participants, the prevalence of Class I was the highest followed by class II and III malocclusion.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship between Breastfeeding and Malocclusion: A Systematic Review of the Literature

BACKGROUND

The purpose of this systematic review was to analyze the available literature about the influence of breastfeeding in primary and mixed dentition on different types of malocclusions.

METHODS

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines were used to perform the present review. The following electronic databases were searched: Pubmed, Evidence-Based Medicine Reviews (EBMR), Embase, Cochrane Library, Medline, Web of Science and Ovid.

RESULTS

A primary research found a total of 279 articles. Two more papers were also considered from the gray literature. Two hundred sixty-three articles were excluded as they were deemed irrelevant on the basis of: duplicates, title, abstract, methods and/or irrelevant contents. Eighteen papers were selected and included in the qualitative analysis.

CONCLUSIONS

breastfeeding is a positive factor that seems to reduce the incidence of posterior crossbite, skeletal class II and distoclusion in primary and mixed dentition. A sort of positive relationship between months of breastfeeding and risk reduction seems to exist. More longitudinal research is needed to avoid bias in the results, with data collected prospectively on the months of exclusive breastfeeding, by means of specific questionnaires and successive clinical evaluation of the occlusal condition at the primary dentition, mixed dentition and permanent dentition stages.

Influence of pacifier use on the association between duration of breastfeeding and anterior open bite in primary dentition

Background

The literature is controversial with regard to the association between longer breastfeeding duration and lower prevalence of anterior open bite. Pacifier use may be involved in this controversy. Thus, the objective of the study was to assess the influence of pacifier use and its duration on the association between longer breastfeeding duration and lower prevalence of anterior open bite in children with primary dentition.

Methods

This was a cross-sectional study nested in a cohort study involving 153 infants recruited at a maternity hospital in the municipality of Porto Alegre, southern Brazil. The study outcome (anterior open bite) was assessed when the children were between 3 and 5 years old. Data on breastfeeding and pacifier use were collected at 7, 30, 60, 120, and 180 days of life and on the date of the evaluation here described. Poisson regression with robust variance was used to analyze the association between the prevalence of anterior open bite and breastfeeding duration, expressed in months.

Results

The univariate analysis showed a protective effect of breastfeeding against anterior open bite (prevalence ratio [PR] 0.96; 95% confidence interval [95%CI] 0.95–0.98). This effect remained significant after adjustment for pacifier use at any time between birth and the date of dental assessment (PR0.98; 95%CI; 0.96–0.99), i.e., there was a reduction of 2% in the prevalence of anterior open bite for each month of breastfeeding. However, this effect lost significance when pacifier use duration was included in the multivariate analysis (PR1.00; 95%CI; 0.99–1.01).

Conclusions

Pacifier use duration influences the association between longer breastfeeding duration and lower prevalence of anterior open bite. It is likely that prolonged pacifier use reduces the magnitude of this association.

The influence of breastfeeding and pacifier use on the association between preterm birth and primary-dentition malocclusion: A population-based birth cohort study

INTRODUCTION

Little is known about the influence of biological characteristics on the occurrence of malocclusion. This study aimed to investigate the association between preterm birth and primary-dentition malocclusion and how breastfeeding and the use of pacifiers are related to this association.

METHODS

A representative sample (n = 1129) of children from the 2004 Pelotas, Brazil birth cohort study underwent a dental examination at age 5 years. Malocclusions were diagnosed according to the World Health Organization criteria, and the outcome was considered as the presence of moderate or severe malocclusion (MSM). Questionnaires including the children's oral health information were completed by the mothers. Data on socioeconomic status, breastfeeding, and preterm birth were obtained from previous follow-ups. Poisson regression analysis was conducted, followed by an interaction test.

RESULTS

The prevalence of MSM was 26.3% (95% confidence interval [CI], 23.6%-29.1%) in the total sample, 24.1% (95% CI, 21.5%-26.9%) in full-term births, and 42.2% (95% CI, 39.1%-45.3%) in preterm births. After adjustment, the prevalence of MSM was 42% higher in preterm births. Breastfeeding duration and pacifier use up to age 4 years modified the effect of gestational age on MSM.

CONCLUSIONS

Preterm birth is associated with the development of MSM. Breastfeeding reduces the effect of preterm birth on MSM, and pacifier use strengthens this association. Dentists should be aware that preterm birth may be a risk factor for malocclusion in primary dentition. The findings reinforce the benefits of breastfeeding on occlusal development and the negative consequences of pacifier use.

Exclusive breastfeeding changes in Brazil attributable to pacifier use

BACKGROUND

Identifying key interventions to increase exclusive breastfeeding duration has been a challenge. Pacifier use has been associated with exclusive breastfeeding discontinuation in Brazil. However, the proportion of the improvement in exclusive breastfeeding duration attributable to pacifier use remains unknown.

RESEARCH AIM

Quantify the proportion of increases in exclusive breastfeeding prevalence that can be attributed to reduced pacifier use over time.

METHODS

Secondary data analyses of two nationally representative cross-sectional surveys conducted in States' capitals in 1999 and in 2008 (N = 42,395 Brazilian infants under 6 months of age). We estimated the fraction of exclusive breastfeeding prevalence improvements that could be attributed to pacifier use based on multilevel regression analysis.

RESULTS

From 1999 to 2008, there was an increase of 15.2 percentage points in exclusive breastfeeding prevalence and a decrease of approximately 17 percentage points in the prevalence of pacifier use among infants under 6 months. Reduction in pacifier use explained an increase in 5.5 percentage points' exclusive breastfeeding rates. If pacifier use were to decrease from 41.6% (prevalence in 2008) to 14% (as found in New Zealand), there would be an expected additional increase in exclusive breastfeeding of approximately 12 percentage points.

CONCLUSIONS

About one-third of the improvements in EBF prevalence observed in Brazil over a decade can be attributed to the corresponding decline in pacifier use.

Breastfeeding Versus Bottle Feeding on Malocclusion in Children: A Meta-Analysis Study

BACKGROUND

Breastfeeding plays an important role in child health. However, there are doubts about its influence on malocclusions. Systematic reviews have yielded contradictory results. Research aim: This study aimed to investigate whether the type and duration of breastfeeding are associated with malocclusions in primary teething.

METHODS

The review strategy included several electronic databases, lists of references, reviews, dissertation and thesis websites, experts, and other relevant documents. Published and unpublished observational studies ( N = 42) were reviewed using the Participants (children), Interventions (breastfeeding), Comparisons (bottle feeding), Outcomes (malocclusion), and Study design (observational) strategy, without restrictions on language or locale. Information about the authors, publication year, country of study, setting, study design, sample size, age, type and duration of exclusive and mixed breastfeeding, and malocclusions was recorded by two blinded evaluators. Quantitative meta-analysis ( N = 30) of the studies with available data was performed.

RESULTS

Breastfeeding was a protective factor against malocclusions. The odds of association increased with breastfeeding duration. Irrespective of duration, breastfeeding had a protective association with open bite. For those who were breastfed for up to 6 months, breastfeeding protected against overjet, open bite, posterior crossbite, and crowding. Breastfeeding for 12 months or longer was associated with lower odds of overjet, open bite, and posterior crossbite. Breastfeeding exclusively for 6 months was also a protective factor against malocclusions. However, studies on this subject presented low quality, statistical heterogeneity, and only unadjusted measures of association in most of the cases.

CONCLUSION

Breastfeeding beneficially affects primary occlusion when practiced for at least 6 months.

Association of breastfeeding and malocclusion in 5-year-old children: Multilevel approach

BACKGROUND

Breastfeeding plays an important role in child health, including the development of normal dental occlusion, but large epidemiological findings on the association breastfeeding-malocclusion are lacking.

AIM

To investigate the association between the proportion of breastfed children in the city level and the prevalence of malocclusion in the primary dentition at age 5.

DESIGN

This cross-sectional analysis used data from national population surveys on oral health and on breastfeeding practices. Data refer to 5278 5-year-old children and 44 Brazilian towns. Information on malocclusion and individual sociodemographic characteristics were obtained from the 2010 Brazilian Oral Health Survey. Breastfeeding rates during the first year of life were extracted from the Breastfeeding Prevalence Survey in Brazilian Towns. Population sociodemographic data were analysed as confounder. Multilevel Poisson analyses were performed.

RESULTS

Malocclusion prevalence was 63.3%. Towns exhibiting higher prevalence of breastfeeding among 9- to 12-month-olds presented lower prevalence of malocclusion among children at age 5 (PR 0.98; 95% CI 0.98-0.99).

CONCLUSIONS

Lower prevalence of malocclusion among 5-year-old children was associated with a higher proportion of children breastfed at ages 9 to 12 months at a city level, regardless of sociodemographic factors. These findings highlight the importance of encouraging breastfeeding during a child's first year.

The association between nutritive, non-nutritive sucking habits and primary dental occlusion

Background

The development of primary dentition can be affected by oral sucking habits. Therefore, this study aims to investigate the association of nutritive and non-nutritive sucking habits with primary dentition development.

Methods

One thousand one hundred and fourteen children aged 2 to 5 years old in Hong Kong were recruited in a cross-sectional study. Information on their nutritive (e.g. breastfeeding and bottle feeding) and non-nutritive sucking habits (e.g. pacifier use and thumb/digit sucking) was collected via questionnaires. The children’s primary occlusions were examined in three dimensions.

Results

Children who were breastfed for more than 6 months had a lower proportion of daily pacifier use (p < 0.05). Children who used pacifiers daily had a higher proportion of thumb/digit sucking (p < 0.05). Children who used pacifiers daily for more than one year had higher chances of developing an anterior open bite (p < 0.05) and a reduced overbite (p < 0.05). Those exhibiting daily thumb/digit sucking for more than one year had higher chances of developing Class II incisor and Class II canine relationships, an increased overjet and anterior open bite (p < 0.05).

Conclusion

Pure breastfeeding for more than 6 months is inversely associated with daily pacifier use and daily pacifier use is positively associated with daily thumb/digit sucking. Children with more than one year of daily pacifier use and thumb/digit sucking have higher chances of developing abnormal dental relationships in the sagittal (i.e. Class II incisor and Class II canine relationships and increased overjet) and vertical (i.e. anterior open bite) dimensions, respectively.

Prevalence of malocclusion in primary dentition in mainland China, 1988-2017: a systematic review and meta-analysis

Malocclusion is a common oral disease affecting children with various reported prevalence rates. This meta-analysis aimed to determine the epidemiological characteristics of malocclusion among pre-schoolers in mainland China from 1988 to 2017. A total of 31 qualified papers describing 51,100 Chinese children aged 2–7 years were selected. The pooled malocclusion prevalence was 45.50% (95% confidence interval (CI): 38.08–52.81%) with 26.50% Class I (CI: 19.96–33.12%), 7.97% Class II (CI: 6.06–9.87%) and 12.60% Class III (CI: 9.45–15.68%) cases. The most common type of malocclusion was overbite (33.66%, CI: 27.66–39.67%), and the flush terminal type (47.10%, CI: 28.76–65.44%) was the most common in the terminal plane relationship. An increasing trend and wide variations across the country were observed. Additionally, there was no significant difference in malocclusion by gender (relative risk (RR) = 1.01, [0.96–1.06]) or urban/rural area (RR = 0.99, [0.82–1.20]). Although this study represents a narrow view of deciduous-dentition malocclusion in mainland China, the results provide sample evidence that can aid clinicians and policy makers towards early prevention and timely treatment.

Aspectos sociodemográficos relacionados à gravidade da maloclusão em crianças brasileiras de 12 anos

Resumo Estudo transversal e analítico para caracterizar a maloclusão em crianças brasileiras de 12 anos e identificar os aspectos sociodemográficos associados, utilizando dados do SB Brasil 2010. Foram incluídas 5539 crianças dentre as quais 41% possuíam algum grau de maloclusão, de acordo com o índice Dental Aesthetic Index (DAI). Conduziu-se análises descritivas, bivariadas e múltiplas por regressão logística multinomial. A maloclusão definida foi maior entre os que avaliaram sua saúde bucal como nem satisfeito/nem insatisfeito (OR 1,24; IC 95%; 1,03-1,50) e insatisfeito (OR 1,76; IC 95%; 1,50-2,08). A maloclusão grave foi maior entre crianças do Sudeste (OR 1,44; IC 95%; 1,06-1,96) e Sul (OR 1,52; IC 95%; 1,05-2,19), sexo masculino (OR 1,24; IC 95%; 1,03-1,48), raça negro/pardo (OR 1,39; IC 95%; 1,14-1,69) e que avaliaram sua saúde bucal como nem satisfeito/nem insatisfeito (OR 1,79; IC 95%; 1,41-2,26) e insatisfeito (OR 2,20; IC 95%; 1,77-2,72). O nível muito grave foi maior entre os residentes de capitais (OR 1,36; IC 95%; 1,07-1,71) e que avaliaram sua saúde bucal como nem satisfeito/nem insatisfeito (OR 1,58; IC 95%; 1,22-2,05) e insatisfeito (OR 2,44; IC 95%; 1,96-3,03). A prevalência da maloclusão é alta entre crianças brasileiras, sendo suas diferentes gravidades associadas a aspectos sociodemográficos.

Association of Breastfeeding Duration, Nonnutritive Sucking Habits, and Malocclusion

AIM

This study aimed to investigate the associations between breastfeeding, nonnutritive sucking habits (NNSHs), and malocclusion in deciduous, mixed, and permanent dentition.

MATERIALS AND METHODS

A sample of 50 children between 3 and 12 years, enrolled in a pediatric dentistry dental care program, underwent orthodontic examination for detection of occlusal patterns and malocclusion. In addition, data regarding breastfeeding duration and NNSH acquisition were obtained from standardized questionnaires responded by the children's parents or legal guardians.

RESULTS

Regardless of a long period of breastfeeding, a high incidence of NNSH in the evaluated sample was observed. Nevertheless, the presence of NNSHs was not significantly associated with malocclusion.

CONCLUSION

The findings could not indicate a statistically significant association between breastfeeding duration, acquisition of NNSHs, and malocclusion. Longitudinal studies with larger samples are still needed to better support clinical decisions.How to cite this article: Roscoe MG, da Silva Bonifacio SV, da Silva TB, Pingueiro JMS, Lemos MM, Feres MFN. Association of Breastfeeding Duration, Nonnutritive Sucking Habits, and Malocclusion. Int J Clin Pediatr Dent 2018;11(1):18-22.

Association between oronasopharyngeal abnormalities and malocclusion in Northeastern Brazilian preschoolers

Objective:

Evidence is contradictory regarding the association between oronasopharyngeal abnormalities and malocclusion. The aim of the present study was to assess the association between oronasopharyngeal abnormalities and malocclusion (anterior open bite and posterior crossbite) in preschoolers.

Methods:

A cross-sectional study was conducted with a representative sample of 732 preschoolers aged 3-5 years old selected randomly from private and public preschools. Anterior open bite (AOB) and posterior crossbite (PC) were evaluated through a clinical exam. Parents/caregivers answered a questionnaire addressing sociodemographic indicators and oronasopharyngeal issues. Statistical analysis involved descriptive analysis and Poisson regression (p < 0.05).

Results:

The prevalences of AOB and PC were 21.0% and 11.6%, respectively. Being three years old (PR = 1.244; 95% CI = 1.110-1.394; p < 0.001), being four years old (PR = 1.144; 95% CI = 1.110 - 1.394; p = 0.015), absence of allergy (PR = 1.158; 95% CI = 1.057 - 1.269; p = 0.002), not having undergone nose surgery (PR = 1.152; 95% CI = 1.041 - 1.275; p = 0.006) and having a sore throat more than five times in the same year (PR = 1.118; 95% CI = 1.011 - 1.237; p = 0.030) were significantly associated with AOB. The absence of asthma (PR = 1.082; 95% CI = 1.012 - 1.156; p = 0.020), not having undergone throat surgery (PR = 1.112; 95% CI = 1.068 - 1.158; p < 0.001) and not having undergone nose surgery (PR = 1.114; 95% CI = 1.069 - 1.160; p < 0.001) remained associated with PC.

Conclusion:

Significant associations were found between oronasopharyngeal-reported abnormalities and the presence of AOB and PC in preschoolers.

Association between duration of breastfeeding and malocclusions in primary and mixed dentition: a systematic review and meta-analysis

The aim of this systematic review and meta-analysis was to examine the current evidence on the possible effects of breastfeeding on different malocclusion traits in primary and mixed dentition. A systematic search was made in three databases, using terms related to breastfeeding and malocclusion in primary and mixed dentition. Of the 31 articles that met the inclusion criteria and were included in the qualitative analysis, nine were included in the quantitative analysis. The quality of the 31 observational studies was moderate to high on the Newcastle-Ottawa Scale. It was found that the odds ratio for the risk of posterior crossbite was 3.76 (95% CI 2.01-7.03) on comparing children who had not been breastfed, with those breastfed for over six months, and rose to 8.78 (95% CI 1.67-46.1) when those not breastfed were compared to those breastfed for over twelve months. The odds ratio for class II malocclusion in children breastfed for up to six months compared to those breastfed for over six months was 1.25 (95% CI 1.01-1.55). Lastly, children who were breastfed for up to six months had an odds ratio of 1.73 (95% CI 1.35-2.22) for non-spaced dentition compared to those who were breastfed for over six months.

Prevalence of Malocclusion in 3- to 5-Year-Old Children in Shanghai, China

The aim of the present study was to obtain the prevalence of malocclusions in preschool children in Shanghai, China. A cross-sectional survey was conducted among 2335 children aged 3-5 years from kindergartens. Several occlusal parameters were clinically assessed, including second deciduous molar terminal plane, canine relationship, degree of overjet and overbite, anterior and posterior crossbite, and the presence or absence of physiologic spaces and crowding. All parents of subjects were asked to fill in the oral health knowledge questionnaires. The prevalence of malocclusion in primary dentition in Shanghai was 83.9%, and no significant differences were found in genders. Data showed that the prevalence of deep overbite (63.7%) was the highest in children with malocclusion, followed by deep overjet (33.9%), midline deviation (26.6%), anterior crossbite (8.0%) and anterior crowding (6.5%). The results revealed a high prevalence of malocclusion in primary dentition in children aged 3-5 years old of Shanghai, especially in vertical anomalies. The need for preventive orthodontic therapy is extremely desired and oral health education about malocclusion should be strengthened.

Desenvolvimento da fala e alimentação infantil: possíveis implicações

RESUMO Objetivo: identificar a associação entre hábito alimentar e desenvolvimento da fala em crianças pré-escolares. Métodos: estudo do tipo caso-controle, com amostra constituída por 273 crianças matriculadas nos Centros Municipais de Educação Infantil da cidade do Recife. Foi pesquisada a associação do desfecho com variáveis referentes a características socioeconômicas, hábitos de sucção nutritiva e não nutritiva e desenvolvimento do sistema estomatognático. Foram utilizados os softwares STATA/SE 9.0 e Excel 2007 para calcular a medida de risco, OddsRatio, o intervalo de confiança de 95% e o valor de p≤0,05. Para verificar a existência de associação, aplicou-se o teste qui-quadrado para variáveis categóricas. Resultados: no que se refere às alterações de fala, verificou-se associação significante no sexo masculino. Já os hábitos de sucção não se associaram significantemente com o desfecho estudado. Com relação ao sistema estomatognático, registra-se associação significante às alterações de fala, principalmente no que concerne à postura habitual de lábios e língua, assim como com a presença de oclusopatias. Não houve associação significante entre a variável de consistência alimentar e o evento estudado. Conclusão: a consistência alimentar demonstrou associação significante com variáveis que impactam na fisiologia adequada do sistema estomatognático, em termos de órgãos fonoarticulatórios e desempenho de funções, podendo-se inferir que padrão alimentar e fala constituem ponto de convergência na saúde infantil.

Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis

BACKGROUND

The authors studied the effects of nonnutritive sucking behavior (NNSB) on malocclusions through a systematic review of association (etiology).

TYPES OF STUDIES REVIEWED

The authors performed a 3-step search strategy, including electronic searches. Studies of healthy participants with a history of active or previous NNSB, for whom specific malocclusion outcomes had been assessed, were eligible for inclusion. The authors considered before-and-after studies, prospective and retrospective (longitudinal) studies, case-control studies, and analytical cross-sectional studies. They excluded reviews, text- and opinion-based articles, conference abstracts, case reports, case-series, and descriptive cross-sectional studies. The authors, using standardized instruments, independently assessed methodological quality and extracted data from the included studies. In situations for which there were sufficient studies, the authors conducted meta-analyses using the random-effects model, supplemented with the fixed-effects model in situations for which statistical heterogeneity was less than 50%, which the authors assessed using the I² statistic.

RESULTS

The authors included 15 identified studies. They found that NNSB was associated with varying risks of developing malocclusions. Pacifier suckers are less likely to develop an increased overjet compared with digit suckers, although the results of a meta-analysis of 7 studies whose investigators had assessed posterior crossbite in the primary dentition demonstrated a significant association with pacifier sucking over digit sucking (n = 5,560; risk ratio, 1.42; 95% confidence interval, 1.18-1.70; P = .0001). Longer duration of NNSB was associated with an increased risk of developing malocclusions. Across-study heterogeneity likely resulted from methodological and sample size differences.

CONCLUSIONS

The authors of this study have confirmed the association between NNSB and the development of malocclusions. This study provides the highest level of evidence on this topic. Pacifiers were associated with a higher risk of developing most malocclusion features when compared with digit sucking.

PRACTICAL IMPLICATIONS

Though malocclusions are of multifactorial etiology, clinicians should inform parents and caregivers about the dental risks of NNSB, an environmental factor that is modifiable. NNSB should be discouraged in order to avoid the development of malocclusions. Future studies should adopt standardized, universally agreed and accepted definitions and classifications when measuring and reporting orthodontic outcome measures. This will help achieve across-study homogeneity.

Oral health in the agenda of priorities in public health

This study describes the scientific production on oral health diffused in Revista de Saúde Pública, in the 50 years of its publication. A narrative review study was carried out using PubMed, as it is the search database that indexes all issues of the journal. From 1967 to 2015, 162 manuscripts specifically focused on oral health themes were published. This theme was present in all volumes of the journal, with increasing participation over the years. Dental caries was the most studied theme, constantly present in the journal since its first issue. Periodontal disease, fluorosis, malocclusions, and other themes emerged even before the decline of dental caries indicators. Oral health policy is the most recurring theme in the last two decades. Revista de Saúde Pública has been an important vehicle for dissemination, communication, and reflection on oral health, contributing in a relevant way to the technical-scientific interaction between professionals in this field.

Prevalence of malocclusion among Iranian children: A systematic review and meta-analysis

BACKGROUND

The high prevalence of malocclusion is a public health problem in the world and the third priority in oral care. Numerous primary studies have presented reports on the prevalence of malocclusion among Iranian children. In combination, the results of these studies using meta-analysis are highly valuable for health policy-making. Similarly, this study aimed at determining the prevalence of different types of malocclusion among Iranian children.

MATERIALS AND METHODS

Using relevant keywords, national and international databases were explored. After narrowing down the search strategy and leaving out the duplicates, the remaining articles were screened based on titles and abstracts. To increase search sensitivity, reference lists of the papers were examined. To identify unpublished articles and documentations, a set of negotiations were done with the people involved and research centers. Finally, the heterogeneity index between the studies was determined using Cochran (Q) and I2 tests. According to the results of heterogeneity, the random effects model was used to estimate the prevalence of malocclusion in Iran.

RESULTS

In total, 25 articles were included in the meta-analysis process. The prevalence of dental malocclusion was estimated in 28,693 Iranian children aged 3-18 years. The total prevalence of Class I, II, and III malocclusion was 54.6% (46.5-62.7), 24.7% (20.8-28.7), and 6.01% (4-7.1), respectively. The prevalence of Class I, II, and III malocclusion was 44.6% (32.9-56.2), 21.5% (18.01-25.1), and 4.5% (3.2-5.9) in boys and 48.8% (36.8-60.8), 21.5% (16.9-25.1), and 5.5% (3.9-7.1) in girls, respectively.

CONCLUSION

This study showed a high prevalence of malocclusion among Iranian children. Also, the results indicated that the prevalence is higher in girls.

Early risk factors for posterior crossbite and anterior open bite in the primary dentition

OBJECTIVE

To investigate risk factors specific to posterior crossbite and anterior open bite at the age of 3 years.

MATERIALS AND METHODS

The study included 422 children of the French EDEN mother-child cohort. The main outcomes were the presence of posterior crossbite and anterior open bite assessed by dentists at 3 years. Social characteristics (collected during pregnancy), neonatal characteristics (collected at birth), duration of breast-feeding (collected prospectively), sucking habits at 3 years, and open lips (as a proxy for mouth breathing) were studied and two logistic regressions conducted.

RESULTS

Preterm birth appears to be a risk factor specific for posterior crossbite (OR: 3.13; 95% CI: 1.13-8.68), whereas small for gestational age seems to be associated with a lower risk of posterior crossbite (OR: 0.32; 95% CI: 0.12-0.87). Ongoing pacifier or thumb sucking at 3 years is a risk factor for both posterior crossbite and anterior open bite.

CONCLUSIONS

Children born preterm seem to be more at risk for posterior crossbite than those born at term. Different mechanisms may be involved in posterior crossbite and anterior open bite.

Pacifier Use and Exclusive Breastfeeding in Brazil

BACKGROUND

Exclusive breastfeeding (EBF) rates for infants younger than 6 months have increased in Brazil, although at the current pace of improvement it would take 6 years to reach an EBF rate of 50%. Thus, it is important to identify relevant modifiable key risk factors for the premature interruption of EBF.

OBJECTIVE

This study aimed to find out if pacifier use is an independent risk factor for the interruption of EBF among Brazilian infants.

METHODS

We conducted secondary cross-sectional data analyses of 2 waves of infant feeding surveys conducted in 1999 and in 2008 in the Brazilian state capitals and Federal District (N = 42 395 children < 6 months). Multivariate logistic regression was used to test the association between pacifier use and the risk of interruption of EBF in a pooled sample and within each survey wave, adjusting for socioeconomic, demographic, and biomedical confounders.

RESULTS

In the pooled sample, a third of the infants were exclusively breastfed (32.7%) and almost 50% had used a pacifier. Whereas EBF prevalence among infants increased from 25.1% in 1999 to 40.3% in 2008, pacifier use prevalence decreased from 58.5% to 41.6% in the same time period. Pacifier use was strongly associated with the risk of interruption of EBF in 1999 (adjusted odds ratio [AOR] = 2.65; 95% confidence interval [CI], 2.38-2.94), in 2008 (AOR = 3.18; 95% CI, 2.81-3.60), and in the pooled sample (AOR = 2.77; 95% CI, 2.63-2.91) after adjusting for key confounders.

CONCLUSION

Pacifier use was the strongest risk factor for EBF interruption. Effective strategies to reduce pacifier use among infants younger than 6 months may further improve EBF rates in Brazil.

The impact of an educational pamphlet on the awareness of parents about 4‒6-year-old children's oral habits and dentofacial discrepancies

Background. This study aimed to evaluate whether the parents’ knowledge about the adverse effects of oral habits and dentoskeletal discrepancies would improve by an educational pamphlet.

Methods. A parallel-group randomized clinical trial was conducted on parents in kindergartens of Shiraz, Iran, 2013. The parents completed a designed questionnaire to determine the pre-intervention score. The study group received an educational pamphlet on the oral habits and dentoskeletal discrepancies, in contrast to the control group. Three weeks later, the parents in both groups took the questionnaire again (post-intervention score). The primary outcome was a change in the parents’ knowledge about oral habits and dentoskeletal discrepancies, which was measured by 13 questions of the questionnaire. Each correct answer was given a positive point and each incorrect answer a negative point. The total pre- and post-intervention scores were calculated by summing up the points and compared using Mann–Whitney U test.

Results. A total of 550 subjects were assessed for eligibility and 413 were randomized. Of the study group, 203 subjects (98.56%), and of the control group, 204 parents (98.54%) completed the questionnaire for the second time. The score of the study group in the "normal occlusion" section of the questionnaire had significantly improved (P < 0.001) and in the "oral habits" section the score of both groups had improved but in the study group the improvement was significantly higher (P < 0.001).

Conclusion. The educational pamphlet can be effective in increasing the level of parents’ knowledge about normal occlusion and complications of oral habits.

Digit Sucking Habit and Association with Dental Caries and Oral Hygiene Status of Children Aged 6 Months to 12 Years Resident in Semi-Urban Nigeria

Objectives

Non-nutritive sucking (NNS) is a common behavior in childhood. The association between digit sucking, dental caries and oral health has been studied with inconclusive results. The objectives of this study were to determine the prevalence of, and the association between digit sucking, caries and oral hygiene status of children age six months to 12 years, resident in Ile-Ife, Osun State, Nigeria.

Methods

A cross-sectional study was conducted in Ife Central Local Government Area of Osun State. Data were collected through a household survey using a multi-stage sampling procedure from children between six months and 12 years. Details of each child’s socio-demographic characteristics, digit sucking habits, caries status and oral health status were collected. The association between digit sucking, caries status and oral hygiene status was determined using Chi square and Logistic regression.

Results

The mean age of the 992 study participants was 5.8 ± (3.2) years. The prevalence of digit sucking, caries and poor oral hygiene were 7.2%, 10.5% and 2.4% respectively. The mean dmft score was 0.22 ± (0.80), mean DMFT score was 0.04 ± (0.30) while mean Oral Hygiene Index score was 1.27 ± (0.73). Digit sucking increased the odds of having caries (OR: 1.28; CI: 0.58–2.81) but decreased the odds of having poor oral hygiene (OR: 0.58; CI: 0.34–1.01) insignificantly.

Conclusions

Digit sucking was not a significant predictor of caries and oral hygiene status, although the odds of having caries increased while the odds of having poor oral hygiene decreased with digit sucking.

Sugar Consumption and Changes in Dental Caries from Childhood to Adolescence

There are no prospective studies investigating the effects of sugar-related feeding practices on changes in dental caries from early childhood to young adulthood. The aim of this study was to assess whether sugar-related feeding practices affect dental caries between the ages of 6 and 18 y. This birth cohort study was initiated in 1993 in Pelotas, Brazil. There were 3 dental clinical assessments; at ages 6 y (n = 359), 12 y (n = 339), and 18 y (n = 307). Sugar-related feeding practices were assessed at ages 4, 15, and 18 y. Covariates included sex and life course variables, such as family income, breast-feeding, mother's education, regularity of dental visit, and child's toothbrushing habits. Group-based trajectory analysis was performed to characterize trajectories of time-varying independent variables that had at least 3 time points. We fitted a generalized linear mixed model assuming negative binomial distribution with log link function on 3-time repeated dental caries assessments. One in 5 participants was classified as "high" sugar consumers, and nearly 40% were "upward consumers." "Low consumers" accounted for >40% of the sample. High and upward sugar consumers had higher dental caries prevalence and mean DMFT in all cohort waves when compared with low sugar consumers. Caries occurred at a relatively constant rate over the period of study, but in all sugar consumption groups, the increment of dental caries was slightly higher between ages 6 and 12 y than between 12 and 18 y. Adjusted analysis showed that dental caries increment ratio between ages 6 and 18 y was 20% and 66% higher in upward and high sugar consumer groups as compared with low consumers. The higher the sugar consumption along the life course, the higher the dental caries increment. Even the low level of sugar consumption was related to dental caries, despite the use of fluoride.

Exploring the association between feeding habits, non-nutritive sucking habits, and malocclusions in the deciduous dentition

Background

This study aimed to explore the association between feeding habits, non-nutritive sucking habits, and malocclusions in deciduous dentition.

Methods

A cross-sectional observational survey was carried out in 275 children aged 3 to 6 years and included clinical evaluations of malocclusions and structured interviews. Statistical significance for the association between feeding habits and the development of malocclusion was determined using chi-square and Fisher’s exact tests. In addition, odds ratio (OR) calculations were used for intergroup comparisons. Controlling for confounders was adjusted by excluding children with non-nutritive sucking habits.

Results

The results indicated that there were no significant relationships between exclusive breastfeeding or bottlefeeding and the presence of any type of malocclusion (p > 0.05). There was also no significant association between breastfeeding or bottlefeeding duration and malocclusion (p > 0.05). In addition, it was observed that exclusive breastfeeding had a protective effect and diminished the risk of acquiring non-nutritive sucking habits (p = 0.001).

Conclusions

There was no association between feeding habits and malocclusions in the deciduous dentition in this sample of children. Exclusive breastfeeding reduced the risk of acquiring non-nutritive sucking habits.

Effect of breastfeeding on malocclusions: a systematic review and meta-analysis

AIM

The objective of this systematic review was to investigate whether breastfeeding decreases the risk of malocclusions.

METHODS

Six databases were systematically searched to the end of October 2014. Observational and interventional studies were included. Breastfeeding was evaluated in three categories: (i) ever versus never; (ii) exclusive versus absence of exclusive; and (iii) longer periods versus shorter periods. All types of malocclusion were considered as the outcome. Pooled adjusted odds ratio and its 95% confidence interval (95%CI) were obtained from meta-analyses. Heterogeneity was assessed with both the Q-test and the I-square. Funnel plots and Egger's test were employed to assess publication bias.

RESULTS

Forty-eight studies were included in the systematic review, and 41 were included in the overall meta-analysis (n = 27 023 participants). Subjects who were ever breastfed were less likely to develop malocclusions than those never breastfed (OR 0.34; 95% CI 0.24; 0.48), those who were exclusively breastfed presented lower risk to present malocclusion than those with absence of exclusive breastfeeding (OR 0.54; 95% CI 0.38; 0.77), and subjects longer breastfed were less likely to have malocclusions than those shorter breastfed (OR 0.40; 95% CI 0.29; 0.54).

CONCLUSION

Breastfeeding decreases the risk of malocclusions.

Changes of some functional speech disorders after surgical correction of skeletal anterior open bite

Skeletal anterior open bite (AOB) or apertognathism is characterized by the absence of contact of the anterior teeth and affects articulation parameters, chewing, biting and voice quality. The treatment of AOB consists of orthognatic surgical procedures. The aim of this study was to evaluate the effects of treatment on voice quality, articulation and nasality in speech with respect to skeletal changes. The study was prospective; 15 patients with AOB were evaluated before and after surgery. Lateral cephalometric x-ray parameters (facial angle, interincisal distance, Wits appraisal) were measured to determine skeletal changes. Before surgery, nine patients still had articulation disorders despite speech therapy during childhood. The voice quality parameters were determined by acoustic analysis of the vowel sound /a/ (fundamental frequency-F0, jitter, shimmer). Spectral analysis of vowels /a/, /e/, /i/, /o/, /u/ was carried out by determining the mean frequency of the first (F1) and second (F2) formants. Nasality in speech was expressed as the ratio between the nasal and the oral sound energies during speech samples. After surgery, normalizations of facial skeletal parameters were observed in all patients, but no statistically significant changes in articulation and voice quality parameters occurred despite subjective observations of easier articulation. Any deterioration in velopharyngeal insufficiency was absent in all of the patients. In conclusion, the surgical treatment of skeletal AOB does not lead to deterioration in voice, resonance and articulation qualities. Despite surgical correction of the unfavourable skeletal situation of the speech apparatus, the pre-existing articulation disorder cannot improve without professional intervention.

Exclusive Breastfeeding and Risk of Dental Malocclusion

OBJECTIVES

The distinct effect of exclusive and predominant breastfeeding on primary dentition malocclusions is still unclear. We hypothesized that exclusive breastfeeding presents a higher protective effect against malocclusions than predominant breastfeeding and that the use of a pacifier modifies the association between breastfeeding and primary dentition malocclusions.

METHODS

An oral health study nested in a birth cohort study was conducted at age 5 years (N = 1303). The type of breastfeeding was recorded at birth and at 3, 12, and 24 months of age. Open bite (OB), crossbite, overjet (OJ), and moderate/severe malocclusion (MSM) were assessed. Poisson regression analyses were conducted by controlling for sociodemographic and anthropometric characteristics, sucking habits along the life course, dental caries, and dental treatment.

RESULTS

Predominant breastfeeding was associated with a lower prevalence of OB, OJ, and MSM, but pacifier use modified these associations. The same findings were noted between exclusive breastfeeding and OJ and between exclusive breastfeeding and crossbite. A lower prevalence of OB was found among children exposed to exclusive breastfeeding from 3 to 5.9 months (33%) and up to 6 months (44%) of age. Those who were exclusively breastfed from 3 to 5.9 months and up to 6 months of age exhibited 41% and 72% lower prevalence of MSM, respectively, than those who were never breastfed.

CONCLUSIONS

A common risk approach, promoting exclusive breastfeeding up to 6 months of age to prevent childhood diseases and disorders, should be an effective population strategy to prevent malocclusion.

Life course models for upper aero-digestive tract cancer

Upper aero-digestive tract (UADT) cancers are collectively cancers of various human body sites, such as the oral cavity, pharynx, oesophagus and larynx. Worldwide, they are the fourth most frequent cancer type and the fourth most common cause of mortality from cancer. Many studies have shown that several chronic diseases, such as cancer, which occur more commonly in later adulthood, are influenced by social and psychological circumstances during birth, childhood, adolescence and early adult life. It is suggested that the build up of problematic circumstances throughout life is the cause of disease, rather than circumstances that happen at one point in time. UADT cancer is a chronic disease of complex multifactorial origin and most of the underlying exposures/risks cannot be considered as individual factors or in isolation, as they act at different levels, which differ from time to time. Thus, life-course epidemiology, rather than drawing false dichotomies between different risk factors of the underlying disease, attempts to integrate biological and social risk processes that cause the chronic disease. It studies how socially patterned exposures during all stages of life--childhood, adolescence and early adult--influence disease risk in adulthood and socio-economic position and hence may account for social inequalities in adult health and mortality. Furthermore, varying health effects, according to the timing or duration of exposure to socio-economic circumstances, may indicate important traces to the causes of cancer. In this paper, we have attempted to draw a conceptual framework on the relationships between socio-economic inequalities, oral health risk factors along the life-course of an individual and incidence of UADT cancer.

Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: a systematic review of cohort studies

The World Health Organization recommends exclusive breast feeding for at least six months. However, there is no scientific evidence of the benefits of breast feeding for oral health in children under primary dentition. This study aimed to search for scientific evidence regarding the following question: is bottle feeding associated with malocclusion in the primary dentition compared to children that are breastfed? An electronic search was performed in seven databases. The systematic review included 10 cohort studies. It was not possible to conduct meta-analysis; therefore a qualitative analysis was assessed. The majority of studies evaluated feeding habits by means of questionnaires and conducted a single examination. Three studies observed that bottle feeding was significantly associated with overjet and posterior crossbite. Studies reported several cut-off times for breastfeeding (varying from 1 month up to 3 years of age) and several types of malocclusion. Controlling for non-nutritive sucking habits was reported for only half of the studies and this may have led to biased results. The scientific evidence could not confirm a specific type of malocclusion associated with the feeding habits or an adequate time of breastfeeding to benefit the children against malocclusion. Further cohort studies are needed to confirm this evidence.

Association of breastfeeding and three-dimensional dental arch relationships in primary dentition

BACKGROUND

The benefits of breastfeeding on oral health are still inconclusive, especially the association on occlusion. This study aimed to investigate the association of breastfeeding and the development of primary dentition.

METHODS

A cross-sectional study was conducted with 851 Asian children aged 2-5 years old in Hong Kong. Questionnaires were completed by the parents to collect information on breastfeeding and the non-nutritive sucking habits. The children's dental arch relationships were examined in the sagittal, vertical, and transverse dimensions by an experienced examiner.

RESULTS

Children who experienced pure breastfeeding for more than 6 months had a lower chance of developing a class II incisal relationship (P < 0.05) or an increased overjet (P < 0.05), and had wider intercanine (P < 0.05) and intermolar widths (P < 0.05). Vertically, no association on the extent of overbite or openbite was found (P > 0.05).

CONCLUSIONS

Pure breastfeeding for more than 6 months is positively associated with primary dental arch development in the anterior sagittal dental segment and on the horizontal arch width in primary dentition. Therefore, pure breastfeeding for more than 6 months is recommended, as it is associated with lower chance of the development of abnormal dental relationships. The results will be valuable for education and promotion of maternal breastfeeding.

Factors associated with the prevalence of anterior open bite among preschool children: a population-based study in Brazil

INTRODUCTION:

The aim of this study was to identify factors associated with the prevalence of anterior open bite among five-year-old Brazilian children.

METHODS:

A cross-sectional study was undertaken using data from the National Survey of Oral Health (SB Brazil 2010). The outcome variable was anterior open bite classified as present or absent. The independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through bivariate and multivariate analysis using SPSS statistical software (version 18.0) with a 95% level of significance.

RESULTS:

The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02). Children identified with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03).

CONCLUSION:

There was a significant association between anterior open bite and the region of Brazil where the children lived, the presence of altered overjet and the prevalence of posterior crossbite.