Association between malocclusion and articulation of phonemes in early childhood.

OBJECTIVES: To evaluate the relationship between dental malocclusion and speech to understand the etiology of speech sound disorders (SSD) in schoolchildren and to make a correct diagnosis and treatment plan. MATERIALS AND METHODS: Articulation and dental occlusion, oromyofunctional evaluation with orofacial praxis and musculature, resting tongue position, and swallowing pattern were analyzed in 290 schoolchildren between the ages of 4 and 7 years. Statistical tests were considered significant for P < .05. RESULTS: A significant association between dental malocclusions (Angle Class II and III, anterior open bite, edge-to-edge bite, overjet and anterior crossbite) and phonetic alterations (P = .008) was observed. Sigmatisms and rhotacisms were the most frequent disorders. Malocclusions also showed a significant association with oral habits and with orofacial praxis and muscle activity. CONCLUSIONS: The presence of malocclusion can cause imbalances in the functions involved in the stomatognathic system. Awareness of this relationship in young children would help professionals to implement preventive measures for the optimum development of children's oral health.

Three-dimensional ultrasound evaluation of tongue posture and its impact on articulation disorders in preschool children with anterior open bite.

Background Tongue posture plays an important role in the etiology of anterior open bite (AOB) and articulation disorders, and is crucial for AOB treatment planning and posttreatment stability. Clinical assessment of tongue posture in children is unreliable due to anatomical limitations. The aim of the study was to present functional diagnostics using three-dimensional ultrasound (3DUS) assessment of resting tongue posture in comparison to clinical assessment, and the associations between the improper tongue posture, otorhinolaryngological characteristics, and articulation disorders in preschool children with AOB. Patients and methods A cross-sectional study included 446 children, aged 3-7 years, 236 boys and 210 girls, examined by an orthodontist to detect the prevalence of AOB. The AOB was present in 32 children. The control group consisted of 43 children randomly selected from the participants with normocclusion. An orthodontist, an ear, nose and throat (ENT) specialist and a speech therapist assessed orofacial and ENT conditions, oral habits, and articulation disorders in the AOB group and control group. Tongue posture was also assessed by an experienced radiologist, using 3DUS. The 3DUS assessment of tongue posture was compared to the clinical assessment of orthodontist and ENT specialist. Results The prevalence of AOB was 7.2%. The AOB group and the control group significantly differed regarding improper tongue posture (p < 0.001), and articulation disorders (p < 0.001). In children without articulation disorders from both groups, the improper tongue posture occured less frequently than in children with articulation disorders (p < 0.001). After age adjustment, a statistical regression model showed that the children with the improper tongue posture had higher odds ratios for the presence of AOB (OR 14.63; p < 0.001) than the others. When articulation disorders were included in the model, these odds ratios for the AOB became insignificant (p = 0.177). There was a strong association between the improper tongue posture and articulation disorders (p = 0.002). The 3DUS detected the highest number of children with improper resting tongue posture, though there was no significant difference between the 3DUS and clinical assessments done by orthodontist and ENT specialist. Conclusions The 3DUS has proved to be an objective, non-invasive, radiation free method for the assessment of tongue posture and could become an important tool in functional diagnostics and early rehabilitation in preschool children with speech irregularities and irregular tongue posture and malocclusion in order to enable optimal conditions for articulation development.

Correlation between functional disorders of the masticatory system and speech sound disorders in children aged 7-10 years.

BACKGROUND: Masticatory system and speech sound disorders concur, have the same causes and similar consequences - both increase the risk of dental and periodontal diseases. OBJECTIVES: The study was conducted to establish the correlation between functional disorders of the masticatory system and speech sound disorders. MATERIAL AND METHODS: Three hundred patients aged 7-10 years were examined to detect functional disorders of the masticatory system and speech sound disorders. Functional disorders were assessed in patients with and without speech sound disorders. RESULTS: According to the study results, functional disorders of the masticatory system concur more often with speech sound disorders than with correct articulation and lead to speech sound disorders. There is a strong correlation between: - any dysfunction and errors in the /p/, /b/, /m/, /s/, /z/, /t͡ s/, /d͡ z/, /ɕ/, /ʑ/, /t͡ ɕ/, and /d͡ ʑ/ sounds, - mouth breathing and errors in the /p/, /b/, /m/, /s/, /z/, /t͡ s/, /d͡ z/, /ɕ/, /ʑ/, /t͡ ɕ/, and /d͡ ʑ/ sounds, - persistent tongue thrust and errors in the /s/, /z/, /t͡ s/, /d͡ z/, /ʂ/, /ʐ/, /t͡ ʂ/, /d͡ ʐ/, /ɕ/, /ʑ/, /t͡ ɕ/, and /d͡ ʑ/ sounds, and - parafunctional sucking and errors in the /s/, /z/, /t͡ s/, /d͡ z/, /ʂ/, /ʐ/, /t͡ ʂ/, /d͡ ʐ/, /ɕ/, /ʑ/, /t͡ ɕ/, and /d͡ ʑ/ sounds. CONCLUSIONS: To implement effective and early prevention and treatment, it is crucial to know the correlation between the masticatory system and speech sound disorders, as it reduces treatment duration and minimizes relapses of not only communication disorders, but also of concurrent masticatory system disorders.

[Effect of dental arch length decrease during orthodontic treatment in the upper airway development. A review]. / Impact de la diminution du périmètre des arcades dentaires lors d'une prise en charge orthodontique dans le développement des voies aériennes supérieures. Une revue de la littérature.

INTRODUCTION: A possible relation between an upper airway space decrease and the development of obstructive sleep apnea syndrom explains the importance to know the effect of the modification of dental arch length on the upper airway during orthodontic treatment. OBJECTIVES: The aim of this article is to expose recent knowledge about upper airway development and dental arch length decrease factors, to determine the influence of this decrease on upper airway development. METHODS: A review was done to determine the upper airway normal development, to define dental arch to specify if an ideal position of dental arch on apical base exists. All of the length dental arch decrease factors during orthodontic treatment (dental extraction, dental agenesis and dental malpositions) and their upper airway resounding were searched. RESULTS: Some authors found a diminution of upper airway space after premolars extractions while others didn't found this diminution after extractions premolars when incisor retraction is finished. A decrease of transversal maxillary diameter and nasal cavity may be due to absence of permanent teeth. CONCLUSION: The effect of dental arch length decrease during orthodontic treatment in the upper airway development was not scientifically proved. However we had to be vigilant and adapt our orthodontic treatment case by case to avoid an upper airway modification.

[Effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition].

OBJECTIVE: To assess the effects of breast-feeding duration, bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Beijing. METHODS: This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents/guardians. The examination was performed by a single, previously calibrated examiner and the following variables were evaluated: presence or absence of deep overbite, open bite, anterior cross bite, posterior cross bite, deep overjet, terminal plane relationship of the second primary molar, primary canine relationship, crowding and spacing. Univariate analysis and multiple Logistic regressions were applied to analyze the associations. RESULTS: It was found that a short duration of breast-feeding (never or ≤6 months) was directly associated with posterior cross bite (OR=3.13, 95%CI=1.11-8.82, P=0.031) and no maxillary space (OR=1.63, 95%CI=1.23-2.98, P=0.038). In children breast-fed for ≤6 months, the probability of developing pacifier-sucking habits was 4 times that for those breast-fed for >6 months (OR=4.21, 95%CI=1.85-9.60, P=0.000 2). The children who were bottle-fed for over 18 months had a 1.45-fold higher risk of nonmesial step occlusion and a 1.43-fold higher risk of class II canine relationship compared with those who were bottle-fed for 6-18 months. Non-nutritive sucking habits were also found to affect occlusion: a prolonged digit-sucking habit increased the probability of an anterior open bite, while a pacifier-sucking habit was associated with excessive overjet and absence of lower arch developmental space. Tongue-thrust habit was associated with anterior open bite (OR=4.21, 95%CI=1.85-9.60, P=0.000 2) and posterior cross bite (OR=7.24, 95%CI=1.30-40.13, P=0.024). Lower lip sucking habit was associated with deep overjet and had a negative association with class III canine relationship. Unilateral chewing was associated with spacing in mandibular (OR=1.57, 95%CI=1.03-2.41, P=0.037). Mouth breathing was associated with chronic rhinitis and adenoidal hypertrophy and had an association with spacing in maxillary. The chi-square test did not indicate a statistically significant association between upper lip sucking habit and any occlusal characteristics. CONCLUSION: Breast-feeding duration was shown to be associated with the prevalence of posterior crossbite, or no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a longer duration of bottle-feeding were more likely to develop class II canine relationship. Children who had an oral habit were more likely to develop abnormal occlusal characteristics.

Implant therapy for a patient with Down syndrome and oral habits: A clinical report.

This clinical report describes prosthodontic therapy with an implant-supported partial fixed dental prosthesis for a patient with Down syndrome and concomitant oral habits, including tongue thrusting and thumb sucking.

[The tongue and ventilation: a recipe for failure?]. / Langue et ventilation : échec et mat∗.

Since publication of the studies by the functionalist school (Ricketts, Linder-Aronson, Gola...), the role of function, and ventilation in particular, appears to be taken more widely into account. The close interconnection of ventilation / growth / lingual function and malocclusion is now evident to all. However, although an ENT diagnosis of a ventilation defect and its etiology is now standard practice, treatment of the condition is not always sufficient to ensure a functional environment conducive to orthodontic stability, even when rehabilitation is prescribed. In some instances, certain highly-invasive surgical treatments can even exacerbate the initial situation.

[The transverse dimension, an all-too-neglected factor]. / La dimension transversale, un facteur trop souvent négligé∗.

A transverse dimension deficiency is most often the result of functional disorders. Poor tongue posture at rest and during function as well as digit-sucking give rise to deficiencies which are initially alveolar but which, with time, frequently end up becoming skeletal. The combination of functional rehabilitation and transverse dimension treatment is the best way to avoid many relapses. We need to monitor this anomaly closely, from diagnosis to retention. Otherwise, failure awaits us.

Timetable for oral prevention in childhood--developing dentition and oral habits: a current opinion.

As most of the etiologic factors of malocclusion are of genetic origin and thus cannot be prevented, environmental causative factors have become the focus for correction. Early interception of oral habits may be an important step in order to prevent occlusal disturbances in children. The identification of an abnormal habit and the assessment of its potential immediate and long-term effects on the dentition and potentially on the craniofacial complex should be made at an early stage. This paper focuses on the most common oral habits influencing dentofacial growth in childhood and management of these habits in the developing dentition.

Oral habits--part 2: beyond nutritive and non-nutritive sucking.

In addition to sucking habits, a range of other habits have been associated with short- and long-term dental and orthodontic problems. These habits include tongue thrusting and atypical swallowing, lip sucking, oral self-mutilation, mouth breathing, and bruxism. Although the association between form and function continues to be controversial, if habits are of sufficient duration they may lead to dental malocclusion and impede successful management. Oral self-injury and bruxism can lead to significant problems, such as soft tissue trauma and infection. Accurate history taking and examination are essential steps in formulating a diagnosis and management plan. Although a range of treatment options are often available, clear guidelines for treatment are difficult to develop due to a lack of high quality clinical trials. Optimal management is likely to be dictated by patient and severity variability. The purpose of this paper is to review and discuss the management of tongue thrust and atypical swallowing, lip sucking, oral self-mutilation, mouth breathing and bruxism.

Atypical swallowing: a review.

AIM: Atypical swallowing is a myofunctional problem consisting of an altered tongue position during the act of swallowing. High incidence in population, multifactorial etiology and the recurring connection with the presence of malocclusions made it a topic of strong interest and discussion in science. The purpose of this review is to illustrate the current orientation on the topic of atypical swallowing, trying in particular to answer two questions: 1) what kind of connection is there between atypical swallowing and malocclusion; 2) what kind of therapy should be used to solve it. METHODS: This review was conducted on the Medline database [www.ncbi.nim.nih.gov/pubmed] searching for the keywords "atypical swallowing" and "tongue thrust". We examined all the documents from the year 1990 onwards, excluding the ones about syndromic cases of the central motor system. RESULTS: The causal relation between the two problems seems to be biunique: some authors affirm that this oral habit starts as a compensation mechanism for a preexisting malocclusion (especially in case of open-bite); other texts show that it has a tendency to exacerbate cases of malocclusion; it is also proven that a non-physiological tongue thrust can negatively influence the progress of an ongoing orthodontic therapy. Thereby, the best therapeutic approach seems to be a multidisciplinary one: beside orthodontics, which is necessary to correct the malocclusion, it is essential to set up a myofunctional rehabilitation procedure to correct the oral habit, therefore granting long time permanent results. There is also proof of a substantial difference between the results obtained from early (deciduous or primary mixed dentition) or later treatments. CONCLUSION: The biunique causal relation between atypical swallowing and malocclusion suggests a multidisciplinary therapeutic approach, orthodontic and myofunctional, to temporarily solve both problems. An early diagnosis and a prompt intervention have a significantly positive influence on the therapy outcome.

One-step surgery and correction of the transverse dimension of the maxilla using the lingual technique: an original assisted transverse surgery method.

During orthodontic-surgical treatment, orthodontics must facilitate the surgery, and vice-versa. More specifically, surgical adjustment of the transverse dimension of the maxilla and its vertical and/or anteroposterior repositioning require orthodontic support. In addition to the orthodontic appliance, a palatal device is needed to guide and maintain the correction. In the lingual technique, this situation might appear to be difficult to manage since both the appliance and the auxiliaries are located on the same side. We demonstrate a removable tooth-supported expander as well as the use of dua-insertion palatal bands to solve a transverse maxillary deficit less than or equal to 5mm.

Midline diastema and its aetiology--a review.

Maxillary midline diastema is a common aesthetic complaint of patients. Treating the midline diastema is a matter of concern for practitioners, as many different aetiologies are reported to be associated with it. The appearance of midline diastema as part of the normal dental development makes it difficult for practitioners to decide whether to intervene or not at an early stage. The aim of this article is to review the possible aetiology and management options which will help the clinician to diagnose, intercept and to take effective action to correct the midline diastema. The available data shows that an early intervention is desirable in cases with large diastemas. Treatment modality, timing and retention protocol depends on the aetiology of the diastema. Therefore, priority needs to be given to diagnosing the aetiology before making any treatment decisions. Clinical Relevance: This article aims to determine and evaluate the aetiology and possible treatment options of midline diastema.

Rigo-Fede disease: case report.

Riga-Fede disease results when an infant's instinctive tongue thrusting and raking motion over recently erupted primary mandibular incisors causes a traumatic ulceration of the tongue and/or mouth floor. The symptoms and therapeutic approach to the condition are highlighted in this case report.

Oral habits as risk factors for anterior open bite in the deciduous and mixed dentition - cross-sectional study.

AIM: Anterior open bite (AOB) is an occlusal anomaly commonly associated with oral habits (OH). The aim of this study was to determine the prevalence of OH as a risk factor for the AOB. MATERIALS AND METHODS: A group of children aged between 3 and 12 years were observed. The statistical methodology included independent chi-square test, Fisher's exact test and binary logistic regression. RESULTS: The frequency of oral habits was of 43.5% in the deciduous dentition and 54.2% in the mixed dentition. There was a statistically significant association of pacifier sucking: 61.7 and 16.1 odd ratios (OR), and tongue thrust: 3.9 and 9.2 OR with AOB in both groups, respectively. Thumb sucking occurred only in the deciduous dentition with 5.6 OR. CONCLUSION: OH and AOB have a high frequency in children. They hinder the normal development of dental and skeletal structures. As OH are risk factors for AOB, the damaging habits most frequently associated are: pacifier sucking, thumb sucking, and tongue thrust. Due to the correlation between the prevalence of AOB and OH, prevention strategies incorporating psychological data related to children should be integrated into a national public health programme.

Oral habits in a population of Albanian growing subjects.

AIM: The aim of this study was to assess the prevalence of oral habits in an Albanian population of schoolchildren. STUDY DESIGN: A sample of 2617 subjects, aged 7-15, was examined by clinical observation without radiograms. The sample comprised 1257 males and 1360 females, with no history of orthodontic treatment. Aestethical frontal and profile analysis, intraoral and functional analysis were performed. STATISTICS: Gender and age differences were compared by chi-square test. The relationship between malocclusions and oral habits was assessed by t-test and the level of significance was assessed at 0.01. RESULTS: The findings indicated that oral habits were present in 2225 subjects (85.0%), 1103 males (87.7%) and 1121 females (82.4%); the most frequent oral habit was pacifier sucking (30%) and it was mostly present in the 7-11 years group. It was observed a significant correlation between oral habits and dental malocclusions, open bite, altered overjet and maxillary contraction. CONCLUSION The high number of oral habits observed in the studied sample suggest that prevention strategies adopted in other countries could be successfully integrated in the development of an effective national programme in Albania aimed at reducing malocclusion risk factors.