The effect of early childhood non-nutritive sucking behavior including pacifiers on malocclusion: a randomized controlled trial.

BACKGROUND/RATIONALE: Systematic reviews on the effects of pacifiers on occlusion have highlighted the need for quality RCTs. TRIAL DESIGN: Single region, three parallel-armed, prospective, randomized controlled trial. OBJECTIVES: To investigate the correlations between early childhood non-nutritive sucking habits and malocclusion. Specifically to test whether the use of a study pacifier has differing effects compared to other pacifiers and control, and whether the duration of pacifier use or digit sucking influence the occlusion. PARTICIPANTS: The subjects were firstborn children, born in 2008 in Vantaa, Finland. INTERVENTION: One-third of participants were offered study pacifiers, free of charge, from birth up to 2 years of age. The history of the subjects' sucking habits, including pacifier use was screened in a questionnaire at the age of 2 years, and clinical examinations were performed at the age of 7 years. In addition, the subjects were divided into groups that were equally matched regarding their mother's level of education. OUTCOMES: Posterior crossbite, anterior crossbite, overjet, deep bite, open bite, and crowding. RANDOMIZATION METHOD: Three districts were randomly allocated to three study groups by drawing lots. BLINDING: It was not possible to blind the clinicians or parents from the intervention. Blinding during data analysis was performed. RESULTS: From the original cohort of 2715 children born in the town of Vantaa, 1911 were excluded and 353 were lost to follow-up. The remaining 451 children were divided into three groups according to the use of pacifiers. The prevalence of posterior crossbite at the age of 7 years was higher if a non-study pacifier had been used (P = .005) even when matched for the mother's level of education (P = .029). The prevalence of posterior crossbite was higher if the pacifier habit had continued for 12 months or more compared to 11 months or less, 7% and 1%, respectively, (P = .003). Digit sucking for 12 months or more was associated with crowding (P = .016). The prevalence of crossbite in the study pacifier group was less than in control pacifiers. HARMS: No adverse harms were reported other than effects on the dentition. CONCLUSION: The use of pacifiers is associated with the posterior crossbite, especially if their use continues for a year or more. Parents/guardians should be advised to stop the use or reduce the use of pacifiers to a minimum after their child's first birthday. TRIAL REGISTRATION: ClinicalTrials.gov NCT01854502.

Effects of non-nutritive sucking habits on malocclusions: a systematic review.

The development of the craniomandibular system is guided by genetic interactions and environmental factors, including specific habits such as breastfeeding, bottle feeding, thumb sucking and the use of pacifiers. These habits can have a considerable impact on the growth of the developing jaws and can lead to malocclusion in children. This review aims to investigate potential associations between non-nutritive sucking habits (NNSHs) and malocclusions compared to the presence of nutritive sucking habits (NSHs). To carry out this systematic review, we followed the PRISMA protocol and performed a bibliographic search of the existing literature until April 2023 in the following electronic databases: Medline, PubMed, The Cochrane Library and Embase. Out of a total of 153 records, we included 21 studies. We found that the chances of diagnosing a malocclusion were higher for children with bottle nutrition when compared to breast-fed children. Breastfeeding provides protection against malocclusions. In the same manner, persistent NNSH habits appeared to be associated with increased chances of having malocclusions. The longer the child was breastfed, the shorter the duration of the pacifier habit and the lower the risk of developing moderate/severe malocclusions. The duration of the habits has a positive influence on the appearance of occlusion defects.

Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3-6 years.

BACKGROUND: Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children. METHODS: A total of 503 Japanese children (258 boys and 245 girls aged 3-6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion. RESULTS: 62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related. CONCLUSIONS: Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.

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.

Deleterious oral habits related to vertical, transverse and sagittal dental malocclusion in pediatric patients.

BACKGROUND: Malocclusion is highly reported among mixed dentition cases. Therefore, we aimed to determine the relationship of dental malocclusions in the vertical, transverse, sagittal planes with deleterious habits in pediatric patients. METHODS: A cross-sectional analytical study was carried out on 155 children aged 6-12 years attended at the clinic of the School of Dentistry of Universidad Nacional Mayor de San Marcos in 2017. RESULTS: Among 155 evaluated patients, 45.3% had vertical malocclusion, 52.0% had sagittal malocclusion and 13.6% had transverse malocclusion. The most frequent type of malocclusion in the vertical plane was anterior deep bite (22.2%), in the transverse plane, the edge-to-edge bite (7.1%) and the anterior crossbite (6.5%) were less frequent. Finally, in the sagittal plane, Class II Div 1 (20%) and Class III (20.7%) were the most frequent. Among the most common deleterious habits, anteroposition (58.7%) and mixed breathing (51.0%) were observed in contrast to the habit of retroposition, lip sucking and mouth breathing, which were the least frequent. Considering age and sex, children who have an atypical swallowing habit are more likely to have malocclusion in all three planes of space. CONCLUSIONS: It is concluded that there is an association between the deleterious habits with the different types of malocclusions in the different planes of the space, being the atypical swallowing a habit that should be early diagnosed and treated interdisciplinary.

Relationship of early weaning and non-nutritive sucking habits with facial development.

OBJECTIVE: To determine the frequency of malocclusion features, convex facial profile and non-nutritive sucking habits among children with and without early weaning. METHODS: The cross-sectional study was conducted at the National Institute of Child Health, Karachi, from June to December 2020, and comprised of either gender aged 3-6 years. The subjects were clinically examined, and details of lactation period, bottle feeding, thumb and pacifiers sucking were gathered from the parents to assess association with malocclusion. Data was analysed using SPSS 20. RESULTS: Of the 180 subjects, 100(55.5%) were boys and 80(45.5%) were girls. There was significant association of early weaning with non-nutritive sucking habits, absent primate spaces, deviated midlines, and complete overbite (p<0.05). Breastfeeding <2 years was significantly associated with anterior crossbite (p<0.05). Early weaning had no association with convex facial profile, distoclusion, anterior and posterior crossbite and increased overjet (p>0.05). Non-nutritive sucking habits had significant relationship with deviated dental midlines (p>0.05). Conclusion: Early weaning was found to be a factor in establishing non-nutritive sucking habits, and was strongly associated with crowding, disturbed vertical overlapping of incisors and developing decreased facial height. Breastfeeding for less than the recommended duration had a tendency to lead to anterior cross-bite.

Non-nutritive sucking habits in a child: A clinical protocol to their prevention and management.

Patients presenting with anterior open bites can be challenging to manage. This paper discusses the clinical features and aetiology of anterior open bites caused by non-nutritive sucking habits in a young child. It explores how these should be recognised and how certain interventions can be effective in their management. Whilst further high quality research is needed into the different methods and their effectiveness, the aim of the article is to provide a practical guide for general dental practitioners, orthodontists and paediatric dentists, who are involved in monitoring the developing dentitions of these patients.

Thumb sucking or nail biting in childhood and adolescence is associated with an increased risk of Crohn's disease: results from a large case-control study.

BACKGROUND: The hygiene hypothesis suggests that a reduction in microbial exposure contributes to an impaired immune response later in life and increases the incidence of immune-mediated diseases such as inflammatory bowel diseases (IBD). Thumb sucking and nail biting are two early habits that modulate the oral microbiota composition and antigen load. OBJECTIVE: We hypothesized a lower risk of Crohn's disease (CD) and ulcerative colitis (UC) in adults with prior thumb sucking and nail biting. METHODS: 918 IBD cases and their 918 siblings without IBD were asked to fill out a survey containing 32 questions on environmental factors in childhood and early adulthood. Prevalence of thumb sucking and/or nail biting at the usually well-remembered time of (1) school enrollment and (2) coming-of-age ceremonies was the predefined combined risk factor of this study. RESULTS: 65% of the patients were female and 57% suffered from CD. About 49% of IBD patients but only 44% of their siblings reported thumb sucking/nail biting at the time of school enrollment or coming-of-age (p = .007). Sensitivity analysis revealed that this difference was observed in patients with CD (50% versus 41%; RR= 1.22; 95% CI 1.09-1.37, p = .001) but not in patients with UC (49% versus 48%; RR= 1.02; 95% CI 0.90-1.17; p = .83). CONCLUSION: Contrary to our expectation and challenging the hygiene hypothesis, we found that common oral habits are not protective against IBD. Instead, nail biting at the time of school enrollment and coming-of-age was a statistically significant risk factor for CD in our cohort. Key summary Evidence available before this study: The hygiene hypothesis suggests that a reduction in microbial exposure due to improved health activities has contributed to an immunological imbalance in the intestine and an increased incidence of allergic and autoimmune diseases. A population-based birth cohort study has demonstrated that thumb-sucking and nail biting in children lead to a reduction of the risk of atopic sensitization, asthma, and hay fever. Added value of this study: Contrary to the hypothesis, thumb sucking and nail biting were not associated with a reduced risk of IBD. Instead, thumb sucking and/or nail biting at the usually well-remembered points in time of school enrollment and of religious or secular coming-of-age ceremonies was associated with a higher risk of Crohn's disease but not of ulcerative colitis. Our data did not support the hygiene hypothesis, one pathogenic concept in the context of IBD.

Distal and lateral subungual onychomycosis of the finger nail in a neonate: a rare case.

BACKGROUND: Onychomycosis is extremely rare in neonates, infrequently reported in children and is considered to be exclusively a disease of adults. CASE PRESENTATION: We, herein report a case of fingernail onychomycosis in a 28-day-old, healthy, male neonate. The child presented with a history of yellowish discoloration of the fingernail of the left hand for one week. The etiological agent was demonstrated both by microscopic examination and culture of nail clippings. The isolate grown on culture was identified as Candida albicans by phenotypic characteristics and by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Antifungal sensitivity testing was performed by broth dilution method as per the Clinical & Laboratory Standards Institute guidelines. An oral swab culture of the child also yielded C. albicans with the same antibiogram as the nail isolate. The case was diagnosed as distal and lateral subungual candida onychomycosis of severity index score 22 (severe) and was treated with syrup fluconazole 6 mg/kg body weight/week and 5% amorolfine nail lacquer once/week for three months. After three months of therapy, the patient completely recovered with the development of a healthy nail plate. CONCLUSIONS: The case is presented due to its rarity in neonates which, we suppose is the first case report of onychomycosis from Nepal in a 28-day-old neonate. Oral colonization with pathogenic yeasts and finger suckling could be risk factors for neonatal onychomycosis.

General anxiety, dental anxiety, digit sucking, caries and oral hygiene status of children resident in a semi-urban population in Nigeria.

BACKGROUND: Digit sucking can represent untreated anxiety or other emotional problems. The aim of this study was to determine if digit sucking is a predictor of general anxiety and dental anxiety; and if general and dental anxiety are associated with caries and oral hygiene status of children resident in sub-urban Nigeria. METHODS: This was a secondary data analysis of a household survey conducted in Ile-Ife, Nigeria. The level of general anxiety and dental anxiety of 450 6 to12 year old children were measured using the Revised Child Manifest Anxiety Scale and Dental Subscale of the Child Fear Survey Schedule respectively. Presence of digit sucking habit, caries and oral hygiene status were determined. General anxiety and dental anxiety scores were dichotomized into low and high levels respectively. Logistic regression was conducted to determine if digit sucking was a predictor of general anxiety and dental anxiety; and if general anxiety and dental anxiety were predictors caries and good oral hygiene status. Adjustments were made for age and sex. RESULTS: Digit sucking is not a significant predictor of dental anxiety (p = 0.99) and general anxiety (p = 0.79). Children with high general anxiety (AOR: 5.02; 95% CI: 2.9-9.74; p <  0.001) and high dental anxiety (AOR: 1.74; 95% CI: 1.15-2.65; p = 0.009) had higher odds of having caries and good oral hygiene respectively. CONCLUSION: Digit sucking was not a significant predictor of general anxiety and dental anxiety. General and dental anxiety however, had effects on the likelihood of having caries and good oral hygiene.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment.

AIMS: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. METHODS: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers' speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ2) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. RESULTS: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. CONCLUSION: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

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.

[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.

Non-nutritive sucking habits and their effects on the occlusion in the deciduous dentition in children.

AIM: The study evaluated the presence of non-nutritive sucking habits and and their effects on the occlusion in the deciduos dentition in Spanish children. MATERIALS AND METHODS: Study design: Cross-sectional survey. A clinical examination was performed by an experienced examiner in 275 children aged 3 to 6 years and the collected data included the presence of anterior open bite (vertical dimension), unilateral or bilateral posterior crossbite (transverse dimensions), midline deviation and sagittal relationships between incisors, molars and canines. In addition, the parents of each child completed a questionnaire about oral habits. Data analysis included descriptive statistics (frequency distribution). Statistical significance for the association between the non-nutritive sucking habits and development of malocclusion was determined using Chi-square and Fisher's exact tests. Multiple logistic regression analysis was used in order to adjust the results for confounding effects of non-nutritive habits before assessing statistical significance. RESULTS: Non-nutritive sucking habit was observed in 224 children (81.5%) and malocclusions were present in 152 children (55.2%). There were significant relationships between pacifier sucking habit and transverse dimension alteration (OR= 3.29, CI: 0.97- 11.17, p=0.044), midline deviation (OR= 3.00, CI: 1.22-7.38, p=0.013). Children with a history of finger sucking (or thumb sucking) had an increased risk of malocclusion 4.25 times higher (CI: 0.92-19.58, p=0.044) and there was a significant relationship between finger sucking and vertical relationship (OR= 8.25, CI: 2.50-27.25, p=0.001). Children with non- nutritive sucking habits had an increased risk of malocclusion 2.55 higher compared to those without non-nutritive sucking habits (p=0.004). CONCLUSION There was an impact of non-nutritive sucking habit and development of malocclusions in this sample of children.

Children using Day Nurseries' Facilities can be Associated with more Risk to Nonnutritive Sucking Habits.

INTRODUCTION: This study evaluated the expression of nonnutritive sucking habits and the presence of malocclusion in children using day nurseries' facilities. MATERIALS AND METHODS: The 195 children (7-40 months) attending 18 public day nurseries were evaluated clinically in Ponta Grossa, Brazil. Statistical package software was used for descriptive, univariate, bivariate, and multiple logistic regressions of the data about the socioeconomic condition, educational family status, malocclusions, and prevalence of nonnutritive sucking habits among the children. RESULTS: The pacifier users had a statistically significant, explanatory association with open bite [odds ratio (OR) = 10.97; 95% confidence interval (CI): 4.95, 24.31; p < 0.0001]. The children older than 25 months had more open bite than younger children (OR = 6.07; 95% CI: 2.81, 13.11; p < 0.0001). Of the children examined, 35.4% had an anterior open bite, 0.51% had posterior cross-bite, and 1.03% showed finger-sucking habits. A high frequency of pacifier-sucking habits was found (52%), with a significant association between this habit and anterior open bite (p < 0.0001, OR = 7.49; 95% CI: 3.71, 15.15). The 126 children without open bite (36.5%) were pacifier users. There was suggestive, though nonsignificant, evidence of a difference in pacifier use by gender (males, 34%; females, 46%; p = 0.07). The 69 children with open bite (81.16%) were pacifier users and (18.84%) nonusers. The boys showed a slightly greater association with open bite (OR = 21.33; 95% CI: 6.12, 74.40; p < 0.0001) than girls (OR = 5.03; 95% CI: 1.26, 20.00; p = 0.02) in the age group of 25 to 40 months; however, it was not observed in younger children. CONCLUSION: Pacifier use is a predictor for open bite in children from the lower socioeconomic classes using day nurseries' facilities. CLINICAL SIGNIFICANCE: The parents, guardians, and caregivers working in public day nurseries should be advised to monitor nonnutritive sucking habits in order to avoid or minimize the occurrence of malocclusion. It demonstrates that the permanence of the children in day nurseries may be linked with deleterious oral habits, and it discusses strategies to minimize the occurrence of alterations in the normal occlusion.

Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition.

BACKGROUND: Early transition from breastfeeding and non-nutritive sucking habits may be related to occlusofacial abnormalities as environmental factors. Previous studies have not taken into account the potential for interactions between feeding practice, non-nutritive sucking habits and occlusal traits. This study assessed the effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Peking city. 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 crossbite, posterior crossbite, 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 = 0.0002). 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 a class II canine relationship compared with those who were bottle-fed for up to 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 associated with excessive overjet and absence of lower arch developmental space. CONCLUSION: Breastfeeding duration was shown to be associated with the prevalence of posterior crossbite, no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a digit-sucking habit were more likely to develop an open bite.

The association between traumatic dental injuries and atypical external root resorption in maxillary primary incisors.

Atypical root resorption (ARR), which is observed on radiographs of primary incisors, has been reported in the dental literature to result from digit sucking; thus ignoring any association between ARR and traumatic dental injuries (TDI). The purpose of this study was to evaluate and compare the contributions of sucking habits and TDI to external ARR in primary incisors. A history of dental trauma was assessed based on clinical and radiographic findings. Periapical radiographs of the premaxilla were evaluated for the presence of ARR. The presence or history of sucking habits was based on parents' report. Data were collected from files of 727 patients with a mean age of 52 months. Sixty-four children (8.8%) presented ARR in one or both central incisors. All 64 had experienced some type of TDI. Five hundred and forty-nine (76%) of the children had sucking habits; of them, 501 were pacifier-suckers and 48 digit suckers. Digit sucking was found in only 4 (6%) of the 64 children presenting ARR. These findings support the association of traumatic dental injury, and not of digit sucking, with ARR in primary incisors.

Occlusal characteristics in 3-year-old children--results of a birth cohort study.

BACKGROUND: Aim of this prospective study was to determine prevalence of malocclusion and associated risk factors in 3-year-old Thuringian children. METHODS: Subjects (n = 377) were participants in a regional oral health programme, a birth cohort study with the aim to prevent caries (German Clinical Trials Register DRKS00003438). Children received continuous dental care since birth. Occlusal characteristics (overjet, overbite, anterior open bite, canine relationship and posterior crossbite) were measured at the age of 3 years by one calibrated clinician using a vernier caliper (accuracy 0.1 mm; Münchner Modell 042-751-00, Germany). A regular parent survey was conducted to assess risk factors for development of malocclusion. RESULTS: Three hundred seventy seven children (mean age 3.31 ± 0.70 years; 52.5% male) were examined. Children had a mean overjet of 2.4 ± 0.8 mm and the mean overbite was 0.8 ± 1.2 mm; 58.8 % of the children had a normal overjet ≤ 3 mm and 88.8% a normal overbite with < [Formula: see text] overlap. Prevalence of malocclusion was 45.2% (10.9% anterior open bite, 41.2% increased overjet ≥ 3 mm, 40.8% Class II/III canine relationship, 3.4% posterior crossbite). All children who sucked the thumb had a malocclusion. Children who used a pacifier had greater odds of having a malocclusion at age of 3 years than children without pacifier use (OR = 3.36; 95% CI: 1.87-6.05). Malocclusion and dental trauma were associated, but not statistically significant (OR = 1.83; 95% CI: 0.99-3.34; p = 0.062). Malocclusion was not associated with gender, migration background, low socioeconomic status, preterm birth, special health care needs, breathing or dietary patterns (p > 0.05). CONCLUSIONS: Non-nutritive sucking habits were important risk factors for development of a malocclusion in the primary dentition.

Clinical and cytologic features of antibiotic-resistant acute paronychia.

BACKGROUND: Acute paronychia usually is treated as a bacterial infection, but antibiotic-resistant acute paronychia may be caused by other infectious and noninfectious problems. OBJECTIVE: We sought to describe the clinical, etiologic, cytologic, and therapeutic features of antibiotic-resistant acute paronychia. METHODS: A retrospective review of medical records and cytology was performed in 58 patients (age, 1 month-91 years; 36 children and adolescents [62%] and 22 adults [38%]) who had antibiotic-resistant acute paronychias. RESULTS: Causes of paronychia included bacteria (25 patients [43%]), viruses (21 patients [36%]), fungi (5 patients [9%]), drugs (3 patients [5%]), pemphigus vulgaris (3 patients [5%]), and trauma (1 patient [2%]). Diagnostic cytologic findings were noted in 54 patients (93%); no diagnostic cytologic findings were present with drug-induced (3 patients) or traumatic (1 patient) paronychia. The most common predisposing factors were the habits of finger- or thumb-sucking (14 patients [24%]) and nail-biting (11 patients [19%]). Complications included id reaction with erythema multiforme in 3 patients (5%). LIMITATIONS: Limitations include retrospective study design from 1 treatment center. CONCLUSION: Antibiotic-resistant acute paronychia may be infectious or noninfectious. Cytologic examination with Tzanck smear may be useful diagnostically and may prevent unnecessary use of antibiotics and surgical drainage.