Do symptoms and signs of temporomandibular disorders have an association with breathing pattern: a cross-sectional study on Turkish children and adolescents.

BACKGROUND: This paper aimed to explore the prevalence of temporomandibular disorders (TMDs) signs/symptoms, and to investigate the possible link between signs/symptoms of TMDs and mouth breathing (MB) by evaluating along with other risk factors, in a Turkish subpopulation of children and adolescence. METHODS: This study was conducted with the archival data of the patients who applied with orthodontic complaints. Data on demographic characteristics, family-related factors, systemic status, occlusion, breathing patterns, oral habits, and bruxism were retrieved from the archival records. RESULTS: Nine hundred forty-five children and adolescents with a mean age of 14.82 ± 2.06 years were included in the study. Of the participants, 66% were girls, 60.4% were delivered by C-section, 8.4% of the participants had at least one systemic disease, 9.2% of the participants had allergy, and 4.3% of the participants' parents were divorced, 18.7% have an oral habit, 6.6% have bruxism, 29.8% have malocclusion and 14.1% have MB. Eight-point-five percent of participants have signs/symptoms of TMD. Among them 2.9% have pain, 3.7% have joint sounds, 1.4% have deflection, and 3.9% have deviation. Evaluation of the risk factors revealed a significant relation between the signs/symptoms of TMD and bruxism (OR 8.07 95% CI 4.36-14.92), gender (OR 2.01 95% CI 1.13-3.59), marital status of parents (OR 2.62 95% CI 1.07-6.42), and MB (OR 3.26 95% CI 1.86-5.71). CONCLUSIONS: According to the study's findings, girls and those with bruxism, divorced parents, and MB behavior are more likely to have signs/symptoms of TMD. Age found to have significant effect on the occurrence of the signs/symptoms of TMD alone, but together with other factors the effect of the age is disappeared. Early screening and intervention of MB as well as the signs/symptoms of TMD can help to limit detrimental effects of these conditions on growth, and quality of life of children and adolescents.

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

OBJECTIVE: Determine the association between breastfeeding and the development of mouth breathing in children. MATERIALS AND METHODS: Seven databases were searched for studies investigating the association between the type of feeding and the development of the breathing pattern in children. Descriptive analysis and meta-analysis were performed, with the calculation of the prevalence and likelihood (odds ratios (95% CI)) of mouth breathing according to the duration of breastfeeding. RESULTS: The overall prevalence of mouth breathing was 44% (95% CI: 38-49) (N total = 1182). Breastfeeding was a protection factor against the development of mouth breathing (OR = 0.62; 95% CI: 0.41-0.93). The likelihood of developing mouth breathing was 41% and 34% lower among children that were breastfed for more than 12 and more than 24 months, respectively. No association was found between exclusive breastfeeding for up to 6 months and the occurrence of mouth breathing (OR = 0.60; 95% CI: 0.31-1.18). CONCLUSIONS: Due to the scarcity of cohort studies that met the inclusion criteria and the low certainty of the evidence, no strong evidence-based conclusion can be drawn. However, breastfeeding should be encouraged due to its possible protective effect, evidenced by the substantial reduction in the prevalence of mouth breathing pattern when performed for up to 2 years. Exclusive breastfeeding was not associated with the development of the breathing pattern. CLINICAL RELEVANCE: The results reveal that breastfeeding can protect children from the development of mouth breathing. Thus, healthcare providers should offer support so that mothers feel prepared and encouraged to perform breastfeeding. TRIAL REGISTRATION: PROSPERO registry: CRD42017062172.

Poor oral habits and malocclusions after usage of orthodontic pacifiers: an observational study on 3-5 years old children.

BACKGROUND: Pacifier sucking habit has been associated in the literature with alterations of dental occlusion, and it could be a predisposing factor for other poor oral habits among children. Orthodontic pacifiers have been introduced in the market aiming to reduce these disadvantages caused by the conventional type of pacifiers. The aim of this study was to evaluate the prevalence of poor oral habits and malocclusions, after usage of orthodontic pacifiers in children with primary dentition. METHODS: A sample of 198 pre-school children, aged 3-5 years, (96 males and 102 females) who had exclusively used an orthodontic pacifier were included in order to assess the level of poor oral habits and the absence/presence of dental malocclusion. Firstly, children's parents/legal guardians were given a validated questionnaire, then the children were clinically examined at a dental clinic. RESULTS: Most of the children (79.79%) had started using the orthodontic pacifier within the first 3 months of life, and the 43.49% of them continued using it over a period of 2 years. The recorded percentage for those who had used it throughout sleep was 89.39%. Mouth breathing during the night was reported for 36.04% of the children. Tongue thrust swallow affected 16.16% of the sample. The 5.56% of the data indicated the presence of fingersucking/thumbsucking habit. The noted percentages for children with lip biting, lingual interposition between teeth at rest and those with nail biting, were 5.56, 12.63 and 15.15%, respectively. The regression revealed a significant contribution between early start of using an orthodontic pacifier with the prevalence of fingersucking/thumbsucking (OR 0.13, 95% CI 0.04-0.47, p = 0.0004). This also reported a noticeable increase of the malocclusion prevalence among the female gender (OR 2.74, 95% CI 1.42-5.31), as well as those who were not exclusively breastfed (OR 2.26, 95% CI 1.17-4.37). CONCLUSIONS: Orthodontic pacifiers does not favor the development of poor oral habits, even if it has been used for a period of 2 years in children with primary dentition. Children who begin to use orthodontic pacifier between 0 and 3 months, are less likely to acquire fingersucking/thumbsucking habit. The use of an orthodontic pacifier appears not to be correlated with the prevalence of malocclusion in primary dentition, differently from what stated in literature about the conventional type of pacifier.

Predictors of sleep disordered breathing in children: the PANIC study.

Objective: We studied longitudinally the associations of craniofacial morphology, mouth breathing, orthodontic treatment, and body fat content with the risk of having and developing sleep disordered breathing (SDB) in childhood. We hypothesized that deviant craniofacial morphology, mouth breathing, and adiposity predict SDB among children. Materials and methods: The participants were 412 children 6-8 years of age examined at baseline and 329 children aged 9-11 years re-examined at an average 2.2-year follow-up. An experienced orthodontist evaluated facial proportions, dental occlusion, soft tissue structures, and mode of breathing and registered malocclusions in orthodontic treatment. Body fat percentage was assessed by dual-energy X-ray absorptiometry and SDB symptoms by a questionnaire. Results: Children with SDB more likely had convex facial profile, increased lower facial height, mandibular retrusion, tonsillar hypertrophy, and mouth breathing at baseline and convex facial profile, mandibular retrusion, and mouth breathing at follow-up than children without SDB at these examinations. Male gender and body adiposity, mouth breathing, and distal molar occlusion at baseline were associated with SDB later in childhood. Adipose tissue under the chin, mandibular retrusion, vertically large or normal throat and malocclusion in orthodontic treatment at baseline predicted developing SDB during follow-up of among children without SDB at baseline. Limitations: We could not conduct polysomnographic examinations to define sleep disturbances. Instead, we used a questionnaire filled out by the parents to assess symptoms of SDB. Conclusions: The results indicate that among children, deviant craniofacial morphology, mouth breathing, body adiposity, and male gender seem to have implications in the pathophysiology of SDB.

Association of oral breathing with dental malocclusions and general health in children.

BACKGROUND: The aims of this study were to analyze the association of oral breathing with dental malocclusions and aspects of general health such as acute illnesses, oxygen saturation in blood and its possible implication in the process of nutrition. METHODS: A prevalence analytic study was carried out. Five dentists explored to children between 6 and 12 years and measured their oxygen saturation. Parents completed a questionnaire of 11 items about general health (colds, ear infections, tonsillitis and taking antibiotics) and the food preferences of their children. At the end, children were classified in oral breathing group (prevalence cases) or nasal breathing group (controls). RESULTS: There were statistical differences between cases (452 children) and controls (752 children) in the facial morphometric measurements. Oral breathing children had statistically less percentage of oxygen saturation than controls (92.3±3.3% versus 96.5±2.3%), took less time to have lunch and preferred less consistent and sugary food. Cases had had more prevalence of pathologies in the last year and of taking the antibiotics. This group also had higher prevalence of allergies compared with controls group (P<0.001). CONCLUSIONS: Oral breathing is significantly associated with specific dental malocclusions and important aspects of general health such as oxygen saturation and the nutrition. On the same line, oral breathing is related to a significantly higher prevalence of allergies and a significantly more likely getting sick and taking medication.

Assessing risk factors for dental caries: a statistical modeling approach.

The problem of identifying potential determinants and predictors of dental caries is of key importance in caries research and it has received considerable attention in the scientific literature. From the methodological side, a broad range of statistical models is currently available to analyze dental caries indices (DMFT, dmfs, etc.). These models have been applied in several studies to investigate the impact of different risk factors on the cumulative severity of dental caries experience. However, in most of the cases (i) these studies focus on a very specific subset of risk factors; and (ii) in the statistical modeling only few candidate models are considered and model selection is at best only marginally addressed. As a result, our understanding of the robustness of the statistical inferences with respect to the choice of the model is very limited; the richness of the set of statistical models available for analysis in only marginally exploited; and inferences could be biased due the omission of potentially important confounding variables in the model's specification. In this paper we argue that these limitations can be overcome considering a general class of candidate models and carefully exploring the model space using standard model selection criteria and measures of global fit and predictive performance of the candidate models. Strengths and limitations of the proposed approach are illustrated with a real data set. In our illustration the model space contains more than 2.6 million models, which require inferences to be adjusted for 'optimism'.

The Comparison of Malocclusion Prevalence Between Children with Cerebral Palsy and Healthy Children.

This study sets out to examine the prevalence of malocclusion and habits in a group of children with cerebral palsy and to compare it with a control group of healthy children. The presence of an anterior open bite was statistically significantly higher in the cerebral palsied group. The presence of aposterior crossbite was not significantly different between the examined groups, as was the case for a lingual crossbite. The occurrence of visceral swallowing, incompetent lips and oral respiration was significantly higher in the cerebral palsied group. The current study cannot satisfactorily sustain the issue of a higher prevalence of posterior and lingual crossbite in children with cerebral palsy because of no significant differences between groups, but it certainly can for an anterior openbite. The present study also adds to the evidence that there is an increased prevalence of oral breathing, visceral swallowing and lip incompetence in children with cerebral palsy.

Screening for obstructive sleep apnea in children treated at a major craniofacial center.

Timely diagnosis of obstructive sleep apnea (OSA) in patients with craniofacial disorders may help prevent long-term adverse sequelae of upper airway obstruction, namely pulmonary hypertension, failure to thrive, and impaired neurocognitive development. Currently, little is known about the incidence of OSA in this high-risk population. A prospective study examining the incidence of positive screening for OSA in patients cared for by the craniofacial team at a large, urban referral center was performed. From January 2011 to August 2013, all patient families were asked to complete the Pediatric Sleep Questionnaire. This validated tool has a sensitivity of 85% and specificity of 87% in predicting a positive sleep study when the ratio of positive-total responses is 0.33 or greater. Screening results were evaluated via Chi-squared and Fisher tests according to demographic and clinical variables. A total of 234 children seen in our craniofacial clinic completed the Pediatric Sleep Questionnaire. The mean screening age was 8.38 years, and 47% were male (110/234). Total incidence of positive OSA screening was 28.2% (66/234). Of the total population, 128 patients had an underlying syndrome (54.7%), whereas 106 patients were nonsyndromic (45.3%). Both groups were at equivalent risk for screening positive for OSA (28.1% versus 28.3%, P = 1.0). Among children with a craniofacial diagnosis, patients with a cleft lip and/or palate were at equivalent risk for screening positive for OSA as patients without a cleft (25.5% versus 32.6%, P = 0.24). The OSA symptoms affect almost one third of patients seen by our craniofacial team. Syndromic and nonsyndromic patients seem to be at equivalent risk as those patients with and without an oropharyngeal cleft. Future work will correlate these findings with formal polysomnography and may serve to heighten awareness of OSA in this at-risk population.

Factors associated with dry mouth in dependent Japanese elderly.

OBJECTIVES: To identify factors associated with dry mouth. BACKGROUND: Dry mouth adversely affects oropharyngeal health, particularly in elderly, and can lead to pneumonia. A better understanding of the epidemiology of dry mouth is therefore important in improving treatment strategies and oral health in high-risk elderly patients. METHODS: We conducted a cross-sectional study involving 383 dependent Japanese elderly individuals (65-84 [n = 167] and ≥85 [n = 216] years) at eight long-term care facilities and hospitals. Thirty-four potential factors associated with dry mouth were examined by multiple logistic regression analysis. The primary outcome was dry mouth, as diagnosed by tongue dorsum moisture. RESULTS: We identified that body mass index and severity of physical disability were identified as a potential factors associated with dry mouth in the super-elderly (≥85 years) group, whereas severity of physical disability, outcome measurement time, high daily water consumption, mouth breathing, use of antidepressants and diuretics, and high frequency of daily brushing (≥2 times per day; Odds ratio: 5.56; 95% Confidence Interval: 1.52-20.00) were associated with dry mouth in the 65- to 84-year-old group. CONCLUSION: To our knowledge, this is the first study to identify a link between frequency of daily brushing and dry mouth and suggests that tooth brushing should be encouraged in high-risk dependent Japanese elderly (65-84 years), particularly those taking antidepressants and/or diuretics.

The association between periodontitis and obstructive sleep apnea: a preliminary study.

BACKGROUND AND OBJECTIVE: Periodontitis is becoming a highly prevalent disease worldwide. Obstructive sleep apnea (OSA) is a common disorder that is characterized by repeated disruptions in breathing during sleep, and mouth breathing is a common characteristic among patients with OSA. We aimed to assess the hypothesis that OSA is associated with the onset and progression of periodontal disease. MATERIAL AND METHODS: This is a cross-sectional study of a total of 687 participants (460 men and 227 women), 47-77 years of age, who were examined between August 2009 and September 2010 as part of the Korean Genome and Epidemiology Study. The participants underwent standard polysomnography, clinical periodontal examination and health-screening examinations. Periodontitis was defined as clinical attachment level (CAL) ≥ 6 mm and probing pocket depth ≥ 4 mm. OSA was determined using the apnea-hypopnea index (AHI), and an AHI score of ≥ 5 was the cut-off used to indicate the presence of OSA. RESULTS: The results showed that 17.5% of the participants had periodontitis, 46.6% had OSA and 60.0% who were diagnosed with periodontitis had OSA. In our study, old age, male gender, current smoking status, mouth breathing during sleep and high AHI were identified as risk factors for periodontitis. OSA was positively associated with periodontitis [odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.18-2.87], probing pocket depth (OR = 2.22, 95% CI = 1.30-3.77) and CAL (OR = 1.86, 95% CI = 1.07-3.21) in a dose-response manner. Additionally, OSA was positively associated with periodontitis (OR = 2.51, 95% CI = 1.37-4.62) in subjects ≥ 55 years of age, but not in subjects < 55 years of age. CONCLUSION: There is a significant association between OSA and periodontal disease. Further research is needed to clarify the causal relationship between the two conditions.

Association between breastfeeding and the development of breathing patterns in children.

UNLABELLED: The aims of the present study were to evaluate the association between breastfeeding and breathing development and to investigate associations between breastfeeding duration and the breathing patterns in children. A cross-sectional study was carried out at the Institute of Integrative Medicine Professor Fernando Figueira, Recife, Brazil, with a random sample of 732 children aged between 6 and 9 years. Breastfeeding and breathing patterns were identified using a questionnaire that was filled out by mothers or guardians, and a clinical examination of the children. Data were analyzed statistically by Pearson's chi-square test at 5 % significance level. The prevalence of mouth breathing was 48 %, whereas 52 % of the children were nasal breathers. Six hundred-forty children were breastfed; 46.2 % of them were mouth breathers and 53.8 % were nasal breathers. Ninety-two children were not breastfed; 59.8 % of them were mouth breathers and 40.2 % were nasal breathers. Breastfeeding for 24 months or more, as well as exclusive breastfeeding in the first 6 months, was associated with the development of nasal breathing. CONCLUSIONS: Extended breastfeeding was associated with correct development of the breathing pattern.

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.

Factors related to mouth breathing syndrome in preschool children and the effects of incompetent lip seal: An exploratory study.

OBJECTIVES: A set of orofacial signs and symptoms completely or partially present in individuals who replace the correct pattern of nasal breathing with an oral or mixed pattern is defined as mouth breathing syndrome (MBS). In a previous report, it was clarified that an incompetent lip seal (ILS) affected the occurrence of MBS among primary school children. However, the factors related to MBS and the effect of ILS in preschool children remain unclear. The purpose of this study was to clarify the factors relevant to MBS in preschool children and investigate the relationship of ILS to MBS. MATERIAL AND METHODS: We surveyed 285 preschool children between 3 and 5 years of age. Their guardians completed the questionnaire, which consisted of 44 questions regarding the children's daily health conditions and lifestyle habits. To classify the closely related questions into their respective factors and to examine the strength of the correlation between the newly revealed factors, an exploratory factor analysis with promax rotation was performed. RESULTS: The factor analysis identified nine items representing four factors. Factors 1-4 were defined as "diseases of the nose," "ILS," "problem with swallowing and chewing," and "eating and drinking habits," respectively. Factor 2 most strongly correlated with Factor 1, and both Factors showed a relatively strong correlation with Factor 3. CONCLUSIONS: The initial stage of MBS may be present in preschool children. ILS and diseases of the nose can cause poor development of oral functions, such as breathing and eating.

Prevalence of mouth breathing, with or without nasal obstruction, in children with moderate to severe obstructive sleep apnea.

BACKGROUND: Mouth breathing (MB) is a symptom of obstructive sleep apnea (OSA) in children, but its diagnosis remains challenging. The main objectives of our study were to evaluate whether parents' and physician's diagnose of MB were concordant and to evaluate the prevalence of nasal obstruction in children with OSA and MB. METHODS: Ninety-three children (median age: 10.6 years, range 3-18) with moderate to severe OSA prospectively underwent otorhinolaryngologist (endoscopy, acoustic rhinometry and pharyngometry allowing calculation of pharyngeal compliance) and orthodontist (clinical exam and cephalometry) assessments together with parental interview (daytime MB: never, sometimes, often, always). MB was also assessed by the otorhinolaryngologist (nasal obstruction on endoscopy) and the orthodontist (incompetent lips or anterior open bite or low tongue position). RESULTS: Thirty-eight children (41%) were mouth (parental criterion: MB often or always, median age 8.2 years) and 55 nasal (11.4 years, p = 0.016) breathers. The agreement of parental and physician diagnosis of MB was slight (orthodontist) to moderate (otorhinolaryngologist). Parental diagnosis of MB was associated with nasal obstruction on acoustic rhinometry and endoscopy (hypertrophy of inferior turbinate, n = 18 or adenoids, n = 15) and with an adenoid facies (increased Frankfort's mandibular plane angle on cephalometry). Eleven children had MB by habit and were characterized by more severe OSA and higher pharyngeal compliance than mouth breathers with nasal obstruction. CONCLUSION: MB diagnosis by parents is acceptable and is mainly related to nasal obstruction. A subset of children had MB by habit associated with worst OSA and increased pharyngeal compliance that could benefit from myofunctional therapy.

Prevalence and risk factors of sleep bruxism and wake-time tooth clenching in a 7- to 17-yr-old population.

Sleep-related bruxism (SB) and wake-time tooth clenching (TC) have been associated with temporomandibular disorders (TMDs), headache, and sleep and behavioral complaints. This study aimed to assess the prevalence and risk factors of these signs and symptoms in a 7- to 17-yr-old population (n = 604) seeking orthodontic treatment. Data were collected by questionnaire and by a clinical examination assessing craniofacial morphology and dental status. Sleep-related bruxism was reported by 15% of the population and TC was reported by 12.4%. The SB group (n = 58) was mainly composed of children (67.3% were ≤12 yr of age) and the TC group (n = 42) was mainly composed of adolescents (78.6% were ≥13 yr of age). The craniofacial morphology of over 60% of SB subjects was dental class II and 28.1% were a brachyfacial type. Compared with controls (n = 220), SB subjects were more at risk of experiencing jaw muscle fatigue [adjusted OR (AOR) = 10.5], headache (AOR = 4.3), and loud breathing during sleep (AOR = 3.1). Compared with controls, TC subjects reported more temporomandibular joint clicking (AOR = 5), jaw muscle fatigue (AOR = 13.5), and several sleep and behavioral complaints. Sleep- and wake-time parafunctions are frequently associated with signs and symptoms suggestive of TMDs, and with sleep and behavioral problems. Their clinical assessment during the planning of orthodontic treatment is recommended.

Orofacial trauma in Brazilian basketball players and level of information concerning trauma and mouthguards.

Orofacial injuries are increasingly considered a public health problem in high impact sports. The purposes of this study were: to assess orofacial trauma (OT) history in basketball players, in relation to wearing mouthguards (MG), facial types, presence of mouth breathing and player's position in the game, also to check athletes' level of knowledge about trauma and MGs. Questionnaires were given to category A-1 adult athletes registered in 2006/07 in the State of São Paulo and Brazilian Basketball Confederation Championships, and National Team members. Of the total sample (n=388), 50% of athletes sustained orofacial injuries; dental trauma accounted for 69.7%, with emphasis on maxillary central incisors, followed by soft tissue (60.8%), in which lip injuries were the most prevalent. No relationship was found between trauma history and player's position (P=0.19), facial type (P=0.97), presence of mouth breathing (P=0.98), but there was statistically significant association between the prevalence of OT and lack of MG use (P≤0.0001). Of all the athletes affected, only 1% wore a MG at the time of the trauma, 26.5% did not know about the MGs and 10.6% did not know their functions. When trauma occurred, 79.6% replied one must look for the tooth at the accident site, 50% knew it must be stored in liquid, as replantation was possible (62.3%) and 75.8% believed elapsed time could influence prognosis. Basketball is a high impact sport with high prevalence of OT, particularly maxillary central incisor and lip injuries, but athletes did not use MGs. There should be more educational campaigns to inform players about orofacial injuries and their prevention in Brazilian basketball.

A Study Correlating Breathing Pattern With Different Malocclusions Among Patients Reporting At Department Of Orthodontics Ayub Medical College, Abbottabad, Pakistan.

BACKGROUND: The present era has been commanded by ample studies correlating breathing modes & risk of occurrence of malocclusion. The early intervention of altered breathing patterns can head off the long-lasting effects of already established malocclusion. The main intention of this project was to establish the possible correlation between mouth-breathing & malocclusions. METHODS: Sixty-two (62) patients undergoing orthodontic treatment were evaluated via data form (including history & clinical evaluation). SPSS software version 25.0 was used for data analysis. Patient's age, gender, type of Angle's malocclusion & breathing pattern was taken in account while analysing data. Descriptive statistics & Chi- Square test was applied on the data. It was anticipated that mouth breathing is associated with malocclusion. p-value of less than 0.05 was considered to be statistically significant. RESULTS: A total of 29 males & 33 females participated in the study. The mean age was 13 years (range 6-20 years). A significant correlation was found between mouth-breathing, tongue thrust (p=0.03) & bleeding gums (p=0.006). Other parameters had no significant correlation with mouth-breathing. CONCLUSIONS: The current study revealed that mouth breathing has significant association with opened mouth at rest & gingival abnormalities (bleeding/ swollen gums) implying that timely diagnosis of such abnormal breathing pattern can hinder with development of altered occlusion & dentofacial conformation.

Long-term outcome of concurrent coblator turbinoplasty with adenotonsillectomy in children with allergic rhinitis.

BACKGROUND: Allergic rhinitis (AR) is one of the most prevalent chronic diseases in children. Patients with AR tend to have more persistent symptoms after adenotonsillectomy (T&A). OBJECTIVES: This study was aimed to evaluate the outcome of additional concurrent coblation-assisted turbinoplasty with adenotonsillectomy (T&A + T) in patients with AR. MATERIAL AND METHODS: This study included 104 children who underwent T&A, and 67 who underwent T&A + T. All patients were diagnosed as AR and were aged < 12 years at the time of surgery. Symptoms (snoring, mouth breathing, nasal obstruction, rhinorrhea, itching, and sneezing) were evaluated preoperatively and postoperatively via a questionnaire and a telephone survey. RESULTS: None of the six symptoms investigated differed significantly between the two groups preoperatively, and all evaluated symptoms exhibited dramatic improvements after the surgery in both groups. The T&A + T group showed significantly greater difference of improvement in mouth breathing and nasal obstruction than T&A group. There were no significant difference of improvements in snoring, rhinorrhea, itching and sneezing postoperatively between two groups. In multiple regression analysis, postoperative obstructive symptoms including mouth breathing and nasal obstruction were significantly associated with concurrent turbinoplasty. CONCLUSION: Concurrent turbinoplasty should be considered especially in patients who have AR and adenotonsillar hypertrophy to improve obstructive symptoms.

Posture and posterior crossbite in oral and nasal breathing children.

The most known etiologic factors of oral breathing may influence the craniofacial development leading to anatomical and functional alterations. A proper head and cervical spine posture allows a well functioning of the stomatognathic system structures and vice versa. This study was conducted to evaluate the prevalence of posterior crossbite in a group of oral breathing children (OB) and nasal (NB) and associate the type of bite with the head and cervical spine posture. It was concluded that most of the children, either oral or nasal breathers, did not present a crossbite and any kind of head posture and cervical spine can vary independently of a posterior crossbite.

Prevalence of Temporomandibular Joint Disorders and its Association with Para Functional Habits in the Patients Attending Tertiary Care Hospital.

BACKGROUND: Temporo-mandibular disorders is a collective term used to describe problems involving muscles of mastication and temporomandibular joint. The study aimed to evaluate the prevalence of temporo-mandibular disorders and its association with parafunctional habits in patients visiting department of dentistry, Patan Academy of Health Sciences. METHODS: A cross-sectional study was carried out among 213 patients coming to Patan Academy of Health Sciences. A screening questionnaire recommended by American Association of Orofacial Pain was used to determine the signs and symptoms of temporo-mandibular disorders. RESULTS: The prevalence of temporomandibular disorders was 31.9 %. The three most common parafunctional habits were chewing gums (32.4 %), mouth breathing (19.7 %) and biting of objects (14.6 %) respectively. Statistically significant association was found between nail biting, grinding of teeth, biting of lips and objects and mouth breathing with signs and symptoms of temporomandibular disorders (p<0.05). Among the signs and symptoms of temporomandibular disorders, getting headaches, neck pain or toothaches often was the most frequent signs of temporomandibular disorders (n=105, 49.3 %). Feeling of recent change in bite was the second most frequent sign reported by 82 participants (38.5 %). CONCLUSIONS: The parafunctional habits between nail biting, grinding of teeth, biting of lips and objects and mouth breathing have statistically significant association with signs and symptoms of temporomandibular disorders.