Breathing mode assessment with thermography: a pilot study. / Avaliação do modo respiratório por meio da termografia: um estudo piloto.

PURPOSE: To present a method for analyzing breathing modes with infrared thermography. METHODS: This exploratory cross-sectional study used 38 thermal images of inspiration and expiration with nasal breathing and simulated mouth breathing in four nasal breathers without respiratory complaints. Three different data selection forms (line, rectangle, and ellipse) were used to extract the minimum, mean, and maximum temperatures of the regions of interest (nose and mouth) using the FLIR Tools® software. RESULTS: Among the three selection forms, there was greater temperature variability obtained with the line, revealing limitations in this measurement. There were no differences between the rectangle and ellipse values, showing that both selection forms present similar temperature extraction results. The comparison results between nose and mouth temperatures during inspiration and expiration indicated a statistically significant difference between all measurements, except for mean inspiration temperatures with the rectangle and ellipse. The breathing mode can be distinguished in both inspiration and expiration when using mean mouth temperatures with the rectangle and ellipse. CONCLUSION: Breathing modes should be assessed based on mean mouth temperatures during inspiration, using the ellipse.

OBJETIVO: Apresentar um método de análise do modo respiratório por meio da termografia infravermelha. MÉTODO: Estudo transversal exploratório de 38 imagens térmicas que representavam o momento da inspiração e da expiração durante a respiração nasal e durante a simulação da respiração oral de quatro voluntárias respiradoras nasais sem queixas respiratórias. Para a extração da temperatura das regiões de interesse (nariz e boca) foram utilizadas três formas de seleção distintas de dados (linha, retângulo e elipse) e três medidas de temperatura (mínima, média e máxima) por meio do software FLIR Tools®. RESULTADOS: Dentre as três formas de seleção houve maior variabilidade nas medidas obtidas pela linha, revelando limitações nessa medida. Não houve diferenças entre as medidas do retângulo e elipse, mostrando que ambas as formas de seleção apresentam resultados semelhantes para a extração das temperaturas. Na comparação entre as temperaturas do nariz e da boca na inspiração e expiração, os resultados indicaram que houve diferença com relevância estatística em todas as medidas realizadas, exceto para as medidas de temperatura média da inspiração, usando o retângulo e a elipse. Percebe-se diferenciação do modo respiratório tanto na inspiração quanto na expiração quando utilizada a temperatura média da boca com o retângulo e a elipse. CONCLUSÃO: Sugere-se para avaliação do modo respiratório a avaliação da boca, por meio da elipse, com análise da temperatura média durante a inspiração.

Assessment of changes in Streptococcus pyogenes levels using N-acetylgalactosamine-6-sulfatase marker and pharyngeal airway space with appliance therapy in mouth breathers - An ELISA-based study.

Background: The frequency of adenotonsillar hypertrophy in mouth-breathing children when compared to the average found in the general population is considered to be higher. Mouth breathing is considered as one of the causative factors for tonsillitis in children. Through continuous irritation on tonsillar wall, tonsils swell up and inflammation develops. Purpose: The purpose of the study is to evaluate Streptococcus pyogenes count using colony-forming units (CFUs) and N-acetylgalactosamine-6-sulfatase side chain marker on ELISA (enzyme linked immunosorbent assay) in mouth breathers and to establish its correlation with pharyngeal airway space pre- and post-oral screen appliance therapy. Materials and Methods: A total number of 24 (n) mouth breathers aged between 5 and 12 years were included in the study and given oral screen appliance therapy. The subjects were evaluated for the various parameters before the delivery of a habit-breaking appliance and then reevaluated for the same parameters (presence of S. pyogenes and its counts, size of tonsils, and pharyngeal airway space dimensions) after 6 months of appliance usage. Results: A statistically significant difference was seen in levels of S. pyogenes using ELISA and CFUs. Furthermore, statistically significant difference was observed in Friedman tonsil scoring and pharyngeal airway space and pre- and post-oral screen appliance therapy. Conclusion: Oral screen appliance therapy reduced the frequency of occurrence of tonsillitis in mouth breathers by decreasing the counts of S. pyogenes bacteria. Upper and lower pharyngeal airway space dimensions were increased after 6 months of appliance therapy in mouth breathers.

Assessment of mouth breathing by Speech-Language Pathologists: an international Delphi consensus.

PURPOSE: mouth breathing (MB) has detrimental effects on children's growth. Diagnosis of MB is possible through a multidisciplinary approach including Speech-Language Pathologist's (SLP) assessment; however, SLPs currently have little to no defined selection criteria to determine the awake and habitual breathing pattern. This study aims at identifying relevant criteria for the assessment of the habitual and awake breathing pattern of preschool children, and developing a grid that would help SLPs diagnose MB in their clinical practice. METHODS: A three-rounded online international Delphi process was conducted to achieve a consensus on the relevant items and their interpretation. Agreement was established through a Content Validity Ratio calculation. Based on the agreed items, we developed a grid through a scoring function. RESULTS: Observing the child at rest (i.e., time spent with an open/closed mouth and position of the tongue/lips) was considered the most important criterion. The experts also considered that observing the breathing pattern while chewing (open/closed mouth) and after swallowing (i.e., air intake and open/ closed mouth just after swallowing) should provide relevant but secondary information in decision-making. We were able to establish a clinical grid based on those criteria. CONCLUSION: The Delphi procedure provided content-valid criteria and conditions of observation for the myofunctional SLP assessment of the awake and habitual breathing pattern in preschoolers. A clinical validation of the developed prototype grid should be conducted in preschool children to explore its effectiveness in the diagnosis of MB.

Evaluación interdisciplinaria estomatognática y postural en un paciente pediátrico respirador oral: Reporte de caso / Interdisciplinary stomatognathic and postural assessment in a pediatric mouth-breathing patient: A case report

Introducción: La respiración oral se asocia con trastornos de los órganos del habla, que generalmente se combina con deformidades faciales y problemas de oclusión dental. Objetivo: Evaluar interdisciplinariamente la fisiología del sistema estomatognático y postural en un paciente respirador oral de 11 años. Presentación del caso: Paciente de sexo masculino, se le realizó examen orofacial mediante mioescanografía, dinamometría y electromiografía, técnica de Payne y prueba Rosenthal. Se evaluó alineación postural, estabilidad con índice de Romberg y presiones plantares con baropodometría. Resultados: El paciente presentó mal oclusión clase I, hipoplasia maxilar hiperdivergente y micrognatismo, en actividad muscular, índice de asimetría 34% en maseteros durante la masticación, en temporales durante la protrusión la simetría fue de 67% y de 62%, alteración de la estabilidad estática con Índice de Romberg de 1,22 y distribución de presión plantar en pie izquierdo 42,2% y derecho 57,8%. Conclusiones: El sujeto presentó disminución en actividad de fuerza muscular orofacial, alteraciones en la alineación de cabeza, hombros, región pélvica, alteración de la estabilidad estática y presiones plantares con mayor distribución en retropié bilateral y miembro inferior derecho.

Introduction: Oral respiration is associated with speech organs disorders, which are generally combined with facial deformities and dental occlusion problems. Objective: To conduct an interdisciplinary assessment of the physiology of the stomatognathic and postural system in a 11-year old mouth-breathing patient. Case presentation: The male subject underwent orofacial examination using myoscanography, dynamometry, electromyography, Payne technique, and Rosenthal test. Postural alignment, stability (Romberg index) and plantar pressures (baropodometry) were evaluated. Results: The subject displayed: class I malocclusion; hyperdivergent maxillary hypoplasia, and micrognathism in muscular activity; a 34% asymmetry index in masseters during mastication; the symmetry in temporals was 67% and 62% during protrusion; alteration of the static stability with a Romberg index of 1.22; and 42.2% and 57.8% plantar pressure distributions in the left and right feet, respectively. Conclusions: The subject showed a reduction in orofacial muscle strength activity, alterations in the alignment of the head, shoulders and pelvic region, an alteration of the static stability, and plantar pressures with a greater distribution on the bilateral hindfoot and right lower limb.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment.

PURPOSE: : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. METHODS: 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. RESULTS: Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). CONCLUSION: We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment / Variáveis associadas ao diagnóstico de respiração oral baseado em uma avaliação multidisciplinar

ABSTRACT Purpose : This study was conducted to identify variables associated with mouth breathing diagnosis in children, based on multidisciplinary domains. Methods 119 children, six to 12 years old, underwent anamnesis, speech therapy (orofacial structures and stomatognathic functions), otorhinolaryngologic (OTRL) with clinical and endoscopic examinations, dental (occlusion) and physiotherapy (body posture and nasal patency) assessments. Nasal patency was evaluated using Peak Nasal Inspiratory Flow (PNIF) and the Nasal Obstruction Symptom Evaluation (NOSE) scale. A multiple logistic regression was performed considering breathing mode as the dependent variable and the co-variables from each multidisciplinary assessment as associated variables. Results Association with MB diagnosis was found in each professional domain with: nasal obstruction report (Odds ratio - OR=5.55), time of pacifier use (OR=1.25), convex facial type (OR=3.78), obtuse nasal angle (OR=4.30), half-open or open lip posture (OR=4.13), tongue position on the mouth floor (OR=5.88), reduced hard palate width (OR=2.99), unexpected contraction during mastication (OR=2.97), obstructive pharyngeal tonsils (OR=8.37), Angle Class II malocclusion (OR=10.85) and regular gingival maintenance (OR=2.89). Conclusion We concluded that a multidisciplinary diagnosis is important, given that each evaluation domain, including OTRL, dental and speech therapy, presented variables associated with MB diagnosis. Body posture and nasal patency variables were not associated with MB.

RESUMO Objetivo Este estudo foi conduzido para identificar as variáveis associadas ao diagnóstico de respiração oral em crianças, baseado nos domínios multidisciplinares. Método Cento e dezenove crianças, de seis a 12 anos, realizaram uma avaliação abrangente composta por uma anamnese e exames fonoaudiológico (estruturas orofaciais e funções estomatognáticas), otorrinolaringológico (avaliação clínica e endoscópica), odontológico (conservação oral e oclusão) e fisioterapêutico (postura corporal e permeabilidade nasal). A permeabilidade nasal foi aferida utilizando-se o Pico de Fluxo Inspiratório Nasal (PFIN) e a escala NOSE (Nasal Obstruction Symptom Evaluation). Foi realizada uma regressão logística múltipla, considerando o modo respiratório como variável dependente e as covariáveis de cada avaliação multidisciplinar como variáveis associadas. Resultados Foi encontrada uma associação do diagnóstico de respiração oral com variáveis de cada domínio profissional: relato de obstrução nasal (Odds ratio - OR=5,55), tempo de uso de chupeta (OR=1,25), tipo facial convexo (OR=3,78), ângulo nasolabial obtuso (OR=4,30), postura de lábios entreabertos e abertos (OR=4,13), postura de língua no assoalho oral (OR=5,88), largura do palato duro reduzida (OR=2,99), contrações inesperadas durante a mastigação (OR=2,97), tonsilas faríngeas obstrutivas (OR=8,37), má oclusão classe II de Angle (OR=10,85) e estado gengival regular (OR=2,89). Conclusão Concluiu-se que o diagnóstico multidisciplinar é importante, uma vez que as avaliações dos domínios fonoaudiológico, otorrinolaringológico e odontológico obtiveram variáveis associadas ao diagnóstico de respiração oral. As variáveis relacionadas à postura corporal e permeabilidade nasal não foram associadas ao diagnóstico de respiração oral.

Sleep and airway assessment: A review for dentists.

INTRODUCTION: Dentists can be the first professionals to recognize a patient's potential sleep problem since they typically have more frequent contact with their patients than do physicians. It is important that dentists have a reasonable understanding of sleep disorders and how to assess their patients if they suspect such a problem so that a timely referral can be made or treatment can be provided as appropriate. OBJECTIVE: To review the key literature relevant to sleep-disordered breathing (SDB) characteristics and diagnosis, including history, examination, and investigation with an emphasis on radiographic airway analyses. CONCLUSION: The authors present a concise explanation of SDB conditions and an outline for thorough patient examination and evaluation, including radiographic airway analyses. Limited two-dimensional and three-dimensional norms exist for adult patients with no SDB and even less so for children. Much more research is needed, particularly in the pediatric population.

Cephalometric Assessment of Upper Airway Effects on Craniofacial Morphology.

To investigate craniofacial growth deformities in children with upper airway obstruction, this controlled study was performed. Cephalometry is used as a screening test for anatomic abnormalities in patients with obstructive sleep apnea syndrome. Therefore, the current work selected this method to investigate the effect of upper airway obstruction on craniofacial morphology.Patients with upper airway obstruction (104) were compared with 71 controls. Patients with upper airway compromise had mandibular hypoplasia, mandibular retrognathism, and higher hard palates in comparison with controls with no history of airway obstruction. The difference was higher in the older age group.Airway obstruction has significant correlation craniofacial morphology. Our findings support the idea of early assessment and thorough management of mouth breathing in children.

Avaliação da associação entre os indicadores de saúde bucal, os aspectos socioeconômicos e crianças com sinais clínicos orofaciais indicativos de respiração oral crônica / Evaluation of the association between indicators of oral health and sociodemographic variables in children with orofacial clinical signs of chronic mouth breathing

Objetivo Avaliar se os indicadores clínicos de saúde bucal e sociodemográficos de crianças em idade escolar (8 a 12 anos), em fase de dentição mista, estão associados com a respiração oral. Métodos Foram avaliadas 55 crianças, selecionadas em uma escola estadual do município de Cachoeira do Sul (RS). Após a autorização dos responsáveis, foram realizados exames por uma fonoaudióloga treinada, para a identificação de crianças com sinais clínicos orofaciais, indicativos de respiração oral. Para a realização dos exames de saúde bucal, os estudantes de odontologia foram treinados e calibrados, de acordo com os critérios para levantamentos epidemiológicos da Organização Mundial de Saúde. Além dos exames intrabucais, foram coletadas informações socioeconômicas e demográficas com os responsáveis pelas crianças, por meio de um questionário. Resultados A prevalência de crianças com sinais de respiração oral foi relevante, porém, menor do que descreve a literatura. Não houve diferença entre os grupos (respiradores orais e respiradores nasais), tanto em relação às variáveis socioeconômicas, como em relação aos aspectos odontológicos testados. Conclusão Não houve associação da respiração oral com nenhum indicador clínico de saúde bucal (cárie, placa visível e sangramento gengival). Também não foi encontrada associação entre as variáveis sociodemográficas e a respiração oral. .

Purpose To evaluate whether clinical and sociodemographic indicators of oral health in school-age children (from 8 to 12 years) with mixed dentition are associated with oral breathing. Methods Fifity-five children selected from a public school in the city of Cachoeira do Sul (RS) were evaluated. After obtaining parental consent, a trained speech pathologist performed examinations to identify children with orofacial clinical signs indicative of oral breathing. For the oral health exams, dental students underwent training and calibration according to the criteria of the World Health Organization for epidemiological surveys. In addition to the intra-oral examinations, socioeconomic and demographic data were collected from the parents of the children using a questionnaire. Results Although the prevalence of children with mouth breathing symptoms was notable, it was lower than that reported in the literature. No difference was observed between the groups (mouth breathers and nose breathers) regarding socioeconomic variables associated with the tested dental aspects. Conclusion Oral breathing was not associated with clinical indicators of oral health such as caries, visible plaque, and gingival bleeding. Further, no association was found between sociodemographic variables and oral breathing. .

A má oclusão e sua associação com variáveis socioeconômicas, hábitos e cuidados em crianças de cinco anos de idade / The malocclusion and its association with socioeconomic variables, habits and care with five years old children

Introdução: O aumento progressivo nos índices de má oclusão gerou a necessidade do conhecimento da sua prevalência, a fim de que medidas de promoção de saúde e prevenção possam ser implantadas. Objetivo: Avaliar a associação entre má oclusão e variáveis socioeconômicas, demográficas, hábitos e cuidados em crianças de cinco anos. Material e Método: A amostra consistiu de 441 crianças com cinco anos, cadastradas em nove Unidades de Saúde da Família (USFs) da zona leste de São Paulo, São Paulo. Foram realizados exames bucais e aplicado questionário estruturado aos pais com questões sobre características demográficas, socioeconômicas relativas à família e ao domicílio, e questões relativas aos hábitos, cuidados e internações hospitalares da criança. A análise dos dados consistiu de análise bivariada pelo teste qui-quadrado seguida de modelo de regressão logística múltipla. Resultado: Foi encontrada má oclusão em 41,7% das crianças. Aquelas que usaram chupeta por até dois anos tiveram 1,24 vez mais chance de apresentar má oclusão do que as que não usaram. Crianças que usaram chupeta por mais de dois anos apresentaram 4,08 vezes mais chance de ter má oclusão do que aquelas que não usaram. As que dormiam de boca aberta tiveram 1,72 vez mais chance de apresentarem má oclusão. Crianças que foram internadas por outros motivos tiveram 5,26 vezes menos chance de apresentarem má oclusão que as que foram internadas por alergia ou bronquite. Conclusão: A má oclusão está fortemente associada aos hábitos deletérios, principalmente ao uso da chupeta, acometendo igualmente crianças de diferentes níveis socioeconômicos.

Introduction: The progressive increase in the rates of malocclusion has generated the need for knowledge of its prevalence, so that measures of health promotion and prevention can be developed. Objective: To evaluate the association between malocclusion and socioeconomic, demographic, habits and care in five years old children. Material and Method:The sample consisted of 441 children under five registered in nine family health units for eastern region of São Paulo city. Oral examinations were conducted and applied structured questionnaire to parents with questions about demographic characteristics, socioeconomic relating to family and home issues and habits, care and hospitalization of the child. Data analysis consisted of bivariate analysis using Chi-square test followed by multiple logistic regression model. Result: Malocclusion was found in 41.7% of children. Those who used a pacifier for up to 2 years were 1.24 times more likely to have malocclusion than those who did not. Children who used a pacifier for more than 2 years were 4.08 times more likely to have malocclusion than those who did not. The sleeping open-mouthed had 1.72 times more likely to have malocclusion. Allergies or bronchitis were associated to a higher chance to develop malocclusion. Conclusion: The malocclusion is strongly associated with harmful habits, especially the use of pacifiers, and affects similarly children of different socioeconomic levels.

The prevalence of anterior open bite in Portuguese children during deciduous and mixed dentition--correlations for a prevention strategy.

INTRODUCTION: Anterior open bite (AOB) is a vertical malocclusion that requires thorough diagnosis to ensure long-term stability. The aim of this study was to determine the prevalence of AOB in Portuguese children during deciduous and mixed dentition in order to assess the need for orthodontic treatment and to determine its relation to other associated features. MATERIAL AND METHODS: A group of 1264 children aged between 3 and 12 from Porto in Portugal were observed. The statistical methodology included the independent Chi(2) test, Fisher's exact test and binary logistic regression. RESULTS: The prevalence of AOB was 16.9% with 95% CI (11.9%, 24.5%) for primary dentition and 11.3% with 95% CI (8.4%, 15.1%) for mixed dentition. Pacifier sucking, thumb sucking, tongue thrust and oral breathing are major risk factors for AOB in primary dentition, ranked in descending order. In mixed dentition, the factors are ranked as follows: pacifier sucking, lip sucking, tongue thrust and oral breathing. CONCLUSION: Due to the close connection between the prevalence of AOB and dysfunctional problems, prevention strategies should be integrated into a national public health program. The habits mentioned above should be eliminated early by using the appropriate protocols in order to reduce the risk factors of malocclusion.

Guiding atypical facial growth back to normal. Part 2: Causative factors, patient assessment, and treatment planning.

It has been well-documented that the most common factors associated with atypical facial growth involve the airway, which when compromised, leads to mouth breathing and associated aberrant tongue function. The most common changes include downward and backward rotation of the mandible, deficient nasomaxillary complex, a vertical growth pattern, posterior displacement of the TMJ, narrow maxillary arch, dental malocclusions, and dental crowding. It is imperative that clinicians recognize, diagnose, and begin treatment as early as possible when facial growth deviates from normal. Several specific diagnostic tools, coupled with traditional diagnostic records, assist the clinician in determining the degree and direction of atypical growth. Such a clear-cut diagnostic process sets in motion the treatment plan requirements necessary to accomplish the goal of returning facial growth to normal. Diagnosis and treatment planning requires that each practitioner has a broad base of knowledge, a good power of observation, and insight into the complex subject of facial growth and development.

Avaliação da postura corporal em crianças e adolescentes respiradores orais / Assessment of the body posture of mouth-breathing children and adolescents

OBJETIVO: Verificar a associação do tipo respiratório oral (RO) e nasal (RN) e da classificação da postura corporal em variáveis clínicas de crianças e adolescentes com a síndrome do respirador oral, em relação a um grupo-controle de mesma faixa etária. MÉTODOS: Estudo analítico do tipo observacional e transversal, com grupo-controle, realizado em hospital universitário. Foram incluídas crianças maiores de 5 anos, distribuídas em dois grupos: controle saudável (RN) e grupo RO. O grupo RO incluiu pacientes com diagnóstico de síndrome do respirador oral confirmado por exame clínico médico e nasofibroscopia. Participaram do grupo-controle voluntários saudáveis da mesma faixa etária, cujo tipo RN foi confirmado por avaliação médica. Todos os participantes foram submetidos à avaliação postural. Para análise dos dados, foram utilizados os testes: não paramétrico de Mann-Whitney, qui-quadrado e exato de Fisher, considerando-se nível de significância de 0,05 por cento. RESULTADOS: Foram incluídos 306 RO e 124 RN. O tipo RO conferiu maior prevalência no gênero masculino (p = 0,0002), maior grau e frequência de obstrução nasal e tamanho das amígdalas (p = 0,0001) em comparação ao RN. Também apresentou maior incidência de rinite alérgica (p = 0,0001), padrão respiratório torácico (p = 0,0001), palato ogival (p = 0,0001) e classificação postural desfavorável (p = 0,0001) em relação ao grupo-controle. Os índices de classificação postural foram diretamente proporcionais à obstrução nasal (p = 0,0001) e ao gênero masculino (p = 0,0008). CONCLUSÕES: Alterações posturais foram significativamente mais frequentes nas crianças do grupo com síndrome do respirador oral, o que reforça a necessidade de precocidade no tratamento interdisciplinar dessa síndrome.

OBJECTIVE: To investigate associations between mouth breathing (MBr), nose breathing (NBr) and body posture classification and clinical variables in children and adolescents, by comparing patients with mouth breathing syndrome with a control group of similar age. METHODS: This was an observational, analytical, controlled, cross-sectional study conducted at a university hospital. Children aged 5 years or more were recruited to one of two groups: healthy controls (NBr) or an MBr group. The MBr group comprised patients with a diagnosis of mouth breathing syndrome confirmed by clinical examination by a physician plus nasal endoscopy. The control group comprised healthy volunteers of the same age, with NBr confirmed by medical examination. All participants underwent postural assessment. Data were analyzed using the Mann-Whitney nonparametric test, the chi-square test and Fisher’s exact test, to a significance level of 0.05 percent. RESULTS: A total of 306 MBr and 124 NBr were enrolled. Mouth breathers were more likely to be male (p = 0.0002), have more frequent and more severe nasal obstruction and larger tonsils (p = 0.0001) than NBr. Mouth breathers also exhibited higher incidence rates of allergic rhinitis (p = 0.0001), of thoracic respiratory pattern (p = 0.0001), high-arched palate (p = 0.0001) and unfavorable postural classifications (p = 0.0001) with relation to the control group. Postural classification scores were directly proportional to nasal obstruction (p = 0.0001) and male sex (p = 0.0008). CONCLUSIONS: Postural problems were significantly more common among children in the group with mouth breathing syndrome, highlighting the need for early interdisciplinary treatment of this syndrome.

Three-dimensional assessment of pharyngeal airway in nasal- and mouth-breathing children.

OBJECTIVES: The aim of this study was to assess the pharyngeal airway space (PAS) in nasal and mouth-breathing children using cone beam computed tomography (CBCT). METHODS: Volume, area, minimum axial area and linear measurements (PAS-NL, PAS-UP, PAS-OccL, PAS-UT, PAS-Bgo, PAS-ML, PAS-TP) of the pharyngeal airway of 50 children (mean age 9.16 years) were obtained from the CBCT images. The means and standard deviations were compared according to sexes (28 male and 22 female) and breathers patterns (25 nasal breathers and 25 mouth breathers). RESULTS: There were no statistically significant differences (p>0.05) between all variables when compared by sexes. Comparisons between nasal and mouth breathers showed significant differences only in two linear measurements: PAS-OccL (p<0.001) and PAS-UP (P<0.05). Airway volume (p<0.001), area (p<0.001) and minimum axial area (p<0.01) had significant differences between the groups. CONCLUSIONS: The CBCT evaluation showed that pharyngeal airway dimensions were significantly greater in nasal-breathers than in mouth-breathers.

Assessment of the body posture of mouth-breathing children and adolescents.

OBJECTIVE: To investigate associations between mouth breathing (MBr), nose breathing (NBr) and body posture classification and clinical variables in children and adolescents, by comparing patients with mouth breathing syndrome with a control group of similar age. METHODS: This was an observational, analytical, controlled, cross-sectional study conducted at a university hospital. Children aged 5 years or more were recruited to one of two groups: healthy controls (NBr) or an MBr group. The MBr group comprised patients with a diagnosis of mouth breathing syndrome confirmed by clinical examination by a physician plus nasal endoscopy. The control group comprised healthy volunteers of the same age, with NBr confirmed by medical examination. All participants underwent postural assessment. Data were analyzed using the Mann-Whitney nonparametric test, the chi-square test and Fisher's exact test, to a significance level of 0.05%. RESULTS: A total of 306 MBr and 124 NBr were enrolled. Mouth breathers were more likely to be male (p = 0.0002), have more frequent and more severe nasal obstruction and larger tonsils (p = 0.0001) than NBr. Mouth breathers also exhibited higher incidence rates of allergic rhinitis (p = 0.0001), of thoracic respiratory pattern (p = 0.0001), high-arched palate (p = 0.0001) and unfavorable postural classifications (p = 0.0001) with relation to the control group. Postural classification scores were directly proportional to nasal obstruction (p = 0.0001) and male sex (p = 0.0008). CONCLUSIONS: Postural problems were significantly more common among children in the group with mouth breathing syndrome, highlighting the need for early interdisciplinary treatment of this syndrome.

Clinical assessment of adenoidal obstruction based on the nasal obstruction index is no longer useful in children.

OBJECTIVE: To evaluate the accuracy of clinical assessment of adenoidal obstruction based on a standardized score of the degree of mouth breathing and speech hyponasality (nasal obstruction index [NOI]) in comparison to nasal fiberoptic endoscopy. STUDY DESIGN: Cross-sectional study with planned data collection. SETTING: Outpatient clinics of the Departments of Maternal and Pediatric Sciences and Specialized Surgical Sciences, University of Milan, Italy. SUBJECTS AND METHODS: Children aged three to 12 years with adenoidal obstruction suspected on the grounds of persistent/recurrent otitis media or perceived obstructive nasal breathing were eligible. Ear, nose, and throat examination, allergy testing, NOI measurement, and nasal fiberoptic endoscopy to assess the degree of adenoidal hypertrophy were performed. Agreement between the NOI and adenoidal hypertrophy grade was assessed in the patients as a whole and by clinical subgroups. RESULTS: A total of 202 children were enrolled: 54.9 percent had otological diseases and 45.1 percent had perceived obstructive nasal breathing. Most of the children (79.2%) showed mild or moderate clinical nasal obstruction. Adenoidal hypertrophy ranged from no obstruction (18%) to severe obstruction (38%). There was no substantial agreement between the NOI and the degree of adenoidal obstruction in the population as a whole and in all the clinical subgroups. False positive findings were significantly more frequent among allergic children (50%) than non-allergic children (22.4%, P = 0.009). CONCLUSION: Clinical assessment based on the NOI is incapable of accurately predicting the degree of adenoidal obstruction. In children with clinical nasal obstruction not explainable by adenoidal size, the clinician should consider, among causes of more anterior obstruction, nasal allergy.

Valoración de la vía aérea superior en la radiografía panorámica y en la telerradiografía lateral / Lateral cephalometric and panoramic radiographs for upper airway evaluation

El propósito de este artículo es hacer una revisión de los factores etiológicos funcionales que producen alteración de la permeabilidad de la vía aérea superior. El odontólogo tiene un rol importante en la detección precoz de esta alteración porque los signos pueden ser reconocibles fácilmente en la práctica dental. La radiografía panorámica puede ser usada como indicativa , pues se puede observar en ella hipertrofias amigdalina, de cornete, adenoides o presumir la respiración bucal. La telerradiografía de perfil es una técnica auxiliar para la evaluación de la obstrucción de la vía aérea

Risk indicators of gingivitis in 5-year-old Brazilian children.

PURPOSE: To identify the risk indicators of gingivitis among socioeconomic, clinical and gender variables in 5-year-old children attending preschools in Piracicaba, Brazil, in 2005. MATERIALS AND METHODS: The sample consisted of 728 subjects attending 22 public (n = 428) and 18 private (n = 300) preschools. A previously calibrated examiner performed the clinical examination in an outdoor setting, under natural light, using a dental mirror, Community Periodontal Index probe and air-drying. Gingival status was measured using the gingival alteration index for 5-year-olds according to the national survey carried out in 2002 in Brazil (Health Ministry of Brazil, 2004). Socioeconomic variables (monthly family income, number of people living in the household, parents' educational level, home ownership and car ownership) were collected by means of a parental semi-structured questionnaire. RESULTS: The prevalence of gingivitis was 16.6%. Monthly family income (p < 0.0001), father's education (p < 0.0007), mother's education (p = 0.0004), type of school (p < 0.0001), car ownership (p = 0.0854), gender (p = 0.0087), initial lesion (p < 0.0001), dental caries (p = 0.0008), crowding (p = 0.0054) and spacing (p = 0.0019) were associated with gingival bleeding at p < 0.15 and were selected for the regression analysis. By means of multiple logistic regression analyses, monthly family income of up to 4 Brazilian minimum wages, presence of initial lesion, presence of crowding and male gender were found to be risk indicators of gingivitis. CONCLUSION: The prevalence of gingivitis in 5-year-old preschool children in Piracicaba was 16.6%. Also, family income of up to 4 minimum wages, male gender, the presence of initial caries lesion and crowding were risk indicators of gingivitis.

Evaluation of adenoidal obstruction in children: clinical symptoms compared with roentgenographic assessment.

BACKGROUND: Obstructive adenoid enlargement is commonly implicated as the major cause of chronic nasal obstruction in children. Although clinical assessment is considered essential, there is little consensus over its reliability. This study was conducted to determine the correlation between graded symptomatology assessment and roentgenographic assessment of adenoidal obstruction. METHOD: Symptoms assessed included snoring, mouth-breathing and obstructive breathing during sleep. Each symptom was rated on a four-point scale (absent = zero, mild = one, moderate = two and severe = three). We summed the ratings for each child to obtain the symptomatology score. We used an adenoidal-nasopharyngeal ratio parameter to classify roentgenographic assessment into minimal, moderate or marked obstruction. RESULTS: Sixty-four children, 42 boys and 22 girls, aged one to 12 years were enrolled. The clinical symptomatology scores correlated significantly with the roentgenographic ratings of nasopharyngeal airway obstruction (r = 0.419; p = 0.001). The correlation was significant at roentgenographic ratings of minimal obstruction (p < 0.05) and gross obstruction (p < 0.001). Both the symptomatology score and the roentgenographic rating showed significant correlations with patient age (r = -0.657, p < 0.01 and r = -0.340, p < 0.01, respectively). CONCLUSION: Clinical rating of adenoidal symptoms in children provides a reasonably reliable assessment of the presence and severity of nasopharyngeal airway obstruction. This technique of assessment is easy to use and is particularly valid when obstruction is either minimal or gross.