The Effect of a Unique Pacifier on Anterior Open Bite and Overjet in the Primary Dentition: A Pilot Study.

PURPOSES: Pacifiers are the most common device used by children to satisfy their sucking needs. Because of their design, reports of anterior open bite and increased overjet are common. The purposes of this pilot study were to measure the effects of a unique pacifier in toddlers who have existing open bites and increased overjets; and secondly to determine the feasibility of recruiting and retaining toddlers for a six-month study. METHODS: Toddlers with existing open bite and increased overjet currently using a conventional pacifier were recruited from a university pediatric dental clinic. Baseline information was obtained. Visual examination and intraoral measurements were obtained. The study pacifier was introduced to replace the existing pacifier. Follow-up data was collected at three and six months post-intervention. RESULTS: Eight of the 11 toddlers (73 percent) completed the study. Recruitment was challenging because of the inclusion criteria and transportation; retaining participants required numerous reminders to parents. There was a significant difference between initial and final open bite and overjet measurements. CONCLUSION: It is feasible to recruit and retain toddlers but it required significant staff interventions. There was a significant improvement in reducing existing open bite and overjet with the pacifier after six months.

Influence of non-orthodontic intervention on digit sucking and consequent anterior open bite: a preliminary study.

OBJECTIVES: This study aimed to assess behavioural and occlusal outcomes of non-orthodontic intervention (NOI) in a sample of children, 4-12 years of age, in Australia, in order to establish clinical relevance. MATERIALS AND METHODS: Data from 91 patient records of 4- to 12-year-old children reporting a habit of digit sucking, from two clinics in north-eastern Australia, were de-identified and used. Each patient had been examined at two visits, separated by an interval of 4 months, using standard clinical procedures. RESULTS: Of the 77 children who received a 4-month NOI, 69 (89.6%) had ceased their digit sucking habit by the end of the NOI period [χ2=67.0, degrees of freedom (d.f.)=1, P<0.001]. Of the 72 subjects who had front teeth, the number with anterior open bite decreased from 37 (51.4%) to 12 (16.7%) upon completion of NOI (χ2=21.3, d.f.=1, P<0.001). Among the 32 patients with a measurable overjet, the mean overjet was found to decrease from 4.2±2.4 mm to 3.1±1.9 mm after implementation of NOI (t=5.8, d.f.=31, P<0.001). Children who received NOI were more likely to quit the digit sucking habit in the 4-month period (P<0.001, OR=51.8, 95% CI: 9.8-273.9) and were more likely to appear without anterior open bite at a 4-month recall (P<0.001, OR=30.0, 95% CI: 5.9-151.6). CONCLUSIONS: This study demonstrated clinical relevance of NOI on the cessation of a digit sucking habit, closure of anterior open bite and reduction of overjet. Further investigations are indicated.

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.

Case history: improved maxillary growth and development following digit sucking elimination and orofacial myofunctional therapy.

Orofacial myologists are frequently called upon to address retained oral habit concerns. During this process, current I.A.O.M. recommended treatment includes addressing tongue, lip, and jaw rest posture concerns. Following digit sucking remediation, we may also be called upon to address these rest posture issues, and tongue thrust more aggressively together. In this process, facial growth and development and jaw structure may coincidentally improve as a result of 'nature taking its course' by addressing both swallow AND rest posture. In a select subset of clients, dramatic improvements may occur if the timing is right. This article discusses one such case that appears to have yielded a significant improvement in oral postures influencing improved facial and oral growth and development.

Long-term stability of anterior open-bite closure with bilateral sagittal split osteotomy.

INTRODUCTION: Maxillary impaction and bimaxillary osteotomies are used to treat anterior open-bite malocclusions but can have adverse soft-tissue effects. Correcting an anterior open bite with a single mandibular procedure avoids these undesirable soft-tissue effects, but the stability of this procedure is unknown. The purpose of this study was to assess the long-term stability of anterior open-bite correction with bilateral sagittal split osteotomy and rigid internal fixation. METHODS: Orthognathic surgical records of 1 oral surgeon were searched for all patients treated for anterior open bite with bilateral sagittal split osteotomy and surgical closing rotation of the mandible with rigid internal fixation. Cephalometric films from initial consultation, presurgery, postsurgery, orthodontic appliance removal, and a mean of 4.5 years after orthodontic appliance removal were collected, traced, and measured. RESULTS: Thirty-one patients fit the inclusion criteria for this study and had an initial mean open bite of -2.6 mm (SD, 1.1 mm). The patients experienced an average mandibular closing rotation of 3.7° (SD, 2.4°) with surgery. By orthodontic appliance removal, the mandible rotated open 1.1°, and incisor overlap was 1.4 mm (SD, 1.0 mm). Approximately 4.5 years after orthodontic appliance removal, the mean incisor overlap was maintained at 1.0 mm (SD, 1.0 mm), yet the mandible rotated open an additional 1.1°. Only 3 patients relapsed to no incisor overlap in the long term, and only 3 patients experienced relapse greater than 1 mm in the long term. CONCLUSIONS: Approximately 90% of the treated patients had a positive incisor overlap 4.5 years after orthodontic appliance removal. Despite a 60% loss of mandibular surgical closing rotation, only 10% of the patients relapsed to no incisor overlap in the long term. Bilateral sagittal split osteotomy and surgical closing rotation of the mandible by using rigid internal fixation should be considered a stable alternative in the treatment of mild-to-moderate anterior open-bite malocclusions.

An innovative approach to cessation of thumb-sucking in a child with epilepsy: a case report.

The thumb-sucking habit is acquired in infancy, but if it persists beyond preschool age, it can have deleterious effects on facial growth, oral function, occlusal relationship, and aesthetics, leading to dental and skeletal deformities. This paper presents a clinical case history of using nonpunitive reminder therapy to intercept the thumb-sucking habits of an 8-year-old child with epilepsy. A modified Bluegrass appliance was used along with the positive reinforcement. The modified Bluegrass appliance utilized an acrylic roller and was very comfortable for the patient; it was also successful in eliminating the habit within a short period of time.

Effectiveness of appliance therapy in reducing overjet and open bite associated with thumb sucking habit.

AIM: The aim of this paper was to compare the effectiveness of appliance therapy and reward therapy in reducing overjet and open bite associated with thumb sucking habit. METHODS: Thirty nine subjects (17 males and 22 females) with chronic thumb sucking habit were allocated to three groups: group A (positive reinforcement), group B (modified triple loop corrector), and group C (control). Pre-treatment and post-treatment study casts were evaluated for changes in overjet and open bite. Data from measurements of the three groups were statistically analyzed using a non-parametric Kruskal-Wallis test and Mann-Whitney U tests. All statistical computation was performed with SPSS 15.0 software. Significance was set at 0.05 level. RESULTS: Statistically significant reductions in mean overjet and open bite were seen for the group treated with appliance therapy when compared to other two groups (P<0.05). CONCLUSION: Appliance therapy was significantly more superior in reducing the overjet and open bite associated with thumb sucking habit. Early interception of these habits is recommended to reduce the incidence of malocclusion in children.

Modification of the bilateral sagittal split osteotomy for the asymmetric mandible.

The asymmetric mandible is often corrected using the bilateral sagittal split osteotomy. Significant rotation or lateralization of the dentate (distal) segment to correct an asymmetry often results in misalignment of the proximal and distal segments. Fixation of the 2 segments can displace the proximal segment out of the glenoid fossa, leading to postoperative malocclusion. A technique using a cortical bone shim between the 2 segments to maintain the passive position of the proximal segment is presented.

Efficacy of a novel pacifier in the prevention of anterior open bite.

PURPOSE: The purpose of this study was to test a novel pacifier (Dentistar) regarding the development of anterior open bite in infants. METHODS: One hundred twenty-nine newborn children were randomly assigned to 2 experimental groups: NUK (N; N =73); and Dentistar (D; N=56. Children (N=42) who did not use a pacifier served as the control (C). At 10- to 26-months old, the children were re-examined (via a blind operator) regarding the existence of an anterior open bite. RESULTS: One hundred twenty-one toddlers (66 females, 55 males) were included in the final analysis (N: N=42; D: N=43; C: N=36). The mean age was 15.9 (±3.9 SD) months. In Group N, 16 children (38%) showed an anterior open bite, 2 (5%) in Group D, and 0 in Group C. The incidence of open bites was significantly less in Groups D and C vs N (chi-square test, P<.001). No significant difference was found between D and C. CONCLUSION: Pacifier use may promote open bites in 16-month-old infants. Compared to a commonly used pacifier, the Dentistar caused almost no anterior open bites and, therefore, can be recommended for children younger than 16 months old.

Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy.

INTRODUCTION: Closure and long-term retention of anterior open bites are significant concerns for orthodontists and their patients. In this study, we investigated the efficacy of orofacial myofunctional therapy (OMT) for maintaining closure of open bites in conjunction with orthodontic treatment. METHODS: The sample included 76 subjects with dental anterior open bites referred for OMT before, during, or after relapse of orthodontic treatment. The experimental cohort consisted of 27 subjects who received OMT and orthodontic treatment or retreatment. The control cohort comprised 49 subjects who had a history of orthodontic treatment with open-bite relapse. Overbite was evaluated by an OMT professional or orthodontist 2 months to 23 years after removal of the fixed appliances. Measurements were compared with t tests. RESULTS: Overbite relapse means were 0.5 mm (range, 0.0-4.0 mm) in the experimental group and 3.4 mm (range, 1.0-7.0 mm) in the control group, a difference that was clinically and statistically significant (P <0.0001). CONCLUSIONS: This study demonstrated that OMT in conjunction with orthodontic treatment was highly effective in maintaining closure of anterior open bites compared with orthodontic treatment alone.

Principales hábitos deformantes en escolares de primer grado del Seminternado 30 de Noviembre / Main deforming habits in first grade schoolchildren from 30 de Noviembre Day Boarding School

Se realizó una investigación descriptiva y transversal de 98 niños de primer grado del Seminternado 30 de Noviembre de Santiago de Cuba, atendidos en la propia escuela por odontólogos de la Clínica Estomatológica de Vista Alegre durante el 2007, para determinar su estado de salud bucal, así como los hábitos bucales deformantes presentes. Entre las principales alteraciones del complejo bucomaxilofacial sobresalieron: gingivitis, caries, deformidad dentofacial (vestibuloversión y mordida abierta anterior), así como la lengua protráctil como hábito deformante, asociada a la higiene bucal deficiente. Predominaron la dieta cariogénica y la placa dentobacteriana como factores de riesgo. Se recomendó elaborar y ejecutar un programa de actividades de educación para la salud, cuyas acciones estratégicas sean dirigidas a niños, padres, familiares y educadores.

A descriptive and cross-sectional study was carried out in 98 first grade schoolchildren from 30 de Noviembre Day Boarding School of Santiago de Cuba, who were attended at their own school by odontologists from the Dental Clinics of Vista Alegre during 2007 to determine their oral health state and deforming habits. Among the main disorders of the oral and maxillofacial complex were gingivitis, decay, dentofacial deformity (vestibuloversion and anterior open bite), as well as protractile tongue as a deforming habit associated with poor oral hygiene. Cariogenic diet and dentobacterial plaque predominated as risk factors. It was recommended to develop and implement a program of educational activities for health, strategic actions of which are addressed to children, parents, relatives and educators.

A new 2-dimensional method for constructing visualized treatment objectives for distraction osteogenesis of the short mandible.

Open bite development during distraction of the mandible is common and partly due to inaccurate planning of the treatment. Conflicting guidelines exist in the literature. A method for Visualized Treatment Objective (VTO) construction is presented as an aid for determining the correct orientation of monodirectional and multidirectional distractors. Distraction on the left and on the right side of the mandible takes place in a parallel manner in order to maintain intercondylar width. It follows that in the absence of marked asymmetry, the amount of mandibular body distraction, the amount of ramus distraction and (should it apply), the amount of closure of the gonial angle, can be derived from a simple 2-dimensional plan. After presurgical orthodontic treatment, a cephalogram is taken and a VTO is constructed, that aims at a good occlusion with the enhanced mandible in centric relation, with little or no change of the original position of the rami.

Malocclusion and orthodontic treatment need of mentally handicapped children in Lagos, Nigeria

Objetivo: Determinar a prevalência de maloclusão e necessidade de tratamento ortodôntico em crianças e adolescentes nigerianos com necessidades especiais através do Dental Aesthetic Index (DAI); e avaliar se a maloclusão sofre influência da idade e do sexo da criança. Método: A amostra foi composta por 102 crianças e adolescentes com idades entre 6 a 18 anos atendidos em 5 escolas/centros para pessoas com necessidades especiais. Um questionário pré estruturado foi utilizado para coletar dados sócio-demográficos. Os pacientes foram examinados no ambiente escolar, sob luz natural, sendo utilizado o Índice DAI. O teste t-student foi usado para a comparação da média dos escores DAI entre os grupos. Fez-se uso ainda da correção de Bonferroni. Resultados: Não se verificou diferenças significativas nos escores dos DAI entre o sexo e a idade(p>0,05). Maloclusão severa com tratamento altamente desejável foi observada em 18,0% da amostra. Maloclusão muito severa foi encontrada em 19%, sendo o tratamento fundamental. A perda de um ou mais dentes estava presente em 8,8%, enquanto o apinhamento incisal foi visto em 28,4% e o espaçamento em 58,8%. Alterações no segmento anterior da maxila e da mandíbula foram encontradas em 38,2% e 47,1%, respectivamente. A mordida aberta foi diagnosticada em 25,5% da amostra. Relação molar de classe I foi observada em 68,6%. Conclusão: Uma grande proporção da população apresenta maloclusão severa, onde o tratamento é considerado fundamental. A amostra apresentou altas frequências de todas os tipos de maloclusão quando comparadas às crianças nigerianas normais, com exceção do apinhamento.

Preventive orthodontics for the 5- to 7-year-old with the Nite-Guide technique.

This preventive orthodontic technique is applicable for the 5- to 7-year-old to prevent problems involving crowding, spacing, rotations, overbite, overjet, gummy smiles, Class II molar relations, and TMJ dysfunction from developing. The technique is based on accepted published research on the development of the dentition. Patients are typically started at 5 or 6 years of age and wear two preformed appliances only while sleeping. The active stage lasts about 2 years. The same appliance is used as a retainer until 12 years when the patient is dismissed About 75% to 80% do not require further orthodontics. The total procedure takes about 2 to 3 hours of total chair time.

Orthodontic intervention in the early mixed dentition: a prospective, controlled study on the effects of the eruption guidance appliance.

INTRODUCTION: A prospective, controlled cohort study was started in 1998 to investigate the effects of orthodontic treatment in the early mixed dentition with the eruption guidance appliance. METHODS: Occlusal changes were recorded in 167 treated children and 104 controls after they had reached the middle mixed-dentition stage. Treatment began when the first deciduous incisor was exfoliated (T1) and ended when all permanent incisors and first molars were fully erupted (T2). The children's mean ages were 5.1 years (SD 0.5) at T1 and 8.4 years (SD 0.5) at T2. RESULTS: From T1 to T2, overjet in the treatment group decreased from 3.1 to 1.9 mm and overbite from 3.2 to 2.1 mm. In the control group, overjet increased from 2.9 to 4.1 mm and overbite from 3.3 to 4.1 mm. At T2, the differences between the groups were highly significant (P <.001). At T1, 18% of the children in the treatment group and 22% of the controls had tooth-to-tooth contact between the maxillary and mandibular incisors. All others had an open bite, or the mandibular incisors were in contact with the palatal gingiva. At T2, tooth-to-tooth contact was observed in 99% of the treated children and 24% of the controls (P <.001). Almost half of children in both groups showed incisor crowding at T1. Good alignment of the incisors was observed in 98% of the treated children at T2, whereas maxillary crowding was found in 32% and mandibular crowding in 47% of the controls (P <.001). At T1, 41% of the children in the treatment group and 53% of the controls had a Class I relationship; the rest had either a unilateral or a bilateral Class II relationship. At T2, a Class I relationship was found in 90% of the treated children and 48% of the controls (P <.001). At least 1 occlusal deviation, including overjet > or =5 mm, overbite > or =5 mm, open bite, gingival contact of the mandibular incisors, crowding, or Class II relationship, was observed in 13% of the treated children, but the deviations were mild, and no child was considered to need treatment. In the control group, 88% of the children showed at least 1 occlusal deviation (P <.001). CONCLUSIONS: Treatment in the early mixed dentition with the eruption guidance appliance is an effective method to restore normal occlusion and eliminate the need for further orthodontic treatment. Only a few spontaneous corrective changes can be expected without active intervention.

Prevalência e fatores de risco da mordida aberta anterior na dentadura decídua completa em pré-escolares na cidade de Natal/RN / Prevalence and risk factors of anterior open bite in the complete deciduous dentition in pre-scholarsïchildren who live in the city of Natal/RN

OBJETIVO: estimar a prevalência da mordida aberta anterior na dentadura decídua completa em crianças pré-escolares da cidade de Natal/RN e a associação desta a alguns fatores de risco. METODOLOGIA: este estudo caracterizou-se por ser do tipo transversal e utilizou como elementos amostrais 366 indivíduos na idade de 5 anos na fase de dentadura decídua completa. A mordida aberta anterior, variável dependente, foi categorizada em presente e ausente. No que se refere às variáveis independentes estas foram divididas em: socioeconômicodemográficas e fatores extrínsecos. Através de um questionário fechado e estruturado, foram obtidas informações a respeito das variáveis socioeconômicodemográficas e os seguintes fatores extrínsecos: tipo de aleitamento, tempo de aleitamento materno exclusivo, tempo de aleitamento artificial, hábito e tempo de hábito. Através do exame clínico, foram obtidos os dados relativos ao padrão facial, considerado como fator extrínseco, e à variável dependente - mordida aberta anterior. A associação entre a mordida aberta anterior e as variáveis independentes foi obtida através do teste qui-quadrado com nível de significância de 5 por cento. RESULTADOS E CONCLUSÕES: verificou-se associação significante entre a classe econômica, renda e a presença de hábito. A prevalência da mordida aberta anterior foi de 20,6 por cento do total da amostra.

AIM: The aim of this study was to determine the prevalence of the anterior open bite in the complete deciduous dentition of pre-scholars children who live in the city of Natal/RN, and the association of this malocclusion to possible risk factors. METHODS: A transverse study was performed. Three hundred sixty six individuals, 5 years-old, with complete deciduous dentition were examined. Anterior open bite, the dependent variable, was classified into present or absent. A number of independent variables were collected through a closed and structured questionary. These were classified into socio-economic-demographic and extrinsic factors. The extrinsic factors were breast-feeding type, time of exclusive maternal breast-feeding, time of artificial breast-feeding, presence of habit and habit duration. The determination of presence of open bite and the facial pattern (extrinsic factor) was done through clinical exams. The association between the anterior open bite and the independent variables was analysed through chi-square tests with a significance value of 5 percent. RESULTS AND CONCLUSIONS: Significant association was found between the economic class, family income and the presence of habits. The prevalence of the anterior open bite was 20.6 percent.

Different geometric patterns of pacifiers compared on the basis of finite element analysis.

AIM: This study was carried out with the purpose to show on a virtual model of oral cavity the mechanical behaviour of different kinds of pacifiers with different pressure levels that can be likened to a condition of rest and deglutition. MATERIALS AND METHODS: Three different types of dummies, orthodontic- (A), cherry- (B) and drop- (C) shaped from an anatomical point of view, were inserted between the palate and the tongue in a virtual system by means of a finite element simulation. The palatal structure was recreated through tridimensional laser scanning, while the tongue structure was reconstructed by a software suitable for reproducing solids. Also the image of the pacifiers was developed by computer-aided scanning and reproduction. Suitable constraints were inserted and high and low pressure levels were exerted on these systems. FEA simulation allowed us to distribute the strain on the palate according to the different geometrical structures of the objects. RESULTS: Dummy A shows a more uniform and wider crosswise stress distribution with also a lesser load on the anterior palatal crest. Dummy B and C, on the contrary, show a more dot-like behaviour inducing a higher stress due to contact on restricted points. CONCLUSION: The characteristics of dummy A, although they have not been clinically investigated yet, seem to be the fittest ones to guarantee the maintenance of the transversal diameters of the premaxilla and reduce the risk of open bite.

Children with Down syndrome: oral development and morphology after use of palatal plates between 6 and 48 months of age.

OBJECTIVE: The aim of this study was to describe the number of erupted teeth, sucking habits, tongue morphology, facial expression and speech in children with Down syndrome (DS) aged 48 +/- 6 months and treated from 6 months of age with palatal plates in combination with speech and language therapy. METHODS: The research took the form of a multicentre, multidisciplinary, longitudinal study of children with DS followed from the age of 6 months. A total of 37 children with DS were included. One child could not cooperate at all and was excluded from the evaluations. In combination with speech and language intervention provided by speech and language therapists, the children used palatal plates provided by dentists from 6 months of age. In the evaluation, the children in the sample (n = 36) were compared with two similarly aged control groups: one group of children with DS who never had used palatal plates (n = 31) and one group of children with normal development (n = 36). The evaluation of oral parameters was performed by dentists after calibration. Registration of facial expression and speech was done by a speech and language therapist, and the evaluation was done by two speech and language therapists and one phonetician who were calibrated in joint discussions. RESULTS: In contrast to the children with DS in the control group, the subjects in the study were found to have as many erupted teeth as the children with normal development. The prevalence of sucking habits did not differ between the three groups. Only children with DS sucked their tongue, a toy or other things in addition to a thumb or dummy. The prevalence of tongue diastase in the study group with DS was of the same magnitude as in the evaluation at the age of 18 +/- 3 months. The palatal plates were used by 57-65% of the children without any larger problems. In the study sample, the possible beneficial effects of palatal plate therapy were a lower prevalence of posterior cross-bite, a higher prevalence of frontal cusp-to-cusp relation and a lower prevalence of frontal open bite. Evaluation of facial expression and speech showed a higher score for facial expression and a better communicative capacity in the children in the study group than in the control children with DS. CONCLUSIONS: In children with DS, palatal plate therapy between 6 and 48 months of age in connection with speech and language intervention had a positive effect on occlusion, oral motor function, facial expression and speech. No harmful effects were observed. Although this is a valuable method, however, it must be emphasized that palatal plate therapy puts additional demands on already burdened children and their caretakers.