Hyperextension of the head versus cervical vertebrae morphology in mouth and nasal breathers: a preliminary study

Objective: This study aimed to compare through cone-beam computed tomography (CBCT) the morphology of the cervical vertebrae atlas (C1) and axis (C2) in mouth breathers (MB) and nose breathers (NB), correlating them with the head and neck postures of the two groups. Materials and Methods: CBCT images of 36 subjects aged 11 to 22 years were evaluated using the InVivo Dental 5.1 (Anatomage, San Jose, California) software. The following measurements were used to assess C1 and C2 morphology: posterior height, anterior height, length, and volume. The craniocervical angle (NSL/OPT) was used to evaluate head posture concerning the neck. Results: The posterior height, length, and volume of C1 and C2 were lower in the MB group, but only the posterior size was significantly shorter than the NB group (C1, p=0.01 / C2, =0.05). Mouth breathers also showed a considerably higher craniocervical angle (p=0.04). Spearman test showed a significant positive correlation between C1 and C2 length and craniocervical angle (C1, =0.629, p=0.005 / C2, =0.665, p=0.003). Conclusion: The mouth breathers showed an increased craniocervical angle and decreased posterior height of the C1 vertebra concerning nasal breathers. The hyperextension of the head present is positively correlated with the length of the vertebra.

Objetivo: Este estudo teve como objetivo comparar por meio da tomografia computadorizada de feixe cônico (TCFC) a morfologia do atlas das vértebras cervicais (C1) e do eixo (C2) em respiradores orais (MB) e nasais (RN), correlacionando-os com a cabeça e posturas do pescoço dos dois grupos. Materiais e Métodos: Imagens de CBCT de 36 indivíduos com idades entre 11 e 22 anos foram avaliadas usando o software InVivo Dental 5.1 (Anatomage, San Jose, Califórnia). As seguintes medidas foram usadas para avaliar a morfologia de C1 e C2: altura posterior, altura anterior, comprimento e volume. O ângulo craniocervical (NSL/OPT) foi utilizado para avaliar a postura da cabeça em relação ao pescoço. Resultados: A altura posterior, comprimento e volume de C1 e C2 foram menores no grupo MB, mas apenas o tamanho posterior foi significativamente menor que o grupo RN (C1, p=0,01 / C2, =0,05). Os respiradores orais também apresentaram um ângulo craniocervical consideravelmente maior (p=0,04). O teste de Spearman mostrou correlação positiva significativa entre comprimento de C1 e C2 e ângulo craniocervical (C1, =0,629, p=0,005 / C2, =0,665, p=0,003). Conclusão: Os respiradores orais apresentaram aumento do ângulo craniocervical e diminuição da altura posterior da vértebra C1 em relação aos respiradores nasais. A hiperextensão da cabeça presente está positivamente correlacionada com o comprimento da vértebra.

Is mouth-breathing related to alterations in facial soft tissues?

Objective: To compare the facial soft tissues of nasal breathers (NB) and mouthbreathers (MB) using cone-beam computed tomography (CBCT).Methods: This was a comparative study of four angular and eight linearcephalometric variables obtained from the facial soft tissues of 43 young menand women aged between 11 and 24 years. Subjects had tomographic examinationprior to the orthodontic treatment and were previously divided into two groupsby an otolaryngologist according to the respiratory pattern of nasal or mouthbreathing. The selection was made in accordance with the results of: clinicalexamination, rhinoscopy, and nasal endoscopy. The data obtained from thesoftware InVivo Dental 5.3 (Anatomage - San Jose, California) was evaluated bycomparing values measured between MB and NB groups. Results: There weresignificant differences between groups for variables, "nasolabial angle", inclinationof upper central incisor" and "convexity of the facial soft tissues". Conclusion:Adolescent and young adult mouth breathers present an open nasolabial angledue to the retroinclination of their upper incisors. In addition to greater convexityof the facial soft tissues.

Objetivo: Comparar os tecidos moles faciais de respiradores nasais (RN) e bucais(RB), utilizando imagens de tomografia computadorizada de feixe cônico (TCFC).Métodos: Foi realizado um estudo comparativo composto por quatro variáveiscefalométricas angulares e oito lineares, obtidas de tecidos moles faciais deindivíduos RN e RB, em uma amostra composta por 43 indivíduos jovens deambos os sexos, com idades entre 11 e 24 anos, submetidos ao exame tomográficoanteriormente ao tratamento ortodôntico. Os indivíduos foram previamentedivididos em dois grupos por um otorrinolaringologista, de acordo com o padrãorespiratório. O diagnóstico da respiração bucal foi feito em conformidade comos resultados de exames específicos: exame clínico, rinoscopia e endoscopia nasal.Os dados obtidos a partir do software InVivo 5.3 Dental (Anatomage - San Jose,Califórnia) foram avaliados através da comparação dos valores das mediçõesdas variáveis dos grupos RN e RB, além da comparação das diferenças entreesses valores. Resultados: Houve diferenças estatisticamente significativas entreos grupos com relação às variáveis, "ângulo nasolabial", "inclinação do incisivocentral superior" e "convexidade dos tegumentos faciais". Conclusão: Osrespiradores bucais adolescentes e adultos jovens apresentam ângulo nasolabialmais aberto, devido à maior inclinação lingual do longo eixo dos incisivossuperiores, além de maior convexidade dos tecidos moles faciais.

Clinical recognition of mouth breathers by orthodontists: A preliminary study.

INTRODUCTION: A routine diagnosis of a patient's breathing status performed by an orthodontist normally includes visual assessment, medical history, clinical examination of habitual lip posture, size and shape of the nostrils, reflex control of the alar muscle and respiratory tests, and the dental mirror test. The objective of this study was to test the recognition of mouth breathers in young persons by an orthodontist and agreement with an otolaryngologist's reference diagnosis when routine assessments were carried out. METHODS: Three independent and blind evaluations were conducted on the same day by 2 orthodontists independently (anamnesis and breathing tests, respectively) and an otolaryngologist (rhinoscopy, nasal endoscopy, and visual assessment). The weighted kappa coefficient was used to test intraexaminer and interexaminer agreement. The frequencies of answers and findings were reported for each breathing status. RESULTS: Fifty-five volunteers composed the sample of this study; 20 participants were nasal breathers, and 35 participants were classified as mouth breathers (and subdivided into mouth breathers with airway obstruction and mouth breathers by habit) by the otolaryngologist. The weighted kappa coefficient showed poor interrater agreement for most comparisons. CONCLUSIONS: Recognition of mouth breathing in young persons by orthodontists is poor.

Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review.

OBJECTIVE:: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS:: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author's opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS:: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS:: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.

Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review

ABSTRACT OBJECTIVE: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author’s opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.

RESUMO OBJETIVO: o objetivo da presente revisão sistemática foi avaliar a duração do período de contenção e a estabilidade do tratamento ortodôntico com expansão maxilar em pacientes em crescimento com mordida cruzada posterior. MÉTODOS: foram realizadas buscas estratégicas nas bases eletrônicas: Cochrane Library, Web of Science, PubMed e Scopus, até 15 de janeiro de 2016. Os critérios de inclusão foram: estudos clínicos controlados e randomizados, prospectivos ou retrospectivos, de pacientes em crescimento com mordida cruzada; tratados com aparelhos expansores maxilares, com fase de contenção pós-expansão e no mínimo seis meses de fase de pós-contenção. Os critérios de exclusão foram: mordida cruzada anterior, anomalias craniofaciais, cirurgia ou outro tratamento ortodôntico; relato de casos; artigos de opinião; teses; revisões de literatura e revisões sistemáticas. O risco de viés dos artigos selecionados foi avaliado a partir do Cochrane risk of bias tool para ensaios clínicos randomizados e Downs and Black checklist para ensaios clínicos não randomizados. RESULTADOS: a busca resultou em 156 títulos/resumos, sendo 44 textos examinados na íntegra. Foram selecionados 6 artigos para o acesso à qualidade metodológica. A duração do período de contenção ocorreu entre 4 semanas e 6 meses. Aparelhos fixos (aparelho em acrílico, Haas, Hyrax e quad-helix) ou removíveis (Hawley e Hawley com expansor) foram utilizados na fase de contenção. CONCLUSÃO: parece que seis meses de contenção com aparelhos fixos ou removíveis são suficientes para evitar a recidiva ou garantir mudanças mínimas em um curto período de acompanhamento pós-contenção.

Avaliação da capacitação de manipuladores em higiene pessoal e boas práticas, em serviços de alimentação do Rio de Janeiro, RJ / Evaluation of training of handlers in personal hygiene and good practices in food services of Rio de Janeiro, RJ

O objetivo deste trabalho foi avaliar o nível de compreensão de um grupo de manipuladores de alimentos em relação aos seus hábitos higiênicos pessoais e procedimentos de Boas Práticas no âmbito de Serviços de Alimentação do município do Rio de Janeiro.