Traumatic dental injuries and their association with malocclusion in the primary dentition of Irish children

Abstract – Aims: This study sought to establish the prevalence of traumatic dental injuries in the primary dentition of Irish children and to investigate the relationship between dental trauma and non‐nutritive sucking habits. Materials and methods: Following ethical approval, a variety of schools and crèches in an urban setting were identified and parents of over 1000 children were contacted. Consent was obtained, and parental questionnaires were completed prior to a clinical examination of the children by one operator in a non‐dental setting. Signs of previous dental trauma were noted, and overbite and overjet were measured. Results: Eight hundred and thirty‐nine children were examined. The prevalence of dental trauma was 25.6%, with boys more frequently affected. The most commonly observed dental injury was fracture of enamel (39.4%), followed by crown discolouration (20.2%). Only 38.8% of the children with a reported history of trauma sought dental care. Non‐nutritive sucking habits were reported in 63.5% of the sample, and these habits, if prolonged, were significantly associated with anterior open bites and increased overjet (P < 0.001). Using regression analysis, it was established that the risk of dental injury is 2.99 times greater if the child has an overjet >6 mm and 2.02 times greater if the child has an anterior open bite. Conclusions: Non‐nutritive sucking habits are associated with the establishment of anterior open bite and increased overjet in the primary dentition. These malocclusions are, in turn, significantly associated with an increased prevalence of dental trauma in the primary dentition.     

Effects of oral habits' duration on dental characteristics in the primary dentition.

BACKGROUND: Studies dating to the 1870s have demonstrated that long-term nonnutritive sucking habits may lead to occlusal abnormalities, including open bite and posterior crossbite. However, little is known as to whether habits of shorter durations have lasting effects. METHODS: The authors collected longitudinal data on nonnutritive sucking among children through a series of questionnaires regularly completed by parents. Researchers examined the children at ages 4 to 5 years and obtained study models. The models were measured for dental arch parameters (including arch width, arch length and arch depth) and assessed for overjet, overbite and posterior crossbite. The authors compared the dental arch and occlusal conditions among groups of children with nonnutritive sucking habits of different durations. RESULTS: Children with nonnutritive sucking habits that continued to 48 months of age or beyond demonstrated many significant differences from children with habits of shorter durations: narrower maxillary arch widths, greater overjet and greater prevalence of open bite and posterior crossbite. In addition, compared with those who ceased their habit by 12 months of age, those with habits at 36 months of age had significantly greater mandibular canine arch widths, maxillary canine arch depths and overjet, while those with habits at 24 months and 36 months had significantly smaller palatal depths. Prevalence of anterior open bite, posterior crossbite and excessive overjet (> 4 millimeters) increased with duration of habits. CONCLUSIONS: While continuous nonnutritive sucking habits of 48 months or longer produced the greatest changes in dental arch and occlusal characteristics, children with shorter sucking durations also had detectable differences from those with minimal habit durations. CLINICAL IMPLICATIONS: It may be prudent to revisit suggestions that sucking habits continued to as late as 5 to 8 years of age are of little concern.     

Jaw clenching effects in relation to two extreme occlusal features: patterns of diagnoses in a TMD patient population

Objective:

The aim of this investigation was to compare the pattern of temporomandibular disorder (TMD) diagnoses in clenching patients with different occlusal features, the null hypothesis being that no between-group differences exist.

Materials and methods:

Two groups of subjects receiving a jaw clenching diagnosis and having large overjet or anterior open bite (Group A; N?=?45, 75·5% females, mean age: 38·1±15·9 years) or normal occlusion (Group B; N?=?69, 71% females, mean age: 34·6±13·8 years) were recruited among a TMD patient population and were given Research Diagnostic Criteria for TMD (RDC/TMD) axis I diagnoses, namely, group I muscle disorders, group II disc displacements, and group III arthralgia/osteoarthritis/osteoarthrosis.

Major findings:

The distribution of RDC/TMD single and combined group diagnoses was significantly different between the two groups (P<0·05), with Group A subjects showing a higher prevalence of multiple diagnoses (60% versus 43·3%), as well as a higher prevalence of combined RDC/TMD axis I group II and III diagnoses (37·8% versus 20·2%). All TMD signs and symptoms were more frequent in the patients with large overjet or anterior open bite with respect to the patients with normal occlusion.

Conclusion:

In a TMD patient population, jaw clenching may have different consequences in subjects with large overjet or anterior open bite with respect to subjects featuring normal occlusion.     

Association between occlusal anomalies and dental caries in 3‐ to 5 year‐old Brazilian children

Abstract

Objective: To investigate the association between certain occlusal anomalies and the occurrence and severity of dental caries in Brazilian preschool children.

Design: Cross‐sectional study.

Setting: Twenty‐eight public nursery schools in Canoas, southern Brazil.

Subjects and methods: The study population comprised 890 three‐ to five‐year‐old children. Five trained and calibrated observers examined children for determination of decayed, missing and filled tooth (dmft) index (World Health Organization criteria including white spots) and orthodontic variables.

Outcome measures: Caries severity (dmft) and caries occurrence (dmft?1).

Statistical analysis: Multivariable analysis was performed using Poisson regression with robust variance in order to determine the occlusal anomalies which represent risk factors for the occurrence of the binary outcome.

Results: Caries severity was significantly higher among children without spacing in the maxillary anterior teeth (P?=?0·001) and mandibular anterior teeth (P?=?0·003) and among children without accentuated overjet (P?=?0·023). The multivariable analysis demonstrated that children without spacing in maxillary anterior teeth had an increased risk of dental caries (prevalence ratio?=?1·43; 95% CI, 1·05–1·93). Open bite, accentuated overjet and posterior cross‐bite were not associated with this outcome in the final model.

Conclusions: Absence of spacing in the maxillary labial segment represents a risk factor for dental caries in preschool children.     

Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition.

The purpose of this study was to determine the association between the duration of nutritive and nonnutritive sucking behaviors and various occlusal characteristics in the primary dentition. Sucking behavior data were collected on 372 children followed longitudinally from birth by using periodic questionnaires completed by parents. Study models were obtained from the children at 4 to 5 years of age and assessed for posterior crossbite, anterior open bite, and overjet. Dental arch parameters including arch widths, arch lengths, and arch depths were measured directly from the models. The subjects were grouped according to type of habit (pacifier or digit) and duration of nonnutritive sucking behaviors (less than 12, 12 to 24, 24 to 36, 36 to 48, and more than 48 months). Children with nonnutritive sucking of less than 12 months were further grouped according to the duration of breast-feeding. The dental arch and the occlusal characteristics were then compared among these groups. The results indicated no relationship between duration of breast-feeding during the first year of life and any dental arch or occlusal parameters. The study found that prolonged pacifier habits resulted in changes to the dental arches and the occlusal parameters that were different from the effects of digit sucking. In addition, some changes in the dental arch parameters and occlusal characteristics (eg, prevalence of posterior crossbite and increased amount of overjet) persisted well beyond the cessation of the pacifier or digit habit. Although further study is needed to determine the effects of nonnutritive sucking behavior in the mixed dentition, the results suggest that current recommendations for discontinuing these habits may not be optimal in preventing habit-related malocclusions.     

Effects of nonnutritive sucking habits on occlusal characteristics in the mixed dentition

PURPOSE: Little is known about the extent to which nonnutritive sucking habits contribute to malocclusion in the mixed dentition. The purpose of this study was to report on the relationship between certain occlusal traits in the mixed dentition and longitudinal sucking behaviors. METHODS: Dental examinations were conducted on 630 children in the mixed dentition who participated in a large, ongoing longitudinal study. Five hundred eighty consented to impressions, and 524 adequate study models were obtained. Of these, 444 also had adequate longitudinal nonnutritive sucking data obtained via mailed questionnaires to parents at 3- to 6-month intervals from birth to 8 years. Sucking behaviors were grouped by predominant type and duration. Study models were hand articulated using wax bites to evaluate the occlusion for the presence of open bite, crossbite, molar relationship, and excessive overjet. Bivariate statistical analyses related presence of these malocclusions to sucking duration and type. RESULTS: Fifty-five percent of the children had malocclusions (anterior open bite, posterior crossbite, bilateral Class II molar relationship, or overjet >4 mm). Class II molar relationship was most common (30%). Overall, anterior open bite and posterior crossbite was associated with habits of 36 months or more. Sustained pacifier habits, including those of 24 to 47 months, were associated with anterior open bite and Class II molar relationships, while digit habits were associated with anterior open bite when sustained for 60 months or longer. CONCLUSIONS: Malocclusions are quite prevalent in the mixed dentition, and anterior open bite and posterior crossbite may be preventable by modifying nonnutritive sucking behaviors.     

下颌尖牙高[牙合]型[牙合]板配合直丝弓矫治器治疗前牙深覆[牙合]深覆盖临床观察

目的：总结下颌尖牙高[牙合]型[牙合]板配合直丝弓矫治器治疗前牙深覆[牙合]深覆盖的临床疗效。方法：选择Angle Ⅰ类错[牙合]上颌前牙有散在间隙伴深覆[牙合]深覆盖病例15例,男7例,女8例。年龄18～22岁。均采用国产直丝弓托槽,先行上颌牙固定矫治。同时下颌配戴尖牙高[牙合]型[牙合]板打开咬合,矫治前拍摄头颅侧位定位片,待咬合打开,后牙有接触时再拍摄头颅侧位定位片,选择头影测量指标22项,对测量结果进行T检验。结果：MP—SN,S-Ar—Go,Y—axis在戴尖牙高[牙合]型[牙合]板治疗前后均有显著性差异,N—Me,ANS—Me也有显著性差异,下颌平面角增大,下颌有后旋趋势,有利于改善低角型面形。U6-PP,L6-PP增大,有显著性差异,上下后牙均有升高,有利于打开咬合,解除深覆[牙合]。U1-PP增大有显著性差异,提示上前牙伸长,L1-Mp有减小的趋势,没有显著性差异,下前牙有压低的可能。U1-SN,UI—NA,U1-PP有非常显著差异,上颌前牙明显内收,深覆盖明显改善。结论：下颌尖牙高[牙合]型[牙合]板配合直丝弓矫治器是-种治疗前牙深覆[牙合]深覆盖的有效方法。     

Oral habits in a group of consecutively treated orthodontic patients,using standardized video recordings for diagnosis

Abstract

Objective. To investigate the prevalence and correlation of soft tissue dysfunctions documented by standardized video recordings in a group of orthodontic patients and to evaluate orthodontic treatment changes. Subjects and methods. The presence of an oral habit was evaluated from standardized pre- and post-treatment video recordings of 80 consecutive patients (30 boys and 50 girls, mean age 12.2 ± 1.7 years). Any digit-sucking habit was noted during a routine interview. Pre- and post-treatment cephalograms were traced to assess sagittal and vertical jaw and incisor relationships. Correlations and differences were tested for statistical significance using the t-test and Odds-ratio. Results. 56.3% had one or more habits before treatment. The total prevalence fell during treatment. A clear correlation was found between digit sucking and atypical tongue activity. Pre-treatment cephalograms showed that patients with a habit had a larger overjet, smaller overbite, more proclined and protruded incisors, a greater ANB angle and a greater inter-maxillary angle (ML/NL) than those without a habit. Cephalometric differences between the groups after orthodontic treatment were much less pronounced. Those with an oral habit also showed a tendency for increased treatment time/number of visits. Conclusions. Standardized video recordings improved the reliability of the recordings of the oral soft tissue dysfunctions. Their overall reduction after the end of orthodontic treatment coincided with a normalization of the sagittal skeletal and dental variables.     

Temporomandibular joint dysfunction and occlusion in the mixed and permanent dentition

The aim of this study was to investigate the relation between occlusal factors: Angle classification, overbite, overjet, openbite, anterior and posterior crossbite, scissors bite or buccal crossbite and lateral openbite--and the presence of mandibular dysfunction in a sample of 359 Turkish children with mixed and permanent dentition. Z Test was used to compare the results. It was found that, Class III malocclusion in the permanent dentition and openbite, overbite = 0, overjet = 0, anterior-posterior crossbite in the mixed dentition were related with TMD.     

Lip buccal mucosa traumatic overgrowth due to sucking habit —A 10-year follow-up of a non-surgical approach: A combination of behavioural and myofunctional therapy

Objective. Traumatic lesion of the lip buccal mucosa may develop due to a repetitive lip sucking habit, secondary to a dental space which opened in the dental in adult patients. The non surgical treatment approach is based on increasing of patient's awareness to the sucking habit along with the creation of a change in the oral and dental surrounding tissues. The following case included a failure to identify a traumatic habit of lower lip sucking, resulting in a buccal mucosa overgrowth. Combined conservative periodontal and orthodontic approach will be presented to address this clinical issue without any need for surgical intervention. Material and methods. 56 year old female patient presented with a complaint of unaesthetic appearance of the intraoral right buccal mucosa of the lower lip at rest position due to an intensive repetitive sucking habit of the right lower lip segment. We initiated a non surgical treatment approach including increasing the patient's awareness to the sucking habit, controlling the periodontal disease and orthodontic treatment to align and level the dental arch and to close the residual space. Result. The soft tissue overgrowth on the lip buccal mucosa almost completely subsided spontaneously as a result of conservative dental and behavioral management without the need for any oral surgery intervention. A 10 years follow-up revealed no repetitive oral mucosa overgrowth, no spaces reopening and no sucking habit redevelopment. Conclusion. Implementation of a morphological correction will assist the patient in breaking the habit and creating an environment that may effectively prevent the reoccurrence of the habit.     

Thumb and finger sucking

A bstract — Information was obtained from 600 parents of their childrens' daytime and nocturnal sucking habits from birth. Most children used some form of supplementary sucking which commenced at birth and lasted for as long as two years. From the second year, the predominant form of supplementary sucking involved a thumb or finger and digit suckers mostly did not suck a dummy or a bottle teat at night. Palatal or arch distortion occurred in only 18 children. This was 17 per cent of the digit sucking group. It was found that of children of the 17 parents who would not allow a dummy, 10 became digit suckers. Of the 72 children who refused a dummy, 38 became digit suckers. Parents should encourage dummy sucking in children who show signs of being potential digit suckers to prevent a digit sucking habit from arising. Where a dummy was not allowed by the parents or used by the child, 56 became digit suckers.     

Stability of orthodontic treatment outcomes after 1-year treatment with the eruption guidance appliance in the early mixed dentition: A follow-up study

Objectives:To investigate occlusal stability from the early mixed to the permanent dentition in children after early treatment with the eruption guidance appliance (EGA).Materials and Methods:Of 46 participants who received 1-year early EGA treatment, 35 attended a follow-up examination at age 12. Group 1 (n = 21) started their EGA treatment at mean age 7.7 years, and group 2 at 9.1 years. Following 1-year treatment, the EGA was used as a retainer. Changes in overjet, overbite, sagittal molar relationship, and anterior crowding were measured on casts obtained before EGA treatment, after EGA treatment, and at follow-up to evaluate occlusal stability.Results:Mean overjet, overbite, sagittal molar relation, and mandibular crowding improved significantly during the study period. Participants with good compliance during the retention period had significantly smaller overjet and overbite values than those with poor compliance.Conclusions:Early correction of increased overjet, overbite, and class II molar relation with the EGA is maintainable and can also be effective in the permanent dentition, provided the EGA is worn regularly as a retainer.     

Overjet Stability after Treatment of Class II Division 1 Malocclusions

Abstract

The results of an analysis of treatment and post-treatment changes in 48 unselected Class II Division 1 malocclusions are presented. All the cases were at least 1 year out of retention (mean 34·7 months).

Mean values have been given for several features. In particular, the mean overjet reduction during treatment was 7·0 mm, the mean relapse 1·1 mm and the mean net overjet reduction 5·9 mm.

The relationship of “final” overjet to overbite, overjet, skeletal pattern and lower lip height at different stages of treatment is described. There is wide variation in “final” overjet in relation to any of the single factors investigated but five significant correlations were found.     

Oral habits,dental trauma,and occlusal characteristics among 4‐ to 12‐year‐old institutionalized orphan children in Riyadh,Saudi Arabia

The aim of this study was to assess the oral habit practices, dental trauma, and occlusal characteristics of 4‐ to 12‐year‐old orphans living in governmental orphanages in Riyadh. This cross‐sectional study was conducted in three government orphanages and three ordinary schools. All 90 orphans, residing in the orphanage, were included. Ninety schoolchildren were selected to serve as the controls. Demographic data, oral habit history, and dental trauma history were obtained through a questionnaire. All children were examined to confirm the presence of signs of oral habits, dental trauma, and associated occlusal characteristics. Pearson chi‐square was used for statistical analysis. Orphans were found to have more digit sucking and oral self‐mutilation habits; however, the control children were found to have more nail biting habit. Nearly 21% of the orphans had dental trauma compared to 10% of the control group. About 70% of the dental trauma affected permanent teeth among orphans, whereas, 85% affected primary teeth in the control children. Dental trauma increased as the orphans got older; however, it decreased significantly as the control children got older. Orphans were found to have more cross‐bite, increased over‐jet, and open‐bite. Digit sucking habit was positively associated with class II molar relation, presence of posterior cross‐bite, and open‐bite. Orphans had increased prevalence of digit sucking habit, self‐mutilation, dental trauma, and malocclusion.     

Occlusal traits in a group of school children in an isolated society in Jerusalem.

Abstract

The prevalence of occlusal features in 939 children, aged 6-13 years, belonging to an ultra-orthodox community of Jewish Ashkenazi descent living in Jerusalem was studied clinically. Sexual dimorphism was found for overjet, overbite, and habit practising. About one-quarter of the sample exhibited some degree of occlusal mutilation due to caries, thus creating a 'caries-affected' subgroup, the rest forming the 'caries-free' subgroup. In the latter set, normocclusion was scarce (7.4 per cent), Class I being the most frequent malocclusion (49.1 per cent). Caries had a significant effect on the symmetry of bilateral occlusal relationships, lower dental midline deviation, and on crowding/spacing conditions in the mixed dentition stage (except for the maxilla in late mixed dentition). The low prevalence of normocclusion can be attributed to genetic background, environmental influences and the definition attached to normal occlusion.     

Occlusal and orofacial myofunctional evaluation in children with anterior open bite before and after removal of pacifier sucking habit

The aim of this study was to evaluate occlusal and orofacial myofunctional characteristics in children with primary dentition and anterior open bite, before and after removal of pacifier sucking habit. A dentist checked anterior open bite, overjet and upper intercanine distance and a speech therapist evaluated posture and tonus of lips and tongue, cheek tonus, swallowing, breathing and speech of twenty-seven 3-5 year-old children at baseline and 3 months later. Habit removal propitiated a mean reduction of 1.97 mm on anterior open bite (P < .001), promoted improvement of lip posture (P = .03), favored nasal breathing (P =. 008) and reduced the occurrence of tongue interposition during swallowing (P = .008). Lack of proper tongue rest posture was capable of preventing spontaneous correction of anterior open bite (odds ratio 17.50).     

Association between early weaning, non-nutritive sucking habits and occlusal anomalies in 3-year-old Finnish children

Objectives, design and subjects . Earlier results on the effect of breastfeeding on the one hand, and non-nutritive sucking habits (pacifier and/or digit sucking) on the other, on the orofacial development of infants are inconclusive. Thus we studied the prevalence of malocclusions and their relationship to the duration of breastfeeding and to non-nutritive sucking habits in a group of randomly selected 3-year-old children ( n  = 148).
Results . Posterior crossbite was detected in 13%, anterior open bite in 18% and large overjet (> 3 mm) in 26% of the children. The proportion of children with anterior vertical open bite was significantly larger among children with non-nutritive sucking habits than among the other children ( P < 0·001). Neither posterior crossbite nor large overjet were associated with non-nutritive sucking habits. The duration of exclusive breastfeeding was 5·8 ± 3·6 months while that of total breastfeeding was 7·3 ± 3·8 months on average. The exclusive and total breastfeeding periods of children with posterior crossbite were both significantly shorter than those of the other children ( P < 0·01 and P  < 0·002, respectively). Children's height and weight were unrelated to the duration of breastfeeding or occlusal anomalies.
Conclusion . We suggest that an early introduction of bottlefeeding, indicating a pattern of low-impact muscular activity, may interfere with the normal development of alveolar ridges and hard palate, and hence lead to posterior crossbite.     

Quantitative description of overjet and overbite and their relationship with the craniofacial morphology

This study was designed to explore whether overjet and overbite relationships might be correlated with the anteroposterior and vertical craniofacial dimensions. The material used to test this hypothesis was lateral cephalometric radiographs from 92 adults (49 women and 43 men) with Angle Class I molar and canine relationships and a harmonious profile. Data were analyzed using the t-test, Kendall's tau-b correlation and cluster analysis. The results revealed that a) women exhibit an increased overjet compared to men, and smaller vertical facial dimensions; b) there is a significant correlation between overjet and overbite, overbite and posterior facial height, and overbite and mandibular angle; c) in the two groups of individuals that were separated on the basis of overjet and overbite, only the mandibular plane exhibited a statistical difference between the two groups: groups with small values for overjet and overbite possess high mandibular angles and a decreased mandibular plane angle accompanies large values for overjet and overbite; d) groups separated on the basis of mandibular plane angle were not independent from the groups separated on the basis of overjet and overbite. In summary, occlusal characteristics are not found to be associated with any particular skeletal pattern.     

Dental compensation for moderate Class?III with vertical growth pattern by extraction of the lower second molars

Objectives

Analysis of the effects and side effects of treatment of patients with moderate skeletal Class?III and vertical growth pattern by means of extraction of the second molars in the lower jaw.

Patients and methods

A total of 20 patients with a mean age of 12.9 years were examined retrospectively. Inclusion criteria consisted of a Wits value of 0 to ?5, a posterior growth pattern of the mandible (Hasund analysis), an overjet of ?2 to 1?mm, and an overbite of 0 to ?3?mm. Treatment was performed using a straight-wire appliance. As part of the treatment, the lower second molars were extracted and Class?III elastics attached. Cephalograms and orthopantomograms taken before and after treatment were used for evaluation.

Results

Treatment resulted in a significant change in the mean overjet from 0.5?mm to 2.1?mm and the attainment of a positive mean overbite of ?1.0?mm to 0.9?mm. The occlusal plane rotated anteriorly from 18.8° to 13.7°. The skeletal parameters showed a change in the Wits value from ?3.3?mm to ?1.4?mm and an anterior mandibular rotation (ML-NSL 35.5° vs. 32.0°). The soft tissues revealed an increase in the distance between the lower lip and the ??esthetic line?? to the posterior (?2.0?mm vs. ?3.9?mm).

Conclusion

Dental compensation of moderate skeletal Class?III with a tendency to an anterior open bite with vertical growth pattern by extracting the lower second molars, combined with Class III elastics, resulted in an anterior rotation of the occlusal plane and mandible. Eighteen of 20 patients achieved a physiological overjet and positive overbite. A prerequisite for this therapy is the presence of lower wisdom teeth; a potential side effect is elongation of the upper second molars.     

Overjet,overbite and dental midline shift as predictors of tooth size discrepancy in a Bangladeshi population and a graphical overview of global tooth size ratios

Abstract

Objectives. This study aimed to measure and compare tooth size ratios in a Bangladeshi population across the following groups: those with normal occlusion, crowding or spacing; those with normal, increased or decreased overjet; those with normal, increased or decreased overbite; those with or without dental mid-line discrepancy; and those with or without lip competence. It also presents a graphical overview of the anterior and overall ratios from the study and using available global data. Materials and methods. This study was performed on dental casts of 260 Bangladeshi individuals, comprising 114 males and 146 females (age range, 18–24 years, mean age = 20). The Bolton anterior ratio and overall ratio were determined for the following groups: those with normal occlusion, crowding or spacing; those with normal, increased or decreased overjet; those with normal, increased or decreased overbite; those with or without dental mid-line discrepancy; and those with or without lip competence. Results. There were statistically significant differences in the anterior tooth size ratios between those with or without dental mid-line discrepancy, with a mean value of 78.83% and 80.05%, respectively. Statistically significant differences were also found in overall tooth size ratios between those with normal, increased or decreased overjet and also between those with normal, increased or decreased overbite. Graphical presentations of anterior and overall ratios from the present study and using global data showed variations between populations. Conclusion. In the Bangladeshi population, increased tooth size ratios in subjects with dental mid-line discrepancy (anterior ratio) and also in those with decreased overjet or decreased overbite (overall ratio) may be predictors of tooth size discrepancies. The graphical overview also suggests that different international ethnic groups display unique Bolton ratios.