Effects of feeding on non‐nutritive sucking habits and implications on occlusion in mixed dentition

International Journal of Paediatric Dentistry 2011; 21: 68–73 Background. Several studies have determined the effects of non‐nutritive sucking habits on malocclusions, but provided conflicting results. Aim. To analyse the influence of infant feeding In the presence of non‐nutritive sucking habits in children after the first year of life and to assess the effects of non‐nutritive sucking habits on occlusion in mixed dentition. Design. Data were collected by self‐reported questionnaire and confirmed by personal interview. Parents of 1451 children (aged 7–11) were asked about their children’s infant feeding and non‐nutritive sucking habits. A clinical evaluation of dental arches included classification of molar relationship (Angle classification), presence or absence of crossbite and open bite. Results. Children with bottle or complementary feeding showed a higher risk of acquiring non‐nutritive sucking habits after the first year of life (P < 0.01). Non‐nutritive sucking habits are associated with a greater risk of crossbite, open bite, Class II molar relationship (P < 0.01). Conclusions. Parents should be educated about benefits of the exclusive breast feeding in the first 6 months of age on mixed dentition. The activity of non‐nutritive sucking should be diagnosed in a timely manner in order to reduce the development of posterior crossbite, anterior open bite, and Class II molar relationship.     

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 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.     

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.     

Feeding and nonnutritive sucking habits and prevalence of open bite and crossbite in children/adolescents with Down syndrome

Objective:To analyze the influence of breastfeeding, bottle feeding, and nonnutritive sucking habits on the prevalence of open bite and anterior/posterior crossbite in children with Down syndrome (DS).Materials and Methods:A cross-sectional study was carried out in 112 pairs of mothers/children with DS between 3 and 18 years of age at a maternal/children''s hospital in Rio de Janeiro, Brazil. The children with DS were clinically examined for the presence of open bite as well as anterior and posterior crossbite. Information on breastfeeding, bottle feeding, and nonnutritive sucking habits was collected using a structured questionnaire. The control variables were age and mouth posture of children/adolescents and mother''s schooling. Statistical analysis of the data was performed using the chi-square test and multiple logistic regression.Results:The prevalence of anterior open bite was 21%, anterior crossbite was 33%, and posterior crossbite was 31%. The use of bottle feeding for more than 24 months (prevalence ratio [PR]  =  1.6) was associated with the occurrence of open bite. Having breastfed for less than 6 months (PR  =  1.4) and pacifier sucking for more than 24 months (PR  =  3.1) were associated with the prevalence of anterior crossbite. Finger sucking (PR  =  2.9) and the use of bottle feeding for more than 24 months (PR  =  2.6) were associated with posterior crossbite.Conclusion:The prevalence of open bite and crossbite in children with DS was associated with the use of bottle feeding and pacifier sucking for more than 24 months, breastfeeding for less than 6 months, and finger sucking.     

Bottle feeding, increased overjet and Class 2 primary canine relationship: is there any association?

The aim of this study was to investigate the association between bottle feeding and prevalence rates of increased overjet and Class 2 primary canine relationship. The sample consisted of 911 children (461 boys, 450 girls) aged 3 (13.9%), 4 (40.8%), 5 (34%) and 6 (11.3%) years, with complete primary dentition. Information about nutritive and nonnutritive (pacifier and/or digit) sucking habits was collected through questionnaires. Three calibrated dentists (κ: 0.9-1.0 and Rs > 0.90) performed the clinical assessments. The children were divided into four groups: G1 - not bottle-fed; G2 - exclusively bottle-fed; G3 - breast- and bottle-fed, bottle feeding ceased before 3 years of age; and G4 - breast- and bottle-fed, bottle feeding ceased between 3 and 4 years of age. Associations between nutritive and nonnutritive sucking behaviors and the malocclusions studied were analyzed by multiple binary logistic regression (α= 0.05). The frequencies of increased overjet were: 25.3% (G1), 38.8% (G2), 39.2% (G3) and 47.8% (G4). The percentages of Class 2 canine relationship were: 27.9% (G1), 48.8% (G2), 43.4% (G3) and 43% (G4). No significant effect of bottle feeding was found. The chances of diagnosing increased overjet (O.R. = 4.42, p < 0.001) and Class 2 canine relationship (O.R. = 4.02, p < 0.001) were greater for children with pacifier and/or digit-sucking habits, compared to those without a history of nonnutritive sucking behavior. It may be suggested that bottle feeding alone is not directly associated with higher prevalence rates of increased overjet and Class 2 canine relationship in the primary dentition.     

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.     

Maximal bite force,facial morphology and sucking habits in young children with functional posterior crossbite

Objective

The maintenance of normal conditions of the masticatory function is determinant for the correct growth and development of its structures. Thus, the aims of this study were to evaluate the influence of sucking habits on the presence of crossbite and its relationship with maximal bite force, facial morphology and body variables in 67 children of both genders (3.5-7 years) with primary or early mixed dentition.

Material and methods

The children were divided in four groups: primary-normocclusion (PN, n=19), primary-crossbite (PC, n=19), mixed-normocclusion (MN, n=13), and mixed-crossbite (MC, n=16). Bite force was measured with a pressurized tube, and facial morphology was determined by standardized frontal photographs: AFH (anterior face height) and BFW (bizygomatic facial width).

Results

It was observed that MC group showed lower bite force than MN, and AFH/ BFW was significantly smaller in PN than PC (t-test). Weight and height were only significantly correlated with bite force in PC group (Pearson’s correlation test). In the primary dentition, AFH/BFW and breast-feeding (at least six months) were positive and negatively associated with crossbite, respectively (multiple logistic regression). In the mixed dentition, breastfeeding and bite force showed negative associations with crossbite (univariate regression), while nonnutritive sucking (up to 3 years) associated significantly with crossbite in all groups (multiple logistic regression).

Conclusions

In the studied sample, sucking habits played an important role in the etiology of crossbite, which was associated with lower bite force and long-face tendency.     

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.     

Nonnutritive sucking habits and anterior open bite in Brazilian children: a longitudinal study

PURPOSE: The purpose of this longitudinal study was to assess the relationship between nonnutritive sucking habits and anterior open bite in 305 4- to 5-year-old children attending state schools in the city of Recife, Brazil. METHODS: The data were collected by interviewing the children's mothers or guardians and through clinical examinations carried out by 1 calibrated examiner (K = 1). Bivariate analyses (Pearson chi-square, McNemar, and Stuart-Maxwell tests) were used for the statistical analysis. RESULTS: The prevalence of sucking habits was low, and the sample showed reductions after 1 year of follow-up. The prevalence of anterior open bite decreased from 33% to 29% after 1 year. A significant association was found between anterior open bite and sucking habits. Open bite self-correction was associated with the abandoning of deleterious habits. CONCLUSIONS: The low prevalence of nonnutritive sucking habits and its reduction during the period studied seem to reflect a natural tendency in preschool children. Even presenting a slight reduction, the high prevalence of anterior open bite draws attention to the importance of longitudinal studies to support scientific evidences for early clinical intervention.     

Correction of collapsed occlusion with degenerative joint disease focused on the mandibular arch and timely relocation of a miniplate

This report describes a novel concept of 3-dimensional tooth movement by using biocreative therapy to provide unrestricted distal movement of the full mandibular dentition. The patient was a 26-year-old Korean woman with multiple problems, including a collapsed occlusion, a full-step Class III relationship with posterior open bite, a crossbite, temporomandibular joint pain, and a tendency for root resorption. Two orthodontic miniplates with tubes were initially placed on both retromolar pads for distalization; 1 miniplate was relocated to the anterior region for angulation and vertical control of the anterior teeth. The total treatment period was 13 months. The occlusion was finished in Class I molar and canine relationships with optimal overjet and overbite. Posttreatment records 2.5 years later showed a stable treatment outcome. The results suggest that an orthodontic miniplate is an efficient tool for the treatment of a collapsed occlusion by changing the affected arch only.     

Occlusal characteristics during different emergence stages of the permanent dentition in Tanzanian Bantu and finnish children

Occlusal characteristics and anomalies were studied among 869 (428 boys, 441 girls) Tanzanian Bantu children aged 3.5-16 years and 706 (319 boys, 387 girls) Finnish children aged 5-11 years during different emergence stages of the permanent dentition. Various occlusal variables were registered according to described criteria. Multiple linear regression, ANOVA, t-test, Chi-square and logistic regression models were used to test for various statistically significant differences between different subgroups. Significant differences between Tanzanians and Finns were found for malocclusion, neutral and distal molar occlusion, mean values for overjet and overbite, overjet greater than 5 mm, deep bite and anterior open bite (all P < 0.0001). The most prevalent anomalies among Tanzanians were anterior open bite (7-19 per cent), increased overjet (3-19 per cent) and distal molar occlusion (3-16 per cent). For the Finns, distal molar occlusion (18-38 per cent) was the most prevalent anomaly, followed by deep bite (4-22 per cent) and increased overjet (4-40 per cent). An anterior crossbite was rare and equally distributed among the two ethnic groups. Girls had a larger mean value for overbite (P = 0.003) and more often a deep bite (P < 0.01) than boys. Mandibular incisor crowding among children with neutral occlusion (Class I malocclusion) occurred significantly more often among Finnish than Tanzanian children. In conclusion, various developmental changes in occlusion were observed leading to variation in occlusal characteristics and anomalies according to the emergence stages of the permanent dentition. Most of the classic malocclusions occur among Tanzanian children, but the prevalence differs from that in other parts of the world.     

Indication for and Frequency of Early Orthodontic Therapy or Interceptive Measures

The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge-to-edge bite) in 1.9%. Extreme anterior open bite > or =6 mm) was recorded in only two children (0.09%). In 19.6% of the children, a supporting zone was reduced in at least one quadrant, necessitating interceptive measures such as the insertion of a space maintainer or later orthodontic treatment (space opening or extraction therapy).     

Treatment of Class II open bite in the mixed dentition with a removable functional appliance and headgear.

Early diagnosis of patients exhibiting open bites that are complicated by skeletal Class II and vertical growth problems can facilitate subsequent treatment. Eight patients with Class II skeletal open bite were treated with the high-pull activator appliance and compared to reasonably matched controls to determine the effects of the appliance. The high-pull activator was found to reduce forward growth of the maxilla and increase mandibular alveolar height, transforming the Class II molar relationship into a Class I molar relationship. The overjet and open bite were decreased, and, in addition, the appliance reduced the amount of forward and downward movement of the maxillary molars, providing vertical control of the maxilla during Class II orthopedic correction. These results demonstrated that open bite complicated by a Class II vertical growth pattern can be treated during the mixed dentition with favorable results by a combination of a removable functional appliance and high-pull headgear.     

Evidence-based orthodontics

Abstract

We describe a 28-year-old man who sought orthodontic treatment complaining about the esthetics of his smile and difficulties associated with masticatory function. The patient had a straight facial profile, skeletal and dental class III relationship, anterior open bite and posterior crossbite. He refused orthognathic surgery and was therefore treated with camouflage orthodontics supplemented with the placement of one mini-implant in each side of the mandible to facilitate movement of the lower dentition distally, tooth-by-tooth. At the end of treatment, a class I molar relationship was obtained, with an ideal overjet and overbite and excellent intercuspation. Furthermore, the open bite and crossbite were corrected. Analysis 2 years after treatment revealed good stability of treatment outcome.     

Nonnutritive sucking habits in Brazilian children: effects on deciduous dentition and relationship with facial morphology.

This study assessed the relationship between nonnutritive sucking habits, facial morphology, and malocclusion in 3 planes of space (transverse, vertical, and anteroposterior) in 330 Brazilian children (4 years of age) attending state schools in the city of Recife, Brazil. The data were collected by interviews with the children's mothers or minders and by clinical examinations carried out by a calibrated examiner (kappa = 1). The chi-square test, Fisher's exact test, and multivariate analysis were used for statistical analysis. The prevalence of malocclusion in the sample was 49.7%, according to occlusal classification, and 28.5% of the children had 2 or 3 factors contributing to their malocclusion. Posterior crossbite was detected in 12.1%, anterior open bite in 36.4%, and increased overjet in 29.7%. A significant association was found between malocclusion and sucking habits (P <.001). Most of the children had a high facial skeletal pattern, although no association was found between facial morphology and malocclusion. The results draw attention to the magnitude of the problem in childhood and emphasize the need for longitudinal studies to support clinical practice guidelines for the target population.     

Prevalence of malocclusions in the 13-20-year-old categories of football athletes

The dentist can offer athletes improvement in their physical performance through the maintenance of oral health, preventing and treating any and all changes in the stomatognathic system, such as dental malocclusions, that compromise the athletes' performance. The objective of this study is to research the presence of dental malocclusions in athletes of the category between 13 and 20 years of age, from the S?o Paulo Football Club. 84 athletes participated in this study, dealing with the following topics: molar relation (Angle's classification); presence of overbite; underbite; overcrowding; abnormal spacing; open bite; and anterior, posterior, bilateral and unilateral crossbite; midline deviation and facial type (mesofacial, brachyfacial and dolichofacial). Only one table was made, showing percentages. In regard to Angle's molar relation, 89% are in Class I, 8% in Class II, 3% Class III, 9% of the athletes had overbite, 4% had underbite, 13% had overcrowding and 21% had abnormal spacing. In regard to the bite, 11% presented anterior open bite. In regard to crossbite, 7% presented unilateral crossbite on the right side and 2% on the left side; 5% presented posterior crossbite and 4% anterior crossbite. In regard to midline deviations, 4% presented deviation in the maxilla and 33% in the mandible. In regard to facial type: 39% are dolichofacial, 4% brachyfacial and 57% mesofacial. Based on the results shown, proposals for the implementation of dental, phoniatric, and Ear, Nose and Throat (ENT) practices are already being discussed with the multidisciplinary team of the club involved.     

Sucking habits and facial hyperdivergency as risk factors for anterior open bite in the mixed dentition.

INTRODUCTION: The aim of this study was to evaluate sucking habits and hyperdivergency as risk factors for anterior open bite in mixed-dentition subjects. METHODS: Anamnestic and pretreatment cephalometric records of 1710 mixed-dentition subjects were assessed for sucking habits, dental open bite, and facial hyperdivergency. RESULTS: The rate of anterior open bite was 17.7%. Multiple logistic regression showed that both prolonged sucking habits and hyperdivergent vertical relationships significantly increased the probability of an anterior dentoalveolar open bite, with a prevalence rate of 36.3%. This was 4 times the prevalence of sucking habits and facial hyperdivergency in subjects without anterior open bite (9.1%). CONCLUSIONS: Prolonged sucking habits and hyperdivergent facial characteristics are significant risk factors for anterior open bite in the mixed dentition.     

Extreme skeletal open bite correction with vertical elastics

Severe skeletal open bites may be ideally treated with a combined surgical–orthodontic approach. Alternatively, compensations may be planned to camouflage the malocclusion with orthodontics alone. This case report describes the treatment of an 18-year-old man who presented with a severe open bite involving the anterior and posterior teeth up to the first molars, increased vertical dimension, bilateral Class III molar relationship, bilateral posterior crossbite, dental midline deviation, and absence of the maxillary right canine and the mandibular left first premolar. A treatment plan including the extraction of the mandibular right first premolar and based on uprighting and vertical control of the posterior teeth, combined with extrusion of the anterior teeth using multiloop edgewise archwire mechanics and elastics was chosen. After 6 months of alignment and 2 months of multiloop edgewise archwire mechanics, the open bite was significantly reduced. After 24 months of treatment, anterior teeth extrusion, posterior teeth intrusion, and counterclockwise mandibular rotation were accomplished. Satisfactory improvement of the overbite, overjet, sagittal malocclusion, and facial appearance were achieved. The mechanics used in this clinical case demonstrated good and stable results for open-bite correction at the 2-year posttreatment follow-up.     

Prevalence and change of malocclusions from primary to early permanent dentition: A longitudinal study

Objective:To follow a group of children from primary to early permanent dentition and determine the prevalence, self-correction, and new development of malocclusions; the need for orthodontic treatment; and the possible influences of habits, breathing disturbances, and allergies.Materials and Methods:Two hundred and seventy-seven children were followed at 3, 7, and 11.5 years of age. Malocclusions and orthodontic treatment need were determined by clinical examinations. Data on sucking habits, breathing disturbances, allergies, dental trauma, and orthodontic treatments were collected from a questionnaire and dental records.Results:Malocclusions were found in 71% of participants at 3 years of age, 56% at 7 years of age, and 71% at 11.5 years of age. Self-correction was noted for anterior open bite, sagittal malocclusions, and posterior crossbite, while deep bite developed. A high number of contact point displacements and spacings contributed to the prevalence of malocclusion rate of 71% at 11.5 years. Severe or extreme orthodontic treatment need was apparent in 22%. Habits, allergies, or breathing disturbances found at 3 years of age had no associations with malocclusions at 11.5 years of age.Conclusions:This sample revealed a significant percentage of malocclusions and orthodontic treatment need. A substantial number of self-corrections and establishment of new malocclusions occurred during the transition from primary to early permanent dentition.