Resident: J. Hencler DMD
Date: 06/15/2011
Article title: A Study of Children with Unilateral Posterior Crossbite, Treated and Untreated, in the Deciduous Dentition
Author(s): Thilander, Lennartsson
Journal: Journal of Orofacial Orthopedics
Major topic: Posterior crossbites: Tx vs. Non-tx and long term outcomes
Main Purpose:
Analyze whether occlusal and skeletal characteristics could be found in the deciduous dentition of children w/ tx success (including self-correction) in contrast to those showing non-correction (including relapse) in the young permanent dentition.
Overview of method of research:
Two grps of children w/ unilateral posterior crossbite were followed from age 5-13yo. The children in one grp were txed in the deciduous dentition while the second grp was txed in the late mixed or early perm dentition. Another 25 children w/ excellent occlusion were included as control grp. Results of clinical examination and biometric and ceph analyses, performed at the first exam, are presented for the three grps.
Key points in the article discussion:
The width of the dental arches seem to be significant in predicting long term outcome in crossbite cases. DUH! Unilateral crossbite is chacterized by asymmetry in the upper dental arch as well as the lower dental arch. The differences b/t the crossbite and non-crossbite sides in both arches appeared relevant to the prediction of long term outcome. A broader upper than lower crossbite side was found in children showing self-correction and correction after expansion tx, while narrower upper than lower crossbite side was found only in non-corrected subjects. If crossbite is left untreated adaptive processes such as TMJ remodeling my lead to craniofacial asymmetry.
Summary of conclusions:
This study has shown that tx of unilateral posterior crossbite is not equivalent to expansion of the upper dental arch but is associated w/ biometric and ceph characteristics of importance for long term result. The aim of early tx in deciduous dentition is to allow the 1st perm molars to erupt in dental arches with ideal transverse dimensions. Selective grinding is performed to eliminate forced guidance of the mand. This will facilitate normal intermaxillary relationship for muscular balance and craniofacial devel. In cases of non-correction after selective grinding, corrective tx is indicated w/ the aim of creating symmetric dental arches and muscle funct. Narrow upper and broad lower dimensions will result in failure if an expansion appliance is used in the upper jaw only.
Assessment of article:
This article was confusing with much biometric and ceph analyses. Seems geared more for an ortho resident. The translation from Swedish to English made for a difficult read. Overall though okay.
Wednesday, June 15, 2011
Stability of unilateral posterior crossbite correction in the mixed dentition: A randomized clinical trial with a 3-year follow-up
Meghan Sullivan Walsh June 15, 2011
Literature Review – St. Joseph/LMC Pediatric Dentistry
Stability of unilateral Posterior cross bite correction in the mixed dentition: A randomized clinical trial with a 3-year follow-up
Resident: Meghan Sullivan Walsh
Program: Lutheran Medical Center –Providence
Article Title: Stability of unilateral posterior cross bite correction in the mixed dentition: A randomized clinical trial with a 3-year follow-up
Authors: Sofia Petren, Kristen Bjerklin, and Lars Bondemark
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Volume (number), Year, Page #’volume 139, Issue 1, January 2011 Pgs. e73-81
Major topic: To discuss and determine long-term stability of treatment for posterior cross bite.
Overview of Method of Research: 60 Subject: (33 girls and 27 boys), 40 with unilateral posterior cross bite and 20 controls with normal occlusion were used for this study. 20 were treated with a quad helix appliance and 20 with expansion plates. The sample size was also distributed by sex and age. Patients had to meet the following criteria – mixed dentition, unilateral posterior cross bite, no sucking habit or sucking habit discontinued at least one year before trial and no previous ortho treatment. Study casts made at baseline, post treatment and three years post treatments. Measurements were made of the casts including maxillary and mandibular intercanine and intermolar changes at the shortest linear distance at gingival margins and the cusps tips of the teeth. Overbite, overjet, midline deviation and arch length were also measured. Treatment for both sets of crossbite patients was retained for six months post treatment. Later in the study 10 more patients were added to the follow-up study.
Findings: No significant differences between the two groups with respect to age, sex or side of cross bite between the two groups and the control. Cross bite subjects at baseline had significantly smaller values for all maxillary variables. Midline deviation was more prevalent in the quadhelix and expansion plate groups than the normal group. During treatment, maxillary intermolar and intercanine distances increased significantly in both treatment groups. Mandibular intermolar expansion was significantly greater in the expansion plate group than in the quad-helix. After treatment, a correct midline was achieved in more than half the cross bite patients. At three years post treatment all 15 patients in the expansion-plate group and 19 of the 20 patients in the quad-helix group had normal transverse relationships: in other words the treatment was longitudinally stable. However, during the post treatment period, significant decreases in maxillary and mandibular transverse dimensions occurred in both treatment groups. For overbite, overjet, and arch length, there were no differences within or between groups.
Key points: This study confirms the hypothesis that patients with cross bite who are treated and corrected successfully have long term stability. However, at the end of the follow-up period the maxillary transverse width of patients with previous cross bite had significantly smaller transverse width. The width of the maxilla in a former cross bite patient group never reaches the mean maxillary width of the normal group. Midline deviation is frequently seen in posterior cross bite patients however, the long term effects are unpredictable. Overbite and Overjet showed no differences between the treated patients and the controls. There was no increase in the maxillary arch length in the treatment groups. Therefore this study does not support the assumption that cross bite correction by quad-helix or expansion plate treatment will increase the available tooth space.
Assessment of the Article: Great study to support early and successful correction of cross bite stability. Interesting to note that the study did not support an increase in available tooth space.
Literature Review – St. Joseph/LMC Pediatric Dentistry
Stability of unilateral Posterior cross bite correction in the mixed dentition: A randomized clinical trial with a 3-year follow-up
Resident: Meghan Sullivan Walsh
Program: Lutheran Medical Center –Providence
Article Title: Stability of unilateral posterior cross bite correction in the mixed dentition: A randomized clinical trial with a 3-year follow-up
Authors: Sofia Petren, Kristen Bjerklin, and Lars Bondemark
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Volume (number), Year, Page #’volume 139, Issue 1, January 2011 Pgs. e73-81
Major topic: To discuss and determine long-term stability of treatment for posterior cross bite.
Overview of Method of Research: 60 Subject: (33 girls and 27 boys), 40 with unilateral posterior cross bite and 20 controls with normal occlusion were used for this study. 20 were treated with a quad helix appliance and 20 with expansion plates. The sample size was also distributed by sex and age. Patients had to meet the following criteria – mixed dentition, unilateral posterior cross bite, no sucking habit or sucking habit discontinued at least one year before trial and no previous ortho treatment. Study casts made at baseline, post treatment and three years post treatments. Measurements were made of the casts including maxillary and mandibular intercanine and intermolar changes at the shortest linear distance at gingival margins and the cusps tips of the teeth. Overbite, overjet, midline deviation and arch length were also measured. Treatment for both sets of crossbite patients was retained for six months post treatment. Later in the study 10 more patients were added to the follow-up study.
Findings: No significant differences between the two groups with respect to age, sex or side of cross bite between the two groups and the control. Cross bite subjects at baseline had significantly smaller values for all maxillary variables. Midline deviation was more prevalent in the quadhelix and expansion plate groups than the normal group. During treatment, maxillary intermolar and intercanine distances increased significantly in both treatment groups. Mandibular intermolar expansion was significantly greater in the expansion plate group than in the quad-helix. After treatment, a correct midline was achieved in more than half the cross bite patients. At three years post treatment all 15 patients in the expansion-plate group and 19 of the 20 patients in the quad-helix group had normal transverse relationships: in other words the treatment was longitudinally stable. However, during the post treatment period, significant decreases in maxillary and mandibular transverse dimensions occurred in both treatment groups. For overbite, overjet, and arch length, there were no differences within or between groups.
Key points: This study confirms the hypothesis that patients with cross bite who are treated and corrected successfully have long term stability. However, at the end of the follow-up period the maxillary transverse width of patients with previous cross bite had significantly smaller transverse width. The width of the maxilla in a former cross bite patient group never reaches the mean maxillary width of the normal group. Midline deviation is frequently seen in posterior cross bite patients however, the long term effects are unpredictable. Overbite and Overjet showed no differences between the treated patients and the controls. There was no increase in the maxillary arch length in the treatment groups. Therefore this study does not support the assumption that cross bite correction by quad-helix or expansion plate treatment will increase the available tooth space.
Assessment of the Article: Great study to support early and successful correction of cross bite stability. Interesting to note that the study did not support an increase in available tooth space.
Tuesday, June 14, 2011
Incorrect Orofacial functions until 5 years of age and their association with posterior crossbite
Resident: Swan
Title: Incorrect Orofacial Functions Until 5 years of age and their association with posterior crossbite.
Author: Maja Ovsenik
Journal: American Journal of Orthodontics and Dentofacial orthopedics
Major Topic: Habits associated with posterior crossbite
Main Purpose: Investigate the prevalence of posterior crossbite in Slovenian preschoolers at 5 years of age and its relationship to sucking habits, mouth breathing, and atypical swallowing patterns at ages 3,4, and 5.
Methods: 243 Slovenian children were evaluated at ages 3,4, and 5. Sucking habits, irregular orofacial functions, and morphologic malocclusion were all noted. Before the clinical exam, the parents completed a questionnaire regarding the child's sucking habits. Then, the child was evaluated for mouth breathing (compentent lip closure or not) and swallowing pattern (tongue thrust/teeth apart swallowing). "Normal" swallowing pattern was characterized by tooth contact and activity of masseter muscle. Intraorally, posterior crossbite, midline deviation, and transverse relationships were noted.
Results: Posterior crossbite age 5 diagnosed in 15.2 % of children. Majority were unilateral.
The difference of irregular orofacial functions between crossbite and non crossbite groups was significantly significant for mouth breathing and pacifier sucking. At age 3, 50% of the children with crossbite had a pacifier habit, while only 20% of the noncrossbite kids did. Pacifier sucking decreased markedly by age 5 among the kids, while mouth breathing stayed relatively constant. Diagnosed in 40% of kids with CB, 25% without. Atypical swallowing was also significantly related to crossbite, as this habit increased by year in the crossbite group and decreased substantially by year in the non CB group.
Conclusions:
1. To intercept CBs and funct. shifts, the deciduous dentition should be observed closely especially in children with habits from 2-3 years old. Sucking habits have a direct effect on the developing occlusion and an indirect effect by changing the swallowing pattern.
2. each clinical examination in children with sucking habits should include assessment of orofacial functions (esp. swallowing pattern) In this study, atypical swallowing was diagnosed principally by palpating the masseter and temporalis muscles. Atypical swallowing was diagnosed with no masseter activity on swallowing.
Title: Incorrect Orofacial Functions Until 5 years of age and their association with posterior crossbite.
Author: Maja Ovsenik
Journal: American Journal of Orthodontics and Dentofacial orthopedics
Major Topic: Habits associated with posterior crossbite
Main Purpose: Investigate the prevalence of posterior crossbite in Slovenian preschoolers at 5 years of age and its relationship to sucking habits, mouth breathing, and atypical swallowing patterns at ages 3,4, and 5.
Methods: 243 Slovenian children were evaluated at ages 3,4, and 5. Sucking habits, irregular orofacial functions, and morphologic malocclusion were all noted. Before the clinical exam, the parents completed a questionnaire regarding the child's sucking habits. Then, the child was evaluated for mouth breathing (compentent lip closure or not) and swallowing pattern (tongue thrust/teeth apart swallowing). "Normal" swallowing pattern was characterized by tooth contact and activity of masseter muscle. Intraorally, posterior crossbite, midline deviation, and transverse relationships were noted.
Results: Posterior crossbite age 5 diagnosed in 15.2 % of children. Majority were unilateral.
The difference of irregular orofacial functions between crossbite and non crossbite groups was significantly significant for mouth breathing and pacifier sucking. At age 3, 50% of the children with crossbite had a pacifier habit, while only 20% of the noncrossbite kids did. Pacifier sucking decreased markedly by age 5 among the kids, while mouth breathing stayed relatively constant. Diagnosed in 40% of kids with CB, 25% without. Atypical swallowing was also significantly related to crossbite, as this habit increased by year in the crossbite group and decreased substantially by year in the non CB group.
Conclusions:
1. To intercept CBs and funct. shifts, the deciduous dentition should be observed closely especially in children with habits from 2-3 years old. Sucking habits have a direct effect on the developing occlusion and an indirect effect by changing the swallowing pattern.
2. each clinical examination in children with sucking habits should include assessment of orofacial functions (esp. swallowing pattern) In this study, atypical swallowing was diagnosed principally by palpating the masseter and temporalis muscles. Atypical swallowing was diagnosed with no masseter activity on swallowing.
Feeding and nonnutritive sucking habits and prevalence of open bit and cross-bite in children/adolescents with Down Syndrome.
Resident: Roberts
Date: 6/15/11
Article: Feeding and nonnutritive sucking habits and prevalence of open bit and cross-bite in children/adolescents with Down Syndrome.
Journal: Angle Orthodontist
Volume: 80 No. 4
Year: 2010
pages: 748-753
Objective: To analyze the influence of breastfeeding, bottle feeding, and nonnutritive sucking habits on the prevalence of open bit and anterior/posterior cross-bite in children with Down Syndrome.
Materials and Methods: A cross sectional study was carried out in 112 pairs of mothers/children with Down Syndrome between 3 and 18 years of age in Rio de Janeiro, Brazil. The children with DS were clinically examined for the presence of open bite as well as anterior and posterior cross-bite. 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 cross-bite was 33% and posterior cross-bite was 31%. The use of bottle feeding for more than 24 months and pacifier sucking form more than 24 months were associated with the prevalence of anterior cross-bite. Finger sucking and the use of bottle feeding for ore than 24 months were associated with posterior cross-bite.
Conclusion: The prevalence of open-bite and cross-bite 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.
Risks and Benefits of Pacifiers
Resident: Cho
Author(s): Sexton S. and Natale, R.
Journal: American Academy of Family Physicians
Year. Volume (number). Page #’s: 2009. 79:681-685.
Major topic: Pacifiers
Type of Article: Handout
Main Purpose: To explain the risk and benefits of using pacifiers in infants
Benefits of pacifiers: Analgesia – pacifiers can be used for pain relief in newborns and infants younger than six months undergoing minor procedures in the emergency department. A small amount of sucrose solution (2mL) can be given within two minutes of the procedure, alone or in combination with a nipple or pacifier. Shorter hospital stays. Improved bottle feeding. Reduced risk of sudden infant death syndrome (SIDS).
Risks of pacifiers: Breastfeeding - conflicting evidence about whether early use of a pacifier disrupts breastfeeding or merely indicates other breastfeeding difficulties. Dental malocclusions – most significant malocclusions occurred in children who continued sucking habits beyond 48 months, however, notable changes in children who continued beyond 24 months. Infection – although some evidence exists for pacifier colonization with microorganism, the direct association between these organisms and infection has not been proven. Otitis Media – the pacifier could cause otitis media in the second six months of life by reflux of nasopharyngeal secretions into the middle ear form sucking, and Eustachian tube dysfunction from altered dental structure.
Thursday, June 9, 2011
Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life
Resident’s Name: Jessica Wilson
Article title: Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life
Author(s): Bishara, S et al.
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Year. Volume (number). Page #’s: 2006. 30:1. 31-36.
Major topic: Nonnutritive sucking patterns
Overview of method of research: Scientific Article
Background:
It is estimated that the prevalence of pacifier use is up to 70% and recently, the trend is for children to prolong their pacifier habits. Studies have also shown a significantly higher proportion of girls having digit habits.
Purpose:
To determine prospectively the duration of nonnutritive sucking behaviors of children between the ages of 1 and 8 and the effect of persistent habits on selected occlusal characteristics in the late deciduous dentition.
Methods:
The investigation was part of the Iowa Fluoride Study, a prospective cohort study. Questionnaires were mailed to participant’s mothers at 3, 6, 9, 12, 16, 20, and 24 months and yearly thereafter. Questionnaires included questions on nonnutritive sucking behaviors. The children were examined at 4 1/2-5 years old and alginate impressions along with a bite registration were taken on the majority of the patients. 372 of the participant’s models met the full primary dentition requirement and were analyzed for canine relationship, posterior crossbite, overjet, overbite and open bite. A total of 797 children were included in the sucking behavior analysis. The McNemar test was used to compare various findings.
Results:
At the end of the first year, there were significantly more children using a pacifier than having a digit habit. Throughout the next 4 years, the incidence of children still using pacifiers was significantly less than those with finger habits. The incidence of pacifier habits decreased between the ages of 3 and 8 years from 10% to 0.3% whereas, the incidence of digit sucking only decreased from 14% to 4%.
When looking at digit habits, there was a statistically significant decrease in incidence from the ages of 1 to 4 years, from 4 to 7 years the decrease reached a plateau, followed by another significant decrease from 7 to 8 years of age.
Children with prolonged (>4 years) pacifier habits had a significantly greater incidence of posterior crossbite than those with a digit habit, while prolonged digit habit had a significantly greater incidence of excessive overjets. Class II canine relationships and anterior openbites were not significantly different between these groups.
Key points/Summary:
1. There were no significant differences in prevalence of digit or pacifier habits between boys and girls between the ages of 1 and 8.
2. Children with habits lasting less than 12 months did not have significantly different occlusal characteristics than those who were breast-fed for 6-12 months.
3. Habits lasting >48 months have detrimental effects on occlusion in the late deciduous dentition.
4. When comparing changes in pacifier and digit habits, more children with digit habits had difficulty in stopping after 4 years of age. “As a result, it might be useful to attempt to substitute the digit habit with a pacifier habit as soon as possible.”
Assessment of Article:
I am not sure how I feel about that last statement made by the authors about substituting a digit habit with a pacifier habit, but overall the article presented some pretty interesting findings. Me sorta likey.
Article title: Changes in the prevalence of nonnutritive sucking patterns in the first 8 years of life
Author(s): Bishara, S et al.
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Year. Volume (number). Page #’s: 2006. 30:1. 31-36.
Major topic: Nonnutritive sucking patterns
Overview of method of research: Scientific Article
Background:
It is estimated that the prevalence of pacifier use is up to 70% and recently, the trend is for children to prolong their pacifier habits. Studies have also shown a significantly higher proportion of girls having digit habits.
Purpose:
To determine prospectively the duration of nonnutritive sucking behaviors of children between the ages of 1 and 8 and the effect of persistent habits on selected occlusal characteristics in the late deciduous dentition.
Methods:
The investigation was part of the Iowa Fluoride Study, a prospective cohort study. Questionnaires were mailed to participant’s mothers at 3, 6, 9, 12, 16, 20, and 24 months and yearly thereafter. Questionnaires included questions on nonnutritive sucking behaviors. The children were examined at 4 1/2-5 years old and alginate impressions along with a bite registration were taken on the majority of the patients. 372 of the participant’s models met the full primary dentition requirement and were analyzed for canine relationship, posterior crossbite, overjet, overbite and open bite. A total of 797 children were included in the sucking behavior analysis. The McNemar test was used to compare various findings.
Results:
At the end of the first year, there were significantly more children using a pacifier than having a digit habit. Throughout the next 4 years, the incidence of children still using pacifiers was significantly less than those with finger habits. The incidence of pacifier habits decreased between the ages of 3 and 8 years from 10% to 0.3% whereas, the incidence of digit sucking only decreased from 14% to 4%.
When looking at digit habits, there was a statistically significant decrease in incidence from the ages of 1 to 4 years, from 4 to 7 years the decrease reached a plateau, followed by another significant decrease from 7 to 8 years of age.
Children with prolonged (>4 years) pacifier habits had a significantly greater incidence of posterior crossbite than those with a digit habit, while prolonged digit habit had a significantly greater incidence of excessive overjets. Class II canine relationships and anterior openbites were not significantly different between these groups.
Key points/Summary:
1. There were no significant differences in prevalence of digit or pacifier habits between boys and girls between the ages of 1 and 8.
2. Children with habits lasting less than 12 months did not have significantly different occlusal characteristics than those who were breast-fed for 6-12 months.
3. Habits lasting >48 months have detrimental effects on occlusion in the late deciduous dentition.
4. When comparing changes in pacifier and digit habits, more children with digit habits had difficulty in stopping after 4 years of age. “As a result, it might be useful to attempt to substitute the digit habit with a pacifier habit as soon as possible.”
Assessment of Article:
I am not sure how I feel about that last statement made by the authors about substituting a digit habit with a pacifier habit, but overall the article presented some pretty interesting findings. Me sorta likey.
Wednesday, June 8, 2011
Pacifiers and Breastfeeding
Resident’s Name: Jessica Wilson
Article title: Pacifiers and Breastfeeding
Author(s): O’Connor et al.
Journal: Archives Pediatrics & Adolescent Medicine
Year. Volume (number). Page #’s: 2009. 163:4. 378-382.
Major topic: Pacifier use
Overview of method of research: Systematic Review
Background:
Pacifier use has traditionally been thought to interfere with optimal breastfeeding and in the 1980s the World Health Organization and UNICEF advised the avoidance of pacifiers in order to achieve success in breastfeeding. Since then, evidence has shown pacifiers may be associated with a decrease in incidence of SIDS by as much as 61%, especially when used during the initiation of sleep. The AAP recommend offering a pacifier at naptime and bedtime to reduce the risk of SIDS.
Purpose:
To summarize the current evidence regarding the impact of pacifier use on breastfeeding.
Methods:
A search was done for articles published between 1950 and 2006 related to pacifiers and breastfeeding and was limited to human studies using healthy infants with adequate follow-up(70%). 29 articles met all of the inclusion criteria. Data was then extracted and analyzed.
Results:
Four randomized control trials (RCTs), 20 cohort studies and 5 cross-sectional studies from 12 different countries were evaluated. None of the studies found a significant difference in breastfeeding outcomes with pacifier-related intervention. One study showed that within the group of infants instructed not to use the pacifier, over 60% still used the pacifier.
Key points/Summary:
The results of the 4 RCTs, the highest level of evidence, did not show a difference in breastfeeding outcomes and pacifier intervention.
The majority of the observational studies however, showed evidence of pacifier use and a shorter duration of breastfeeding.
This systematic review demonstrates the complex relationship between pacifier use and breastfeeding and the need for further research.
Assessment of Article:
Although the authors had great intentions and reviewed many different articles, the findings did not lead to many conclusions. This is still a very debatable topic and the matter remains unsettled.
Article title: Pacifiers and Breastfeeding
Author(s): O’Connor et al.
Journal: Archives Pediatrics & Adolescent Medicine
Year. Volume (number). Page #’s: 2009. 163:4. 378-382.
Major topic: Pacifier use
Overview of method of research: Systematic Review
Background:
Pacifier use has traditionally been thought to interfere with optimal breastfeeding and in the 1980s the World Health Organization and UNICEF advised the avoidance of pacifiers in order to achieve success in breastfeeding. Since then, evidence has shown pacifiers may be associated with a decrease in incidence of SIDS by as much as 61%, especially when used during the initiation of sleep. The AAP recommend offering a pacifier at naptime and bedtime to reduce the risk of SIDS.
Purpose:
To summarize the current evidence regarding the impact of pacifier use on breastfeeding.
Methods:
A search was done for articles published between 1950 and 2006 related to pacifiers and breastfeeding and was limited to human studies using healthy infants with adequate follow-up(70%). 29 articles met all of the inclusion criteria. Data was then extracted and analyzed.
Results:
Four randomized control trials (RCTs), 20 cohort studies and 5 cross-sectional studies from 12 different countries were evaluated. None of the studies found a significant difference in breastfeeding outcomes with pacifier-related intervention. One study showed that within the group of infants instructed not to use the pacifier, over 60% still used the pacifier.
Key points/Summary:
The results of the 4 RCTs, the highest level of evidence, did not show a difference in breastfeeding outcomes and pacifier intervention.
The majority of the observational studies however, showed evidence of pacifier use and a shorter duration of breastfeeding.
This systematic review demonstrates the complex relationship between pacifier use and breastfeeding and the need for further research.
Assessment of Article:
Although the authors had great intentions and reviewed many different articles, the findings did not lead to many conclusions. This is still a very debatable topic and the matter remains unsettled.
Open Bite in Prematurely Born Children
Resident: Swan
Title: Open Bite in Prematurely Born Children
Authors: Harila et al.
Journal: Journal of Dentistry for Children 74:3, 2007
Purpose: "examine the expression of open bite in prematurely born children and discuss the etiological factors that may lead to bite it."
Intro: Preterm birth has been associated with various dentofacial findings, including enamel hypoplasia, dental caries, palatal deformities, early eruption of permanent incisors and first molars, and occlusal asymmetries. This study set out to determine any correlation between PTB and anterior open bite.
Methods: N=2132: 328 Preterm and 1804 fullterm born children. 60 Caucasian children and 268 African American children in preterm group, 803 Caucasian and 1001 AA children in control group. All children were among 60,000 in Collaborative Perinatal Study of National Institute of Neurological Disorders and Stroke. Dental examinations were carried out in a standardized way with casts made and photographs taken between ages 6 and 12 in 95% of cases. Casts were examined, arch dimensions and occlusal variables (incl. molar and canine relationships) were determined. Mean age at which casts were taken was 8.8 years. Vertical open bite was determined only for "fully erupted teeth." Results were analyzed with chi-square analysis.
Results: AA children had higher incidence of anterior open bite than Caucasian children (9 vs 3%). Girls had greater incidence than boys (8 vs 6%).
Greater prevalence of ant. open bite was found in the premature children (9 vs 7%). In preterm AA boys, prevalence was 11% compared to 8% among controls. When Caucasian and AA children were combined, prevalence of ant open bite was greater for preterm boys (8 vs 5%) and for preterm girls (9 vs 8%).
Discussion: According to literature, prevalence of open bite in gen. pop. aged 8-11 is 4%. In US, incidence of open bit is approx. 16% in AA population and 4% in Caucasian population. The results of this study conform to these findings.
Literature also shows that most common reason for ant. open bite is non-nutritive sucking habits, but also included in the list are mouth breathing, tongue thrusting, myopathies of facial muscles. It is recommended that children be guided to stop a non-nutritive sucking habit by about age 2.
"Preterm children are predisposed to several systemic derangements, respiratory problems, and other infections. Additionally, the head posture may be altered due to difficulties with breathing, which can interfere with the developing teeth and may help explain the increased prevalence of open bite in some preterm children."
Conclusions: Greater prevalence of ant. open bite among AA children compared to Caucasian and in preterm children compared to full term children.
Assessment: Weak article in my opinion. Briefly hypothesized why preterm babies might have more open bite tendency, but even then it was only a sentence and a weak one at that. Also, only "fully erupted teeth" on the casts were evaluated for open bite. It seems hard to know when a tooth is fully erupted on a cast, and I wonder if this resulted in some false positives and false negatives as they evaluated them.
Title: Open Bite in Prematurely Born Children
Authors: Harila et al.
Journal: Journal of Dentistry for Children 74:3, 2007
Purpose: "examine the expression of open bite in prematurely born children and discuss the etiological factors that may lead to bite it."
Intro: Preterm birth has been associated with various dentofacial findings, including enamel hypoplasia, dental caries, palatal deformities, early eruption of permanent incisors and first molars, and occlusal asymmetries. This study set out to determine any correlation between PTB and anterior open bite.
Methods: N=2132: 328 Preterm and 1804 fullterm born children. 60 Caucasian children and 268 African American children in preterm group, 803 Caucasian and 1001 AA children in control group. All children were among 60,000 in Collaborative Perinatal Study of National Institute of Neurological Disorders and Stroke. Dental examinations were carried out in a standardized way with casts made and photographs taken between ages 6 and 12 in 95% of cases. Casts were examined, arch dimensions and occlusal variables (incl. molar and canine relationships) were determined. Mean age at which casts were taken was 8.8 years. Vertical open bite was determined only for "fully erupted teeth." Results were analyzed with chi-square analysis.
Results: AA children had higher incidence of anterior open bite than Caucasian children (9 vs 3%). Girls had greater incidence than boys (8 vs 6%).
Greater prevalence of ant. open bite was found in the premature children (9 vs 7%). In preterm AA boys, prevalence was 11% compared to 8% among controls. When Caucasian and AA children were combined, prevalence of ant open bite was greater for preterm boys (8 vs 5%) and for preterm girls (9 vs 8%).
Discussion: According to literature, prevalence of open bite in gen. pop. aged 8-11 is 4%. In US, incidence of open bit is approx. 16% in AA population and 4% in Caucasian population. The results of this study conform to these findings.
Literature also shows that most common reason for ant. open bite is non-nutritive sucking habits, but also included in the list are mouth breathing, tongue thrusting, myopathies of facial muscles. It is recommended that children be guided to stop a non-nutritive sucking habit by about age 2.
"Preterm children are predisposed to several systemic derangements, respiratory problems, and other infections. Additionally, the head posture may be altered due to difficulties with breathing, which can interfere with the developing teeth and may help explain the increased prevalence of open bite in some preterm children."
Conclusions: Greater prevalence of ant. open bite among AA children compared to Caucasian and in preterm children compared to full term children.
Assessment: Weak article in my opinion. Briefly hypothesized why preterm babies might have more open bite tendency, but even then it was only a sentence and a weak one at that. Also, only "fully erupted teeth" on the casts were evaluated for open bite. It seems hard to know when a tooth is fully erupted on a cast, and I wonder if this resulted in some false positives and false negatives as they evaluated them.
Effects of oral habits' duration on dental characteristics in the primary dentition
Resident: Adam J. Bottrill
Date: 08JUN11
Region: Providence
Article title: Effects of oral habits' duration on dental characteristics in the primary dentition
Journal: JADA
Page #s: 1685-1693
Vol:No Date: 132, Dec 2001
Major topic: Oral Habits, Primary Dentition
Minor topic(s): None
Type of Article: Longitudinal Study
Main Purpose: The purpose of this study was to assess the effects of different durations of nonnutritive sucking habits on the occlusal relationships and the dental arch characteristics in the primary dentition.
Key points in the article discussion:
I. General:
A. Studies have demonstrated that long-term nonnutritive sucking habits can lead to occlusal abnormalities. Not much known about habits of shorter duration.
II. Methods:
A. Longitudinal data collected on nonnutritive sucking among children through a series of questionnaires. (547 children)
B. Ages 4-5, study models obtained. (526 children)
C. Excluded those with permanent dentition and insufficient descriptive data. (372 children)
D. Dental arch parameters measured
E. Occlusal conditions analyzed for the groups of children with nonnutritive sucking habits of different durations.
III. Results:
A. Only 8 of the 372 children reported no sucking habit.
B. Children with nonnutritive sucking habits that continued to 48 months of age or beyond demonstrated many significant differences from children with habits of shorter duration:
1. narrower maxillary arch widths, greater overjet and greater overjet and greater prevalence of open bite and posterior crossbite.
C. Even when the habit was ceased between 2-3yo, pts still had increased risk of developing posterior crossbite and increased mandibular arch width when compared to those ceasing at 12mo.
D. Those who ceased at 36mo vs 12mo of age had significantly greater mandibular canine arch widths, maxillary canine arch depths and overjet and open bite.
E. Prevalence of anterior open bite, posterior crossbite and excessive overjet increased with duration of habits.
IV. Conclusions:
A. Children with shorter sucking habits also have detectable differences in dimensions
B. As pediatric dentists, we may consider revisiting our suggestions that sucking habits may last until permanent dentition eruption with little concern.
C. Will attempt to follow the children into mixed dentition and draw further conlclusions.
D. Recommending children stop habits prior to 24 months of age is unrealistic.
E. The results of this study suggest 24 months is a realistic and beneficial age to begin the tapering and ceasing of nonnutritive sucking habits.
Assessment of Article: These sucking habits were followed on an ongoing basis and at regular intervals, rather than relying on retrospective gathering of the data. As an observational cohort study, it was not limited to those children "seeking treatment" which lends to it's validity. HOWEVER... This article describes something I believe we all consider intuitive. Longer habit = worsened occlusion
Date: 08JUN11
Region: Providence
Article title: Effects of oral habits' duration on dental characteristics in the primary dentition
Journal: JADA
Page #s: 1685-1693
Vol:No Date: 132, Dec 2001
Major topic: Oral Habits, Primary Dentition
Minor topic(s): None
Type of Article: Longitudinal Study
Main Purpose: The purpose of this study was to assess the effects of different durations of nonnutritive sucking habits on the occlusal relationships and the dental arch characteristics in the primary dentition.
Key points in the article discussion:
I. General:
A. Studies have demonstrated that long-term nonnutritive sucking habits can lead to occlusal abnormalities. Not much known about habits of shorter duration.
II. Methods:
A. Longitudinal data collected on nonnutritive sucking among children through a series of questionnaires. (547 children)
B. Ages 4-5, study models obtained. (526 children)
C. Excluded those with permanent dentition and insufficient descriptive data. (372 children)
D. Dental arch parameters measured
E. Occlusal conditions analyzed for the groups of children with nonnutritive sucking habits of different durations.
III. Results:
A. Only 8 of the 372 children reported no sucking habit.
B. Children with nonnutritive sucking habits that continued to 48 months of age or beyond demonstrated many significant differences from children with habits of shorter duration:
1. narrower maxillary arch widths, greater overjet and greater overjet and greater prevalence of open bite and posterior crossbite.
C. Even when the habit was ceased between 2-3yo, pts still had increased risk of developing posterior crossbite and increased mandibular arch width when compared to those ceasing at 12mo.
D. Those who ceased at 36mo vs 12mo of age had significantly greater mandibular canine arch widths, maxillary canine arch depths and overjet and open bite.
E. Prevalence of anterior open bite, posterior crossbite and excessive overjet increased with duration of habits.
IV. Conclusions:
A. Children with shorter sucking habits also have detectable differences in dimensions
B. As pediatric dentists, we may consider revisiting our suggestions that sucking habits may last until permanent dentition eruption with little concern.
C. Will attempt to follow the children into mixed dentition and draw further conlclusions.
D. Recommending children stop habits prior to 24 months of age is unrealistic.
E. The results of this study suggest 24 months is a realistic and beneficial age to begin the tapering and ceasing of nonnutritive sucking habits.
Assessment of Article: These sucking habits were followed on an ongoing basis and at regular intervals, rather than relying on retrospective gathering of the data. As an observational cohort study, it was not limited to those children "seeking treatment" which lends to it's validity. HOWEVER... This article describes something I believe we all consider intuitive. Longer habit = worsened occlusion
Tuesday, June 7, 2011
Influence of Nonnutritive Sucking Habits, Breathing Pattern and Adenoid Size on the Development of Malocclusion
Resident: Roberts
Date: 6/8/11
Title: Influence of Nonnutritive Sucking Habits, Breathing Pattern and Adenoid Size on the Development of Malocclusion
Author: Gois E, Junior H, et al.
Journal: Angle Orthodontics
Volume: 78
Number: 4
pages: 647 - 654
Objective: To investigate the association of finger and pacifier - sucking habits, breathing pattern, and adenoid size with the development of malocclusion in primary dentition.
Materials and Methods: A case control study was carried out involving 300 preschool children ages 3 to 6 years, randomly selected from 10 public and 10 private schools from a large sample of 745. The case group(n=150) was made up of individuals with at least one of the following malocclusions: anterior open bite, posterior open bite, or over-jet of more than 3 mm. The control group(n=150) was made up of individuals without malocclusions. Variables were assessed through questionnaires such as: oral habits, mouth breathing analysis, and analysis of a lateral ceph to evaluate airway obstruction related to the adenoids.
Results: The risk factors for the occurrence of malocclusion in preschool children were duration of pacifier - sucking after age 2 and mouth breathing pattern. No significant associations were found between hypertrophied adenoids or finger-sucking habits and the occurrence of malocclusion due to the small number of children in this study with these conditions.
Conclusion: The presence of nonnutritive sucking habits and pacifier - sucking habits were directly associated with the presence of a malocclusion. The malocclusion in the primary dentition in preschool children was directly related to the duration of pacifier - sucking after 2 years of age and the mouth breathing pattern.
Pacifier Use in Children: A Review of Recent Literature
Meghan Sullivan Walsh June 8, 2011
Literature Review - St. Joseph/LMC Pediatric Dentistry
Pacifier Use in Children: A Review of Recent Literature
Resident: Meghan Sullivan Walsh
Program: Lutheran Medical Center- Providence
Article Title: Pacifier Use in Children: A Review of Recent Literature
Authors: Steven M. Adair, DDS, MS
Journal: Pediatric Dentistry
Volume (number), Year, Page #’s; 25:5, 2003, 449-458.
Major Topic: Review of literature concerning the role of pacifier in nonnutritive sucking in four areas 1) SIDS, 2) breast-feeding 3) otitis media and other infections and 4) safety.
Overview of Method of Research: Review of studies published since 1950. Searches limited to clinical trials, meta-analysis and multicenter studies. Diagnosis limited to sensitivity and specificity. Etiology/harm limited to cohort studies, case control studies and risk. Natural history/prognosis included prognosis, cohort studies, disease progression and time factors.
Findings:
1) Relationship between pacifier use and SIDS
Studies have shown that pacifier use at sleep time was associated with a greater than 50% reduction in the risk of SIDS. There were several explanations offered: 1) Airway may be less compromised or restricted with pacifier use. 2) Pacifier use may prevent the infant from turning to a prone position. 3) Infants are aroused while sleeping when they lose their pacifier 4) other misc such as reduced risk of GERD, simulation of saliva, simulation of somatostatin and gastrin and altered mother’s behavior causing the mom to check on the infant more frequently.
2) Effect of pacifier use on breast-feeding
Recent decades have shown a trend towards reduced breast-feeding and many studies blame pacifier use. Studies have refuted the “nipple confusion” theory, however, mother’s have admitted to using pacifiers to control the interval between breast-feeding, or to wean their infants from the breast. It is reasonable to consider that mothers who do not plan on breast-feeding may use a pacifier to comfort the infant and assist in weaning.
3) Pacifier use and it’s relationship with acute otitis media and other aspects of health.
Data shows a strong relationship between pacifier use and acute otitis media (AOM). Higher percentages of children with a history of AOM has used a pacifier for less than 4 years. In addition pacifiers have been proved to become a vector for bacterial and fungal transport.
4) Physical safety.
Pacifier material and design, combined with improper usage has been reported towards morbidity and mortality. Ventilation holes are essential as well as flanges with a minimum horizontal and vertical dimension of 43mm. Parents and caregivers are warned not to use cords on pacifiers for fear of strangulation.
Chemical safety includes a volatile n-nitrosamines found in baby bottle nipples that have shown to produce carcinogens in animal testing. In addition, there are questionable reports on latex allergies associated with pacifier use.
Key Points: Summary: Recommendations for our patient’s parents should include:
1) Education on the safety of pacifier use
2) Withhold pacifiers until breast-feeding is established. Limit pacifier use for soothing only.
3)Advise parents to exercise judgment and restraint with pacifier use.
4) Instruct parents to clean pacifiers routinely and avoid sharing.
5)Curtailing pacifier use before the age of 2 to prevent habits and malocclusion.
Assessment of the Article: Great article. Very thorough and usefu
06/08/2011 Predictors of Bruxism, Other Oral Parafunctions, and Tooth Wear over a 20-Year Follow-up Period
Resident: J. Hencler
Date: 06/08/2011
Article title: Predictors of Bruxism, Other Oral Parafunctions, and Tooth Wear over a 20-Year Follow-up Period
Author: Carlsson et al
Journal: Journal of Orofacial Pain Volume 17, Number 1, 2003
Major topic: Oral parafunctions
Type of Article: Longitudinal study
Main Purpose:
Analyze predictors of bruxism, other oral parafunctions, and anterior tooth wear by the use of logistical regression models w/ variables recorded at the first exam as independent variable.
Overview of method of research:
Originally 402 randomly selected 7-, 11-, and 15-year old patients were examined clinically and by questionnaire. Twenty years later 320 completed and returned the questionnaire. 100 returned patients underwent a clinical exam focusing on occlusal factors and function/dysfunction of the masticatory system. For analyses of predictors of oral parafunctions and tooth wear registered at the 20 yr f/u, logistic regression was used w/ recordings at the first exam as independent variables.
Findings:
The bivariate analyses between the dependent variable (reported bruxism at 20 year f/u) and selected variables from the first exam 20 years earlier resulted in five significant associations. These 5 variables (reported bruxism and other oral parafunctions, headache, pain after heavy chewing, TMD symptoms including pain after chewing) plus 1 dental variable (anterior open bite) were included in the logistical regression model with reported bruxism at the 20 year f/u as the dependent variable. See tables for details.
Key points in the article discussion:
The hypothesis was that bruxism and other oral parafunctions in childhood would be identified as predictors of bruxiam and other oral parafunctions and tooth waer 20 years later. Many clinicians have suggested a positive between relationship bruxism and TMD but the knowledge of what causes TMD is limited. The etiology of bruxism has also been controversial and theories have considered occlusal, psychological, genetic, and stress factors. Currently, there is a concensus about the multifactorial nature of its etiology, and bruxism is thought to be a CNS phenomenon related to stress and pain behavior more than to structural components.
Summary of conclusions:
This study found:
1) Reports in childhood bruxism, tooth clenching, tooth grinding at night and nail biting and/or other parafunctions were predictors of the same oral parafunctions 20 yrs later. This suggests that oral parafunctions may be a persistent trait in many subjects
2) Predictors of the 2 components of bruxism, tooth clenching during daytime and tooth grinding at night, were not the same, which supports the opinion that these 2 occlusal parafunctions may be different
3) Postnormal occlusion (Class II) and tooth wear in childhood predicted increased tooth wear in adulthood
4) Nonworking-side interference reduced the risk for extensive tooth wear of the anterior teeth in 100 35-year old subjects.
Assessment of article:
Interesting conclusion. I find that many parents report that their children grind their teeth and want to know if there are any specific causes and possible treatment to make them stop. I find the answer to this question one of the more difficult to explain to parents because we don’t really know the answer for sure. Usually occlusal guard or TMJ therapy is not indicated in very young patients so the best we can do is encourage the parents and continue to monitor the bruxism.
Date: 06/08/2011
Article title: Predictors of Bruxism, Other Oral Parafunctions, and Tooth Wear over a 20-Year Follow-up Period
Author: Carlsson et al
Journal: Journal of Orofacial Pain Volume 17, Number 1, 2003
Major topic: Oral parafunctions
Type of Article: Longitudinal study
Main Purpose:
Analyze predictors of bruxism, other oral parafunctions, and anterior tooth wear by the use of logistical regression models w/ variables recorded at the first exam as independent variable.
Overview of method of research:
Originally 402 randomly selected 7-, 11-, and 15-year old patients were examined clinically and by questionnaire. Twenty years later 320 completed and returned the questionnaire. 100 returned patients underwent a clinical exam focusing on occlusal factors and function/dysfunction of the masticatory system. For analyses of predictors of oral parafunctions and tooth wear registered at the 20 yr f/u, logistic regression was used w/ recordings at the first exam as independent variables.
Findings:
The bivariate analyses between the dependent variable (reported bruxism at 20 year f/u) and selected variables from the first exam 20 years earlier resulted in five significant associations. These 5 variables (reported bruxism and other oral parafunctions, headache, pain after heavy chewing, TMD symptoms including pain after chewing) plus 1 dental variable (anterior open bite) were included in the logistical regression model with reported bruxism at the 20 year f/u as the dependent variable. See tables for details.
Key points in the article discussion:
The hypothesis was that bruxism and other oral parafunctions in childhood would be identified as predictors of bruxiam and other oral parafunctions and tooth waer 20 years later. Many clinicians have suggested a positive between relationship bruxism and TMD but the knowledge of what causes TMD is limited. The etiology of bruxism has also been controversial and theories have considered occlusal, psychological, genetic, and stress factors. Currently, there is a concensus about the multifactorial nature of its etiology, and bruxism is thought to be a CNS phenomenon related to stress and pain behavior more than to structural components.
Summary of conclusions:
This study found:
1) Reports in childhood bruxism, tooth clenching, tooth grinding at night and nail biting and/or other parafunctions were predictors of the same oral parafunctions 20 yrs later. This suggests that oral parafunctions may be a persistent trait in many subjects
2) Predictors of the 2 components of bruxism, tooth clenching during daytime and tooth grinding at night, were not the same, which supports the opinion that these 2 occlusal parafunctions may be different
3) Postnormal occlusion (Class II) and tooth wear in childhood predicted increased tooth wear in adulthood
4) Nonworking-side interference reduced the risk for extensive tooth wear of the anterior teeth in 100 35-year old subjects.
Assessment of article:
Interesting conclusion. I find that many parents report that their children grind their teeth and want to know if there are any specific causes and possible treatment to make them stop. I find the answer to this question one of the more difficult to explain to parents because we don’t really know the answer for sure. Usually occlusal guard or TMJ therapy is not indicated in very young patients so the best we can do is encourage the parents and continue to monitor the bruxism.
6/8/11 Sucking, Chewing, and Feeding Habits and the Development of Crossbite: A Longitudinal Study of Girls from birth to 3 years of Age
Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Sucking, Chewing, and Feeding Habits and the Development of Crossbite: A Longitudinal Study of Girls from birth to 3 years of Age
Author(s): Erik Larsson, Odont Dr
Journal: Angle Orthodontist
Year. Volume (number). Page #’s: 2001. vol 71, No 2
Major topic: Development of post. X bite
Minor topic(s): various things that may cause xbite
Main Purpose: Follow the development of xbites in pacifier suckers and to determine the possibility of reducing the prevalence of xbite by informing/instructing the parents about sucking habits and reducing the amount of time the child has the pacifier in the mouth
Overview of method of research:
60 Swedish girls, all born from 1995-1997 were followed from birth until age three. Over this time period, 5 interviews/exams were conducted. The child’s eating habits, their habit, if they had one, was discussed, and an assessment of their dentition was completed. Variables assessed at the interviews include the following
1. Breast feeding, duration, and frequency
2. Chewing resistance of food
3. Sucking habits, duration, intensity, changes in intensity
4. Biting/chewing habits
5. xbites, functional interferences
6. Problems with teething
7. Design and material of teat
Findings:
Numerous studies have shown that there is an increased prevalence of post. Xbite in children with artificial sucking habits. These studies indicate that a xbite is more likely to develop in pacifier users as opposed to digit suckers. It has been suggested that when the ‘teat’ of a pacifier is kept in the mouth, the tongue is forced to a lower position, thereby reducing palatal support for the max. canines and molars against the cheeks. Conversely, the tongue will increase lateral pressure on the mand. canines and molars, These changes act synergistically to create a transverse instability, possibly leading to post. Xbite. Profit concluded that pressure must be applied to the teeth for 6h/d to produce tooth movement. Therefore, we must encourage the parents to decrease the amount of time the child uses their paci, or sucks their digits.
90% of the children were breastfed. 72% of the girls developed a paci habit, 10% a digit habit, and 18% had no habit. Interferring contacts were noted in 12 of the girls with the paci habit. In all 12 of the girls, the interfering teeth were the primary canines.
In conjunction with previous studies, it was found that the longer a child is breastfed, the less likely they are to develop a sucking habit.
5% of the girls who were still paci users at age three had developed a xbite. In one girl who had a habit until age 2.5 and had developed a xbite, her xbite self corrected by the 3 year check up. As we have heard many times before, we must try to stop the habit before age 3.
Key points/Summary:
Long term artificial sucking habits can cause posterior xbite. Habits should be stopped at all costs by age 3. We should encourage parents to decrease the amount of time the child has their paci, for example only when they are falling asleep.
Assessment of Article: Good, informative article. Things to remember for boards are 1, Stop habits ASAP, definitely by age 3. 2. Try to educate the caregivers on why it is important to stop the habit, and give them tools and ideas to help them stop it.
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Sucking, Chewing, and Feeding Habits and the Development of Crossbite: A Longitudinal Study of Girls from birth to 3 years of Age
Author(s): Erik Larsson, Odont Dr
Journal: Angle Orthodontist
Year. Volume (number). Page #’s: 2001. vol 71, No 2
Major topic: Development of post. X bite
Minor topic(s): various things that may cause xbite
Main Purpose: Follow the development of xbites in pacifier suckers and to determine the possibility of reducing the prevalence of xbite by informing/instructing the parents about sucking habits and reducing the amount of time the child has the pacifier in the mouth
Overview of method of research:
60 Swedish girls, all born from 1995-1997 were followed from birth until age three. Over this time period, 5 interviews/exams were conducted. The child’s eating habits, their habit, if they had one, was discussed, and an assessment of their dentition was completed. Variables assessed at the interviews include the following
1. Breast feeding, duration, and frequency
2. Chewing resistance of food
3. Sucking habits, duration, intensity, changes in intensity
4. Biting/chewing habits
5. xbites, functional interferences
6. Problems with teething
7. Design and material of teat
Findings:
Numerous studies have shown that there is an increased prevalence of post. Xbite in children with artificial sucking habits. These studies indicate that a xbite is more likely to develop in pacifier users as opposed to digit suckers. It has been suggested that when the ‘teat’ of a pacifier is kept in the mouth, the tongue is forced to a lower position, thereby reducing palatal support for the max. canines and molars against the cheeks. Conversely, the tongue will increase lateral pressure on the mand. canines and molars, These changes act synergistically to create a transverse instability, possibly leading to post. Xbite. Profit concluded that pressure must be applied to the teeth for 6h/d to produce tooth movement. Therefore, we must encourage the parents to decrease the amount of time the child uses their paci, or sucks their digits.
90% of the children were breastfed. 72% of the girls developed a paci habit, 10% a digit habit, and 18% had no habit. Interferring contacts were noted in 12 of the girls with the paci habit. In all 12 of the girls, the interfering teeth were the primary canines.
In conjunction with previous studies, it was found that the longer a child is breastfed, the less likely they are to develop a sucking habit.
5% of the girls who were still paci users at age three had developed a xbite. In one girl who had a habit until age 2.5 and had developed a xbite, her xbite self corrected by the 3 year check up. As we have heard many times before, we must try to stop the habit before age 3.
Key points/Summary:
Long term artificial sucking habits can cause posterior xbite. Habits should be stopped at all costs by age 3. We should encourage parents to decrease the amount of time the child has their paci, for example only when they are falling asleep.
Assessment of Article: Good, informative article. Things to remember for boards are 1, Stop habits ASAP, definitely by age 3. 2. Try to educate the caregivers on why it is important to stop the habit, and give them tools and ideas to help them stop it.
Monday, June 6, 2011
The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers
Resident: Cho
Author(s): Barbosa C et al.
Journal: BMC Pediatrics
Year. Volume (number). Page #’s: 2009. 9:1-8.
Major topic: Speech disorders, nonnutritive sucking habits
Type of Article: Research Article
Main Purpose: Evaluate risk factors among pre-school Chilean Patagonia children focusing on past and present sucking behaviors for developing speech disorders.
Methods: Observational study on 128 children aged 37 to 70 months old attending three local public kindergartens in Punta Arenas (Patagonia), Chile, during a one year period. Information was gathered using parent questionnaires (feeding hx., demographics, social economic status), child speech evaluations (TEPROSIF test used by Chilean speech therapist – child shown drawing and examiner tells him/her standardized phrase that includes name of the drawing and child is asked to imitate the phrase) and physical examinations of the children’s mouths conducted by the pediatrician.
Results: 58 three year olds, 49 four year olds, and 21 five year olds were evaluated in this study. Children with below normal occurrence of speech phonological processes were breastfed for a shorter period of time. More than twice as many children with below normal speech used a pacifier for more than three years compared to those without speech problems.
Key points:
Sucking habits such as pacifier use, finger sucking and bottle feeding are associated with speech disorders in preschool children. Starting bottle feeding after 9 months was found to be protective of developing speech disorders. Children who suck their fingers were 3X more likely to obtain an abnormal classification on the TEPROSIF evaluation. Pacifier use was shown to negatively impact the development of speech alterations if used for more than 3 years old while less use was found not be harmful.
Wednesday, June 1, 2011
Dental Caries of Refugee Children Compared with US Children
Meghan Sullivan Walsh June 1, 2011
Literature Review - St. Joseph/LMC Pediatric Dentistry
Dental Caries of Refugee Children Compared with US Children
Resident: Meghan Sullivan Walsh
Program: Luterhan Medical Center - Providence
Article Title: Dental Caries of Refugee Children Compared with US Children
Authors: Susan Cote, RDH, MS; Paul Geltman, MD, MPH; Martha Nunn, DDS, PhD; Kathy Lituri, RdH, MPH; Michelle Henshaw, DDS, MPH; and Raul I. Garcia, DMD
Journal: Pediatrics
Volume, Number, Year, Pages; Vol. 114, No.6, December 2004, pgs 733-740
Major Topic: To describe the prevalence of caries experience and untreated decay among newly arrived refugee children classified by their region of origin and compared with US children.
Overview of Method of Research: Within 90 days of arrival to Massachusetts, US, screenings were completed of some 224 refugees starting January 2001 and ending in September 2002. A dental hygienist performed the screening and the parent and/or child was interviewed about their dental history and history of pain. Demographic information was recorded (age, gender, race/ethnicity, and country of origin.) Caries experience was recorded as well as ‘ECC’. Treatment urgency was estimated with their own scale. In comparison to these numbers, the NHANES III database was used including a total of 11,296 US children between the ages of 2 to 16.9. Information gathered was used to construct comparisons to the refugee database. Logistical regression models were constructed to test the differences in prevalence of untreated cares and the prevalence of caries experience between US and refugee children.
Findings:
REFUGEE ANALYSIS
*Refugee children from Africa were the least likely ever to have been to a dentist
*For treatment urgency:
1) 5% of children from Africa were classified as needing urgent care as compared to 32.2% of Eastern Europeans and 13.6% from other areas.
2)Highest proportion of children with NO obvious dental problems were from Africa 40.5%
*Caries experience in total refugee population was 51.3% ; 38% - African, 79.9% -Eastern European and 50% - Other
*Refugee children from Africa had the fewest dental needs while Eastern Europeans had the greatest.
US NHANES analysis
*77.7% of US children exhibited “no obvious problem”
*77.2% of US children has no untreated caries
Comparison
*White/other refugee children were 9.4 times as likely to have untreated caries compared to white US children, 5.4 times as likely compared to African American children and 4.4 times as likely compared with other US children.
*African refugee children were only twice as likely to have untreated caries compared with white US children and not significantly different from African American children or other US children.
*White/other refugee children were 4.6 times as likely to exhibit caries compared with African refugee children.
*African refugee children were only half as likely to have caries experience compared with white US children and African American children.
Key Points/Summary:
African refugee children had significantly lower dental caries experience as well as fewer untreated caries as compared to Eastern European refugee children. African refugees were also less likely to have seen a dentist. In addition, African refugee children were also half as likely to have had a caries experience were compared with African American children. Eastern European refugees in contrast were three times as likely to have caries experience than US children and 9.4 times as likely to have untreated caries as white US children. Many factors can be attributed to these numbers. It’s been found that many Eastern African countries have naturally occurring optimal levels of fluoride in drinking water with others having very high levels of fluoride. In addition the African countries which were studied also consume far less annual per capita sugar as compared to Eastern Europeans and the US. One interesting fact in the article was that many African’s use ‘chewing sticks’ to clean their teeth which have been found to be an effective means of plaque removal.
Assessment of the Article:
I’m unsure as to why I was ‘randomly’ selected to report on this article?... In any case, this article and research was fascinating! When comparing the few families we’ve treated at St. Joseph, the numbers don’t match up, however, our families in Providence have been from Western African communities which may account for the differences. Many questions came into my head... Are Western Countries in Africa fluoridated? What kind of diets are these families consuming while in these refugee camps? Are these children now at higher risk for dental disease now that they’ve moved to the US? It would be interesting to use the data were are collecting at St. Joseph to form our own research project! The article does mention several times how important it is for us to become aquatinted with Refugee families and the children as the US does receive a huge number of these families each month. Fortunately for us we are already getting a good sense of their dental history, caries experience and the many barriers they and we face when attempting to treat their dental needs.
Oral Lesions in HIV Infection in Developing Countries: An Overview
Resident: Adam J. Bottrill
Date: 01JUN11
Region: Providence
Article title: Oral Lesions in HIV Infection in Developing Countries: An Overview
Journal: Adv Dent Res
Page #s: 63-68
Vol:No Date: 19, Apr, 2006
Major topic: HIV Infection. Oral Lesions
Minor topic(s): None
Type of Article: Descriptive article
Main Purpose: The objective of this work was to ascertain the nature and prevalence of oral lesions in different regions, and to identify any gaps in our understanding of these lesions in HIV disease.
Key points in the article discussion:
I. General:
A. Studies are needed WRT these oral lesions in developing countries and developed countries if a proper course of treatment is to be effectively formulated.
B. End of 2003: 46mill ppl infected... with more than 95% from developing countries.
C. Oral lesions are often an early finding in HIV infection.
D. 2.9 million children with HIV.
II. Methods:
A. Oral lesion reports from developing countries over a 14 year period.
B. Reports sub-grouped into 4 groups, based on region: India, Thailand, Africa, Latin America.
III. Results:
A. Detailed report and data tabulation presented in article...
B. Route of transmition primarily sexual for adults... with the exception of the Thai cohort which showed predominately IV drug use.
C. Men primarily infected with women as the majority in Zaire, Kenya, Zambia and Thailand.
D. Pediatric patients with oral lesions ranged from 25% to 63%.
E. Oral Candidiasis most common with the most common type of pseudomembranous.
F. Angular Cheilitis and Oral Hairy Leukoplakia reported from ALL regions.
G. Other common lesions: Gingivitis, Periodontitis, Linear gingival erythema, necrotizing ulcerative periodontitis, ulcers, oral hyperpigmentation.
H. Oral Kaposi's Sarcoma most prevalent in Mexico and Zimbabwe.
I. Oral submucous fibrosis in India due to areca nut chewing.
J. Often, the predominance of certain oral lesions was a direct effect of the populations access to care or stage of disease.
Assessment of Article: This article serves as a baseline for further studies regarding geographic prevalence and the nature of the disease process.
Date: 01JUN11
Region: Providence
Article title: Oral Lesions in HIV Infection in Developing Countries: An Overview
Journal: Adv Dent Res
Page #s: 63-68
Vol:No Date: 19, Apr, 2006
Major topic: HIV Infection. Oral Lesions
Minor topic(s): None
Type of Article: Descriptive article
Main Purpose: The objective of this work was to ascertain the nature and prevalence of oral lesions in different regions, and to identify any gaps in our understanding of these lesions in HIV disease.
Key points in the article discussion:
I. General:
A. Studies are needed WRT these oral lesions in developing countries and developed countries if a proper course of treatment is to be effectively formulated.
B. End of 2003: 46mill ppl infected... with more than 95% from developing countries.
C. Oral lesions are often an early finding in HIV infection.
D. 2.9 million children with HIV.
II. Methods:
A. Oral lesion reports from developing countries over a 14 year period.
B. Reports sub-grouped into 4 groups, based on region: India, Thailand, Africa, Latin America.
III. Results:
A. Detailed report and data tabulation presented in article...
B. Route of transmition primarily sexual for adults... with the exception of the Thai cohort which showed predominately IV drug use.
C. Men primarily infected with women as the majority in Zaire, Kenya, Zambia and Thailand.
D. Pediatric patients with oral lesions ranged from 25% to 63%.
E. Oral Candidiasis most common with the most common type of pseudomembranous.
F. Angular Cheilitis and Oral Hairy Leukoplakia reported from ALL regions.
G. Other common lesions: Gingivitis, Periodontitis, Linear gingival erythema, necrotizing ulcerative periodontitis, ulcers, oral hyperpigmentation.
H. Oral Kaposi's Sarcoma most prevalent in Mexico and Zimbabwe.
I. Oral submucous fibrosis in India due to areca nut chewing.
J. Often, the predominance of certain oral lesions was a direct effect of the populations access to care or stage of disease.
Assessment of Article: This article serves as a baseline for further studies regarding geographic prevalence and the nature of the disease process.
Oral Health and Preterm Delivery Education
Resident: Swan
Article Title: Oral Health and Preterm Delivery Education: A New Role for the Pediatric Dentist
Author: Katz et al.
Journal: Pediatric Dentistry
Volume (Number): 28:6 2006
Major Topic: Preterm Delivery and Poor oral health status
Type of Article: Literature Review
Main Purpose: Review the current literature that correlates poor oral health status and risk of preterm delivery; identify pediatric dentist’s role in educating expecting mothers
Findings: Periodontal disease and its associated bacteria are thought to be involved with various systemic conditions. Recent literature has suggested that these bacteria or their byproducts may cross the placenta and affect the developing fetus by stimulating an inflammatory response in the mother, which may ultimately result in PTD (before 37 weeks). Several human studies have highlighted this potential correlation:
1. significant inverse relationship between mother’s P.Gingivalis-specific IgG levels and birth weight
2. women with severe periodontal disease 7-8 times more likely to have PLBW infants
3. PTD significantly associated with attachment loss; periodontal disease independently associated with PTD and LBW
4. one systematic review: of 25 relevant studies, 18 suggested association between perio disease and adverse pregnancy outcome.
5. trends in literature support association between perio disease and adverse outcomes, primarily in economically disadvantaged populations.
One possible mechanism: PGE2, TNF alpha levels rise within amniotic fluid until threshold is reached, which induces labor/delivery. These molecules are produced in perio disease, possibly inducing labor if they cross the placenta. (PGE2 in crevicular fluid can be measured to give current perio disease activity).
Interventional Studies:
1. SRP may reduce Spontaneous Preterm Birth (study with 300 pregnant women)
2. Perio therapy significantly decreased levels of PGE2.
Animal Models:
1.rabbit model showed that P gingivalis cells implanted into subcutaneous chambers resulted in systemic dissemination, transplacental passage and fetal exposure. All rabbits exposed showed placental exposure to the bacteria.
2. Injected LPS from 3 perio bacteria compared to E. Coli LPS in sheep. Perio LPS had high rates of fetal lethality compared to E Coli LPS.
Key Points/Summary: PTD is a major public health concern. >20 % among poor/minorities and hasn’t changed for 30 years. Studies in humans argue for a correlation between perio disease and preterm delivery/LBW infants. Could be argued that those at increased risk for perio disease are more prone to experience pregnancy complications—intervention and animal model studies support the link though—especially with P. Gingivalis. It’s our job to emphasize the importance of oral health care during pregnancy to the mothers we see in the clinic.
Assessment of Article: Good review that helped clarify and somewhat murky subject.
Article Title: Oral Health and Preterm Delivery Education: A New Role for the Pediatric Dentist
Author: Katz et al.
Journal: Pediatric Dentistry
Volume (Number): 28:6 2006
Major Topic: Preterm Delivery and Poor oral health status
Type of Article: Literature Review
Main Purpose: Review the current literature that correlates poor oral health status and risk of preterm delivery; identify pediatric dentist’s role in educating expecting mothers
Findings: Periodontal disease and its associated bacteria are thought to be involved with various systemic conditions. Recent literature has suggested that these bacteria or their byproducts may cross the placenta and affect the developing fetus by stimulating an inflammatory response in the mother, which may ultimately result in PTD (before 37 weeks). Several human studies have highlighted this potential correlation:
1. significant inverse relationship between mother’s P.Gingivalis-specific IgG levels and birth weight
2. women with severe periodontal disease 7-8 times more likely to have PLBW infants
3. PTD significantly associated with attachment loss; periodontal disease independently associated with PTD and LBW
4. one systematic review: of 25 relevant studies, 18 suggested association between perio disease and adverse pregnancy outcome.
5. trends in literature support association between perio disease and adverse outcomes, primarily in economically disadvantaged populations.
One possible mechanism: PGE2, TNF alpha levels rise within amniotic fluid until threshold is reached, which induces labor/delivery. These molecules are produced in perio disease, possibly inducing labor if they cross the placenta. (PGE2 in crevicular fluid can be measured to give current perio disease activity).
Interventional Studies:
1. SRP may reduce Spontaneous Preterm Birth (study with 300 pregnant women)
2. Perio therapy significantly decreased levels of PGE2.
Animal Models:
1.rabbit model showed that P gingivalis cells implanted into subcutaneous chambers resulted in systemic dissemination, transplacental passage and fetal exposure. All rabbits exposed showed placental exposure to the bacteria.
2. Injected LPS from 3 perio bacteria compared to E. Coli LPS in sheep. Perio LPS had high rates of fetal lethality compared to E Coli LPS.
Key Points/Summary: PTD is a major public health concern. >20 % among poor/minorities and hasn’t changed for 30 years. Studies in humans argue for a correlation between perio disease and preterm delivery/LBW infants. Could be argued that those at increased risk for perio disease are more prone to experience pregnancy complications—intervention and animal model studies support the link though—especially with P. Gingivalis. It’s our job to emphasize the importance of oral health care during pregnancy to the mothers we see in the clinic.
Assessment of Article: Good review that helped clarify and somewhat murky subject.
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