The effect of hypertrophic adenoids and tonsils on the development of posterior crossbite and oral habits

Author(s): Constantine Oulis, George Vadiakas, John Ekonomides and Joanna Dratsa
Journal: Journal of Clinical Pediatric Dentistry
Month, Year: 1994
Major topic: adenoid effect on bite and habits
Type of Article: Observational study
Findings: Adenoids are described as hypertrophied state of the pharyngeal tonsils in the upper posterior wall of the nasopharynx and consist of the upper part of the Waldeyer Ring. Adenoids may be associated with rhinitis, sinusitis and otitis media. The inferior posterior movement of the tongue and mandible to achieve an open airway may posturally affect the position of the teeth. This investigation studied the incidence of crossbite and oral habits in children whose hypertrophy was significant enough to require surgical treatment. One hundred twenty Caucasian children in Athens, Greece, who had an adenoidectomy scheduled were included in the study. They were screened for the number of teeth in crossbite and oral habits. Severity of airway obstruction was determined surgically and radiographically. The children were split into 2 age groups: 3-5 y.o. and 5-8 y.o. There was a 74% agreement between ragiographic and surgical screening of airway obstruction confirming lateral cephalometrics as a viable addition to screening of restricted airways. 45.8% and 47.2% of patients had posterior crossbite in the younger and older populations respectively (normally 7-10% in the mixed dentition). 89% of permanent molars had erupted in crossbite. The higher the degree of obstruction, the higher the number of children in crossbite. Eighty percent of children with a 3rd or 4th degree obstruction were in crossbite. Only 13% of patients with a 1st or 2nd degree obstruction were in crossbite. All children, according to parental interview, with a posterior crossbite had a history of mouth-breathing during sleep. 71.4% were continuous mouth-breathers. Interestingly, the use of a pacifier or a digit sucking habit was not correlated with crossbite.
Key points/Summary: Larger airway obstructions in young children will very often lead to posterior crossbite. Patients in crossbite who do not have a history of digit sucking or pacifier use should be evaluated for upper airway obstruction with the lateral ceph film a valuable tool.
Assessment of article: Interesting correlation and something to look out for in our population.


Brian Schmid DMD