Abstracts
INTRODUCTION:
The aim of this study was to identify factors associated with the prevalence of anterior open bite among five-year-old Brazilian children.
METHODS:
A cross-sectional study was undertaken using data from the National Survey of Oral Health (SB Brazil 2010). The outcome variable was anterior open bite classified as present or absent. The independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through bivariate and multivariate analysis using SPSS statistical software (version 18.0) with a 95% level of significance.
RESULTS:
The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02). Children identified with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03).
CONCLUSION:
There was a significant association between anterior open bite and the region of Brazil where the children lived, the presence of altered overjet and the prevalence of posterior crossbite.
Oral health surveys; Open bite; Preschool child
INTRODUÇÃO:
este estudo objetivou identificar os fatores associados à prevalência de mordida aberta anterior em crianças brasileiras com cinco anos de idade.
MÉTODOS:
foi realizado um estudo transversal analítico com dados do inquérito epidemiológico nacional de saúde bucal SB Brasil 2010. O desfecho estudado foi a mordida aberta, classificada em presente ou ausente. As variáveis independentes foram classificadas em individuais, sociodemográficas e clínicas. Os dados foram analisados por meio das análises bivariada e multivariada por meio do programa estatístico SPSS (versão 18.0), com nível de significância de 5%.
RESULTADOS:
a prevalência de mordida aberta anterior foi de 12,1% entre as crianças investigadas. Aqueles pré-escolares residentes na região Sul do Brasil apresentaram uma chance 1,8 vezes maior de serem diagnosticados com a mordida aberta anterior (IC 95%: 1,16 - 3,02). As crianças identificadas com alguma alteração de sobressaliência tiveram 14,6 vezes mais chance de pertencer ao grupo de crianças com mordida aberta (IC 95%: 8,98 - 24,03).
CONCLUSÃO:
verificou-se que mordida aberta anterior apresentou associação significativa com a região brasileira em que as crianças viviam, com a presença de alguma alteração de sobressaliência e com a prevalência de mordida cruzada posterior.
Inquéritos de saúde bucal; Mordida aberta; Criança; Pré-escolar
INTRODUCTION
With worldwide reduction in dental caries prevalence, other oral problems have become
more common.11 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Projeto SB
Brasil 2003: condições de saúde bucal da população brasileira 2002-2003. Resultados
principais. Brasília, DF: Ministério da Saúde; 2004. [Acesso em: 2012 Jul. 12].
Disponível em:
http://portalweb02.saude.gov.br/portal/arquivos/pdf/relatorio_brasil_sorridente.pdf.
http://portalweb02.saude.gov.br/portal/a...
,
22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
Malocclusion is among them and may be
associated with genetic, environmental and behavioral factors, thereby resulting in
morphological, functional and esthetic problems.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI.
Breastfeeding and non-nutritive sucking patterns related to the prevalence of
anterior open bite in primary dentition. J Appl Oral Sci.
2011;19(2):161-8.
Anterior open bite (AOB) and posterior crossbite have been identified as the most common
occlusal abnormalities in primary dentition.44 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA.
Prevalence of malocclusion in primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatr Dent.
2011;12(2):107-11.
,
55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7. AOB is characterized by lack of occlusal
contact in the anterior region, while the remaining teeth are in occlusion.66 Fränkel R, Fränkel C. A functional approach to treatment of skeletal
open bite. Am J Orthod. 1983;84(1):54-68.
,
77 Artese A, Drummond S, Nascimento JM, Artese F. Criteria for diagnosing
and treating anterior open bite with stability. Dental Press J Orthod.
2011;16(3):136-61. AOB is more prevalent in primary dentition,
with a prevalence between 6.2% and 50.0% worldwide, varying according to the population
group studied.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI.
Breastfeeding and non-nutritive sucking patterns related to the prevalence of
anterior open bite in primary dentition. J Appl Oral Sci.
2011;19(2):161-8.
,
44 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA.
Prevalence of malocclusion in primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatr Dent.
2011;12(2):107-11.
,
55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
,
88 Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle
feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch
Dis Child. 2004;89(12):1121-3.
9 Peres KG, Latorre MR, Sheiham A, Peres MA, Victora CG, Barros FC. Social
and biological early life influences on the prevalence of open bite in Brazilian
6-year-olds. Int J Paediatr Dent. 2007;17(1):41-9.
10 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt
A. Non-nutritive sucking habits, anterior open bite and associated factors in
Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5.
-
1111 Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion and
orthodontic treatment need in the United States: estimates from the NHANES III
survey. Int J Adult Orthodon Orthognath Surg. 1998;13(2):97-106. This is most likely to be associated with an
increase in overbite during the mixed dentition period, and the self-correcting nature
of the majority of cases of anterior open bite in primary dentition.55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
,
1212 Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous
dentition: longitudinal follow-up and craniofacial growth considerations. Am J Orthod
Dentofacial Orthop. 2002;122(4):353-8.
When non-nutritive sucking habits are no longer present in children, AOB tends to disappear.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI. Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci. 2011;19(2):161-8. , 55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in children at 3 and 7 years of age: a longitudinal study. Eur J Orthod. 2011;33(3):1-7. , 88 Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch Dis Child. 2004;89(12):1121-3. , 1010 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt A. Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5. , 1212 Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous dentition: longitudinal follow-up and craniofacial growth considerations. Am J Orthod Dentofacial Orthop. 2002;122(4):353-8. , 1313 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA. Incidence of malocclusion between primary and mixed dentitions among Brazilian children: a 5-year longitudinal study. Angle Orthod. 2012;82(3):495-500. Góis et al1313 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA. Incidence of malocclusion between primary and mixed dentitions among Brazilian children: a 5-year longitudinal study. Angle Orthod. 2012;82(3):495-500. showed that 70.1% of AOB present in primary dentition were self-corrected during the transition from primary to mixed dentition. Early treatment of AOB, during the primary or mixed dentition, usually reaches better results and reduces indices of relapse;1414 Huang GJ, Justus R, Kennedy DB, Kokich VG. Stability of anterior openbite treated with crib therapy. Angle Orthod. 1990;60(1):17-26. , 1515 Ngan P, Fields HW. Open bite: a review of etiology and management. Pediatr Dent. 1997;19(2):91-8. , 1616 Janson G, Valarelli FP, Beltrão RT, Freitas MR, Henriques JF. Stability of anterior open-bite extraction and nonextraction treatment in the permanent dentition. Am J Orthod Dentofacial Orthop. 2006;129(6):768-74. thus, spontaneous correction of AOB during the initial stages might be, in part, result of individual's face and dentition development process.1212 Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous dentition: longitudinal follow-up and craniofacial growth considerations. Am J Orthod Dentofacial Orthop. 2002;122(4):353-8. , 1616 Janson G, Valarelli FP, Beltrão RT, Freitas MR, Henriques JF. Stability of anterior open-bite extraction and nonextraction treatment in the permanent dentition. Am J Orthod Dentofacial Orthop. 2006;129(6):768-74.
In this context, primary dentition directly influences the development of permanent
occlusion. A number of anomalies and occlusal characteristics present in the primary
dentition remain or even deteriorate in permanent dentition.1313 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA.
Incidence of malocclusion between primary and mixed dentitions among Brazilian
children: a 5-year longitudinal study. Angle Orthod.
2012;82(3):495-500. It is important to advise parents that these habits should be
eliminated before eruption of upper permanent incisors in order to allow further
self-correction of this malocclusion.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI.
Breastfeeding and non-nutritive sucking patterns related to the prevalence of
anterior open bite in primary dentition. J Appl Oral Sci.
2011;19(2):161-8.
,
55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
,
88 Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle
feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch
Dis Child. 2004;89(12):1121-3.
,
1010 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt
A. Non-nutritive sucking habits, anterior open bite and associated factors in
Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5.
,
1212 Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous
dentition: longitudinal follow-up and craniofacial growth considerations. Am J Orthod
Dentofacial Orthop. 2002;122(4):353-8.
,
1313 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA.
Incidence of malocclusion between primary and mixed dentitions among Brazilian
children: a 5-year longitudinal study. Angle Orthod.
2012;82(3):495-500. AOB is considered one of the most difficult
occlusal abnormalities to be corrected in the permanent dentition, especially with
respect to stability.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI.
Breastfeeding and non-nutritive sucking patterns related to the prevalence of
anterior open bite in primary dentition. J Appl Oral Sci.
2011;19(2):161-8.
4 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA.
Prevalence of malocclusion in primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatr Dent.
2011;12(2):107-11.
5 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
6 Fränkel R, Fränkel C. A functional approach to treatment of skeletal
open bite. Am J Orthod. 1983;84(1):54-68.
7 Artese A, Drummond S, Nascimento JM, Artese F. Criteria for diagnosing
and treating anterior open bite with stability. Dental Press J Orthod.
2011;16(3):136-61.
8 Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle
feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch
Dis Child. 2004;89(12):1121-3.
9 Peres KG, Latorre MR, Sheiham A, Peres MA, Victora CG, Barros FC. Social
and biological early life influences on the prevalence of open bite in Brazilian
6-year-olds. Int J Paediatr Dent. 2007;17(1):41-9.
-
1010 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt
A. Non-nutritive sucking habits, anterior open bite and associated factors in
Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5.
,
1212 Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous
dentition: longitudinal follow-up and craniofacial growth considerations. Am J Orthod
Dentofacial Orthop. 2002;122(4):353-8.
13 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA.
Incidence of malocclusion between primary and mixed dentitions among Brazilian
children: a 5-year longitudinal study. Angle Orthod.
2012;82(3):495-500.
14 Huang GJ, Justus R, Kennedy DB, Kokich VG. Stability of anterior
openbite treated with crib therapy. Angle Orthod. 1990;60(1):17-26.
15 Ngan P, Fields HW. Open bite: a review of etiology and management.
Pediatr Dent. 1997;19(2):91-8.
16 Janson G, Valarelli FP, Beltrão RT, Freitas MR, Henriques JF. Stability
of anterior open-bite extraction and nonextraction treatment in the permanent
dentition. Am J Orthod Dentofacial Orthop. 2006;129(6):768-74.
17 Trottman A, Elsbach HG. Comparison of malocclusion in preschool black
and white children. Am J Orthod Dentofacial Orthop.
1996;110(1):69-72.
18 Katz CR, Rosenblatt A, Gondim PP. Nonnutritive sucking habits in
Brazilian children: effects on deciduous dentition and relationship with facial
morphology. Am J Orthod Dentofacial Orthop. 2004;126(1):53-7.
19 Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and
sucking habits on malocclusion in a birth cohort study. Rev Saúde Pública.
2007;41(3):343-50.
-
2020 Onyeaso CO, Isiekwe MC. Occlusal changes from primary to mixed
dentitions in Nigerian children. Angle Orthod. 2008;78(1):64-9. Due to functional and esthetic abnormalities,
AOB may cause negative psychosocial impact in many cases, predisposing individuals to
low self-esteem, social alienation due to bullying, and behavioral disorders, with
potential negative impact on their quality of life.1313 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA.
Incidence of malocclusion between primary and mixed dentitions among Brazilian
children: a 5-year longitudinal study. Angle Orthod.
2012;82(3):495-500.
The aim of this study was to identify factors associated with the prevalence of AOB among five-year-old children in Brazil.
MATERIAL AND METHODS
Study design
A cross-sectional analytical study was performed. Data from the Epidemiological
Survey of the Oral Health Conditions of the Brazilian Population, known as
"SB Brasil 2010", was used.22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
Ethical considerations
The Brazilian Oral Health Project was submitted to and approved by the National
Council on Ethics and Human Research. An informed consent form was signed by all
individuals participating in the study.22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
Sample population
The population of Brazil comprises approximately 190.7 million people, with 2.9
million children under the age of five.2121 Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010.
Rio de Janeiro, 2010. [Acesso em : 2012 Jul. 12]. Disponível em:
ftp://ftp.ibge.gov.br/Censos/Censo_Demografico_2010/Caracteristicas_Gerais_Religiao_Deficiencia/tab1_1.pdf.
ftp://ftp.ibge.gov.br/Censos/Censo_Demog...
The epidemiological survey SB Brasil 2010 assessed the oral health
conditions of the Brazilian population in urban and rural areas, classifying it into
different age ranges. The study surveyed 37, 519 individuals living in 26 state
capitals in the Federal District and in 150 municipal districts of varying population
sizes located in the countryside.22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
The database created by this study is of public domain and freely accessible on the
website of the Brazilian Ministry of Health.22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
Data collection
Data were collected in each participant's home. Data collection included an oral examination and a questionnaire. Dental teams comprised an examiner and an assistant who performed clinical data collection using instruments (oral mirror and periodontal probe), as recommended by the World Health Organization (WHO).2222 World Health Organization. Oral Health Surveys: basic methods. 4th ed. Geneva, Switzerland: World Health Organization; 1997.
The presence of AOB or any other form of malocclusion was registered using the Foster and Hamilton index (Table 1).2323 .Foster TD, Hamilton MC. Occlusion in the primary dentition. Study of children at 2 and one-half to 3 years of age. Br Dent J. 1969;126(2):76-9.
Sample calculation
A conglomerate sampling technique was used with three stratifications. The first used domains and primary sampling units: Capitals and municipal districts from the countryside, according to each macroregion. The second was a subdivision of municipal districts: 27 capitals plus 30 municipal districts from the countryside of each region of Brazil. The third used lottery to guarantee representativeness in the municipal districts, census sectors, and residences.
A maximum of 250 volunteers were assessed for anterior open bite in each one of the
172 cities in Brazil, thereby resulting in a total sample of 5,622 five-year-old
children. The following parameters were used to calculate sample size: Values of z,
variance, mean DEFT, acceptable margin of error, effect of design and non-reply rate.
These data were taken from SB Brasil 2003.11 Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Projeto SB
Brasil 2003: condições de saúde bucal da população brasileira 2002-2003. Resultados
principais. Brasília, DF: Ministério da Saúde; 2004. [Acesso em: 2012 Jul. 12].
Disponível em:
http://portalweb02.saude.gov.br/portal/arquivos/pdf/relatorio_brasil_sorridente.pdf.
http://portalweb02.saude.gov.br/portal/a...
Calibration
Each fieldwork team was properly trained in workshops of 20 hours (6 classes).
Training was divided into phases as follows: 4 hours of theory, 2 hours of practical
training, 8 hours for calibration, 2 hours of final discussion and 4 hours of
fieldwork strategy. The technique of consensus was used to calculate the correlation
between each examiner and the results obtained by consensus of the team. The model
proposed by the WHO was used as reference. Kappa coefficient was calculated, weighted
for each examiner, age-group and medical complaint with a value of 0.65 adopted as
the minimal acceptable limit.22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
Study variables
The dependent variable was AOB. Table 2 describes the independent variables.
Data analysis
Data were analyzed using the Statistical Package for Social Sciences (SPSS for Windows, version 18.0, SPSS Inc, Chicago, IL, USA) software. First, bivariate data analysis was performed. Chi-square test was used to investigate the association between the dependent variable (AOB) and the independent variables (child's city of residence, region of Brazil, sex, family income, dental caries, need for treatment of dental caries, canine relationship, overjet, posterior crossbite) (P < 0.05). In order to identify the independent impact of each variable, multiple logistic regression was performed. The independent variables were inserted into logistic model on a decreasing scale according to their statistical significance (P < 0.25, stepwise backward procedure).
RESULTS
Table 1 displays the results of bivariate analysis. The variables statistically associated with the prevalence of AOB among five-year-old children were: Region of Brazil in which the child lived, canine relationship, overjet and posterior crossbite (P < 0.001).
The results of multivariate analysis are shown in Table 2. Regardless of the other variables analyzed, five-year-old children from Southern Brazil were two times more likely to be identified with AOB than children in the Southeastern region of the country (OR = 1.87 [CI 95%: 1.16 - 3.02]). Preschool children diagnosed with alterations in overjet had 14.7 times greater chances of suffering from AOB (OR= 14.69 [CI 95%: 8.98 - 24.03]).
DISCUSSION
The prevalence of AOB in the studied population of five-year-old children was
12.1%.22 Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde.
Secretaria de Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. [Acesso: 2012
Jul. 12]. Disponível em:
http://dab.saude.gov.br/cnsb/sbbrasil/download.htm.
http://dab.saude.gov.br/cnsb/sbbrasil/do...
However, there is considerable
variation in such epidemiological data in worldwide literature (6.2 to 50.0%), even when
the same regions of Brazil are compared.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI.
Breastfeeding and non-nutritive sucking patterns related to the prevalence of
anterior open bite in primary dentition. J Appl Oral Sci.
2011;19(2):161-8.
,
44 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA.
Prevalence of malocclusion in primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatr Dent.
2011;12(2):107-11.
,
55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
,
88 Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle
feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch
Dis Child. 2004;89(12):1121-3.
,
99 Peres KG, Latorre MR, Sheiham A, Peres MA, Victora CG, Barros FC. Social
and biological early life influences on the prevalence of open bite in Brazilian
6-year-olds. Int J Paediatr Dent. 2007;17(1):41-9.
,
1010 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt
A. Non-nutritive sucking habits, anterior open bite and associated factors in
Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5.
,
2424 Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits
and malocclusion in preschool children. Rev Saúde Pública.
2000;34(3):299-303. A direct comparison of the results yielded by
different studies is difficult due to variation in diagnostic and classification
criteria from an epidemiological perspective. Variations in study design, sample
criteria and methods of analyzing results can also result in data discrepancy.
Multivariate data analysis confirmed the prevalence of AOB statistically associated with the region in which the child lived and also with the prevalence of posterior crossbite and alterations in overjet. The chances of children resident in the Southern of Brazil being diagnosed with AOB was nearly twice greater than that of children living in other regions of the country. This variation can be possibly explained by different cultural habits that may result in greater or less exposure to risk factors associated with AOB, such as time spent in breast-feeding, diet and variations in non-nutritive sucking habits in different regions of Brazil.99 Peres KG, Latorre MR, Sheiham A, Peres MA, Victora CG, Barros FC. Social and biological early life influences on the prevalence of open bite in Brazilian 6-year-olds. Int J Paediatr Dent. 2007;17(1):41-9. , 1313 Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA. Incidence of malocclusion between primary and mixed dentitions among Brazilian children: a 5-year longitudinal study. Angle Orthod. 2012;82(3):495-500. , 2424 Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits and malocclusion in preschool children. Rev Saúde Pública. 2000;34(3):299-303. These data corroborate the findings in the literature. Another study conducted in Southern Brazil also found a higher percentage of AOB in primary dentition when compared with studies undertaken in the Southeastern and Northeast regions.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI. Breastfeeding and non-nutritive sucking patterns related to the prevalence of anterior open bite in primary dentition. J Appl Oral Sci. 2011;19(2):161-8. , 44 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA. Prevalence of malocclusion in primary dentition in a population-based sample of Brazilian preschool children. Eur J Paediatr Dent. 2011;12(2):107-11. , 99 Peres KG, Latorre MR, Sheiham A, Peres MA, Victora CG, Barros FC. Social and biological early life influences on the prevalence of open bite in Brazilian 6-year-olds. Int J Paediatr Dent. 2007;17(1):41-9. , 1010 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt A. Non-nutritive sucking habits, anterior open bite and associated factors in Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5.
Regional, cultural and socioeconomic variations of each city should be considered and
are the most probable explanation for the different prevalence of AOB found in other
studies. A survey undertaken in the Southeastern of Brazil found a prevalence of AOB of
7.9% among 1,069 preschool children from Belo Horizonte,44 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA.
Prevalence of malocclusion in primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatr Dent.
2011;12(2):107-11. whereas in São Paulo there was a prevalence of 22.4% among 309
children.33 Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI.
Breastfeeding and non-nutritive sucking patterns related to the prevalence of
anterior open bite in primary dentition. J Appl Oral Sci.
2011;19(2):161-8. In Southern Brazil, particularly in
Pelotas, 46.3% of 359 children had AOB in primary dentition.1919 Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and
sucking habits on malocclusion in a birth cohort study. Rev Saúde Pública.
2007;41(3):343-50. In the Northeastern Brazil, particularly in Recife, 30.2% of
1,308 five-year-old children had AOB.1010 Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt
A. Non-nutritive sucking habits, anterior open bite and associated factors in
Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5. Moreover,
studies outside Brazil also demonstrate a range of different results, with a prevalence
of AOB among preschool children varying from 13.0% in Italy to 50.0% in Sweden.55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
,
88 Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle
feeding, and non-nutritive sucking; effects on occlusion in deciduous dentition. Arch
Dis Child. 2004;89(12):1121-3. In addition, racial characteristics may
influence the occurrence of AOB. Thus, there was significant difference in the
prevalence of malocclusion between Caucasian and Afro American children aged from 3 to 5
years old, with no differences between males and females.1919 Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and
sucking habits on malocclusion in a birth cohort study. Rev Saúde Pública.
2007;41(3):343-50. In the present study, the statistical significance found between
prevalence of AOB and the region of children's residence can also be related to diverse
racial, economic and sociodemographic characteristics in Brazil. The Brazilian
population is one of the most diverse in the world, with bi or trihybrid miscegenation
prevailing in some regions. The country is of continental extension; thus, its
population reveals great complexity and diversity, especially in terms of physical and
cultural characteristics. Although the present study did not investigate the racial
composition of the Brazilian population, the Brazilian Census of 2010 demonstrates that
racial characteristics, which were self-declared, among children between 0-14 years old
considerably vary according to each region of Brazil.2121 Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010.
Rio de Janeiro, 2010. [Acesso em : 2012 Jul. 12]. Disponível em:
ftp://ftp.ibge.gov.br/Censos/Censo_Demografico_2010/Caracteristicas_Gerais_Religiao_Deficiencia/tab1_1.pdf.
ftp://ftp.ibge.gov.br/Censos/Censo_Demog...
The Brazilian Census of 2010 also demonstrates that higher median income
and lower illiteracy indices were seen in Midwestern, Southeastern and Southern Brazil,
while lower median income and higher illiteracy indices were present in Northern and
Northeastern Brazil.2121 Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010.
Rio de Janeiro, 2010. [Acesso em : 2012 Jul. 12]. Disponível em:
ftp://ftp.ibge.gov.br/Censos/Censo_Demografico_2010/Caracteristicas_Gerais_Religiao_Deficiencia/tab1_1.pdf.
ftp://ftp.ibge.gov.br/Censos/Censo_Demog...
However, family income did
not influence the occurrence of AOB. Therefore, differences in race and sociodemographic
characteristics may influence the prevalence of malocclusion among the population.2424 Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits
and malocclusion in preschool children. Rev Saúde Pública.
2000;34(3):299-303.
Preschool children identified with alterations in overjet (increased edge-to-edge bite
or anterior crossbite) had greater chances of having AOB.55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7.
,
2323 .Foster TD, Hamilton MC. Occlusion in the primary dentition. Study of
children at 2 and one-half to 3 years of age. Br Dent J.
1969;126(2):76-9.
24 Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits
and malocclusion in preschool children. Rev Saúde Pública.
2000;34(3):299-303.
25 Greenlee GM, Huang GJ, Chen SS, Chen J, Koepsell T, Hujoel P. Stability
of treatment for anterior open-bite malocclusion: a meta-analysis. Am J Orthod
Dentofacial Orthop. 2011;139(2):154-69.
-
2626 Cuccia AM, Eotti M, Caradonna D. Oral breathing and head posture. Angle
Orthod. 2008;78(1):77-82. Non-nutritive sucking habits and tongue
posture are included as environmental factors.44 Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus IA.
Prevalence of malocclusion in primary dentition in a population-based sample of
Brazilian preschool children. Eur J Paediatr Dent.
2011;12(2):107-11.
,
55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7. Such transversal and sagittal abnormalities,
which share the same etiological factors, may be associated with AOB. Considering that
AOB is directly related to non-nutritive sucking habits, the increased prevalence of
malocclusion at a younger age can be associated with an increased incidence of this
habit among younger children. A longitudinal study of 386 children (aged 3 years old at
study onset and examined again at 7 years of age) performed in Sweden found that the
prevalence of non-nutritive sucking habits decreased from 66.0% to 4.0% between 3 and 7
years of age, which might have influenced the reduction of AOB incidence from 50% to 10%
at the age of seven.55 Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in
children at 3 and 7 years of age: a longitudinal study. Eur J Orthod.
2011;33(3):1-7. In addition, oral
respiration may also significantly contribute to the etiology of dentofacial
abnormalities in children during growth.28 Furthermore, a study of
schoolchildren from Lithuania aged between 7 and 15 years old found a significant
association between nasal obstruction and increased overjet, open bite and maxillary
growth.2727 Lopatiene K, Babarskas A. Malocclusion and upper airway obstruction.
Medicina. 2002;38(3):277-83. A study performed among preschool
children in Brazil showed that children who had the habit of sucking a pacifier after
two years of age and those who were oral breathers had a greater chance of developing
malocclusion.1919 Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and
sucking habits on malocclusion in a birth cohort study. Rev Saúde Pública.
2007;41(3):343-50. While the design of the
present study is robust, some limitations should be observed. Data assessed the presence
or absence of AOB without differentiating its extension, severity and dental or skeletal
impairment. Other factors such as the presence of harmful habits, facial and respiratory
patterns, which are etiological factors of this malocclusion, were not investigated
either. This is most probably due to the comprehensive character of the other variables
studied, as well as the need for collecting brief data because of the large sample
comprising 5.622 children. Data provided, however, is an accurate indicator of the
prevalence of AOB in the different regions of Brazil. Such data are important for the
strategic planning of government programs aimed at prevention, interception and
treatment of AOB.
The present study alerts oral health care programs to the need for preventive measures that can deter or at least reduce the prevalence of this and other malocclusions among the infant population. In Brazil, the road towards an universal dental care for the general population, especially infants, is long. Orthodontic treatment is not just a matter of vanity. The more severe the problem, the greater the functional and psychological impact of anterior open bite. Child may often become target of bullying which can result in behavioral disorders and personality maladjustments. Additional studies are needed to clarify the etiology and severity of AOB according to each region of Brazil.
CONCLUSION
Children living in Southern Brazil showed greater chances of being diagnosed with anterior open bite.
Children identified with alterations in overjet showed greater chances of having anterior open bite.
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» The authors report no commercial, proprietary or financial interest in the products or companies described in this article.
Publication Dates
-
Publication in this collection
Sep-Oct 2014
History
-
Received
25 June 2013 -
Accepted
01 Nov 2013