Craniofacial changes and symptoms of sleep-disordered breathing in
               healthy children

Pacheco, Maria Christina Thomé; Fiorott, Bruna Santos; Finck, Nathalia Silveira; Araújo, Maria Teresa Martins de

doi:10.1590/2176-9451.20.3.080-087.oar

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Articles • Dental Press J. Orthod. 20 (3) • May-Jun 2015 • https://doi.org/10.1590/2176-9451.20.3.080-087.oar copy

Craniofacial changes and symptoms of sleep-disordered breathing in healthy children

Authorship SCIMAGO INSTITUTIONS RANKINGS

INTRODUCTION:

The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees.

OBJECTIVE:

The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children.

METHODS:

A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire.

RESULTS:

Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good.

CONCLUSION:

High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB.

Malocclusion; Mouth breathing; Quality of life

	Groups				p value	Total
	Nose breathers		Mouth breathers			n	%
	n	%	n	%		n	%
Palatine tonsils
I	83	16.0	20	12.0	0.230	103	15.0
II	281	54.0	80	47.9	0.167	361	52.5
III	138	26.5	59	35.3	0.025*	197	28.7
IV	18	3.5	8	4.8	0.434	26	3.8
Mallampati score
I	221	42.5	41	24.5	0.000*	262	38.2
II	219	42.1	82	49.1	0.113	301	43.8
III	71	13.7	37	22.2	0.009*	108	15.7
IV	9	1.7	7	4.2	0.067	16	2.3
Nasal septum
Normal	302	58.1	67	40.1	0.000*	369	53.7
Swollen	119	22.9	61	36.5	0.000*	180	26.2
Deviated	86	16.5	32	19.2	0.492	118	17.2
Swollen/ deviated	13	2.5	7	4.2	0.383	20	2.9
Turbinate hypertrophy
No	223	42.9	45	26.9	0.000*	268	39.0
Yes	297	57.1	122	73.1	0.000*	419	61.0

	Groups				p value	Total
	Nose breathers		Mouth breathers			n	%
	n	%	n	%		n	%
Facial type
Mesofacial	404	77.7	100	60.5	0.000*	505	73.5
Dolichofacial	61	11.7	58	34.7	0.000*	119	17.3
Brachyfacial	55	10.6	8	4.8	0.000*	63	9.2
Facial profile
Straight	367	70.6	75	44.9	0.000*	442	64.3
Convex	142	27.3	85	50.9	0.000*	227	33.1
Concave	11	2.1	7	4.2	0.144	18	2.6
Lip competence
Present	507	97.5	107	64.1	0.000*	614	89.3
Absent	13	2.5	60	35.9	0.000*	73	10.7

	Groups				p value	Total
	Nose breathers		Mouth breathers			n	%
	n	%	n	%		n	%
Overbite
Normal	271	52.1	73	43.7	0.072	344	50.1
Moderate	135	26.0	45	26.9	0.897	180	26.2
Severe	24	4.6	9	5.4	0.832	33	4.8
Does not apply	90	17.3	40	24.0	0.070	130	18.9
Open bite
Absent	437	84.1	128	76.6	0.025*	565	82.3
Top	40	7.7	18	10.8	0.274	58	8.4
Present	43	8.2	21	12.6	0.121	64	9.3
Crossbite
Absent	417	80.2	137	82.0	0.909	554	80.6
Anterior	28	5.4	4	2.4	0.165	32	4.7
Posterior	67	12.8	24	14.4	0.689	91	13.2
Ant/Posterior	8	1.6	2	1.2	0.997	10	1.5
Overjet
1-2 mm	341	65.6	88	52.7	0.004*	429	62.4
3-4 mm	109	21.0	48	28.7	0.051	157	22.9
> 4 mm	11	2.1	11	6.6	0.009*	22	3.2
Does not apply	59	11.4	20	12	0.943	79	11.5
Molar relationship
Class I	409	78.7	123	73.7	0.098	532	77.5
Class II	92	17.7	35	21.0	0.400	127	18.5
Class III	19	3.7	9	5.4	0.460	28	4.1
Palate
Normal	328	63.1	77	46.1	0.000*	405	58.9
Atresic	192	36.9	90	53.9	0.000*	282	41.0
TOTAL	520	100.0	167	100.0		687	100.0

	Groups				p value	Total
	Nose breathers		Mouth breathers			n	%
	n	%	n	%		n	%
Mirror test
Halo > 30 mm	512	98.5	143	85.6	0.000*	655	95.3
Halo < 30 mm	8	1.5	24	14.4	0.000*	32	4.7
Lip seal test
For 3 minutes	510	98.1	86	51.5	0.000*	596	86.8
Less than 3 minutes	10	1.9	81	48.5	0.000*	91	13.2
Water retention test
For 3 minutes	511	98.3	90	53.9	0.000*	601	87.5
Less than 3 minutes	9	1.8	77	46.1	0.000*	86	12.5
TOTAL	520	100.0	167	100.0		687	100.0

Fields	Highest value	Median	Mean	Standard deviation
Nose problem	52	17.00	18.08	10.73
Sleeping problem	51	19.00	20.34	11.95
Food	35	15.00	13.98	7.98
Dentition / esthetic	26	10.00	10.29	6.27
Education	18	6.00	5.99	4.42
Communication	47	21.00	18.51	11.69
Atopy	48	15.00	16.41	11.96
Overall score	241	102.00	103.61	48.07

Nose problems field	Frequency (%)	Sleep problems field	Frequency (%)
Do you have any nasal problems?	32.00	Do you have any sleeping problems?	33.54
Does your nose bother you?	30.00	Is your sleep usually restless?	31.00
Do you often feel a stuffy nose?	32.27	Do you wake up during the night?	32.27
Do you often sneeze?	32.27	Do you often complain of being sleepy during the day?	33.54
Do you present any nose itching?	22.78	Do you sleep with your mouth open?	38.60
Do you ever have a runny nose?	17.72	Have you ever stopped breathing while sleeping?	9.49
Do you snore at night?	19.62	Do you ever wake up with a headache?	11.39
Do you ever feel your mouth or throat itch?	23.41	Does your mouth feel dry when you wake up?	41.13

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[1] Contact address: Maria Christina Thomé Pacheco E-mail: christp@terra.com.br