Alterations of oral functions and dental malocclusions in adolescents: a cross-sectional population-based study

Freitas, Heloiza Viana; Alves, Cláudia Maria Coelho; Silva, Luciana Freitas Gomes e; Pereira, Alex Luiz Pozzobon; Hugo, Fernando Neves; Thomaz, Erika Barbara Abreu Fonseca

doi:10.1590/1413-812320212611.3.07992020

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FREE THEMES • Ciênc. saúde coletiva 26 (suppl 3) • 2021 • https://doi.org/10.1590/1413-812320212611.3.07992020 copy

Alterations of oral functions and dental malocclusions in adolescents: a cross-sectional population-based study

Alterações das funções orais e má oclusão em adolescentes: um estudo transversal de base populacional

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This article aims to assess whether alterations of oral functions (AOF) are associated with malocclusion (MO)’s type and severity. Cross-sectional study of a representative sample of 332 adolescents aged 12 years in São Luís-MA, Northeastern Brazil. MO criteria included Angle’s classification, Dental Aesthetic Index, and other morphological problems. The AOF were evaluated by breathing, phonation, chewing, and swallowing. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using logistic and multinomial regression analyses (α=5%). Mouth breathing was associated with defined (OR=3.84; 95%CI=1.45-10.12), disabling (OR=4.34; 95%CI=1.99-9.49), and class III (OR=4.15; 95%CI=1.19-14.54) MO. Phonation problems were associated with defined (OR=2.01; 95%CI=1.02-4.39), disabling (OR=3.04; 95%CI=1.55-5.96), and Class II (OR=2.02; 95%CI=1.28-3.18) MO. Chewing disorders were associated with posterior crossbite (PCB) (OR=2.32; 95%CI=1.12-4.82). Swallowing disorders were associated with Class III MO (OR=5.66; 95%CI=1.35-23.71), PCB (OR=6.13; 95%CI=2.76-13.62), and posterior open bite (OR=4.53; 95%CI=1.72-8.92). Breathing and phonation alterations are associated with MO in anterior arch segments, while chewing and swallowing disorders, in the posterior segments.

Key words:
Malocclusion; Mouth Breathing; Phonation; Swallowing

Variables		Breathing alterations			P- value		Phonation alterations				P- value
		No		Yes			No		Yes
		n	%	n	%		n	%	n	%
Malocclusion (DAI)						0.002¹					0.048¹
	Normal/Mild	81	84.1	16	15.9	0.007²	69	70.0	28	30.0	0.029²
	Defined	51	55.1	31	44.9		47	51.9	35	48.1
	Severe	60	77.5	19	22.5		51	61.8	28	38.2
	Disabling	43	54.2	31	45.8		34	43.5	40	56.5
Malocclusion (Angle)						0.494³					0.003³
	Normal	10	85.3	2	14.7		11	96.5	1	3.5
	Class I	142	70.1	56	29.9		130	63.3	98	36.7
	Class II	72	72.5	31	27.5		51	53.1	52	46.9
	Class III	11	41.7	8	58.3		9	30.5	10	69.5
Posterior crossbite						0.085¹					0.280¹
	No	201	73.1	76	26.9		170	60.8	107	39.2
	Yes	34	53.4	21	46.6		31	47.9	24	52.1
Posterior open bite						0.384¹					0.298¹
	No	214	70.2	83	29.8		184	59.8	113	40.2
	Yes	21	65.0	14	35.0		17	48.0	18	52.0
Overbite						0.165¹					0.927¹
	No	142	72.9	51	27.1		118	58.7	75	41.3
	Yes	93	63.7	46	36.3		83	58.2	56	41.8
Sex						0.724¹					0.147¹
	Female	109	68.2	45	31.8		92	52.3	62	47.7
	Male	126	70.9	52	29.1		109	64.0	69	36.0
Race/color						0.166¹					0.082¹
	White	65	79.5	16	20.5		49	54.5	32	45.5
	Brown	147	66.6	70	33.4		126	57.1	91	42.9
	Black	23	67.7	11	32.3		26	73.8	8	26.2
Economic class (ABEP)						0.224¹					0.587¹
	A-B	102	74.9	35	25.1	0.132²	89	62.8	48	37.2	0.261²
	C	117	68.2	51	31.8		95	55.8	73	44.2
	D-E	16	60.9	11	39.1		17	61.7	10	38.3
School type						0.216¹					0.134¹
	Public	162	68.5	74	31.5		137	56.7	629	43.3
	Private	73	75.1	23	24.9		64	67.3	185	32.7
History of school failure						0.913¹					0.752¹
	No	165	69.3	67	30.7		144	59.5	88	40.5
	Yes	70	70.3	30	29.7		57	56.6	43	43.4
Pacifier sucking						0.986¹					0.351¹
	No	160	69.6	62	30.4		134	56.1	88	43.9
	Yes	75	69.7	35	30.3		67	63.3	43	36.7
Finger sucking						0.398¹					0.764¹
	No	210	68.5	87	31.5		181	58.0	116	42.0
	Yes	25	77.4	10	22.6		20	61.7	15	38.3
Biting lips/cheeks						0.476¹					0.425¹
	No	125	71.7	51	28.3		108	60.7	68	39.3
	Yes	110	67.3	46	32.7		93	56.1	63	43.9
Biting objects						0.077¹					0.510¹
	No	154	73.8	52	26.2		123	57.1	83	42.9
	Yes	81	64.7	45	35.3		78	60.1	48	39.9
Nail biting						0.978¹					0.380¹
	No	86	69.8	36	30.2		75	62.2	47	37.8
	Yes	149	69.6	61	30.4		126	56.3	84	43.7
Bruxism						0.094¹					0.121¹
	No	193	72.9	74	27.1		165	61.6	102	38.4
	Yes	42	55.8	23	44.2		36	45.2	29	54.8
Sleeping with hands under the face						0.252¹					0.596¹
	No	157	72.1	58	27.9		130	59.5	85	40.5
	Yes	78	64.9	39	35.1		71	56.6	46	43.4
Lingual interposition						0.913¹					0.249¹
	No	201	69.9	86	30.1		174	60.7	113	39.3
	Yes	34	68.2	11	21.8		27	46.7	18	53.3

Variables		Chewing alterations				P- value	Swallowing alterations				P- value
		No		Yes			No		Yes
		n	%	n	%		n	%	n	%
Malocclusion (DAI)						0.554¹					0.453¹
	Normal/Mild	30	31.9	67	68.1	0.523²	74	80.0	23	20.0	0.160²
	Defined	16	21.6	66	78.4		64	68.7	18	31.3
	Severe	20	29.2	59	70.8		57	73.6	22	26.3
	Disabling	19	27.2	55	72.8		50	67.7	24	32.3
Malocclusion (Angle)						0.012³					0.027³
	Normal	6	64.9	6	35.1		12	100.0	0	0.0
	Class I	41	20.3	157	79.7		145	73.1	53	26.9
	Class II	35	37.4	68	62.6		78	77.6	25	22.4
	Class III	3	11.9	16	88.1		10	36.8	9	63.2
Posterior crossbite						0.031¹					<0.001¹
	No	74	30.7	203	69.3		220	80.5	57	19.5
	Yes	11	14.6	44	85.4		25	40.3	30	59.7
Posterior open bite						0.225¹					0.114¹
	No	75	27.0	222	73.0		228	75.6	69	24.4
	Yes	10	35.0	25	65.0		17	54.8	18	45.2
Overbite						0.078¹					0.420¹
	No	55	33.1	138	66.9		147	75.5	46	24.5
	Yes	30	18.2	109	81.8		98	69.3	41	30.7
Sex						0.352¹					0.712¹
	Female	42	30.2	112	69.8		117	74.9	37	25.1
	Male	43	25.8	135	74.2		128	72.0	50	28.0
Race/color						0.274¹					0.190¹
	White	25	32.8	56	67.2		65	78.0	16	20.0
	Brown	50	23.8	167	76.2		153	69.8	64	30.2
	Black	10	40.3	24	59.7		27	80.2	7	19.8
Economic class (ABEP)						0.870¹					0.231²
	A-B	40	29.6	97	70.4	0.218²	104	79.6	33	20.4	0.836²
	C	39	27.2	129	72.8		118	68.1	50	31.9
	D-E	6	25.9	21	74.1		23	86.8	4	13.2
School type						0.758¹					0.610¹
	Public	56	27.2	710	72.8		174	72.8	62	27.2
	Private	29	31.0	220	69.0		71	76.0	25	24.0
History of school failure						0.743¹					0.825¹
	No	61	27.1	171	72.9		171	74.1	61	25.9
	Yes	24	29.2	76	70.8		74	71.9	26	28.1
Pacifier sucking						0.612¹					0.816¹
	No	54	26.9	168	73.1		163	72.8	59	27.2
	Yes	31	29.8	79	70.2		82	74.5	28	25.5
Finger sucking						0.107¹					0.188¹
	No	70	25.8	227	74.2		218	71.8	79	28.2
	Yes	15	41.2	20	58.8		27	83.9	8	16.1
Biting lips/cheeks						0.104¹					0.821¹
	No	48	31.6	128	68.4		125	72.8	51	27.2
	Yes	37	23.7	119	76.3		120	74.0	36	26.0
Biting objects						0.251¹					0.240¹
	No	48	25.9	158	74.1		155	76.2	51	23.8
	Yes	37	30.1	89	69.9		90	70.0	36	30.0
Nail biting						0.153¹					0.789¹
	No	36	32.5	86	67.5		90	74.6	55	25.4
	Yes	49	25.1	161	74.9		155	72.6	87	27.4
Bruxism						0.022¹					0.284¹
	No	75	31.0	192	69.0		199	75.7	68	24.3
	Yes	10	14.2	55	85.8		46	63.1	19	36.9
Sleeping with hands under the face						0.442¹					0.226¹
	No	59	29.0	156	71.0		153	70.7	62	29.3
	Yes	26	25.5	91	74.5		92	78.4	25	21.6
Lingual interposition						0.323¹					0.699¹
	No	70	25.7	217	74.3		210	74.3	77	25.7
	Yes	15	39.2	30	60.2		35	68.4	10	31.6

Variables		Breathing alterations						Phonation alterations
		Unadjusted analysis			Adjusted analysis			Unadjusted analysis			Adjusted analysis
		OR	95%CI	P- value	OR	95%CI	P- value	OR	95%CI	P- value	OR	95%CI	P- value
Malocclusion (DAI)
	Normal/Mild	1	-	-	1	-	-	1	-	-	1	-	-
	Defined	4.31	1.44-12.92	0.012	3.84¹	1.45-10.12	0.010	2.17	0.83-5.67	0.107	2.01¹	1.02-4.39	0.047
	Severe	1.53	0.69-3.41	0.273	1.44¹	0.69-3.01	0.303	1.44	0.65-3.21	0.341	1.43¹	0.62-3.28	0.372
	Disabling	4.47	2.17-9.18	<0.001	4.34¹	1.99-9.49	0.001	3.03	1.56-5.91	0.003	3.04¹	1.55-5.96	0.003
Malocclusion according to Angle
	Normal/Class I	1	-	-	1	-	-	1	-	-	1	-	-
	Class II	0.94	0.60-1.46	0.763	0.87²	0.56-1.36	0.528	1.69	1.01-2.85	0.049	2.02²	1.28-3.18	0.005
	Class III	3.45	0.67-17.72	0.127	4.15²	1.19-14.54	0.028	4.34	0.94-20.07	0.059	3.07²	0.95-9.92	0.059
Posterior crossbite
	No	1	-	-	1	-	-	1	-	-	1	-	-
	Yes	2.38	0.86-6.60	0.090	2.36³	0.87-6.39	0.085	1.23	0.62-4.57	0.283	1.68³	0.62-4.57	0.283
Posterior open bite
	No	1	-	-	1	-	-	1	-	-	1	-	-
	Yes	1.26	0.72-2.22	0.385	1.28⁴	0.70-2.31	0.396	1.61	0.62-4.17	0.302	1.59⁴	0.61-4.16	0.319
Overbite
	No	1	-	-	1	-	-	1	-	-	1	-	-
	Yes	1.53	0.82-2.85	0.166	1.64⁵	0.81-3.34	0.157	1.02	0.65-1.59	0.927	1.05⁵	0.66-1.68	0.821

Variables		Chewing alterations						Swallowing alterations
		Unadjusted analysis			Adjusted analysis			Unadjusted analysis			Adjusted analysis
		OR	95%CI	P- value	OR	95%CI	p- value	OR	95%CI	P- value	OR	95%CI	P- value
Malocclusion (DAI)
	Normal/Mild	1	-	-	1	-	-	1	-	-	1	-	-
	Defined	1.45	0.75-2.81	0.247	1.39¹	0.64-2.74	0.415	0.90	0.45-1.82	0.780	1.57¹	0.61-4.06	0.322
	Severe	1.16	0.46-2.92	0.731	1.09¹	0.43-2.74	0.851	1.24	0.63-2.45	0.532	1.38¹	0.71-2.69	0.322
	Disabling	1.38	0.49-3.87	0.511	1.28¹	0.51-3.21	0.579	1.54	0.79-3.03	0.207	1.94¹	0.90-4.17	0.087
Malocclusion according to Angle
	Normal/Class I	1	-	-	1	-	-	1	-	-	1	-	-
	Class II	0.77	0.31-1.96	0.574	0.73²	0.30-1.77	0.463	0.86	0.37-2.00	0.715	0.80²	0.33-1.96	0.612
	Class III	3.39	0.88-13.03	0.072	3.66²	0.88-15.23	0.072	5.13	1.11-18.78	0.046	5.66²	1.35-23.71	0.021
Posterior crossbite
	No	1	-	-	1	-	-	1	-	-	1	-	-
	Yes	2.30	1.08-4.90	0.032	2.32³	1.12-4.82	0.027	6.12	2.68-13.97	<0.001	6.13³	2.76-13.62	<0.001
Posterior open bite
	No	1	-	-	1	-	-	1	-	-	1	-	-
	Yes	0.60	0.24-1.49	0.250	0.60⁴	0.24-1.51	0.261	3.55	0.75-8.65	0.124	4.53⁴	1.72-8.92	0.037
Overbite
	No	1	-	-	1	-	-	1	-	-	1	-	-
	Yes	1.64	0.66-4.07	0.265	1.79⁵	0.78-4.10	0.157	1.36	0.61-3.04	0.421	1.42⁵	0.59-3.42	0.404

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[1] Collaborations

HV Freitas and EBAF Thomaz worked on the conception of the work. HV Freitas and LFG Silva worked on the acquisition of data for the work. EBAF Thomaz worked on analysis and interpretation of data for the work. CMC Alves, LFG Silva, ALP Pereira, FN Hugo and EBAF Thomaz worked on drafting the work or revising it critically for important intellectual content; and final approval of the version to be published.