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Introduction: Correct breathing is a fundamental condition for adequate vocal production. Respiratory dynamics are able to modify the growth of facial mass and lingual posture, i.e., of the skull, the mandibular one. For this reason, infant mouth breathing can cause hoarseness. Materials and methods: We evaluated the actual changes in the characteristics of the voice and articulation of language in a group of subjects affected by adenotonsillar hypertrophy (grade 3–4), with frequent episodes of pharyngo-tonsillitis who underwent adenotonsillectomy. Our study included 20 children—10 boys and 10 girls—aged 4 to 11 years who had adenotonsillar hypertrophy and pharyngotonsillitis episodes exceeding 5–6 per year in the previous 2 years. The control group (Group B) included 20 children—10 boys and 10 girls—aged 4 to 11 years (average age of 6.4 years) who had not undergone surgery and shared the same degree of adenotonsillar hypertrophy as those in Group A but who did not experience recurrent pharyngotonsillitis episodes. Discussion: The hypertrophy of adenoids and tonsils significantly impacted breathing, vocal function, and speech articulation. All this is responsible for a state of tension in the neck muscles, which at the level of the vocal tract causes hoarseness. The changes objectively observed in our study in the pre- and post-operative phase demonstrate how adenotonsillar hypertrophy is responsible for an increase in resistance to the passage of air at the glottic level. Conclusions: For this reason, adenotonsillectomy has an impact on recurrent infections and can also lead to an improvement in speech, breathing, and posture.

RESUMO Vários estudos mostram a importância da avaliação quantitativa na patência nasal e do estado funcional das vias aéreas superiores para fornecer informações clínicas e diagnósticas em indivíduos respiradores orais, as quais são de grande interesse para a fonoaudiologia. O objetivo deste estudo foi avaliar o efeito da irrigação de solução salina nasal nas vias aéreas superiores através da aeração nasal e rinomanometria anterior ativa em crianças respiradoras orais. Estudo de série de oito casos, realizado em crianças com idades entre 7 e 10 anos, com diagnóstico clínico otorrinolaringológico de respiração oral. O estudo consistiu em três etapas: avaliação inicial; intervenção e avaliação final. Foram aplicados os questionários do Índice de Identificação dos Sinais e Sintomas da Respiração Oral e qualidade de vida específica para doenças em pacientes pediátricos com queixas sinonasais. Realizaram-se as avaliações da aeração nasal e o exame da rinomanometria anterior ativa. A intervenção foi realizada por meio da irrigação de solução salina nasal com 10 ml. Em seguida, os pacientes foram reavaliados pela avaliação da aeração nasal e rinomanometria, para comparar os resultados. Em relação à avaliação da aeração nasal e rinomanometria, das 16 medidas comparativas entre pré e pós-irrigação nasal, constataram-se mudanças significativas na aeração nasal e na resistência nasal. A irrigação nasal resultou em melhora nas medidas da aeração nasal, enquanto para o fluxo nasal da rinomanometria, as medidas permaneceram inalteradas entre pré e pós-irrigação nasal. ABSTRACT Several studies have shown the importance of quantitative assessment in nasal patency and functional status of the upper airways to provide clinical and diagnostic information in oral breather individuals, which are of great interest to speech therapy. The aim of the study was to evaluate the effect of nasal saline solution irrigation on the upper airways through nasal aeration and active anterior rhinomanometry in oral breathing children. This was an eight case series study, carried out in children aged 7 to 10 years with an otorhinolaryngological clinical diagnosis of mouth breathing. The study consisted of three stages: (I) initial evaluation; (II) intervention; and (III) final evaluation. The questionnaires of the Index for the Identification of Oral Breathing Signs and Symptoms and disease-specific quality of life in pediatric patients with sinonasal complaints were applied, nasal aeration assessments and the anterior active rhinomanometry exam were carried out. The intervention was performed by irrigating nasal saline solution with 10ml. Afterwards, they were re-evaluated by nasal aeration evaluation and rhinomanometry to compare the results. Regarding nasal aeration and rhinomanometry evaluation, from the 16 comparative measurements between pre and post nasal irrigation, we obtained significant changes in nasal aeration and nasal resistance. Nasal irrigation resulted in improvement in nasal aeration measurements while nasal flow measurements from rhinomanometry remained unchanged considering pre and post nasal irrigation.

The breathing pattern of Mouth Breathing (MB) implies the adaptation of body posture to facilitate the passage of airflow through the oral cavity, which can be prevented or reversed through physical exercise. However, there is no consensus on which is the best model of exercise program to minimise these postural adaptations. The purpose of the review was to investigate the effect of different physical exercise programs on the posture of mouth-breathing children and adolescents. The research was performed in Scopus, PubMed, Lilacs, Bireme, and Scielo databases in November 2022. The following descriptors were included: "mouth breather and exercise", "mouth breathing and exercise", "nasal obstruction and exercise", "mouth breather and exercises", "mouth breathing and exercises", and "nasal obstruction and exercises". Clinical trials related to the effect of physical exercise on the posture of MB children and adolescents were considered. Among 2796 identified studies, six were included. The mean score of the methodological quality scale of the selected studies was 5.5 points on a scale of 0 to 10. All studies showed an improvement in body posture after the exercise program. The exercise programs comprised muscle strengthening and stretching exercises, neuromuscular proprioceptive facilitation, and postural and diaphragmatic reeducation. The duration of the programs and the weekly frequency varied in the studies. Although it is difficult to compare studies and establish guidelines for formulating an exercise protocol, it was observed that upper limb strengthening and stretching exercises could effectively improve the body posture of MB children and adolescents., Motricidade, Vol. 19 No. 1 (2023): Motricidade

Allergic rhinitis (AR) is an independent risk factor for sleep disorders in children, including abnormal sleep behaviors. We investigated the occurrence of abnormal sleep behaviors in children with AR to determine indoor environmental risk factors affecting sleep.This case-control study collected the sleep status and characteristics of the indoor environment of children aged 3-14 years with and without AR using a questionnaire. The differences between the two groups were compared using the Mann-Whitney U test, chi-square test, and Fisher's exact test. The indoor environmental factors affecting sleep behavior were analyzed using logistic regression analysis.Children with AR (n=427) had a higher probability of snoring (8.7 % vs. 2.9 %; P0.001), mouth breathing (14.1 % vs. 5.2 %; P0.001), restless sleep (6.6 % vs. 4.1 %; P = 0.047), sleep talking (3.3 % vs. 1.1 %; P = 0.003), and hyperhidrosis (16.4 % vs. 8.5 %; P0.001) than those without AR (n=1046). Emulsion wall paint (odds ratio (OR) = 2.779; 95 % confidence interval (CI), 1.332-5.796; P = 0.006) and tobacco exposure in early infancy (OR = 2.065; 95 % CI 1.079-3.950; P = 0.029) were associated with hyperhidrosis.Children with AR are more likely to have abnormal sleep behaviors than those without, including snoring, mouth breathing, restless sleep, sleep talking, and hyperhidrosis. Emulsion paint wall and tobacco smoke exposure in early infancy had a twofold higher risk of hyperhidrosis during sleep.

Background/purpose Nasal obstruction leads to oral breathing and consequently hypoxia. The purpose of this study was to determine the influence of hypoxia on inflammatory response and the effect on alveolar bone development in a rat model in which mouth breathing was induced by nasal obstruction. Materials and methods Unilateral nasal obstruction was performed by injecting a Merocel sponge into the nasal cavity of 8-week-old Sprague Dawley (SD) rats. After 3 and 6 weeks of nasal obstruction, rats were sacrificed, the organs were weighed, and the changes in mandibular bone quality were examined by micro-computed tomography (μ-CT). The stereomicroscope was used for the morphological analysis of alveolar bone loss in response to nasal obstruction. Hematoxylin and Eosin (H&E) and immunohistochemical staining were employed to examine inflammation and bone remodeling induced by hypoxia. Results Nasal obstruction led to a delay in overall growth and organ development. The bone mineral density (BMD) and bone volume/total volume (BV/TV) of the mandible were reduced due to nasal obstruction, and the loss of the alveolar bone was confirmed morphologically. Our nasal obstruction method was observed to be successful in inducing hypoxia along with an increase in hypoxia-inducible factor 1-alpha (HIF-α). Oral hypoxia induced by nasal obstruction increased inflammatory response, and increased expression of receptor activator of nuclear factor kappa-Β ligand (RANKL) led to bone destruction. Conclusion This study demonstrated that nasal obstruction induced mouth breathing led to hypoxia in a rat model. Under hypoxic conditions, an increase in osteoclast differentiation induced by activation of the inflammatory pathway causes destructive changes in the alveolar bone.

Objectives To investigate the evidence on the association between ankyloglossia and obstructive sleep apnea. Methods An integrative literature review was carried out in the databases. Observational and interventional studies that assessed the lingual frenulum in children with sleep-disordered breathing were included. As exclusion criteria: studies in animals, in vitro, letters to the editor, expert opinions, other reviews. The selected articles were analyzed regarding the study design, sample, characterization of the lingual frenulum and sleep assessment, in addition to the main results and conclusions. Results Ninety-seven articles were identified, but only 4 met the inclusion criteria. Two retrospective studies concluded that the untreated shortened lingual frenulum at birth is associated with obstructive sleep apnea. A prospective study concluded that there was an improvement in speech and deglutition after lingual frenectomy, in addition to improved sleep. A retrospective cohort concluded that lingual frenuloplasty combined with myofunctional therapy is effective in the treatment of snoring and mouth breathing. Conclusion The studies included in this review contribute to corroborate the association between ankyloglossia and obstructive sleep apnea. Resumo Objetivo Investigar as evidências sobre a associação entre a anquiloglossia e a apneia obstrutiva do sono. Método Foi feita revisão de literatura integrativa nas bases de dados. Foram incluídos estudos observacionais e intervencionais em que foi feita a avaliação do frênulo de língua em crianças com distúrbios respiratórios do sono. Como critérios de exclusão: estudo em animais, in vitro, carta ao editor, opinião de expert, outras revisões. Os artigos selecionados foram analisados quanto ao desenho do estudo, casuística, caracterização da avaliação do frênulo lingual e do sono, além dos principais resultados e conclusões. Resultado Foram localizados 97 artigos, porém apenas 4 atenderam aos critérios de inclusão. Dois estudos retrospectivos concluiram que o frênulo lingual curto não tratado ao nascimento está associado à apneia obstrutiva do sono. Um estudo prospectivo concluiu que, após a frenectomia lingual, além da melhoria do sono, houve melhoria na fala e deglutição. Um coorte retrospectivo concluiu que a frenuloplastia lingual associada à terapia miofuncional é eficaz no tratamento do ronco e respiração oral. Conclusão Os estudos incluídos na presente revisão contribuem para corroborar a associação entre anquiloglossia e apneia obstrutiva do sono.

A change in the mode of respiration, such as mouth breathing due to an inadequate nasal airway, could affect craniocervical posture, maxillomandibular relationship, and position of the tongue. This in turn could cause changes in dentofacial growth and positions of the teeth. The reported dentofacial and physiologic changes range from long anterior facial height, a retrognathic mandible, an open-mouthed posture, and extended head position to intraoral ramifications such as open bite, increased overjet, deep palatal vault, halitosis, increased caries, and gingivitis. These changes depend on the frequency, severity, and duration of the action as well as other factors such as genetic features, variability in functional demands, and age. Treatment of patients with a diagnosis of mouth breathing needs to be a conjunct effort between otolaryngologist, pediatrician, and orthodontist. Etiology is the key factor in establishing a treatment plan. To determine the etiology, objective evaluation of mouth breathing is important. If the cause of mouth breathing is obstructive, elimination of the obstruction is necessary to prevent abnormal facial and dental growth. In cases of obstructive adenoids and tonsils or allergic rhinitis, surgical or medical treatment is frequently indicated. Favorable changes in dentofacial structures and head posture are seen in these patients, especially when treatment is performed at an earlier age. Some of these patients may further need orthodontic treatment if they have already developed malocclusions. Depending on the severity of the malocclusion, the orthodontic treatment plan may include myofunctional therapy, maxillary expansion, use of functional appliances, dentofacial orthopedics, or orthognathic treatment.

Inadequate masticatory function can be linked to oral problems and result in functional limitation. In children, this function is extremely important for their development, and therefore efforts are made to keep it adequate. To evaluate whether dental pain-related behaviors are associated with masticatory performance (MP). A cross-sectional study was conducted with a sample of 123 children from three to five years old. Toothache was evaluated using the Dental Discomfort Questionnaire. Anthropometric data, predominant type of breathing, presence of malocclusion, number of posterior teeth cavitated by dental caries, and masticatory units were collected. MP was measured by the median size of the crushed particles (X50 ) after 20 cycles of chewing the Optocal test material and was calculated with the Rosin-Rammler equation. Data analysis involved a description of variable frequencies, as well as simple and multiple linear regression, and a confidence level set at 95%. The mean scores of dental pain-related behaviors were 1.14 (± 1.90) points, and the mean X50 value was 3.96 mm (± 1.34). In the multiple linear regression, a larger median size of the particles remained associated with a higher score of dental pain-related behaviors (β = + 0.81, p = 0.01), mouth breathing (β = + 0.22, p = 0.01), and a smaller number of masticatory units (β = - 0.22, p = 0.02). Greater dental pain-related behavior scores are associated with worse MP, regardless of the presence of associations with predominantly oral breathing and fewer chewing units. This article is protected by copyright. All rights reserved.

Aims and objectives Persistent mouth breathing affects stomatognathic functions along with effects on the academics and social life of a child. Sleep-related problems and behavioral symptoms similar to that found in attention-deficit hyperactivity disorder (ADHD) can be present in mouth breathers. This study aims at assessing the sleep disturbances and pattern of symptoms of ADHD in children with mouth breathing. Materials and methods A cross-sectional study was carried out on 100 children of mouth breathing (consecutively selected) in 7–12 years of age using semi-structured proforma, children's sleep habit questionnaire (CSHQ), and diagnostic and statistical manual of mental disorders, version 5 (DSM 5). Statistical analysis was done using SPSS software version 21. Mean, standard deviation, Chi-square, and Pearson's correlation coefficient test were utilized during the analysis. p value of

With increasing age, structures of the internal and external nose change. Many elderly patients complain about rhinitis with nasal obstruction, endonasal crusting, epistaxis, intermittent rhinorrhea, and olfactory disorders. These symptoms are mainly caused by atrophy of the mucosa and the olfactory epithelium, but may also be an expression of drug side effects. Additionally, there are changes in the shape of the nose (continuous growth, altered elasticity of supporting structures) and in the dermis, which may develop tumors due to its sun-exposed position. These multiple internal and external changes of the nose can be summarized by the collective term "aging nose," whose treatment options are complex. These range from conservative (nasal care, medication changes, hemostatic measures) to surgical lines of therapy (septorhinoplasty, tumor excision, vascular ligation) and will require further scientific study in the future.

Aim The present manuscript aims at providing a comprehensive overview of the epidemiology, risk factors, diagnostic aids, and management of halitosis in a pediatric population. Background Halitosis refers to bad breath from the mouth that seems unpleasant or offensive to others. This condition is prevalent worldwide, including all age-groups. However, studies on the pediatric population are limited. Self-confidence and personality development are important factors that the child builds up during their developmental stages. Halitosis may affect them both on personal and social aspects; hence, it is important to have beforehand knowledge and the modes to intercept it, paving the way to a positive growth of the child. Review results On reviewing the literature, the common risk factors for halitosis in children constituted predominantly oral factors that varied from poor oral hygiene, gingivitis, periodontal diseases, dental caries, tongue coating, mouth breathing, and so on. Their diagnosis commonly included the organoleptic test, sulfide monitoring, and gas chromatography along with the assessment of questionnaire by the parents and older children. The management was predominantly directed toward the identified source of halitosis along with instructions and counseling on the benefits of a good oral hygiene regime. Conclusion The importance of cultivating a day-to-day practice of oral hygiene regime in the children will not only accustom them toward the benefits of good oral health but also help them to tackle halitosis and in turn their inhibitions associated with it. Clinical significance Halitosis, though a prevalent condition experienced at various stages of life, is crucial to identify and manage, especially in the pediatric population owing to its influence on personal and on social aspects of life.

This study aimed to evaluate the effects of nasal septum deviation on the pharyngeal airway and craniocervical posture measurements using cone beam computed tomography (CBCT).This retrospective study analyzed the CBCTs of 25 patients with and without nasal septum deviation. Various parameters defining the pharyngeal airway and craniocervical and facial skeletal morphology were measured and compared between the groups after confirming intra-examiner reliability.Compared to the control group, the group with nasal septum deviation had a statistically significantly shorter nasopharyngeal length (Children with a nasal septum deviation of 4 mm or more on their CBCT scan are susceptible to unfavorable pharyngeal airway and craniocervical postural changes.

Objectives Mouth breathing is a key feature of obstructive sleep apnea (OSA). The current study evaluated dental, salivary and orthodontic characteristics of children with OSA, and compared them to those of children without OSA. Materials and methods Twenty-two children (mean age 5.3 years, 13 males) with OSA and 21 children without OSA who served as a control group (mean age 6.8 years, 11 males) underwent dental examinations. The OSA group was classified according to the apnea-hypopnea Index. Clinical examination included plaque index, gingival index, caries status, pH at 7 oral sites, salivary carries bacterial counts and inflammatory cytokine levels. Orthodontics measurements were calculated as the percentage of children with values in the normal range, in each group. Results The mean values of the decayed, missing and filled teeth (DMFT)/dmft index, the gingival index and the plaque index were higher in the OSA than the control group. Salivary Mutans streptococci and lactobacilli counts were significantly higher in the OSA than the control group; as were pH values in the hard and soft palate, and in the posterior and middle tongue. Significantly lower values were observed in the OSA than the control group for most of the orthodontic variables examined. Similarly, stratification of AHI according to severity shows the lowest values among those with mild OSA, and the highest among those with severe AHI. Conclusions Compared to a control group, mouth breathing children with obstructive sleep apnea had differences in oral microbiota, greater acidity and poorer dental status. Clinical relevance Clinicians should be aware of the various oral disturbances that may accompany OSA, and implement preventive measures.

[EN] Background and Objectives To present a world panorama of the published papers on bruxism in children and adolescents, emphasising the characteristics of studies related to the sleep features of these patients. Methods Literature searches were conducted in six databases without language or date restrictions. Data on the titles, types of study, main subjects, countries of origin, keywords, years of publication, authors and their network collaborations, journals and sleep studies were extracted and analysed using VantagePoint (TM) software. Results A total of 725 studies met the eligibility criteria. Most included only children (75.31%), with observational design (66.34%), and risk or aetiology (53.93%) as the main subject. Brazil (18.06%) and Brazilian authors (54.84%) had the largest number of studies, with a low amount of network collaboration. The Journal of Oral Rehabilitation published most of the studies (6.2%); publications in this field have grown considerably from 2000 to 2020. Of the studies, 123 (16.96%) included sleep studies; night sweating, restless sleep, sleep talking, mouth breathing, snoring, obstructive sleep apnoea syndrome, sleep-disordered breathing, nightmares, poor sleep quality and duration, and daytime naps were significantly associated with bruxism in most. Conclusion Studies on bruxism in children and adolescents have increased in the past 20 years, with most being observational, and risk or aetiology as the main subject. Brazil and the Journal of Oral Rehabilitation have published most in the field. Sleep studies have shown some features associated with bruxism, such as night sweating, restless sleep, somniloquy, snoring, breathing problems, nightmares, daytime naps, and poor sleep quality and duration., Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior--Brazil (CAPES), Grant/Award Number: 001; Conselho Nacional de Desenvolvimento Cientifico e Tecnologico (CNPq), Grant/Award Number: 401058/2016-6

Although nasal obstruction (NO) during growth causes maxillofacial growth suppression, it remains unclear whether eliminating the NO affects maxillary and mandibular growth differentially. We aimed to clarify whether eliminating NO can help regain normal maxillofacial growth and to determine the optimal intervention timing. Forty-two 4-week-old male Wistar rats were randomly divided into six groups. Their left nostril was sutured to simulate NO over different durations in the experimental groups; the sutures were later removed to resume nasal breathing. Maxillofacial morphology was assessed using microcomputed tomography. Immunohistochemical changes in hypoxia-inducible factor (HIF)-1α, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-B ligand (RANKL) of the condylar cartilage were evaluated to reveal the underlying mechanisms of these changes. Maxillary length was significantly lower in rats with NO for ≥5 weeks. In groups with NO for ≥7 weeks, the posterior mandibular length, ramus height, thickness of the hypertrophic cell layer in the condylar cartilage, HIF-1α levels, and RANKL levels were significantly lower and OPG levels and RANKL/OPG were significantly higher than those in the control group. Our findings suggest that eliminating NO is effective in regaining maxillofacial growth. Moreover, the optimal timing of intervention differed between the maxilla and mandible.

This work aims to study the relationship between a mouth breathing patient and orthodontic treatment through a literature review. Breathing is essential for the functioning of the system, which malfunctions throughout the human body and diverse systems. Correct breathing brings benefits to the body, in digestion, in the body, even in the accumulation of organic organs, in the rebalancing of organic functions and in the fight against anxiety and obesity. The most common differences of people who are mouth breathers are changes in craniofacial and also dental structure, changes in phonoarticular, corporeal, behavioral and oral function. The multidisciplinary treatment must be greater and treated as soon as possible, the earlier the recognition and treatment of oral obstructions, speech therapy and orthodontics, the better the patient's final result. Este trabajo tiene como objetivo estudiar la relación entre un paciente que respira por la boca y el tratamiento de ortodoncia a través de una revisión de la literatura. La respiración es fundamental para el funcionamiento del sistema, el cual funciona mal en todo el cuerpo humano y diversos sistemas. Una correcta respiración trae beneficios al organismo, en la digestión, en el organismo, incluso en la acumulación de órganos orgánicos, en el reequilibrio de las funciones orgánicas y en la lucha contra la ansiedad y la obesidad. Las diferencias más comunes de las personas que respiran por la boca son los cambios en la estructura craneofacial y también dental, los cambios en la función fonoarticular, corporal, conductual y oral. El tratamiento multidisciplinario debe ser mayor y tratado lo antes posible, cuanto antes se reconozcan y se traten las obstrucciones orales, logopedia y ortodoncia, mejor será el resultado final del paciente. Este trabalho tem como objetivo estudar as relações entre um paciente respirador bucal e o tratamento ortodôntico por meio de uma revisão de literatura. A respiração é essencial para o funcionamento do sistema, cujo funcionamento é mau em todo o corpo humano e sistemas diversos. A respiração correta traz os benefícios ao organismo, na digestão, no organismo, até mesmo no acúmulo de órgãos orgânicos, no reequilíbrio das funções orgânicas e no combate à ansiedade e à obesidade. As diferenças mais comuns das pessoas que são respiradoras bucais são as mudanças na estrutura craniofaciais e também dentárias, mudanças na função fonoarticular, corpórea, comportamental e oral. O tratamento multidisciplinar deve ser maior e tratado o mais rápido possível, quanto mais precoce o reconhecimento e tratamento das obstruções bucais, fonoaudiologia e ortodontia, melhor o resultado final do paciente.

OBJECTIVE: This study aimed to investigate the long-term clinical efficacy and safety of inferior turbinate submucosal plasma ablation combined with or without tonsillar and adenoid surgery in children with allergic rhinitis(AR) combined with obstructive sleep apnea syndrome(OSAS) who were ineffective after conservative systemic treatment. METHODS: A total of 43 children with AR complicated with OSAS who met the inclusion criteria among 68 children hospitalized from January 2019 to February 2022 were retrospectively analyzed. The data were collected, including the clinical characteristics, surgical methods perioperative management and prevention and treatment of complications. Moreover, one year follow-up was performed to compare the VAS scores of children before and after surgery, and to evaluate their mid-term and long-term outcomes. RESULTS: The average operation time was 36 minutes, meanwhile, the intraoperative blood was limited. The symptoms of nasal congestion, runny nose, sleep snoring, and mouth breathing were significantly improved after operation, and the results were satisfactory after one-year follow-up without complications such as bleeding, hematoma, intraoperative adhesion, and nasal dryness. CONCLUSION: Submucosal plasma ablation of inferior turbinate with or without tonsillectomy adenoidectomy in children with AR can effectively improve the clinical symptoms of AR combined with OSAS children who are ineffective after conservative treatment. It can improve the symptoms of sleep-disordered breathing such as sleep snoring and mouth breathing, with good mid-and long-term curative effects and fewer complications, which is an effective and safe treatment for children with AR combined with OSAS.

Objectives: In recent years, we have witnessed a growing interest in pediatric sleep-related breathing disorders (SRBD). Although a Pediatric Sleep Questionnaire (PSQ) exists and was found reliable in screening SRBD in children, many of the children remain underdiagnosed. The aim of the present study was to define anamnestic and clinical findings that can serve as red flags indicating the presence of SRBD in children. Methods: 227 children aged 4–12 years old were evaluated with regard to the following parameters: (i) anamnestic variables (e.g., general state of health, oral habits, bruxism, esophageal reflux, sleep continuity, snoring); (ii) clinical parameters (e.g., oral mucosa, palate, tonsils, tongue, floor of the mouth, angle classification, gingival health, caries risk) and (iii) presence of SRBD (through the PSQ). Results: Significant differences between children with and without SRBD were observed regarding continuous sleep, developmental delay, mouth breathing, and snoring. Taking medications for ADHD increased the odds of SRBD in children by over seven times, non-continuous sleep increased the odds of SRBD by six times, mouth breathing increased the odds by almost five times, and snoring increased the odds by over three times. Conclusions: Child caregivers from various fields (dentists, orthodontists, pediatric physicians, school nurses) should actively inquire about disturbed sleep, medications for ADHD, snoring, and mouth breathing among their young patients. Initial screening through a few simple questions may help raise red flags that can assist in the early detection of SRBD in children and lead to proper diagnosis and treatment.

Objective: To map existing knowledge about deleterious habits such as pacifiers and bottle feeding and the implications on the development of children aged 0-6 years. Review Method: Scoping review protocol according to the Joanna Briggs Institute method. Published and unpublished bibliographic materials will be considered, according to the following inclusion criteria: to report the types of harmful habits (concept) occurring in the population of children aged 0-6 years (population) and their impact on child development (context). A detailed individual search strategy will be used for each database: Virtual Health Library (VHL), PubMed and Scopus. Two reviewers will screen the titles and abstracts, read the full texts, and extract data from the included material. Presentation and Interpretation of Results: The results included in this scoping review will be classified into conceptual categories of analysis from Thematic Categorical Analysis, grounded in Bardin's content analysis. Objetivo: Mapear el conocimiento existente sobre hábitos nocivos, como chupetes y biberones, y las implicaciones para el desarrollo de niños de 0 a 6 años. Método de revisión: Protocolo de revisión de alcance según el método del Instituto Joanna Briggs. Se considerarán materiales bibliográficos publicados e inéditos, de acuerdo con los siguientes criterios de inclusión: informar los tipos de hábitos nocivos (concepto) que se presentan en la población infantil de 0 a 6 años (población) y su impacto en el desarrollo infantil (contexto). Se utilizará una estrategia de búsqueda detallada e individual para cada base de datos: Biblioteca Virtual en Salud (BVS), PubMed y Scopus. Dos revisores revisarán los títulos y resúmenes, leerán los textos completos y extraerán datos del material incluido. Presentación e Interpretación de Resultados: Los resultados incluidos en esta revisión de alcance serán clasificados en categorías de análisis conceptual con base en el Análisis Categórico Temático, basado en el análisis de contenido de Bardin. Objetivo: Mapear conhecimento existente sobre hábitos deletérios, como chupeta e mamadeira e as implicações no desenvolvimento de crianças de 0-6 anos. Método de Revisão: Protocolo de scoping review segundo o método do Joanna Briggs Institute. Serão considerados materiais bibliográficos publicados e não publicados, conforme os seguintes critérios de inclusão: relatar os tipos de hábitos deletérios (conceito) ocorridos na população de crianças de 0 a 6 anos (população) e seu impacto no desenvolvimento infantil (contexto). Será utilizada estratégia de busca detalhada e individual para cada base de dados: Biblioteca Virtual em Saúde (BVS), PubMed e Scopus. Dois revisores triarão os títulos e resumos, lerão os textos completos e extrairão os dados do material incluído. Apresentação e Interpretação dos resultados: os resultados incluídos na presente revisão de escopo serão classificados em categorias de análise conceituais a partir da Análise categorial temática, fundamentada na análise de conteúdo de Bardin.

Mouth breathing is one of the most common deleterious oral habits in children. It often results from upper airway obstruction, making the air enter completely or partially through oral cavity. In addition to nasal obstruction caused by various kinds of nasal diseases, the pathological hypertrophy of adenoids and/or tonsils is often the main etiologic factor of mouth breathing in children. Uncorrected mouth breathing can result in abnormal dental and maxillofacial development and affect the health of dentofacial system. Mouth breathers may present various types of growth patterns and malocclusion, depending on the exact etiology of mouth breathing. Furthermore, breathing through the oral cavity can negatively affect oral health, increasing the risk of caries and periodontal diseases. This review aims to provide a summary of recent publications with regard to the impact of mouth breathing on dentofacial development, describe their consistencies and differences, and briefly discuss potential reasons behind inconsistent findings.

Background: Parafunctional habit has been associated in the literature with alterations of dental occlusion; it could be a predisposing factor for malocclusion. This cross-sectional study is aimed to assess the prevalence of parafunctional habits and its relation to parent’s education. Subjects and Methods: Convenience sample of 500 children aged between 4 and 6 years of both gender 262 boys and 238 girls receiving their medical care in primary health-care centers and in Raparin Pediatric Hospital of Erbil city to study parafunctional habits and its relation to parents education. Results: Mouth breathing and nail biting were more prevalent habits in the included children than lip sucking and bruxism. The former habits prevalence showed no significant differences in children whose their parents education background are different (high, middle, or low education). Conclusion: Mouth breathing and nail biting were highly prevalent habits among preschool children in Erbil city. No significant association was found between the prevalence of bad oral habits and parents education.

Adenotonsillar hypertrophy is one of the commonest causes of upper airway obstruction in children. It can cause hypoxic state by impairing pulmonary functions. Peak expiratory flow rate is a basic, convenient and reliable indicator of pulmonary function in children. To study the improvement in pulmonary functions by assessing Peak expiratory flow rate, before and after adenotonsillectomy in children. Design: Cross sectional, prospective, observational study. Setting: Department of otorhinolaryngology in tertiary care centre. Subjects: Included 40 children aged between 5 and 15 years, who had adenotonsillar hypertrophy and underwent adenotonsillectomy. Method: Diagnostic nasal endoscopy and X-ray, nasopharynx, was done to assess the grade of adenoid hypertrophy endoscopically and radiologically respectively. Peak expiratory flow rate was assessed using Mini Wright peak expiratory flow meter pre-operatively and 1 month post-operatively and both the readings were compared. Subjective improvement was also compared pre-operatively and post-operatively using visual analogue score. This study included 40 patients with male to female ratio of 1.6:1, 92.5% presented with mouth breathing. 92.5% presented with grade III tonsillar hypertrophy and 70% with grade III adenoid hypertrophy endoscopically. After adenotonsillectomy, improvement in Peak expiratory flow rate ranged from 16 to 25.3% which was statistically significant. Patients with grade III tonsillar and grade IV adenoid hypertrophy showed 25.3% improvement. Subjective improvement was 98.8% in the complaint of snoring. Adenotonsillectomy significantly improves pulmonary functions. This may help to improve physical and cognitive development in children and decrease chances of getting cardiopulmonary problems in later life.

ObjectiveDiagnosis of obstructive sleep apnoea (OSA) is made on overnight polysomnography (PSG). Given the widespread availability of smartphone video technology, we aimed to develop and test a standardised scoring system for smartphone videos and compare these scores to PSG results.MethodsChildren aged 1–16 years undergoing PSG for suspected OSA were included. Parents were asked to take 1–2 min videos of the breathing they were concerned about. Videos were scored using a newly developed and tested tool on five components: inspiratory obstructive noises (1–4), presence of obstructive events (0–1), increased work of breathing (0–1), mouth breathing (0–1) and neck extension (0–1). Video scores and the Obstructive Apnoea Hypopnoea Index (OAHI) were compared using Spearman correlation. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for different cut-off scores to achieve the best results.ResultsVideos from 43 children (28 men (65.1%), median age 5.7 years (range 2.6–14.0 years), median OAHI 3.8/hour (range 0–82 events/hour) were included. Nine children (20.9%) had a video score of 5 events/hour) .ConclusionWe have developed and validated a simple clinical tool (the Monash Obstructive Sleep Apnoea Video Score) to quantify abnormalities in breathing seen on short video recordings made on a smartphone. A low score rules out moderate–severe OSA and may be valuable in the triage of children with symptoms of OSA.

BACKGROUND We conducted a meta-analysis and systematic review to identify a reliable estimate of sleep problems prevalence among children in mainland China and to describe its epidemiological characteristics. METHODS Relevant studies were searched thoroughly via electronic databases included China National Knowledge Infrastructure, Wanfang, Weipu, PubMed, Embase and Medline databases from inception until December 2020. Prevalence estimates were calculated by random-effects models. The sources of heterogeneity were explored using subgroup analyses and Meta-regression analysis, and publication bias was estimated by funnel plots and Egger's Test. RESULTS Overall, 66 studies were included in this meta-analysis, which revealed that the pooled prevalence of sleep problems was 37.6% (95%CI: 34.3-40.9%) with high heterogeneity (I2 = 99.6%,P

Introduction Diagnosis and treatment of obstructive sleep apnea (OSA) in children is often delayed due to the high prevalence and limited physician and sleep testing resources. As a result, children may be referred to multiple specialties, such as pediatric sleep medicine and pediatric otolaryngology, resulting in long waitlists. Method We used data from our pediatric OSA clinic to identify predictors of tonsillectomy and/or adenoidectomy (AT). Before being seen in the clinic, parents completed the Pediatric Sleep Questionnaire (PSQ) and screening questionnaires for restless leg syndrome (RLS), nasal rhinitis, and gastroesophageal reflux disease (GERD). Tonsil size data were obtained from patient charts and graded using the Brodsky-five grade scale. Children completed an overnight oximetry study before being seen in the clinic, and a McGill oximetry score (MOS) was assigned based on the number and depth of oxygen desaturations. Logistic regression, controlling for otolaryngology physician, was used to identify significant predictors of AT. Three triage algorithms were subsequently generated based on the univariate and multivariate results to predict AT. Results From the OSA cohort, there were 469 eligible children (47% female, mean age = 8.19 years, SD = 3.59), with 89% of children reported snoring. Significant predictors of AT in univariate analysis included tonsil size and four PSQ questions, (1) struggles to breathe at night, (2) apneas, (3) daytime mouth breathing, and (4) AM dry mouth. The first triage algorithm, only using the four PSQ questions, had an odds ratio (OR) of 4.02 for predicting AT (sensitivity = 0.28, specificity = 0.91). Using only tonsil size, the second algorithm had an OR to predict AT of 9.11 (sensitivity = 0.72, specificity = 0.78). The third algorithm, where MOS was used to stratify risk for AT among those children with 2+ tonsils, had the same OR, sensitivity, and specificity as the tonsil-only algorithm. Conclusion Tonsil size was the strongest predictor of AT, while oximetry helped stratify individual risk for AT. We recommend that referral letters for snoring children include graded tonsil size to aid in the triage based on our findings. Children with 2+ tonsil sizes should be triaged to otolaryngology, while the remainder should be referred to a pediatric sleep specialist. Graphical abstract

Background: Anterior open bite (AOB) is the vertical separation between upper and lower teeth when all other teeth are in maximum intercuspation. It is considered abnormal when it affects patient’s function, speech, mastication, future dental health risks and aesthetics. Aim: The current study was conducted to determine the prevalence of anterior open bite and its etiological factors in a group of Egyptian children aged 8 years and above. Methods: The sample comprised 115 participants aged between 8 and 10 years, attending the Outpatients’ Clinic of Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University. AOB was assessed on study cast models using digital caliper. Increased overjet, abnormal oral habits, and parents’ educational level were checked. A close ended questionnaire was answered by patients’ guardians. Data were statistically analyzed with SPSS software package (version 21 SPSS Inc., Chicago, USA). Results: About 24(20.9%) of the 115 participants had AOB, 82 (71.2%) had normal overbite, 9 (7.8%) had increased overbite. Overjet relationship was increased in 51(44.4%). The most common etiological factor was mouth breathing 13(11.3%). Abnormal oral habits revealed higher percentages of tongue thrust 5 (7.2%), thumb sucking 4(5.8%) and lip biting 6(8.7%) in girls. Boys revealed higher percentages regarding mouth breathing 7(15.2%) and nail biting 1(2.2%). There was significant low positive correlation between parents’ educational level and the amount of AOB (r < 0.5, P-value < 0.05). Conclusions: Prevalence of AOB is relatively low, with no sex predilection. Abnormal oral habit may be a causative factor of AOB.

The dental apparatus and the respiratory organs of the skull are closely related. Respiratory tract defects lead to mouth breathing and abnormalities in the development of the dental apparatus. Elimination of dental anomalies does not guarantee against recurrence of dental diseases and encourages the improvement of methods of comprehensive examination and diagnosis. There are many methods for determining the transverse parameters of the facial skull: by diagnostic models or by frontal teleradiography. These methods do not always reflect the true position of the facial skull. We have proposed a method of measuring the transverse dimensions of the upper jaw and upper respiratory tract using computed tomography, which through the use of appropriate mathematical modeling can improve the diagnosis of respiratory organs and dental apparatus during orthodontic treatment. In the clinic of the dental medical center of the National Medical University. O.O. Bogomolets underwent orthodontic treatment of children with the first form of gnatal mesial occlusion according to Betelman. Treatment of mesial occlusion was performed using a fixed device for transverse dilation of the upper jaw. From the patients treated, we selected a group of 17 boys and 20 girls. Children aged 7 to 12 years had the first molars, clinically established 3rd or 2nd grade molar defects, congestion of more than 3 millimeters and nasal breathing problems. Before and after treatment with computed tomography, three distances of the upper jaw were measured: between the medial-palatine mounds of the first permanent molars, between the bones of the alveolar arch at the level of the resistance center of the first permanent molar, and between the cortical plates of the basal arch at the resistance center of the first permanent molars. In addition, three distances of the upper respiratory tract were measured: between the lateral points of the nasal walls at the level of the large palatal canals, between the lateral points of the nasal walls at the level of the large palatal canals and between the rudiments of the canines at the level of the pear-shaped opening. The results of changes in these parameters of the facial skeleton were subjected to statistical processing to determine the maximum and minimum values, mean, confidence interval. Testing the hypothesis of the normal distribution of sample data by the Shapiro-Wilk test showed that the frequency distribution of measurement data in the samples is close to normal. The closeness of the relationship between the parameters of the facial skeleton was assessed by the correlation coefficient and the adequacy of these coefficients - by Student’s criterion. As a result, there was no statistically significant dependence of the change in the distance between the medial palatine mounds of the first permanent molars on changes in the distances between the bones of the alveolar arch at the resistance center of the first permanent molar, between the cortical plates of the basal arch at the level of the center of resistance of the first permanent molars and the lateral points of the nasal walls at the level of the large palatal canals. It is shown that the change in the distance between the lateral points of the nasal walls at the level of the large palatal canals is statistically weakly related to the change in the distance between the medial palatal mounds of the first permanent molars and is not related to other parameters considered. Linear regression equations were constructed between the parameters of the change in the transverse dimensions of the facial skeleton. Verification of these models by Fisher's parameter showed their adequacy in general. Additional verification of the adequacy of the constant coefficients included in these models, according to Student's test, showed that the free member in the model changes the distance of the upper respiratory tract between the lateral points of the nasal walls at the level of the large palatal canals from the change in the distance between the cortical plates of the basal arch at the level of the center of resistance of the first permanent molars is not statistically significant. The rejection of the free term in this regression dependence led to an increase in the Fisher and Student criteria, which indicates an increase in the adequacy of this equation. The obtained regression equations allow predicting the change of some transverse dimensions of the facial skeleton depending on the change of others in the treatment of mesial occlusion and thus can improve the diagnosis of patients.

Oral habits, such as mouth breathing, sucking, and lip and tongue habits, are important factors that lead to malocclusion. The abnormal pressure will disrupt the muscle balance of the oral and maxillofacial complex and interfere with the normal development of the maxillofacial complex. Therefore, early diagnosis and successful treatment of oral habits are pivotal to the early treatment of malocclusion. This paper discusses the malocclusion caused by children's oral habits and the corresponding intervention methods.口腔不良习惯如口呼吸习惯、吮咬习惯、唇习惯、舌习惯等是导致错（牙合）畸形发生发展的重要因素，其产生的异常压力可破坏口颌系统肌力平衡，干扰颌面部正常发育。因此，早期发现并破除口腔不良习惯是错（牙合）畸形早期矫治的关键。本文针对儿童口腔不良习惯所导致的错（牙合）类型及相应的干预手段进行讨论，以期为临床提供参考。.

Periodontal disease involves pathological processes affecting the periodontium. Mouth breathing parafunction leads to changes in salivary flow patterns and water imbalance, resulting in oral disease. The aim of this study was, through a literature review, to analyze the results of several investigations that have established a relationship between periodontal disease and mouth breathing. Methodology: a search and selection of articles related to periodontal disease in patients with mouth breathing was carried out. The search criteria taken into account were: electronic databases, key words and meeting the indispensable requirement of being less than 5 years old. Thirty-three articles were selected that met the criteria for the present review. Results and conclusion: periodontal disease and mouth breathing may be associated with generalized systemic inflammation. Changes in the nasal breathing pattern may alter normal anatomical structures leading to the development of periodontal disease triggers. La enfermedad periodontal involucra procesos patológicos que afectan al periodonto. La parafunción de respiración bucal, conduce a cambios en los patrones de flujo salival y al desequilibrio hídrico, lo que resulta en afecciones bucodentales. El objetivo de este estudio fue, mediante una revisión bibliográfica, analizar los resultados de varias investigaciones que hayan establecido una relación entre la enfermedad periodontal y la respiración bucal. Metodología: se realizó una búsqueda y selección de artículos relacionados con la enfermedad periodontal en pacientes con respiración bucal. Los criterios de búsqueda tomados en cuenta fueron: bases de datos electrónicos, palabras clave y cumplir con el requisito indispensable de tener una antigüedad menor a 5 años de su publicación. Se seleccionaron 33 artículos que cumplieron los criterios para la presente revisión. Resultados y conclusión: la enfermedad periodontal y la respiración bucal pueden estar asociadas con una inflamación sistémica generalizada. Cambios en el patrón de respiración nasal pueden alterar las estructuras anatómicas normales dando lugar al desarrollo de factores desencadenantes de enfermedad periodontal. A doença periodontal envolve processos patológicos que afetam o periodonto. A parafunção da respiração bucal leva a mudanças nos padrões de fluxo salivar e desequilíbrio da água, resultando em condições bucais e dentárias. O objetivo deste estudo foi, através de uma revisão bibliográfica, analisar os resultados de várias investigações que estabeleceram uma relação entre a doença periodontal e a respiração bucal. Metodologia: foi realizada uma busca e seleção de artigos relacionados à doença periodontal em pacientes com respiração bucal. Os critérios de busca levados em conta foram: bancos de dados eletrônicos, palavras-chave e atendimento ao requisito essencial de ter menos de 5 anos de idade desde a publicação. Foram selecionados 33 artigos que preenchiam os critérios para a presente revisão. Resultados e conclusão: A doença periodontal e a respiração bucal podem estar associadas à inflamação sistêmica generalizada. Mudanças nos padrões de respiração nasal podem alterar as estruturas anatômicas normais levando ao desenvolvimento de desencadeadores de doenças periodontais.

Objective This study aimed to investigate whether the subjects with mouth breathing (MB) or nasal breathing (NB) with different sagittal skeletal patterns showed different maxillary arch and pharyngeal airway characteristics. Methods Cone-beam computed tomography scans from 70 children aged 10 to 12 years with sagittal skeletal Classes I and II were used to measure the pharyngeal airway, maxillary width, palatal area, and height. The independent t-test and the Mann–Whitney U test were used for the intragroup analysis of pharyngeal airway and maxillary arch parameters. Results In the Skeletal Class I group, nasopharyngeal airway volume (P P P P Conclusion Regardless of sagittal Skeletal Class I or II, the pharyngeal airway and maxillary arch in children with MB differ from those with NB. However, the pharyngeal airway was not significantly different between Skeletal Class I and II in children with MB.

We aimed to investigate the oral health of children in terms of the presence of dental caries, periodontal health, halitosis, and dentofacial changes in patients who had adenotonsillar hypertrophy related to mouth breathing and compared these findings with nasal breathing healthy and adenotonsillectomy-operated children. The patient group comprised 40 mouth-breathing children who were diagnosed with adenotonsillar hypertrophy, while the control group consisted of 40 nasal breathing children who had no adenotonsillar hypertrophy. Forty children who had undergone an adenotonsillectomy operation at least 1 year prior to the study were included in the treatment group. Oral examinations of all children were conducted, and the parents were asked about medical and dental anamnesis, demographic parameters, toothbrushing and nutrition habits, oral health-related quality of life (OHRQoL), and symptoms of their children. Demographic parameters, toothbrushing and nutrition habits, and the presence of bad oral habits did not differ between groups ( p > 0.05 ). Adenotonsillectomy is associated with a remarkable improvement in symptoms; however, some symptoms persist in a small number of children. The salivary flow rate, dmft/s, DMFT/S index, plaque, and gingival index scores did not differ between groups ( p > 0.05 ). The patient group showed higher rates of halitosis when compared with the treatment and control groups ( p < 0.001 ). Mouth breathing due to adenotonsillar hypertrophy caused various dentofacial changes and an increase in Class II division 1 malocclusion ( p < 0.001 ). It was shown that adenotonsillar hypertrophy does not negatively affect OHRQoL, it could be a risk factor for dental caries, periodontal diseases, and halitosis, but by ensuring adequate oral health care, it is possible to maintain oral health in children with adenotonsillar hypertrophy. Also, it is recommended that orthodontic treatment should start as soon as possible if it is required. In this context, otorhinolaryngologists, pedodontists, and orthodontists should work as a team in the treatment of children with adenotonsillar hypertrophy.

Background Mouth breathing syndrome (MBS) is defined as a set of signs and symptoms that may be completely or incompletely present in subjects who, for various reasons, replace the correct pattern of nasal breathing with an oral or mixed pattern. Better understanding of the characteristics of MBS at each stage of growth will be helpful for the accurate diagnosis and treatment of MBS. Objective This review aimed to clarify the relevant factors affecting MBS in children and to examine the influence of an incompetent lip seal (ILS) on facial soft tissue form in preschool-aged children. Results Recent data have shown that an ILS affects MBS in children. In addition, the factors associated with MBS in preschool-aged children were not mutually unrelated, and multiple factors such as general conditions, lifestyle, and eating habits may interact with one another. Furthermore, children with an ILS already tended to have a flattened nose and an anteriorly prominent lip at 3 years of age, implying that the adverse effects of an ILS on the growth of the craniofacial region appear relatively early. Conclusions These results suggest the importance of early diagnosis and treatment of MBS. Early treatment of MBS may prevent possible dental and physical problems in the future.

The current manuscript sheds light on the possible role of bioaerosols (from mouth breathing) that may serve as vectors for transmitting COVID-19 in asymptomatic carriers reporting to dental hospitals and, hence, may pose a great challenge for even a simple orthodontic diagnosis. Further, we would like to add a few preventive considerations for containment of this novel disease spread via bioaerosols emitted, particularly during mouth breathing.

Mouth breathing can occur due to obstructive, habitual, or anatomical factors, and it causes various side effects such as decreased blood oxygen saturation, respiratory diseases, skeletal disorders in the facial area, decreased concentration, and sleep disorders. However, previous studies on these side effects of mouth breathing have mainly focused on structural changes. Because oxygen and glucose are essential for brain metabolism, studies on their changes due to mouth breathing have been required. Therefore, this study was to investigate the activation of brain regions during different types of breathing (nasal and mouth breathing) using fluorodeoxyglucose (FDG) positron emission tomography (PET) and blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI). FDG-PET and BOLD-fMRI data were obtained from ten healthy subjects. Image pre-processing and group analysis were conducted using statistical parametric mapping (SPM12). FDG-PET showed that cerebral areas, such as middle frontal, superior and inferior parietal and inferior frontal gyrus, were highly active during nasal breathing and that the cerebellar areas were highly active during mouth breathing. BOLD-fMRI showed that the inferior occipital and the superior frontal gyrus, and the gyrus rectus were highly active during nasal breathing. This study confirmed that mouth breathing interferes with the normal functioning of the cerebrum, such as its metabolism, thereby reducing the activations of the olfactory, autonomic nervous system, as well as the default mode network. These, along with structural changes, may cause deteriorations in brain functions.

This study aimed to compare the children having enlarged adenoids with and without otitis media with effusion (OME) concerning clinical features like mouth breathing, snoring, recurrent episodes of cold, hearing impairment and specific morphology of adenoid. Further, the flora of adenoid tissue and middle ear fluid were also compared. One hundred and twenty children having clinical features suggestive of enlarged adenoids with [Group A (n = 60)] or without [Group B (n = 60)] OME were included in this cross-sectional study. All patients underwent clinical examination, diagnostic nasal endoscopy, radiography of the nasopharynx, blood absolute eosinophil count and immittance. Core adenoid tissue was subjected to microbiological culture after adenoidectomy. OME fluid was subjected to microbial analysis after myringotomy. In group A patients, snoring was present in 90% (p = 0.011), adenoid facies in 76.6% (p

Aim. Study of the development of somatic and oncological diseases and the state of the dentoalveolar system as an indicator of somatic health on the example of the city of Kizlyar (a city of ecological trouble) and the city of Khasavyurt (ecological well-being).Materials and methods. To determine the health status of children and their mothers, a survey was conducted of 1015 children and (or) their parents (three age groups of the study), of which 528 were girls and 487 were boys, and for comparison, 542 children aged 2-17 years in the city of Khasavyurt (ecological well-being) northern zone of Dagestan. Patient selection criteria: 1) identical area of residence (Kizlyar, Khasavyurt); 2) children of preschool age from 2-6 years (1, 2, 3 health groups in the absence of somatic diseases in sub- and decompensated forms), 4 health groups with chronic somatic diseases and congenital malformations; 3) Children at the age of the period of changeable occlusion from 7 to 13 years old, 1-4 health groups; 4) Children aged 14 to 17 years of permanent occlusion, 1-4 health groups.Results. According to a study of schoolchildren aged 7 to 17 years in the city of Kizlyar, 47.1% of children with habitual mouth breathing or mixed breathing. Infantile type of swallowing in children was found in 23.8% of cases. Violation of posture in children was observed in 29% of cases, while in children from the city of Khasavyurt, this type of violation was observed only in 10.5% of cases. The main localizations of malignant neoplasms in the male population are the respiratory organs, stomach, skin, bladder, lip; in the structure of oncological morbidity in the female population, the largest number of patients with neoplasms of the mammary gland, skin, lymphatic and hematopoietic tissue, cervix, and stomach.In the population (period of permanent occlusion), there was a significant decrease in tumors from 0.8% to 0.4% out of 1000 examined, the endocrine system from 0.5% to 0.4%, blood diseases from 0.2% to 0.1%.Conclusions. The results obtained confirm the presence and development of somatic and oncological diseases from unfavorable factors in the region of residence. All indicators for the city of Khasavyurt (ecological well-being) 2 times lower than the data of the city of Kizlyar (city of ecological trouble).

Background & Objectives: Generally, the blockage of upper respiratory tract in children is seen with the hypertrophy of adenoids and tonsils. Normally for patients with adenoid hypertrophy (AH), Adenoidectomy with or without Tonsillectomy is carried out, however it has its own complications like haemorrhage and recurrence of adenoid tissue. Consequently, therapeutic approach has increased extraordinary consideration rather than surgical procedure. The inflammatory process proposed for AH has prompted the utilization of anti-inflammatory drugs to treat this issue. The objective of this study was to assess the impacts of Montelukast sodium in children with enlarged adenoids. Methods: A randomized controlled trail was performed from April 2018 to March 2019 in the Otorhinolaryngology clinic of Dr. Akbar Niazi Teaching Hospital, Islamabad. In this randomized, placebo treatment-controlled trial, 60 children aged 4-12 years meeting inclusion criteria were isolated into two groups. The study group was treated with Montelukast sodium 5mg consistently for three months while the control group got placebo treatment for a similar timeframe. A questionnaire was filled by parents/ guardians of every child before and after the intervention to evaluate the severity of sleep discomfort, snoring and mouth breathing. Results: Following 3 months of treatment, significant reduction in size of the adenoids was seen in 76% of study group compared with just 3% of control group getting placebo treatment. Conclusion: Montelukast sodium seems to be effective in the reduction of the size of adenoids and improvement in clinical manifestations. It can be viewed as a viable option in contrast to surgical treatment in children with hypertrophy of adenoids. doi: https://doi.org/10.12669/pjms.37.2.2670 How to cite this:Naqi SA, Ashfaq AH, Umar MA, Karmani JK, Arshad N. Clinical outcome of Montelukast Sodium in Children with Adenoid Hypertrophy. Pak J Med Sci. 2021;37(2):362-366. doi: https://doi.org/10.12669/pjms.37.2.2670 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Aim and objective Mouth breathing is one of the most common deleterious habits prevalent in children which leads to various skeletal and dental malocclusions. Due to the close relationship between nasal and nasopharyngeal cavity volume and maxilla, transverse maxillary deficiency causes reduced nasal and nasopharyngeal cavity volume leading to mouth breathing. Therefore, knowledge of average nasal and nasopharyngeal cavity volume is essential to accurately diagnose mouth breathing and to evaluate underlying causative factors. Materials and methods Cone-beam computed tomographic scans of 60 children were taken and nasal cavity and nasopharyngeal volumes were calculated using Planmeca Romexis 5.2.0.R software. Average volumes were computed using predetermined landmarks and compared among gender. Results The nasal cavity and nasopharyngeal volume showed significant differences among the gender (p value < 0.001 and 0.018, respectively). Conclusion and clinical significance Knowledge of the average nasal and nasopharyngeal cavity volumes can be a useful diagnostic aid for mouth breathing patients and also assess the causative factors and treatment outcomes in these patients. How to cite this article Kalaskar R, Balasubramanian S, Kalaskar A. Evaluation of the Average Nasal and Nasopharyngeal Volume in 10–13-year-old Children: A Preliminary CBCT Study. Int J Clin Pediatr Dent 2021;14(2):187–191.

Summary box #### What is already known? #### What are the new findings? Saliva is an imperative watery liquid which is secreted by glands, providing lubrication for chewing, swallowing and aiding in digestion. Saliva acts as a ‘mirror of the body’s health’. Majorly constituted by the secretions of three paired major salivary glands: parotid, submandibular and sublingual. It also contains the secretions of the minor salivary glands.1 This critical fluid acts as a lubricant to keep the mouth moist, helps in appreciation of taste, a cleanser by protecting the mouth and teeth free of food debris and the digestive enzymes help in digestion of the food to some extent.2 Xerostomia, commonly referred to as dry mouth, is defined as the reduced or mere absence of salivary flow. It may be described as a subjective sensation of dryness of the oral mucous membrane but not always associated with the objective evidence of significantly decreased salivary flow.3 Xerostomia is however not a disease by itself; it is an indicator of various medical conditions (autoimmune disorders), as an aftereffect of radiation to the head and neck region, or a side effect of a wide variety of medications. Few other non-specific causes are mouth breathing, nasal destruction, smoking, stress anxiety, and so on.4 One another major reason contributing to hyposalivation is physiological changes at old age. Ageing causes atrophy of salivary glands which further leads to hypofunction causing a decrease in salivary flow.5 6 Treatment strategies for xerostomia include use of lubricants, salivary substitutes, saliva replacement gels, and so on. Medication includes sialagogues (pilocarpine and cevimeline) but has its own side effects. And …

Objective: The purpose of this study is to identify the prevalence of parafunctional oral habits among schoolchildren aged 6 to 12 years in Alexandria, Egypt. Materials and methods: A total of 255 Egyptian children, consisting of 158 males and 94 females were randomly examined. The examination included 1-Tongue thrusting: masseteric palpation 2-Thumb sucking: finger examination and intra-oral examination. 3-Mouth breathing: a. medical history. b. Mirror test (fog test) c. Jwemen’s Butterfly test. d. Water Holding Test (Masslers test). 4-Nail biting: fingers, nails examination and intraoral examination. Questionnaires were handed out to the parents to obtain information about the child’s gender, age, medical and dental history and any noticeable oral habits and collected a week later. Data was collected, sorted and registered. The subjects were assigned to different groups according to the habit. Percentile distribution of the subjects was calculated for different habit and their relation to each other, Categorical variables were analyzed using the chi-square test and Student t-test. Significance of the obtained results was judged at the 5% level (P ≤ 0.05). Results: the majority of subjects shows with 41.07% of the subjects had nail biting followed by tongue thrust with 29.4% then mouth breathing with 15.9% and the least prevalent oral habit was thumb sucking with 14.73%. 32.1% of the subjects had no habits at all and 67.9% had at least one habit. conclusion: Nail biting was the most dominant oral habit and the least common was thumb sucking, no patients were found practicing more than 3 habits.

Background This retrospective study investigated the effect of breathing pattern, skeletal class (Class I, Class II), and age on the hyoid bone position (HBP) in normodivergent subjects. Methods A total of 126 subjects (61 males, 65 females) aged 7–9 years and 10–12 years were scanned using cone-beam computed tomography (CBCT). All participants were classified according to the anteroposterior skeletal pattern into (Class I, Class II). Each skeletal group was further divided according to the breathing mode into mouth breathers (MB) and nasal breathers (NB). The HBP was measured accordingly. Independent sample t-test and Mann Whitney U test were used to detect significant differences between the groups, and binary logistic regression was used to identify MB predictive indicators. Results The breathing mode and skeletal class affected the vertical HBP in subjects with 7–9 years, while they affected the anteroposterior HBP in subjects with 10–12 years. Regarding the age effect, hyoid bone was located more anteriorly in the older NB subjects, and hyoid bone was more inferiorly in the older age group. A regression equation of the significant variables was formulated, C3-Me (P: 001, OR: 2.27), and H-EB (P: 0.046, OR: 1.16) were positively correlated with occurrence of MB. Conclusion There were significantly different HBPs among subjects with different anteroposterior skeletal classes, breathing modes, and age cohorts. Moreover, C3-Me, and H-EB were significant predictors and correlated with increased likelihood of being MB subject.

Objectives This study aimed to examine the clinical effects of myofunctional treatment on children with functional mouth breathing by cephalometric radiographs and study models. Methods A total of 224 children (6–10 years old; 114 males and 110 females; SNA°: 82.24 ± 1.67°; ANB°: 2.79 ± 0.80°, 28° n = 75); MB-N group (mouth breathers with no treatment,n = 70); NB group (nasal breathers with no treatment, n = 79). A blind evaluation of cephalometric radiographs and study models was conducted at T1(pre-study) and T2 (post-study), respectively. Results Two hundred four children (MB-M:66, MB-N:68, NB:70) completed the present study. At T1, MB-M and MB-N groups, compared to their NB counterpart, had greater anterior lower facial height(P P P P P P P > 0.05), and maxillary canines width increased slightly (P P Conclusions Mouth breathers demonstrated increased anterior facial height and overjet but reduced overbite and maxillary arch width, which improved significantly following myofunctional treatment. Trial registration TCTR: TCTR20220401001. Registered 1stApril 2022-Retrospectively registered.

1. Rohan Thompson, MD*,† 2. Mark Splaingard, MD*,† 1. *Nationwide Children’s Hospital, Columbus, OH 2. †Ohio State University Wexner Medical Center, Columbus, OH Snoring is a sound caused by vibration of tissue (pharyngeal walls, soft palate, tonsillar pillars, uvula, and tongue) during sleep. It is associated with relaxation of airway muscles and narrowing of the airway, leading to turbulent airflow. Historically it was viewed as a humorous curiosity or nuisance until 1976, when Christian Guilleminault first described obstructive sleep apnea syndrome (OSAS): verified by nocturnal polysomnography (PSG), 8 children with loud snoring, nocturnal enuresis, morning headaches, hypertension, and poor school performance showed dramatic clinical improvement after surgical interventions that included tonsillectomy, adenoidectomy, and even tracheostomies. Snoring is usually the major symptom in childhood sleep-disordered breathing (SDB), a spectrum ranging from primary snoring to severe OSAS. Habitual snoring, defined as snoring that occurs at least 3 nights per week, is reported in approximately 10% of preschool and school-age children, of whom only 2% to 3% demonstrate clinical OSAS. Parental report of a snoring child, although highly sensitive for OSAS (few with OSAS do not snore), lacks specificity because most children who snore do not meet the diagnostic criteria for OSAS. Risk factors for habitual snoring and OSAS include prematurity, obesity, male sex, of African American descent, cigarette smoke exposure, daytime mouth breathing, lower paternal educational level, and recurrent pharyngitis/tonsillitis. Snoring and OSAS are also more common in children with comorbidities such as asthma, Down syndrome, neuromuscular disorders (cerebral palsy, muscular dystrophy), Prader-Willi syndrome, sickle cell disease, and craniofacial abnormalities such as repaired cleft palate and Pierre Robin syndrome. Snoring and OSAS have …

The whole world has been affected by the coronavirus disease 2019 (COVID-19) pandemic, and many researchers are racing to understand the disease course and to undertake risk analyses to formulate effective treatment strategies. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible through coughing and sneezing, and through breathing and talking which may account for viral transmission from asymptomatic carriers. Bioaerosols produced during mouth-breathing, an expiratory process in habitual mouth breathers, should be considered in addition to nasal bioparticles as a potential transmissible mode in COVID-19. Oral health professionals are justifiably apprehensive about the exposure risk due to close face-to-face contact and the mode of transmission. The aim of this commentary is to summarize the research conducted in this area and suggested strategies to limit the spread of COVID-19, especially in dental offices.

Purpose: This study was conducted to clarify the effects of experimentally induced nasal obstruction (NO) on prefrontal activation and jaw movement activities, as well as feelings of discomfort and...

Malocclusion is a condition that deviates from normal occlusion including irregularities of the teeth in the arch of the jaw such as crowding, protrusive, malposition and relationships that are not harmonious with the antagonist teeth. Non-physiological oral habits are abnormal human habits that cause stresses and tendencies that persist and are repeated continuously so that it affects craniofacial growth and is usually called bad habits. Changes in the activity of these muscles will lead to modification of facial growth patterns and head posture that can result in dentofacial deformity. Adaptation from nasal breathing to mouth breathing causes several unhealthy things, such as chronic middle ear infections, sinusitis, upper respiratory tract infections, sleep disor-ders, and facial growth disorders.

Introduction: Supervising the development of occlusion, managing problems during the transition from mixed to permanent dentition, as well as controlling environmental factors that contribute to establishing malocclusion, are important actions to achieve a Class I occlusion with facial balance. Among these problems, the malocclusions associated with dysfunctions such as mouth breathing or obstructive sleep apnea syndrome (OSAS), atypical swallowing and abnormal tongue position, open bites, crossbites and maxillomandibular discrepancies, and especially the Class III malocclusion can be listed. Objective: The purpose of this article is to present and discuss the main aspects relevant to the benefits of performing the treatment of Class III malocclusion in patients with growth. RESUMO Introdução: A supervisão do desenvolvimento da oclusão e o gerenciamento de problemas durante a transição da dentição mista para a permanente, bem como o controle de fatores ambientais que contribuem para estabelecer a má oclusão, são importantes ações para se obter uma oclusão de Classe I com equilíbrio facial. Entre esses problemas, pode-se considerar más oclusões associadas às disfunções como respiração bucal ou síndrome da apneia obstrutiva do sono (SAOS), deglutição atípica, posição anormal da língua, mordidas abertas e mordidas cruzadas e discrepâncias maxilomandibulares, especialmente, a má oclusão de Classe III. Objetivo: O objetivo do presente artigo é apresentar e discutir os principais aspectos pertinentes aos benefícios de se realizar o tratamento da má oclusão de Classe III em pacientes com crescimento.