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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

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.

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.

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.

Extraneous activities of either the mouth, tongue or the jaw comprise the oral parafunctional habits of the stomatognathic system. This denominated habit is expressed through bruxism, digit sucking, nail biting to name a few, have led to hypothesizing the possible relationship of evolution of occluso-facial abnormalities such as malocclusion thereby hindering the conventional developmental process. Hence, the present study aimed to determine the prevalence and the possible relationship of parafunctional oral habits with the types of malocclusions among 12–16 years old females in Jeddah, Saudi Arabia. This cross-sectional study was conducted through questionnaire and clinical examinations, where the sagittal abnormalities within a randomly selected 672 participants who met the eligibility criteria were tabulated and analyzed. A positive history of the presence of parafunctional habit was recorded among all the participants with nasal and mouth breathing [46.6%], nail biting [39.6%] being predominant. 36.4% presented with significantly higher prevalence of bi-maxillary protrusion in mouth breathers while 17.1% with moderate overbite in participants with nail biting habit. Therefore, within the limitations of the present study, the findings do support the literature on the prevalence and the possible association of these habits with the malocclusion development thereby emphasizing on the importance of early recognition, management and prevention of them.

Globally adenoidectomy is increasingly being performed in isolation for children who have middle ear effusion or chronic otitis media, chronic rhinosinusitis and nasopharyngeal obstruction causing sleep apnoea and mouth breathing. Several techniques have been described lately including endoscopic powered adenoidectomy with debrider. The present study was undertaken to compare the effectiveness of endoscopic powered adenoidectomy (EA) with respect to conventional adenoidectomy (CA). It is a prospective study of 60 patients requiring adenoidectomy consisting of 33 males and 27 females randomized into group A with 30 patients undergoing conventional adenoidectomy with curette and 30 patients undergoing endoscopic powered adenoidectomy with micro-debrider. The demographic data (age, sex, adenoid hypertrophy grade assessed by Clemens and Mcmurray scale) in both groups were not statistically significant (p > 0.05). However, significant differences were observed in mean operative time of both groups (CA-29.12 ± 6.70, EA-37.80 ± 6.90 min, p 0.05). We conclude that endoscopic powered adenoidectomy is more complete, accurate, with less post-operative pain and lower incidence of recurrence in comparison with conventional adenoidectomy.

Choanal atresia is a rare congenital malformation of the nasal cavity characterized by obliteration of posterior choanae. It can be unilateral or bilateral. Bilateral choanal atresia is one of the life-threatening conditions and survival up to adulthood is rare A 9-year-old female presented to our department with complaints of a bilateral nasal block, nasal discharge, snoring, anosmia, and mouth breathing. Diagnostic nasal endoscopy and computerized tomography of the nose and paranasal sinuses revealed bilateral choanal atresia. Transnasal endoscopic choanoplasty was performed and discharged on postoperative day 7. Postoperative follow up on two weeks showed significant improvement in symptoms and endoscopy revealed bilateral patent posterior choanae. The child with bilateral choanal atresia surviving up to nine years of age is rare. In contrast to unilateral choanal atresia, bilateral choanal atresia is a diagnostic and therapeutic emergency. Diagnostic nasal endoscopy and computerized tomography help in planning surgery. Minimally invasive endoscopic choanoplasty has replaced the transpalatal approach.

Aim The difficulty of assessing the likelihood of obstructive sleep apnoea (OSA) in children who snore without full-night polysomnography is widely recognised. Our aim was to identify features that were characteristic of two-year-old children with OSA and evaluate whether this information could be used to assess the likelihood of OSA. Methods The study was carried out as part of the Child-Sleep Project, a longitudinal birth cohort study of children born at Tampere University Hospital, Finland. This part of the study focused on the children in the cohort who snored and was carried out between 2013 and 2015. The primary outcomes were measured using parental questionnaires, polysomnography and clinical examinations. Results In total, 52 children participated at a mean age of 27 months (range 23-34). Of these, 32 (44% male) snorers and 20 (70% male) controls. The most significant findings were that children who had OSA demonstrated longer snoring time (P = .003), a greater tendency for mouth breathing (P = .007) and bigger adenoid size (P = .008) than snorers without OSA. Conclusion Snoring time, adenoid tissue size and mouth breathing were important features that identified the likelihood of OSA in snoring toddlers.

Several studies have been performed using recently developed smartphone-based acoustic analysis techniques. We investigated the effects of septoplasty and turbinoplasty in patients with nasal septal deviation and turbinate hypertrophy accompanied by snoring by recording the sounds of snoring using a smartphone and performing acoustic analysis. A total of 15 male patients who underwent septoplasty with turbinoplasty for snoring and nasal obstruction were included in this prospective study. Preoperatively and 2 months after surgery, their bed partners or caregivers were instructed to record the snoring sounds. The intensity (dB), formant frequencies (F1, F2, F3, and F4), spectrogram pattern, and visual analog scale (VAS) score were analyzed for each subject. Overall snoring sounds improved after surgery in 12/15 (80%) patients, and there was significant improvement in the intensity of snoring sounds after surgery (from 64.17 ± 12.18 dB to 55.62 ± 9.11 dB, p = 0.018). There was a significant difference in the F1 formant frequency before and after surgery (p = 0.031), but there were no significant differences in F2, F3, or F4. The change in F1 indicated that patients changed from mouth breathing to normal breathing. The degree of subjective snoring sounds improved significantly after surgery (VAS: from 5.40 ± 1.55 to 3.80 ± 1.26, p = 0.003). Our results confirm that snoring is reduced when nasal congestion is improved, and they demonstrate that smartphone-based acoustic analysis of snoring sounds can be useful for diagnosis.