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Background Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro-facial function (OF) and malocclusion have great impact on psychological well-being and quality of life (QoL). Objectives The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well-being in children and adolescents with large overjet. Methods The study was a case–control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9–14 years old. OF was examined by use of Nordic Orofacial Test-Screening (NOT-S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well-being were examined using KIDSCREEN-10 and Strengths and Difficulties Questionnaire. Results The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT-S score (p < .001) and reduced BF (p = .011), numbers of contacts (p < .001) and CE (p = .005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p = .007), hyperactivity (p = .043) and total difficulties score (p = .009) were found in the study group. Conclusion The study group showed higher NOT-S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well-being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group., Background Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro-facial function (OF) and malocclusion have great impact on psychological well-being and quality of life (QoL). Objectives The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well-being in children and adolescents with large overjet. Methods The study was a case–control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9–14 years old. OF was examined by use of Nordic Orofacial Test-Screening (NOT-S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well-being were examined using KIDSCREEN-10 and Strengths and Difficulties Questionnaire. Results The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT-S score (p < .001) and reduced BF (p = .011), numbers of contacts (p < .001) and CE (p = .005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p = .007), hyperactivity (p = .043) and total difficulties score (p = .009) were found in the study group. Conclusion The study group showed higher NOT-S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well-being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group.

Aim: The aims of the study were to examine the signal quality (SQ) of home polygraphy (PG) in children and adolescents and to compare automatic and manual scoring of the PGs. Methods: Clinical Trials Registration: NCT04964830. Participants and caregivers were instructed to set up the equipment and perform home PGs themselves. The PGs were analysed according to SQ and their interpretability and differences in automatic vs. manual scoring regarding apnoea-hypopnoea index (AHI), apnoea index (AI), hypopnoea index (HI) and oxygen desaturation index (ODI) were examined. Results: 54 healthy children aged 9-14 years participated in the study. 86% of the PGs were interpretable with mean SQ of 79.1% (CI 95%: 73.5%; 84.8%). Significant differences between the automatic and manual scoring were found for AHI, AI, HI and ODI (p < 0.0001). Conclusion: Home PGs of children and adolescents are feasible to be performed with good SQ. Significantly higher markers of sleep-disordered breathing were achieved in the automatic scoring in comparison with the manual scoring.

Hvorvidt morfologisk okklusion har en sammenhæng med funktionsforstyrrelser i muskler og kæbeled, har været genstand for stor diskussion i litteraturen. Formålet med nærværende oversigt er at beskrive potentielle sammenhænge mellem afvigelser i den morfologiske okklusion, tyggefunktion og eventuel temporomandibulær dysfunktion (TMD). Morfologisk okklusion er et komplekst begreb, og den ændrer sig livet igennem. TMD er også en kompleks tilstand, som er multifaktoriel med mange prædisponerede, initierende og fastholdende faktorer. Morfologiske okklusionsafvigelser som ekstremt horisontalt maksillært overbid, anteriort åbent bid og lateralt krydsbid kan have en sammenhæng med ændringer i tyggemuskelaktiviteten, mindre antal tandkontakter og lav bidkraft, som kan føre til ringere findeling af fødepartikler under tygning. Ved dybt bid ses der ofte ingen forskel i okklusal kontakt, tyggemuskelaktivitet og bidkraft sammenlignet med neutral okklusion. Dog ses ændret smertefølsomhed ved dybt bid. Der er ingen klar eller direkte sammenhæng mellem morfologisk okklusion og TMD, men okklusionsafvigelser i kombination med andre faktorer relateret til tyggefunktionen samt smerte kan have en betydning ved TMD. Generelt må det fastslås, at ortodontisk behandling hverken kan forårsage eller helbrede TMD. Men korrekt diagnostik og udført ortodontisk behandling kan bedre tyggefunktionen og øge bidkraften samt reducere eksisterende symptomer og fund på TMD i specifikke og selekterede tilfælde.

This study compared differences in dental maturation and dental age in Scandinavian children born in 1969–1973 and 2005–2010. The study was based on 130 ethnic Scandinavian children, who were divided in two groups corresponding to the time periods and matched on age and sex. Each group consisted of 65 children (30 girls, 35 boys, mean age 9.29 years and 9.30 years, respectively). Dental maturation was analysed by orthopantomographs, in accordance with Demirjian and Haavikko. Dental age was analysed by orthopantomographs in accordance with Demirjian. Boys and girls were analysed separately by linear regression analysis adjusted for age. For the children born in 2005–2010, teeth matured significantly earlier (Demirjian: 0.21 maturities, CI 95% 0.11–0.31, p < 0.000. Haavikko: maxilla: 0.39 maturities, CI 95% 0.21–0.56, p < 0.000. Mandible: 0.42 maturities, CI 95% 0.17–0.67, p = 0.001) and the dental age was significantly higher (Demirjian: 6.04 months, CI 95% 0.23–0.77, p < 0.000) in comparison with the children born in 1969–1973. In conclusion, the teeth of Scandinavian children born 2005–2010 matured significantly earlier than those of children born in 1969–1973. The results may prove valuable in forensic dentistry, pedodontics, and for the timing of pedodontic and orthodontic treatment.

Objective: The aim of this cross-sectional study was to analyse the association between dental and skeletal maturation in children born between 2005 and 2010. Materials and methods: Dental and skeletal maturation of 117 ethnic Scandinavian children born between 2005 and 2010 (70 girls, 47 boys, mean age 11.48 years) was analysed. Dental maturation (DM) was assessed on orthopantomographs (OPs) by using Demirjian’s and Haavikko’s methods while skeletal maturation was assessed on hand-wrist radiographs by use of Helm’s method. The correlation between skeletal and DM was analysed using Spearman’s rho (Rs). Additionally, the most frequent DM stage in relation to the skeletal maturation stage was analysed by logistic regression adjusted for age and sex. Results: The correlation between dental and skeletal maturation was significant for all teeth (Rs = 0.071–0.562; p <.000–p =.035) except for the first incisor and the first molar. Logistic regression analysis showed that when the mandibular and maxillary canines are ¾ mineralized, this is significantly associated with the beginning of the adolescent period before peak height velocity (PHV) (PP2= p <.005–<.05). Likewise, when the mandibular second premolars are ¾ mineralized, this is significantly associated with the maturation stage PP2= or S (PP2= p <.05, S: p <.005–<.05), both of which are before PHV at the beginning of the adolescent period. Limitations: Limited sample size and the X-rays were taken before orthodontic treatment, which may have introduced a selection bias. Conclusions: When the root of the canines or second premolars is ¾ mineralized, it may indicate the beginning of the adolescent period with increased skeletal growth intensity.

Background Sleep-disordered breathing (SDB) has negative influence on children's development and well-being. Malocclusion due to some craniofacial anatomical characteristics may be associated with SDB. Objectives The aim of this paper is to ascertain whether SDB is associated with malocclusion in children/adolescents, aged 6-15 years compared to healthy controls. Methods Prospero ID: CRD42021232103. A systematic electronic literature search following PRISMA was performed in PubMed, Embase and Cochrane Library. Inclusion criteria were as follows: Healthy children/adolescents aged 6-15 years with malocclusion undergoing polysomnography (PSG) or polygraphy (PG) and/or sleep questionnaire and orthodontic screening; compared to a healthy age-matched control group with neutral or minor deviation in the occlusion without requirement for orthodontic treatment; publications in English, Danish, Norwegian or Swedish published until 23 March 2021. JBI Critical Appraisal Tools and GRADE were used to evaluate the risk of bias and level of evidence. Results The search resulted in 1996 records, 610 duplicates were removed, 1386 records were screened, and 1322 records were excluded. Sixty-four studies were selected for full-text reading, and four publications fulfilled the inclusion criteria. The included studies had moderate risk of bias, and the quality of evidence was low. Conclusion No firm conclusion can be drawn regarding an association between specific malocclusion traits and SDB. Thus, the studies found no association between molar relationship and crowding and SDB symptoms in children. It may be recommended that future studies include objective PSG or PG in diagnosis of SDB and compare groups of children with skeletal malocclusion and controls with neutral malocclusion.

Aim To ascertain and illustrate specific clinical dento-craniofacial characteristics associated with sleep-disordered breathing (SDB) in non-syndromic children. Methods Narrative review of literature on SDB, dental occlusion and craniofacial morphology retrieved through online literature database search for these terms. The review focused on clinical examples and graphical illustrations in order to ascertain the association between dento-craniofacial characteristics and SDB. Only publications concerning healthy non-syndromic children without any somatic or psychological diagnosis were included. Results Dento-craniofacial characteristics such as anterior open bite, large overjet, cross bite and facial appearance such as convex profile due to mandibular retrognathia and inclination, narrow and high palate can predispose to SDB in non-syndromic children. Furthermore, extended head posture, mouth breathing and general adenoidal face may be symptoms or predisposing factors to SDB in non-syndromic children. Conclusion Dento-craniofacial characteristics as anterior open bite, large overjet due to mandibular retrognathia, cross bite, and narrow and high palate can predispose to SDB in non-syndromic children. Facial characteristics predisposing to SDB can be a convex facial profile, extended head posture, mouth breathing and general adenoidal face. Interdisciplinary collaboration between medical doctors and dentists can prove valuable in diagnostics, prevention and treatment of SDB in non-syndromic children.

Antallet af voksne, som efterspørger ortodontisk behandling, er stigende, og der ses en tilsvarende vækst i andelen af ortodontiske behandlinger i almen praksis. Indikationsområdet for ortodontisk behandling på voksne dækker korrektion af mindre trangstillinger på patienter med neutral okklusion og normal kraniofacial morfologi til omfattende tandflytninger på patienter med større basale/skeletale tandstillingsafvigelser. Kravene til forudgående diagnostik er omfattende, uanset graden af afvigelse. Formålet med nærværende artikel er at beskrive diagnostik før ortodontisk behandling af voksne. Diagnostiske undersøgelser i forbindelse med ortodontisk behandling bør som minimum indeholde anamnese, intra- og ekstraoral klinisk undersøgelse, kliniske fotos, studiemodeller og relevante røntgenbilleder. På baggrund af diagnostiske undersøgelser udarbejdes en behandlingsplan indeholdende følgende elementer: formål, mål, behandlingsprincip, retention, forbehold, tidshorisont og prognose. Behandlingsplanen skal indeholde alle elementer uanset valg af behandlingsprincip og sværhedsgrad af tandstillingsafvigelsen. Det er altafgørende, at en behandlingsplan udarbejdes på baggrund af netop det apparatur, der kan indfri behandlingsmålene, og ikke hvilke behandlingsmål der kan opnås med et givent ortodontisk apparatur. Tandflytninger monitoreres under behandling, både i forhold til forventede fremskridt og i relation til udvikling af rodresorptioner eller andre skadevirkninger. Retention af tandflytninger efter ortodontisk behandling hos voksne planlægges individuelt med udgangspunkt i den oprindelige tandstillingsfejl sammenholdt med graden af tandflytninger og orofacial funktion på den pågældende patient.

OBJECTIVES: The aim of this cross-sectional study was to examine the method error and reliability of acoustic pharyngometry and rhinometry in children and adolescents and to describe the feasibility of these methods in a young population.MATERIAL AND METHODS: The study sample included 35 healthy subjects in the age of 9 to 14 years. The subjects were randomly recruited for the present project in the period from June 2021 to February 2022. Repeated measurements of the upper airway dimensions in standing mirror position were performed by the use of Acoustic Pharyngometer and Rhinometer. Volume (cm3), calculated resistance (cm H2O/L/min), mean area (cm2), minimum cross-sectional area (MCA, cm2) and distance to MCA (cm) were examined. Method errors and reliability coefficients were evaluated using Dahlberg's formula and the Houston reliability coefficient. The feasibility of the methods were analysed using paired t-test and estimated by difference in drop-out rates.RESULTS: No systematic error exhibited in the repeated measurements except volume in the left nostril (P = 0.017). The method errors of the acoustic pharyngometry and rhinometry were betweeen 0.0002 to 0.069 and 0.001 to 0.082 respectively. The Houston reliability coefficient for both methods were between 0.952 to 0.999. The acoustic pharyngometry was significantly more feasible compared to rhinometry (P < 0.001).CONCLUSIONS: The study shows that acoustic pharyngometry and rhinometry in the standing mirror position are reliable methods, with acoustic pharyngometry being even more feasible than rhinometry, which is why it is recommended to practice the methods with children and ensure reliability of results before registering measurements.

This study compared daytime sleepiness and quality of life in OSA patients with healthy controls and compared sleepiness and quality of life in OSA patients before and after long-term treatment with a mandibular advancement device (MAD). A total of 27 OSA patients (18 men, 9 women, mean age 52.3 years) and 32 healthy age- and sex-matched controls (20 men, 12 women, mean age 51.1 years) were included. At baseline and after MAD treatment, daytime sleepiness and quality of life were recorded by the Epworth Sleepiness Scale (ESS) and Short Form-36 questionnaires (SF-36). Daytime sleepiness occurred significantly more often in OSA patients compared to controls at baseline (p = 0.01). The quality of life domains Energy and vitality (p < 0.0001), General perception of health (p = 0.0002), Mental health (p = 0.0031), Social functioning (p = 0.0119), Role limitations due to emotional problems (p = 0.0173) and Physical functioning (p = 0.0226) were significantly poorer in OSA patients compared to controls at baseline. After long-term MAD treatment, daytime sleepiness decreased (p < 0.01) and the quality of life domain Energy and Vitality increased (p < 0.01) in OSA patients compared to baseline. The results of the present study support the relevance of MAD treatment as an effective tool for decreasing daytime sleepiness and increasing the quality of life in OSA patients—also in the long term.

INTRODUCTION: Functional appliances (FA) have a positive effect on the upper airway volume and minimal cross-sectional area (MCA) in children. An association between morphologic deviations of the upper spine (MDUS) and reduced treatment response was found in appliances used to treat adults with obstructive sleep apnea. This study aimed to: (1) compare airway changes after FA treatment in children with and without MDUS and controls; (2) identify if MDUS causes a smaller upper airway.METHODS: Pretreatment and posttreatment cone-beam computed tomography scans were included from 21 children with MDUS and 42 without MDUS treated with a fixed FA, along with a pair-matched control group (matched for chronological age, skeletal age, gender, and mandibular inclination) who received orthodontic treatment for minor malocclusions without an FA. The influence of MDUS on changes in upper airway volume and MCA were evaluated with 3-dimensional cone-beam computed tomography scans using standardized, previously validated methods and mixed-effects linear regression.RESULTS: There was a significantly increased volume and MCA in the FA groups with and without MDUS compared with control (P = 0.003 and P = 0.049) and in the FA group without MDUS compared with the MDUS group (P = 0.008 and P = 0.011) after treatment. There was no significant pretreatment difference in airway dimensions between the MDUS and non-MDUS FA groups.CONCLUSIONS: The airway response with fixed FA is significantly reduced in MDUS children. MDUS caused no significant pretreatment airway differences in children. However, MDUS may be important in predicting airway changes in FA treatment.

Background: Ehlers-Danlos syndrome (EDS) is a hereditary disorder that affects the connective tissue and collagen structures in the body characterised by joint hypermobility, skin hyperextensibility and tissue fragility. Objective: The aim was to investigate temporomandibular disorders (TMD), bite force, teeth in occlusal contact and osseous changes of the temporomandibular joints (TMJs) in 26 patients with hypermobile EDS (hEDS), differentiated by a genetic test, compared to 39 healthy controls. Methods: Clinical examination according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), radiological examinations of the TMJs by cone-beam-computed tomographic (CBCT) scans, registration of bite force and teeth in occlusal contact was performed. Statistical analyses included Fisher's Exact Test, multiple logistic and linear regression models adjusted for age, gender and Body Mass Index (BMI). Results: Single symptoms and signs of TMD occurred significantly more often in hEDS (p =.002; p =.001; p =.003; p = <.0001; p =.012) and maximum mouth opening was significantly smaller in hEDS compared to controls (p = <.0001). The DC/TMD diagnosis myalgia, myofascial pain with referral, arthralgia, headache attributed to TMD, disc displacement disorders and degenerative joint disease occurred significantly more often in hEDS compared to controls (p =.000; p =.008; p =.003; p =.000; p = <.0001; p =.010, respectively). No significant differences were found in bite force and in teeth in occlusal contact between the groups (p >.05). On CBCT of the TMJs, subcortical sclerosis occurred significantly more often in hEDS compared to controls (p =.005). Conclusion: Symptoms and signs of TMD and osseous changes of the TMJs occurred significantly more often in hEDS. Bite force and teeth in occlusal contact were comparable to controls.

Previously, bite force, occlusal contact and pain were investigated in orthodontic patients with moderate-to-severe malocclusion, but not in patients with minor malocclusion. The purpose of this study was to investigate changes in bite force, teeth in occlusal contact and pain in orthodontic patients with minor crowding before orthodontic treatment (T0), after bonding (T1), during treatment (T2), post-treatment (T3) and during retention (T4). In total, 27 patients (21 females, 6 males, median age 15.3 years) with neutral occlusion and normal craniofacial morphology were treated with non-extractions and fixed appliances. Differences in the registered data were analysed by a mixed linear model with repeated measures. Bite force and teeth in occlusal contact significantly decreased between T0 and T1 (p < 0.0001, respectively) and between T0 and T2 (p < 0.01, respectively). Bite force and teeth in occlusal contact significantly increased between T1 and T4 (p < 0.05, p < 0.0001, p < 0.001, respectively) and between T2 and T4 (p < 0.05, p < 0.0001, p < 0.01, respectively). No significant difference in pain was found. The results indicate that bite force and teeth in occlusal contact significantly decreased during treatment and reached baseline level at retention. The findings may prove valuable for informing orthodontic patients with minor malocclusion.

Søvnrelaterede respirationsforstyrrelser (SDB) forårsaget af hæmmet åndedrætsfunktion under søvn reducerer søvnkvaliteten og påvirker børns vækst, udvikling og trivsel negativt. Diagnostik af SDB foretages vha. en søvnundersøgelse suppleret med spørgeskemaer omhandlende søvnighed, hyperaktivitet i dagtimerne og snorken/lyde under søvn. Hovedårsagen til SDB hos børn er forstørrede mandler og/eller næsepolypper, som behandles ved kirurgisk fjernelse. Nogle typer tandstillingsfejl som stort overbid grundet bagudstående underkæbe, anteriort åbent bid, krydsbid og smalle ganedimensioner kan have en sammenhæng med mindre luftvejsdimensioner og kan derfor øge risikoen for SDB. Bøjlebehandling til korrektion af bagudstående underkæbe og krydsbid kan øge luftvejsdimensionerne og derved muligvis bedre søvnkvaliteten. Det er derfor vigtigt at være opmærksom på afvigelser i det dento-kraniofaciale område, som kan øge risikoen for SDB og derved bidrage til interdisciplinær forebyggelse, diagnostik og behandling af børn med SDB associeret med tandstillingsfejl.