Objectives Current literature suggests that infant oral anatomy may impact breastfeeding outcomes. Our research seeks to evaluate superior labial frenulum (SLF) attachment site grade utilizing a modified existing system and investigate the correlation with breastfeeding outcomes. Methods Two hundred and eight dyads were recruited from the nursery at Brooke Army Medical Center. The neonate's SLF and lingual frenulum were evaluated and photo‐documented. Photos were assessed by blinded reviewers utilizing a modified Stanford SLF grade. Breastfeeding mothers completed surveys on attitudes and associated pain with feedings 24 h postdelivery, at 2 weeks and at 2 months. Categorical data were analyzed using chi‐squared tests or Fisher's exact tests. Means and standard deviations were analyzed using analysis of variance or Wilcoxon's test. Results At 2 weeks and 2 months, 86.8% and 72.8% were breastfeeding, respectively. At 2 months, SLF grade 1 newborn dyads had a significantly lower breastfeeding rate (50.0%) compared to SLF grade 2 (75.3%) and SLF grade 3 (85.7%) subjects (p = 0.0384). At 2 weeks and 2 months, there was no difference between SLF groups with regard to maternal breastfeeding attitudes or pain scores. There was no significant difference in terms of weight, referrals, or lingual–labial frenulectomy between SLF groups. Conclusions Our study shows no correlation between SLF attachment grade and breastfeeding outcomes to include length of breastfeeding, maternally reported confidence, maternal pain, or infant weight. Our findings do not support labial frenulectomy based on SLF grade alone and highlight the need for a more robust functional grading system. Level of Evidence 2 Oxford Center for Evidence‐Based Medicine. http://www.cebm.net/index.aspx?o=5653 Laryngoscope, 132:2498–2504, 2022
A paper by Bruszt (J. dent. Res., 38:416, 1959) proposed a statistical technique of analyzing the relationship of caries incidence in deciduous and permanent dentitions from the following summarized data in Table 1. TABLE 1 AGE 11 AGE 5 TOTAL Caries-free PermaCarious nent Dentitions Permanent Dentitions Carious deciduous dentitions 4 70 74 Caries-free deciduous dentitions 12 11 23 Total .. .16 6 81 97The data consisted of 97 children, 74 with carious deciduous dentitions and 23 with caries-free deciduous dentitions at age five. The results of examination at age eleven are shown in the table. The author concluded that the probability that a caries-free permanent dentition at eleven came from a caries-free deciduous dentition was twelve to sixteen or 0.75. From this, the author "deduced the fact that children with caries-free deciduous dentition will probably have caries-free permanent dentition." The deduction was logically in error. The observation that 12 out of the 16 caries-free permanent dentitions at age eleven were from caries-free deciduous dentitions at age five might indicate that caries-free permanent dentitions are more likely to have come from caries-free deciduous dentitions, but it gave no cause to infer that caries-free deciduous dentition tends to give rise to caries-free permanent dentition. This latter inference could be drawn, however, from the comparison of the two proportions, namely:Number of caries-free permanent dentitions at age 11 that had carious = deciduous dentitions at age 5 4 Number of various deciduous dentitions at age 5 74 and Number of caries-free permanent dentitions at age 11 that had P caries-free deciduous dentitions at age 5 _ 12 2 = Number of caries-free deciduous dentitions at age 5 2 (2) To test the hypothesis that PI = P2, a simple x2 test with one degree ol f reedom may be performed: H[ 4 X 1 1-1 2 X 7 0 1 ( 9 7 )]29 7 v2 = 2 23 -O 2* = 16 X 81 X 74 X 23It was highly significant; consequently, we conclude that P2 ± Pi, and then infer P2 > Pl.The validity of the above test lies in the fact that the chi-square test, in a 2 X 2 contingency table, is effectively testing the significance of the difference of the respective frequency corresponding to PI and P2, since the expected values for the cells a and c are calculated on the assumption that these proportions are the same under the null hypothesis.
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