Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study

Abstract

Background: Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. Objective: Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. Methodology: This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years' schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle's classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results: A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). Conclusion: Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Speech Disorder in Anterior Open Bite (AOB): Systematic Review

“…The position of the anterior teeth is also one of the main factors that changes the articulation of sounds because almost 90% of consonant sounds are formed in this area. 8,16,17 The dental arches (dental and bony arches) serve as structural boundaries of the tongue and lips, which are inherently involved in the production of sound during speech. The study conducted by Leavy et al (2016) found that individuals with anterior open bite (AOB) experienced the most disturbances in the pronuncial-types of malocclusion.…”

“…9 In line with this, Assaf (2021) found that patients with AOB showed 2.3 times more fre-quency of changing tongue position. 8 Aberrant tongue function associated with speech impairment in which the association between AOB and abnormal swallowing was reported as high as 75%. 19 The position of the tongue resting on the floor of the mouth when activated can alter tooth position and jaw growth including the shape and size of the arch.…”

“…AOB is the most common malocclusion associated with speech and articulation disorders. 8,9 Fimbo (cited in Ocampo-Parra) evaluated 410 patients with AOB and found that 63% of them had speech disorders. Meanwhile, Bernstein (cited in Ocampo-Parra) examined 437 children with speech disorders and found that malocclusion was not always associated with phonation problems, except in the case of AOB.…”