Craniofacial changes and symptoms of sleep-disordered breathing in healthy children

Abstract

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB.

Variables associated with mouth breathing diagnosis in children based on a multidisciplinary assessment

“…Mouth breathing (MB) has been an object of interest in various studies during recent decades (1)(2)(3)(4)(5) and has been considered a public health problem in Brazil, with prevalence in school-age children varying between 55 and 60% (6) . MB etiologic factors may be obstructive, such as palatine and pharyngeal tonsillary hypertrophy and nasal septum deviation.…”

“…A lack of standardization of MB diagnosis makes it hard to establish a comparison between studies and the application of a global clinical approach. Some relevant factors have been found to define this diagnosis, which may consist of predictors for MB recognition, such as a lack of lip sealing associated with typical signs and symptoms (9,13) , as well as multidisciplinary evaluation (1,4) or association of these items with respiratory tests, such as graded mirror or water retention tests (5,8) .…”

A qualidade do sono modificada pela síndrome da respiração oral pode prejudicar o desempenho físico do atleta

“…[16][17][18] The etiology of the condition is mainly associated with alterations or obstruction of the upper airways, such as septal deviation, choanal atresia, nostril stenosis, alterations of the cartilage of the nasal pyramid, hypertrophy of adenoids, rhinitis, rhinosinusitis. 19 The main characteristics involve alterations in the oral cavity, such as narrowing of the jaw and stretch of the perioral muscle, halitosis, increase in the number of caries and periodontal diseases, constant pain or irritation in the throat, dry and persistent cough, morning headache, nocturnal enuresis, difficulty in feeding, dentofacial deformities, irritability, sleepiness, cognitive deficit, facial asymmetry, and postural problems.…”

“…[19][20][21] MBS is a predisposing factor for the development of sleep-related breathing disorders, and this relation has been described with concern, due to the clinical impact resulting from these conditions on health. 18,22 Nasal breathing is the preference way for air flow in the body and its modification can lead to important morphological and functional alterations. 23 Respiratory interference occurs primarily by periodic reduction or cessation of airflow during sleep, which leads to hypoventilation, apnea, and fragmentation of the processes involved in this condition.…”

Força de mordida em respiradores bucais

“…Additionally, nasal breathing allows for the tongue to remain inside the oral cavity and in contact with the palate, which exerts an expansive force within the oral cavity that opposes the inwardly directed forces of the buccinator muscle (1) . Chronic mouth breathing, or mixed pattern, is used as a substitution for the nasal breathing pattern, resulting in functional, structural, postural, and biomechanical changes that additionally interfere with the lip seal closure (2,3,4,5,6,7) . The main changes occur in the craniofacial morphology (1) .…”