Abstract
We analyzed the association between birthweight, nutritional status and transverse maxillary growth in 7- to 9-year-old schoolchildren. We undertook a cross-sectional survey nested in a population-based cohort study of 158 schoolchildren. The participants lived in the urban area of a small town within the Western Brazilian Amazon. The outcome was represented by the upper intermolar distance given in millimeters (mm), as an indicator of the degree of maxillary bone growth in its transverse dimension. The exposures were sex, birthweight, the bottle-feeding pattern operationalized by a scale corresponding to the age of introduction of the bottle and Body Mass Index-for-age z-score (BAZ) at 4 to 6 ys. Path analysis was employed to estimate standardized direct, indirect and total effects of exposures on the outcome using structural equations model (SEM) supported by Mplus 7 program. The values of standardized coefficients (SC) showed significant direct positive effects of sex (SC = 0.203; p = 0.006), birth weight (SC = 0.155; p = 0.030) and BAZ (SC = 0.165; p = 0.014) on transverse maxillary growth. The indirect effects (SC = 0.057; p = 0.012) and the total effect (SC = 0.261; p<0.001) of sex on the outcome were statistically significant. The indirect effects of birth weight on the outcome were not significant (SC = 0.018; p = 0.488), however, the total effect was significant (SC = 0.174; p = 0.011). In conclusion, sex, birthweight, bottle beginning age and BAZ showed association with the transverse growth of the maxillary bone. In addition to contributing to an adequate birth weight of the child, policies and programs that favor prenatal care and conditions to guarantee a full-term birth can positively affect transverse growth of the maxilla. From a Public Health Surveillance point of view, children with reduced birthweight, inadequate breastfeeding pattern and nutritional deficit for age may be more likely to develop atrophy of the jaws which, depending on the severity, may result in malocclusion with an important impact on quality of life.
Highlights
Malocclusion is a multifactorial alteration of the normal growth and development with effects on muscles and facial bones during childhood and adolescence; it is a collection of situations, any of which can aggravate due to genetic predisposition or external factors
The aim of the study was to investigate the factors associated with transverse growth of maxillary bone, expressed by the upper intermolar distance, from a point of view related to the course of life
It links to a larger research project on health and nutrition conditions at Acre state developed by Sao Paulo University and Acre Federal University, whose field activities began with population-based cross-sectional surveys in 2003 in the urban area of a small town within the Western Brazilian Amazon [11]
Summary
Malocclusion is a multifactorial alteration of the normal growth and development with effects on muscles and facial bones during childhood and adolescence; it is a collection of situations, any of which can aggravate due to genetic predisposition or external factors. Much epidemiological information is the result of the analysis of cross-sectional studies, including the possible bias inherent in such research, it is recognized that the prevalence and severity of malocclusions have increased in the last 200 years, especially dental crowding, which is the most prevalent type of malocclusion [1, 2] Malocclusion such as posterior crossbite, dental crowding and asymmetries may occur because of transverse changes of the maxillary bones [3] and the upper intermolar distance may be used as an indicator of transverse growth of the maxilla [4]. The maxilla is a complex anatomical structure whose growth process is given by multiple factors, such as sutural growth until 7 years old After this age it gets slower and is more characterized by areas of apposition and resorption, simultaneously accompanied by displacement forward and downward. The expansion of the upper dental arch width is greater than in the lower one [5]
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