Atypical Swallowing Research Articles

Use of hyperboloid as an adjunct in functional jaw orthopedics – case report

Anterior open bite can be defined as a malocclusion with a negative vertical discrepancy between the incisal edges of the upper and lower anterior teeth, which do not have occlusal contacts with the antagonists and sometimes extends to the canines and, less frequently, to the premolars is one of the malocclusions with the greatest aesthetic and/or functional impairment. Anterior open bite can have several etiologies: finger sucking and/or pacifier, oral breathing, onychophagia, lip interposition, atypical swallowing, tongue interposition when uttering phonemes and anterior posture of the tongue at rest. Orofacial myofunctional disorders are present in cases of anterior open bite, generally associated with etiologies and adapt to this altered morphological condition. Regarding the anterior opening amplitude, the anterior open bite is classified as: minimum up to 1 mm, moderate between 1 and 5 mm and severe +5 mm [1]. Open bite can be classified into: maxillary, mandibular and hybrid open bite [2]. Myofunctional therapy is considered a treatment method that can increase muscle strength, cause changes in functional patterns and thus prevent deviations in craniofacial development, as it promotes new posture of structures at rest and during the performance of the functions of the stomatognathic system [3]. The hyperboloid is an instrument for increasing muscle tone and when used in chewing, it is efficient in inducing growth and remodeling. The hyperboloid fills a gap in the modern diet, with the consistency of hard, raw and dry foods [4]. Exercises with a size M hyperboloid with wire were prescribed as an initial approach. After 2 months of treatment, there was an improvement in the interincisor distance. The exercise was maintained for another 5 months. He stopped attending appointments for 2 years and 2 months. Upon his return, the results of the functional examination of swallowing, chewing, protrusion and laterality were observed, and we opted for the installation of the SN3. the hyperboloid, in this case, showed its efficiency in balancing the stomatognathic system.

Orthodontic treatment in patients with atypical swallowing and malocclusion: a systematic review.

This review aimed to analyze the correlation between atypical swallowing and malocclusions and how this dysfunction can be treated. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed to conduct this systematic review, and the protocol was registered at International Prospective Register of Systematic Reviews (PROSPERO) with the CRD42024499707. A thorough search was conducted on PubMed, Scopus and Web of Science to find papers that discussed myofunctional and orthodontic treatment for patients with atypical swallowing and malocclusion from 01 January 2003 to 27 November 2023. The search yielded 2554 articles, of which only 12 records were selected for qualitative analysis. The analysis of these articles revealed that orofacial myofunctional therapy, criab appliance, Habit corrector™, and soft tongue restrainers are potential therapies for treating atypical swallowing and malocclusions. The tongue's position affects muscle behavior, leading to malocclusions that can be treated with various therapies, resulting in effective clinical outcomes. However, more research is required to delve deeper into the topic.

Analyzing effects on anterior open bite in twins by PLS-SEM and sobel test

ObjectiveThis study aimed to assess the different pathways between predictor factors such as zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding related to anterior open bite (AOB) in twins.MethodsThe study was conducted in monozygotic (MZ) and dizygotic (DZ) twin children aged 3–15 years. AOB, atypical swallowing, mouth breathing, feeding type, duration of bottle use, and mouth opening status during sleep were recorded during oral examination. Partial least squares structural equation model (PLS-SEM) and sobel tests were performed to assess the total and indirect effects among the variables on AOB.ResultsA total of 404 children (29.2% MZ;70.8% DZ) participated in this study. The effect of zygosity on mouth breathing in the PLS-SEM model was statistically significant. Conversely, it was determined that mouth breathing effected that atypical swallowing (p = 0.001). Atypical swallowing triggered AOB (p = 0.001). The atypical swallowing has a mediation effect between AOB and mouth breathing (p = 0.020). Mouth breathing causes atypical swallowing and therefore indirectly increases the likelihood of AOB. While breastfeeding decreases AOB incidence (p = 0.023), bottle feeding increases AOB incidence (p = 0.046). The sobel tests show that the fully mediator variable feature of mouth breathing is statistically significant in the negative relation between zygosity and atypical swallowing.ConclusionThe PLS-SEM model showed that mouth breathing triggers atypical swallowing and atypical swallowing triggers AOB. As a result of this chain of relationships, an indirect effect of zygosity on AOB was observed. According to sobel tests, zygosity has an indirect effect on atypical swallowing through mouth breathing, while mouth breathing has a positive indirect effect on AOB through atypical swallowing.Clinical relevanceThis study identified the relationships between different factors and the presence of AOB. The findings of this study demonstrate in detail the relationships between AOB and zygosity, atypical swallowing, mouth breathing, breastfeeding and bottle feeding. Brestfeeding has a reducing effect on the frequency of AOB. Among the nutritional forms, breastfeeding ensures the proper development of the stomatognathic system by working the oro-facial muscles.

Oral Habits in Childhood and Occlusal Pathologies: A Cohort Study.

To analyse the relationship between the different habits that occur in childhood and the different malocclusions in the three planes of space. A clinical examination of 106 children between 5 and 12 years of age was carried out and a survey validated by professors of the Faculty of Dentistry of the University of Seville was made for the parents in order to identify the habits and relate them to the possible malocclusions detected in the child's mouth. 72.64% of the sample presented a malocclusion in at least one of the three planes of space, with a similar distribution. When correlating the variables, statistically significant relationships were observed in the vertical plane with atypical swallowing (p = 0 < 0.05; V > 0.3) and lip sucking (p = 0 < 0.05; V > 0.3) and in the horizontal plane with oral breathing (p = 0 < 0.05; V > 0.3), atypical swallowing (p = 0 < 0.05; V < 0.3) and digital sucking (p = 0 < 0.05; V < 0.3). It has been observed that the prevalence and prolongation of habits in childhood is increasing, so it is essential to detect pernicious habits at an early age to prevent the establishment of malocclusions and to favour the correct craniofacial growth of the child.

Effects of Froggy Mouth Appliance in Pediatric Patients with Atypical Swallowing: A Prospective Study.

Atypical swallowing has a high incidence in growing subjects. Orthopedic treatment with orthodontic appliances and speech therapy are the main approaches to this problem. The aim of this prospective study was to evaluate the changes in the dental arches induced by one year of treatment with the Froggy Mouth myofunctional appliance designed to correct atypical swallowing. In total, 16 patients with atypical swallowing were instructed to use the Froggy Mouth appliance. A digital intraoral impression was taken at baseline (T0). The Froggy Mouth appliance had to be used for 15 min/day throughout the treatment period. At the end of the first year of treatment (T1), another impression was taken with the same intraoral scanner. Digital casts of the T0 and T1 impressions were obtained using software and the two casts were superimposed to record the following measurements: upper intercanine distance, upper arch diameter, upper arch width, overbite and overjet. The data were statistically analyzed (significance threshold: p < 0.05). Student's t-test was used to compare pre- and post-treatment measurements. Linear regressions were performed to assess the influence of arch width on anterior and posterior diameters. A significant increase was found for the upper arch diameters (p < 0.05), whereas no statistically significant difference was found for the incisor relationship (overjet/overbite) (p > 0.05). To date, the efficacy of this appliance has not been extensively studied. According to the present prospective study, the Froggy Mouth protocol could be a valuable method as a myofunctional therapy for atypical swallowing, but further studies are needed to confirm these preliminary results.

Case report – distoclusion treated with Bimler A períod of 12 months

The Bimler type A utilizes forces derived from muscles, particularly the tongue, concomitantly, it acts as a systemic, dynamic and functional treatment, Bimler appliances transmit neural excitation throughout the system. The objective of this study was to present a clinical case and demonstrate the efficacy of the functional orthopedic appliance, specifically the Bimler A elastic modeler, in the treatment of a patient diagnosed with distoclusion (prognathism of the maxilla and retrognathism of the mandible) according to Bimler and McNamara cephalometry. The case involved a 9-year and 11-month-old male patient with atypical swallowing, respiratory issues, and allergic conditions such as asthma. Clinical examination and complementary tests revealed a large overjet, a narrow maxilla and mandible, an open bite, and distoclusion (retrognathism). The proposed intervention included the installation of the Bimler Elastic Modeler (BEM), type A. The treatment duration was 12 months, with ongoing monitoring every 2 or 3 months. The comprehensive approach, combining BEM type A, chewing exercises, and occlusal adjustments, resulted in orthopedic changes improved mandibular, tongue, lip, and head posture, as well as enhanced chewing balance. Importantly, the appliance effectively repositioned the mandible into a more balanced, normoccluded position without the need for elastic or constant forces. Beyond the orthodontic changes, the active engagement of facial expression muscles during these activities contributed to an overall improvement in facial harmony, achieving lip seal and notable enhancements in breathing. These positive changes extended to the patient’s daily activities and sports performance. The observed outcomes not only increased the child’s active participation in the treatment but also positively impacted self-esteem, driven by the aesthetic, functional, and psychological improvements experienced.

Case report – mesioclusion treated with Bimler C períod of 12 months

This study aims to present a clinical case and assess the efficacy of the Bimler C Elastic Modeler, a functional orthopedic appliance, in the early treatment of a patient diagnosed with mesiocclusion (mandibular prognathism) based on Bimler and McNamara Cephalometrics. Additionally, we aim to delineate the observed positive changes in facial expression during the course of treatment with this functional orthopedic appliance. The female patient, aged six years and nine months, manifested atypical swallowing, respiratory challenges, and allergic conditions such as rhinitis. Comprehensive examination further revealed facial asymmetry and a smile with lip asymmetry. Intra-oral examination exposed a rightward deviation of the mandible, crossbite, open bite, and mesiocclusion. The proposed intervention encompassed the application of the Bimler Elastic Modeler (BEM) functional orthopedic appliance. The documented treatment duration spanned 12 months, with ongoing monitoring every 2 or 3 months. The treatment, utilizing the BEM functional orthopedic appliance, coupled with exercises and adjustments, improved mandibular and tongue posture, enhancing overall chewing balance. The appliance effectively repositioned the mandible to a more balanced position approaching normocclusion, achieving this without causing pain or discomfort and without the necessity for elastic or constant forces. Given the crucial role of facial expression muscles in these activities, a pronounced enhancement in facial harmony was observed. These affirmative outcomes significantly contributed to heightened patient engagement throughout the treatment process and a concomitant enhancement in patient self-esteem, attributable to the documented aesthetic and functional ameliorations.

Mouth Breathing and Its Impact on Atypical Swallowing: A Systematic Review and Meta-Analysis.

The aim of this systematic review is the assessment of the effect of mouth breathing on the prevalence of tongue thrust. The review was performed according to the PRISMA 2020 checklist guidelines, and the protocol was registered with PROSPERO (CRD42022339527). The inclusion criteria were the following: studies of clinical trials and cross-sectional and longitudinal descriptive studies that evaluate the appearance of tongue thrust in patients with mouth breathing; healthy subjects of any age, race or sex; and studies with a minimum sample group of five cases. The exclusion criteria were the following: studies with syndromic patients, articles from case reports, and letters to the editor and/or publisher. Searches were performed in electronic databases such as The National Library of Medicine (MEDLINE via PUBMED), the Cochrane Central Register of Controlled Trials, Web of Science and Scopus, including studies published until November 2023, without a language filter. The methodological quality of the included case-control studies was assessed using the Newcastle-Ottawa Scale (NOS), and the Joanna Briggs Institute (JBI) tool was used for descriptive cross-sectional studies and cross-sectional prevalence studies. A meta-analysis was conducted on studies that provided data on patients' classification according to mouth breathing (yes/no) as well as atypical swallowing (yes/no) using Review Manager 5.4. From 424 records, 12 articles were selected, and 4 were eligible for meta-analysis. It was shown that there is no consensus on the diagnostic methods used for mouth breathing and tongue thrust. The pooled risk ratio of atypical swallowing was significantly higher in the patients with mouth breathing (RR: 3.70; 95% CI: 2.06 to 6.66). These studies have several limitations, such as the heterogeneity among the individual studies in relation to the diagnostic tools and criteria for the assessment of mouth breathing and atypical swallowing. Considering the results, this systematic review shows that patients with mouth breathing presented higher risk ratios for atypical swallowing.

Elastodontic Appliances for the Interception of Malocclusion in Children: A Systematic Narrative Hybrid Review.

Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications. To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used. The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention. Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits.

A Multidisciplinary Approach to Swallowing Rehabilitation in Patients with Forward Head Posture.

(1) Background and Objectives: The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) Materials and Methods: A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) Results: There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) Conclusions: The combined therapy proved to be more effective than single OMT therapy.

Clinical assessment of deleterious oral habits and dental caries–periodontal parameters among Turkish twins

Twin studies are crucial to assess the relative contribution of genetic and environmental factors. This study was conducted to evaluate association between deleterious oral habits and dental caries-periodontal parameters among Turkish twins. The study comprised 143 pairs of dizygotic (DZ) twins and 59 pairs of monozygotic (MZ) twins aged 3-15 years. Twins were examined for dental caries, plaque index, gingival index, bleeding on probing and deleterious oral habits. Mann Whitney U test was used to examine the data. The MZ twin pairs consisted of 60 male and 58 female twin pairs, whereas the DZ twin pairs consisted of 144 male and 142 female. The mean age of the twins was 9.63±3.0 in MZ twins and 9.47±3.2 in DZ twins. The mean DMFS value of MZ twins with bruxism is higher than those of MZ twins without bruxism (P=0.001). The mean DMFS value of DZ twins with pacifier sucking is lower than those without (P=0.007). A statistically significant difference was found between MZ twins with and without nail biting in terms of bleeding on probing and dmfs values (P=0.035; P=0.012). The mean values of the plaque index increased due to the mouth breathing in DZ twins (P=0.024). Regarding the bleeding on probing, there was a statistically significant difference between MZ twins with and without atypical swallowing (P=0.016). These findings suggest that dental caries-periodontal parameters are similarly affected by deleterious oral habits in MZ and DZ twins.

Orofacial myofunctional reeducation assisted by a prefabricated reeducation appliance: a systematic review of the literature

Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. RMOF mainly uses isotonic and isometric exercises targeting the oral and oropharyngeal structures, combined with specific exercises for ventilation, swallowing and mastication. It may involve the use of prefabricated reeducation appliances (PRAs), which may also be prescribed to modify the shape and relationship of the dental arches. The primary objective of this systematic review of the literature was to describe and evaluate the efficacy of prefabricated reeducation appliance-assisted OFMR in orthodontics, occlusodontics and dental sleep medicine. Its secondary objective was to assess whether the use of currently available PRAs is associated with adverse effects. The systematic literature review was undertaken using five electronic databases: Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Google Scholar, to identify studies evaluating the efficacy of PRA-assisted OFMR in the treatment of orofacial dysfunctions and parafunctions, temporo-mandibular dysfunction (TMD) or obstructive sleep apnea (OSA) in children, adolescents and adults, published until 20 March 2023. The primary outcome of interest was the therapeutic efficacy of PRA-assisted OFMR. In patients with obstructive sleep apnoea (OSA), efficacy was assessed primarily by a decrease in the apnoea/hypopnoea index (AHI) of at least five episodes per hour from baseline, improvement in subjective sleep quality, sleep quality measured by nocturnal polysomnography and subjectively measured quality of life. In patients with orofacial dysfunctions, parafunctions or TMD, efficacy was assessed mainly by electromyography (EMG), history and clinical examination. Secondary outcomes were dentoalveolar or skeletal improvements, and possible adverse effects of the PRAs used, including adverse effects on occlusion. Only fourteen studies met all inclusion criteria: two randomised controlled trials, one non-randomised controlled trial, five prospective case-control studies, two retrospective case-control studies, two prospective case series and two retrospective case series. The two randomised controlled trials were assessed as "low risk of bias" according to the Cochrane Back Review Group's 12 risk of bias criteria. The methodological quality of the remaining 12 included studies was assessed using the ROBINS-I tool, according to the recommendations of the Cochrane Handbook. One was judged to have a measured risk of bias, eight a significant risk of bias and three a critical risk of bias. Based on the available evidence, PRA-assisted OFMR results in a statistically significant (p=0.0425) reduction in AHI in children with mild to moderate obstructive sleep apnea. In children with obstructive sleep apnoea undergoing adenoid and/or tonsil surgery, postoperative OFMR combined with a flexible PRA leads to a greater reduction in AHI compared to a control group and an improvement in SaO2 at 6 months and 12 months after surgery (p<0.01). It also contributes to greater improvement in sleep disturbance, physical fitness, daytime lethargy in the treated group than in the control group 6 months and 12 months after surgery (p<0.05). PRA-assisted OFMR provides correction of atypical swallowing and improvement in orofacial muscle balance. GRPs are generally less effective than activators for the treatment of Class II Division 1 malocclusions and appear to cause more adverse effects, mainly vestibuloversion of the mandibular incisors. The use of PRA-assisted OFMR for the management of TMD is not validated by current evidence. Published data, albeit of uneven methodological quality, appear to show the superiority of OFMR combined with the use of a PRA, compared with the implementation of OFMR without PRA. Prospective studies with large sample sizes would be useful to better evaluate the new therapeutic possibilities brought by the combination of OFMR with a PRA. Continued attention should be paid to the monitoring of possible adverse effects of PRA-assisted OFMR on the dental arches, especially the vestibuloversion of the mandibular incisors. It might be useful to reflect on the relevance of the arguments put forward by manufacturers about the particularities of their devices and their supposed effects. PRA-assisted OFMR appears to be a necessary paradigm shift, which it seems useful to bring to our patients. This protocol was registered on March 02, 2023 in the International Prospective Register of Systematic Review (PROSPERO) and received the CRD number: CRD42023400421.

Effects of the radio electric asymmetric conveyer (REAC) on motor disorders: An integrative review.

The radio electric asymmetric conveyer (REAC) is a technology that has the purpose of restoring the cellular polarity triggering the rebalancing of the endogenous bioelectric field, which considering the neurological dysfunctions, affects the neural communication mechanisms. The studies published so far show that the REAC neuromodulation technology has positive effects in treating these dysfunctions, with the principles of endogenous bioelectricity as a basis to achieve these effects. This study aims to review the literature that explored the effects of REAC protocols on motor control and to identify which mechanisms would be involved. This integrative review considered studies that used REAC as a therapeutic intervention directed at human motor control and experimental research with animals that applied REAC to obtain effects related to motor behavior. Ten articles were included, eight clinical and two experimental studies. The clinical studies used the neuro postural optimization (NPO) protocol in 473 patients, of which 53 were healthy subjects, 91 were Alzheimer's disease patients, 128 were patients with atypical swallowing, 12 subjects with neurological diseases, and 189 were without the specification of disease. The experimental studies used the antalgic neuromodulation and neurodegeneration protocols in animal models. The information integrated in this review made it possible to consider REAC technology a promising resource for treating motor control dysfunctions. It is possible to infer that the technology promotes functional optimization of neuronal circuits that may be related to more efficient strategies to perform motor tasks.

Using Reference Values to Identify Profiles of Swallowing Impairment in a Case Series of Individuals With Traumatic Spinal Cord Injury.

In this article, we illustrate use of a systematic approach to rating videofluoroscopic swallowing studies (VFSS), the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) method. The method is applied to a clinical case series of individuals with a history of traumatic spinal cord injury (tSCI) requiring surgical intervention using a posterior approach. Previous studies suggest that swallowing is highly variable in this population given heterogeneity in mechanisms, location and extent of injury, and in surgical management approaches. The case series involved 6 individuals who were at least 1 month postsurgery for management of tSCI. Participants completed a VFSS using a standardized bolus protocol. Each VFSS was blindly rated in duplicate using the ASPEKT method and compared with published reference values. The analysis revealed considerable heterogeneity across this clinical sample. Penetration-aspiration scale scores of 3 or higher were not observed in this cohort. Of note, patterns of impairment did emerge, suggesting there are some commonalities across profiles in this population, including the presence of residue associated with poor pharyngeal constriction, reduced upper esophageal opening diameter, and short upper esophageal sphincter opening duration. Although the participants in this clinical sample shared a history of tSCI requiring surgical intervention using a posterior approach, there was great heterogeneity in swallowing profile. Using a systematic method to identify atypical swallowing parameters can guide clinical decision making for determining rehabilitative targets and measuring swallowing outcomes.

Interceptive orthodontics: awareness and prevention is the first cure.

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.

Elastodontic treatment with oral bio-activators in young children.

Elastodontic therapy can correct bad oral habits and malocclusions in young patients by guiding jaw growth, eliminating functional disorders, and improving tooth position. The aim of this study was to assess the effects of bio-activator therapy on the presence of atypical swallowing with tongue thrust in growing patients. A retrospective study was conducted. Data regarding the early orthodontic treatment of 40 consecutive patients with atypical swallowing and tongue thrust (23 males and 17 females) were assembled from January 2019 to January 2020. All patients (≥7 and ≤15 years of age) were monitored for 1 year in a private practice in Isernia, Italy. The mean age at commencement of orthodontic treatment was 8.5 years (range=7.1-14.9 years), and the mean total duration of therapy was 1 year (range=11 months-1 year). Final lateral radiographs demonstrated a mean of improvement of 8° for upper and lower incisor proclination (I/SN) and 3.5° for incisor mandibular plane angle (IMPA) in 36 patients, and 5° of I/SN and 2° of IMPA in the remaining 4 children after 1 year of treatment. Bad oral habits in younger patients must not be ignored. The duration of treatment can differ depending on the severity of the open bite and the patient's cooperation. This study demonstrates the short-term efficacy of these myofunctional appliances in the treatment of atypical swallowing. In order to quickly eliminate factors which endanger healthy development of dento-skeletal structure, it is important to closely monitor patients during their development phase.

EVALUATION OF THE FACIAL PATTERN AND ORAL FUNCTIONS IN CHILD PATIENTS WITH MICROCEPHALY

<h3>Objectives</h3> The study aimed to evaluate the correlation of facial pattern and oral functions in children with microcephaly. <h3>Study Design</h3> The population consisted of 7 children with complete primary dentition. Data collection consisted of the analysis of clinical records and front and profile facial photography. <h3>Results</h3> There was a predominance of dolichofacial type (100%) and vertical pattern (85.71%). All had unilateral chewing, mouth breathing, bruxism, and atypical swallowing. The proportion of severe microcephaly (-3DP) was higher in males (<i>P</i> = .04). There was no association between the severity of microcephaly and facial type (<i>P</i> > .05), although the vertical pattern predominated in severe microcephaly (100%). There was a moderate association between the dolichofacial type and the presence of orofunctional disorders (<i>P</i> < .05). <h3>Conclusions</h3> Oral health care for these children should include dental development, the stomatognathic system, and craniofacial growth in early childhood to significantly reduce curative procedures.

Co-Sleeping as a Protector against Malocclusion in the Primary Dentition: A Cross-Sectional Study.

Mothers practice co-sleeping and breastfeeding simultaneously, for convenience and to strengthen bonding. Due to the scarcity of studies analyzing the impact of co-sleeping on primary dentition, this study aimed to analyze the possible effects of co-sleeping on children’s occlusion. In this cross-sectional study, mothers of 221 children aged 2–5 years who had been breastfed for less than 6 months completed a questionnaire about non-nutritive sucking habits. The WHO (World Health Organization) and IOTN-AC indices (the Aesthetic Component of the Index of Orthodontic Treatment Need) were used to assess malocclusion. The type of sagittal (dental and skeletal), transverse and vertical malocclusion was recorded. The non-co-sleeping group showed significantly higher pacifier use (p < 0.05), digital sucking (p < 0.05) and atypical swallowing (p < 0.05) habits. The non-co-sleeping group showed significantly higher mean scores on the IOTN-AC (p < 0.05) and WHO (p < 0.01), a significantly higher presence of canine class II (p < 0.05), anterior open bite (p < 0.05), posterior crossbite (p < 0.05), overbite (p < 0.05), skeletal class II (p < 0.01) and protrusion (p < 0.05). In conclusion, children who practice co-sleeping appear to have a lower frequency and duration of non-nutritive sucking habits. Co-sleeping may contribute to a lower development of malocclusions in children who are weaned early (before six months of age).

Is it possible to reveal atypical swallowing pattern for specific skeletal malocclusion types using M-mode sonographic imaging of tongue movements?

The present study aims to compare the M‑mode ultrasound findings of different skeletal malocclusions and to evaluate whether sonographic parameters can be used for the diagnosis of malocclusions. Tongue movements of 36adolescents aged between 10.37 and 17.29years (mean 14.25 ± 1.78years) were assessed using simultaneous two-dimensional real-time B‑mode and M‑mode sonography. The swallowing patterns of the subjects were visualized recording the motion of the tongue surface in the ultrasound images utilizing afixed scan line through the middle of the tongue. M‑mode scans of tongue motion during empty deglutition were recorded. The parameters range, duration, and speed were computed for the entirety of the swallowing process using M‑mode examination. Findings were evaluated and statistically analyzed. No clear intraindividual repeatability in the M‑mode imaging of the subjects' swallowing process could be observed. Considering the setup used in the study, it was not always possible to distinguish individual swallowing stages in the M‑mode images with regard to the chosen reference points. The average duration, range of motion, and speed of swallowing were found to be 2.43 s, 24.06 mm, and 10.34 mm/s, respectively. The findings showed both intra- and intersubject variability during empty swallowing. With the help of the metrics that could be calculated based on the M‑mode images, it was not possible to differentiate the swallowing acts of different skeletal malocclusion types. It remains unclear whether M‑mode imaging can accurately visualize the swallowing pattern. Therefore, further progress in technology and multidisciplinary work is needed in order to establish diagnostic references regarding swallowing.

Atypical Swallowing, Open Bite and Musculo-Postural Consequences

Atypical Swallowing, Open Bite and Musculo-Postural Consequences