Mouth Breathing Children Research Articles

Risk factors for residual mouth breathing in children who had completely resolved obstructive sleep apnea after adenotonsillectomy.

Adenotonsillectomy is the first-line treatment for pediatric obstructive sleep apnea (OSA). However, although completely resolved OSA after adenotonsillectomy, some children still showed persistence of mouth breathing. Therefore, we attempted to identify risk factors for residual mouth breathing in children with OSA after successful adenotonsillectomy. This study retrospectively enrolled children who underwent adenotonsillectomy as a treatment of OSA. Additionally, children who showed apnea-hypopnea index ≥ 1 on 1-year postoperative polysomnography or adenoid regrowth on one-year postoperative lateral cephalogram were excluded. The presence of allergic rhinitis, septal deviation, dentofacial abnormalities, the size of tonsil and adenoid was also evaluated in all enrolled children. Dentofacial abnormalities were defied as a high palatal arch, macroglossia, retrognathia, micrognathia, and overcrowding of teeth which assessed by dentists. A total of 62 children were enrolled (no residual mouth-breathing group, n = 18 and residual mouth-breathing group, n = 44) in this study. There were no significant differences in demographic factors, physical examination, and sleep parameters, except age and preoperative adenoid size. On the multiple logistic regression analysis, we found that older age, large adenoid size, and presence of dentofacial abnormalities significantly correlated with residual mouth breathing (adjusted coefficient estimates = 0.3890, 2.3611, and 2.8615, respectively) after successful adenotonsillectomy. Older age, large adenoid size, and presence of dentofacial abnormalities in children with OSA may be the risk factors for residual mouth breathing after successfully resolved OSA.

Diagnosis and treatment of mouth breathing in children

Mouth breathing in children are increasingly concerned by the physicians and the society. Incompetent lip closure can be classified as oral habit and pathological mouth breathing. Pathologic mouth breathing due to hypertrophy of adenoids and tonsils is often the cause of obstructive sleep apnea in children, which may lead to craniofacial deformities and other consequences. At present, there are many problems in the definition, diagnosis and treatment of mouth breathing, which need to be clarified. Key words: Mouth breathing; Child; Diagnosis; Risk management

Surface electromyography in orofacial and cervical musculature in mouth breathing children: an integrative literature review

ABSTRACT Purpose: to review, in an integrative manner, studies using surface electromyography in the orofacial and cervical musculature in mouth breathing children aged from three to 11 years and 11 months old. Methods: the survey was conducted in national and international databases, from 1998 to 2018, in Portuguese, English and Spanish. Review articles, dissertations, book chapters, case studies and editorials were excluded. Results: 86 articles were found, 14 of which met the inclusion criteria. Most of these studies used surface electromyography to assess and describe the muscle condition of the mouth breathing population. Only one study addressed the influence of myofunctional speech therapy and two studies included physical therapy treatment, using electromyographic evaluation before and after the intervention. Given the main categories of analysis, the discussion was based on the year, state of publication and journal, sample size, scientific methodology, muscles assessed, assessment protocols used and the results of the publications. Conclusions: surface electromyography has been used mainly in the initial assessment of orofacial and postural myofunctional changes caused by mouth breathing and not as a therapeutic biofeedback, thus, it is important to conduct longitudinal studies using this instrument in mouth breathers.

Determining the main reasons for difficult nasal breathing among children with primary and mixed dentition

Introduction: Difficult nasal breathing is the condition where there is a partial or full, temporary or permanent obstruction of the airways and the processes of inhalation and exhalation are carried out through the mouth. Aim: The aim of this paper is to define and analyse the reasons for mouth breathing among children with primary and mixed dentition. Materials and Methods: A total of 1 667 children between the ages 3 and 12 years were examined. We used the methods of anterior and posterior rhinoscopy, acoustic rhinometry, and rhinomanometry Results: Among all the studied mouth-breathing children with deciduous dentition, the main reason for the difficult nasal breathing was allergic rhinitis. The children with first degree of obstruction predominated (54.50%), The second cause in this studied age group was adenoid hypertrophy. In early mixed dentition, the percentage distribution of second and third degree of obstruction was the same (45.70%). In the early mixed dentition, the most common cause of difficult nasal breathing was adenoid hypertrophy. The percentage of children in late mixed dentition who were with adenoid hypertrophy was lower. Conclusion: The main reason for difficult nasal breathing in primary dentition is allergic rhinitis, but in early mixed dentition it is adenoid hypertrophy. Our results showed that of all the children with difficult nasal breathing 24% had first degree of nasal obstruction, 39.30% had second degree, followed by 36.70% children with third degree.

Assessment of Craniofacial Morphology in Mouth Breathing Children. A retrospective case-control study

The aim of this retrospective case-control study is to determine a possible correlation between breathing mode and craniofacial morphology. The study was carried out in the Department of Pedodontics,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. The sample comprised 80 patients, age between 6 and 13 years, which were divided in two groups based on respiratory pattern: control group composed of 38 nasal breathing children and case group composed of 42 oral breathing children. Three quantitative craniofacial parameters were measured from the frontal and lateral photos: facial index, lower facial height ratio and upper lip ratio. The statistical analysis showed a significant higher facial index (p=0.006*) and an increase lower facial height (p=0.033*) for the oral breathers group. No differences in facial morphology were found between genders and age groups, when comparing the data between the same type of respiratory pattern children. Spearman�s rho Correlation show a significant positive correlation (p=0.002*) between facial index and lower facial height and a significant negative correlation between facial index and upper lip (p=0,005*). Long faces children are more likely to develop oral breathing in certain conditions, which subsequently have a negative effect on increasing the lower facial height by altering the postural behavior of mandible and tongue.

Assessment of Craniofacial Morphology in Mouth Breathing Children. A retrospective case-control study

The aim of this retrospective case-control study is to determine a possible correlation between breathing mode and craniofacial morphology. The study was carried out in the Department of Pedodontics,Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. The sample comprised 80 patients, age between 6 and 13 years, which were divided in two groups based on respiratory pattern: control group composed of 38 nasal breathing children and case group composed of 42 oral breathing children. Three quantitative craniofacial parameters were measured from the frontal and lateral photos: facial index, lower facial height ratio and upper lip ratio. The statistical analysis showed a significant higher facial index (p=0.006*) and an increase lower facial height (p=0.033*) for the oral breathers group. No differences in facial morphology were found between genders and age groups, when comparing the data between the same type of respiratory pattern children. Spearman’s rho Correlation show a significant positive correlation (p=0.002*) between facial index and lower facial height and a significant negative correlation between facial index and upper lip (p=0,005*). Long faces children are more likely to develop oral breathing in certain conditions, which subsequently have a negative effect on increasing the lower facial height by altering the postural behavior of mandible and tongue. Keywords: craniofacial morphology, facial growth, facial index, long face, oral breathing

Three-dimensional morphological analysis of the palate of mouth-breathing children in mixed dentition

To study the effects of mouth-breathing on maxillary arch development by comparing the palatal morphology of mouth- and nose-breathing children in mixed dentition. Children in mixed dentition were enrolled and categorized into mouth-breathing (test group) and nose-breathing groups (control group) according to their breathing patterns. Children's plaster models were scanned with 3D laser scanner, and the 3D data were reconstructed and measured using Minics 15.0 and Geomagic 12.0 software. Measurement data (inter-molar width, palatal height, palatal volume, and palatal surface area) of the two groups were compared, and the correlation among the four measurement items was analyzed. The participants were 73 children (37 in test group and 36 in control group) with a mean age of (8.63±0.78) years old. The test group had significantly smaller inter-molar width, palatal volume, and palatal surface area but significantly higher palatal height than the control group (P<0.05). Inter-molar width and palatal volume were positively correlated with the palatal surface area in the test group (P<0.05). Inter-molar width and palatal height were positively correlated with the palatal surface area in the control group (P<0.01). Mouth-breathing children have significantly reduced inter-molar width, palatal volume, and surface, and substantially increased palatal height, leading to different developmental patterns of the palatal morphology.

Impact of adenotonsilectomy on nasal airflow and pulmonary blood pressure in mouth breathing children

IntroductionAdenotonsillar hyperplasia (ATH) causing upper airway obstruction (UAO) may increase pulmonary artery systolic pressure (PASP). Early diagnosis and mouth breathing (MB) management may help in cases of high PASP. Total inspiratory nasal airflow (TINAF) obtained by active anterior rhinomanometry (AARM) is a means to quantify nasal patency. This study aimed to correlate TINAF with high PASP. MethodsThis is a prospective study involving 30 children between two and twelve years of age, with indication for adenotonsillectomy due to ATH, evaluated before and six months after surgery; and 29 nasal breathing (NB) children in the same age group. We obtained the PASP, calculated for tricuspid regurgitation, by means of a transthoracic echocardiography. We assessed nasal patency using the AARM to estimate the TINAF. ResultsThe mean PASP among mouth breathing children was 25.99 mmHg, with a Standard Deviation of (±) 3.27, p = 0.01 in the preoperative period; and 21.79 mmHg (±2.48; p = 0.01) in the postoperative period. Among nasal breathers, this mean value was 21.64 mmHg (±3.87, p = 0.01). The mean pre-operative TINAF was 266.76 cm3/s (±112.21, p = 0.01); and 498.93 cm3/s (±137.80, p = 0.01) after surgery. Among nasal breathers it was 609.37 cm3/s (±109.16; p = 0.01). The mean nasal patency in the preoperative period was 42.85% (±17.83; p = 0.01); and 79.33% (±21.35; p = 0.01) in the post-op. Among nasal breathers it was 112.94% (±15.88, p = 0.01). There was a significant Spearman correlation value between TINAF and PASP (r = −0.459; p = 0.01) when we analyzed all the groups. ConclusionPASP and TINAF values improved postoperatively and had an inverse correlation. This study suggests that by improving TINAF there was a decrease in PASP.

Benefits of physical therapy in the quality of life of mouth breathing children: Literature review

Introduction: The correct breathing process is through thenasal route, since it provides that the air during aspiration isfiltered, humidified and heated, thus conditioning the lungsfor gas exchange to occur. Allergic processes or other formsof affections can lead to the obstruction of the passage of airthrough the nose, leading the body to make an alternativeadaptation for the passage of air to occur through the mouth.A person who uses the mouth to breathe is called a mouthbreather. Once this adaptive process occurs, as a way tocompensate for this alternative airway, the body promotesa series of alterations in several segments of the body, such aschanges in the postural, respiratory, behavioral and stomatognathicsystems. Several techniques are used to treat themusculoskeletal dysfunctions presented by mouth breathers.Objective: to analyze how physiotherapy can contribute tothe improvement of the quality of life of mouth breathingchildren and to find out which are the most effective treatments.Methods: a search of data in the literature was carriedout by consulting the following electronic databases: Scielo,Bireme, Pub Med, Lilacs Google Scholar, as well as specializedbooks in the field. We excluded articles published before theyear 2000. Result: Among the analyzed articles, we perceivethat the treatment of mouth breathers occurs in a multidisciplinaryway, since it presents changes that encompassseveral body and systemic segments. Among the professionalsinvolved in the rehabilitation process, we highlight therole of physiotherapists. Conclusion: the physiotherapist isqualified to intervene in this pathology, with expertise inevaluation and establishment of the best treatment program,with physiotherapeutic conduits, allowing an improvementin respiratory patterns.Keywords: Mouth breathing children; Physiotherapy; Posturalevaluation; Treatment.

Alta frequência dos fatores de risco à oclusão dentária entre escolares no município de Petrópolis: um estudo transversal

Introdução: A má oclusão dentária tem origem multifatorial, logo é difícil definir estratégicas específicas de como preveni-la. A respiração bucal e certos hábitos de sucção, se persistir por mais de 36 meses, podem influenciar de forma negativa. Objetivo: Identificar fatores de risco à oclusão dentária como: respiração bucal e hábitos de sucção em escolares de 8 a 10 anos de idade em Petrópolis, RJ. Métodos: Estudo observacional, transversal, de caráter descritivo. Incluídos escolares de ambos os sexos, 8 a 10 anos, matriculados em sete escolas municipais de Petrópolis. Distribuído aos escolares o protocolo para a identificação da criança respiradora bucal e o questionário sobre hábitos de sucção (mamadeira, chupeta e dedo). Resultados: Foram avaliados 377 protocolos para a identificação de criança respiradora bucal e 377 questionários sobre hábitos de sucção. Nos protocolos foram referidos sintomas como: dormir de boca aberta em 193 (51,2%), babar no travesseiro em 172 (45,6%), roncos em 131 (34,7%) e obstrução nasal diária em 118 (31,2%). Ao aplicar os critérios de Abreu, constatou-se uma frequência de 243 (64%) respiradores bucais e 134 (36%) respiradores nasais. Ao avaliar os 377 questionários sobre os hábitos de sucção encontraram-se: 276 (73%) crianças com hábitos de sucção e 101 (27%) sem tais hábitos. Dos 276 escolares que tiveram hábitos de sucção, houve persistência destes hábitos acima de três anos e 11 meses em 149 crianças (54%). Conclusão: Encontrada uma alta frequência de respiradores bucais e de crianças com hábitos de sucção.

SENSORY CHANGES IN MOUTH BREATHERS: SYSTEMATIC REVIEW BASED ON THE PRISMA METHOD.

ABSTRACTObjective: To review, in the literature, information regarding changes in the sensory systems of mouth breathers. Data sources: The search was conducted in the following databases PubMed, BIREME, LILACS, Web of Science and Scopus. The search was independently carried out by two researchers, following the selection criteria. Original articles that approached mouth breathing and changes in sensory systems published in Portuguese, English and Spanish were published. Literature review of articles, dissertations, book chapters, case studies and editorials were excluded. Data synthesis: We found 719 articles. Among them, 663 were excluded by the title and 22 by the summary. Among the 34 analyzed manuscripts, 23 were repeated and 8 were excluded by reading the full text. Thus, 3 articles were selected for this review. Conclusions: Most studies presents the occurrence of changes in sensory systems in mouth breathing children. However, sensory reception is a matter of more concern. Besides, the evaluation of sensory systems was not standardized, which may have led to less precise results in the studied population.

Relationship between mouth breathing etiology and maximum tongue pressure.

To verify the relationship between maximum tongue pressure and the etiology of oral breathing in oral breathing children attended at the Oral Respiratory Outpatient Clinic. A descriptive and analytical cross-sectional study was accomplished with 59 mouth breathing children aged 3 to 12 years (mean age 6.5 years and SD: standard deviation= 2.4). To collect tongue pressure, the Iowa Oral Performance Instrument (IOPI) was used and data regarding the etiology of oral breathing and dental occlusion were collected in the records of these patients for analysis. The associations between the maximum tongue pressure and the etiology of oral breathing, age, gender and dental occlusion were verified by the T test, ANOVA, Spearman's coefficient and Tuckey's test, using a significance level of 5%. There was a moderate and positive correlation between age and maximum pressure, it was verified that there was a statistically significant difference between the maximum tongue pressure and the variables pharyngeal tonsil hypertrophy and palatine tonsil hypertrophy. There were no statistical differences between the other variables. It was concluded that mechanical obstructions, among them the pharyngeal and palatine tonsil hypertrophy alter the maximum tongue pressure in oral breathing children.

Epidemiological research on the incidence of malocclusions among mouth-breathing children with primary and mixed dentition

Introduction: A literature review established that the number of mouth-breathing children varies between 5-75%. Girls are more often diagnosed with this condition compared to the boys. In the 19 th century Linder-Aronson established the relationship between mouth-breathing and malocclusions. The recognition of the mouth-breathing pattern and the habitual mouth breathing as factors in developing malocclusions requires prophylaxis and timely treatment. Aim: The purpose of this study is to establish the incidence and type of malocclusions among mouth-breathing children with primary and mixed dentition. Materials and Methods: A total of 412 children diagnosed with mouth breathing and 317 children diagnosed with habitual mouth breathing aged 3-12 years were examined. The dental occlusion of every child was assessed in the three planes of space - sagittal, transverse and horizontal in both segments - frontal and buccal. Results: In both groups a statistically significant difference in dental malocclusions was demonstrated (p<0.001) depending on type of dentition. In both groups the vast majority of children were diagnosed with class II Angle malocclusion in both primary and mixed dentition. The children with primary dentition were more often diagnosed with class I Angle malocclusion. Conclusion: In both groups the most frequent malocclusions present were class II Angle, overjet, bilateral posterior crossbite, open bite within 3 mm in the frontal segment. In primary dentition the most frequent type of malocclusion was class I Angle.

Maxilo-facial and occlusal characteristic in mouth breathing children

Maxilo-facial and occlusal characteristic in mouth breathing children

Speech production assessment of mouth breathing children with hypertrophy of palatines and/or pharyngeal tonsils

ABSTRACT Objective: to evaluate the speech sound production of children diagnosed with a palatine mouth breathing and / or hypertrophic pharyngeal tonsil and compare it to that of a group of children that do not show any respiratory alterations, besides associating with age and sex. Methods: a quantitative, cross-sectional, analytical and observational research. Children from five to twelve years old have took part of the study, 50 of them diagnosed as mouth breathers (research group - RG) and 50 with no respiratory alteration (control group - CG). Anamnesis and evaluation based on MBGR protocol was performed, focusing on the speech, supported by figures and with samples of automatic and spontaneous speech. Results: there were no differences between the groups, taking into account the parents' complaint. Speech alterations, such as phonetic deflection, lingual interposition and distortions, and occlusion alterations were more frequent in RG. Speech alterations prevailed for males in 83% and the average age related to speech did not show any significance. Conclusion: mouth breathing children present more alterations of speech sounds than those presented with no respiratory alteration, regardless of the age group, being more common in male children.

Oral health status of children with mouth breathing due to adenotonsillar hypertrophy

ObjectivesMouth breathing is an important health problem, commonly encountered in children. In children, adeno-tonsillar hypertrophy is the main reason causing partial or complete upper airway obstruction and reduction in airflow. This study aimed to determine the oral health status of children aged 3–15 years, with mouth breathing who were due to have surgery for adeno-tonsillar hypertrophy and referred to the Department of Otorhinolaryngology at Children's Hospital of a University in Ankara, Turkey between January–July 2015. MethodsThe approval of the Non-Interventional Clinical Researches Ethics Board of Hacettepe University and written informed consents from the parents were obtained. The parents completed a questionnaire before the surgery. The children were examined using dental mirror and explorer under dental unit lighting. Oral health status was evaluated with DMFT/S, dmft/s, ICDAS II, dental plaque and gingival indices. The chi-square test, Kruskal Wallis and Mann Whitney U tests were used to statistically analyse the results, with statistical significance p<0.05. ResultsOf the 170 children who had adenotonsillar hypertrophy with mouth breathing, 150 the parents agreed to participate the study. 77 of the children (51.3%) were male; the mean age was 5.9 ± 2.6. Mean dmft was 3.8 ± 3.6, dmfs 9.7 ± 1.1, DMFT 0.4 ± 1.0 and DMFS 0.6 ± 1.5 respectively. Among the children, 101 (67.3%) had cavitated dental caries, and according to ICDAS II, none had healthy teeth, 15 (10.0%) had initial, 42 (28.0%) had moderate and 93 (62.0%) had advanced caries. Of the children, 89.3% had gingivitis and the proportion of gingivitis in posterior region was found to be significantly higher than anterior region (p < 0,001). ConclusionsThe oral health status of mouth breathing in children with adeno-tonsillar hypertrophy was poor. To reduce the risk of dental caries and periodontal disease among these children, regular dental follow-up and preventive programmes for oral health are needed.

Mouth breathing in children and its impact in dental malocclusion: a systematic review of observational studies.

Mouth breathing in childhood can compromise the dental occlusion and, consequently, the functions performed by the stomatognathic system. The purpose of this systematic review was to evaluate which is the highest prevalence of dental malocclusion in mouth breathing children. Bibliographic searches of observational studies were performed in five electronic databases (PubMed, LILACS, SciELO, Scopus and Open Grey) without language restriction, from 2007 to 2014. Were selected cross-sectional or longitudinal studies of the past seven years that described the prevalence of malocclusions of Angle Class I and Class II, division 1. After the selection, the studies were evaluated for their methodological quality. Subsequently, the description of the selected articles was made. From 125 records, seven articles were selected (5.6%), with a majority of Brazilian authors (71.43%). There seems to be a higher prevalence of malocclusion in mouth breathers when related to gender. The prevalence of malocclusion of Angle Class II, division 1, was higher than Class I malocclusion in mouth breathers, according to most studies in the sample. Interdisciplinary and controlled studies deserve more attention from researchers of the area, given the need for researches with greater methodological strength. Considering the results, the prevalence of malocclusion of Angle Class II, division 1 tends to be higher than Class I malocclusion in mouth breathing children.

Mouth breathing in children and its connection with obstructive sleep apnea

Introduction: The influence of mouth breathing on development of the dentition and dento-facial deformities is a problem causes concerns among the medical specialists. Mouth breathing has a major impact on the development of the maxillo-facial region, occlusion and muscle tonus. Both – nose and mouth breathing provide lungs with oxygen but with extremely disparate effects on the body and different levels of oxygen supply. Aim: The aim of this study is to assess the relationship between mouth breathing children and obstructive sleep apnea. Material and methods: For this article, data is obtained from 30 medical, literary sources. Results: Mouth breathing has been linked to oral conditions such as dental caries, secondary halitosis, craniofacial deformity and malocclusion, as well as abnormal swallowing. It is also related to medical conditions such as altered head, neck and body posture, obstructive sleep apnea and asthma. Conclusion: The habitual mouth breathing is a great medical problem nowadays. Although the relationship between mouth breathing and oral and medical conditions seems well established, it is difficult to assess in all cases the cause-effect link. More studies are needed to explore a causal relationship.

Are computed tomography 3D measurements of the upper airways in mouth-breathing children in agreement with the ENT clinical diagnosis of obstruction?

IntroductionImaging studies have hystorically been used to support the clinical otorhinolaryngological evaluation of the upper respiratory tract for the diagnosis of obstructive causes of oral breathing. ObjectiveThe objective of this study was to compare 3D volumetric measurements of nasal cavity, nasopharynx and oropharynx of obstructed mouth-breathing children with measurements of non-obstructed mouth-breathing children. MethodsThis retrospective study included 25 mouth-breathing children aged 5–9 years evaluated by otorhinolaryngological clinical examination, flexible nasoendoscopy and full-head multi-slice computed tomography. Tomographic volumetric measurements and dichotomic otorhinolaryngological diagnosis (obstructed vs. non-obstructed) in three anatomical regions (the nasal cavity, nasopharynx and oropharynx) were compared and correlated. An independent sample t-test was used to assess the association between the 3D measurements of the upper airways and the otorhinolaryngological diagnosis of obstruction in the three anatomical regions. Inter- and intra-observer intraclass correlation coefficients were used to evaluate the reliability of the 3D measurements. ResultsThe intra-class correlation coefficients ranged from 0.97 to 0.99. An association was found between turbinate hypertrophy and nasal cavity volume reduction (p<0.05) and between adenoid hyperplasia and nasopharynx volume reduction (p<0.001). No association was found between palatine tonsil hyperplasia and oropharynx volume reduction. Conclusions(1) The nasal cavity volume was reduced when hypertrophic turbinates were diagnosed; (2) the nasopharynx was reduced when adenoid hyperplasia was diagnosed; and (3) the oropharynx volume of mouth-breathing children with tonsil hyperplasia was similar to that of non-obstructed mouth-breathing children. The adoption of the actual anatomy of the various compartments of the upper airway is an improvement to the evaluation method.

Molar-incisor enamel hypomineralization cross-sectional prevalence evaluation in oral-breathing allergic children

Objective: Molar-incisor hypomineralization (MIH) is a highly prevalent dental development disturbance caused by dis­rupted ameloblast maturation. This condition affects up to 44% of children around the world and several systemic con­ditions have been associated with MIH, including Mouth-Breathing. It is important to show that MIH has multifacto­rial etiology and is associated with allergic mouth-breathing children. Methods: To evaluate MIH prevalence in MBCS children with positive and negative allergic response to the skin prick test, a cross-sectional quantitative and qualitative comparative assessment was conducted in 23 mouth-breathing children and 25 sex/age-matched siblings. Enamel defects were classified by the modified rate of FDI Development Defects of Enamel. Statistical Student’s t tests were applied to ve­rify the relevance of the data. Results: MIH prevalence showed significant statistical differences in the comparison betwe­en molars, independently of individual age (p = 0.01513474). MBCS children under 5 years old had higher statistical preva­lence of MIH (p = 0.00594). MBCS children with positive skin reactions to the prick test had higher prevalence of MIH (p = 0,023). MBCS children had statistically significant higher prevalence of demarcated opacity (p = 0.00012). Conclusions: Finally, MBCS children with positive skin reactions to the prick test had higher prevalence of MIH (p = 0,023), indicating that mouth-breathing allergy-responsive children had higher MIH prevalence. Our results corroborate our previous hypo­thesis that MBCS children have increased MIH prevalence in comparison to their siblings, with statistical significance (p = 0.01513474). Further investigations with larger samples may enhance and confirm the accuracy of our results.