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BMC Oral Health
Published in: BMC Oral Health 1/2021

Open Access 01-12-2021 | Obstructive Sleep Apnea Syndrome | Research article

Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis

Authors: Ziyi Zhao, Leilei Zheng, Xiaoya Huang, Caiyu Li, Jing Liu, Yun Hu

Published in: BMC Oral Health | Issue 1/2021

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Abstract

Background

Mouth breathing is closely related to the facial skeletal development and malocclusion. The purpose of this systematic review and meta-analysis was to assess the effect of mouth breathing on facial skeletal development and malocclusion in children.

Methods

An electronic search in PubMed, the Cochrane Library, Medline, Web of Science, EMBASE and Sigle through February 23rd, 2020, was conducted. Inclusion criteria were children under 18 years of age with maxillofacial deformities due to mouth breathing. The risk of bias in nonrandomized studies of interventions (ROBINS-I) tool for controlled clinical trials. The Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used for the quality assessment. The included indicators were SNA, SNB, ANB, SN-OP, SN-PP, PP-MP, SNGoGn, MP-H, 1-NA, 1. NA, 1. NB, 1-NB, Overjet, Overbite, SPAS, PAS, and C3-H. Data concerning the mean difference in mesial molar movement and extent of canine retraction were extracted for statistical analysis. The mean differences and 95% confidence intervals were analyzed for continuous data. Review Manager 5.3, was used to synthesize various parameters associated with the impact of mouth breathing on facial skeletal development and malocclusion.

Results

Following full-text evaluations for eligibility, 10 studies were included in the final quantitative synthesis. In Sagittal direction, SNA (MD: − 1.63, P < 0.0001), SNB (MD: − 1.96, P < 0.0001) in mouth-breathing children was lower than that in nasal-breathing children. ANB (MD: 0.90, P < 0.0001), 1. NA (MD: 1.96, P = 0.009), 1-NA (MD: 0.66, P = 0.004), and 1-NB (MD: 1.03, P < 0.0001) showed higher values in children with mouth breathing. In vertical direction, SN-PP (MD: 0.68, P = 0.0050), SN-OP (MD: 3.05, P < 0.0001), PP-MP (MD: 4.92, P < 0.0001) and SNGoGn (MD: 4.10, P < 0.0001) were higher in mouth-breathing individuals. In airway, SPAS (MD: − 3.48, P = 0.0009), PAS (MD: − 2.11, P < 0.0001), and C3-H (MD: − 1.34, P < 0.0001) were lower in mouth breathing group.

Conclusions

The results showed that the mandible and maxilla rotated backward and downward, and the occlusal plane was steep. In addition, mouth breathing presented a tendency of labial inclination of the upper anterior teeth. Airway stenosis was common in mouth-breathing children.
Trial registration crd-register@york.ac.uk, registration number CRD42019129198.
Appendix
Available only for authorised users
Literature
1.
Pereira TC, Furlan RMMM, Motta AR. Relationship between mouth breathing etiology and maximum tongue pressure. Codas. 2019;31(2):e20180099–e20180099.PubMedCrossRef
2.
Abreu RR, Rocha RL, Lamounier JA, Guerra AF. Etiology, clinical manifestations and concurrent findings in mouth-breathing children. J Pediatr. 2008;84(6):529–35.CrossRef
3.
Thomaz EBAF, Cangussu MCT, Assis AMO. Maternal breastfeeding, parafunctional oral habits and malocclusion in adolescents: a multivariate analysis. Int J Pediatr Otorhinolaryngol. 2012;76(4):500–6.PubMedCrossRef
4.
Jimenez EL, Barrios R, Calvo JC, de la Rosa MT, Campillo JS, Bayona JC, Bravo M. Association of oral breathing with dental malocclusions and general health in children. Minerva Pediatr. 2017;69(3):188–93.PubMed
5.
Occasi F, Perri L, Saccucci M, Di Carlo G, Ierardo G, Luzzi V, De Castro G, Brindisi G, Loffredo L, Duse M, et al. Malocclusion and rhinitis in children: an easy-going relationship or a yet to be resolved paradox? A systematic literature revision. Ital J Pediatr. 2018;44(1):100.PubMedPubMedCentralCrossRef
6.
7.
Frasson JMD, Magnani MBBDA, Nouer DF, De Siqueira VCV, Lunardi N. Comparative cephalometric study between nasal and predominantly mouth breathers. Rev Bras Otorrinolaringol. 2006;72(1):72–82.CrossRef
8.
McNamara JA. Influence of respiratory pattern on craniofacial growth. Angle Orthod. 1981;51(4):269–300.PubMed
9.
Raffat A, ul Hamid W. Cephalometric assessment of patients with adenoidal faces. J Pak Med Assoc. 2009;59(11):747–52.PubMed
10.
Koca CF, Erdem T, Bayindir T. The effect of adenoid hypertrophy on maxillofacial development: an objective photographic analysis. J Otolaryngol Head Neck Surg (Le Journal d’oto-rhino-laryngologie et de chirurgie cervico-faciale). 2016;45(1):48.
11.
D’Ascanio L, Lancione C, Pompa G, Rebuffini E, Mansi N, Manzini M. Craniofacial growth in children with nasal septum deviation: a cephalometric comparative study. Int J Pediatr Otorhinolaryngol. 2010;74(10):1180–3.PubMedCrossRef
12.
Rosetti Lessa FC, Enoki C, Neuppmann Feres MF, Pereira Volera FC, Anselmo Lima WT, Nakane Matsumoto MA. Breathing mode influence on craniofacial development. Rev Bras Otorrinolaringol. 2005;71(2):156–60.CrossRef
13.
Rossi RC, Rossi NJ, Rossi NJ, Yamashita HK, Pignatari SS. Dentofacial characteristics of oral breathers in different ages: a retrospective case-control study. Prog Orthod. 2015;16:23.PubMedPubMedCentralCrossRef
14.
Chung Leng Munoz I, Beltri Orta P. Comparison of cephalometric patterns in mouth breathing and nose breathing children. Int J Pediatr Otorhinolaryngol. 2014;78(7):1167–72.PubMedCrossRef
15.
Chambi-Rocha A, Cabrera-Dominguez ME, Dominguez-Reyes A. Breathing mode influence on craniofacial development and head posture. J Pediatr. 2018;94(2):123–30.CrossRef
16.
Mattar SE, Valera FC, Faria G, Matsumoto MA, Anselmo-Lima WT. Changes in facial morphology after adenotonsillectomy in mouth-breathing children. Int J Pediatr Dent. 2011;21(5):389–96. CrossRef
17.
Becking BE, Verweij JP, Kalf-Scholte SM, Valkenburg C, Bakker EWP, van Merkesteyn JPR. Impact of adenotonsillectomy on the dentofacial development of obstructed children: a systematic review and meta-analysis. Eur J Orthod. 2017;39(5):509–18.PubMedCrossRef
18.
do Nascimento RR, Masterson D, Trindade Mattos C, de Vasconcellos VO. Facial growth direction after surgical intervention to relieve mouth breathing: a systematic review and meta-analysis. J Orofac Orthop. 2018;79:412–26.PubMedCrossRef
19.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-34.CrossRefPubMed
20.
Tinano MM, Godinho J, Becker HMG, Franco LP, Souki BQ. Prevalence of malocclusion in children with upper airway obstruction. Revista Portuguesa de Estomatologia, Medicina Dentaria e Cirurgia Maxilofacial. 2017;58(4):199–204.
21.
Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2011;343:d5928.CrossRef
22.
Franco LP, Souki BQ, Cheib PL, Abrao M, Pereira TB, Becker HM, Pinto JA. Are distinct etiologies of upper airway obstruction in mouth-breathing children associated with different cephalometric patterns? Int J Pediatr Otorhinolaryngol. 2015;79(2):223–8.PubMedCrossRef
23.
Franco LP, Souki BQ, Pereira TB, Meyge de Brito G, Goncalves Becker HM, Pinto JA. Is the growth pattern in mouth breathers comparable with the counterclockwise mandibular rotation of nasal breathers? Am J Orthod Dentofac Orthop. 2013;144(3):341–8.CrossRef
24.
Juliano ML, Machado MAC, Coin De Carvalho LB, Fernandes Do Prado LB, Fernandes DO Prado G. Mouth breathing children have cephalometric patterns similar to those of adult patients with obstructive sleep apnea syndrome. Arq Neuropsiquiatr. 2009;67(3 B):860–5.PubMedCrossRef
25.
Juliano ML, Machado MAC, de Carvalho LBC, Zancanella E, Santos GMS, do Prado LBF, do Prado GF. Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children. J Clin Sleep Med. 2009;5(6):554–61.PubMedPubMedCentralCrossRef
26.
Juliano ML, Machado MAC, de Carvalho LBC, dos Santos GMS, Zancanella E, do Prado LBF, do Prado GF. Obstructive sleep apnea prevents the expected difference in craniofacial growth of boys and girls. Arq Neuropsiquiatr. 2013;71(1):18–24.PubMedCrossRef
27.
Agostinho HA, Furtado IÁ, e Silva FS, Ustrell Torrent J. Cephalometric evaluation of children with allergic rhinitis and mouth breathing. Acta Med Port. 2015;28(3):316–21.PubMedCrossRef
28.
Souki BQ, Lopes PB, Pereira TB, Franco LP, Becker HM, Oliveira DD. Mouth breathing children and cephalometric pattern: does the stage of dental development matter? Int J Pediatr Otorhinolaryngol. 2012;76(6):837–41.PubMedCrossRef
29.
Yang K, Zeng X, Yu M. A study on the difference of craniofacial morphology between oral and nasal breathing children. Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chin J Stomatol. 2002;37(5):385–7.
30.
Sousa JBR, Anselmo-Lima WT, Valera FCP, Gallego AJ, Matsumoto MAN. Cephalometric assessment of the mandibular growth pattern in mouth-breathing children. Int J Pediatr Otorhinolaryngol. 2005;69(3):311–7.PubMedCrossRef
31.
Wang MF, Li S, Liu L. Influence on the condyle position by decreasing posterior occlusal plane angle in Class II high angle cases. Shanghai kou qiang yi xue = Shanghai J Stomatol. 2018;27(4):386–9.
32.
Kwon HB, Kim H, Jung WS, Kim TW, Ahn SJ. Gender differences in dentofacial characteristics of adult patients with temporomandibular disc displacement. J Oral Maxillofac Surg. 2013;71(7):1178–86.PubMedCrossRef
33.
Kim DK, Rhee CS, Yun PY, Kim JW. Adenotonsillar hypertrophy as a risk factor of dentofacial abnormality in Korean children. Eur Arch Oto-Rhino-Laryngol. 2015;272(11):3311–6.CrossRef
34.
El Aouame A, Daoui A, El Quars F. Nasal breathing and the vertical dimension: a cephalometric study. Int Orthod. 2016;14(4):491–502.PubMed
35.
Peltomäki T. The effect of mode of breathing on craniofacial growth—Revisited. Eur J Orthod. 2007;29(5):426–9.PubMedCrossRef
36.
Freng A. Restricted nasal respiration, influence on facial growth. Int J Pediatr Otorhinolaryngol. 1979;1(3):249–54.PubMedCrossRef
37.
Pacheco MC, Fiorott BS, Finck NS, Araújo MT. Craniofacial changes and symptoms of sleep-disordered breathing in healthy children. Dental Press J Orthod. 2015;20(3):80–7.PubMedPubMedCentralCrossRef
38.
Fraga WS, Seixas VM, Santos JC, Paranhos LR, César CP. Mouth breathing in children and its impact in dental malocclusion: a systematic review of observational studies. Minerva Stomatol. 2018;67(3):129–38.PubMed
39.
O’Ryan FS, Gallagher DM, LaBanc JP, Epker BN. The relation between nasorespiratory function and dentofacial morphology: a review. Am J Orthod. 1982;82(5):403–10.PubMedCrossRef
40.
Hultcrantz E, Larson M, Hellquist R, Ahlquist-Rastad J, Svanholm H, Jakobsson OP. The influence of tonsillar obstruction and tonsillectomy on facial growth and dental arch morphology. Int J Pediatr Otorhinolaryngol. 1991;22(2):125–34.PubMedCrossRef
41.
Subtelny JD. Oral respiration: facial maldevelopment and corrective dentofacial orthopedics. Angle Orthod. 1980;50(3):147–64.PubMed
42.
Kukwa W, Guilleminault C, Tomaszewska M, Kukwa A, Krzeski A, Migacz E. Prevalence of upper respiratory tract infections in habitually snoring and mouth breathing children. Int J Pediatr Otorhinolaryngol. 2018;107:37–41.PubMedCrossRef
43.
Leal RB, Gomes MC, Granville-Garcia AF, Goes PS, de Menezes VA. Impact of breathing patterns on the quality of life of 9- to 10-year-old schoolchildren. Am J Rhinol Allergy. 2016;30(5):147–52.PubMedCrossRef
44.
Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Association between oral habits, mouth breathing and malocclusion. Acta otorhinolaryngologica Italica: organo ufficiale della Societa italiana di otorinolaringologia e chirurgia cervico-facciale. 2016;36(5):386–94.
45.
Tachibana M, Kato T, Kato-Nishimura K, Matsuzawa S, Mohri I, Taniike M. Associations of sleep bruxism with age, sleep apnea, and daytime problematic behaviors in children. Oral Dis. 2016;22(6):557–65.PubMedCrossRef
46.
Bonuck KA, Chervin RD, Cole TJ, Emond A, Henderson J, Xu L, Freeman K. Prevalence and persistence of sleep disordered breathing symptoms in young children: a 6-year population-based cohort study. Sleep. 2011;34(7):875–84.PubMedPubMedCentralCrossRef
47.
Pereira L, Monyror J, Almeida FT, Almeida FR, Guerra E, Flores-Mir C, Pachêco-Pereira C. Prevalence of adenoid hypertrophy: a systematic review and meta-analysis. Sleep Med Rev. 2018;38:101–12.PubMedCrossRef
Metadata
Title
Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis
Authors
Ziyi Zhao
Leilei Zheng
Xiaoya Huang
Caiyu Li
Jing Liu
Yun Hu
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Oral Health / Issue 1/2021
Electronic ISSN: 1472-6831
DOI
https://doi.org/10.1186/s12903-021-01458-7

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