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Title Mouth breathing and Posterior Cross-Bite
Clinical Question In growing children, does upper airway nasal respiratory obstruction in combination with mouth breathing increase the incidence of posterior cross-bite?
Clinical Bottom Line Yes, mouth breathing in conjunction with upper airway nasal respiratory obstruction increases the risk of posterior cross-bite based upon the current best evidence.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 19282036Souki/2009401 children, age 2-12Cross-sectional case series
Key resultsThis study showed that children with mouth breathing nasal respiratory impairment more frequently exhibited posterior cross-bite than the general population.
#2) 8054305Oulis/1994120 children ranging from 3-8 yearsCase series
Key resultsPosterior cross-bite presence is higher in children with upper respiratory airway obstruction.
#3) 20352571Stellzig-Eisenhauer/2010N/AReview
Key resultsOulis and Souki articles were reviewed in this article. Prevalence of lateral crossbite in nasal airway obstructed children was increased in comparison with the overall population.
Evidence Search Mouth breathing posterior cross-bite OR nasopharyngeal airway and craniofacial complex.
Comments on
The Evidence
Souki- Each child was evaluated by otorhinolaryngologist to confirm mouth breathing. The dental clinical examinations were performed by 10 orthodontists who were previously calibrated and had worked together. Oulis- The sample population consisted of 120 children aged 3-8 years old who were to receive an adenoidectomy. Clinical examinations of upper respiratory airways were performed by an ENT doctor to determine severity of upper respiratory obstruction and verified blindly by radiologists. In general, this article was valid according to our validity standards. Stellzig-Eisenhaur- This review was inclusive of the available publications up to the time that this review was published in April 2011. This was published in an Otorhinolaryngology head and neck surgery journal. There were only two articles that represented a correlation with upper nasal airway obstruction. Those two articles were the above two articles cited in this CAT. The articles that we reviewed had no competing interests.
Applicability These articles are pertinent to pre-adolescent children with upper airway obstruction, mouth breathers, and those with posterior cross-bite.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords Posterior Cross-bite, upper airway nasal obstruction
ID# 2258
Date of submission: 04/13/2012spacer
E-mail ryanjk@livemail.uthscsa.edu
Author Joseph Ryan
Co-author(s) e-mail
Faculty mentor/Co-author Damon Wilkerson, DDS
Faculty mentor/Co-author e-mail orthodont@aol.com
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
post a rationale
None available
Comments and Evidence-Based Updates on the CAT
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by Thien Ho, Juan Verastegui (San Antonio, Texas) on 11/30/2017
A PubMed search performed in November 2017 results in a longitudinal cohort study: Moimaz, 2014 (PMID# 25091288) and across section study: Grippaudo, 2016 ( PMID# 27958599) as more recent evidence. Collective results show that posterior crossbite was associated with nocturnal mouth breathing at 12 and 18 months and with bottle feeding at 12 and 30 months. Additionally, that mouth breathing both increased and decreased overjets past the normal range, which both led to an increased posterior cross-bite. This data supports the clinical statement from CAT#2258 that mouth breathing does increase the risk of resultant posterior cross-bites.

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