Title	Adenoidectomy and/or Tonsillectomy has a Beneficial Role on Occlusion of Permanent Dentition in Preadolescent Children with Hypertrophic Adenoids and/or Tonsils
Clinical Question	Does adenoidectomy and tonsillectomy in preadolescent children with hypertrophic adenoids and/or tonsils, improve the occlusion of their permanent dentition?
Clinical Bottom Line	Adenoidectomy and tonsillectomy in preadolescent children with hypertrophic adenoids and/or tonsils, improves the occlusion of their permanent dentition.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22030968 Pereira/2011 38 patients of both genders, aged between 7 and 11 years grouped into: oral group, 18 patients with obstructive hypertrophy of pharyngeal tonsil and/or palate grade 3 or 4; control group, 20 patients with normal breathing. Cohort Study Key results Post adenotonsillectomy the axial tilt and the sagittal position of the upper (Is-APO (mm)) and lower incisor (Ii-APO (0) and Ii-APO (mm)) teeth increased significantly (P<0.05) tending towards clinical normality. After treatment patients also had significant (P<0.05) increase in the overbite, which means improvements in the trend towards anterior open bite the patient had before the adenotonsillectomy. 8480710 Linder-Aronson/1993 81 children underwent adenoidectomies. 21 were excluded as they had otitits media. 60 children remained in the treatment group and were age and gender matched with 81 children in the control group Cohort Study Key results Sagittal size in nasopharyngeal airway increased significantly (10mm, p<0.001) in both boys and girls. Airflow through the nose increased significantly (p<0.05) and approached control levels 1 year post adenoidectomy. There were significant changes in the labial inclination of both upper and lower incisors post adenoidectomy in both sexes with the exception of the female maxillary incisors. Girls displayed a significantly greater (p<0.01) horizontal mandibular growth (mean 61.20 vs 72.30 in controls) while boys showed increased maxillary arch length.
Evidence Search	("adenoidectomy"[MeSH Terms] OR "adenoidectomy"[All Fields]) AND ("tonsillectomy"[MeSH Terms] OR "tonsillectomy"[All Fields]) AND ("dental occlusion"[MeSH Terms] OR ("dental"[All Fields] AND "occlusion"[All Fields]) OR "dental occlusion"[All Fields])
Comments on The Evidence	In the Linder-Aronson and Pereira study all groups were similar at the start, treated the same and had adequate follow up. There was >80% completion rate in the Pereira study while the Linder-Aronson had a 60% completion rate at the end of the 5 year the study. To minimize operator error the Linder-Aronson study used two independent clinicians (otolaryngologist and orthodohtist) to recorded/collect data and any variations of 1mm or more were invalidated and measurements retaken.
Applicability	These studies supports the rationale that changes in breathing after adenoidectomy and/or tonsillectomy is associated with significant changes in both the position of the incisors and mandibular/maxillary arch length. These changes combined were shown to significantly improve occlusion of dentition in pre-adolescents patients. Furthermore, adenotonsillectomy may prove to be beneficial in patients who are in their growth phase, as this treatment may be effective in preventing dental malocclusions from becoming difficult to treat or even becoming permanent. Adenoidectomy and/or tonsillectomy are both simple procedures that are low cost and easy to guarantee compliance.
Specialty	(Orthodontics) (Pediatric Dentistry)
Keywords	Adenoidectomy Tonsillectomy Dental Occlusion
ID#	2895
Date of submission	04/03/2015
E-mail	Laings@uthscsa.edu
Author	Suzette D. Laing
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Peter Gakunga, BDS, MS, PhD
Faculty mentor e-mail	GAKUNGA@uthscsa.edu
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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available