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200 rev port estomatol med dent cir maxilofac. 2017;58(4):199-204

Prevalência de má-oclusão em crianças com obstrução
das vias aéreas superiores

r e s u m o

Palavras-chave: Objetivos: Determinar a prevalência das má-oclusões dentárias em crianças respiradoras
Adenóides orais, bem como a sua associação com o tipo de obstrução das vias aéreas superiores.
Rinite alérgica Métodos: 1002 crianças respiradoras orais, com idade média de 6,7 ± 2,7, foram avaliadas
Má-oclusão num centro hospitalar por uma equipa multidisciplinar. A relação das arcadas dentárias no
Respiração oral sentido vertical, sagital e tranversal foi registada e o teste do qui-quadrado foi utilizada para
Prevalência determinar a associação entre obstrução das vias aéreas superiores (por hipertrofia das
Amígdalas amígdalas ou dos adenóides e/ou por rinite alérgica), e as más-oclusões.
Resultados: A hipertrofia das amígdalas esteve presente em 41,3%, a hipertrofia dos adenói-
des em 54,1% e a rinite alérgica em 68,0% das crianças avaliadas. As má-oclusões com
mordida aberta e classe II de Angle foram encontradas em aproximadamente 30% da amos-
tra, enquanto que a mordida cruzada posterior esteve presente em 25% das crianças. Mais
da metade das crianças respiradoras orais tinham uma relação inter-arcadas normal no
plano sagital (59,3%), vertical (53,0%) e transversal (75,1%). A análise estatística não demons-
trou nenhuma associação significativa entre o tipo de obstrução respiratória e as má-oclu-
sões dentárias.
Conclusões: A maioria das crianças com respiração oral apresentaram oclusão dentária nor-
mal nos três planos do espaço avaliados. A associação entre classe II de Angle, mordida
aberta e mordida cruzada posterior e o tipo de obstrução respiratória não foi significativa.
(Rev Port Estomatol Med Dent Cir Maxilofac. 2017;58(4):199-204)
© 2017 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Publicado por SPEMD. Este é um artigo Open Access sob uma licença CC BY-NC-ND
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

mouth opened without labial sealing at rest, short and hypo-
Introduction
tonic upper lip, everted lower lip, short and underdeveloped
For normal craniofacial growth to occur, a fine balance be- nose, more inferiorly and anteriorly positioned tongue, labial-
tween stomatognathic functions, according to the genetic ly inclined upper incisors and allergic shiners. 10
and morphological patterns of each person, is essential. Chronic oral breathers are expected to have maxillary atre-
Breathing is a vital function that occurs permanently, and sia, posterior crossbite, excessive vertical growth pattern, an-
therefore oral breathing could have a deep impact on dento- terior open bite and class II malocclusion. Although these
11
facial development. Upper airway obstructions can change classic features of oral breathers are fully described in the
1
the normal naso-respiratory function by restricting the air literature, epidemiological studies have shown that typical
flow passage, thus making oral breathing required for air to “adenoid facies” are not common in mouth-breathing children,
2
reach the lungs. Tonsils and adenoids hypertrophy, polyps, in whom, moreover, normal occlusal relationships are fre-
allergies, recurrent infections and nasal deformities can quently found. 12-14 Some authors have even questioned the
cause oral breathing, which in turn may lead to muscular, association between the respiratory pattern and the dentofa-
postural and dentofacial changes. The association between cial morphology. Isolated skeletal features such as increased
dentofacial abnormalities and breathing has been studied lower anterior facial height and maxillary constriction have a

since the mid-nineteenth century and is a subject of great in- higher prevalence in oral breathers; however, contrary to what
terest for pediatricians, otorhinolaryngologists, allergists, or- would be expected, Angle class I is the most common occlu-
thodontists, speech therapists, physiotherapists and other sion type, and not Angle class II. 15,16
health professionals dealing with patients’ growth. 3-7 The objective of this study was to report epidemiological
A positive association has been found between upper air- data on malocclusion prevalence among a group of children
way obstruction and various forms of malocclusion or skeletal consecutively referred to the mouth-breathing Ear Nose and
9
problems. Moss’s functional matrix theory can be applied to Throat Center in the Faculty of Medicine of the Federal Uni-
8
oral breathers based on the form-function relationship, since versity of Minas Gerais, Brazil. The hypothesis tested is that
nasal breathing impairments may change facial form, oral there is an association between upper airway obstructions
musculature and soft tissues. In 1872, Tomes introduced the caused by enlarged tonsils or adenoids and/or by allergic rhi-
concept of “adenoid facies” or long face syndrome to describe nitis and the presence of sagittal, transversal and vertical mal-
typical dentofacial characteristics in oral breathers, such as occlusions.