Estudo da incidência de distúrbios do sono, associados à cárie dentária, má oclusão e hábitos bucais deletérios em pré-escolares
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Data
2018-03-01
Autores
Castilho, Ricardo Leão
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Universidade Estadual Paulista (Unesp)
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Introdução: Os distúrbios do sono tem ganho crescente importância em pediatria. Além do ronco, abrange distúrbios mais graves, como a Síndrome da Apneia Obstrutiva do Sono (SAOS). Crianças que apresentam esta síndrome passam por um desenvolvimento inadequado da face e da oclusão. Os distúrbios do sono afetam a qualidade de vida das crianças e estão relacionados à respiração bucal, uma das principais causas de má oclusão. Alterações nos mecanismos de defesa mediados pela saliva e hábitos bucais deletérios podem estar associados a cáries, mudanças na erupção dentária e desenvolvimento dos maxilares, respectivamente. Objetivo: Estudar a incidência de respiração bucal e sua associação com distúrbios do sono, má oclusão, cárie dentária e hábitos bucais deletérios, em pré-escolares. Métodos: Em um estudo transversal, 3 escolas com diferentes indicadores socioeconômicos, foram selecionadas pela Secretaria de Educação de Botucatu/SP. Das 417 crianças, que concordaram em participar, 152 completaram o protocolo proposto. As crianças, com idade entre 6 e 9 anos, de ambos os sexos, foram convidadas a realizar avaliação clínica da cavidade oral e aplicação do questionário OSA-18, como screening para risco de SAOS, entre maio de 2016 e novembro de 2017. Resultados: 89 (59%) apresentaram respiração bucal (RB), sendo 40 (45%) com má oclusão, 50 (56%) com cárie dentária, 34 (38%) com perda dentária, 45 (51%) com bruxismo e 46 (52%) com o hábito de chupar dedo ou chupeta, comparado a 40%, 40%, 21%, 27% e 43%, respectivamente, nas 63 crianças com respiração nasal (RN). 35 RB mostraram moderado a alto risco para SAOS, enquanto apenas 8 dos RN mostraram risco moderado. A pontuação média do OSA-18 foi 50, sendo que 109 (72%) crianças mostraram baixo risco e dentre estas, 54 (50%) apresentaram respiração bucal, 48 (44%) má oclusão, 49 (45%) cárie dentária, 30 (28%) perda dentária, 41 (38%) bruxismo e 48 (44%) chuparam dedo ou chupeta. Nas 29 (19%) com risco moderado, as proporções foram 74%, 26%, 61%, 35%, 42% e 55%, e nas 14 (9%) com alto risco, foram 100%, 75%, 58%, 50%, 67% e 67%, respectivamente. Não foi encontrada diferença estatística significativa nos resultados do questionário OSA-18 para grave impacto entre os gêneros (p=0,4421) e as faixas etárias (p=0,0634), mas foi encontrada entre a incidência de respiração bucal (p=0,0010) e de bruxismo (p=0,0144). Conclusão: Foram observadas frequências elevadas de distúrbios respiratórios, com repercussão no sono, associados a alterações bucais, reforçando a correlação entre respiração bucal em crianças e complicações no crescimento craniofacial.
Introduction: Sleep-disordered breathing have gained importance in pediatrics. In addition to snoring, this term also encompasses more severe disorders like obstructive sleep apnea syndrome (OSAS). Children with this syndrome have inadequate development of the face and occlusion. Sleep disorders affect children's quality of life and it is related to oral breathing, one of the major causes of malocclusion. Alterations in the saliva-mediated defense mechanisms and deleterious oral habits may be associated with caries, changes in dental eruption and development of jaws, respectively. Objective: To study the incidence of mouth breathing and its association with sleep disorders, dental caries, malocclusion and deleterious oral habits, in preschoolers. Methods: In a cross-sectional study, 3 schools with different socioeconomic indicators were selected by the Education Department of Botucatu/SP. Of the 417 children, who agreed to participate, 152 completed the proposed protocol. The children, aged between 6 and 9 years, of both sexes, were invited to perform clinical evaluation of the oral cavity and the application of the OSA-18 questionnaire as a screening for OSA risk between May 2016 and November 2017. Results: 89 (59%) presented mouth breathing (MB), being 40 (45%) with malocclusion, 50 (56%) with dental caries, 34 (38%) with tooth loss, 45 (51%) with bruxism and 46 (52%) with the habit of sucking finger or pacifier, compared to 40%, 40%, 21%, 27% and 43%, respectively, in the 63 children with nasal breathing (NB). 35 MB showed moderate to high risk for OSAS, while only 8 of the newborns showed moderate risk. The average score of OSA-18 was 50, with 109 (72%) children showing low risk, and among these, 54 (50%) presented mouth breathing, 48 (44%) malocclusion, 49 (45%) dental caries, 30 (28%) tooth loss, 41 (38%) bruxism and 48 (44%) sucked finger or pacifier. In the 29 (19%) with moderate risk, the proportions were 74%, 26%, 61%, 35%, 42% and 55%, and in the 14 (9%) with high risk, they were 100%, 75%, 58 %, 50%, 67% and 67%, respectively. No significant statistical difference was found in the results of the OSA-18 questionnaire for severe impact between genders (p=0.4421) and age groups (p=0.0634), but was found between the incidence of mouth breathing (p=0.0010) and bruxism (p=0.0144). Conclusion: High frequencies of respiratory disorders with sleep repercussions associated with oral alterations were observed, reinforcing the correlation between mouth breathing in children and complications in craniofacial growth.
Introduction: Sleep-disordered breathing have gained importance in pediatrics. In addition to snoring, this term also encompasses more severe disorders like obstructive sleep apnea syndrome (OSAS). Children with this syndrome have inadequate development of the face and occlusion. Sleep disorders affect children's quality of life and it is related to oral breathing, one of the major causes of malocclusion. Alterations in the saliva-mediated defense mechanisms and deleterious oral habits may be associated with caries, changes in dental eruption and development of jaws, respectively. Objective: To study the incidence of mouth breathing and its association with sleep disorders, dental caries, malocclusion and deleterious oral habits, in preschoolers. Methods: In a cross-sectional study, 3 schools with different socioeconomic indicators were selected by the Education Department of Botucatu/SP. Of the 417 children, who agreed to participate, 152 completed the proposed protocol. The children, aged between 6 and 9 years, of both sexes, were invited to perform clinical evaluation of the oral cavity and the application of the OSA-18 questionnaire as a screening for OSA risk between May 2016 and November 2017. Results: 89 (59%) presented mouth breathing (MB), being 40 (45%) with malocclusion, 50 (56%) with dental caries, 34 (38%) with tooth loss, 45 (51%) with bruxism and 46 (52%) with the habit of sucking finger or pacifier, compared to 40%, 40%, 21%, 27% and 43%, respectively, in the 63 children with nasal breathing (NB). 35 MB showed moderate to high risk for OSAS, while only 8 of the newborns showed moderate risk. The average score of OSA-18 was 50, with 109 (72%) children showing low risk, and among these, 54 (50%) presented mouth breathing, 48 (44%) malocclusion, 49 (45%) dental caries, 30 (28%) tooth loss, 41 (38%) bruxism and 48 (44%) sucked finger or pacifier. In the 29 (19%) with moderate risk, the proportions were 74%, 26%, 61%, 35%, 42% and 55%, and in the 14 (9%) with high risk, they were 100%, 75%, 58 %, 50%, 67% and 67%, respectively. No significant statistical difference was found in the results of the OSA-18 questionnaire for severe impact between genders (p=0.4421) and age groups (p=0.0634), but was found between the incidence of mouth breathing (p=0.0010) and bruxism (p=0.0144). Conclusion: High frequencies of respiratory disorders with sleep repercussions associated with oral alterations were observed, reinforcing the correlation between mouth breathing in children and complications in craniofacial growth.
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distúrbios respiratórios, respiração bucal, má oclusão, cárie dentária, bruxismo