INTRODUCTION: Mouth breathing (MB) is an etiological factor for sleep-disordered breathing (SDB) during childhood. The habit of breathing through the mouth may be perpetuated even after airway clearance. Both habit and obstruction may cause facial muscle imbalance and craniofacial changes. OBJECTIVE: The aim of this paper is to propose and test guidelines for clinical recognition of MB and some predisposing factors for SDB in children. METHODS: Semi-structured interviews were conducted with 110 orthodontists regarding their procedures for clinical evaluation of MB and their knowledge about SDB during childhood. Thereafter, based on their answers, guidelines were developed and tested in 687 children aged between 6 and 12 years old and attending elementary schools. RESULTS: There was no standardization for clinical recognition of MB among orthodontists. The most common procedures performed were inefficient to recognize differences between MB by habit or obstruction. CONCLUSIONS: The guidelines proposed herein facilitate clinical recognition of MB, help clinicians to differentiate between habit and obstruction, suggest the most appropriate treatment for each case, and avoid maintenance of mouth breathing patterns during adulthood.

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB.

Objetivo: este estudo avaliou a relação clínica entre a forma de aleitamento da criança, orientação prévia das mães sobre amamentação natural, instalação de hábitos de sucção não-nutritivos e a presença de más oclusões. Metodologia: foram examinadas 79 crianças (39 com hábitos de sucção e 40 sem hábitos de sucção), de ambos os gêneros, entre 2 e 5 anos, com a dentadura decídua completa e sem perda de tecido dentário interproximal, selecionadas de maneira randomizada, que participavam do Projeto de Bebês da Universidade Federal do Espírito Santo. Apenas um examinador (Kappa intra-examinador: 0,96) avaliou as características faciais e oclusais das crianças, no sentido ântero-posterior, transversal e vertical. As mães foram instruídas a responderem um questionário sobre o desenvolvimento da criança e o grau de orientação prévia que receberam sobre amamentação natural, hábitos, más oclusões e respiração bucal. Foram empregados os testes estatísticos qui-quadrado, teste exato de Fischer, t de Student e Odds Ratio. Resultados: os resultados mostraram que: 1) existe uma relação estatisticamente significante entre o prolongamento do aleitamento materno e a redução da instalação de hábitos de sucção (p<0,01); 2) a orientação prévia das mães sobre amamentação natural resultou num prolongamento no tempo de aleitamento natural, para crianças com e sem hábitos (p<0,01); 3) crianças com hábitos tiveram maior risco relativo de desenvolver más oclusões no sentido vertical (OR: 12,8), transversal (OR: 4,25) e alteração ântero-posterior na relação dos caninos (p<0,01). A alteração da relação ântero-posterior dos segundos molares decíduos não mostrou diferença estatisticamente significante (p:0,07). Conclusão: os resultados sugerem que o grau de informação das mães e o prolongamento do período de aleitamento natural estão diretamente relacionados com a menor incidência de más oclusões nessa fase do desenvolvimento da criança. ResumoPalavras-chave: Hábitos de sucção. Má oclusão. Amamentação.

These data confirm an increase in the AHI on the night following UPPP with or without septoplasty. This increase promotes an absence of nocturnal dipping and a significant increase in urinary catecholamine levels. CPAP therapy was effective to prevent the transitory increase in BP.