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ORTHO 159 1-17

2015 CEO
Published by / Edite par Elsevier Masson SAS
All rights reserved / Tous droits reserves

Original article
Article original

Occlusal characteristics of children


with hypertrophied adenoids in Nigeria
ristiques occlusales des enfants
Caracte
sentant des ve
 ge
tations hypertrophie
es
pre
ria
au Nige
Vivien Ijeoma OSIATUMAa, Olayinka Donald OTUYEMIa,
Kikelomo Adebanke KOLAWOLEa,*, Babatunde Ogunbiyi OGUNBANJOb,
Yemisi Bola AMUSAc
a

Department of Child Dental Health, Obafemi Awolowo University Teaching Hospitals


Complex, Ile-Ife, Nigeria
b
Department of Child Dental Health, Lagos State University Teaching Hospital, Ikeja, Nigeria
c
Otorhinolaryngology Unit, Department of Surgery, Obafemi Awolowo University, Ile-Ife,
Nigeria
Available online: XXX / Disponible en ligne : XXX

Summary

sume

Re

Background: Nasorespiratory function and its relation to craniofacial growth are of great interest because of the basic biological relationship between form and function, and the accumulating findings of the relationship between mode of
breathing, craniofacial growth and orthodontic treatment.

Contexte : La fonction nasorespiratoire et sa relation a` la crois et


^ certain en raison de la
sance cranio-faciale sont dun inter
connexion biologique fondamentale entre la forme et la fonc
tion et les decouvertes
toujours plus nombreuses reliant le
mode ventilatoire, la croissance cranio-faciale et le traitement
orthodontique.



Objectifs : Le but de cette etude
etait
devaluer
leffet de
 dienne et de variables sociolhypertrophie adeno


demographiques
sur locclusion denfants au Nigeria.

^ es
 de 3 a` 12 ans ont et
 e
Methodologie
: En tout, 180 sujets ag

 au CHU Obafemi, Ile-Ife, Nigeria.

selectionn
es
Quatre-vingt
 etations

 tandis
dix sujets presentaient
des veg
hypertrophiees

que 90 enfants normaux ont constitue le groupe temoin.
Les
 e effectues
 et des empreintes
examens orthodontiques ont et
 e prises pour realiser

 detude.

ont et
des modeles
Locclusion
 e evalu

 dans les sens anteropost


a et
ee
erieur,
transversal et
vertical.

 e locclusion la plus
Resultats
: Une relation de classe I a et

 dans les deux groupes, adeno
 diens
frequemment
observee

et temoins
(55,6 % et 72,2 %, respectivement). Lincidence

 ee

de relations de classe II, 1 etait
significativement plus elev

Objectives: The aim of this study was to evaluate the effect of


adenoid hypertrophy and sociodemographic variables on the
occlusion of children.
Methodology: A total of 180 subjects aged 312 years were
selected at the Obafemi Awolowo University Teaching
Hospital Complex, Ile-Ife, Nigeria. Ninety subjects had hypertrophied adenoids while 90 normal children served as the control group. Orthodontic examinations were carried out and
impressions for study models taken. Occlusion was assessed in
the anterior-posterior, transverse and vertical planes.
Results: Class I relationship was the most prevalent occlusion in
both adenoid and control subjects (55.6% and 72.2%, respectively). The occurrence of class II division 1 was significantly
higher among adenoid than control subjects (P = 0.003).

* Correspondence and reprints / Correspondance et tires a` part :


e-mail addresses / Adresses e-mail : kikelomokolawole@gmail.com,
kkole@oauife.edu.ng (Vivien Ijeoma OSIATUMA)

International Orthodontics 2010 ; X : 1-17


http://dx.doi.org/10.1016/j.ortho.2014.12.009

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

2015 CEO. Published by Elsevier Masson SAS. All rights


reserved

 diens que parmi les temoins



parmi les sujets adeno
 croises
 posterieurs


(p = 0,003). Les articules
etaient
signifi
 diens ag
^ es

cativement plus frequents
chez les sujets adeno

de 9 a` 12 ans. Dans le plan vertical, les supraclusions etaient

 diens que
significativement plus frequentes
chez les adeno
 diennes. Lage
^ a affiche une correlation

parmi les adeno
sta
tistiquement significative, quoique faible, avec les beances

^ et lIMC ont egalement

anterieures
(r = 0,37). Lage
montre


des correlations
significatives mais faibles avec les articules
 posterieurs

 diennes (r = 0,39 et
croises
chez les adeno

r = 0,36, respectivement). Lanalyse de regression
a

^ avait un effet significatif sur la
egalement
montre que lage



frequence
des beances
anterieures,
alors que lIMC a eu un

effet significatif sur la frequence
des occlusions de classe II
 diens (p < 0,05).
parmi les sujets adeno

 etations


Conclusion : La presence
de veg
hypertrophiees
^ et
affecte locclusion dans les trois plans de lespace. Lage


lIMC ont un impact significatif sur la frequence
des beances

anterieures
et les malocclusions de classe II, division 1,

 etations

respectivement, chez les sujets presentant
des veg

hypertrophiees.
2015 CEO. Edite par Elsevier Masson SAS. Tous droits
reserves

Key-words

s
Mots-cle

Posterior crossbites occurred significantly more in adenoid subjects in the 912 years category. In the vertical plane, the
occurrence of deep bite was significantly greater in male than
female adenoid subjects. Age had a statistically significant but
weak correlation with anterior open bite (r = 0.37). Age and
BMI also had significant though weak correlations with posterior crossbite in female adenoid subjects (r = 0.39 and r = 0.36,
respectively). Regression analysis also showed that age had a
significant effect on the occurrence of anterior open bite, while
BMI had a significant effect on the occurrence of class II
occlusion in adenoid subjects (P < 0.05).

Conclusion: The presence of hypertrophied adenoids affects the


occlusion in the three planes. Age and BMI have significant
effects on the occurrence of anterior open bite and class II
division 1 malocclusion respectively in adenoid subjects.

Adenoid hypertrophy.
Mouth breathing.
Occlusion.
Malocclusion.

nodienne.
Hypertrophie ade
Respiration orale.
Occlusion.
Malocclusion.

Introduction

Introduction

It is established that respiratory needs are the primary determinants of the posture of the jaws and tongue and to a lesser
extent, of the cranium itself [1]. Therefore, an altered respiratory pattern due to mouth breathing can cause postural alterations such as open lips, lowered or anterior tongue position,
and posterior inferior rotation of the mandible in order to
stabilize the airway [2,3]. Postural alterations in soft tissues
have been said to change the equilibrium of the pressure
exerted on teeth and facial bones, thus altering these structures [36]. Nasal obstruction leading to an alteration in mode
of breathing can be due to a variety of factors such as enlarged
turbinates, hypertrophied adenoids, deviation of the nasal
septum, allergy and chronic inflammation of the membranes
with oedematous nasal mucosa, choanal atresia and tumours of
the nose and nasopharynx [79]. However, enlarged nasopharyngeal adenoids have been reported as one of the most frequent causes of nasal obstruction [3,911]

tabli que les besoins respiratoires sont les


Il est bien e
 le
ments primordiaux pour la de
termination de la posture
e
^choires et de la langue et, dans une moindre mesure,
des ma
^ ne lui-me
^me [1]. Il sen suit quune modification du mode
du cra
respiratoire en faveur de la respiration orale peut provoquer
cartement des le
vres,
des changements de posture tels que le
e de la langue ou la rotation postlabaissement ou lavance
rieure infe
rieure de la mandibule afin de stabiliser les voies
e
riennes [2,3]. Les alte
rations posturales des tissus mous
ae
quilibre des pressions
modifieraient, selon certains auteurs, le
qui sexercent sur la denture et sur les os du visage, remaniant
ainsi ces structures [36]. Les obstructions nasales qui donma de respiration peuvent
nent lieu a` une modification du sche
 ge
tations
relever de plusieurs facteurs : cornets agrandis, ve
es, de
viation de la cloison nasale, allergies ou
hypertrophie
me de la
inflammation chronique des membranes avec de
sie choanale et tumeurs nasales et
muqueuse nasale, atre
es [79]. Il a e
 te
 rapporte
, ne
anmoins, que les
nasopharynge
 ge
tations nasopharynge
es hypertrophie
es sont lune des
ve
quentes de lobstruction nasale [3,911].
causes les plus fre

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

The relationship between hypertrophied adenoids, mouth


breathing, and how it results in peculiar facial characteristics
and malocclusion of either the dental arches or the dentition
have long been a subject of intense research, studies and
controversies [3,12,13]. However, previous published literature regarding this relationship has mostly dealt with selected
patients in the Western world [24,8,9]. A search through the
literature suggests that studies in this area are scarce in the
Nigerian population [14].
In experiments that induced oral respiration in primates,
Harvold et al. confirmed that environmental impact such as
severe airway obstruction can produce major malocclusion
symptoms [15]. Linder-Aronson and others also demonstrated
features such as steep mandibular plane angle, narrow maxillary arches and retroclined mandibular incisors in mouthbreathing individuals [16].
According to previous reports, mouth breathing may be associated with various types of occlusion [46]. However, it has
been reported that class II malocclusion is somewhat more
commonly associated with patients with hypertrophied adenoids [3,7,17,18]. In another study of 7-year-olds with atopic
(allergic) diseases, mouth-breathers had significantly more
class II and cusp-to-cusp sagittal molar relationships compared with the nose-breathers [19]. Mouth breathing allergic
children have been shown to have narrower maxillary arches
compared with nose-breathers [13].
A sound knowledge of occlusal characteristics plays a major
role in orthodontics [20]. Occlusal characteristics affects dental aesthetics, availability of space, and stability of the dentition [20,21]. With increasing awareness of the benefits of
orthodontic treatment, patients with enlarged adenoids may
present for correction of dental irregularities that may be
associated with their condition. It is therefore important that
the clinician is familiar with occlusal characteristics peculiar
to this group of individuals. This study was therefore carried
out to evaluate the effect of adenoid hypertrophy and sociodemographic variables on the occlusion of children and to
compare the findings with that of control subjects.

ge
tations hypertrophie
es, la respiration
Les liens entre les ve
 percussions en termes danomalies faciales et
orale et leurs re
de malocclusions des arcades dentaires ou de la denture
tudes et de
font lobjet depuis longue date de recherches, de
rature
controverses intenses [3,12,13]. Cependant, la litte
e surtout sur
existante concernant ces relations sest focalise
des patients dans le monde occidental [24,8,9]. Une
rature sugge
 re que les e
tudes dans ce
recherche de la litte
 riane sont rares [14].
domaine sur la population nige
alise
 des expe
riences ou` ils ont
Harvold, Tomer et al. ont re
induit la respiration orale chez des primates. Ils ont ainsi
 que des influences environnementales telles quune
confirme
 ve
re des voies ae
riennes peuvent de
clencher
obstruction se
^mes majeurs de malocclusion [15]. Linderdes sympto
galement souligne
 limportance, chez les
Aronson et al. ont e
ristiques telles quun angle
respirateurs buccaux, de caracte
important du plan mandibulaire, lendognathie maxillaire ou la
 troversion des incisives mandibulaires [16].
re
tudes, la respiration buccale serait associe
e
Selon diverses e
 te
 rapporte
, cependant,
a` divers types docclusion [46]. Il a e
es plus
que les malocclusions de classe II sont associe
quemment a` des patients pre
sentant des ve
ge
tations
fre
es [3,7,17,18]. Dans une autre e
tude portant
hypertrophie
^ge
s de 7 ans atteints de maladies atopiques
sur des enfants a
sentaient un nom(allergiques), les respirateurs buccaux pre
leve
 de classes II et de relations
bre significativement plus e
s aux respiramolaires sagittales cuspide a` cuspide compare
 te
 de
montre
 que les enfants allergiteurs nasaux [19]. Il a e
sentent une arcade maxillaire
ques respirateurs buccaux pre
troite par rapport aux respirateurs nasaux [13].
plus e
ristiques de locclusion
Une bonne connaissance des caracte
ristiques
est primordiale en orthodontie [20]. Les caracte
tique des dents, lespace dispoocclusales influent sur lesthe
 de la denture [20,21]. De plus en plus
nible, et la stabilite
conscients des avantages du traitement orthodontique, les
sentant des ve
 ge
tations hypertrophie
es consulpatients pre
es
tent parfois pour se faire corriger les anomalies dentaires lie
a` cette affection. Il est donc important que le clinicien soit bien
 des caracte
ristiques occlusales spe
cifiques a` ce
informe
quent, cette e
tude a e
 te
 re
alise
e
groupe de sujets. Par conse
valuer limpact de lhypertrophie ade
nodienne et des
afin de
mographiques sur locclusion des enfants
variables socio-de
sultats avec ceux de sujets te
moins.
et de comparer les re

Materials and methods

riel et me
thodes
Mate

The study was carried out in Obafemi Awolowo University


Teaching Hospital Complex. (OAUTHC), a tertiary Hospital
in Ile-Ife, South-Western Nigeria. It was a cross-sectional
survey whose population consisted of a total of 180 children
in the primary and mixed dentition between the ages of 3
12 years. The children were divided into experimental and
control groups:
experimental/adenoid group: consisted of 90 children
between the ages of 312 years, attending the Ear, Nose and

tude a e
 te
 re
alise
e au CHU Obafemi Awolowo, ho
^pital
Cette e
 a` Ile-Ife au Nige
 ria du sud-ouest. Il sagit dune
tertiaire situe
^te transversale portant sur 180 enfants a
^ ge
s de 3
enque
 te

a` 12 ans en denture primaire ou mixte. Les enfants ont e
 partis en deux groupes, un groupe expe
rimental et un
re
moin :
groupe te

International Orthodontics 2010 ; X : 1-17

rimental/ade
nodien consistait en 90 enfants
le groupe expe
^ ge
s de 3 a` 12 ans consultant a` la clinique ORL du CHU
a

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

Throat Clinic of Obafemi Awolowo University Teaching


Hospital Complex (OAUTHC) who had been diagnosed clinically and radiographically with hypertrophied adenoids;
the control group: consisted of 90 children aged between
312 years recruited from patients attending the Child Dental
Health clinic of the OAUTHC. They were interviewed to rule
out any clinical presentations of adenoidal hypertrophy.
Each of the study populations was further subdivided into
three age groups based on the stage of dental development.
Primary dentition category was made up of 3- to 5-year-olds,
early mixed dentition category the 6- to 8-year-olds and the
late mixed dentition/early permanent category was made up of
9- to 12-year-olds.
All consecutive children presenting in both clinics who met
the inclusion criteria were recruited into the study until
required sample size was attained. Sample size was determined as 174 subjects for both groups in order to detect a
statistically significant difference of 20% between study
groups, at 80% power where P < 0.05, this was rounded up
to 180. The selection of participants was based on the following criteria: clinical/radiographic diagnosis of enlarged adenoids, subjects between the ages of 312 years, both parents
were Nigerians by nationality and children who had no history
of previous orthodontic treatment. Post-adenoidectomy
patients, children with oro-facial developmental anomalies,
very ill children and those not consenting to take part in the
study were excluded.
Ethical approval was sought and obtained from the Obafemi
Awolowo University Teaching Hospitals Complex Ethical
Review Committee. Informed consent was obtained from the
parents or guardians of those subjects willing to participate in
the study. The procedure for the collection of data, the benefits
of the research, the confidentiality of data collected, the risks
and discomfort of the procedure were all carefully explained to
the children and their parents or guardians. The voluntary
participation of the subjects or withdrawal from the study at
any time without prejudice was also assured.
Demographic and anthropometric data were obtained for participants in both study groups including age, sex and ethnicity.
Their weight and height were measured in kilograms and
metres respectively. The body mass index (BMI) was calculated by dividing the weight (kg) by height in meters squared
(m2). The BMI values from all participants were grouped into
normal, low, and high values appropriate for age and sex. This
was based on the age and sex specific cut off points of BMI for
children aged 218 years provided by Cole et al. [22].

Intra-oral orthodontic examination was performed with the


mouth open and later with the teeth in occlusion using examination gloves and a mouth mirror.

 te
 diagnostique
s par examen
Obafemi Awolowo qui avaient e
clinique et radiographique avec une hypertrophie
nodienne ;
ade
moin consistait en 90 enfants a
^ge
s de 3
le groupe te
 dentaire du CHU
a` 12 ans consultant a` la clinique de sante
 te
 interviewe
s pour e
carter toute
Obafemi Awolowo. Ils ont e
sentation dhypertrophie ade
nodienne.
pre
tude a e
 te
 sous-divise
e en
Chacune des populations dans le
^ge en fonction du de
veloppement dentaire. La
trois groupes da
gorie dentition primaire comprenait les enfants de 3
cate
gorie dentition mixte pre
coce les enfants
a` 5 ans, la cate
gorie dentition mixte tardive ou
de 6 a` 8 ans et la cate
coce les enfants de 9 a` 12 ans.
dentition permanente pre
sentant de facon conse
cutive dans les
Tous les enfants se pre
res dinclusion ont e
 te

deux cliniques et satisfaisant les crite
s dans le
tude jusqua` obtention de la taille
recrute
chantillon requise. Celle-ci a e
 te
 fixe
e a` 174 sujets afin de
de
tecter une diffe
rence statistiquement significative de 20 %
de
entre les deux groupes avec une puissance de 80 % et une
chantillon a finalement e
 te
 arrondi
valeur de p < 0,005. Le
lection des participants a e
 te
 base
e sur
a` 180 sujets. La se
res suivants : ve
 ge
tations hypertrophie
es diagles crite
es par examen clinique/radiologique, a
^ge entre 3 et
nostique
 nige
 riane, et aucun traite12 ans, deux parents de nationalite
rieur. Les patients postment orthodontique ante
inodectomie, les enfants pre
sentant des anomalies de
ade
veloppement orofacial, les enfants tre
s malades et ceux
de
tude ont e
te
 exclus.
qui ne voulaient pas prendre part a` le
thique a e
 te
 demande
e et obtenue aupre
s du
Lautorisation e
 de
thique du CHU Obafem Awolowo. Un consentement
comite
ae
 te
 obtenu aupre
s des parents ou des tuteurs des
informe
sireux de participer a` le
tude. La proce
dure de
sujets de
es, les avantages de cette e
tude, la
collecte de donne
 des donne
es recueillies et les risques et linconconfidentialite
s a` la proce
dure ont e
 te
 soigneusement explique
s
fort associe
re
aux enfants ainsi qua` leurs parents ou tuteurs. Le caracte
tude ainsi que la possibilite
 de
libre de la participation a` le
 judice ont
retrait a` nimporte quel moment et sans pre
galement e
 te
 souligne
s.
e
es de
mographiques et anthropome
triques,
Les donne
^ge, le sexe et lorigine ethnique, ont e
 te
 recueilcomprenant la
s des participants dans les deux groupes de
tude. Le
lies aupre
te
 releve
s en kilos et en
poids et la taille des sujets ont e
tres, respectivement. Lindice de masse corporelle (IMC)
me
 te
 calcule
 en divisant le poids (kg) par la taille en me
tres
ae
s (m2). Les valeurs IMC de tous les participants ont e
 te

carre
es selon les valeurs normales, faibles et e
leve
es
regroupe
es a` leur a
^ge et sexe. Ces parame
tres e
taient base
s
approprie
cifiques dIMC en fonction de la
^ge
sur les seuils limites spe
^ge
s de 2 a` 18 ans fournis par Cole
et du sexe denfants a
et al. [22].
 te
 re
alise
 a` bouche
Un examen orthodontique intraoral a e
ouverte et, plus tard, avec les dents en occlusion utilisant
des gants dexamen et un miroir buccal.

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

Anterior-posterior arch relationship was determined in the


permanent dentition using the British Standards Institutes
incisor classification [23] with the following classes:
class I incisal relationship: this was registered when the
lower incisors edges occluded with or lay immediately below
the cingulum plateau of the upper incisors;
class II incisal relationship: this was registered when the
lower incisors occluded posterior to the cingulum plateau of
the upper. Class II was registered with two subdivisions;
class II division 1: this was registered when the upper
central incisors were proclined, and there was an increase in
overjet;
class II division 2: this was registered when the upper
central incisors were retroclined, and the overjet was minimal
or slightly increased;
class III incisal relationship: this was registered when the
lower incisors edges occlude anterior to the cingulum plateau
of the upper and these teeth met either in an edge to edge
relationship or there was an obvious reverse overjet.
In the primary dentition, it was considered a class I dental
relationship when the upper primary canine occluded in the
embrasure between the lower primary canine and first primary
molar. Class II was registered when the maxillary primary
canine occluded mesial to class I, while class III was registered when the primary maxillary canine occluded distal to
class I.
Vertical relationship was classified as normal, anterior open
bite or deep bite.
A normal vertical relationship was registered when the upper
incisors overlapped one-third or less of the incisal edges of the
lower incisors. An open bite was registered in cases that
lacked any overlap or contact between the upper and lower
incisors involving two or more opposing teeth. A deep bite was
registered when more than half of the labial surfaces of the
lower incisors were overlapped by the incisal edges of the
upper incisors.
A transverse relationship was classified as either normal or
with posterior crossbite.
A normal transverse arch relationship was registered when the
buccal cusps of the upper posterior teeth overlapped the buccal cusps of the lower posterior teeth.
Posterior cross bite was registered when two or more posterior
maxillary teeth were in frank lingual cross bite with their lower
antagonists [24].
After intra-oral examination, impressions were made in alginate for all participants with disposable trays. Impressions
were rinsed under running water and disinfected with diluted

International Orthodontics 2010 ; X : 1-17

roposte
rieure des arcades a e
 te
 de
termine
e
La relation ante
dans la denture permanente a` laide de la classification des
incisives du British Standards Institute [23] et des classes
suivantes :
 te
 enregistre
e lors relation de classe I incisive : celle-ci a e
rieures e
taient en occlusion
que les bords des incisives infe
es imme
diatement en dessous, du plat
avec, ou positionne
rieures ;
cingulaire des incisives supe
 te
 enregistre
e
relation de classe II incisive : celle-ci a e
rieures e
taient en occlusion avec la
lorsque les incisives infe
rieure du plat cingulaire supe
rieure. La classe II a
partie poste
 te
 enregistre
e avec deux sous-divisions ;
e
 te
 enregistre
e lorsque les
classe II, division 1 : celle-ci a e
rieures e
taient en vestibuloversion et
incisives centrales supe
sence dun overjet excessif ;
en pre
 te
 enregistre
e lorsque les
classe II, division 2 : celle-ci a e
rieures e
taient en palatoversion et que
incisives centrales supe
 ge
 rement augmente
;
loverjet fut minimal ou le
 te
 enregistre
e
relation incisive de classe III : celle-ci a e
rieures e
taient en occlusion
lorsque les bords des incisives infe
rieure du plat cingulaire et que les incisives
avec la partie ante
sence dun
se trouvaient en relation bord a` bord ou en pre
e
vident.
overjet inverse
Pour la denture primaire, nous avons retenu la relation denrieures
taire de classe I lorsque les canines primaires supe
taient en occlusion dans lembrasure entre la canine primaire
e
rieure et la premie
re molaire primaire. Une classe II a e
 te

infe
e lorsque la canine primaire maxillaire e
tait en
enregistre
siale avec la classe I, alors quune classe III a
occlusion me
 te
 enregistre
e lorsque la canine primaire maxillaire se troue
vait en occlusion distale avec la classe I.
 te
 classe
es en normale, be
ance
Les relations verticales ont e
rieure ou supraclusion.
ante
 te
 enregistre
e lorsque les
Une relation verticale normale a e
rieures recouvraient dun tiers ou moins les
incisives supe
rieures. Une be
ance a e
 te

bords incisifs des incisives infe
e chez les sujets qui ne pre
sentaient ni recouvreenregistre
ment ni contact dau moins deux dents antagonistes entre les
rieures et infe
rieures. Une supraclusion a e
 te

incisives supe
e lorsque plus de la moitie
 des aspects labiaux des
enregistre
rieures e
tait recouverte par les bords incisifs des
incisives infe
rieures.
incisives supe
te
 classe
es comme e
tant
Les relations transversales ont e
sentant un articule
 croise
 poste
rieur.
normales ou comme pre
 te

Une relation transversale normale des arcades a e
e lorsque les cuspides vestibulaires des dents postenregistre
rieures supe
rieures de
bordaient les cuspides vestibulaires
e
rieures infe
rieures.
des dents poste
 croise
 poste
rieur a e
 te
 enregistre
 lorsque deux ou
Un articule
rieures se trouvaient en posiplus des dents maxillaires poste
 croise
 poste
rieur franc par rapport a` leurs antation darticule
rieures [24].
gonistes infe
s examen intraoral, des empreintes en alginate ont e
 te

Apre
alise
es au moyen de porte-empreintes chez tous les partire
te
 rince
es a` leau courante et
cipants. Les empreintes ont e
sinfecte
es avant moulage avec une solution dhypochlorite
de

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

sodium hypochlorite solution before casting. All data were


collected by one investigator (V.I.O).
Data analysis: statistical analysis was carried out with SPSS
version 16 (Chicago Inc. 2007). Frequencies and mean values
(with their standard deviations) of variables were generated.
Association between discrete variables was tested by Chi2.
Association between continuous variables was tested using
student t-test and analysis of variance. Correlation coefficient
(r) was used to test associations between variables. Multiple
regression analysis was used to determine the effects of demographic variables (age, sex and BMI) on the occlusion of subjects with hypertrophied adenoids. Significance was inferred
at P < 0.05.

e. Toutes les donne


es ont e
 te
 recueillies par le
de sodium dilue
^me ope
rateur (V.I.O).
me
es : lanalyse statistique a e
 te
 effectue
e
Analyse des donne
avec SPSS version 16 (Chicago Incorporation 2007). Les
quences et les valeurs moyennes (avec leurs e
carts-types)
fre
 te
 ge
 ne
re
es. Lassociation entre les variades variables ont e
 tes a e
 te
 teste
e utilisant le test Chi2. Lassociation
bles discre
 te
 teste
e utilisant le test-t de
entre les variables continues a e
 lation
Student et lanalyse de variance. Le coefficient de corre
 te
 utilise
 pour tester les associations entre variables.
(r) a e
gression multiple a e
 te
 utilise
e pour de
terminer
Lanalyse de re
mographiques (a
^ge, sexe et IMC)
les effets des variables de
sentant des ve
ge
tations
sur locclusion des sujets pre
es. La significativite
ae
 te
e
tablie a` p < 0,05.
hypertrophie

Results

sultats
Re

A total of 180 children were selected for this study based on


the stated criteria. There were 93 (51.7%) boys and 87
(48.3%) girls, with a mean age of 6.89 W 2.43 years. Table I
shows the demographic characteristics of the study population
according to gender and age groups described. The adenoid
population had 45.5% of children in the 35-year age groups;
37.8% in the 68-year groups and 16.7% in the 912-year age
groups. The control population had 24.5%, 43.3% and 32.2%,
respectively in the various age groups (Table I).
Table II shows the means of weight, height and body mass
index (BMI) for both adenoid and control groups according to
their age groups and gender. The Games-Howell multiple
comparison of means demonstrated that significant differences in weight occurred among the subjects in the 35-year
and 68-year age groups as shown. Differences in height were

 te
 se
lectionne
s pour cette e
tude
Un total de 180 enfants ont e
res de
ja` de
crits. Il y avait 93 (51,7 %)
en fonction des crite
^ge moyen de
garcons et 87 (48,3 %) filles, avec un a
ristiques
6,89 W 2,43 ans. Le Tableau I montre les caracte
mographiques des populations e
tudie
es en fonction du
de
^ge de
crits ci-dessus. La population
sexe et des groupes da
nodienne contenait 45,5 % denfants a
^ ge
s de 3 a` 5 ans,
ade
^ge de 6 a` 8 ans et 16,7 %
37,8 % denfants dans le groupe da
^ge de 9 a` 12 ans. La population te
moin
dans le groupe da
contenait 24,5 %, 43,3 % et 32,2 %, respectivement, dans
^ge (Tableau I).
les divers groupes da
Le Tableau II montre les moyennes de poids, de taille et
dindice de masse corporelle (IMC) pour les groupes
nodiens et te
moin selon leur groupe da
^ge et leur sexe.
dade
La comparaison multiple de moyennes Games-Howell a
 des diffe
rences significatives de poids parmi les sujets
releve
rences
dans les groupes de 3 a` 5 ans et de 6 a` 8 ans. Des diffe

Table I

Tableau I

ristiques de
mographiques de la population de
tude.
Caracte

Demographic characteristics of the study population.


^ (ans)
Age group (years) / Groupe dage

Adenoid group / Groupe


 dien
adeno

Male /
Garc ons

Female /
Filles

Control group / Groupe

Total


temoin

Male /

Female /

Garc ons

Filles

(%)

(%)

(%)

(%)

35

26

(14.44)

15

(8.33)

14

(7.78)

(4.44)

63

(35.0)

68

21

(11.67)

13

(7.22)

12

(6.67)

27

(15.0)

73

(40.56)

912

(4.44)

(3.99)

12

(6.67)

17

(9.44)

44

(24.44)

Total

55

(30.56)

35

(19.44)

38

(21.11)

52

(29.0)

180

(%)

(100)

Chi2 = 16.02, df = 6, P = 0.013.

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

Table II

Tableau II

carts-types des variables de


mographiques.
Moyennes et e

Means and standard deviations of demographic variables.

Demographic variables /
Variables

demographiques

Age group
(years) /

 dien
Adenoid group / Groupe adeno

Male / Garc ons

^
Groupe dage
(ans)
n

Mean /


Control group / Groupe temoin

Female / Filles
W SD /

Mean /

Moyennea W ET

Male / Garc ons


W SD /

Moyenneb W ET

Female / Filles
W SD /

Mean /

Meand /

Moyennec W ET

W SD /

Moyenned W ET

Weight / Poids
35

26

16.62

2.49

15

16.87

2.26

14

20.36

2.27

23.75

6.71

68

21

21.71

2.30

13

23.31

5.28

12

25.08

3.96

27

25.81

4.29

912

31.25

4.06

29.00

5.71

12

32.50

5.71

17

33.47

7.22

35

26

103.55

9.70

15

105.53

9.26

14

112.71

8.04

115.87

6.05

68

21

120.62

12.66

13

119.38

8.79

12

122.25

7.81

27

123.89

11.98

912

137.50

10.11

129.00

9.47

12

133.41

13.78

17

138.82

5.98

35

26

15.58

1.99

15

15.24

2.14

14

16.06

1.31

17.46

3.42

68

21

15.38

3.72

13

16.71

5.03

12

16.79

2.17

27

16.95

2.73

912

16.54

1.36

17.57

4.23

12

18.47

3.18

17

17.28

Height / Taille

BMI / IMC

BMI: body mass index. Games-Howell multiple comparison of means: weight: 35 years, P < 0.05
12 years, P < 0.05 bd.

, 68 years, P < 0.05,

ac,ad,bc,bd

ac,ad

; height: 35 years, P < 0.05

2.87
ac,ad,bc,bd

. 9

No statistically significant differences in BMI were observed in all the age groups.

also observed in the 35-year and 912-year age groups


(Table II).
The mean body mass index (BMI) was 16.49 W 3.00. The
mean BMI value of adenoid subjects was significantly lower
than that of the control subjects (P = 0.006). However there
were no significant differences in BMI when subjects were
categorised into age groups. The majority (75%) of all subjects
(adenoid and control) had low BMI, 11.7% had normal and
13.3% had high BMI. There was, however, a significant difference in the distribution of adenoid and control subjects into
these categories of BMI (Chi2 = 19.18, P = 0.000). About
2.2% of adenoid subjects and 21.1% of control subjects had
normal BMI, respectively.
Comparisons of occlusal characteristics of both groups in the
three planes of space are shown in Table III. In the anteriorposterior plane, class I incisal relationship was the most prevalent malocclusion in both adenoid and control groups (55.6%
and 72.2%, respectively). However, the frequency of occurrence was significantly higher in the control group compared
to the adenoid group (P = 0.02). Class II division 1 was significantly higher in the adenoid subjects compared to the
control subjects (P = 0.003). In the vertical and transverse
planes, no statistically significant differences were observed
in the occlusal characteristics between both groups (Table III).

International Orthodontics 2010 ; X : 1-17

galement e
 te
 observe
es dans les groupes a
^ ge
s
de taille ont e
de 3 a` 5 et de 9 a` 12 ans (Tableau II).
tait de
Lindice de masse corporelle (IMC) moyen e
16,49 W 3,00. La valeur IMC moyenne des sujets
nodiens e
tait significativement plus faible que celle des
ade
moins (p = 0,006). Cependant, nous navons pas
sujets te
 de diffe
rences significatives dIMC lorsque les sujets
releve
taient classe
s selon leur groupe da
^ge. La majorite
 (75 %) de
e
nodiens et te
moins) avaient un IMC
tous les sujets (ade
leve
.
faible ; 11,7 % avaient un ICM normal et 13,3 % un ICM e
 une diffe
rence significative
Cependant, nous avons observe
nodiens et te
moin
au niveau de la distribution des sujets ade
gories dIMC (Chi2 = 19,18, p = 0,000).
dans ces cate
nodiens et 20 %
Approximativement 2,2 % des sujets ade
moins avaient un IMC normal.
te
ristiques des deux groupes
Les comparaisons des caracte
es au Tableau III.
dans les trois plans de lespace sont donne
roposte
rieur, une relation de classe l inciDans le plan ante
tait la malocclusion la plus fre
quente dans les deux
sive e
nodien et te
moin (55,6 % et 72,2 %, respectigroupes ade
quence de cette malocclusion
vement). Cependant, la fre
tait significativement plus e
leve
e dans le groupe te
moin
e
nodiens (p = 0,02). Les classes
que dans le groupe dade
taient significativement plus fre
quentes chez
II division 1 e
nodiens que chez les sujets te
moin
les sujets ade
(p = 0,003). Dans les plans occlusal et transversal, aucune

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

Table III

Tableau III

ristiques occlusales chez les sujets


Comparaison des caracte
nodiens et te
moin.
ade

Comparison of occlusal characteristics of adenoid and control


subjects.

Occlusal characteristics /


Caracteristiques
occlusales

Adenoid group (n = 90) /

 dien (n = 90)
Groupe adeno

Control group (n = 90) /


Groupe temoin
(n = 90)

Chi2 P-value /
Valeur de p

(%)

(%)

Class I / Classe I

50

(55.6)

65

(72.2)

5.42

0.020b

Class II division 1 / Classe II division 1

35

(38.8)

17

(18.9)

8.76

0.003b

Class II division 2 / Classe II division 2

(0)

(2.2)

Class III / Classe III

(5.6)

(6.7)

0.00

1.000

Normal overbite / Recouvrement normal

33

(36.6)

29

(32.2)

0.39

0.530



Anterior open bite / Beance
anterieure

19

(21.2)

23

(25.6)

0.49

0.481

Deep bite / Recouvrement excessif

38

(42.2)

38

(42.2)

0.00

1.000

Normal relationship / Relation normale

80

(89.9)

(92.2)

0.58

0.445

Posterior crossbite / Articule croise A-P

10

(11.1)

(7.8)

1.91

0.633

Anteroposterior incisal relationship /




Relation incisive anteropost
erieure

0.497a

Vertical relationship / Relation verticale

Transverse relationship / Relation transversale

a
b

Fishers Exact Test.


Statistically significant.

After categorizing into the various age groups, there were


significant differences in the AP plane only in the 35-year
age groups. While the occurrence of class I incisal relationship was significantly greater in the control group (P = 0.006),
class II division 1 was significantly higher in the adenoid
group (P = 0.001). In the transverse plane the occurrence of
posterior cross bites was significantly higher in the 912-year
adenoid group compared with their counterpart control group
(P < 0.001).

Table IV shows the comparisons of occlusal characteristics of


adenoid subjects across age groups. There were no statistically
significant differences in occlusal characteristics in the anterior-posterior and vertical occlusal planes across the age
groups (P > 0.05). In the transverse plane, the occurrence
of posterior crossbite differed significantly across the age
groups (P < 0.01). Gender comparisons were done in the
anterior-posterior, vertical and transverse planes of male

rence statistiquement significative na e


 te
 observe
e
diffe
ristiques occluentre les deux groupes au niveau des caracte
sales (Tableau III).
s classement des sujets en plusieurs groupes da
^ge,
Apre
 des diffe
rences significatives dans le plan
nous avons releve
^ge de 3 a` 5 ans. Alors que
A-P uniquement dans le groupe da
quence des relations de classe I incisive e
tait significatila fre
leve
e dans le groupe te
moin (p = 0,006), les
vement plus e
taient significativement plus fre
quentes
classes II, division 1 e
nodiens (p = 0,001). Dans le plan transdans le groupe dade
quence des articule
s croise
s poste
rieurs e
tait
versal, la fre
leve
e dans le groupe dade
nodiens
significativement plus e
^ ge
s de 9 a` 12 ans par rapport au groupe te
moin e
quivalent
a
quence des articu(p < 0,001). Dans le plan transversal, la fre
s croise
s poste
rieurs a affiche
 des diffe
rences significatives
le
^ge (p < 0,01).
pour tous les groupes da
Le Tableau IV montre les comparaisons en fonction du sexe
 te
 re
alise
es dans les plans ante
roposte
rieur, vertical et
ont e
nodiens et
transversal de tous les sujets, garcons et filles, ade
moins. Dans le plan ante
roposte
rieur, la fre
quence des
te
tait statistiquement plus e
leve
e chez
classes II, division 1 e
nodiens par rapport aux garcons te
moins
les garcons ade
rence statistiquement
(p = 0,03). Parmi les filles, aucune diffe
 te
 observe
e. Dans les plans vertical et
significative na e

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

Table IV

Tableau IV

Comparison of occlusal characteristics across age groups in


adenoid subjects.

Occlusal characteristics /

ristiques occlusales chez les sujets


Comparaison des caracte
nodiens dans les diffe
rents groupes.
ade

Chi2

35 years
(n = 41) /

68 years
(n = 34) /

912 years
(n = 15) /

35 ans
(n = 41)

68 ans
(n = 34)

912 ans
(n = 15)

n (%)

n (%)

n (%)

Class I / Classe I

24 (58.5)

15 (44.1)

11 (73.3)

0.38

0.146

Class II division 1 / Classe II division 1

15 (36.6)

16 (47.1)

4 (26.7)

2.02

0.372a


Caracteristiques
occlusales

P-value /
Valeur de p

Anteroposterior (incisal) relationship /




Relation (incisive) anteropost
erieure

Class II division 2 / Classe II division 2

0 (0)

0 (0)

0 (0)

Class III / Classe III

2 (4.9)

3 (8.8)

0 (0)

2.34

0.378a

Normal overbite / Recouvrement normal

15 (36.6)

10 (29.4)

8 (53.3)

2.51

0.284a



Anterior open bite / Beance
anterieure

10 (24.4)

7 (20.6)

2 (13.3)

0.86

0.648a

Deep bite / Recouvrement excessif

16 (39.0)

17 (50.0)

5 (33.3)

1.50

0.472

4 (9.8)

4 (11.8)

2 (13.3)

2.91

0.000a,,b

Vertical relationship / Relation verticale

Transverse relationship / Relation transversale


Posterior crossbite / Articule croise A-P
a
b

Fishers Exact Test.


Statistically significant.

and female adenoid and control subjects. In the anterior-posterior plane, the frequency of occurrence of class II division 1
was statistically significantly higher in male adenoid subjects
compared to male control subjects (P = 0.03). Between the
female subjects, no statistically significant differences were
observed. In the vertical and transverse planes, no significant
differences were observed in the occlusal characteristics of
male and female adenoid and control subjects (Table IV).
Male and female adenoid subjects were also compared
(Table V), in the anterior-posterior plane, the frequency of
occurrence of class I was statistically significantly higher in
female adenoid subjects compared to the males (P = 0.016).
The reverse was observed with class II division 1 which was
statistically significantly higher in the male subjects
(P = 0.003). In the vertical plane, the frequency of occurrence of normal overbite was significantly more in female
adenoid subjects while deep bite was significantly higher in
the male subjects (P < 0.05). In the transverse plane, no
statistically significant differences were observed in the
occlusal characteristics between male and female adenoid
subjects.

International Orthodontics 2010 ; X : 1-17

rence significative na e
 te
 releve
e
transversal, aucune diffe
ristiques occlusales des sujets garcons et
pour les caracte
nodiens et te
moins (Tableau IV).
filles, ade

 te
 re
alise
e (Tableau V) des sujets
Une comparaison a e
nodiens garcons et filles relative au plan ante
roposte
rieur.
ade
quence des classes l e
tait significativement plus e
leve
e
La fre
nodiennes par rapport aux garcons
chez les filles ade
tait observe
 concernant les classes II
(p = 0,016). Linverse e
taient significativement plus fre
quentes chez
division 1, qui e
nodiens. Dans le plan vertical, la fre
quence
les garcons ade
tait significativement
des recouvrements incisifs normaux e
leve
e chez les filles ade
nodiennes, alors que les
plus e
taient significativement plus
recouvrements incisifs excessifs e
quents chez les garcons (p < 0,05). Dans le plan transverfre
rence statistiquement significative na e
 te

sal, aucune diffe
e relative aux caracte
ristiques occlusales chez les
trouve
nodiens (Tableau V).
garcons et les filles ade

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

Table V

Tableau V

ristiques occlusales des sujets


Comparaison des caracte
nodiens garcons et filles.
ade

Comparison of occlusal characteristics in male and female


adenoid subjects.

Occlusal characteristics /


Caracteristiques
occlusales

Male (n = 55) /

Female (n = 35) /

Garc ons (n = 55)

Filles (n = 35)

n (%)

n (%)

Chi2

P-value /
Valeur de p

Anteroposterior (incisal) relationship /




Relation (incisive) anteropost
erieure

Class I / Classe I

25 (45.5)

25 (71.4)

5.84

0.016b

Class II division 1 / Classe II division 1

28 (50.9)

7 (20.0)

8.59

0.003b

Class II division 2 / Classe II division 2

0 (0)

0 (0)

Class III / Classe III

2 (3.6)

3 (8.8)

Normal overbite / Recouvrement normal

15 (27.3)

18 (51.4)

5.37

0.020b



Anterior open bite / Beance
anterieure

12 (21.8)

7 (20.0)

0.04

0.837

Deep bite / Recouvrement excessif

28 (50.9)

10 (28.6)

4.37

0.036b

50 (90.9)

30 (85.7)

0.58

0.445

5 (9.1)

5 (14.3)

1.28

0.845

0.373a

Vertical relationship / Relation verticale

Transverse relationship / Relation transversale


Normal relationship / Relation normale

Posterior crossbite / Articule croise posterieur
a

Fishers Exact Test.


b
Statistically significant.

Spearmans correlation tests of the relationship between age,


BMI and occlusal characteristics in male and female adenoid
subjects showed that age had a statistically significant
(P = 0.03), but weak correlation with anterior open bite
(r = 0.37) and posterior cross bites (P = 0.02, r = 0.39) in
the female adenoid subjects (Table VI).
BMI had an inverse but strong correlation with class II division 1 in adenoid subjects, this correlation however was not
statistically significant. BMI also showed a statistically significant (P = 0.03) but weak correlation (r = 0.36) with posterior crossbite in the female adenoid subjects.
Table VII shows the multiple regression analysis of the effect
of age, gender and BMI on the occlusion of adenoid subjects.
Results showed that age had a statistically significant effect
(P = 0.005) on the occurrence of anterior open bite in adenoid
subjects. However, the relative association with this occlusal
trait is weak (b = 0.24). BMI also had significant but weak
association with the occurrence of class II occlusion in adenoid subjects (P < 0.05).

10

 lation de Spearman portant sur la relation


Les tests de corre
^ge, lIMC et les caracte
ristiques occlusales des sujets
entre la
nodiens, garcons et filles, ont montre
 que la
^ge avait une
ade
 lation significative quoique faible (p = 0,03) avec la
corre
ance ante
rieure (r = 0,37) ainsi quavec les articule
s croise
s
be
rieurs (p = 0,02, r = 0,39) chez les filles ade
nodiennes
poste
(Tableau VI).
 une corre
 lation oppose
e mais forte avec
LIMC a montre
nodiens.
les classes II division 1 chez les sujets ade
lation ne
tait pas statistiquement
Cependant, cette corre
galement montre
 une corre
 lation stasignificative. LIMC a e
tistiquement significative (p = 0,03) quoique faible (r = 0,36)
s croise
s poste
rieurs chez les filles
avec les articule
nodiennes.
ade
gression multiple concerLe Tableau VII montre lanalyse de re
^ge, du sexe et de lIMC sur locclusion chez
nant limpact de la
nodiens. Les re
sultats montrent que la
^ge avait
les sujets ade
un effet statistiquement significatif (p = 0,005) sur la
quence des be
ances ante
rieures chez les sujets
fre
nodiens. Ne
anmoins, lassociation relative de cette carade
ristique occlusale e
tait faible (b = 0,24). LIMC a
acte
galement affiche
 une association significative mais faible
e
quence des occlusions de classe II chez les sujets
avec la fre
nodiens (p < 0,05) (Tableau VII).
ade

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

Table VI

Tableau VI

 lations da
^ge, dIMC et les caracte
ristiques occlusales
Corre
nodiens garcons et filles.
chez des sujets ade

Correlations of age, BMI and occlusal characteristics in male


and female adenoid subjects.

Anterior-posterior incisal relationship / Relation



(incisive) anteropost
erieure

Class I /
Classe I

Class II
division 1 /

Class II
division 2 /

Classe II
division 1

Classe II
division 2

Vertical relationship /

Transverse relationship /

Relation verticale

Class III /
Classe III

Normal
overbite /

Relation transversale

Anterior
open bite /

Recouvrement
normal


Beance

anterieure

Deep bite /
Recouvrement
excessif

Posterior
crossbite /

Articule croise

posterieur

 dien (n = 90)
Adenoid subject (n = 90) / Groupe adeno

Age / Age
Coefficient (r)

0.07

P-value / Valeur de p 0.531

0.02

0.04

0.12

0.02

0.10

0.08

0.890

0.742

0.258

0.872

0.367

0.05

0.15

0.05

0.06

0.061

0.159

0.611

0.564

0.480

0.210

0.07

0.15

0.04

0.601

0.281

0.771

0.04

0.24

0.39

0.083

0.784

0.813

0.60

0.39

0.734

0.021a

0.477

0.12
0.278

BMI / IMC
Coefficient (r)

0.17

P-value / Valeur de p 0.104

0.90
0.402

0.14

0.13

 dien garc ons (n = 55)


Male adenoid subjects (n = 55) / Groupe adeno

Age / Age
Coefficient (r)

0.08

P-value / Valeur de p 0.571

0.10

0.05

0.490

0.721

0.14

0.17

0.312

0.134

0.22
0.100

BMI / IMC
Coefficient (r)

0.22

P-value / Valeur de p 0.114

0.26
0.057

 dien filles (n = 35)


Female adenoid subjects (n = 35) / Groupe adeno

Age / Age
Coefficient (r)

0.05

P-value / Valeur de p 0.770

0.15
0.390

0.072
0.704

0.30
0.08

0.28
0.100

0.37
0.032

BMI / IMC
Coefficient (r)

0.18

P-value / Valeur de p 0.307

0.11

0.10

0.518

0.56

0.05
0.76

0.14
0.438

0.24
0.167

0.09
0.621

0.36
0.032a

BMI: body mass index.


a

Statistically significant.

Discussion

Discussion

This study was carried out to evaluate the occlusal characteristics in patients with hypertrophied adenoids and compare
the findings with control subjects. Dental inter-arch relationship in the three planes of space is the basic clinical parameter
in understanding the patients occlusion and its behaviour
when exposed to unbalanced muscular activities. Generally,
the triad of class II malocclusion, anterior open bite and
posterior cross bite has been described as the occlusal pattern
for mouth-breathers [13,25,26]

tude e
te
 re
alise
e afin de
valuer les caracte
ristiques
Cette e
sentant des ve
ge
tations
occlusales chez des patients pre
es et de comparer les re
sultats avec des sujets
hypertrophie
moins. Les relations inter-arcades dans les trois plans de
te
tres cliniques fondamentaux
lespace fournissent des parame
pour mieux comprendre locclusion des patients ainsi que le
e
comportement de celle-ci lors dune exposition prolonge
s musculaires non-e
quilibre
es. En ge
ne
ral, la
a` des activite
e par une malocclusion de classe II, une be
ance
triade forme

International Orthodontics 2010 ; X : 1-17

11

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

Table VII

Tableau VII

gression multiple de la
^ge, du sexe, de lIMC et
Analyse de re
nodien.
de locclusion des sujets ade

Multiple regression analysis of age, gender, BMI and


occlusion of adenoid subjects.

Anteroposterior incisal relationship /

Vertical relationship / Relation



Relation incisive anteropost
erieure

Class I /
Classe I

verticale

Class II
division 1 /

Class II
division 2 /

Classe II
division 1

Classe II
division 2

Class III /
Classe III

Transverse relationship /
Relation transversale

Anterior
open bite /

Beance

anterieure

Deep bite /
Supraclusion

Posterior
crossbite /

Articule croise

posterieur

Age / Age
95% CI / IC95 %
b-coefficient

0.03 to 0.08
0.12

P-value / Valeur de p 0.391

0.09 to 0.004

0.004 to 0.031

0.03 to 0.03

0.10 to 0.01

0.08 to 0.04

0.09 to 0.02

0.25

0.21

0.04

0.24

0.10

0.15

0.084

0.144

0.753

0.005a

0.481

0.317

Gender / Sexe
95% CI / IC95 %
b-coefficient

0.36 to 0.04
0.18

P-value / Valeur de p 0.121

0.01 to 0.03

0.005 to 0.13

0.18 to 0.06

0.31 to 0.10

0.02 to 0.46

0.08 to 0.38

0.19

0.21

0.11

0.12

0.23

0.15

0.091

0.068

0.302

0.309

0.058

0.192

BMI (low) / IMC (faible)


95% CI / IC95 %
b-coefficient

0.06 to 0.64
0.32

P-value / Valeur de p 0.021

0.50 to 0.001
0.26

0.047

0.04 to 0.16

0.34 to 0.001

0.35 to 0.24

0.32 to 0.35

0.29 to 0.37

0.17

0.25

0.05

0.01

0.032

0.221

0.057

0.711

0.085

0.186

 e)

BMI (high) / IMC (elev

95% CI / IC95 %
b-coefficient

0.04 to 0.48
0.18

P-value / Valeur de p 0.094

0.47 to 0.01

0.05 to 0.12

0.17 to 0.13

0.46 to 0.06

0.18 to 0.42

0.45 to 0.10

0.23

0.09

0.03

0.17

0.19

0.15

0.045a

0.382

0.793

0.133

0.042

0.201

BMI: body mass index.


a

Statistically significant.

The majority of adenoid and control subjects had low BMI, this
is similar to the report of Adegoke et al. in the same environment [27]. The authors found that 77.8% of schoolchildren
studied were underweight with BMI less than 18.50. The
greatest differences in height and weight between adenoid
and control subjects were observed among the 35-year age
groups. Somatic growth impairment due to abnormal growth
hormone secretion documented in patients with enlarged adenoids probably shows its greatest effect early in life [28].
Studies have however found that normalization and catch up
somatic growth may occur as respiratory obstruction is
relieved [28,29].

The prevalence of class II division 1 was found to be significantly higher in the adenoid subjects as in previous studies in
patients with hypertrophied adenoids [7,18,30]. This can be

12

rieure et un articule
 croise
 poste
rieur a e
 te
 de
crite comme
ante
ma occlusal des respirateurs oraux [13,25,26].
le sche
 des sujets ade
nodiens et te
moin avaient un IMC
La majorite
sultat similaire a` celui obtenu dans le
tude dAdegoke et
bas, re
^me environnement [27]. Ces auteurs ont
al. et dans le me
 que 77,8 % des enfants da
^ge scolaire e
taient en
trouve
rieur a` 18,50. Les diffe
rences
sous-poids avec un IMC infe
es de taille et de poids entre les groupes
les plus marque
nodiens et te
moin ont e
 te
 observe
es dans le groupe
ade
^ge des 3 a` 5 ans. Une insuffisance de la croissance somada
cre
 tion anormale des hormones de croistique due a` une se
e chez les patients pre
sentant une hypersance documente
nodienne se manifeste probablement de facon
trophie ade
res anne
es de la vie [28].
maximale pendant les premie
tudes ont montre
 que la normalisation et le
Cependant, des e
aliser
rattrapage de la croissance somatique peuvent se re
e [28,29].
lorsque lobstruction respiratoire est leve
sultats, similaires a` ceux de
tudes ante
rieures sur des
Nos re
ge
tations hypertrophie
es [7,18,30], ont
patients avec des ve
 une pre
 valence significativement plus e
leve
e des
montre

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

explained by the fact that prolonged mouth breathing can lead


to proclination of the upper anterior incisors as the equilibrium effect from the lips on the position of the teeth is lost
when the lips are habitually left apart [1,30]. It could also be
due to the retroclination of mandibular incisors and retrognathic mandible previously documented for these subjects
when they were compared to healthy control subjects
[2,20,31].
This study found that the prevalence of class II division 1
malocclusion was more in the 35-year age groups compared
to other age groups. This is similar to the report of Souki et al.
[25]. This could be because, as the child grows, the nasopharynx also increases in size and concurrently the mass of adenoid lymphoid tissues reduces in size [7,32]. Therefore, the
effect of obstruction may not be as severe as a child grows
older. This early onset of the development of class II division 1
malocclusion can also be related to the early presentation of
adenoid hypertrophy in this environment as congenital adenoid hypertrophy has been documented [14].
In spite of the significant association between the presence of
class II division 1 malocclusion and hypertrophied adenoids,
which was established, it was not found to be the most prevalent relationship in the anterior-posterior plane. Most of the
adenoid children showed class I incisal relationship. This may
be because anterior-posterior dental inter-arch relationship is
mostly determined by heredity [7,8,25]. Mouth breathing
resulting from enlarged adenoids therefore acts as a secondary
aetiological factor. Even in the presence of obstructed airflow,
the force of unbalanced muscular activities due to mouth
breathing may not be enough to shift a genetically determined
class I occlusion into class II.
The results of this study did not indicate any difference in the
occurrence of anterior open bite between adenoid and control
subjects which had earlier been described by Souki et al. in
2009 as one of the occlusal traits seen in mouth breathing
children [25]. They found an overall increased occurrence of
anterior open bite in all samples of mouth breathing subjects
considered. A reason for this discrepancy may be due to
differences in the definition of open bites. They registered
anterior open bite in all cases where the subjects lacked any
over bite regardless of the amount, and the number of teeth
involved. However, in this study, anterior open bite was registered when there was no vertical overlap or contact between
at least two anterior teeth. Vertical dental relationship also has
heredity as the major determinant but environmental factors
such as non-nutritive sucking habits and mouth breathing can
act as secondary causes of anterior open bite [2,3335]. We
however noted that the presence of deep bite was significantly
more among male than female adenoid subjects in this study

International Orthodontics 2010 ; X : 1-17

nodiens.
classes II division 1 dans le groupe de sujets ade
e
Cela sexplique par le fait que la respiration orale prolonge
rieures
peut induire la proclination des incisives ante
rieures puisque le
quilibration entretenue par les le
vres
supe
vres sont
sur la position des dents est perdue lorsque les le
carte
e [1,30]. Ce
habituellement maintenues en position e
nome
ne sexplique aussi par la re
 troinclinaison des inciphe
 trognathie mandibulaire qui
sives mandibulaires et par une re
te
 retrouve
es chez cette cate
gorie de patients
ja` e
ont de
s a` des sujet te
moins sains [2,20,31].
compare
tude a montre
 une plus grande pre
 valence des malCette e
occlusions de classe II division 1 chez les 3 a` 5 ans par rapport
^ge. Ce re
sultat est similaire aux
aux autres groupes da
es de Souki et al. [25]. Cela est peut-e
^tre du au fait
donne
que, pendant la croissance de lenfant, le nasopharynx
le a` la diminution de la masse de tissus
saccrot en paralle
nodo-lymphodes [7,32]. Par conse
quent, lobstruction va
ade
^tre diminuer dimportance a` mesure que lenfant grandpeut-e
nodienne conira. Par ailleurs, des cas dhypertrophie ade
nitale ont e
 te
 rapporte
s [14], ce qui sugge
 re que la survenue
ge
coce du de
veloppement dune malocclusion de classe II
pre
^tre lie
e a` la pre
sentation pre
coce dune
division 1 est peut-e
nodienne.
hypertrophie ade
 le
tablissement dune association significative entre la
Malgre
sence de malocclusions de classe II division 1 et les
pre
 ge
tations hypertrophie
es, cette relation ne sest pas e
^tre
ve
 ve
 le
e e
^tre la relation la plus fre
quente dans le plan ante
rore
rieur. La majorite
 des enfants ade
nodiens ont pre
sente

poste
^tre du fait que les relaune relation incisive de classe I, peut-e
roposte
rieures sont surtout
tions dentaires inter-arcades ante
termine
es par lhe
re
dite
 [7,8,25]. La respiration orale due
de
ge
tations hypertrophie
es repre
sente, par cona` des ve
quent, un facteur e
 tiologique secondaire. Me
^me en
se
sence dun flux respiratoire obstrue
, la force des activite
s
pre
quilibre
es en raison de la respiration orale,
musculaires, non-e
peut suffire pour transformer une occlusion de classe I
 ne
tiquement de
termine
e en classe II.
ge
sultats de cette e
tude nont pas re
 ve
le
 de diffe
rences
Les re
nodiens et les te
moins concernant la
entre les sujets ade
quence des be
ances ante
rieures, pourtant de
crites par
fre
risBernardo Souki et al. en 2009 comme lune des caracte
tiques de la respiration orale enfantine [25]. Ces auteurs ont
 une augmentation globale de lincidence des be
ances
trouve
rieures chez tous les e
chantillons de respirateurs oraux
ante
tudie
s. Cette disparite
 est peut-e
^tre due a` des de
finitions
e
ance. Souki et al. ont
divergentes de ce qui constitue une be
 des be
ances ante
rieures chez tous les sujets
enregistre
sentant un manque de recouvrement incisif, inde
pendampre
 et du nombre de dents implique
es. Dans la
ment de la quantite
sente e
tude, au contraire, une be
ance ante
rieure a e
 te

pre
e en labsence de recouvrement vertical ou de
enregistre
rieures. Par ailleurs,
contact entre au moins deux dents ante
re
dite
 constitue le de
terminant principal des relations denlhe
taires verticales bien que des facteurs environnementaux tels
que la succion non-nutritive et la respiration orales puissent
ances ante
rieures
intervenir comme causes secondaires de be

13

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

Regarding the presence of posterior cross bites, the findings in


this study showed some similarity with the aforementioned
study of Souki et al. [25]. The occurrence of posterior cross
bites was significantly more in the adenoid than the control
group in the 912-year-old groups. Intragroup comparisons
among the adenoid population also showed that occurrence of
posterior crossbite differed significantly across the age groups.
The older adenoid subjects exhibited a greater tendency
towards posterior cross bites. These show that transverse dental relationship can be influenced by environmental factors
such as mouth breathing. Thus, early normalization of nasal
airflow passage in younger children may be beneficial from an
orthodontic point of view.

In the female subjects, the occurrence of class II division 1


malocclusion was inversely correlated with age of the patient
but this was not a significant relationship. However, with
respect to anterior open bite, and posterior cross bites, the
female adenoid subject could be said to have a 37% (r = 0.37)
and 39% (r = 0.39) chance of developing an anterior open bite
and a posterior cross bite respectively as she increases in age.
Further study would be required to either confirm or dispute
this.
Although not statistically significant, a strong negative correlation was found to exist between BMI and class II division 1
occlusion in all adenoid subjects while a significant but weak
relationship was also observed between BMI and posterior
cross bites in the female adenoid subjects. BMI also showed
significant but weak associations with the occurrence of class
II occlusion in adenoid subjects on regression analysis. These
findings suggest that an association between BMI and certain
occlusal characteristics cannot be ruled out in patients with
adenoid hypertrophy. The increased tendency to class II malocclusion and posterior cross bites have also been previously
documented for OSAS patients [24,35].
The current understanding of OSAS supports the existence of a
dynamic imbalance in upper airway function that results from
a combination of alterations in structural and anatomical characteristics, protective reflexes and neuromotor function of the
upper airway [36]. In obese children, the effects of fat deposition in the pharyngeal muscles and extra-pharyngeal compression from superficial subcutaneous fat further decreases
the pharyngeal lumen and increases pharyngeal collapsibility
[37]. Furthermore, abdominal fat causes an upward displacement of the diaphragm when supine and this leads to reduced
chest wall compliance: it also reduces ventilatory efforts, lung
volumes and oxygen reserves [36]. This reduced lung volumes

14

, cependant, que la pre


sence
[2,3335]. Nous avons observe
tait significativement plus
dun recouvrement incisif excessif e
quente parmi les sujets ade
nodiens garcons que parmi les
fre
tude.
filles dans cette e
sence darticule
s croise
s postEn ce qui concerne la pre
rieurs, les re
sultats de nos recherches ont montre
 une cere
 avec le
tude de Souki et al. de
ja` mentionne
e
taine similarite
^ ge
s de 9 a` 12 ans, les articule
s croise
s
[25]. Parmi les sujets a
rieurs avaient une pre
 valence significativement plus
poste
leve
e dans le groupe ade
nodien que dans le groupe te
moin.
e
La comparaison intra-groupe parmi la population
nodienne a e
galement montre
 que lincidence darticule
s
ade
s poste
rieurs variait beaucoup dun groupe da
^ge a` un
croise
nodiens plus a
^ ge
s affichaient une tenautre. Les sujets ade
e aux articule
s croise
s poste
rieurs, ce qui
dance plus marque
^tre modifie
e
montre que la relation dentaire transversale peut e
par des facteurs environnementaux tels que la ventilation
coce du passage dair dans
orale. Ainsi, la normalisation pre
les voies respiratoires nasales chez les enfants plus jeunes
^tre be
ne
fique du point de vue orthodontique.
peut e
quence des malocclusions de classe II
Parmi les filles, la fre
 une corre
 lation inverse
e avec la
^ge de la
division 1 a montre
patiente, mais sans que la relation soit significative.
ances ante
rieures et des articule
s
Cependant, au sujet des be
s poste
rieurs, lon pourrait conclure que les sujets
croise
nodiens fe
minins avaient, en grandissant, 37 %
ade
velopper, respec(r = 0,37) et 39 % (r = 0,39) de chances de de
ance ante
rieure ou un articule
 croise
 posttivement, une be
rieur. Des e
tudes supple
mentaires seraient ne
cessaires pour
e
valider cette conclusion.
lation
Quoique statistiquement non-significative, une corre
gative forte entre lIMC et les occlusions de classe II, division
ne
 te
 note
e chez tous les sujets ade
nodiens tandis quune
1ae
 lation faiblement significative a e
galement e
te
 observe
e
corre
s croise
s chez les sujets ade
nodiens
entre lIMC et les articule
minin. Par ailleurs, lanalyse de re
gression a re
 ve
le

de sexe fe
des associations faiblement significatives entre lIMC et la surnodiens.
venue docclusions de classe II chez les sujets ade
sultats sugge
 rent quune association entre lIMC et cerCes re
ristiques occlusales ne peuvent e
^tre exclue chez
taines caracte
sentant une hypertrophie ade
nodienne. Une
les patients pre
tendance accrue a` des malocclusions de classe II et a` des
s croise
s poste
rieurs a e
galement e
te
 rapporte
e chez
articule
des patients souffrant du SAOS [24,35].
Nos connaissances actuelles au sujet du SAOS plaident en
se
quilibre dynamique au niveau
faveur de lexistence dun de
riennes supe
rieures de
coulant
du fonctionnement des voies ae
ristiques strucdune combinaison de modifications de caracte
flexes de protection et de la
turelles et anatomiques, de re
riennes supe
rieures [36].
fonction neuromotrice des voies ae
ses, les effets du de
 po
^t de graisse dans
Chez les enfants obe
s et la compression extra-pharynge
e
les muscles pharynge
e par la graisse sous-cutane
e superficielle re
duisent
provoque
re pharynge
e et augmentent le risque dun
encore plus la lumie
effondrement du pharynx [37]. Par ailleurs, la graisse abdoplacement ascendant du diaphragme
minale provoque un de

International Orthodontics 2010 ; X : 1-17

ORTHO 159 1-17

Occlusal characteristics of children with hypertrophied adenoids in Nigeria

ristiques occlusales des enfants pre


sentant des ve
ge
tations hypertrophie
es au Nige
ria
Caracte

cause a reflexive decrease in the size of the pharyngeal airway


exacerbating the respiratory compromise [38]. A recent paper
has also discussed the potential role of leptin, a potent respiratory stimulant and central chemoreceptor modulator as a
link between obesity and OSAS [37].

One of the limitations in this study was that the participants


had their dental occlusion evaluated, but their nasorespiratory
function, age of occurrence of nasal obstruction and degree of
obstruction were not evaluated. Each of these could also affect
the extent to which the occlusion would be altered [2,3,12,13].
It has been established that the size of the nasopharynx varies
considerably in different individuals [39,40] and that this
variation provides an important explanation for the varying
effects which large adenoids have on passage of air and consequently on the development of malocclusion. Further work
where degree of obstruction, duration of obstruction, and size
of the pharyngeal airway in relation to the size of the enlarged
adenoid are assessed with follow up after surgery would be
highly desirable.

e sur le dos, ce qui a pour re


sultat de
en position allonge
duire la compliance des parois thoraciques et re
duit aussi
re
serves en
leffort ventilatoire, les volumes pulmonaires et les re
ne [36]. Cette re
duction des volumes pulmonaires
oxyge
clenche une diminution des dimensions des voies
de
riennes pharynge
es, exacerbant ainsi le compromis respirae
tude re
cente a e
galement discute
 le ro
^ le
atoire [38]. Une e
potentiel de la leptine, un stimulant respiratoire puissant et
more
cepteur central, comme lien entre le
modulateur che
site
 [37].
SAOS et lobe
tude provient du fait quune
Une des limitations de cette e
valuation a e
 te
 faite de locclusion dentaire des participants
e
^ge de
mais non pas de leur fonction nasorespiratoire, de la
survenue de lobstruction nasale et de limportance de
 le
ments aurait pu e
galement
lobstruction. Chacun de ces e
e de locclusion [2,3,12,13]. Il a e
 te
 e
tabli
affecter la porte
rablement
que les dimensions du nasopharynx varient conside
rents [39,40] et que cette variation fournit
chez des sujets diffe
s par les
une explication importante des divers effets impose
 ge
tations sur le passage de lair et, par conse
quent, sur le
ve
veloppement de la malocclusion. De nouvelles recherches
de
s souhaitables pour e
 valuer, avec suivi post-chirseraient tre
tendue de lobstruction, la dure
e de lobstruction et
ugical, le
riennes pharynge
es par rapport
les dimensions des voies ae
ge
tations hypertrophie
es.
a` limportance des ve

Conclusions

Conclusions

From the findings in this study, the following conclusions are


drawn:
a significant association between the presence of a class II
division 1 malocclusion and hypertrophied adenoid was established. The occurrence of class II division 1 was higher in the
adenoid than control group;

sultats de cette e
tude nous permettent de tirer les
Les re
conclusions suivantes :
^tre e
tablie entre la
une association significative a pu e
sence dune malocclusion de classe II division 1 et de
pre
 ge
tations hypertrophie
es. La survenue de classes II division
ve
tait plus e
leve
e dans le groupe des ade
nodiens que parmi
1e
moins ;
les te
 une fre
quence signifi les classes II division 1 ont montre
leve
e chez les 3 a` 5 ans dans le groupe
cative plus e
nodien et chez les garcons ade
nodiens que chez les filles
ade
nodiennes ;
ade
quence des recouvrements inci dans le plan vertical, la fre
tait significativement plus e
leve
e chez les
sifs excessifs e
nodiens que chez les filles;
garcons ade
s croise
s poste
rieurs e
taient significativement
les articule
quents chez les sujets ade
nodiens que chez les
plus fre
moins dans le groupe da
^ge de 9 a` 12 ans. Parmi les sujets
te
nodiens, la survenue darticule
s croise
s poste
rieurs augade
^ge ;
mentait avec la
lIMC montre des associations significatives avec la survenue des occlusions de classe II chez tous les sujets
nodiens et avec les articule
s croise
s poste
rieurs chez
ade
nodiennes ;
les filles ade
^ge a un effet statistiquement significatif sur la survenue
la
ances ante
rieures chez tous les sujets ade
nodiens et
des be
ances ante
rieures et les articule
s croise
s poste
rieurs
sur les be
nodiennes.
chez les filles ade

class II division 1 was a significant occurrence in the 35year adenoid groups and in male more than in female adenoid
subjects;
in the vertical plane, the frequency of occurrence of deep
bite was significantly more in male than female adenoid
subjects;
posterior crossbite occurred significantly more in adenoid
than control subject in the 912-year age groups. Among the
adenoid subjects the occurrence of post crossbite increased
with age;
BMI has significant associations with the occurrence of
class II occlusion in all adenoid subjects and with posterior
crossbites in the female adenoid subjects;
age has a statistically significant effect on the occurrence
of anterior open bite in all adenoid subjects and on anterior
open bite and posterior cross bites in the female adenoid
subjects.

International Orthodontics 2010 ; X : 1-17

15

ORTHO 159 1-17

Vivien Ijeoma OSIATUMA et al.

Disclosure of interest

claration dinte
re
^ts
De

The authors declare that they have no conflicts of interest


concerning this article.

clarent ne pas avoir de conflits dinte


re
^ ts en
Les auteurs de
relation avec cet article.

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