See

discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/51214519

Prevalence of malocclusion in primary

dentition in a population-based sample of
Brazilian preschool children

Article in European Journal of Paediatric Dentistry · June 2011

Source: PubMed

CITATIONS READS

20 239

6 authors, including:

Saul Paiva Ana Carolina Scarpelli

Federal University of Minas Gerais Federal University of Minas Gerais
308 PUBLICATIONS 2,807 CITATIONS 29 PUBLICATIONS 375 CITATIONS

SEE PROFILE SEE PROFILE

Claudia Marina Viegas Isabela Almeida Pordeus

Federal University of Minas Gerais Federal University of Minas Gerais
22 PUBLICATIONS 222 CITATIONS 210 PUBLICATIONS 2,539 CITATIONS

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Estudo longitudinal da fluorose dentária com relação à dose de exposição ao flúor e avaliação de
testes-diagnóstico View project

Teledentistry View project

All content following this page was uploaded by Ana Carolina Scarpelli on 05 August 2014.

The user has requested enhancement of the downloaded file.

 A.C. Carvalho*, S.M. Paiva*, A.C. Scarpelli*, facial muscles [Peres et al., 2007]. The aetiology of
C.M. Viegas*, F.M. Ferreira**, I.A. Pordeus* malocclusions is primarily genetic with environmental
influences [Corruccini and Potter, 1980; Vig and Fields,
2000; Peres et al., 2007; Heimer et al., 2008]. The facial
*Department of Pediatric Dentistry and Orthodontics, School of growth pattern is an important genetic factor that
Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, contributes to the development of malocclusions and also
Brazil influences treatment [Heimer et al., 2008]. Studies suggest
**Department of Estomatology, School of Dentistry, Universidade that malocclusions are also influenced by behavioural
Federal do Paraná, Curitiba, Brazil factors, such as eating soft foods, breathing infections, the
premature loss of primary teeth and nonnutritive sucking
e-mail: anita.odontologia@hotmail.com
habits [Kiliaridis et al., 1985; Peres et al., 2002].
A number of studies have investigated the prevalence of
malocclusions in the primary dentition in different
countries and populations, with prevalence values ranging
from 26.0% to 87.0% in Brazil, India and Germany (Table
Prevalence 1) [Frazão et al., 2002; Ministry of Health, 2003; Katz et
al., 2004; Stahl and Grabowski, 2004; da Silva Filho et al.,
of malocclusion 2007; Dhar et al., 2007; Grabowski et al., 2007; Leite-
Cavalcanti et al., 2007]. The high prevalence of
in primary dentition malocclusion described in these studies as well as the
variation in its value depends of the interpretation of what
in a population-based is malocclusion [Almeida et al., 2008]. This variation can
be attributed to the interaction between genetic
sample of Brazilian background and environmental factors as well as
differences in the criteria for interpreting relevant occlusal
preschool children deviations [Ogaard et al., 1994; Charchut et al., 2003;
Pétren et al., 2003; Katz et al., 2004; Almeida et al.,
2008].
ABSTRACT There is increasing interest in the early diagnosis and
Aim The purpose of the present study was to assess the treatment of malocclusions as well as a more
prevalence of malocclusion in the primary dentition in a comprehensive, rigorous assessment of the clinical
randomised representative sample of Brazilian preschool children. dimensions [Almeida et al., 2008]. Studies have
Methods A cross-sectional survey was carried out in Belo demonstrated an association between
Horizonte, Brazil, involving 1069 male and female preschool malocclusion/orthodontic treatment need and poor
children from 60 to 71 months of age, randomly selected health-related quality of life [Cunningham and Hunt,
from public and private preschools and daycare centers. A 2001; Liu et al., 2009]. From a public health perspective,
questionnaire addressing demographic data was sent to the assessment of malocclusion in the primary dentition
parents/guardians in order to characterise the sample. The should focus on its magnitude and severity as well as the
oral examination of the children was performed by a single, prevention of occlusion problems later in life [Almeida et
previously calibrated dentist (kappa inter-examiner agreement al., 2008]. Thus, evaluating the occlusal relation in the
value = 0.82). The criterion for the categorisation of primary dentition is an important factor to the
malocclusion was at least one of the following conditions: development of the permanent dentition [Góis et al.,
posterior crossbite, overjet (> 2 mm), anterior crossbite, 2008]. It is believed that posterior crossbite is transferred
anterior open bite and deep overbite. Univariate analysis was from the primary to the permanent dentition [Harrison
performed using the SPSS software programme. and Ashby, 2001; McNamara, 2002; Thilander and
Results and Statistics The prevalence of malocclusion was Lennartsson, 2002].
46.2%. Deep overbite was the most prevalent alteration The aim of the present study was to evaluate the
(19.7% of the sample). Posterior crossbite was diagnosed in prevalence of malocclusion in the primary dentition of
13.1% of the children; 10.5% had accentuated overjet; 7.9%
had anterior open bite; and 6.7% had anterior crossbite.
Conclusion Malocclusion in primary dentition is becoming a Author/Year Country Sample Age Prev.
significant problem. The prevalence in the present study was
high, especially vertical and transversal malocclusions. Frazão et al. (2002) Brazil 985 5-12 y 48.9%
Katz et al. (2004) Brazil 330 3y 49.7%
Keywords Malocclusion; Preschool; Prevalence; Primary teeth. Stahl & Grabowski (2004) Germany 1,225 4y 42.0%
Brasil (2004) Brazil 26,641 5y 36.4%
Leite Cavalcanti et al. (2007) Brazil 342 3-5 87.0%
Dhar et al. (2007) India 188 5 to 7 26.0%
Introduction Grabowski et al. (2007) Germany 766 4 74.7%
da Silva Filho et al. (2007) Brazil 2,016 3 to 6 73.2%
Malocclusion is a developmental disorder of the
craniofacial complex that affects the jaws, tongue and TABLE 1 - Prevalence of malocclusion in preschool children.

EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY • VOL. 12/2-2011 107

CARVALHO A.C. ET AL.
preschoolers in a randomised representative sample in the
city of Belo Horizonte, MG, Brazil.
Materials and methods
Sample characteristics
Belo Horizonte is the capital city of that state of Minas
Gerais, which is located in south-eastern Brazil. The city
has a population of 2,238,526 inhabitants, all of whom
reside in urban areas [IBGE, 2010].
A population-based cross-sectional study was carried
out. The sample was composed to 1069 children. The
subjects were randomly selected through a two-stage
sampling method. The first-stage was the randomisation
of preschools and daycare centers (65.9% public and
34.1% private) and the second was the randomisation of
the children.
The calculation of the sample size involved a standard
error of 5.0%, 95.0% confidence interval (CI) and a
36.46% prevalence of malocclusion [Ministry of Health,
2003]. This calculation determined a sample of 671
children. A correction factor of 1.4 was applied to increase
the precision, as a multi-stage sampling method was
adopted. The sample size was also increased by 20% to
compensate for possible losses during the data collection.
Thus, the minimal sample size to satisfy the requirements
was estimated at 1127 individuals.
Children ranging from 60 to 71 months of age and
regularly enrolled in preschools and daycare centers were
included in the sample. The exclusion criteria were the
presence of permanent teeth and loss of any primary
teeth, dental caries that affected the integrity of the
mesiodistal diameter and previous orthodontic treatment.
Pilot study
A pilot study was carried out at a daycare center with 88
preschoolers to test the methodology of the study and the
comprehension of the instruments as well as to perform
the calibration of the examiner. The data on the children
in the pilot study were not included in the main study. The
results demonstrated that there was no need to modify
the questions or the methodology proposed.
Calibration and training exercises were conducted in this
step. The calibration consisted of theoretical and clinical
steps. The theoretical step involved a discussion of the
criteria for the diagnosis of malocclusion and the analysis of
eight orthodontic dental models and photographs. A
specialist in orthodontics (gold standard in the theoretical
framework) coordinated this step, instructing a general
dentist on how to perform the examination and diagnosis
using the criteria for the different malocclusions. In the
clinical step, the dentist examined eight previously selected
children from 60 to 71 months of age. Inter-examiner
agreement was tested by comparing the examiner with the
gold standard. The interval between evaluations of the
models and those of the children to test the intra-examiner
agreement was seven to 14 days and all the eight children
returned for re-examination in this step. Cohen’s kappa
coefficient was used for data analysis on a person-by-
person basis to test the agreement between examiners. To
assess the reproducibility of the diagnostic criteria, 10% of
108
the sample was re-examined during the data collection.
The interval between the exams was 7 to 14 days.
Clinical data collection
The previously calibrated dentist performed the oral
examination of each child at the preschools or daycare
centers. The visual inspection of the participant’s teeth was
carried out under natural light and in the knee-to-knee
position. The examiner used individual cross-infection
protection equipment and all the materials used were
packaged and sterile. For the examination, a mouth mirror
(PRISMA®, São Paulo, SP, Brazil), a WHO probe (Golgran
Ind. e Com. Ltda., São Paulo, SP, Brazil) and dental gauze
were used.
The clinical examination recorded aspects of overbite,
overjet and crossbite. No radiography was used for the
diagnosis. The criteria used for the diagnosis of the
occlusion were based on findings from Foster and
Hamilton [1969], Grabowski et al. [2007] and Oliveira et
al. [2008]. Overbite was considered the vertical overlap of
the incisors when the posterior teeth were in occlusion
and was considered normal when at least one of the
upper incisors overlapped the lower incisor by 2 mm
[Grabowski et al., 2007]. Deep overbite was characterised
by the maxillary teeth covering more than 2 mm of the
vestibular surface of the mandibular teeth. Anterior open
bite was considered the absence of vertical overlap
covering the lower incisors [Grabowski et al., 2007].
Horizontal overlap of the incisors was considered overjet.
Accentuated overjet was recorded if the upper incisors
were at a distance of more than 2 mm from the lower
ones [Foster and Hamilton, 1969; Grabowski et al., 2007].
Anterior crossbite was recorded when the lower incisors
were observed in front of the upper ones [Foster and
Hamilton, 1969; Oliveira et al., 2008]. Normal overjet was
considered when positive incisor overjet did not exceed 2
mm measured on the primary upper central incisors
[Foster and Hamilton, 1969]. To measure overbite and
overjet, the examiner applied the WHO probe from the
labial surface of the most anterior lower central incisor to
the labial surface of the most anterior upper central
incisor, parallel to the occlusal plane. Posterior crossbite
was recorded when the upper primary molars occluded in
lingual relationship to the lower primary molars in centric
occlusion [Foster and Hamilton, 1969]. The criteria used
for the diagnosis of malocclusion are summarised in Table
2. Positive overjet, anterior crossbite, deep overbite,
anterior open bite and posterior crossbite all indicated
malocclusion. The preschool children who exhibited at
least one of these conditions were classified with
malocclusion [Oliveira et al., 2008].
Non-clinical data collection
Following the clinical examination, a questionnaire
addressing demographic data (child’s date of birth, child’s
gender, parents’/guardians’ schooling, place of residence,
type of school) was sent to the parents/ guardians. For the
determination of socioeconomic status, the Social
Vulnerability Index (SVI) was used. The SVI measures the
vulnerability of the population of Belo Horizonte by
determining neighborhood infrastructure, access to work,
income, sanitation services, healthcare services, education,
EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY • VOL. 12/2-2011
 MALOCCLUSION IN BRAZILIAN PRESCHOOLERS

Overbite out using the Statistical Package for Social Science (SPSS for
Windows, version 17.0, SPSS Inc, Chicago, IL, USA). Inter-
Normal Upper incisors overlap lower incisors by 2 mm
examiner agreement was evaluated using Cohen’s kappa
Deep overbite Maxillary teeth cover more than 2 mm of vestibular
coefficient. Data analysis was carried out with the
surface of mandibular teeth
determination of descriptive statistics to describe the
Anterior open bite Absence of vertical overlap of lower incisors
prevalence of malocclusion and characteristics of the sample.
Overjet
Ethical considerations
Normal Positive incisor overjet not exceeding 2 mm, The study received approval from the Research Ethics
measured on primary upper central incisors Committee of Universidade Federal de Minas Gerais,
Accentuated Upper incisors at a distance of more than 2 mm Brazil. Terms of informed consent were signed by the
from lower incisors parents/guardians allowing their children to participate in
Anterior crossbite Lower incisors in front of upper incisors (negative the study.
overjet, absence of overbite)

Posterior crossbite Results

Upper primary molars occluded in lingual relationship
to lower primary molars in centric occlusion The sample was composed of 1069 preschool children
between 60 and 71 months of age (mean: 64.4 months).
TABLE 2 - Criteria used for the diagnosis of malocclusion The response rate was 94.9%; 5.1% of the sample was lost
(Modified by Oliveira et al., 2008). either because children were absent from school on the day
of the oral exam or because they refused to be examined.
Cohen´s Kappa coefficient for inter-examiner agreement
legal assistance and public transportation [Nahas et al., was greater than 0.82 and was tested by comparing the
2000]. There are five different classes; Classes I, II and III values of the examiner with the gold standard.
are comprised of families with greater social vulnerability, Table 3 displays the characterisation of the sample. A
while Classes IV and V consist of families with the less total of 570 participants were boys (53.3%) and 499 were
vulnerability [Nahas et al., 2000; Serra-Negra et al., 2009]. girls (46.7%). The mother was the most common
The following socioeconomic indicators were also used: caregiver, accounting for 86.2% of the sample, while
monthly family income (categorised based on the other caregivers accounted for 13.8% (father, babysitter,
minimum wage used in Brazil – one minimum wage is brother, sister and grandparents). With regard to
roughly equal to US$258.33) and parents’/guardians’ schooling, 68.9% of the parents/guardians had more than
schooling (categorised in years of study). eight years of study and 31.1% had eight or fewer years.
According to the Social Vulnerability Index (SVI), most of
Statistical analysis the children and families (55.8%) were socially less
The data organisation and statistical analysis were carried vulnerable, while 44.2% of the sample was socially more
vulnerable. The majority of the parents/guardians (74.1%)
reported that they received three times the minimum
Child’s characteristics Frequency n % wage or less per month, while 25.9% reported receiving
more than three times the minimum wage.
Age (months) 60 to 65 661 61.8 Table 4 displays the oral characteristics diagnosed during
66 to 71 408 38.2 the clinical examinations. The prevalence of malocclusion
Gender Male 570 53.3
Female 499 46.7
Preschool Private 365 34.1 Child's clinical disease Frequency n %
Public 704 65.9
Posterior Crossbite Absent 929 86.9
Parents’/Guardians’ characteristics Frequency n % Present 140 13.1
Age (years) 18 to 33 556 52.0 Overjet Normal 957 89.5
34 to 71 513 48.0 Increased 112 10.5
Relationship to child Mother 922 86.2 Anterior Open Bite Absent 985 92.1
Other 147 13.8 Present 84 7.9
Years of schooling > 8 years 737 68.9 Deep Overbite Absent 858 80.3
8 years 332 31.1 Present 211 19.7
Social Vulnerability Index Less vulnerable 596 55.8 Anterior Crossbite Absent 997 93.3
More vulnerable 473 44.2 Present 72 6.7
Month Family income > 3 times minimum wage 277 25.9 Malocclusion Absent 575 53.8
≤3 times minimum wage 792 74.1 Present 494 46.2

TABLE 3 - Descriptive analyses of demographic characteristics TABLE 4 - Descriptive analyses of clinical characteristics of
of sample, Belo Horizonte, Brazil, 2009 (n=1069). sample, Belo Horizonte, Brazil, 2009 (n=1069).

EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY • VOL. 12/2-2011 109

CARVALHO A.C. ET AL.
in the primary dentition was 46.2%. A total of 89.5% of
the sample exhibited normal overjet and 10.5% exhibited
accentuated overjet (> 2 mm). Anterior crossbite was
absent in 93.3% of the children and present in 6.7%.
Deep overbite was present in 19.7% of the sample and
absent in 80.3%. Anterior open bite was present in 7.9%
of the sample. The prevalence of posterior crossbite was
13.1%.
Discussion
Epidemiological studies are important to understand
the distribution of oral health conditions in different
populations and individuals [Almeida et al., 2008].
The aim of the present study was to determine the
prevalence of malocclusion in the primary dentition. At
least one type of malocclusion was found in 46.2% of the
children examined. This prevalence is different to that
described in other studies carried out in Brazil, such as the
49.7% reported for the city of Recife, 36.4% reported in
a representative study of Brazil as a whole, 48.9% in the
city of São Paulo, 73.2% in the city of Bauru and 87.0%
in the city of Campina Grande [Frazão et al., 2002;
Ministry of Health, 2003; Katz et al., 2004; da Silva Filho
et al., 2007; Leite-Cavalcanti et al., 2007]. The prevalence
was also different from that reported in studies carried
out in different countries, such as the 26.0% prevalence
reported for India and 42.0% to 74.7% prevalence
reported for Germany [Stahl and Grabowski, 2004; Dhar
et al., 2007; Grabowski et al., 2007].
Direct comparison of the results from different studies is
hindered by the variety of nomenclatures used to classify
malocclusions and the application of different diagnostic
criteria [Grabowski et al., 2007]. The sample selection
method and sample size are important when comparing
results. Other difficulties that arise when attempting to
describe and interpret data on malocclusion in the
primary dentition involve the inclusion of children with
mixed and permanent dentition within the sample,
differences in the measurement of specific disorders, the
lack of a specific index for assessing malocclusion in the
primary dentition and the identification of cases and non-
cases from an epidemiological perspective [Almeida et al.,
2008]. Thus, the development of a standardised
measurement is very important to assess malocclusion in
the primary dentition, as there is no available occlusal
index for such an assessment. Moreover, the assessment
of morphological deviations alone is insufficient when
evaluating the progress of malocclusion [Grabowski et al.,
2007]. It is important to mention that there is an index
especially developed to assess treatment need in young
patients [Grippaudo et al., 2007; Grippaudo et al., 2008].
The ‘Risk of Malocclusion Assessment Index` (ROMA
Index) was developed and validated for use in Italian
children. Thus, we strongly encourage further studies to
carry out the cross-cultural validation for its use in other
countries and cultures. So, it can be used in large surveys
all around the world.
In the present study, the most prevalent type of
malocclusion was deep overbite (19.7%), followed by
increased overjet (10.5%) and posterior crossbite
110
(13.1%). These results are similar to those reported in
previous studies [Karjalainen et al., 1999; Grabowski et
al., 2007; Almeida et al., 2008; Macena et al., 2009].
Deep overbite generally interferes in the opening,
protrusion and lateral movements of the mouth. The
19.7% prevalence of this condition is less than that
reported a German study (33.2%) [Grabowski et al.,
2007]. This difference may be due to the fact that the
study cited was carried out on children with primary and
early mixed dentition. Moreover, children with both
permanent incisors and/or molars were accepted. The
authors found a high proportion of accentuated overjet
and deep overbite in the mixed dentition, suggesting
that neither condition corrected itself [Grabowski et al.,
2007].
In the present study, 10.5% of the children had
accentuated overjet, which is lower than that reported in
previous studies carried out with children of the same age
with primary teeth, such as the 29.7% and 16.0%
prevalence reported in studies conducted in Brazil [Katz et
al., 2004; Almeida et al., 2008]. A study carried out with
Finnish children reports a 26.0% prevalence of this
condition [Karjalainen et al., 1999]. These differences may
be due to the different methodology used by the authors,
who considered an accentuated overjet to be that greater
than 3 mm, in comparison to the 2 mm used in the
present study for the determination of this condition.
The prevalence of posterior crossbite was 13.1% in the
present study. Previous studies report a frequency of this
condition in the primary dentition ranging from 7.2% to
20.81% [da Silva Filho et al., 2007; Grabowski et al.,
2007]. Posterior crossbite is one of the most prevalent
malocclusions in the primary and early mixed dentitions
[Petrén et al., 2003]. It is also believed that this condition
can be transferred from the primary to the permanent
dentition [Petrén et al., 2003; Almeida et al., 2008]. The
majority of studies on posterior crossbite associate this
alteration to nonnutritive sucking habits, as children with
such habits tend to have a greater chance of exhibiting
malocclusion than those without pacifier-sucking habits
[da Silva Filho et al., 2007; Scavone et al., 2007; Góis et
al., 2008; Macena et al., 2009].
The present study has some inherent limitations that
should be addressed. Cross-sectional studies are carried
out either at a single point in time or over a short period.
Thus, associations identified in this type of study cannot
be considered a causal relationship. Furthermore,
Brazilian epidemiological studies in early childhood are
limited due to the difficult access to children who are too
young to attend daycare centers and schools [Macena et
al., 2009].
Conclusion
The present study offers evidence that malocclusion is a
problem in Brazilian preschool children. The prevalence of
malocclusion was high among the children analyzed,
suggesting that malocclusion is a public health problem in
this population. Thus, an early intervention is indicated to
prevent worsening and stimulating well-balanced dento
dental and skeletal growth.
EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY • VOL. 12/2-2011

Aknowledgement
This study was supported by the National Council for
Scientific and Technological Development (CNPq), the
Ministry of Science and Technology and the Research
Foundation of the State of Minas Gerais (FAPEMIG), Brazil.
References
Almeida ER, Narvai PC, Frazão P, Guedes-Pinto AC. Revised criteria for the
assessment and interpretation of occlusal deviations in the deciduous
dentition: a public health perspective. Cad Saude Publica. 2008;24:897-
904.
Charchut SW, Allred EN, Needleman HL. The effects of infant feeding
patterns on the occlusion of the primary dentition. J Dent Child (Chic).
2003;70:197-203.
Corruccini RS, Potter RH. Genetic analysis of occlusion variation in twins. Am
J Orthod. 1980;78:140-154.
Cunningham SJ, Hunt NP. Quality of life and its importance in orthodontics.
J Orthod. 2001;28:152-158
da Silva Filho OG, Santamaria M Jr, Capelozza Filho L. Epidemiology of
posterior crossbite in the primary dentition. J Clin Pediatr Dent.
2007;32:73-78.
Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of gingival diseases,
malocclusion and fluorosis in school-going children of rural areas in
Udaipur district. J Indian Soc Pedod Prev Dent. 2007;25:103-105.
Foster TD, Hamilton MC. Occlusion in the primary dentition. Study of children
at 2 and one-half to 3 years of age. Br Dent J. 1969;126:76-79.
Frazao P, Narvai PC, Latorre Mdo R, Castellanos RA. Malocclusion prevalence
in the deciduous and permanent dentition of schoolchildren in the city of
São Paulo, Brazil, 1996. Cad Saude Publica. 2002;18:1197-1205.
Góis EG, Ribeiro-Júnior HC, Vale MP, Paiva SM, Serra-Negra JM, Ramos-Jorge
ML, Pordeus IA. Influence of nonnutritive sucking habits, breathing
pattern and adenoid size on the development of malocclusion. Angle
Orthod. 2008;78:647-654.
Grabowski R, Stahl F, Gaebel M, Kundt G. Relationship between occlusal
findings and orofacial myofunctional status in primary and mixed
dentition. Part I: Prevalence of malocclusions. J Orofac Orthop.
2007;68:26-37.
Grippaudo C, Paolantonio EG, Deli R, La Torre G. Validation of the risk of
malocclusion assessment (ROMA) index. Eur J Paediatr Dent.
2007;8:136-142.
Grippaudo C, Paolantonio EG, Deli R, La Torre G. Orthodontic treatment need
in the Italian child population. Eur J Paediatr Dent. 2008;9:71-75.
Harrison JE, Ashby D. Orthodontic treatment for posterior crossbites.
Cochrane Database Syst Rev. 2001;1:CD000979.
Heimer MV, Tornisiello Katz CR, Rosenblatt A. Non-nutritive sucking habits,
dental malocclusions, and facial morphology in Brazilian children: a
longitudinal study. Eur J Orthod. 2008;30:580-585.
Instituto Brasileiro de Geografia e Estatítica. Available at:
http://www.ibge.gov.br. Accessed January 28, 2010.
Karjalainen S, Rönning O, Lapinleimu H, Simell O. Association between early
weaning, non-nutritive sucking habits and occlusal anomalies in 3-year-
old Finnish children. Int J Paediatr Dent. 1999;9:169-173.
Katz CR, Rosenblatt A, Gondim PP. Nonnutritive sucking habits in Brazilian
EUROPEAN JOURNAL OF PAEDIATRIC DENTISTRY • VOL. 12/2-2011
View publication stats
MALOCCLUSION IN BRAZILIAN PRESCHOOLERS
children: effects on deciduous dentition and relationship with facial
morphology. Am J Orthod Dentofacial Orthop. 2004;126:53-57.
Kiliaridis S, Engström C, Thilander B. The relationship between masticatory
function and craniofacial morphology. I. A cephalometric longitudinal
analysis in the growing rats fed a soft diet. Eur J Orthod. 1985;7:273-
283.
Leite-Cavalcanti A, Medeiros-Bezerra PK, Moura C. Breast-feeding, bottle-
feeding, sucking habits and malocclusion in Brazilian preschool children.
Rev Salud Publica. 2007;9:194-204.
Liu Z, McGrath C, Hägg U. The impact of malocclusion/orthodontic treatment
need on the quality of life: a systematic review. Angle Orthod.
2009;79:585-591.
Macena MC, Katz CR, Rosenblatt A. Prevalence of a posterior crossbite and
sucking habits in Brazilian children aged 18-59 months. Eur J Orthod.
2009;31:357-361.
McNamara JA Jr. Early intervention in the transverse dimension: is it worth
the effort? Am J Orthod Dentofacial Orthop. 2002;121:572-574.
Ministry of Health. Projeto SB Brasil, 2003: condição de saúde bucal da
população brasileira: 2002-2003. Resultados principais. Brasília:
Ministério da Saúde, 2004. Availabe at:
http://portal.saude.gov.br/portal/saude/visualizar_texto.cfm?idtxt=2365
1 Accessed February 04, 2010.
Nahas MI, Ribeiro C, Esteves O, Moscovitch S, Martins VL. O mapa da
exclusão social de Belo Horizonte: metodologia de construção de um
instrumento de gestão urbana. Cad Cienc Soc. 2000;7:75–88.
Ogaard B, Larsson E, Lindsten R. The effect of sucking habits, cohort, sex,
intercanine arch widths, and breast or bottle feeding on posterior
crossbite in Norwegian and Swedish 3-year-old children. Am J Orthod
Dentofacial Orthop. 1994;106:161-166.
Oliveira AC, Paiva SM, Campos MR, Czeresnia D. Factors associated with
malocclusions in children and adolescents with Down syndrome. Am J
Orthod Dentofacial Orthop. 2008;133:489.e1-8.
Peres KG, Traebert ES, Marcenes W. Differences between normative criteria
and self-perception in the assessment of malocclusion. Rev Saude
Publica. 2002;36:230-236.
Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and
sucking habits on malocclusion in a birth cohort study. Rev Saude
Publica. 2007;41:343-350.
Petrén S, Bondemark L, Söderfeldt B. A systematic review concerning early
orthodontic treatment of unilateral posterior crossbite. Angle Orthod.
2003;73:588-596.
Scavone H Jr, Ferreira RI, Mendes TE, Ferreira FV. Prevalence of posterior
crossbite among pacifier users: a study in the deciduous dentition. Braz
Oral Res. 2007;21:153-158.
Serra-Negra JM, Ramos-Jorge ML, Flores-Mendoza CE, Paiva SM, Pordeus
IA. Influence of psychosocial factors on the development of sleep bruxism
among children. Int J Paediatr Dent. 2009;19:309-317.
Stahl F, Grabowski R. Malocclusion and caries prevalence: is there a
connection in the primary and mixed dentitions? Clin Oral Investig.
2004;8:86-90.
Thilander B, Lennartsson B. A study of children with unilateral posterior
crossbite, treated and untreated, in the deciduous dentition--occlusal
and skeletal characteristics of significance in predicting the long-term
outcome. J Orofac Orthop. 2002;63:371-383.
Vig KW, Fields HW. Facial growth and management of orthodontic problems.
Pediatr Clin North Am. 2000;47:1085-1123.
111