Riitta Pahkala

Eruption pattern of permanent teeth in a rural community in northeastern Finland.

Cross-sectional data on permanent tooth eruption were collected by examining the children and adolescents 5-15 years old in a northeastern municipality of Finland. There were 1008 subjects in the whole sample, 483 girls and 525 boys. The results showed statistically significant differences between the girls and boys in timing of eruption of some permanent teeth, indicating earlier eruption in girls than in boys. This difference was most clearly seen in the second phase of the mixed dentition. Interindividual variation in the emergence age was also wider in the second phase of the mixed dentition. The present results seem to indicate earlier eruption of the permanent teeth in rural children in northeastern Finland than in other parts of the country.

Standards for permanent tooth emergence in Finnish children

Two groups of Finnish children, 1008 from the eastern part of the country and 569 from the western part, aged 5 to 16 years, were examined to determine the timing of permanent tooth emergence and any regional variation therein. The probit analysis was used to calculate the median ages of eruption. Permanent teeth in the first phase of the mixed dentition erupted earlier and premolars erupted later than previously reported for Scandinavian populations. The former finding could reflect the secular trend; the latter is probably related to the dramatically improved dental health in Finnish children. No regional variation in eruption was found. The median ages of eruption of permanent teeth determined in the present study are suggested for use as national standards for permanent tooth emergence in Finland, separately for girls and boys.

Effects of sagittal split ramus osteotomy on temporomandibular disorders in seventy‐two patients

Preoperative and postoperative temporomandibular disorders (TMDs) were observed in 72 patients before surgical‐orthodontic treatment and about 2 years after bilateral sagittal split osteotomy. Prevalence and degree of TMD were assessed using the modified clinical dysfunction index of Helkimo. A total of 49 women and 23 men (mean age 32 years) were included in the study. To find out which patients benefit most from the treatment, the sample was classified into subgroups—myogenous, arthrogenous, or both components of TMD. The prevalence of clicking and headache decreased significantly with the treatment, while the incidence of crepitation increased. In general, severity of the dysfunction was greatly reduced. Furthermore, multiple regression analysis showed that patients with excessive overjet and previous occlusal splint therapy benefit most from orthognathic treatment. In addition, patients with signs of mainly myogenous origin got more relief from their dysfunction than patients with mainly arthrogenous components of TMD. The results suggest that in patients with severe maxillomandibular discrepancy surgical‐orthodontic therapy is a good choice of treatment for reducing myogenous TMD pain and discomfort.

Changes in TMD signs and in mandibular movements from 10 to 15 years of age in relation to articulatory speech disorders

This study is part of a longitudinal study on the associations between different orofacial dysfunctions. The aim was to determine changes in signs of temporomandibular disorders (TMD) and in mandibular movement capacity in subjects with articulatory speech disorders and in controls by re-examining a sample of 187 previously studied children from 10 to 15 years of age. Articulatory speech disorders were diagnosed by a phoniatrician. Mandibular movement capacity, signs of TMD, occlusal contacts/interference and slide between retruded and intercuspal positions were recorded by a dentist. The followup results showed that mandibular mobility mainly increased up to the age of 15, but there was a decrease in protrusion capacity in almost half of the cases. This fluctuation probably reflects the normal changes in growth pattern. Signs of TMDs proved to be inconsistent in nature, especially among the controls. With age, girls in the control group, more so than boys, were prone to new signs of TMD, but no gender difference was found in the group of subjects with misarticulations of speech. The findings indicate that in adolescence different orofacial dysfunctions are related.

Mandibular movement capacity in 19-year-olds with and without articulatory speech disorders.

Associations between articulatory speech disorders and mandibular movement capacity, as well as between malocclusions and jaw movements, were examined in two groups of adolescents, i.e. 52 individuals with and 45 without misarticulations of speech. The mean age of the whole sample was 19.2 years. Articulatory speech disorders and functioning of the speech articulators were diagnosed by a phoniatrician. Mandibular movement capacity, malocclusions, occlusal interferences, and signs of temporomandibular dysfunction were recorded by an orthodontist. Multiple regression analyses showed that subjects with articulatory speech disorders were likely to have smaller opening capacity than subjects with a correct speech articulation. Excessive overjet, lateral cross bite, and a tendency to anterior open bite were associated with large movements of the jaw. These results suggest that in young adulthood mandibular movement capacity seems to vary depending on occlusion and is related to misarticulations of speech.

Risk factors for sleep-disordered breathing: the role of craniofacial structure.

Abstract Objective. To evaluate possible differences in craniofacial structure between overweight patients and normal-weight patients with mild sleep-disordered breathing (SDB). Material and methods. Subjects were recruited from patients referred to Kuopio University Hospital due to suspicion of SDB. They were divided into two groups based on their body mass index (BMI). The overweight group (BMI > 27 kg/m2) consisted of 58 males and 19 females and the normal weight group (BMI ≤ 27 kg/m2) of 33 males and 15 females. The mean age of the subjects was 51.4 years. All subjects underwent an overnight cardiorespiratory recording. The mean apnea–hypopnea index (AHI) was 9.3 events/h for the entire study population. Occlusion and craniofacial morphology were examined by an experienced orthodontist. Results. Significant differences in craniofacial morphology and occlusion were found between the groups: the craniofacial profile in normal-weight patients was more convex (P < 0.000) and the mandible more retrusive (P = 0.004) than in overweight subjects. In addition, distal molar occlusion (P = 0.005) was more prevalent in normal-weight subjects, and their overjet and overbite were increased as compared to overweight patients (P = 0.009 and 0.006, respectively). Similarly, cross bite was detected significantly more often in normal-weight subjects (P = 0.052). Conclusions. These results reveal that deviations in craniofacial morphology and occlusion are more frequent in normal subjects than in overweight subjects with mild SDB; this may well have implications in the pathophysiology of SDB.

Perception and respiratory responses of the upper airway mechanism to added resistance with aging

To assess breathing behaviors and perception of added respiratory loads in young compared to old individuals, and to determine whether aging affects the perception and response to changes in nasal airway resistance.

Lateral facial profile may reveal the risk for sleep disordered breathing in children—The PANIC-study

Abstract Objective. To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs. Materials and methods. The present study sample consisted of 382 children 6–8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile. Results. The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000–0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951–0.992. Conclusion. In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Health-related correlates of psychological well-being among girls and boys 6-8 years of age: The Physical Activity and Nutrition in Children study: Correlates of psychological well-being

Due to limited knowledge on the differences in the correlates of psychological well‐being (PSWB) between girls and boys, we compared the correlates of PSWB between primary school girls and boys.

Predictors of sleep disordered breathing in children: the PANIC study

Objective We studied longitudinally the associations of craniofacial morphology, mouth breathing, orthodontic treatment, and body fat content with the risk of having and developing sleep disordered breathing (SDB) in childhood. We hypothesized that deviant craniofacial morphology, mouth breathing, and adiposity predict SDB among children. Materials and methods The participants were 412 children 6-8 years of age examined at baseline and 329 children aged 9-11 years re-examined at an average 2.2-year follow-up. An experienced orthodontist evaluated facial proportions, dental occlusion, soft tissue structures, and mode of breathing and registered malocclusions in orthodontic treatment. Body fat percentage was assessed by dual-energy X-ray absorptiometry and SDB symptoms by a questionnaire. Results Children with SDB more likely had convex facial profile, increased lower facial height, mandibular retrusion, tonsillar hypertrophy, and mouth breathing at baseline and convex facial profile, mandibular retrusion, and mouth breathing at follow-up than children without SDB at these examinations. Male gender and body adiposity, mouth breathing, and distal molar occlusion at baseline were associated with SDB later in childhood. Adipose tissue under the chin, mandibular retrusion, vertically large or normal throat and malocclusion in orthodontic treatment at baseline predicted developing SDB during follow-up of among children without SDB at baseline. Limitations We could not conduct polysomnographic examinations to define sleep disturbances. Instead, we used a questionnaire filled out by the parents to assess symptoms of SDB. Conclusions The results indicate that among children, deviant craniofacial morphology, mouth breathing, body adiposity, and male gender seem to have implications in the pathophysiology of SDB.