original article

Factors associated with the prevalence of

anterior open bite among preschool children:
A population-based study in Brazil
Daniella Borges Machado1, Valéria Silva Cândido Brizon1, Gláucia Maria Bovi Ambrosano2,
Davidson Fróis Madureira3, Viviane Elisângela Gomes4, Ana Cristina Borges de Oliveira4

DOI: http://dx.doi.org/10.1590/2176-9451.19.5.103-109.oar

Introduction: The aim of this study was to identify factors associated with the prevalence of anterior open bite among
five-year-old Brazilian children. Methods: A cross-sectional study was undertaken using data from the National Sur-
vey of Oral Health (SB Brazil 2010). The outcome variable was anterior open bite classified as present or absent. The
independent variables were classified by individual, sociodemographic and clinical factors. Data were analyzed through
bivariate and multivariate analysis using SPSS statistical software (version 18.0) with a 95% level of significance. Results:
The prevalence of anterior open bite was 12.1%. Multivariate analysis showed that preschool children living in Southern
Brazil had an increased chance of 1.8 more times of having anterior open bite (CI 95%: 1.16 - 3.02). Children identified
with alterations in overjet had 14.6 times greater chances of having anterior open bite (CI 95%: 8.98 - 24.03). Conclu-
sion: There was a significant association between anterior open bite and the region of Brazil where the children lived, the
presence of altered overjet and the prevalence of posterior crossbite.

Keywords: Oral health surveys. Open bite. Preschool child.

Introdução: este estudo objetivou identificar os fatores associados à prevalência de mordida aberta anterior em crianças
brasileiras com cinco anos de idade. Métodos: foi realizado um estudo transversal analítico com dados do inquérito epi-
demiológico nacional de saúde bucal SB Brasil 2010. O desfecho estudado foi a mordida aberta, classificada em presente
ou ausente. As variáveis independentes foram classificadas em individuais, sociodemográficas e clínicas. Os dados foram
analisados por meio das análises bivariada e multivariada por meio do programa estatístico SPSS (versão 18.0), com nível
de significância de 5%. Resultados: a prevalência de mordida aberta anterior foi de 12,1% entre as crianças investigadas.
Aqueles pré-escolares residentes na região Sul do Brasil apresentaram uma chance 1,8 vezes maior de serem diagnosti-
cados com a mordida aberta anterior (IC 95%: 1,16 - 3,02). As crianças identificadas com alguma alteração de sobressa-
liência tiveram 14,6 vezes mais chance de pertencer ao grupo de crianças com mordida aberta (IC 95%: 8,98 - 24,03).
Conclusão: verificou-se que mordida aberta anterior apresentou associação significativa com a região brasileira em que as
crianças viviam, com a presença de alguma alteração de sobressaliência e com a prevalência de mordida cruzada posterior.

Palavras-chave: Inquéritos de saúde bucal. Mordida aberta. Criança. Pré-escolar.

1
MSc in Dentistry, Federal University of Minas Gerais (UFMG). How to cite this article: Machado DB, Brizon VSC, Ambrosano GMB, Madu-
2
Professor, School of Dentistry — State University of Campinas (UNICAMP). reira DF, Gomes VE, Oliveira ACB. Factors associated with the prevalence of ante-
3
PhD resident, Biological Sciences Institute of UFMG. rior open bite among preschool children: A population-based study in Brazil. Dental
4
Professor, School of Dentistry — UFMG. Press J Orthod. 2014 Sept-Oct;19(5):103-9. DOI: http://dx.doi.org/10.1590/2176-
9451.19.5.103-109.oar

» The authors report no commercial, proprietary or financial interest in the

Contact address: Ana Cristina Borges de Oliveira
products or companies described in this article.
Faculdade de Odontologia da UFMG, Av. Antônio Carlos, 6627
Campus Pampulha CEP: 31270-901 Belo Horizonte, MG — Brazil
Submitted: June 25, 2013 - Revised and accepted: November 01, 201 E-mail: [email protected]

© 2014 Dental Press Journal of Orthodontics 103 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9
original article Factors associated with the prevalence of anterior open bite among preschool children: A population-based study in Brazil

INTRODUCTION MATERIAL AND METHODS

With worldwide reduction in dental caries preva- Study design
lence, other oral problems have become more com- A cross-sectional analytical study was performed.
mon.1,2 Malocclusion is among them and may be asso- Data from the Epidemiological Survey of the Oral
ciated with genetic, environmental and behavioral fac- Health Conditions of the Brazilian Population, known
tors, thereby resulting in morphological, functional and as “SB Brasil 2010”, was used.2
esthetic problems.3
Anterior open bite (AOB) and posterior crossbite Ethical considerations
have been identified as the most common occlusal ab- The Brazilian Oral Health Project was submitted
normalities in primary dentition.4,5 AOB is character- to and approved by the National Council on Ethics
ized by lack of occlusal contact in the anterior region, and Human Research. An informed consent form was
while the remaining teeth are in occlusion.6,7 AOB is signed by all individuals participating in the study.2
more prevalent in primary dentition, with a prevalence
between 6.2% and 50.0% worldwide, varying accord- Sample population
ing to the population group studied.3,4,5,8-11 This is most The population of Brazil comprises approximately
likely to be associated with an increase in overbite dur- 190.7 million people, with 2.9 million children under
ing the mixed dentition period, and the self-correcting the age of five.21
nature of the majority of cases of anterior open bite in The epidemiological survey SB Brasil 2010 assessed
primary dentition.5,12 the oral health conditions of the Brazilian population
When non-nutritive sucking habits are no longer in urban and rural areas, classifying it into different age
present in children, AOB tends to disappear.3,5,8,10,12,13 ranges. The study surveyed 37, 519 individuals living
Góis et al13 showed that 70.1% of AOB present in pri- in 26 state capitals in the Federal District and in 150
mary dentition were self-corrected during the transi- municipal districts of varying population sizes located
tion from primary to mixed dentition. Early treatment in the countryside.2
of AOB, during the primary or mixed dentition, usually The database created by this study is of public do-
reaches better results and reduces indices of relapse;14,15,16 main and freely accessible on the website of the Brazilian
thus, spontaneous correction of AOB during the initial Ministry of Health.2
stages might be, in part, result of individual’s face and
dentition development process.12,16 Data collection
In this context, primary dentition directly influences Data were collected in each participant’s home. Data
the development of permanent occlusion. A number of collection included an oral examination and a question-
anomalies and occlusal characteristics present in the pri- naire. Dental teams comprised an examiner and an as-
mary dentition remain or even deteriorate in permanent sistant who performed clinical data collection using in-
dentition.13 It is important to advise parents that these struments (oral mirror and periodontal probe), as recom-
habits should be eliminated before eruption of upper per- mended by the World Health Organization (WHO).22
manent incisors in order to allow further self-correction The presence of AOB or any other form of maloc-
of this malocclusion.3,5,8,10,12,13 AOB is considered one of clusion was registered using the Foster and Hamilton
the most difficult occlusal abnormalities to be corrected in index (Table 1).23
the permanent dentition, especially with respect to stabil-
ity.3-10,12-20 Due to functional and esthetic abnormalities, Sample calculation
AOB may cause negative psychosocial impact in many A conglomerate sampling technique was used with
cases, predisposing individuals to low self-esteem, social three stratifications. The first used domains and pri-
alienation due to bullying, and behavioral disorders, with mary sampling units: Capitals and municipal districts
potential negative impact on their quality of life.13 from the countryside, according to each macroregion.
The aim of this study was to identify factors associ- The second was a subdivision of municipal districts:
ated with the prevalence of AOB among five–year-old 27 capitals plus 30 municipal districts from the country-
children in Brazil. side of each region of Brazil. The third used lottery to

© 2014 Dental Press Journal of Orthodontics 104 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9
Machado DB, Brizon VSC, Ambrosano GMB, Madureira DF, Gomes VE, Oliveira ACB original article

Table 1 - Foster and Hamilton index.

Calibration
Each fieldwork team was properly trained in work-
Diagnosis Diagnostic criteria
shops of 20 hours (6 classes). Training was divided into
» Class I: Tip of upper canine in the same vertical plane as the phases as follows: 4 hours of theory, 2 hours of practical
distal surface of lower canine when in centric occlusion. training, 8 hours for calibration, 2 hours of final discus-
Canine » Class II: Tip of upper canine in anterior relationship to the
sion and 4 hours of fieldwork strategy. The technique of
relationship distal surface of lower canine when in centric occlusion.
» Class III: Tip of upper canine in posterior relationship to the
consensus was used to calculate the correlation between
distal surface of lower canine when in centric occlusion. each examiner and the results obtained by consensus of
the team. The model proposed by the WHO was used as
Normal: Primary upper central incisor overjet ≤ 2 mm. reference. Kappa coefficient was calculated, weighted for
With alteration:
» Increased: Primary upper central incisor overjet > 2 mm.
each examiner, age-group and medical complaint with a
Overjet » Edge-to-edge: Upper and lower primary central incisors in value of 0.65 adopted as the minimal acceptable limit.2
edge-to-edge position.
» Anterior crossbite: Lower primary central incisors in anterior
Study variables
relationship to upper primary central incisors in occlusion.
The dependent variable was AOB. Table 2 describes
Normal: Incisal tips of primary lower central incisors the independent variables.
contacting the palatal surfaces of upper primary central
incisors when in centric occlusion.
Data analysis
With alteration:
» Reduced: Incisal tips of primary lower central incisors not
Data were analyzed using the Statistical Package for
contacting the palatal or incisal surfaces of upper primary Social Sciences (SPSS for Windows, version 18.0, SPSS
Overbite
central incisors when in centric occlusion. Inc, Chicago, IL, USA) software. First, bivariate data
» Anterior open bite: Incisal tips of lower primary central
incisors below the level of the incisal tips of upper primary
analysis was performed. Chi-square test was used to
central incisors when in centric occlusion. investigate the association between the dependent vari-
» Deep bite: Incisal tips of lower primary central incisors able (AOB) and the independent variables (child’s city
touching the palate when in centric occlusion.
of residence, region of Brazil, sex, family income, dental
caries, need for treatment of dental caries, canine rela-
Present: Upper primary molars occluding in lingual relationship
Posterior
with lower primary molars when in centric occlusion. tionship, overjet, posterior crossbite) (P < 0.05). In or-
crossbite
Absent der to identify the independent impact of each variable,
Source: Adapted from Foster and Hamilton23.
multiple logistic regression was performed. The inde-
pendent variables were inserted into logistic model on a
decreasing scale according to their statistical significance
(P < 0.25, stepwise backward procedure).

RESULTS
Table 1 displays the results of bivariate analysis.
The variables statistically associated with the prevalence
of AOB among five-year-old children were: Region
of Brazil in which the child lived, canine relationship,
guarantee representativeness in the municipal districts, overjet and posterior crossbite (P < 0.001).
census sectors, and residences. The results of multivariate analysis are shown in Table
A maximum of 250 volunteers were assessed for an- 2. Regardless of the other variables analyzed, five-year-
terior open bite in each one of the 172 cities in Brazil, old children from Southern Brazil were two times more
thereby resulting in a total sample of 5,622 five-year- likely to be identified with AOB than children in the
old children. The following parameters were used to Southeastern region of the country (OR = 1.87 [CI 95%:
calculate sample size: Values of z, variance, mean DEFT, 1.16 - 3.02]). Preschool children diagnosed with altera-
acceptable margin of error, effect of design and non-re- tions in overjet had 14.7 times greater chances of suffer-
ply rate. These data were taken from SB Brasil 2003.1 ing from AOB (OR= 14.69 [CI 95%: 8.98 - 24.03]).

© 2014 Dental Press Journal of Orthodontics 105 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9
original article Factors associated with the prevalence of anterior open bite among preschool children: A population-based study in Brazil

Table 2 - Independent variables and respective categories.

Independent variables Category

Age State capital Other city
Region of Brazil North Northeast Southeast South Midwest
Sex Male Female
Family incomea < 250 251 - 500 501 - 1500b 1501 - 2500 2501 - 4500 4500 - 9500 > 9501
Tooth caries deft = 0 deft > 1
Need for treatment Absent Present
Canine relationship Class I Class II Class III
Overjet Normal With alteration
Posterior crossbite Absent Present

a
R$ (R$ 1,00 = US$ 0,49) / bpopulation family income.

DISCUSSION in São Paulo there was a prevalence of 22.4% among

The prevalence of AOB in the studied population 309 children.3 In Southern Brazil, particularly in Pelo-
of five-year-old children was 12.1%.2 However, there tas, 46.3% of 359 children had AOB in primary denti-
is considerable variation in such epidemiological data tion.19 In the Northeastern Brazil, particularly in Re-
in worldwide literature (6.2 to 50.0%), even when the cife, 30.2% of 1,308 five-year-old children had AOB.10
same regions of Brazil are compared.3,4,5,8,9,10,24 A direct Moreover, studies outside Brazil also demonstrate a
comparison of the results yielded by different studies is range of different results, with a prevalence of AOB
difficult due to variation in diagnostic and classification among preschool children varying from 13.0% in Italy
criteria from an epidemiological perspective. Variations to 50.0% in Sweden.5,8 In addition, racial characteristics
in study design, sample criteria and methods of analyz- may influence the occurrence of AOB. Thus, there was
ing results can also result in data discrepancy. significant difference in the prevalence of malocclusion
Multivariate data analysis confirmed the preva- between Caucasian and Afro American children aged
lence of AOB statistically associated with the region from 3 to 5 years old, with no differences between males
in which the child lived and also with the prevalence and females.19 In the present study, the statistical signifi-
of posterior crossbite and alterations in overjet. The cance found between prevalence of AOB and the region
chances of children resident in the Southern of Brazil of children’s residence can also be related to diverse ra-
being diagnosed with AOB was nearly twice greater cial, economic and sociodemographic characteristics in
than that of children living in other regions of the Brazil. The Brazilian population is one of the most di-
country. This variation can be possibly explained by verse in the world, with bi or trihybrid miscegenation
different cultural habits that may result in greater or prevailing in some regions. The country is of continental
less exposure to risk factors associated with AOB, such extension; thus, its population reveals great complexity
as time spent in breast-feeding, diet and variations in and diversity, especially in terms of physical and cultural
non-nutritive sucking habits in different regions of characteristics. Although the present study did not in-
Brazil.9,13,24 These data corroborate the findings in the vestigate the racial composition of the Brazilian popu-
literature. Another study conducted in Southern Bra- lation, the Brazilian Census of 2010 demonstrates that
zil also found a higher percentage of AOB in primary racial characteristics, which were self-declared, among
dentition when compared with studies undertaken in children between 0-14 years old considerably vary ac-
the Southeastern and Northeast regions.3,4,9,10 cording to each region of Brazil.21 The Brazilian Census
Regional, cultural and socioeconomic variations of of 2010 also demonstrates that higher median income
each city should be considered and are the most probable and lower illiteracy indices were seen in Midwestern,
explanation for the different prevalence of AOB found Southeastern and Southern Brazil, while lower me-
in other studies. A survey undertaken in the Southeast- dian income and higher illiteracy indices were present
ern of Brazil found a prevalence of AOB of 7.9% among in Northern and Northeastern Brazil.21 However, fam-
1,069 preschool children from Belo Horizonte,4 whereas ily income did not influence the occurrence of AOB.

© 2014 Dental Press Journal of Orthodontics 106 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9
Machado DB, Brizon VSC, Ambrosano GMB, Madureira DF, Gomes VE, Oliveira ACB original article

Table 1 - Sample distribution according to the prevalence of anterior open bite and associated factors. (n = 5,622).

Prevalence of anterior open bite

Independent variables n (total)
n (%) Gross OR (CI 95%) P value*
Age
State capital 4,272 543 (16.6) 1
0.472
Other city 1,350 163 (13.7) 0.93 (0.77-1.13)
Region of Brazil
North 1,476 127 (9.41) 0.53 (0.41-0.69)
Northeast 1,567 214 (15.8) 0.97 (0.77-1.22)
Southeast 1,009 141 (16.2) 1 <0.001
South 751 152 (25.3) 1.75 (1.36-2.27)
Midwest 819 72 (9.6) 0.55 (0.41-0.74)
Sex
Male 2,803 337 (13.6) 1
0.163
Female 2,819 369 (15.0) 1.12 (0.96-1.31)
Family income**
< 250 a
270 37 (15.8) 1.05 (0.73-1.52)
251 to 500 894 97 (12.1) 0.77 (0.61-0.98)
501 to 1,500b 2,917 386 (15.2) 1
1,501 to 2,500 808 104 (14.7) 0.96 (0.76-1.22) 0.335
2,501 to 4,500 309 43 (16.1) 1.07 (0.76-1.51)
4,501 to 9,500 112 11 (10.8) 0.68 (0.36-1.28)
> 9,500 48 5 (11.6) 0.73 (0.29-1.87)
Tooth caries
deft = 0 2,571 303 (13.3) 1
0.062
deft = > 1 3,051 403 (15.2) 1.16 (0.99-1.37)
Need for treatment of tooth caries
Absent 2,764 335 (13.7) 1
0.263
Present 2,858 371 (14.9) 1.10 (0.93-1.29)
Canine relationship**
Class I 4,308 385 (9.81) 1
Class II 941 228 (31.98) 4.32 (3.58-5.22) < 0.001
Class III 361 92 (34.20) 4.78 (3.64-6.28)
Overjet**
Normal 3,842 157 (4.26) 1
< 0.001
With alteration 138 44 (46.81) 19.78 (12.79-30.57)
Posterior crossbite**
Absent 1,142 194 (20.46) 1
< 0.001
Present 4,447 509 (12.93) 0.58 (0.48-0.69)

OR: Odds ratio; CI 95%: Confidence interval.

* c2 test/ ** missing values / aR$ (R$ 1,00 = US$ 0,49) / b population family income.

Table 2 - Multiple logistic regression models explaining the prevalence of anterior open bite in five-year-old children in Brazil.

Categories Adjusted OR [CI] P value*

Southern Brazil 1.87 (1.16-3.02) < 0.001

Overjet with alteration 14.69 (8.98-24.03) < 0.001

Posterior crossbite present 0.62 (0.44-0.87) 0.006

OR: Odds ratio; CI 95%: Confidence interval.

© 2014 Dental Press Journal of Orthodontics 107 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9
original article Factors associated with the prevalence of anterior open bite among preschool children: A population-based study in Brazil

Therefore, differences in race and sociodemographic absence of AOB without differentiating its extension,
characteristics may influence the prevalence of maloc- severity and dental or skeletal impairment. Other fac-
clusion among the population.24 tors such as the presence of harmful habits, facial and
Preschool children identified with alterations in over- respiratory patterns, which are etiological factors of this
jet (increased edge-to-edge bite or anterior crossbite) malocclusion, were not investigated either. This is most
had greater chances of having AOB.5,23-26 Non-nutritive probably due to the comprehensive character of the
sucking habits and tongue posture are included as en- other variables studied, as well as the need for collecting
vironmental factors.4,5 Such transversal and sagittal brief data because of the large sample comprising 5.622
abnormalities, which share the same etiological factors, children. Data provided, however, is an accurate indica-
may be associated with AOB. Considering that AOB tor of the prevalence of AOB in the different regions of
is directly related to non-nutritive sucking habits, the Brazil. Such data are important for the strategic planning
increased prevalence of malocclusion at a younger age of government programs aimed at prevention, intercep-
can be associated with an increased incidence of this tion and treatment of AOB.
habit among younger children. A longitudinal study of The present study alerts oral health care programs
386 children (aged 3 years old at study onset and exam- to the need for preventive measures that can deter or at
ined again at 7 years of age) performed in Sweden found least reduce the prevalence of this and other malocclu-
that the prevalence of non-nutritive sucking habits de- sions among the infant population. In Brazil, the road
creased from 66.0% to 4.0% between 3 and 7 years of towards an universal dental care for the general popula-
age, which might have influenced the reduction of AOB tion, especially infants, is long. Orthodontic treatment
incidence from 50% to 10% at the age of seven.5 In ad- is not just a matter of vanity. The more severe the prob-
dition, oral respiration may also significantly contribute lem, the greater the functional and psychological impact
to the etiology of dentofacial abnormalities in children of anterior open bite. Child may often become target
during growth.28 Furthermore, a study of schoolchildren of bullying which can result in behavioral disorders
from Lithuania aged between 7 and 15 years old found a and personality maladjustments. Additional studies are
significant association between nasal obstruction and in- needed to clarify the etiology and severity of AOB ac-
creased overjet, open bite and maxillary growth.27 A study cording to each region of Brazil.
performed among preschool children in Brazil showed
that children who had the habit of sucking a pacifier after CONCLUSION
two years of age and those who were oral breathers had Children living in Southern Brazil showed greater
a greater chance of developing malocclusion.19 While chances of being diagnosed with anterior open bite.
the design of the present study is robust, some limita- Children identified with alterations in overjet
tions should be observed. Data assessed the presence or showed greater chances of having anterior open bite.

© 2014 Dental Press Journal of Orthodontics 108 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9
Machado DB, Brizon VSC, Ambrosano GMB, Madureira DF, Gomes VE, Oliveira ACB original article

REFERENCES

1. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Projeto SB 13. Góis EG, Vale MP, Paiva SM, Abreu MH, Serra-Negra JM, Pordeus IA. Incidence
Brasil 2003: condições de saúde bucal da população brasileira 2002-2003. of malocclusion between primary and mixed dentitions among Brazilian
Resultados principais. Brasília, DF: Ministério da Saúde; 2004. [Acesso children: a 5-year longitudinal study. Angle Orthod. 2012;82(3):495-500.
em: 2012 Jul. 12]. Disponível em: http://portalweb02.saude.gov.br/portal/ 14. Huang GJ, Justus R, Kennedy DB, Kokich VG. Stability of anterior openbite
arquivos/pdf/relatorio_brasil_sorridente.pdf. treated with crib therapy. Angle Orthod. 1990;60(1):17-26.
2. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de 15. Ngan P, Fields HW. Open bite: a review of etiology and management. Pediatr
Atenção à Saúde. Coordenação Nacional de Saúde Bucal. SB2010. Pesquisa Dent. 1997;19(2):91-8.
Nacional de Saúde Bucal. Resultados principais. Brasília, DF: MS, 2011. 16. Janson G, Valarelli FP, Beltrão RT, Freitas MR, Henriques JF. Stability of
[Acesso: 2012 Jul. 12]. Disponível em: http://dab.saude.gov.br/cnsb/sbbrasil/ anterior open-bite extraction and nonextraction treatment in the permanent
download.htm. dentition. Am J Orthod Dentofacial Orthop. 2006;129(6):768-74.
3. Romero CC, Scavone-Junior H, Garib DG, Cotrim-Ferreira FA, Ferreira RI. 17. Trottman A, Elsbach HG. Comparison of malocclusion in preschool black
Breastfeeding and non-nutritive sucking patterns related to the prevalence of and white children. Am J Orthod Dentofacial Orthop. 1996;110(1):69-72.
anterior open bite in primary dentition. J Appl Oral Sci. 2011;19(2):161-8. 18. Katz CR, Rosenblatt A, Gondim PP. Nonnutritive sucking habits in Brazilian
4. Carvalho AC, Paiva SM, Scarpelli AC, Viegas CM, Ferreira FM, Pordeus children: effects on deciduous dentition and relationship with facial
IA. Prevalence of malocclusion in primary dentition in a population- morphology. Am J Orthod Dentofacial Orthop. 2004;126(1):53-7.
based sample of Brazilian preschool children. Eur J Paediatr Dent. 19. Peres KG, Barros AJ, Peres MA, Victora CG. Effects of breastfeeding and
2011;12(2):107-11. sucking habits on malocclusion in a birth cohort study. Rev Saúde Pública.
5. Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions 2007;41(3):343-50.
in children at 3 and 7 years of age: a longitudinal study. Eur J Orthod. 20. Onyeaso CO, Isiekwe MC. Occlusal changes from primary to mixed
2011;33(3):1-7. dentitions in Nigerian children. Angle Orthod. 2008;78(1):64-9.
6. Fränkel R, Fränkel C. A functional approach to treatment of skeletal open 21. Instituto Brasileiro de Geografia e Estatística. Censo demográfico 2010. Rio
bite. Am J Orthod. 1983;84(1):54-68. de Janeiro, 2010. [Acesso em : 2012 Jul. 12]. Disponível em: ftp://ftp.ibge.
7. Artese A, Drummond S, Nascimento JM, Artese F. Criteria for diagnosing gov.br/Censos/Censo_Demografico_2010/Caracteristicas_Gerais_Religiao_
and treating anterior open bite with stability. Dental Press J Orthod. Deficiencia/tab1_1.pdf.
2011;16(3):136-61. 22. World Health Organization. Oral Health Surveys: basic methods. 4th ed.
8. Viggiano D, Fasano D, Monaco G, Strohmenger L. Breast feeding, bottle Geneva, Switzerland: World Health Organization; 1997.
feeding, and non-nutritive sucking; effects on occlusion in deciduous 23.Foster TD, Hamilton MC. Occlusion in the primary dentition. Study of children
dentition. Arch Dis Child. 2004;89(12):1121-3. at 2 and one-half to 3 years of age. Br Dent J. 1969;126(2):76-9.
9. Peres KG, Latorre MR, Sheiham A, Peres MA, Victora CG, Barros FC. Social 24. Tomita NE, Bijella VT, Franco LJ. The relationship between oral habits and
and biological early life influences on the prevalence of open bite in Brazilian malocclusion in preschool children. Rev Saúde Pública. 2000;34(3):299-303.
6-year-olds. Int J Paediatr Dent. 2007;17(1):41-9. 25. Greenlee GM, Huang GJ, Chen SS, Chen J, Koepsell T, Hujoel P. Stability
10. Vasconcelos FM, Massoni AC, Heimer MV, Ferreira AM, Katz CR, Rosenblatt of treatment for anterior open-bite malocclusion: a meta-analysis. Am J
A. Non-nutritive sucking habits, anterior open bite and associated factors in Orthod Dentofacial Orthop. 2011;139(2):154-69.
Brazilian children aged 30-59 months. Braz Dent J. 2011;22(2):140-5. 26. Cuccia AM, Eotti M, Caradonna D. Oral breathing and head posture. Angle
11. Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion and orthodontic Orthod. 2008;78(1):77-82.
treatment need in the United States: estimates from the NHANES III survey. Int J 27. Lopatienė K, Babarskas A. Malocclusion and upper airway obstruction.
Adult Orthodon Orthognath Surg. 1998;13(2):97-106. Medicina. 2002;38(3):277-83.
12. Klocke A, Nanda RS, Kahl-Nieke B. Anterior open bite in the deciduous
dentition: longitudinal follow-up and craniofacial growth considerations. Am
J Orthod Dentofacial Orthop. 2002;122(4):353-8.

© 2014 Dental Press Journal of Orthodontics 109 Dental Press J Orthod. 2014 Sept-Oct;19(5):103-9