Allergic rhinitis and its influence on the development of mouth breathing and temporomandibular dysfunction (TMD) in children from Río Negro, Argentina

Abstract

Background: Temporomandibular dysfunction (TMD) is a pathological entity related to functional problems of the joint and/or masticatory muscles. This entity is a public health problem studied for a long time, seeking to identify, among other characteristics, early identification strategies in order to reduce its chronic consequences. Aim: The aim of this study was to describe the results obtained in clinical dental and morphometric evaluations that can be routinely performed in a dental office, in order to verify if these allow an early diagnosis in children and adolescents with probable TMD. Methods: An observational, longitudinal and prospective study was carried out evaluating 36 mouth breathing patients aged 7-14 years, divided into two equal groups according to whether or not they had allergic rhinitis. DTM was studied by means of validated questionnaires and clinical tests, together with morphometric parameters calculated on radiographic images. Results: Tests and mouth breathing questionnaire showed significant differences between both groups. All the children in the control group had a mild disorder, while in the case group the totality was distributed between moderate (89%) and severe (11%) disorders. The movement indicator (Manglione index) showed that 83% of the patients in the control group were moderately impaired and 17% were severely impaired, while 100% of the patients in the case group were severely impaired at the time of consultation. The results of the morphometric analysis of the panoramic radiographs indicated that all patients with mouth breathing, whether due to allergic rhinitis or another cause, present differences in reference to condyle, ramus, body and ramus width symmetry between left and right side of the face in linear and angular measurements, with only the Condilion to Gnation distance being significantly lower in the cases. Conclusions: The diagnosis of DTM requires an oriented clinical examination to assess functional limitation. In addition, a complementary imaging study of low complexity such as panoramic radiography can allow visualization of changes such as the presence of osteophytes, which provide clarity to the diagnosis, given that pediatric patients do not always present the signs and symptoms classically described for adult patients.