喂养方式和口腔不良习惯对乳牙列牙合关系的影响

Effects of breast-feeding duration,bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition

目的：调查北京地区3～6岁儿童母乳喂养和奶瓶喂养的持续时间以及口腔不良习惯与乳牙列牙合特征的关联。方法：采用横断面研究,检查北京市3所幼儿园734名儿童的牙合特征;并使用调查问卷收集儿童的喂养方式和口腔不良习惯资料。牙合特征由经标准化训练的儿童口腔科医师检查,检查内容包括：是否存在深覆牙合、开牙合、前牙反牙合、后牙反牙合、深覆盖、牙列拥挤、生理间隙、尖牙关系以及第二乳磨牙的末端平面类型。喂养方式和口腔不良习惯与牙合特征的关联用单因素分析和多因素回归分析进行统计。结果：母乳喂养持续时间未超过6个月（≤6个月）增加乳牙列后牙反牙合以及上颌牙弓无间隙的风险,增加使用安慰奶嘴习惯和咬物习惯的风险;奶瓶喂养大于18个月增加形成非近中型末端平面以及Ⅱ类尖牙关系的风险;安慰奶嘴习惯增加乳牙列深覆盖及无下颌发育间隙的风险;吮指习惯增加前牙开牙合的风险;吐舌习惯增加前牙开牙合及后牙反牙合的风险。结论：母乳喂养持续时间长于6个月可减少错牙合的风险以及形成口腔不良习惯的风险,口腔不良习惯与乳牙列错牙合的发生呈正相关。

Objective： To assess the effects of breast-feeding duration,bottle-feeding duration and oral habits on the occlusal characteristics of primary dentition in 3-6-year-old children in Beijing. Methods：This cross sectional study was conducted via an examination of the occlusal characteristics of 734 children combined with a questionnaire completed by their parents / guardians. The examination was performed by a single,previously calibrated examiner and the following variables were evaluated： presence or absence of deep overbite,open bite,anterior cross bite,posterior cross bite,deep overjet,terminal plane relationship of the second primary molar,primary canine relationship,crowding and spacing. Univariate analysis and multiple Logistic regressions were applied to analyze the associations. Results： It was found that a short duration of breast-feeding（ never or ≤6 months） was directly associated with posterior cross bite（ OR = 3. 13,95% CI = 1. 11-8. 82,P = 0. 031） and no maxillary space（ OR = 1. 63,95% CI =1. 23-2. 98,P = 0. 038）. In children breast-fed for ≤6 months,the probability of developing pacifiersucking habits was 4 times that for those breast-fed for 〉6 months（ OR = 4. 21,95% CI = 1. 85-9. 60,P = 0. 000 2）. The children who were bottle-fed for over 18 months had a 1. 45-fold higher risk of nonmesial step occlusion and a 1. 43-fold higher risk of class Ⅱ canine relationship compared with those who were bottle-fed for 6-18 months. Non-nutritive sucking habits were also found to affect occlusion： a prolonged digit-sucking habit increased the probability of an anterior open bite,while a pacifier-sucking habit was associated with excessive overjet and absence of lower arch developmental space. Tongue-thrust habit was associated with anterior open bite（ OR = 4. 21,95% CI = 1. 85-9. 60,P = 0. 000 2） and posterior cross bite（ OR = 7. 24,95% CI = 1. 30-40. 13,P = 0. 024）. Lower lip sucking habit was associ-ated with deep overjet and had a negative association with class Ⅲ canine relationship. Unilateral chewing was associated with spacing in mandibular（ OR = 1. 57,95% CI = 1. 03-2. 41,P = 0. 037）.Mouth breathing was associated with chronic rhinitis and adenoidal hypertrophy and had an association with spacing in maxillary. The chi-square test did not indicate a statistically significant association between upper lip sucking habit and any occlusal characteristics. Conclusion： Breast-feeding duration was shown to be associated with the prevalence of posterior crossbite,or no maxillary space in the deciduous dentition and development of a pacifier-sucking habit. Children who had a longer duration of bottle-feeding were more likely to develop class Ⅱ canine relationship. Children who had an oral habit were more likely to develop abnormal occlusal characteristics.