Pressão máxima da língua e a etiologia da respiração oral em crianças

Abstract

Introduction: Mouth breathing installation and maintenance can cause changes in the child's speech, dentofacial deformities, poor positioning of teeth, improper body posture and changes in the respiratory system. Other commonly reported effects in studies involving oral breathing children is the presence of disturbances in orofacial structures, such as the tongue and lips. For this reason a detailed evaluation of these structures is necessary. Objective: To describe and analyze the most commonly assessment methods used for strength and tone classification of the cheeks, lips and tongue, to know the maximum pressure values exerted by the tongue in mouth breathing children and the relation between them and the etiology of mouth breathing. Methods: This study consists of two phases, the first one is a systematic review of the literature and the second one a field survey with 59 mouth breathing children who were treated at the Mouth Breathing Outpatient Clinic of the Federal University of Minas Gerais (HCUFMG). For the systematic review, a research was conducted involving the following steps: establishment of guiding question; keywords and criteria for inclusion / exclusion of articles; selection and critical evaluation of articles. A search of the scientific literature was conducted on portal databases MEDLINE, LILACS and Scielo. The following descriptors were used: "Exercise Therapy, Myofunctional Therapy", Rehabilitation, " Evaluation of Results of Therapeutic Interventions ", " Evaluation of the Efficacy-Effectiveness of Interventions", "Assessment", "Tongue", "Lips", "Cheek", "Mouth Breathing", "Muscle Strength" and "Tonus Muscle and their equivalents in Portuguese and Spanish.The selection criteria established the inclusion of case reports articles and experimental studies, in Spanish, English or Portuguese, published between 2005 and 2014, which used as subjects, human beings at any age and independent of health condition. Data analysis was conducted by two independent researchers. After elimination of duplicate references and analysis of the summaries, the articles were obtained in full and the data regarding the sample was collected, as well as the procedures related to the perceptive and instrumental evaluation. In the second phase a descriptive and analytical observational cross-sectional study was conducted with 59 children aged between 3 and 12 years (mean 6.5 years, SD = 2.4) with mouth breathing behavior treated at the Mouth Breathing Outpatient Clinic of Hospital das Clinicas, Federal University of Minas Gerais (HC-UFMG). The study was approved by the Ethics Committee of UFMG, CAAE 36663614.8.0000.5149. Measurements were performed with the participants sitting with their back and feet supported. The Iowa Oral Performance Instrument (IOPI) was used. It was a validated device that comprises an air filled bulb with approximately 3 cm x 1.5 cm x 1cm. The bulb was positioned at the alveolar papilla of upper teeth and it was asked to each participant to push the bulb with maximum force and to maintain the muscle contraction for 3 seconds. Three measures for each participant with a rest time of 30 seconds between series were performed. Results: in the first phase, after initial assessment 39 articles remained. Regarding the tongue, two articles (5,7%) reported only perceptual strength assessment, four (14,3%) described perceptual and instrumental assessment and other 28 (80%) articles only addressed the instrumental evaluation. For the lip, two (28,6%) reported the perceptual evaluation and four (71,4%) reported the instrumental method. Only two (5%) articles evaluated the strength of the cheeks, both by instrumental evaluation. In the second phase, the Spearman coefficient noticed a moderate and positive correlation between age and maximum pressure (r = 0.653; p <0.001), it was found that there was a statistically significant difference between the maximum pressure of the tongue and the variables tonsils (p <0.008) and adenoids (p <0.043). There were no statistical differences between the other variables. Conclusion: it was found that several authors have used instruments to perform tongue, lips and cheeks strength evaluations. Among the instruments, the IOPI was the most used. It was also verified that 10% of them held concurrently the perceptual and instrumental assessment. In the second phase of this research, it was concluded that the hypertrophic adenoids and the tonsils change the maximum pressure of the tongue in oral breathers.