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Prevalence of Malocclusion and Related Oral Habits in 5-to 6-year-old

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 ORIGINAL ARTICLE

Prevalence of Malocclusion and Related Oral Habits

in 5- to 6-year-old Children
Renata Reis dos Santosa/João Guilherme Rodrigues Naymea/Artênio José Isper
Garbinb/Nemre Salibac/Cléa Adas Saliba Garbind/Suzely Adas Saliba Moimazc

Purpose: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5-
and 6-year-old children enrolled in Brazilian public elementary schools during 2010.

Materials and Methods: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the
method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information
about the type of arch, social and economic data and harmful oral habits of the children were collected through a struc-
tured questionnaire.

Results: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found.
Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior cross-
bite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of pos-
terior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles
predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle
and finger sucking was reported by 17.2%.

Conclusion: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

Key words: child welfare, dentition, malocclusion, public health dentistry

Oral Health Prev Dent 2012;10: 311-318 Submitted for publication: 05.10.11; accepted for publication: 01.02.12

M alocclusion is considered a public health prob-

lem due to its high prevalence, occupying third
place on the scale of oral health priorities, being
surpassed by dental caries and periodontal dis-
ease (WHO, 1989). It has been frequently observed
in children at different ages (Emmerich et al, 2004;
Freire et al, 2010; Garbin et al, 2010). Its etiology
is multifactorial, with a range of influences that in-
a The majority of malocclusions are principally
Master’s Student, Postgraduate Programme in Preventive and So-
cial Dentistry, Araçatuba Dental School, Estadual Paulista Univer-
sity, Unesp, Araçatuba, Brazil.
b
Senior Lecturer, Preventive and Social Dentistry Postgraduate Pro-
gramme, Araçatuba Dental School, Estadual Paulista University,
Unesp, Araçatuba, Brazil.
c
Full Professor, Preventive and Social Dentistry Postgraduate Pro-
gramme, Araçatuba Dental School, Estadual Paulista University,
Unesp, Araçatuba, Brazil.
d
Coordinator of Postgraduate Programme in Preventive and Social
Dentistry, Araçatuba Dental School, Estadual Paulista University,
Unesp, Araçatuba, Brazil.
Correspondence: Renata Reis dos Santos, 1193, José Bonifácio
Street, Vila Mendonça, Araçatuba, SP, Brazil. Tel: +55-18-3636-
3249/+55-18-9113-3308. Email: renatar.santos@yahoo.com.br
volves congenital, morphological, biomechanical
and environmental problems (Moyers, 1999; Em-
merich et al, 2004; Roncalli, 2005). The World
Health Organization (WHO, 1989) does not consid-
er malocclusion to be a disease per se, but rather
a group of deviations of dental position, including
cases that are directly or indirectly linked to quality
of life (WHO, 1989; Marques et al, 2006; Borges et
al, 2010).
caused by external factors, such as acquired func-
tional conditions, soft diet, harmful oral habits and
breathing problems, as has been observed by many
authors (Planas, 1997; Dias et al, 2008; Heimer et
al, 2008; Izuka et al, 2008; Marcomini et al, 2010;
Garbin et al, 2010). Considering that they are the
principal agents, is necessary to consider the pre-
vention of malocclusion as part of treatment (Pla-
nas, 1997; Tomita et al, 1998).
It is important to emphasise that treatment of
malocclusions should be included in the dental ser-
vices of public health systems, because of result-

Vol 10, No 4, 2012 311

Dos Santos et al
ing physiological changes in the oral cavity (Ron-
calli, 2005). In a Brazilian national study that
evaluated the oral health status of the population,
malocclusion was verified in 5-, 12- and 15- to
19-year-old children, using the method developed
by the WHO for epidemiological surveys in oral
health (WHO, 1989). The prevalence of moderate or
severe occlusion was 14.5% in 5-year-olds, severe
or incapacitating in 21% of 12-year-old children and
around 19% in 15- to 19-year-old adolescents (BRA-
SIL, 2003).
In another recent study (Traebert and Peres,
2007), 1566 socioeconomically disadvantaged
pre-teens between the ages of 8 and 11 years were
analysed based on the Index of Orthodontic Treat-
ment Need (IOTN), revealing that more than 17% of
participants had a high need of treatment. Based
on the aesthetic component of the IOTN, 16.7%
needed definitive treatment.
First of all, it is necessary to identify the maloc-
clusion rate in the population in order to effectively
implement action (Bresolin, 2008), because the
skeletal changes can be avoided with structural
and orthopedic alterations if diagnosis is made ear-
lier on (Gribel, 1999). If malocclusion persists un-
treated, it can cause a negative and significant im-
pact on the quality of life of the children and their
families, due to the associated physiological and
social changes resulting from this disorder (Johal
et al, 2007).
Thus, the aim of this study was to verify the prev-
alence of malocclusions and the influence of harm-
ful oral habits on the deciduous dentition of children
enrolled in Brazilian public schools during 2010.
MATERIALS AND METHODS
The study population consisted of all pupils be-
tween the ages of 5 and 6 years who were enrolled
in all 56 public elementary schools of São Paulo
State, Brazil, during 2010. The study was conduct-
ed after approval by the Ethics Committee for Re-
search with Humans, Araçatuba Dental School, São
Paulo State University, respecting all dictates of the
Ministry of Health’s resolution no. 196/96 (Brasil,
1996). A “Free and Clear Consent” form (TCLE)
was sent to the parents or guardians of each child,
allowing the exam to be performed, as well as a
form with social and economics questions about
access to health services and children’s oral hab-
its. This provided a basis for making associations
with other variables.
312
The socioeconomic questionnaire asked with
whom the child spent the most time, the child’s
grade in school, the number of people in the child’s
household and monthly income. In terms of dental
services access, the responsible adults were asked
the following: if they perceived a need for the child
to receive dental and/or orthodontic treatment; if
the child had felt dental pain during the past 6
months; whether the child had visited a dentist at
least once in his/her life; where the first consulta-
tion took place and the reason for this appoint-
ment; if the parents/guardians were satisfied with
received treatment; and if the child used some type
of brackets. In relation to oral habits, questions
were posed on the use of pacifiers and bottles, and
whether finger sucking had occurred at any point in
the child’s life.
All pupils enrolled in 56 public schools were in-
vited to take part in the study. Only those were ex-
cluded whose parents did not sign the informed
consent (TCLE) and those who were not present on
the examination day. The exam was performed by a
team consisting of 10 previously trained dentists.
This training was intended to guarantee standard-
ised interpretation, comprehension and application
of criteria. To resolve theoretical discussions about
criteria and diagnosis of malocclusion, the exams
were performed on people from the same age (not
included in population sample) using the consen-
sus technique (Bulman and Osborn, 1989), yielding
a Kappa value of 0.842. Documentation and moni-
toring of the pupils was performed by 10 auxiliaries
who had also been trained prior to the study. The
same examination method described by the WHO
(1989) was used in this study. Table 1 shows an
abstract of the parameters recorded in the clinical
exams.
Posterior crossbite was classified as absent
when there was occlusion between the mandibular
buccal cuspid and the occlusal surface of the maxil-
lary teeth. It was classified as present when the
buccal cuspids of the posterior maxillary teeth fit
on the occlusal sulcus of the mandibular teeth, es-
tablishing crossing. The presence of crossbite was
subclassified as unilateral or bilateral.
The overjet was classified as normal, severe or
crossbite. The overbite was classified as normal,
severe or open bite. ‘Severe’ overjet and overbite
were values > 2 mm.
The type of deciduous arch was classified ac-
cording Baume’s criteria (1950). The arches can
exhibit the presence or absence of spaces between
teeth: the type I arch is characterised by spaces
Oral Health & Preventive Dentistry
 Dos Santos et al

between the anterior teeth (‘primate spaces’); type Table 1 Indices and criteria used
II shows no spaces, ie, the teeth contact each oth-
er. Type II can show crowding, is less favourable Index Criteria
and occurs relatively infrequently (Table 2). Absent
The oral exams were performed at the schools
Posterior Unilateral
under natural light, using flat oral mirrors and
crossbite
probes developed by the WHO. The current norms Bilateral
of biosecurity of biosecurity were observed, i.e. No information
gloves, head coverings, masks and aprons were
Normal (< 2 mm)
worn by examiners and the flat mirrors and WHO
probes were sterile, in order to protect both the ex- High overjet (> 2 mm)
aminers and the children. Overjet Edge-to-edge

Anterior crossbite
Statistical analysis No information

Normal (incisal surfaces of central mandibu-

The data gathered on the questionnaires were re-
corded using the Epi Info Software version 3.5.2
(Epi Info, Centers for Disease Control; Atlanta, GA,
USA). The absolute and percent prevalence were
calculated using descriptive statistics; the chi-
Overbite
square test was applied to verify the association
between harmful oral habits and posterior cross-
bite.
lar incisors in contact with palatal surface
of maxillary central incisors)
Short overbite (incisal surfaces of maxillary
central incisors without contact on palatal
surface or incisal of maxillary central
incisors)
Open bite (incisal surfaces of mandibular
central incisors, lower level of incisal
surfaces of maxillary central incisors)

High overbite (incisal surfaces of mandibu-

lar central incisors in contact with palate)
RESULTS
No information
The socioeconomic section of the exam of 1385
Canine Class I
children between the ages of 5 and 6 years showed
relation Class II
that in 64.8% of cases, the mother was the adult
who spent the most time with the child. The educa- Class III
tional level of the responsible adults showed 53.1%
Type I
had attended high school, 21.3% elementary
school, only 9.3% had studied at university and Arch type Type II
2.6% were illiterate. The median family consisted of No information
4 people and had a monthly income of US$ 687.43.
When the parents were asked if their children
needed dental treatment, 76.1% of them answered
Table 2 Baume’s classification
‘yes’. Although the children were considered to
need treatment and 53.2% of them had experi- Type I With spaces between teeth (primate spaces)
enced dental pain, 34.3% had never visited a den- Type II Without spaces between teeth
tist. Of the children that had already visited a den-
tist at least once, the majority had attended a
public dental service (49.3%) and the other 50.7%
had received private dental services, a dental pro-
fessional belonging to a the patient’s dental health
plan or other types of consultation. The main rea- dren needed to wear them for possible corrections.
son for seeking dental treatment was a recall visit 49% of all parents said that they did not know if
or prevention (29.2%), followed by pain (10.4%) and orthodontic treatment was necessary or not.
other causes (13.4%). In relation to harmful habits, the use of pacifiers
95.9% of all children did not wear braces, al- was reported by 44.17%, the use of bottles was
though 22.5% of parents affirmed that their chil- related by 86%, and finger sucking was reported for

Vol 10, No 4, 2012 313

Dos Santos et al

2.3 % 9.1 %

7.9 %
100
0.07 78.54 51.55 58.6 %
13.94
90
22.1 %
normal
80 high overjet
edge-to-edge
51.55 anterior crossbite
70
no information
60
Fig 2  Percent distribution of overjet in preschoolers from
78.54
per cent

Araçatuba city, São Paulo State, Brazil, 2010.

50

85.99
40 9.0 %

30
16.8 %

20 44.17 46.6 %

10 14.4 % normal
17.63
short overbite
0
open bite
Baby Bottle Digital Pacifier 13.2 %
high overbite
Sucking
no information

Fig 1    Percent distribution of harmful oral habits in pre- Fig 3  Percent distribution of overbite in preschoolers from
schoolers from Araçatuba city, São Paulo State, Brazil, Araçatuba city, São Paulo State, Brazil, 2010.
2010.

17.63% (Fig 1). The clinical exam of factors associ-
ated with malocclusions found that ca 10%
(n = 139) of children had crowding and 3.6%
showed some teeth with rotation.
Following Baume’s classification (1950), the
arches were divided in type I and type II, according
to the presence or absense of primate and general
spaces. 67.9% and 31.4% of the maxillary arches
were type I and II, respectively. For the mandibular
arch, 47.5% were type I and 51.7% were type II.
In terms of canine relation, the majority showed
Class I (74.5%), followed by Class II (19.4%). In rela-
tion to overjet, there was a frequency of 22.1% of
high overjet, 7.9% edge-to-edge occlusion and 2.3%
anterior crossbite (Fig 2). There was statistically sig-
nificant association between overjet and sucking
habits: pacifier (P = 0.0003), bottle (P = 0.0360)
and finger sucking (P < 0.0001) (Table 3). A fre-
quency of 13.2% of short overbite, 14.4% open bite
and 16.8% high overbite were observed (Fig 3).
There was a statistically significant association be-
tween overbite and sucking habits, except for bottle:
pacifier (P < 0.0001), bottle (P = 0.3298) and finger
sucking (P = 0.0052) (Table 4). Posterior crossbite
occurred in 14.4% of children, and among them,
83.2% showed unilateral posterior crossbite and
16.8% bilateral posterior crossbite. There was a sig-
nificant association between crossbite and sucking
habits: pacifier (P < 0.0001), bottle (P = 0.0139)
and digital sucking (P = 0.0229) (Table 5).

314 Oral Health & Preventive Dentistry

 Dos Santos et al

Table 3 Association between overjet and sucking habits in preschoolers from Araçatuba city, São Paulo State, Brazil,
2010
Overjet Normal Total P-value*

Pacifier

Yes 222 317 539 0.0003

No 219 486 705

Total 441 803 1244 **

Baby bottle

Yes 398 681 1079 0.0360

No 49 124 173

Total 447 805 1252 **

Finger sucking

Yes 103 106 209 < 0.0001

No 325 683 1008

Total 428 789 1217 **

* Chi-square test. ** Some parents/guardians did not answer the questions.

Table 4 Association between overbite and sucking habits in preschoolers from Araçatuba city, São Paulo State, Brazil,
2010
Overbite Normal Total P-value*

Pacifier

Yes 302 243 545 < 0.0001

No 305 396 701

Total 607 639 1246 **

Baby bottle

Yes 537 543 1080 0.3298

No 79 95 174

Total 616 638 1254 **

Finger sucking

Yes 122 91 213 0.0052

No 467 538 1005

Total 589 629 1218 **

* Chi-square test. ** Some parents/guardians did not answer the questions.

Vol 10, No 4, 2012 315

Dos Santos et al

Table 5 Association between posterior crossbite and sucking habits in Brazilian preschoolers, 2010

Crossbite

No Yes Total P-value*

Baby bottle

No 172 17 189 0.0139

Yes 981 185 1166

Total 1153 202 1355 **

Finger sucking

No 925 140 1065   0.0229

Yes 194 45 239  

Total 1119 185 1304 **

Pacifier

No 635 64 699   < 0.0001

Yes 463 136 599  

Total 1098 200 1298 **

* Chi-square test. ** Some parents/guardians did not answer the questions.

DISCUSSION sucking was more frequent than finger sucking.

Epidemiological surveys are crucial for determining
the prevalence and the incidence of many diseas-
es; they facilitate the individualisation of disease
distribution according to the given environmental
conditions. Such studies establish the real needs
of the studied population and offer to professionals
the tool with which to plan preventive and corrective
treatment (Kniest et al, 2011).
In this study, it was observed that a large per-
centage of the children were the responsibility of
mothers who had about 11 years of schooling. The
mothers’ education had a direct influence on non-
nutritive sucking habits, because the higher the pa-
rental schooling level is, the less frequent are the
harmful habits (Gonçalves et al, 2007).
In this study 74.7% of children had already visit-
ed a dentist at least once, an important fact be-
cause – as shown in the study by Gonçalves et al
(2007) – a higher prevalence of pacifier sucking is
found in children who have not had any access to
dental treatment.
The most frequent harmful habit found in this
study was bottle sucking, which resemble findings
by other authors (Santos, 2005), where pacifier
Some authors suggest pacifier sucking to avoid
other harmful habits that are more difficult to stop,
such as finger sucking (Martin et al, 2003).
Type I arch was predominant in the current study,
which corroborates the results of other authors (To-
mita et al, 1998). This is the most favourable type
of arch, as it expediates the good positioning of
permanent teeth when they erupt. However, the lit-
erature also contains studies where type II was
more prevalent than type I in both arches, inde-
pendent of gender (Ferreira et al, 2001; Raupp et
al, 2001).
The relation between maxillary and mandibular
deciduous canines is an excellent adjunct marker
for classification of deciduous dentition. Similar re-
sults were found in other studies (Ferreira et al,
2001; Santos, 2005; Kataoka et al, 2006).
The literature contains large variation on overjet
and overbite prevalence. Oliveira et al (2004) ob-
served high overjet in 31.3% of cases and overbite
in 29% in children with open bite. Bhayya et al
(2011) found a high prevalence of overjet and nor-
mal overbite, 81.6% and 84.5%, respectively, but
these children did not have any harmful oral habits.
Martin et al (2003) observed a high prevalence of

316 Oral Health & Preventive Dentistry


overbite associated with a high presence of open
bite (38.5%) and a positive relation to sucking hab-
its. In another study performed by Kataoka et al
(2006), normal overjet was the most prevalent
(71.3%), followed by high overjet (14.2%), anterior
crossbite (7.4%) and finally, edge-to-edge bite
(7.1%). This study showed similar results and an
association between overjet and harmful habits.
The presence of crossbite in this study was low
compared to the study by Gomes e Silva et al
(2010), who reported a 29.05% crossbite preva-
lence. In contrast, Heimer et al (2008) observed
that the prevalence of posterior crossbite was
10.4%, associated with age and sucking habits,
similar to the results of the present study.
Knowing the etiology of malocclusion is essen-
tial to the success of orthodontic treatment, be-
cause a prerequisite for correction is the elimina-
tion of causes. Considering the increased interest
in diagnosis and treatment of malocclusions, it is
crucial to deepen knowledge by studies that exam-
ine the prevalence of malocclusion and the cause-
effect relationship between sucking habits and mal-
occlusion (Heimer, 2008).
Orthodontic treatment has been and should con-
tinue to be performed by public health-care sys-
tems; however, preventive treatment for malocclu-
sions should receive emphasis. The elimination of
harmful habits, treatment of mouth breathing and
the incentive for breastfeeding should be prioritised
by health services.
CONCLUSION
There was a high prevalence of malocclusion as-
sociated with harmful oral habits on deciduous
dentition. This research suggests that new health
actions can be implemented for earlier identifica-
tion of malocclusions and educational actions di-
rected at the general population, improving the
knowledge about prevention of this disorder.
REFERENCES
1. Baume LJ. Physiologic tooth migration and its significance
for the development of occlusion. II The biogenesis of ac-
cessional dentition, J Dent Res 1950;29:331–337.
2. Bhayya DP, Shyagali TR. Gender influence on occlusal char-
acteristics of primary dentition in 4- to 6-year-old children of
Bagalkot City, India. Oral Health Prev Dent 2011;9:17-27.
Vol 10, No 4, 2012
Dos Santos et al
3. Borges CM, Peres MA, Peres KG. Associação entre presen-
ça de oclusopatias e insatisfação com a aparência dos
dentes e gengivas: estudo com adolescentes brasileiros.
Rev Bras Epidemiol 2010;134:713–723.
4. Brasil, Ministério da Saúde, Secretaria de Ciência, Tecnolo-
gia e Insumos Estratégicos. Departamento de Ciência e
Tecnologia. Agenda nacional de prioridades de pesquisa
em saúde. Brasília: Editora do Ministério da Saúde; 2008.
5. Brasil, Ministério da Saúde. Resolução 196/96 do Con-
selho Nacional de Saúde/MS Sobre Diretrizes e Normas
Regulamentadoras de Pesquisa envolvendo seres hu-
manos. Diário Oficial da União, 10 de outubro de 1996.
6. Brasil. Projeto SB 2003: Condições de saúde bucal na
população brasileira. Ministério da Saúde. 2003. 68 p.
Disponível em:<http://cfo.org.br/wp-content/uploads/
2009/10/04_0347_M.pdf >. Acesso em: jun. 2010.
7. Bresolin D. Controle e prevenção de maloclusão. In: Pinto VG.
Saúde bucal cqoletiva. São Paulo: Santos, 2008:561–567
8. Bulman JS, Osborn JF. Simple summary calculation. Brazil
Dent J 1989;166:87–90.
9. Dias PF, Gleiser R. O índice de necessidade de tratamento
ortodôntico como um método de avaliação em saúde públi-
ca. Rev Dental Press Ortod Ortop Facial 2008;13:74–78.
10. Emmerich A, Fonseca L, Elias AM, Medeiros UV. Relação
entre hábitos bucais, alterações oronasofaringianas e mal-
oclusões em pré-escolares de Vitória, Espírito Santo, Bra-
sil. Cad Saúde Pública 2004; 20:689–697.
11. Epi Info™, a database and statistics program for public
health professionals. Centers for Disease Control and Pre-
vention, 2007.
12. Ferreira RI, Barreira AK, Soares CD, Alves AC. Prevalência
de características da oclusão normal na dentição decídua.
Pesqui Odontol Bras 2001;15:23–28.
13. Freire MCM, Reis SCGB, Gonçalves MM, Balbo PL, Leles
CR. Condição de saúde bucal em escolares de 12 anos de
escolas públicas e privadas de Goiânia, Brasil. Rev Panam
Salud Pública 2010;28:86–91.
14. Garbin AJI, Perin PCP, Garbin CAS, Lolli LF. Prevalência de
oclusopatias e comparação entre a Classificação de Angle
e o Índice de Estética Dentária em escolares do interior do
estado de São Paulo – Brasil. Rev dent press ortodon orto-
pedi facial 2010;15:94–102.
15. Gomes e silva L, Lopes FF, Oliveira AEF, Ribeiro CCC, Leal
CB, Lima MVV. Estudio de la prevalencia de mordida cru-
zada em los pacientes ortodoncios em São Luís – MA. Acta
odontol venez 2010;48:34–37.
16. Gonçalves PE, Garbin CAS, Garbin AJI, P AFG. Aspectos so-
cioeconomicos versus hábitos bucais deletérios: análise de
uma relação causal. Rev Fac Odontol Lins 2007;19:13–18.
17. Gribel MN. Tratamento de mordidas cruzadas unilaterais
posteriores com desvio postural mandicular com pistas di-
retas planas. Rev Dent Press Ortodon Ortopedi Facial
1999; 4:47–54.
18. Heimer MV, Tornisiello Katz CR, Rosenblatt A. Non-nutritive
sucking habits, dental malocclusions, and facial morph-
ology in Brazilian children: a longitudinal study. Eur J Orthod
2008;30:580-585.
19. Izuka EM. A influência da respiração oral na oclusão dentária:
uma visão geral da literatura. Acta ORL 2008;26:151–154.
20. Johal A, Cheung MY, Marcene W. The impact of two different
malocclusion traits on quality of life. Br Dent J 2007;202:E2 
317
Dos Santos et al
21. Kataoka DY, Vellini-Ferreira F, Scavoni JR, Cotrini-Ferreira FA,
Sato V. Estudo do relacionamento antero-posterior entre os
arcos dentários decíduos, de crianças nipo-bbrasileiras,
dos dois aos seis anos de idade. Rev Dent Press Ortodon
Ortopedica Facial 2006;11:83–92.
22. Kniest G, Stramandinoli RT, Ávila LFC, Izidoro ACAS.
Frequência das lesões bucais diagnosticadas no Centro de
Especialidades Odontológicas de Tubarão (SC). RSBO
2011;8:13–18.
23. Llompart G, Marin GH, Silberman M, Merlo I, Zurriaga O,
GIS. Oral health in 6-year-old school children from Berisso,
Argentina: falling for short of WHO goals. Med Oral Patol
Oral Cir Bucal 2010;15:101–105.
24. Marcomini L, Santamaria Junior M, Lucato AS, Santos JCB,
Tubel, CAM. Prevalence of malocclusion and its relation-
ship with functional changes in the breathing and in the
swallowing. Braz Dent Sci 2010;13:52–58.
25. Marques LS, Ramos-Jorge ML, Paiva SM, Pordeus IA. Mal-
occlusion: esthetic impact and quality of life among Brazil-
ian schoolchildren. Am J Orthod Dentofacial Orthop
2006;129:424–427.
26. Martin RJ, Fortes FDS, Garbin CAS, Moimaz SAS, Saliba NA.
Relação entre hábitos de sucção não nutritiva e mordida
aberta anterior. Rev Inst Cienc Saúde 2003;21:401–404.
27. Moyers RE. Ortodontia, ed 4. Rio de Janeiro: Guanabara
Koogan, 1991:167–186.
28. Oliveira CM. Maloclusão no contexto da saúde pública. In:
Bonecker M, Sheiham A. Promovendo saúde bucal na infân-
cia e adolescência. São Paulo: Santos, 2004:55–80.
318
29. Planas P. Reabilitação neuroclusal, ed 2. Rio de Janeiro:
Medsi, 1997.
30. Raupp SMM, Ruschel HC, Ferreira SH, Kramer PF. Con-
tribuição ao estudo das características morfofuncionais de
dentição decídua: análise em pré-escolares da cidade de
Canoas/RS. Pesq Bras Odontopediatria Clin Integr
2008;8:197–202.
31. Roncalli AGA. Epidemiologia: um olhar coletivo sobre a
saúde bucal. In: Ferreira A, Roncalli AG, Lima KC. Saúde
bucal coletiva: conhecer para atuar. Natal: Ed. da Universi-
dade Federal do Rio Grande do Norte, 2005:39–62.
32. Santos SA. Prevalência e fatores de risco à persistência de
hábitos bucais de succção não nutritiva em crianças de 3
a 5 anos de idade [dissertação]. Natal (RN): Universidade
Federal do Rio Grande do Norte; 2005.
33. Tomita NE, Bijella MFTB, Silva SMB, Bijella VT, Lopes ES,
Novo NF et al. Prevalência de má oclusão em pré-escolares
de Bauru-SP, Brasil. Rev Fac Odontol Bauru 1998; 6:35–44.
34. Traebert ES, Peres MA. Do malocclusions affect the indi-
vidual’s oral health-related quality of life? Oral Health Prev
Dent 2007;5:3–12.
35. WHO. Health through oral health: guidelines for planning
and monitoring for health care. London: Quintessence,
1989.
36. WHO. Levantamento epidemiológico básico de saúde bu-
cal, manual de instruções, ed 4. São Paulo: Santos, 1999.
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