Research explores link between tonsil hypertrophy and pediatric dentofacial development

China: Inter-departmental researchers at Fudan University conducted a cross-sectional study to explore the association of tonsil hypertrophy with pediatric dentofacial development.

In recent years, the upper airway (UA) obstruction-induced sleep-disordered breathing (SDB) has been identified as a major contributor to the prevalence of dentofacial deformity – which has reportedly increased significantly since the 1960s.

Given that tonsil hypertrophy appears relatively common among pediatrics, the researchers wanted to explore the relationship between tonsil hypertrophy and pediatric dentofacial deformity among young children in Shanghai.

Stratified cluster sampling

Titled “The Association of Tonsil Hypertrophy with Pediatric Dentofacial Development: Evidence from a Cross-Sectional Study of Young Children in Shanghai, China”, the research study has been published in the October issue of Nature of Science and Sleep Journal.

The research team adopted a sampling design and standard protocols for the Chinese version of the OSA-18 questionnaire and oral examination. The Obstructive Sleep Apnea-18 (OSA-18) is a “quality-of-life” questionnaire that assesses sleep disordered breathing-related quality of life targeting paediatrics.

“The cross-sectional research provided an accurate prevalence of dentofacial abnormalities in the young children population of Shanghai and compared several risk factors, including tonsil hypertrophy and SDB issues,” said the authors.

Using a stratified cluster sampling procedure, they carried out representative sampling of 715 young children (8– 10 years old). The OSA-18 quality-of-life questionnaires (OSA-18) were completed by their guardians. The oral examinations were conducted by specialist orthodontists. The descriptions and analyses were run by statistical software (SPSS, version 26.0).

715 children (334 boys and 381 girls) participated in the analyses. The current prevalence of malocclusion identified by Angle’s classification was 45.6% in this sample.

No evident relationship

The researchers found no evident relation between OSA-18 scores and dentofacial abnormalities (P > 0.05). With the enlargement of tonsil size, the proportion of children with triangular dental arch form (P < 0.05) and high vault palate (P < 0.001) was increasingly higher.

More children with protruding profiles and fewer upright profiles were observed as the tonsil size increased, although it did not show a statistical difference (P = 0.103).

The current prevalence of malocclusion in mixed dentition appeared higher in comparison with the comprehensive investigation of Chinese children (35.42%) in 2002, but matched with the estimated overall prevalence of malocclusion in Chinese school children from 1991 to 2018 (47.92%).

“A higher prevalence of overjet, overbite, and crossbite could be observed compared to the literature,” the authors noted.

“Occlusion in mixed dentition was not stable due to incomplete eruption, and this malocclusion would be spontaneously corrected with the growth of the mandible.”

According to the researchers, this observation might be attributed to the discrepancy of age, geography, race, time among selected samples, methodological diversity, and publication bias.

“It has been universally acknowledged that the prevalence of dentofacial deformity increased over the years in children, requiring comprehensive epidemiological researches and proactive interventions,” they added.

Insufficient focus on tonsil enlargement

Combining their results with current literature, the team believes the severity of obstructive tonsil enlargement could be a crucial indication for SDB and dentofacial growth, requiring preventive and interceptive treatments in the early stage.

Dentofacial deficiency not only impairs multiple functions but also directly connects with the quality of a child’s whole life, said the team.

“Issues on dentofacial abnormalities induced by adenoid hypertrophy have raised more concerns than decades ago among parents and doctors in communities,” they added.

“However, the tonsil enlargement has not been sufficiently focused. We call for more efforts from local government and health authorities to enhance public propaganda and education on preventive and interceptive measurements for related dentofacial abnormalities.”

The study is conducted by researchers from various dental departments at Fudan University, including: Department of Orthodontics, Shanghai Stomatological Hospital & School of Stomatology; Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases; Department of Pediatric Dentistry, Shanghai Stomatological Hospital & School of Stomatology; Department of Preventive Dentistry, Shanghai Stomatological Hospital & School of Stomatology.

Read the full article “The Association of Tonsil Hypertrophy with Pediatric Dentofacial Development: Evidence from a Cross-Sectional Study of Young Children in Shanghai, China”.