Introduction
Materials and methods
Information sources and search strategy
Study selection
Inclusion/exclusion criteria
Data extraction
Data synthesis
Quality assessment
Results
Study selection
Author | Country | Objective | Study design | Age | Sample size | Malocclusion or OM definition used as criteria to ascertainment | Cofounders | Sex | Evidence |
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Watase et al. (1998) | USA | Malocclusion in children with otitis media | Survey | < 6 years | 108 | Class II or Class III relationships for the primary canines on the right and left sides; distal step relationship; overbite > 70%; overjet > 5 mm; presence of an anterior open bite; presence of an anterior crossbite; presence of a posterior crossbite | Pacifier sucking habits, thumb/finger-sucking habit, mouth breathing habit, snoring, allergies, asthma, upper respiratory infections, history of breastfeeding, history of bottle feeding, history of otitis media in the family | 64 males and 44 females | 56/108 (51.9%) of children with malocclusion Prominent types of malocclusions: anterior open bites (17%) and overbites > 70% (17%) and accounted for about 70%% of all malocclusions No statistically significant association between all explanatory variables (factors related to otitis media) and malocclusion |
McDonnell et al. (2001) | USA | Relationship between dental overbite and Eustachian Tube Dysfunction (dysfunction which predisposes to OM) | Observational study | 2–6 years | 105 | Deep bite (70%), Overjet > 3 mm, non-mesial step occlusion | Age, medical/environmental history, family history of OM, Non-breast-fed (0–6 mo), URI > 5 per year, home cigarette smoke exposure, Tonsillectomy, Snoring history, Seasonal allergy history, Pacifier History | NR | 57% (n = 60) of the children had ETD Deep bite > 70% in 32% (n = 34) of children Overjet > 3 mm in 23% (n = 24) of children Mesial step terminal plane relationship in 80% (n = 84) of children Flush terminal plane in 15% (n = 16) of children Distal step relationship in 5% (n = 5) of children Univariate analysis: Children with ETD were approximately twice as likely to have a deep bite as children without ETD (P = 0.02) Children with a deep bite were significantly more likely to be white, to have a history of seasonal allergy, and to have a non-mesial step occlusion Children with a deep bite did not have an open bite Children with ETD were significantly more likely to have a family history of middle ear disease, to have five or more URIs per year, and to be under three years Multivariate logistic regression: Children with deep bites were 3.5 times more likely to have ETD than children without (95% confidence interval [CI]: 1.1, 11.2; P = .03) Children with deep bites were 2.8 times more likely to have ETD greater (95% CI: 1.1, 7.1; P = .03) than children without. Other independent risk factors for ETD in the final model were family history of OM (odds ratio [OR] = 3.6; 95% CI: 1.3, 9.8; P = .01) and age < 3 years (OR = 5.8; 95% CI: 1.2, 29.2; P = .3) |
Kim et al. (2008) | USA | Relationship between dental OM and the anatomic form of the hard palate | Retrospective study | 4–6 years | 175 | Palatal vault form: Class I—medium—(palatal slope forms an angle of 30 to 45 degrees to the horizontal plane; the palatal slope is characterized by a round curvature that forms a slight concavity); Class II—high/steep—(palatal slope is steeper compared to that of the medium plate; an angle greater than 45 degrees; the slope in usually round and pronounced (convex) at the coronal third); Class III—low/flat—(shallow palate; the palatal slope is flatter compared to that of the medium palate; an angle less than 30 degrees is created by the previously described landmarks; the palatal slope is usually short, and the mid-palate has a flat surface) | Age, race, gender, systemic health, tobacco smoke exposure, method of feeding during infancy, history of intubation, history of a finger-sucking habit and pacifier use, history of acute OM, age during the initial episode of acute OM, number of episodes of acute OM experienced, treatments rendered to manage episodes of acute Om | NR | 148 (85%) of the total sample had a positive history of AOM, with 76% experiencing AOM before age 1 and 61% experienced more than three bouts of AOM High palatal vault was a significant finding in children that experienced AOM before age 1 (OR: 3.49; 95%CI: 1.14, 10.69; P = 0.03) Children with high palatal vaults underwent myringotomy and tympanostomy tube placement procedures more often than the rest of the study population (OR: 2.49; 95%CI: 1.15,5–39; P = 0.02) |
Giuca et al. (2011) | Italy | Correlation between OM and dental malocclusion | Case–Control | Study group: 7.7 ± 0.9 years; Control group: 7.9 ± 1.1 years | 50 (25 study group; 25 healthy subjects) | OM and Malocclusion variables were defined, but criteria were not identified | NA | 26 males (13 in the study group and 13 in the control group) and 24 females (12 in the study group and 12 in the control group) | Bilateral posterior crossbite and unilateral posterior crossbite were more observed in study group (11/44% and 8/32%) than in control group (4/16% and 0/0%) with a statistically significant difference (P = 0.046 and P = 0.026) |
Bernkopf et al. (2016) | Italy | The role of dental malocclusion treatment in the outcomes of RAOM | Case–Control | Study group: 6.6 ± 1.9 Control group: 5.3 ± 1.9 | 61 consecutive children | 3 AOM episodes within 6 months, or four episodes during one year—Malocclusion: sagittal discrepancies (increased overjet or anterior crossbite); vertical discrepancies (open bite or deep bite); transversal discrepancies (deviated bite or unilateral crossbite) | Age, Skin-prick test (negative vs positive), adenoid hypertrophy, number of AOM recurrences | 35 females and 26 males | Children in group A treated for dental malocclusion were strongly associated with a lower number of acute episode recurrences at both univariate (OR: 37, 9%CI: 7.18–233.0; p < 0.0001) and multivariate analysis (P = 0.0001) |
Risk of bias
Study characteristics
Prevalence of malocclusion in patients with otitis media
Prevalence of otitis media in patients with malocclusion
Discussion
Conclusion
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there is some evidence that there is an association between otitis and two malocclusions (i.e., deep bite and crossbite), but at the moment, it is not yet possible to establish a definitive correlation, given the small number of studies and the relevant limitations, such as the lack of uniformity in definitions and data collection, variable outcomes, and non-standardized treatments.
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there is an undeniable anatomical and functional relation among middle ear, TMJ, and the mandible, for their proximity and direct and indirect connections.
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randomized-controlled trials, with homogeneous groups for confounding factors, are encouraged to establish the role of malocclusion in the onset of OM and the effectiveness of orthodontic treatment in OM prevention.