Association between atypical swallowing and malocclusions: a systematic review

GONÇALVES, Flávio Magno; TAVEIRA, Karinna Veríssimo Meira; ARAUJO, Cristiano Miranda de; RAVAZZI, Glória Maria Nogueira Cortz; GUARIZA FILHO, Odilon; ZEIGELBOIM, Bianca Simone; SANTOS, Rosane Sampaio; STECHMAN NETO, Jose

doi:10.1590/2177-6709.27.6.e2221285.oar

Flávio Magno GONÇALVES

Conception or design of the study

Data acquisition, analysis or interpretation

Writing the article

Critical revision of the article

Final approval of the article

Universidade Tuiuti do Paraná, Programa de Pós-Graduação em Distúrbios da Comunicação (Curitiba/PR, Brazil).

Núcleo de Estudo Avançado em Revisão Sistemática e Meta-análise (NARSM).

https://orcid.org/0000-0002-7972-2844

Karinna Veríssimo Meira TAVEIRA

Conception or design of the study

Data acquisition, analysis or interpretation

Writing the article

Critical revision of the article

Final approval of the article

Universidade Federal do Rio Grande do Norte, Programa Associado de Pós-graduação em Fonoaudiologia (Natal/RN, Brazil).

Núcleo de Estudo Avançado em Revisão Sistemática e Meta-análise (NARSM).

https://orcid.org/0000-0001-6978-4083

Cristiano Miranda de ARAUJO

Conception or design of the study

Data acquisition, analysis or interpretation

Writing the article

Critical revision of the article

Final approval of the article

Universidade Tuiuti do Paraná, Programa de Pós-Graduação em Distúrbios da Comunicação (Curitiba/PR, Brazil).

Núcleo de Estudo Avançado em Revisão Sistemática e Meta-análise (NARSM).

https://orcid.org/0000-0003-1325-4248

Glória Maria Nogueira Cortz RAVAZZI

Data acquisition, analysis or interpretation

Critical revision of the article

Final approval of the article

Universidade Tuiuti do Paraná, Programa de Pós-Graduação em Distúrbios da Comunicação (Curitiba/PR, Brazil).

https://orcid.org/0000-0002-6574-9878

Odilon GUARIZA FILHO

Data acquisition, analysis or interpretation

Critical revision of the article

Final approval of the article

Pontifícia Universidade Católica do Paraná, Departamento de Ortodontia (Curitiba/PR, Brazil).

Núcleo de Estudo Avançado em Revisão Sistemática e Meta-análise (NARSM).

https://orcid.org/0000-0001-9799-1223

Bianca Simone ZEIGELBOIM

Data acquisition, analysis or interpretation

Critical revision of the article

Final approval of the article

Universidade Tuiuti do Paraná, Programa de Pós-Graduação em Distúrbios da Comunicação (Curitiba/PR, Brazil).

https://orcid.org/0000-0003-4871-2683

Rosane Sampaio SANTOS

Data acquisition, analysis or interpretation

Critical revision of the article

Final approval of the article

Universidade Tuiuti do Paraná, Programa de Pós-Graduação em Distúrbios da Comunicação (Curitiba/PR, Brazil).

Núcleo de Estudo Avançado em Revisão Sistemática e Meta-análise (NARSM).

https://orcid.org/0000-0001-6400-5706

Jose STECHMAN NETO

Conception or design of the study

Data acquisition, analysis or interpretation

Writing the article

Critical revision of the article

Final approval of the article

Overall responsibility

Universidade Tuiuti do Paraná, Programa de Pós-Graduação em Distúrbios da Comunicação (Curitiba/PR, Brazil).

Núcleo de Estudo Avançado em Revisão Sistemática e Meta-análise (NARSM).

https://orcid.org/0000-0002-0259-2420

karinnavm@hotmail.com

The authors report no commercial, proprietary or financial interest in the products or companies described in this article.

Figures (2)
Tables (4)

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Figure 1:
Flow diagram of the literature search and the selection criteria.

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Figure 2:
Summary of risk of bias assessed by Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies: author’s judgments for each study included (generated using the software Review Manager 5.4, The Cochrane Collaboration).

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Table 1:
Summary of the characteristics of the studies included (n=4).

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Table 2:
Analysis of information quality through GRADE. Research question: “Is there an association between atypical swallowing and malocclusions?”

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Database Search (July 10th 2020; updated on February 26th, 2020) Cochrane Library (“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”) Embase (“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”) LILACS (“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional” OR “trastornos de la deglución” OR “trastorno de la deglución” OR “deglución” OR “deglución atípica” OR “Distúrbios da deglutição” OR “distúrbio da deglutição” OR “deglutição atípica” OR “deglutição” OR “Miofuncional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “open bite” OR “openbite” OR “open-bite” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “Angle Class I” OR “Angle Class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion” OR “Maloclusiones” OR “maloclusión” OR “posición dental” OR “posiciones dentales” OR “apiñamiento de los dientes” OR “mordida cruzada” OR “mordidas cruzadas” OR “mordida abierta” OR “Clasificación de Angle” OR “Clase I de Angle I” OR “Clase II de Angle” OR “Clase III de Angle” OR “maloclusión, Angle clase III” OR “maloclusión Angle clase III” OR “maloclusión esquelética clase III” OR “maloclusión clase III” OR “desarrollo maxilofacial” OR “clase de Angle II” OR “maloclusión de clase II del Angle” OR “maloclusión esquelética clase II” OR “maloclusión clase II” OR “clase Angle I” OR “maloclusión classe I del Angle” OR “maloclusión clase I esquelética” OR “maloclusión clase I” OR “Maloclusões” OR “maloclusão” OR “má oclusão” OR “posição dentária” OR “posições dentárias” OR “apinhamento dos dentes” OR “mordida cruzada” OR “mordida aberta” OR “mordida profunda” OR “Classificação de angle” OR “Classe I de Angle” OR “Classe II de Angle” OR “Classe III de Angle” OR “Classe I” OR “Classe II” OR “Classe III” OR “má oclusão, classe de Angle III” OR “má oclusão de classe III de Angle” OR “má oclusão esquelética de classe III” OR “má oclusão de classe III” OR “desenvolvimento maxilofacial” OR “classe de Angle II” OR “má oclusão de classe de Angle II” OR “má oclusão esquelética de classe II” OR “má oclusão de classe II” OR “classe de Angle I” OR “má oclusão de classe I de Angle” OR “má oclusão esquelética de classe I” OR “má oclusão de classe I”) LIVIVO TI=(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND TI=(“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”) PubMed (Deglutition Disorders”[MeSH Terms] OR “Deglutition Disorders”[All Fields] OR “Deglutition Disorder”[All Fields] OR “Swallowing”[All Fields] OR “swallowed”[All Fields] OR “swallowings”[All Fields]) OR “swallowable”[All Fields] OR “swallower”[All Fields] OR “swallowers”[All Fields] OR “swallows”[MeSH Terms] OR “swallows”[All Fields] OR “swallow”[All Fields] OR “Swallowing Disorders”[All Fields] OR “Swallowing Disorder”[All Fields] OR “atypical swallowing”[All Fields] OR “atypical deglutition”[All Fields] OR “Myofunctional”[All Fields]) AND (“Malocclusions”[All Fields] OR “malocclusion”[MeSH Terms] OR “malocclusion”[All Fields] OR “dental position”[All Fields] OR “dental positions”[All Fields] OR “tooth crowding”[All Fields] OR “crossbite”[All Fields] OR “crossbites”[All Fields] OR “cross-bite”[All Fields] OR “cross-bites”[All Fields] OR “cross-bite”[All Fields] OR “cross-bites”[All Fields] OR “open-bite”[All Fields] OR “openbite”[All Fields] OR “open-bite”[All Fields] OR “deep bite”[All Fields]) OR “Overbites”[All Fields] OR “overbite”[MeSH Terms] OR “deep bite”[All Fields] OR “deep bites”[All Fields] OR “deep bite”[All Fields] OR “deep bites”[All Fields] OR “Over Bite”[All Fields] OR “Over Bites”[All Fields] OR “Angle’s Classification”[All Fields] OR “Angle Classification”[All Fields] OR “Angles Classification”[All Fields] OR “angle class I”[All Fields] OR “angle class II”[All Fields] OR “Angle Class III”[All Fields] OR “Class I”[All Fields] OR “Class II”[All Fields] OR “Class III”[All Fields] OR “malocclusion, angle class III”[MeSH Terms] OR “angle class III malocclusion”[All Fields] OR “skeletal class III malocclusion”[All Fields] OR “class III malocclusion”[All Fields] OR “maxillofacial development”[All Fields] OR “angle class II”[All Fields] OR “angle class II malocclusion”[All Fields] OR “skeletal class II malocclusion”[All Fields] OR “class II malocclusion”[All Fields] OR “angle class I”[All Fields] OR “angle class I malocclusion”[All Fields] OR “skeletal class I malocclusion”[All Fields] OR “class I malocclusion”[All Fields]) Scopus (“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”) Web of Science TS=(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional” AND TS=(“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”) Google Scholar (“atypical swallowing” OR “atypical deglutition”) AND (“Malocclusions”) Open Grey (“atypical swallowing” OR “atypical deglutition”) AND (“Malocclusions”) ProQuest (“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)

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Author, Year Reason for exclusion Alvarez Utria., et al (2016)1 4 Aragon de Macedo, P.F. et al (2014)2 2 Ardakani, F.E (2006)3 2 Baldrighi, S. E. Z. M (1999)4 1 Begnoni, G., et al (2020)5 2 Bertolini, M. M., et al (2003)6 2 Bourdiol, P. et al (2017)7 4 Mezzomo C. L., et al (2011)8 5 Chiodelli, L., et al (2015)9 1 Del Aguila, M. A., et al (2007)10 4 Emmerich, A. et al (2004)11 3 Farronato, G. P. et al (1982)12 6 Genolet, M (1993)13 5 Grabowski R, et al (2007)14 4 Gustafsson M, et al (1975)15 4 Haynes, S. (1975)16 4 Ichida, t. et al (1999) 17 4 Jin, I. J.; Yang, W. S. (1987)18 4 Leme, M. S. et al (2013)19 4 Limme, M. (1991)20 4 Lin, L. H. et al (2013) 21 5 Lindsey, C. A.; English, J. D. (2003)22 5 Lopes C. M. I.; Barros, A. M. S. (2019)23 2 Lopes Freire, G. M.;(2016) 24 4 Lyszczarz, J. et al (2012)25 4 MacAvoy, S. K. et al (2016) 26 4 Machado Jr, A. J.; Crespo, A. N. (2012)27 2 Machado Jr, A. J.; Crespo, A. N. (2012)28 2 Machado Jr, A. J.; Crespo, A. N. (2010)29 2 Maciel, C. T.; Leite, I. C. (2005)30 4 Maciel, C. T., et al (2006)31 4 Marcomini, L., et al (2010)32 3 Martin, C. et al (2012) 33 4 Mason, R. M. (2011)34 5 Medeiros, A. P. M. et al (2009)35 4 Morari. A. c. et al (2019)36 4 Mutlu, E. et al (2019)37 4 Nashashibi, I. A. (1987)38 4 Ngom, P. I. et al (2007)39 4 Nihi, V. S. et al (2015)40 4 Ning, B. et al (2007)41 4 Ono, T. et al (1998)42 4 Onyeaso, C.O. et al (2008)43 4 Gaymer, G.O. et al (1971)44 1 Ovsenik, M., et al (2007)45 3 Owens, S. et al (2002) 46 4 Padovan, B. A. (1995) 47 5 Parisella, V. D et al (2002) 48 1 Perkins, J. A. 49 5 Piancino, M. G. (2012)50 4 Picinato, M. et al (2012)51 1 Premkumar, S. et al (2011)52 4 Primozic, J. et al (2013)53 4 Regalo, S. C. H. et al (2003)54 4 Regina, C. et al (2005)55 2 Rochelle, I. M. F. et al (2010)56 3 Saccomanno, S. et al (2012) 57 1 Schneider, E. et al. (1975) 58 1 Seemann, J et al (2011) 59 3 Shenoy, U. et al (2015) 60 4 Silva, C. E. F. M et al (1994)61 3 Silva, M. et al (2014)62 5 Silva, R. A. (2016)63 3 Sorokin, A. et al (2015)64 1 Stormer, K. et al (1999)65 2 Taner, T. et al (2013)66 5 Truer. U. et al (1986)67 3 Tosello, D. O. (1999)68 2 Trannin, P. G. et al (2012)69 4 Turvey, T. A. et al (1976)70 1 Urzal, V. et al (2013)71 4 Volk, J. et al (2010) 72 2 Williamson, E. et al (1990)73 1 Xu, K. et al (2016)74 1 Xue, M. et al (2009)75 4 Zhou, Y. et al (1995)76 2

Author, Year, Country	Objective	Sample size, characteristics and exposition	Malocclusion studied and form of diagnosis	Diagnosis of atypical swallowing	Outcome of interest	Prevalence ratio* (95% CI)
Melink et al.¹³13 Melink S, Vagner MV, Hocevar-Boltezar I, Ovsenik M. Posterior crossbite in the deciduous dentition period, its relation with sucking habits, irregular orofacial functions, and otolaryngological findings. Am J Orthod Dentofacial Orthop. 2010 Jul;138(1):32-40., 2010, Slovenia	Find an association between posterior crossbite, sucking habits, orofacial functions, and otorhinolaryngological findings	30 children with posterior crossbite (13 boys, 17 girls, mean age: 5.5 years, range: 3.6-7.2 years) 30 children without posterior crossbite (17 boys, 13 girls; mean age 5.9 years, range 5.4-6.7 years)	Posterior crossbite diagnosed by clinical evaluation	Evaluated by the method suggested by Melsen et al.¹²12 Melsen B, Stensgaard K, Pedersen J. Sucking habits and their influence on swallowing pattern and prevalence of malocclusion. Eur J Orthod. 1979;1(4):271-80., 1979	Crossbite group: 6 (22%) with atypical swallowing Group without crossbite: 2 (8%) with atypical swallowing	3.00 [0.66, 13.69]*
Melsen et al.¹²12 Melsen B, Stensgaard K, Pedersen J. Sucking habits and their influence on swallowing pattern and prevalence of malocclusion. Eur J Orthod. 1979;1(4):271-80., 1979, Denmark	Analyze the relationship of sucking habits, swallowing pattern, and prevalence of malocclusions	A total of 723 children were evaluated (366 boys, 357 girls) aged 10-11 years; of which 313 children with atypical swallowing and 399 children with normal swallowing	Authors classified all malocclusions in the sample, including posterior crossbite. Clinical evaluation and molding	Clinical evaluation and palpation of the masseter and temporal muscles	Of the 313 children with atypical swallowing, 44 had a diagnosis of posterior crossbite. In the group of 399 children with normal swallowing, only 42 had posterior crossbite	1.335 [0.85, 2.09]*
Ovsenik et al.¹⁰10 Ovsenik M. Incorrect orofacial functions until 5 years of age and their association with posterior crossbite. Am J Orthod Dentofacial Orthop. 2009 Sep;136(3):375-81., 2009, Slovenia	To investigate the prevalence of crossbite in 5-year-old Slovenian preschoolers and its relationship with atypical swallowing habits and patterns at 3, 4 and 5 years of age	243 children (119 boys, 124 girls), assessed at ages 3, 4 and 5 years. 206 children without crossbite and 37 children with posterior crossbite	Posterior crossbite diagnosed by clinical evaluation and obtaining plaster models	Assessed by the method suggested by Melsen et al.¹²12 Melsen B, Stensgaard K, Pedersen J. Sucking habits and their influence on swallowing pattern and prevalence of malocclusion. Eur J Orthod. 1979;1(4):271-80., 1979	Presence of atypical swallowing in: 206 children without crossbite at 5 years of age: 35% (n=72) 37 children with posterior crossbite at age 5 years: 63% (n=23)	2.27 [1.27, 4.04]*
Ovsenik et al.¹¹11 Ovsenik M, Volk J, Marolt MM. A 2D ultrasound evaluation of swallowing in children with unilateral posterior crossbite. Eur J Orthod. 2014 Dec;36(6):665-71. 2014, Slovenia	To assess the prevalence of swallowing in patients with and without Unilateral Posterior Crossbite using ultrasound examination	23 children with unilateral posterior crossbite (13 girls and 10 boys), aged 4.1-6.6 years). Average age 5.4 ± 0.8 years 22 children without unilateral posterior crossbite (10 girls and 12 boys) aged 5.7-6.7 years. Average age 6.1 ± 0.3 years.	Clinically evaluated by a calibrated orthodontist	Swallowing pattern was determined according to the method described by Peng et al.¹⁶16 Peng CL, Jost-Brinkmann PG, Yoshida N, Miethke RR, Lin CT. Differential diagnosis between infantile and mature swallowing with ultrasonography. Eur J Orthod. 2003 Oct;25(5):451-6., 2003. Through ultrasound examination	83% (n=22) of children with unilateral posterior crossbite had visceral swallowing. Only 36% (n=8) of children without unilateral posterior crossbite presented this swallowing type (p= 0.002)	1.78 [1.30, 4.04]*

Certainty assessment							№ of patients		Effects		Overall certainty of evidence
№ of studies	Study design	Risk of bias	Inconsistency	Indirect evidence	Imprecision	Publication bias	Posterior crossbite	Placebo	Relative (95% CI)	Absolute (95% CI)
3	Observational study	Serious^a	No serious	Serious^b	Serious^c	none	48/90 (53.3%)	82/258 (31.8%)	RR 1.98 (1.49 to 2.63)	311 more per 1.000 (from 156 more to 518 more)	⨁◯◯◯ VERY LOW

Database	Search (July 10^th 2020; updated on February 26^th, 2020)
Cochrane Library	(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)
Embase	(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)
LILACS	(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional” OR “trastornos de la deglución” OR “trastorno de la deglución” OR “deglución” OR “deglución atípica” OR “Distúrbios da deglutição” OR “distúrbio da deglutição” OR “deglutição atípica” OR “deglutição” OR “Miofuncional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “open bite” OR “openbite” OR “open-bite” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “Angle Class I” OR “Angle Class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion” OR “Maloclusiones” OR “maloclusión” OR “posición dental” OR “posiciones dentales” OR “apiñamiento de los dientes” OR “mordida cruzada” OR “mordidas cruzadas” OR “mordida abierta” OR “Clasificación de Angle” OR “Clase I de Angle I” OR “Clase II de Angle” OR “Clase III de Angle” OR “maloclusión, Angle clase III” OR “maloclusión Angle clase III” OR “maloclusión esquelética clase III” OR “maloclusión clase III” OR “desarrollo maxilofacial” OR “clase de Angle II” OR “maloclusión de clase II del Angle” OR “maloclusión esquelética clase II” OR “maloclusión clase II” OR “clase Angle I” OR “maloclusión classe I del Angle” OR “maloclusión clase I esquelética” OR “maloclusión clase I” OR “Maloclusões” OR “maloclusão” OR “má oclusão” OR “posição dentária” OR “posições dentárias” OR “apinhamento dos dentes” OR “mordida cruzada” OR “mordida aberta” OR “mordida profunda” OR “Classificação de angle” OR “Classe I de Angle” OR “Classe II de Angle” OR “Classe III de Angle” OR “Classe I” OR “Classe II” OR “Classe III” OR “má oclusão, classe de Angle III” OR “má oclusão de classe III de Angle” OR “má oclusão esquelética de classe III” OR “má oclusão de classe III” OR “desenvolvimento maxilofacial” OR “classe de Angle II” OR “má oclusão de classe de Angle II” OR “má oclusão esquelética de classe II” OR “má oclusão de classe II” OR “classe de Angle I” OR “má oclusão de classe I de Angle” OR “má oclusão esquelética de classe I” OR “má oclusão de classe I”)
LIVIVO	TI=(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND TI=(“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)
PubMed	(Deglutition Disorders”[MeSH Terms] OR “Deglutition Disorders”[All Fields] OR “Deglutition Disorder”[All Fields] OR “Swallowing”[All Fields] OR “swallowed”[All Fields] OR “swallowings”[All Fields]) OR “swallowable”[All Fields] OR “swallower”[All Fields] OR “swallowers”[All Fields] OR “swallows”[MeSH Terms] OR “swallows”[All Fields] OR “swallow”[All Fields] OR “Swallowing Disorders”[All Fields] OR “Swallowing Disorder”[All Fields] OR “atypical swallowing”[All Fields] OR “atypical deglutition”[All Fields] OR “Myofunctional”[All Fields]) AND (“Malocclusions”[All Fields] OR “malocclusion”[MeSH Terms] OR “malocclusion”[All Fields] OR “dental position”[All Fields] OR “dental positions”[All Fields] OR “tooth crowding”[All Fields] OR “crossbite”[All Fields] OR “crossbites”[All Fields] OR “cross-bite”[All Fields] OR “cross-bites”[All Fields] OR “cross-bite”[All Fields] OR “cross-bites”[All Fields] OR “open-bite”[All Fields] OR “openbite”[All Fields] OR “open-bite”[All Fields] OR “deep bite”[All Fields]) OR “Overbites”[All Fields] OR “overbite”[MeSH Terms] OR “deep bite”[All Fields] OR “deep bites”[All Fields] OR “deep bite”[All Fields] OR “deep bites”[All Fields] OR “Over Bite”[All Fields] OR “Over Bites”[All Fields] OR “Angle’s Classification”[All Fields] OR “Angle Classification”[All Fields] OR “Angles Classification”[All Fields] OR “angle class I”[All Fields] OR “angle class II”[All Fields] OR “Angle Class III”[All Fields] OR “Class I”[All Fields] OR “Class II”[All Fields] OR “Class III”[All Fields] OR “malocclusion, angle class III”[MeSH Terms] OR “angle class III malocclusion”[All Fields] OR “skeletal class III malocclusion”[All Fields] OR “class III malocclusion”[All Fields] OR “maxillofacial development”[All Fields] OR “angle class II”[All Fields] OR “angle class II malocclusion”[All Fields] OR “skeletal class II malocclusion”[All Fields] OR “class II malocclusion”[All Fields] OR “angle class I”[All Fields] OR “angle class I malocclusion”[All Fields] OR “skeletal class I malocclusion”[All Fields] OR “class I malocclusion”[All Fields])
Scopus	(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)
Web of Science	TS=(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional” AND TS=(“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)
Google Scholar	(“atypical swallowing” OR “atypical deglutition”) AND (“Malocclusions”)
Open Grey	(“atypical swallowing” OR “atypical deglutition”) AND (“Malocclusions”)
ProQuest	(“Deglutition Disorders” OR “Deglutition Disorder” OR “Swallowing” OR “swallowed” OR “swallowings” OR “swallowable” OR “swallower” OR “swallowers” OR “swallows” OR “swallow” OR “Swallowing Disorders” OR “Swallowing Disorder” OR “atypical swallowing” OR “atypical deglutition” OR “Myofunctional”) AND (“Malocclusions” OR “malocclusion” OR “dental position” OR “dental positions” OR “tooth crowding” OR “crossbite” OR “crossbites” OR “cross-bite” OR “cross-bites” OR “cross-bite” OR “cross-bites” OR “open-bite” OR “openbite” OR “open-bite” OR “deep bite” OR “Overbites” OR “overbite” OR “deep bite” OR “deep bites” OR “deep bite” OR “deep bites” OR “Over Bite” OR “Over Bites” OR “Angle’s Classification” OR “Angle Classification” OR “Angles Classification” OR “angle class I” OR “angle class II” OR “Angle Class III” OR “Class I” OR “Class II” OR “Class III” OR “malocclusion, angle class III” OR “angle class III malocclusion” OR “skeletal class III malocclusion” OR “class III malocclusion” OR “maxillofacial development” OR “angle class II” OR “angle class II malocclusion” OR “skeletal class II malocclusion” OR “class II malocclusion” OR “angle class I” OR “angle class I malocclusion” OR “skeletal class I malocclusion” OR “class I malocclusion”)

Author, Year	Reason for exclusion
Alvarez Utria., et al (2016)¹	4
Aragon de Macedo, P.F. et al (2014)²	2
Ardakani, F.E (2006)³	2
Baldrighi, S. E. Z. M (1999)⁴	1
Begnoni, G., et al (2020)⁵	2
Bertolini, M. M., et al (2003)⁶	2
Bourdiol, P. et al (2017)⁷	4
Mezzomo C. L., et al (2011)⁸	5
Chiodelli, L., et al (2015)⁹	1
Del Aguila, M. A., et al (2007)¹⁰	4
Emmerich, A. et al (2004)¹¹	3
Farronato, G. P. et al (1982)¹²	6
Genolet, M (1993)¹³	5
Grabowski R, et al (2007)¹⁴	4
Gustafsson M, et al (1975)¹⁵	4
Haynes, S. (1975)¹⁶	4
Ichida, t. et al (1999) ¹⁷	4
Jin, I. J.; Yang, W. S. (1987)¹⁸	4
Leme, M. S. et al (2013)¹⁹	4
Limme, M. (1991)²⁰	4
Lin, L. H. et al (2013) ²¹	5
Lindsey, C. A.; English, J. D. (2003)²²	5
Lopes C. M. I.; Barros, A. M. S. (2019)²³	2
Lopes Freire, G. M.;(2016) ²⁴	4
Lyszczarz, J. et al (2012)²⁵	4
MacAvoy, S. K. et al (2016) ²⁶	4
Machado Jr, A. J.; Crespo, A. N. (2012)²⁷	2
Machado Jr, A. J.; Crespo, A. N. (2012)²⁸	2
Machado Jr, A. J.; Crespo, A. N. (2010)²⁹	2
Maciel, C. T.; Leite, I. C. (2005)³⁰	4
Maciel, C. T., et al (2006)³¹	4
Marcomini, L., et al (2010)³²	3
Martin, C. et al (2012) ³³	4
Mason, R. M. (2011)³⁴	5
Medeiros, A. P. M. et al (2009)³⁵	4
Morari. A. c. et al (2019)³⁶	4
Mutlu, E. et al (2019)³⁷	4
Nashashibi, I. A. (1987)³⁸	4
Ngom, P. I. et al (2007)³⁹	4
Nihi, V. S. et al (2015)⁴⁰	4
Ning, B. et al (2007)⁴¹	4
Ono, T. et al (1998)⁴²	4
Onyeaso, C.O. et al (2008)⁴³	4
Gaymer, G.O. et al (1971)⁴⁴	1
Ovsenik, M., et al (2007)⁴⁵	3
Owens, S. et al (2002) ⁴⁶	4
Padovan, B. A. (1995) ⁴⁷	5
Parisella, V. D et al (2002) ⁴⁸	1
Perkins, J. A. ⁴⁹	5
Piancino, M. G. (2012)⁵⁰	4
Picinato, M. et al (2012)⁵¹	1
Premkumar, S. et al (2011)⁵²	4
Primozic, J. et al (2013)⁵³	4
Regalo, S. C. H. et al (2003)⁵⁴	4
Regina, C. et al (2005)⁵⁵	2
Rochelle, I. M. F. et al (2010)⁵⁶	3
Saccomanno, S. et al (2012) ⁵⁷	1
Schneider, E. et al. (1975) ⁵⁸	1
Seemann, J et al (2011) ⁵⁹	3
Shenoy, U. et al (2015) ⁶⁰	4
Silva, C. E. F. M et al (1994)⁶¹	3
Silva, M. et al (2014)⁶²	5
Silva, R. A. (2016)⁶³	3
Sorokin, A. et al (2015)⁶⁴	1
Stormer, K. et al (1999)⁶⁵	2
Taner, T. et al (2013)⁶⁶	5
Truer. U. et al (1986)⁶⁷	3
Tosello, D. O. (1999)⁶⁸	2
Trannin, P. G. et al (2012)⁶⁹	4
Turvey, T. A. et al (1976)⁷⁰	1
Urzal, V. et al (2013)⁷¹	4
Volk, J. et al (2010) ⁷²	2
Williamson, E. et al (1990)⁷³	1
Xu, K. et al (2016)⁷⁴	1
Xue, M. et al (2009)⁷⁵	4
Zhou, Y. et al (1995)⁷⁶	2

[1] karinnavm@hotmail.com

Brasil

Brasil

Association between atypical swallowing and malocclusions: a systematic review

ABSTRACT

Objective:

Methods:

Results:

Conclusion:

Registration: