Allergic rhinitis and its influence on the development of mouth breathing and temporomandibular dysfunction (TMD) in children from Río Negro, Argentina




Trastornos de la Articulación Temporomandibular, Trastornos Respiratorios, Odontopediatría


Background: Temporomandibular dysfunction (TMD) is a pathological entity related to functional problems of the joint and/or masticatory muscles. This entity is a public health problem studied for a long time, seeking to identify, among other characteristics, early identification strategies in order to reduce its chronic consequences. Aim: The aim of this study was to describe the results obtained in clinical dental and morphometric evaluations that can be routinely performed in a dental office, in order to verify if these allow an early diagnosis in children and adolescents with probable TMD. Methods: An observational, longitudinal and prospective study was carried out evaluating 36 mouth breathing patients aged 7-14 years, divided into two equal groups according to whether or not they had allergic rhinitis. DTM was studied by means of validated questionnaires and clinical tests, together with morphometric parameters calculated on radiographic images. Results: Tests and mouth breathing questionnaire showed significant differences between both groups. All the children in the control group had a mild disorder, while in the case group the totality was distributed between moderate (89%) and severe (11%) disorders. The movement indicator (Manglione index) showed that 83% of the patients in the control group were moderately impaired and 17% were severely impaired, while 100% of the patients in the case group were severely impaired at the time of consultation. The results of the morphometric analysis of the panoramic radiographs indicated that all patients with mouth breathing, whether due to allergic rhinitis or another cause, present differences in reference to condyle, ramus, body and ramus width symmetry between left and right side of the face in linear and angular measurements, with only the Condilion to Gnation distance being significantly lower in the cases. Conclusions: The diagnosis of DTM requires an oriented clinical examination to assess functional limitation. In addition, a complementary imaging study of low complexity such as panoramic radiography can allow visualization of changes such as the presence of osteophytes, which provide clarity to the diagnosis, given that pediatric patients do not always present the signs and symptoms classically described for adult patients.


Download data is not yet available.


Hu Z, Sun H, Wu Y, Wu X, Mei P, Wang B, et al. Mouth breathing impairs the development of temporomandibular joint at a very early stage. Oral Diseases. 2020;26(7):1502-12.

Farronato GP, Gianni E, Forchino F, Caravaglia E, Dolci C. Función respiratoria y su repercusión estomatognática y orgánica. Ortodoncia. 1997:61-76.

Schuler IV CF, Montejo JM. Allergic rhinitis in children and adolescents. Immunology and Allergy Clinics. 2021;41(4):613-25.

Turner PJ, Kemp AS. Allergic rhinitis in children. Journal of paediatrics and child health. 2012;48(4):302-10.

Varela MAR, Pastor AC. Síndrome del respirador bucal: aproximación teórica y observación experimental: MA Ruiz; 2001.

Molina GIG. Etiología y Diagnóstico de pacientes Respiradores Bucales en edades tempranas-Revisión bibliográfica. Revista latinoamericana de Ortodoncia y Odontopediatría. 2011.

Agostinho HA, Furtado IÁ, Silva FS, Torrent JU. Cephalometric evaluation of children with allergic rhinitis and mouth breathing. Acta Médica Portuguesa. 2015;28(3):316-21.

Islas NR, Moreno NV, Ruidíaz VC, Jiménez JC. Disfunción de la articulación temporomandibular en pacientes de 9 a 14 años pretratamiento de ortodoncia. Revista odontológica mexicana. 2011;15(2):72-6.

Grau León I, Fernández Lima K, González G, Osorio Núñez M. Algunas consideraciones sobre los trastornos temporomandibulares. Revista cubana de estomatología. 2005;42(3):0-.

Ramírez-Caro SN, Espinosa de Santillana IA, Muñoz-Quintana G. Prevalencia de trastornos temporomandibulares en niños mexicanos con dentición mixta. Revista de Salud Pública. 2015;17:289-99.

Aranza OT, Gutiérrez YLG, Aranza ST, Núñez VMM. Prevalencia de signos y síntomas de los trastornos temporomandibulares en un grupo de adultos mayores. Revista de la asociación dental Mexicana. 2004;61(4):125-9.

Vasconcelos B, Silva E, Kelner N, Miranda K, Silva A. Meios de diagnóstico das desordens temporomandibulares. Rev Cir Traumat Buco-Maxilo-Facial. 2002;1(2):49-57.

Ferreira LA, Grossmann E, Januzzi E, Paula MVQd, Carvalho ACP. Diagnosis of temporomandibular joint disorders: indication of imaging exams. Brazilian journal of otorhinolaryngology. 2016;82:341-52.

Quirós O. "Terapia Miofuncional". Bases Biomecánicas y sus aplicaciones en Ortodoncia Interceptiva: AMOLCA; 2006.

Marchesan IQ. Evaluación y terapia de los problemas de respiración. Centro de Especialização em Fonoaudiologia Clínica http://www cefac br/library/artigos/faa7aac365b615843c75a2c02e1bb2d5 pdf. 2016.

Mancilla-Hernández E, Medina-Ávalos MA, Osorio-Escamilla RE. Validación de un cuestionario diagnóstico de rinitis alérgica para estudios epidemiológicos. Revista Alergia México. 2014;61(3):153-61.

Ohashi E, Paredes DA, Razzeto JAB. Análisis de los factores articulares para el diagnóstico de los desórdenes temporomandibulares en adultos jóvenes. Revista estomatológica herediana. 2002;12(1-2):15-.

Lázaro Valdiviezo JA. Validación del índice anamnésico simplificado de Fonseca para el diagnóstico de trastornos temporomandibulares. 2008.

Tatis DF. Análisis cefalométrico de Tatis para la radiografía panorámica. Monografías clínicas en ortodoncia: Publicación oficial de la Asociación Iberoamericana de Ortodoncistas. 2007;26(3):52-8.

Simões W. Análisis de simetría de las radiografías panorámicas. Simões WA Ortopedia funcional de los maxilares Rio de Janeiro (RJ): Ediciones Ysaro. 1996:311-25.

Vega L. Alergia respiratoria en el Alto Valle de Río Negro y Neuquén, Argentina: EDUCA; 2014.

Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. Journal of oral & facial pain and headache. 2014;28(1):6.

Schiffman EL, Truelove EL, Ohrbach R, Anderson GC, John MT, List T, et al. The Research Diagnostic Criteria for Temporomandibular Disorders. I: overview and methodology for assessment of validity. Journal of orofacial pain. 2010;24(1):7.

Schiffman EL, Truelove EL, Ohrbach R, Anderson GC, John MT, List T, et al. Assessment of the validity of the research diagnostic criteria for temporomandibular disorders: overview and methodology. Journal of orofacial pain. 2010;24(1):7.

Galhardo APM, da Costa Leite C, Gebrim EMMS, Gomes RLE, Mukai MK, Yamaguchi CA, et al. The correlation of research diagnostic criteria for temporomandibular disorders and magnetic resonance imaging: a study of diagnostic accuracy. Oral surgery, oral medicine, oral pathology and oral radiology. 2013;115(2):277-84.

Ohrbach R, Greene C. Temporomandibular joint diagnosis: striking a balance between the sufficiency of clinical assessment and the need for imaging. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2013;116(1):124-5.

Berghe LVd, Simoen L. Temporomandibular Disorders in Children and Adolescents. Pediatric Dentistry: Springer; 2022. p. 475-83.

Howard JA. Temporomandibular joint disorders in children. Dental Clinics. 2013;57(1):99-127.

Farman AG, Ludlow JB, Davies KL, Tyndall DA. Temporomandibular joint imaging: a comparative study of diagnostic accuracy for the detection of bone change with biplanar multidirectional tomography and panoramic images. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 1995;80(6):735-43.

Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2009;107(6):844-60.

Emshoff R, Rudisch A. Validity of clinical diagnostic criteria for temporomandibular disorders: clinical versus magnetic resonance imaging diagnosis of temporomandibular joint internal derangement and osteoarthrosis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2001;91(1):50-5.

Ladeira DBS, Cruz ADd, Almeida SMd. Digital panoramic radiography for diagnosis of the temporomandibular joint: CBCT as the gold standard. Brazilian oral research. 2015;29:01-7.

Campos M, Herrera A, Ruan V. Desórdenes témporomandibulares en la población infantil. Un tema controversial. Revisión bibliográfica. Revista de ortodoncia y odontopediatría Ortodoncia ws edición electrónica junio. 2006.

Tyagi P, Hegde R, Agrawal N. Paediatric Temporomandibular Joint Disorders. Temporomandibular Joint Disorders: Springer; 2021. p. 327-37.



How to Cite

Mulbany PE, Giraud-Billoud M. Allergic rhinitis and its influence on the development of mouth breathing and temporomandibular dysfunction (TMD) in children from Río Negro, Argentina. Interamerican Journal of Health Sciences [Internet]. 2022 Dec. 26 [cited 2024 Jun. 21];(2):124. Available from:



Original Article