Associations Between Non-nutritive Sucking Habits, Developing Malocclusion and Various Feeding Practices in 3-6-year-old Indian Urban Children: a Case- Control Study

Associations Between Non-nutritive Sucking Habits, Developing Malocclusion and Various Feeding Practices in 3-6-year-old Indian Urban Children: a Case- Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Associations Between Non-nutritive Sucking Habits, Developing Malocclusion and Various Feeding Practices in 3-6-year-old Indian Urban Children: a Case- Control Study Priyanka Singh, Ashwin Jawdekar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3546363/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Nutritive sucking and non-nutritive sucking (NNS) may affect the craniofacial development, differently. Aim and objectives : We investigated associations between non-nutritive sucking habits (NNSH), developing malocclusion and various feeding practices in 3-6-year-old children. Study design : A sample of 350 children of 3-6-year-old from various preschools was selected for this case-control study (94 with NNSH and 256 without NNSH). NNSH (outcome) and feeding practices and developing malocclusions (exposures) were assessed using a structured study tool. Results : The prevalence of NNSH in 3-6- year-old children was 26.8%. The odds [95% (CI)] of boys compared to girls having NNSH were 0.66 (0.4121 to 1.706) [p=.0290]. The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57% followed by spacing 8.5%, increased overjet 6.8%, crowding 2.2%, posterior crossbite and rotation 1.4% and overbite 1.14%. Breastfeeding was found to be the most commonly used mode of feeding reported by 53.42% of mothers. It was found that the odds [95% (CI)] of subjects having NNSH were 0.66 [0.4694 to 0.9460] (p <.0001) who were not breastfed as compared to those who were breastfed. Amongst developing malocclusions, increased overjet with p =.0019, open bite with p =.0416 and spacing with p =.0243 were found to be associated with feeding practices. Conclusion : To conclude, the prevalence of NNSH and developing malocclusions (increased overjet, open bite and spacing) were 26.8% and 34.01% respectively. Breastfeeding played a protective role against developing NNSH. nonnutritive sucking habits breastfeeding thumb sucking malocclusion feeding practices Introduction Suckling of milk provides a stimulus in infants for the overall development of the craniofacial complex with the use of lips, tongue, palate and overall oral musculature. 1 Sucking habits are of two types- Nutritive sucking habits and Non-nutritive sucking habits. Nutritive sucking includes breast-feeding and bottle-feeding while non-nutritive sucking habits involves digit sucking, lip sucking and pacifier sucking, etc. 2 , 3 Extracting of milk during the breast-feeding is an important factor in the development of stomatognathic system. 4 During extraction of milk, when the tongue is raised upwards an under pressure of -64mmHg is created and when the tongue is lowered this pressure rises to -145mmHg. 4 , 5 The under pressure which is created in the oral cavity has an impact on breathing, heart rate and suck-swallow-breathe coordination, however, the impact is still unclear. 4 , 5 On the contrary, in bottle-feeding, there is less creation of under pressure, less force required for sucking, poor involvement of orofacial structures and lower oxygen saturation levels. 5 “The World Health Organization (WHO, 2001) recommends exclusive maternal breastfeeding for first 6 months of age and appropriate complementary feeding after the 6 months; with continued breast-feeding till 2 years or beyond”. 3 , 6 , 7 Sometimes breast-feeding is either shifted to bottle-feeding at an early age or substituted by complementary feeding. 7 Feeding through bottles although considered as nutritive, is inferior to breast-feeding for a variety of reasons; it does not sufficiently add to the development of oral musculature, being one of them. 2 Non-nutritive sucking habits involves thumb or digit sucking, lip sucking, pacifier sucking and sucking of clothes. 2 , 3 , 7 These habits develop due to either improper feeding habits or psychological conditions. 8 Thumb sucking is defined as “repeated and forceful sucking of thumb with associated strong buccal and lip contractions (Moyers)”. 9 According to the classification given by Subtelny (1973), 50% of the children follow type A kind of thumb sucking wherein the whole digit is placed in the mouth, with the pad of the thumb pressing over the palate while at the same time maxilla and mandible anterior teeth contact is present”. 9 Pacifiers are used as a preventive measure against development of thumb/digit sucking habits. 10 But over a period of time they have been found to play as one of the important etiological factor in developing malocclusion. 10 Other non-nutritive sucking habits include sucking of toys, blankets, other fingers, toes, etc. 11 These habits produce a sense of relief for children particularly who are distressed, apprehensive, insecure or deprived of parental care or affection. 11 Persistence of non-nutritive sucking habits till the age of 3 is considered to be normal; however, retention of these habits beyond 3 year of age acts as a contributing factor in the development of malocclusion. 11 According to a study conducted by Dhull et al (2018), around 36% of the children have deleterious oral habits. 9 Presence of any of these habits may result in the developing malocclusion in early childhood such as anterior open bite, overjet, midline diastema, posterior crossbites, spacing, proclination of maxillary and mandibular anterior teeth, incompetent lips and protruded maxilla. 2 , 3 , 9 Association between various non-nutritive sucking habits, developing malocclusion and its etiological factors such as improper feeding practices is largely unexplored in Indian scenario in 3-6-year-old children. Therefore, this study was conducted to evaluate the association between non-nutritive sucking habits, developing malocclusion and various feeding practices in 3-6-year-old Indian urban children with the following objectives: Research objectives To assess various feeding practices in 3-6-year-old children. To assess the presence of non-nutritive sucking habits in 3-6-year-old children. To assess the presence of developing malocclusion in 3-6-year-old children. To assess various feeding practices in 3-6-year-old children. To associate the feeding practices with non-nutritive sucking habits in 3- 6- year-old children. To associate the feeding practices with developing malocclusion in 3-6- year-old children. Methodology Study design This study is a case-control study; wherein, based on the outcome (non-nutritive sucking habits- NNSH), children were grouped into cases (94) and controls (256). Settings This was carried out in the various preschools in an urban area of metro city after taking prior permission from the higher authorities. Children of 3-6-year-old were included in the study. Verbal/written consent were taken from parents. Approvals The research protocol was approved by the the Institutional Ethical Committee and Review Board prior to its commencement. Eligibility of participants Healthy children of 3–6 years of age having the consent of parents for their participation were included in the study. Children undergoing orthodontic or any other dental treatment, children having any syndromes or congenital disorders, affecting orofacial structures, adopted children or children who have lived with guardians other than mothers or children with medical conditions that may have impacted their examination or outcome assessment were excluded from the study. Data sources/measurement : A single calibrated examiner examined all children in day light using mouth mirror, tongue blades. Data were collected using a structured study tool. Apart from the demographic variables (age, gender, and SES); descriptive variables were recorded as categorial variables; such as the type of feeding practices (breast-fed or other feeding types) and developing malocclusion types such as increased overjet, spacing, crowding, cross-bite, open bite, etc. (dichotomous: presence or absence). Sample size estimation was based on the reported data for the prevalence of sucking habits as reported by Dhull et al (2018). 9 Sample size was calculated using one-sample proportion test (binomial) for prevalence of sucking habits in 3-6-years-old Indian Urban children. A minimal total sample of 348 achieved a power of > 80% to detect a prevalence of 36.0% for sucking habits in 3-6-year-old Indian urban children. Thus, a total of 350 children between 3–6 years of age were included for the study. Statistical methods Data obtained was compiled on a MS Office Excel Sheet (v 2019, Microsoft Redmond Campus, Redmond, Washington, United States). Data were subjected to statistical analysis using Statistical package for social sciences (SPSS v 26.0, IBM) and Social Science Statistics (socstatistics). Associations of variables were checked using Chi square test and odds ratio [CI (95%)] as appropriate and reported. Results Descriptive analysis The characteristics of the study population are described in Table 1 as categories, frequencies and percentages of variables. About 46.6% of the subjects were boys and 53.4% were girls. 87.4% of the mothers of subjects included in the study were educated above 7th class. About 60.3% of the subjects belonged to families of income above 10 lakhs per annum. Amongst the mothers of the subjects included in the study, 50.85% were unemployed. In the category of feeding practices-breastfeeding, bottle-feeding and a combination of both were considered, of which, 96% of the subjects were breast-fed, 57.14% were bottle-fed and 7.4% had received both breast-feeding and bottle-feeding. Amongst the category of non-nutritive sucking habits, 23.42% of the subjects had a history of digit sucking. About 2.4% of the subjects had a history of lip sucking and 0.8% reported pacifier sucking. In the category of malocclusion, in 6.8% increased overjet, in 1.14% increased overbite, in 12.57% open bite, in 1.4% posterior cross bite, in 2.2% crowding, in 1.4% rotation and in 8.5% increased spacings were observed. About 13.42% subjects were found to have tongue-tie. Table 1 Characteristics of Study Population Variables Category Frequency Percentage Demographic Gender Male Female 163 187 46.57 53.42 Mother’s education Up to 7th pass Above 7th pass Illiterate 15 306 29 4.28 87.42 8.28 Combined family income ≤ 10 lakhs Above 10 lakhs 139 211 39.71 60.28 Occupation Employed Unemployed 172 178 49.14 50.85 Birth history Duration Full term Pre term 300 50 85.71 16.66 Type of delivery Cesarean Normal 161 189 46 54 Feeding practices Breastfeeding N Y 15 335 4 96 bottle-feeding N Y 150 200 42.85 57.14 Combined N Y 324 26 92.57 7.4 Non-nutritive sucking habits Digit sucking N Y 268 82 76.57 23.42 Lips sucking N Y 341 9 97.42 2.4 Pacifier sucking N Y 347 3 99.14 0.8 Malocclusion Overjet (anterior) N Y 326 24 93.14 6.8 Overbite (anterior) N Y 346 4 98.85 1.14 Open bite N Y 306 44 87.42 12.57 Posterior crossbite N Y 345 5 98.57 1.4 Crowding N Y 342 8 97.71 2.2 Rotation N Y 345 5 98.57 1.4 Spacing N Y 320 30 91.42 8.5 Other Tongue tie N Y 303 47 86.57 13.42 BMI cat Above mean 13.7 Below mean 13.7 156 194 44.57 55.42 Non-nutritive sucking habits and other oral habits Approximately 52.16% subjects showed presence of oral habits, out of which, 26.85% had non-nutritive sucking habits and 25.31% had other oral habits. Amongst non-nutritive sucking habits, 23.42% subjects had digit sucking followed by 2.5% lip sucking and 0.8% pacifier sucking. Amongst subjects with other oral habits, 11.71% ha d mouth breathing, 6.8% had tongue thrust and 6.8% had bruxism as shown in Table 2 . Table 2 Distribution of NNSHs and other oral habits Habits Frequency Percentage Non-nutritive sucking habits 94 26.85 Digit sucking 82 23.42 Lip sucking 9 2.5 Pacifier sucking 3 0.8 Tongue thrust 24 6.8 Mouth breathing 41 11.71 Bruxism 1 0.2 All habits 45.71 Presence/absence of non-nutritive sucking habit and malocclusion The odds [95% (CI)] of subjects with non-nutritive sucking habits having malocclusion as compared to those not having non-nutritive sucking habits were 2.72 [1.7736, 4.1818] (p < .0001) as shown in Table 3 . Table 3 Inferential statistics: Presence/absence of non-nutritive sucking habits and malocclusion Non- nutritive sucking habits Presence of malocclusion % Chi – square P - value OR (95% CI) Present 60/94 68.08 59.751 P < .0001* 2.7234 (1.7736 to 4.1818 Absent 60/256 23.43 *P < 0.05 – significant Presence/absence of any other habits (mouth breathing, tongue thrust and bruxism) and malocclusion The odds [95% (CI)] of subjects with any other oral habits having malocclusion as compared to those not having any other oral habits were 2.87 [1.8275, 4.5347] (p < .0001) as shown in Table 4 . Table 4 Inferential statistics: Presence/absence of any other habits (mouth breathing, tongue thrust and bruxism) and malocclusion Any other habits Presence of malocclusion % Chi – square P - value OR (95% CI) Present 60/66 90.90 68.973 P < .0001* 2.8788 (1.8275 to 4.5347) Absent 60/190 31.57 *P < 0.05 – significant Association of feeding practices and non-nutritive sucking habits The odds of subjects who were breastfed as compared to those who were fed by other means having non-nutritive sucking habits were 0.66 (0.4694 to 0.9460) [chi square: 18.588, p < .0001] as shown in Table 5 . Table 5 Association of feeding practices and non-nutritive sucking habits Breast feeding Non – nutritive sucking habits % Chi – square P - value OR (95% CI) Present 44/187 23.52 18.588 P < .0001* 0.6664 (0.4694 to 0.9460) Absent (other feeding practices) 74/163 45.39 *P < 0.05 – significant Association of feeding practices and developing malocclusion The odds of subjects who were breastfed as compared to those who were fed by other means having increased overjet were 0.14 (0.0320 to 0.6587) [chi square: 9.680, p = .0019]. The odds of subjects who were breastfed as compared to those who 43 were fed by other means having open bite were 0.53 (0.2643 to 1.0650) [chi square: 4.152, p = .0416]. The odds of subjects who were breastfed as compared to those who were fed by other means having spacing were 0.3353 (0.1170 to 0.9605) [chi square: 12.220, p = .0243] as shown in Tables 6 , 7 and 8 . Table 6 Association of feeding practices with developing malocclusion (Increased overjet) Breast feeding Increased overjet % Chi – square P - value OR (95% CI) Present 2/187 1.0 9.680 P < .0 .0019 * 0.1453 (0.0320 to 0.6587 Absent (other feeding practices) 12/163 7.6 *P < 0.05 – significant Table 7 Association of feeding practices with developing malocclusion (Open bite) Breast feeding Open bite % Chi – square P - value OR (95% CI) Present 14/187 7.6 4.152 P < .0416* 0.5306 (0.2643 to 1.0650) Absent (other feeding practices) 23/163 14.11 *P < 0.05 – significant Table 8 Association of feeding practices with developing malocclusion (Spacing) Breast feeding Spacing % Chi – square P - value OR (95% CI) Present 5/187 2.6 12.220 P < .0243* 0.3353 (0.1170 to 0.9605) Absent (other feeding practices) 13/163 7.9 *P < 0.05 – significant Discussion Importance of breast-feeding need not be over-emphasized as weaning at a very early age can interfere with the development of the orofacial structures affecting important functions such as breathing, chewing, swallowing and speech. 1 Non-nutritive sucking habits develop due to stress as a result of insufficient care or affection perceived by the child from parents or caregivers. 8 Development of non-nutritive sucking habits has little or no effect if present for a shorter duration of time; however, if practised for a prolonged period these have an overall effect on the developing dentition and jaws and on the occlusal characteristics such as the development of the anterior open bite, increased overjet, posterior crossbites, Angle’s class II malocclusion, and canine class II relationship, etc. 11 Sometimes these malocclusions are self-correcting if early interventions are made. Various cross-sectional studies have assessed the effect of non-nutritive sucking habits on the developing dentition through structured questionnaires. 11 There are no studies conducted in India to assess the association of non-nutritive sucking habits on developing malocclusion and various types of feeding practices in a particular age group i.e. 3-6-years. In the present case-control study, outcomes were assessed primarily were non-nutritive sucking habits and developing malocclusion and an association was tried to establish between these outcomes and the feeding practices. The preschool age group is an accessible population and parental counseling regarding the deleterious habits of children in this age-group is important for preventing persistence of the damage and further complications. 12 Our results showed that there was a significant association between feeding practices and the presence of non-nutritive sucking habits. Children who were bottle-fed for a longer duration of time showed significantly higher chances of developing non-nutritive sucking habits. Results of studies by Lopes et al in 2014, Chen et al in 2015 and Montaldo et al in 2010 have shown similar relationship of non-nutritive sucking habits with feeding practices in different settings and population. 1 , 2 , 13 The odds of developing various malocclusions such as increased overjet, deep bite, open bite and posterior crossbite were higher in subjects with non-nutritive sucking habits as compared to those without non-nutritive sucking habits reported in our study. In a systematic review conducted by Dogramaci et al in 2016, it has been reported that there are higher chances of developing malocclusion in participants with non-nutritive sucking habits. 14 Subjects with oral habits other than non-nutritive sucking habits also showed higher presence of malocclusion as compared to those who did not have any habits. Paolantonio et al in 2019 reported that the prevalence of bad habits and mouth breathing have increased the risk of developing malocclusion and also increases the severity of the present malocclusion. 15 Increased overjet was found to be significantly associated with non-nutritive sucking habits. In studies conducted by various authors such as Mistry et al (2010), Luzzi et al (2011) and Ling et al (2018) reported association between increased overjet and the presence of non-nutritive sucking habits. 16 , 17 , 18 The presence of spacing is considered normal in primary dentition as it provides space for the eruption of permanent dentition, particularly in the age group selected for our study. The absence of spacing could result in crowding which needs to be prevented at an early age by orthodontic intervention. 2 The present study reported the presence of spacing to be higher in subjects who were fed through other feeding practices (bottle-feeding/combination). The limitations of this study include inadequate sample size for further exploratory analyses in view of all recorded parameters. Reporting of feeding practices and oral habits was done as per the information given by the parents, thus, with a certain recall bias. The odds ratio is known to amplify the risks compared to the relative risk, however, due to the constraints of time a long-term cohort study was not possible to explore such associations. The generalizability of the findings of this study is limited due to the study settings and the sample size. Conclusion The prevalence of non-nutritive sucking habits in 3-6- year-old children was 26.8% out of which, 23.42% was digit sucking, 2.5% was lip sucking and 0.8% was pacifier sucking. The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57%. Breastfeeding was found to be most commonly reported in 3-6-year-old children as compared to other feeding practices. The odds of developing non-nutritive sucking habits were 0.66 times in children who were not breastfed and the results were statistically significant. Amongst malocclusions, increased overjet, open bite and spacing were found to be associated with feeding practices in 3-6-year-old children. Declarations Ethical approval: The ethical approval was carried out by the Institutional Ethical Committee under the protocol number: IEC264022021 dated 11/01/2021. Consent to participate: The parent of every child was provided with a consent form. The procedure was carried out only after signing the consent form. Form has been uploaded in supplementary data. Consent for publication: We hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental there to, exclusively to the journal, in the event that such work is published by the journal. Availability of data: The data was collected through a well-designed study tool. The study tool has been uploaded in the supplementary data. Competing interests: Not applicable Source of funding: Self-funded. Author’s Contribution: The corresponding author, PS, contributed in writing the manuscript, while the other author, AJ, contributed in tabulating results, preparing study tool, consent for participation. Acknowledgement: We acknowledge support from the staff of Department of Public Health Dentistry, Bharati Vidyapeeth, Dental College and Hospital, and Bharati Vidyapeeth School, Navi Mumbai. Author’s information: Dr. Priyanka Singh, a Dr. Ashwin Jawdekar b a Postgraduate student, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai b Professor and Head and Vice Principal, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai Corresponding author: Dr. Priyanka Singh, postgraduate student, Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, India. Email id: [email protected] References Lopes TS, de Deus Moura LD, Lima MC. Breastfeeding and sucking habits in children enrolled in a mother-child health program. BMC Research Notes. 2014 Dec;7(1):1-8. Chen X, Xia B, Ge L. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC pediatrics. 2015 Dec;15(1):1-9. Agarwal SS, Nehra K, Sharma M, Jayan B, Poonia A, Bhattal H. Association between breastfeeding duration, non-nutritive sucking habits and dental arch dimensions in deciduous dentition: a cross-sectional study. Progress in orthodontics. 2014 Dec;15(1):1-8. Cudziło D, Pałczyńska D, Bednarczyk M. Infant and baby feeding and the development of the maxillofacial complex based on own observations and the literature. Journal of Mother and Child. 2018 Jan 1;22(3):255-9. Sakalidis VS, McClellan HL, Hepworth AR, Kent JC, Lai CT, Hartmann PE, Geddes DT. Oxygen saturation and suck-swallow-breathe coordination of term infants during breastfeeding and feeding from a teat releasing milk only with vacuum. International Journal of Pediatrics. 2012 Apr;2012. 84 Cacho NT, Lawrence RM. Innate immunity and breast milk. Frontiers in immunology. 2017 May 29;8:584. Kogade P, Gaidhane A, Choudhari S, Khatib MN, Kawalkar U, Gaidhane S, Zahiruddin QS. Socio-cultural determinants of infant and young child feeding practices in rural India. Medical Science. 2019;23(100):1015-22. Bradley l, Houghton S. The reduction of inappropriate sucking behaviour in a 7-year-old girl through response-cost and social-reinforcement procedures. Behaviour change-Bundoora then Sydney then Bowen hills-. 1992 dec;9:254-. Dhull KS, Verma T, Dutta B. Prevalence of deleterious oral habits among 3-to 5-year-old preschool children in Bhubaneswar, Odisha, India. International journal of clinical pediatric dentistry. 2018 may;11(3):210. Schmid KM, Kugler R, Nalabothu P, Bosch C, Verna C. The effect of pacifier sucking on orofacial structures: a systematic literature review. Progress in orthodontics. 2018 dec 1;19(1):8. Feştilă D, Ghergie M, Muntean A, Matiz D, ŞERBǍNESCU A. Suckling and non-nutritive sucking habit: what should we know?. Clujul medical. 2014;87(1):11. Bhat SS, Rao HA, Hegde KS, Kumar BK. Characteristics of primary dentition occlusion in preschool children: An epidemiological study. International journal of clinical pediatric dentistry. 2012 May;5(2):93. Montaldo L, Montaldo P, Cuccaro P, Caramico N, Minervini G. Effects of feeding on non‐nutritive sucking habits and implications on occlusion 89 in mixed dentition. International Journal of Paediatric Dentistry. 2011 Jan;21(1):68-73. Doğramacı EJ, Rossi-Fedele G. Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis. The Journal of the American Dental Association. 2016 Dec 1;147(12):926-34. Paolantonio EG, Ludovici N, Saccomanno S, La Torre G, Grippaudo C. Association between oral habits, mouth breathing and malocclusion in Italian preschoolers. European journal of paediatric dentistry. 2019;2019(20/3):204-8. Mistry P, Moles DR, O'Neill J, Noar J. The occlusal effects of digit sucking habits amongst school children in Northamptonshire (UK). Journal of Orthodontics. 2010 Jun;37(2):87-92. Luzzi V, Guaragna M, Ierardo G, Saccucci M, Consoli G, Vestri AR, Polimeni A. Malocclusions and non-nutritive sucking habits: a preliminary study. Progress in orthodontics. 2011 Nov 1;12(2):114-8. Ling HT, Sum FH, Zhang L, Yeung CP, Li KY, Wong HM, Yang Y. The association between nutritive, non-nutritive sucking habits and primary dental occlusion. BMC oral health. 2018 Dec;18(1):1-0. Additional Declarations No competing interests reported. Supplementary Files STUDYTOOL.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3546363","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":246597223,"identity":"3b5c1fbf-ffd9-4032-82fe-0d3608a7e84f","order_by":0,"name":"Priyanka Singh","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIiWNgGAWjYFACxgYJIGnHxsx+8AGQwcNHpBaDZH72nmQDkBY2YuwBaWGc2XPADGQdA0Et5tKHG2983PGH2eBGQlrl1xw7GTYG5oePbuDRYtmX2Gw584wBn8GNxGO3ZbclAx3GZmycg0eLwRnGNmneNgOwLbcltzEDtfCwSRPU8rfNgHHDjQSzYslt9URqYWyDeJ/x47bDhLVY9jA2W/a2GYMDWZpx23EeNmYCfjHnYX9442ebHDgqP/7cVm3Pz9788DFehyFzmHnAJB7lGFoYfxBQPQpGwSgYBSMTAACS0UTlb7wqqQAAAABJRU5ErkJggg==","orcid":"","institution":"Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Priyanka","middleName":"","lastName":"Singh","suffix":""},{"id":246597224,"identity":"3f6d9ad9-9063-48bd-9c1a-f0aaad477ce6","order_by":1,"name":"Ashwin Jawdekar","email":"","orcid":"","institution":"Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ashwin","middleName":"","lastName":"Jawdekar","suffix":""}],"badges":[],"createdAt":"2023-11-02 17:59:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3546363/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3546363/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":46201593,"identity":"74fc22a5-1c9d-4bcb-ab44-138ee5daeaf0","added_by":"auto","created_at":"2023-11-10 05:52:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":529989,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3546363/v1/0a16f9d2-066e-4652-87fb-2d26f24bad01.pdf"},{"id":46090318,"identity":"6aea2811-4b56-4e38-8a33-f21530447bce","added_by":"auto","created_at":"2023-11-08 13:45:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":13208,"visible":true,"origin":"","legend":"","description":"","filename":"STUDYTOOL.docx","url":"https://assets-eu.researchsquare.com/files/rs-3546363/v1/f8b661865647590e4349a13d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAssociations Between Non-nutritive Sucking Habits, Developing Malocclusion and Various Feeding Practices in 3-6-year-old Indian Urban Children: a Case- Control Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSuckling of milk provides a stimulus in infants for the overall development of the craniofacial complex with the use of lips, tongue, palate and overall oral musculature.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Sucking habits are of two types- Nutritive sucking habits and Non-nutritive sucking habits. Nutritive sucking includes breast-feeding and bottle-feeding while non-nutritive sucking habits involves digit sucking, lip sucking and pacifier sucking, etc.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eExtracting of milk during the breast-feeding is an important factor in the development of stomatognathic system.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e During extraction of milk, when the tongue is raised upwards an under pressure of -64mmHg is created and when the tongue is lowered this pressure rises to -145mmHg.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e The under pressure which is created in the oral cavity has an impact on breathing, heart rate and suck-swallow-breathe coordination, however, the impact is still unclear.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e On the contrary, in bottle-feeding, there is less creation of under pressure, less force required for sucking, poor involvement of orofacial structures and lower oxygen saturation levels.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e\u0026ldquo;The World Health Organization (WHO, 2001) recommends exclusive maternal breastfeeding for first 6 months of age and appropriate complementary feeding after the 6 months; with continued breast-feeding till 2 years or beyond\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Sometimes breast-feeding is either shifted to bottle-feeding at an early age or substituted by complementary feeding.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Feeding through bottles although considered as nutritive, is inferior to breast-feeding for a variety of reasons; it does not sufficiently add to the development of oral musculature, being one of them.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eNon-nutritive sucking habits involves thumb or digit sucking, lip sucking, pacifier sucking and sucking of clothes.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e These habits develop due to either improper feeding habits or psychological conditions.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Thumb sucking is defined as \u0026ldquo;repeated and forceful sucking of thumb with associated strong buccal and lip contractions (Moyers)\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e According to the classification given by Subtelny (1973), 50% of the children follow type A kind of thumb sucking wherein the whole digit is placed in the mouth, with the pad of the thumb pressing over the palate while at the same time maxilla and mandible anterior teeth contact is present\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Pacifiers are used as a preventive measure against development of thumb/digit sucking habits.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e But over a period of time they have been found to play as one of the important etiological factor in developing malocclusion.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOther non-nutritive sucking habits include sucking of toys, blankets, other fingers, toes, etc.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e These habits produce a sense of relief for children particularly who are distressed, apprehensive, insecure or deprived of parental care or affection.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Persistence of non-nutritive sucking habits till the age of 3 is considered to be normal; however, retention of these habits beyond 3 year of age acts as a contributing factor in the development of malocclusion. \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAccording to a study conducted by Dhull et al (2018), around 36% of the children have deleterious oral habits.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Presence of any of these habits may result in the developing malocclusion in early childhood such as anterior open bite, overjet, midline diastema, posterior crossbites, spacing, proclination of maxillary and mandibular anterior teeth, incompetent lips and protruded maxilla.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAssociation between various non-nutritive sucking habits, developing malocclusion and its etiological factors such as improper feeding practices is largely unexplored in Indian scenario in 3-6-year-old children. Therefore, this study was conducted to evaluate the association between non-nutritive sucking habits, developing malocclusion and various feeding practices in 3-6-year-old Indian urban children with the following objectives:\u003c/p\u003e \u003cp\u003e \u003cb\u003eResearch objectives\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess various feeding practices in 3-6-year-old children.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the presence of non-nutritive sucking habits in 3-6-year-old children.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess the presence of developing malocclusion in 3-6-year-old children.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo assess various feeding practices in 3-6-year-old children.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo associate the feeding practices with non-nutritive sucking habits in 3- 6- year-old children.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eTo associate the feeding practices with developing malocclusion in 3-6- year-old children.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eThis study is a case-control study; wherein, based on the outcome (non-nutritive sucking habits- NNSH), children were grouped into cases (94) and controls (256).\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSettings\u003c/strong\u003e \u003cp\u003e This was carried out in the various preschools in an urban area of metro city after taking prior permission from the higher authorities. Children of 3-6-year-old were included in the study. Verbal/written consent were taken from parents.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eApprovals\u003c/strong\u003e \u003cp\u003e The research protocol was approved by the the Institutional Ethical Committee and Review Board prior to its commencement.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEligibility of participants\u003c/strong\u003e \u003cp\u003e Healthy children of 3\u0026ndash;6 years of age having the consent of parents for their participation were included in the study. Children undergoing orthodontic or any other dental treatment, children having any syndromes or congenital disorders, affecting orofacial structures, adopted children or children who have lived with guardians other than mothers or children with medical conditions that may have impacted their examination or outcome assessment were excluded from the study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eData sources/measurement\u003c/b\u003e: A single calibrated examiner examined all children in day light using mouth mirror, tongue blades. Data were collected using a structured study tool. Apart from the demographic variables (age, gender, and SES); descriptive variables were recorded as categorial variables; such as the type of feeding practices (breast-fed or other feeding types) and developing malocclusion types such as increased overjet, spacing, crowding, cross-bite, open bite, etc. (dichotomous: presence or absence).\u003c/p\u003e \u003cp\u003eSample size estimation was based on the reported data for the prevalence of sucking habits as reported by Dhull et al (2018).\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Sample size was calculated using one-sample proportion test (binomial) for prevalence of sucking habits in 3-6-years-old Indian Urban children. A minimal total sample of 348 achieved a power of \u0026gt;\u0026thinsp;80% to detect a prevalence of 36.0% for sucking habits in 3-6-year-old Indian urban children. Thus, a total of 350 children between 3\u0026ndash;6 years of age were included for the study.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical methods\u003c/strong\u003e \u003cp\u003eData obtained was compiled on a MS Office Excel Sheet (v 2019, Microsoft Redmond Campus, Redmond, Washington, United States). Data were subjected to statistical analysis using Statistical package for social sciences (SPSS v 26.0, IBM) and Social Science Statistics (socstatistics). Associations of variables were checked using Chi square test and odds ratio [CI (95%)] as appropriate and reported.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDescriptive analysis\u003c/h2\u003e \u003cp\u003eThe characteristics of the study population are described in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e as categories, frequencies and percentages of variables. About 46.6% of the subjects were boys and 53.4% were girls. 87.4% of the mothers of subjects included in the study were educated above 7th class. About 60.3% of the subjects belonged to families of income above 10 lakhs per annum. Amongst the mothers of the subjects included in the study, 50.85% were unemployed. In the category of feeding practices-breastfeeding, bottle-feeding and a combination of both were considered, of which, 96% of the subjects were breast-fed, 57.14% were bottle-fed and 7.4% had received both breast-feeding and bottle-feeding. Amongst the category of non-nutritive sucking habits, 23.42% of the subjects had a history of digit sucking. About 2.4% of the subjects had a history of lip sucking and 0.8% reported pacifier sucking. In the category of malocclusion, in 6.8% increased overjet, in 1.14% increased overbite, in 12.57% open bite, in 1.4% posterior cross bite, in 2.2% crowding, in 1.4% rotation and in 8.5% increased spacings were observed. About 13.42% subjects were found to have tongue-tie.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of Study Population\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003eDemographic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e163\u003c/p\u003e \u003cp\u003e187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e46.57\u003c/p\u003e \u003cp\u003e53.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMother\u0026rsquo;s education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUp to 7th pass Above 7th pass\u003c/p\u003e \u003cp\u003eIlliterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e306\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4.28\u003c/p\u003e \u003cp\u003e87.42\u003c/p\u003e \u003cp\u003e8.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCombined family\u003c/p\u003e \u003cp\u003eincome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;10 lakhs\u003c/p\u003e \u003cp\u003eAbove 10 lakhs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e139\u003c/p\u003e \u003cp\u003e211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e39.71\u003c/p\u003e \u003cp\u003e60.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e172\u003c/p\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e49.14\u003c/p\u003e \u003cp\u003e50.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth history\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDuration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eFull term\u003c/p\u003e \u003cp\u003ePre term\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e300\u003c/p\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e85.71\u003c/p\u003e \u003cp\u003e16.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eType of delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e161\u003c/p\u003e \u003cp\u003e189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e46\u003c/p\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFeeding practices\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBreastfeeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ebottle-feeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e150\u003c/p\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e42.85\u003c/p\u003e \u003cp\u003e57.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCombined\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN Y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e324\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e92.57\u003c/p\u003e \u003cp\u003e7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNon-nutritive sucking habits\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDigit sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e268\u003c/p\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e76.57\u003c/p\u003e \u003cp\u003e23.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLips sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e341\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e97.42\u003c/p\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePacifier sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e347\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e99.14\u003c/p\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMalocclusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverjet (anterior)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e326\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e93.14\u003c/p\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverbite (anterior)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e346\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e98.85\u003c/p\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOpen bite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e306\u003c/p\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e87.42\u003c/p\u003e \u003cp\u003e12.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePosterior crossbite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e345\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e98.57\u003c/p\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCrowding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e342\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e97.71\u003c/p\u003e \u003cp\u003e2.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRotation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e345\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e98.57\u003c/p\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSpacing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e320\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e91.42\u003c/p\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c8\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOther\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTongue tie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003cp\u003eY\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e303\u003c/p\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e86.57\u003c/p\u003e \u003cp\u003e13.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBMI cat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAbove mean 13.7\u003c/p\u003e \u003cp\u003eBelow mean 13.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e156\u003c/p\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e44.57\u003c/p\u003e \u003cp\u003e55.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c9\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eNon-nutritive sucking habits and other oral habits\u003c/h2\u003e \u003cp\u003e Approximately 52.16% subjects showed presence of oral habits, out of which, 26.85% had non-nutritive sucking habits and 25.31% had other oral habits. Amongst non-nutritive sucking habits, 23.42% subjects had digit sucking followed by 2.5% lip sucking and 0.8% pacifier sucking. Amongst subjects with other oral habits, 11.71% ha d mouth breathing, 6.8% had tongue thrust and 6.8% had bruxism as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of NNSHs and other oral habits\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHabits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon-nutritive sucking habits\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDigit sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLip sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePacifier sucking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTongue thrust\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMouth breathing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBruxism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAll habits\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e45.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePresence/absence of non-nutritive sucking habit and malocclusion\u003c/h2\u003e \u003cp\u003eThe odds [95% (CI)] of subjects with non-nutritive sucking habits having malocclusion as compared to those not having non-nutritive sucking habits were 2.72 [1.7736, 4.1818] (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) as shown in Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInferential statistics: Presence/absence of non-nutritive sucking habits and malocclusion\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon- nutritive sucking\u003c/p\u003e \u003cp\u003ehabits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of malocclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi \u0026ndash; square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60/94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e59.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;.0001*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.7234\u003c/p\u003e \u003cp\u003e(1.7736 to\u003c/p\u003e \u003cp\u003e4.1818\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60/256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u0026ndash; significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003ePresence/absence of any other habits (mouth breathing, tongue thrust and bruxism) and malocclusion\u003c/h2\u003e \u003cp\u003eThe odds [95% (CI)] of subjects with any other oral habits having malocclusion as compared to those not having any other oral habits were 2.87 [1.8275, 4.5347] (p\u0026thinsp;\u0026lt;\u0026thinsp;.0001) as shown in Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInferential statistics: Presence/absence of any other habits (mouth breathing, tongue thrust and bruxism) and malocclusion\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny other\u003c/p\u003e \u003cp\u003ehabits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePresence of\u003c/p\u003e \u003cp\u003emalocclusion\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi \u0026ndash; square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%\u003c/p\u003e \u003cp\u003eCI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60/66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e68.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;.0001*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.8788\u003c/p\u003e \u003cp\u003e(1.8275 to\u003c/p\u003e \u003cp\u003e4.5347)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60/190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u0026ndash; significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of feeding practices and non-nutritive sucking habits\u003c/h2\u003e \u003cp\u003eThe odds of subjects who were breastfed as compared to those who were fed by other means having non-nutritive sucking habits were 0.66 (0.4694 to 0.9460) [chi square: 18.588, p\u0026thinsp;\u0026lt;\u0026thinsp;.0001] as shown in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of feeding practices and non-nutritive sucking habits\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast feeding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon \u0026ndash; nutritive sucking\u003c/p\u003e \u003cp\u003ehabits\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi \u0026ndash; square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44/187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e18.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;.0001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.6664\u003c/p\u003e \u003cp\u003e(0.4694 to\u003c/p\u003e \u003cp\u003e0.9460)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent (other feeding practices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74/163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u0026ndash; significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAssociation of feeding practices and developing malocclusion\u003c/h2\u003e \u003cp\u003eThe odds of subjects who were breastfed as compared to those who were fed by other means having increased overjet were 0.14 (0.0320 to 0.6587) [chi square: 9.680, p\u0026thinsp;=\u0026thinsp;.0019]. The odds of subjects who were breastfed as compared to those who 43 were fed by other means having open bite were 0.53 (0.2643 to 1.0650) [chi square: 4.152, p\u0026thinsp;=\u0026thinsp;.0416]. The odds of subjects who were breastfed as compared to those who were fed by other means having spacing were 0.3353 (0.1170 to 0.9605) [chi square: 12.220, p\u0026thinsp;=\u0026thinsp;.0243] as shown in Tables \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e,\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e and \u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of feeding practices with developing malocclusion (Increased overjet)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003cp\u003efeeding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003cp\u003eoverjet\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi \u0026ndash; square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%\u003c/p\u003e \u003cp\u003eCI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2/187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e9.680\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;.0\u003c/em\u003e .0019\u003cem\u003e*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.1453 (0.0320\u003c/p\u003e \u003cp\u003eto 0.6587\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent (other\u003c/p\u003e \u003cp\u003efeeding practices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12/163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u0026ndash; significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of feeding practices with developing malocclusion (Open bite)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003cp\u003efeeding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOpen bite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi \u0026ndash; square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%\u003c/p\u003e \u003cp\u003eCI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e4.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;.0416*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.5306\u003c/p\u003e \u003cp\u003e(0.2643 to\u003c/p\u003e \u003cp\u003e1.0650)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent (other\u003c/p\u003e \u003cp\u003efeeding practices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23/163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u0026ndash; significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of feeding practices with developing malocclusion (Spacing)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003cp\u003efeeding\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpacing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi \u0026ndash; square\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP - value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR (95%\u003c/p\u003e \u003cp\u003eCI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePresent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5/187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e12.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;.0243*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.3353\u003c/p\u003e \u003cp\u003e(0.1170 to\u003c/p\u003e \u003cp\u003e0.9605)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsent (other feeding\u003c/p\u003e \u003cp\u003epractices)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13/163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cem\u003e*P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 \u0026ndash; significant\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eImportance of breast-feeding need not be over-emphasized as weaning at a very early age can interfere with the development of the orofacial structures affecting important functions such as breathing, chewing, swallowing and speech.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Non-nutritive sucking habits develop due to stress as a result of insufficient care or affection perceived by the child from parents or caregivers.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e Development of non-nutritive sucking habits has little or no effect if present for a shorter duration of time; however, if practised for a prolonged period these have an overall effect on the developing dentition and jaws and on the occlusal characteristics such as the development of the anterior open bite, increased overjet, posterior crossbites, Angle\u0026rsquo;s class II malocclusion, and canine class II relationship, etc.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Sometimes these malocclusions are self-correcting if early interventions are made. Various cross-sectional studies have assessed the effect of non-nutritive sucking habits on the developing dentition through structured questionnaires.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e There are no studies conducted in India to assess the association of non-nutritive sucking habits on developing malocclusion and various types of feeding practices in a particular age group i.e. 3-6-years.\u003c/p\u003e \u003cp\u003eIn the present case-control study, outcomes were assessed primarily were non-nutritive sucking habits and developing malocclusion and an association was tried to establish between these outcomes and the feeding practices. The preschool age group is an accessible population and parental counseling regarding the deleterious habits of children in this age-group is important for preventing persistence of the damage and further complications.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur results showed that there was a significant association between feeding practices and the presence of non-nutritive sucking habits. Children who were bottle-fed for a longer duration of time showed significantly higher chances of developing non-nutritive sucking habits. Results of studies by Lopes et al in 2014, Chen et al in 2015 and Montaldo et al in 2010 have shown similar relationship of non-nutritive sucking habits with feeding practices in different settings and population.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe odds of developing various malocclusions such as increased overjet, deep bite, open bite and posterior crossbite were higher in subjects with non-nutritive sucking habits as compared to those without non-nutritive sucking habits reported in our study. In a systematic review conducted by Dogramaci et al in 2016, it has been reported that there are higher chances of developing malocclusion in participants with non-nutritive sucking habits.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Subjects with oral habits other than non-nutritive sucking habits also showed higher presence of malocclusion as compared to those who did not have any habits. Paolantonio et al in 2019 reported that the prevalence of bad habits and mouth breathing have increased the risk of developing malocclusion and also increases the severity of the present malocclusion.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIncreased overjet was found to be significantly associated with non-nutritive sucking habits. In studies conducted by various authors such as Mistry et al (2010), Luzzi et al (2011) and Ling et al (2018) reported association between increased overjet and the presence of non-nutritive sucking habits.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe presence of spacing is considered normal in primary dentition as it provides space for the eruption of permanent dentition, particularly in the age group selected for our study. The absence of spacing could result in crowding which needs to be prevented at an early age by orthodontic intervention.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e The present study reported the presence of spacing to be higher in subjects who were fed through other feeding practices (bottle-feeding/combination).\u003c/p\u003e \u003cp\u003eThe limitations of this study include inadequate sample size for further exploratory analyses in view of all recorded parameters. Reporting of feeding practices and oral habits was done as per the information given by the parents, thus, with a certain recall bias. The odds ratio is known to amplify the risks compared to the relative risk, however, due to the constraints of time a long-term cohort study was not possible to explore such associations.\u003c/p\u003e \u003cp\u003eThe generalizability of the findings of this study is limited due to the study settings and the sample size.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of non-nutritive sucking habits in 3-6- year-old children was 26.8% out of which, 23.42% was digit sucking, 2.5% was lip sucking and 0.8% was pacifier sucking. The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57%. Breastfeeding was found to be most commonly reported in 3-6-year-old children as compared to other feeding practices. The odds of developing non-nutritive sucking habits were 0.66 times in children who were not breastfed and the results were statistically significant. Amongst malocclusions, increased overjet, open bite and spacing were found to be associated with feeding practices in 3-6-year-old children.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThe ethical approval was carried out by the Institutional Ethical Committee under the protocol number: IEC264022021 dated 11/01/2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e The parent of every child was provided with a consent form. The procedure was carried out only after signing the consent form. Form has been uploaded in supplementary data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e We hereby transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental there to, exclusively to the journal, in the event that such work is published by the journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data:\u003c/strong\u003e The data was collected through a well-designed study tool. The study tool has been uploaded in the supplementary data.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eCompeting interests:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of funding:\u003c/strong\u003e Self-funded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution:\u0026nbsp;\u003c/strong\u003eThe corresponding author, PS, contributed in writing the manuscript, while the other author, AJ, contributed in tabulating results, preparing study tool, consent for participation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge support from the staff of\u0026nbsp;Department of Public Health Dentistry, Bharati Vidyapeeth, Dental College and Hospital, and\u0026nbsp;Bharati\u0026nbsp;Vidyapeeth\u0026nbsp;School, Navi Mumbai.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s information:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Priyanka Singh,\u003csup\u003ea \u0026nbsp;\u0026nbsp;\u003c/sup\u003eDr. Ashwin Jawdekar\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003ea Postgraduate student, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai\u003c/p\u003e\n\u003cp\u003eb Professor and Head and Vice Principal, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai\u003c/p\u003e\n\u003cp\u003eCorresponding author: Dr. Priyanka Singh, postgraduate student, Department of Paediatric and Preventive Dentistry, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, India.\u003c/p\u003e\n\u003cp\u003eEmail id: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLopes TS, de Deus Moura LD, Lima MC. Breastfeeding and sucking habits in children enrolled in a mother-child health program. BMC Research Notes. 2014 Dec;7(1):1-8. \u003c/li\u003e\n\u003cli\u003eChen X, Xia B, Ge L. Effects of breast-feeding duration, bottle-feeding duration and non-nutritive sucking habits on the occlusal characteristics of primary dentition. BMC pediatrics. 2015 Dec;15(1):1-9. \u003c/li\u003e\n\u003cli\u003eAgarwal SS, Nehra K, Sharma M, Jayan B, Poonia A, Bhattal H. Association between breastfeeding duration, non-nutritive sucking habits and dental arch dimensions in deciduous dentition: a cross-sectional study. Progress in orthodontics. 2014 Dec;15(1):1-8. \u003c/li\u003e\n\u003cli\u003eCudziło D, Pałczyńska D, Bednarczyk M. Infant and baby feeding and the development of the maxillofacial complex based on own observations and the literature. Journal of Mother and Child. 2018 Jan 1;22(3):255-9.\u003c/li\u003e\n\u003cli\u003eSakalidis VS, McClellan HL, Hepworth AR, Kent JC, Lai CT, Hartmann PE, Geddes DT. Oxygen saturation and suck-swallow-breathe coordination of term infants during breastfeeding and feeding from a teat releasing milk only with vacuum. International Journal of Pediatrics. 2012 Apr;2012. 84 \u003c/li\u003e\n\u003cli\u003eCacho NT, Lawrence RM. Innate immunity and breast milk. Frontiers in immunology. 2017 May 29;8:584.\u003c/li\u003e\n\u003cli\u003eKogade P, Gaidhane A, Choudhari S, Khatib MN, Kawalkar U, Gaidhane S, Zahiruddin QS. Socio-cultural determinants of infant and young child feeding practices in rural India. Medical Science. 2019;23(100):1015-22. \u003c/li\u003e\n\u003cli\u003eBradley l, Houghton S. The reduction of inappropriate sucking behaviour in a 7-year-old girl through response-cost and social-reinforcement procedures. Behaviour change-Bundoora then Sydney then Bowen hills-. 1992 dec;9:254-. \u003c/li\u003e\n\u003cli\u003eDhull KS, Verma T, Dutta B. Prevalence of deleterious oral habits among 3-to 5-year-old preschool children in Bhubaneswar, Odisha, India. International journal of clinical pediatric dentistry. 2018 may;11(3):210. \u003c/li\u003e\n\u003cli\u003eSchmid KM, Kugler R, Nalabothu P, Bosch C, Verna C. The effect of pacifier sucking on orofacial structures: a systematic literature review. Progress in orthodontics. 2018 dec 1;19(1):8. \u003c/li\u003e\n\u003cli\u003eFeştilă D, Ghergie M, Muntean A, Matiz D, ŞERBǍNESCU A. Suckling and non-nutritive sucking habit: what should we know?. Clujul medical. 2014;87(1):11. \u003c/li\u003e\n\u003cli\u003eBhat SS, Rao HA, Hegde KS, Kumar BK. Characteristics of primary dentition occlusion in preschool children: An epidemiological study. International journal of clinical pediatric dentistry. 2012 May;5(2):93. \u003c/li\u003e\n\u003cli\u003eMontaldo L, Montaldo P, Cuccaro P, Caramico N, Minervini G. Effects of feeding on non‐nutritive sucking habits and implications on occlusion 89 in mixed dentition. International Journal of Paediatric Dentistry. 2011 Jan;21(1):68-73. \u003c/li\u003e\n\u003cli\u003eDoğramacı EJ, Rossi-Fedele G. Establishing the association between nonnutritive sucking behavior and malocclusions: A systematic review and meta-analysis. The Journal of the American Dental Association. 2016 Dec 1;147(12):926-34.\u003c/li\u003e\n\u003cli\u003ePaolantonio EG, Ludovici N, Saccomanno S, La Torre G, Grippaudo C. Association between oral habits, mouth breathing and malocclusion in Italian preschoolers. European journal of paediatric dentistry. 2019;2019(20/3):204-8. \u003c/li\u003e\n\u003cli\u003eMistry P, Moles DR, O\u0026apos;Neill J, Noar J. The occlusal effects of digit sucking habits amongst school children in Northamptonshire (UK). Journal of Orthodontics. 2010 Jun;37(2):87-92.\u003c/li\u003e\n\u003cli\u003eLuzzi V, Guaragna M, Ierardo G, Saccucci M, Consoli G, Vestri AR, Polimeni A. Malocclusions and non-nutritive sucking habits: a preliminary study. Progress in orthodontics. 2011 Nov 1;12(2):114-8. \u003c/li\u003e\n\u003cli\u003eLing HT, Sum FH, Zhang L, Yeung CP, Li KY, Wong HM, Yang Y. The association between nutritive, non-nutritive sucking habits and primary dental occlusion. BMC oral health. 2018 Dec;18(1):1-0.\u003c/li\u003e\n\u003c/ol\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"nonnutritive sucking habits, breastfeeding, thumb sucking, malocclusion, feeding practices","lastPublishedDoi":"10.21203/rs.3.rs-3546363/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3546363/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Nutritive sucking and non-nutritive sucking (NNS) may affect the craniofacial development, differently.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim and objectives\u003c/strong\u003e: We investigated associations between non-nutritive sucking habits (NNSH), developing malocclusion and various feeding practices in 3-6-year-old children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e: A sample of 350 children of 3-6-year-old from various preschools was selected for this case-control study (94 with NNSH and 256 without NNSH). NNSH (outcome) and feeding practices and developing malocclusions (exposures) were assessed using a structured study tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The prevalence of NNSH in 3-6- year-old children was 26.8%. The odds [95% (CI)] of boys compared to girls having NNSH were 0.66 (0.4121 to 1.706) [p=.0290]. The overall prevalence of developing malocclusion in 3-6-year-old children was 34.01% out of which open bite was most commonly reported with 12.57% followed by spacing 8.5%, increased overjet 6.8%, crowding 2.2%, posterior crossbite and rotation 1.4% and overbite 1.14%. Breastfeeding was found to be the most commonly used mode of feeding reported by 53.42% of mothers. It was found that the odds [95% (CI)] of subjects having NNSH were 0.66 [0.4694 to 0.9460] (p \u0026lt;.0001) who were not breastfed as compared to those who were breastfed. Amongst developing malocclusions, increased overjet with p =.0019, open bite with p =.0416 and spacing with p =.0243 were found to be associated with feeding practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: To conclude, the prevalence of NNSH and developing malocclusions (increased overjet, open bite and spacing) were 26.8% and 34.01% respectively. Breastfeeding played a protective role against developing NNSH.\u003c/p\u003e","manuscriptTitle":"Associations Between Non-nutritive Sucking Habits, Developing Malocclusion and Various Feeding Practices in 3-6-year-old Indian Urban Children: a Case- Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-08 13:44:30","doi":"10.21203/rs.3.rs-3546363/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"93eb9ce8-67fe-43f7-804d-f9745c3551b4","owner":[],"postedDate":"November 8th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-12-01T05:44:23+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-08 13:44:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3546363","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3546363","identity":"rs-3546363","version":["v1"]},"buildId":"cBFmMYwuxLRRLfASyISRj","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}