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Does the position of a bottle during infant feeding influence the jaw's postural position? A Case Study

Bree Zhang1, R Rosivack2, Hua Zhu*1

1 Columbia University College of Dental Medicine, 1,2 Rutgers School of Dental Medicine, Department of Pediatric Dentistry and Department of Restorative Dentistry

Anterior crossbite, a condition in which maxillary anterior teeth are positioned lingually in relationship to mandibular anterior teeth, occurs in about 7.8% of the population [12].

  • Currently, early treatment (tongue blade therapy and a variety of fixed or removable appliances) is performed on children of at least 3 years of age [1,3].

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Previous studies in primary dentition have shown that malocclusions, including anterior crossbite, are associated more with bottle-feeding than breastfeeding. Most studies, however, cannot link bottle-feeding with any specific increase in malocclusion. No studies have related the cause of malocclusions to bottle or nipple angle [4,5].

BACKGROUND

The purpose of this study was to investigate whether the position of a bottle during infant feeding can influence the jaw's postural position.

  • Rationale: Because infants grow rapidly and their bones are pliable, a small force (such as consistent bottle-feeding angle), if repeated frequently, may impact the jaw and teeth position and affect facial development.

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OBJECTIVES

Case History

  • Asian American 10-month-old boy
  • Clinical examination: incisors presented in anterior crossbite (confirmed by parents as habitual position)
  • Family History: parents presented with a Class I occlusion with no history or orthodontic treatment. Denied family history of anterior crossbite.
  • Medical history: unremarkable.

MATERIALS & METHODS

CONCLUSIONS

RESULTS

DISCUSSION

A Second Case

  • 10-month-old with no family history of anterior crossbite. 2 months of mixed feeding followed exclusively by bottle-feeding from a traditional bottle in position B.
  • After the bottle was switched to position C, the anterior crossbite was corrected in 4 months.
  • As no good quality pretreatment photographs of this patient are available, this has not been presented as an independent case.

The cause and resolution of observed anterior crossbite may have been unrelated to bottle-feeding.

  • A negative control would be needed to rule out possibility of a naturally occurring self-correction.
  • A larger sample size of infants would be required to validate the proposed recommendations.
  • A controlled clinical trial would be needed to confirm cause–effect relationships while creating a greater understanding of the etiology of anterior crossbite.

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LIMITATIONS + FUTURE DIRECTIONS

The authors wish to thank Dr. Anil Ardeshna, Dr. Christopher V. Hughes, and Dr. Rob Whiteley for their help with the manuscript, and Rutgers School of Dental Medicine for support of this research.

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ACKNOWLEDGEMENTS

1. Vadiakas G, Viazis AD. Anterior crossbite correction in the early deciduous dentition Am J Orthod Dentofacial Orthop. 1992;102:160–2

2. Ngan P, Hu AM, Fields HW Jr. Treatment of class III problems begins with differential diagnosis of anterior crossbites Pediatr Dent. 1997;19:386–95

3. Borrie F, Bearn D. Early correction of anterior crossbites: A systematic review J Orthod. 2011;38:175–84

4. Hermont AP, Martins CC, Zina LG, Auad S M, Paiva SM, Pordeus IA, et al Breastfeeding, bottle feeding practices and malocclusion in the primary dentition: A systematic review of cohort studies Int J Environ Res Public Health. 2015;12:3133–51

5. Narbutytė I, Narbutytė A, Linkevičienė L. Relationship between breastfeeding, bottle-feeding and development of malocclusion Stomatologija. 2013;15:67–72

6. Inoue N, Sakashita R, Kamegai T. Reduction of masseter muscle activity in bottle-fed babies Early Hum Dev. 1995;42:185–93

7. Gomes CF, Trezza EM, Murade EC, Padovani CR. Surface electromyography of facial muscles during natural and artificial feeding of infants J Pediatr (Rio J) 2006.;82:103–9

8. Nowak AJ, Smith WL, Erenberg A. Imaging evaluation of artificial nipples during bottle feeding Arch Pediatr Adolesc Med. 1994;148:40–2

9. Bennett R How to Bottle Feed your Baby. 2013 Available from: http://www.kidspot.com.au/baby/feeding/bottle-feeding/how-to-bottle-feed-your-baby/news-story/219a2ad1a9675d3ccacb8de9dda5275f;http://www.webcitation.org/6sW3Opmq0. [Last accessed on 2017 Aug 06]

10. Fredregill S, Fredregill R. Bottle feeding your baby The Everything Breastfeeding Book. 20022nd ed Avon, Mass Adams Media Corp.:152–4

11. Corrêa Cde C, Bueno Mda R, Lauris JR, Berretin-Felix G. Interference of conventional and orthodontic nipples in system stomatognatic: Systematic review Codas. 2016;28:182

12 De Ridder L, Aleksieva A, Willems G, Declerck D, Cadenas de Llano-Pérula M. Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review. Int J Environ Res Public Health. 2022;19(12):7446. Published 2022 Jun 17. doi:10.3390/ijerph19127446

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REFERENCES

Figure 3: Clinical pictures before and after changing the bottle angle ([a] anterior crossbite of a 10-month-old infant before treatment. [b] anterior crossbite corrected 5 months after treatment. [c] anterior teeth 2 years after treatment. [d] facial profile 2 years after treatment)

Bottle Feeding History

  • 2 months of mixed feeding followed exclusively by 8 months of bottle-feeding.
  • The child was bottle-fed with a traditional bottle
  • It was determined that the child’s parents had fed the child mainly in position B, attempting to reduce air intake when the patient was feeding.

Recommendation

  • It was hypothesized that a contributing factor to anterior crossbite may have been the position of the bottle's nipple during feeding
  • A recommendation was made to shift the position of the bottle downward to position C without changing the baby's head position while feeding. Parents followed recommendation.

Figure 1: current bottles on the market

Figure 2: The three bottle-feeding positions:

[a] position A: bottle held perpendicular to the mouth.

[b] position B: bottle tilted at an upward angle.

[c] position C: bottle tilted at a downward angle)

At the patient’s next visit (5 months later):

  • Anterior teeth no longer presented in crossbite, and there was 1.5 mm of overbite and 1.5 mm of overjet present [Figure 3b].
  • Positioned in a Class I occlusion.
  • Dentition: patient's eight maxillary and mandibular incisors, four primary canines, and four first primary molars had erupted.

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The parents were then instructed to switch the feeding position of the bottle to that shown in Figure 2a.

  • Two years later, at age 3, the patient presented again with all teeth in a Class I occlusion (overbite of 2 mm and an overjet of 1.5 mm [Figure 3c and d]).
  • All primary teeth had erupted.

Differential pressures on the teeth and jaw influence the development of the maxilla–mandible relationship in the sagittal plane. This paper hypothesizes that the bottle feeding perpendicular position A is likely puts balanced pressure on the maxilla and mandible.

  • Position B may contribute to anterior crossbite by retroclining the maxillary incisors and proclining the mandibular incisors or encouraging a forward posturing of the mandible through the pressure of the nipple [Figure 4b].
  • Position C will have the opposite effect [Figure 4c].
  • Since positions B and C have opposing effects, they may be used to correct already existing malocclusions through counterbalancing forces (i.e., B can correct excessive anterior overjet; C can correct anterior crossbite).

This case report describes the successful correction of anterior crossbite in an infant, without the need for an appliance. Currently, no standardized bottle-feeding angle recommendations have been found among local hospitals, pediatric offices, maternity care books, printed literature, or Internet searches. [9,10]

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If the hypothesis is confirmed:

  • Educational programs can be established to inform and encourage parents to use proper positioning during bottle-feeding
  • Practitioners can provide early correction of developing occlusion, allowing patients to avoid or reduce complicated, lengthy, and painful orthodontic procedures.
  • Proper bottle positioning may improve a child's facial esthetics, thereby contributing to a healthy psychological, social, and emotional development.

Figure 4: The three bottle-feeding positions:

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[a] position A: bottle held perpendicular to the mouth.

[b] position B: bottle tilted at an upward angle.

[c] position C: bottle tilted at a downward angle)

  1. Retrospect Record Review
  2. 8-11 month-olds screened
  3. Group 1: infants with no anterior crossbite
  4. Group 2: infants with anterior crossbite
  5. Collect age, gender, race, and family history of anterior crossbite
  6. Collect feeding history: if bottle fed ->
    • Images of the bottles used for feeding
    • whether child holds bottle themselves
    • percentage that parents bottle-feed their children at 0-2 months, 3-4 months, 5-6 months, 7-8 months and 9-10 months

2. Case Control

  • Bottle-fed infants with anterior crossbite (who do not hold their own bottle) split into Group 1 & 2
    • Group 2a: parents instructed to change bottle-feeding angle downward to position C
    • Group 2b: no bottle feeding instruction
  • Group 1: Infants without anterior crossbite will serve as negative control
  • Clinical evaluation at 3, 6, and 18 months.
    • 0-3 months: parents will be asked to send monthly pictures of teeth position and videos of feeding to monitor progress

Sample size 150 achieves 80% power to detect an effect size (W) of 0.2290 using a 1 df Chi-Square Test with a significance level of 0.05000. If 35% of subjects are lost during the research, sample size of 280 will be safe. (140 anterior crossbite and 140 non-anterior crossbite controls). Sample size 50 achieves 81% power to detect effect size (W) of 0.4000 using a 1 degree of freedom Chi-Square Test with significance level of 0.05000.

Part 2 of Study (IRB Approved)