Influence of tonsillar grade on the dental arch measurements

• The higher the tonsillar grade, the lower the transversal dimension of the maxillary arch.
• Ratio of the depth of palatal vault to the maxillary interfirst molar width was correlated to grade.
• Grade 4 patients were more likely to develop a Class II than Grade 0 patients.
• Grades 3 and 4 patients were more likely to develop an open bite than grades 2 and 1 patients.
• Grade 4 was associated with a posterior crossbite with lateral deviation of the mandible.

IntroductionThe role of the palatine tonsils in the development of dental intra-arch and interarch abnormalities is often brought up in the literature, but it remains controversial. Data on the probable relationship between enlarged tonsils and the occurrence of orthodontic abnormalities are subjective. The purpose of this study was to seek an association between the space occupied by the palatine tonsils and the dental arch measurements.MethodsA cross-sectional study was performed on a group of children subdivided into 5 groups according to the standardized tonsillar hypertrophy grading scale. Dental arch measurements were recorded for each child. Data were analyzed with software. Comparisons of qualitative variables according to tonsillar grade were made using the chi-square test. The strength of the association between tonsillar grade and qualitative variables was evaluated with a phi coefficient (φ). The strength of the association between tonsillar grade and quantitative variables was assessed by the Spearman' rank correlation coefficient (rho). The significance threshold was set at P = 0.05.ResultsThe maxillary dental arch depth was significantly and positively correlated to grade. The maxillary intercanine, interpremolar, and intermolar widths were significantly and negatively correlated to grade. Grade 4 was strongly associated with molar Class II malocclusions, and posterior crossbite with functional lateral deviation of the mandible.ConclusionsEarly evaluation of the size of the palatine tonsils would help to prevent orthodontic abnormalities caused by upper airway obstruction. Thus, patients could be spared late, more aggressive treatments that are less efficient than treatments during childhood.