Impact of Oral Habits and Buccal Frenulum on Gingival Microcirculation in Children: Findings and Clinical Significance

Abstract

Background. Oral mucosal abnormalities such as abnormal lip frenulum, buccal frenulum, ankyloglossia are commonly observed in a routine dental practice. The close anatomical and functional relationship between the gingiva and the alveolar bone determines the significance of abnormal mucosal structures in the development of malocclusions and periodontal diseases. Oral habits are more prevalent in childhood; however, they can persist into adolescence and adulthood, potentially leading to dentofacial impairments and malocclusions. Therefore, there is a growing interest in understanding oral mucosal blood flow in the presence of oral habits and abnormal mucosal structures, as their combined effects may have a synergistic influence on the development of maxillomandibular anomalies. Aim. This study was aimed to investigate age-depended parameters of gingival microcirculation in children with buccal frenulum, oral habits, and maxillomandibular anomalies. Methods. This cross-sectional study involved 45 apparently healthy children and 180 children with oral habits, buccal frenulum, and maxillomandibular anomalies, divided into 3 age groups (ages 9 to 12, 12 to 15, and 15 to 17 years). Oral mucosal blood flow was assessed using a rheograph DX (Kharkiv, Ukraine) by measuring qualitative characteristics and quantitative parameters such as the vascular tone index (VTI), venous outflow index (VOI), peripheral resistance index (PRI), extensive blood flow index (EBFI), and rheographic index (RI). Statistical analysis included Spearman’s correlation, a Kruskal-Wallis H test, and a Dunn’s post-hoc test. Results. The study revealed a significantly higher VTI in all patient groups, increasing with age and reaching +80.54% in the oldest age group compared to the respective control group. This elevation was accompanied by a moderate correlation enhancing the PRI (+4.61% in 9-12-year-old group to +33.42% in 15-17-year-old group). Furthermore, the VOI exhibited a noteworthy and age-dependent increase; however, there was a notable reduction in the RI (-41.10% to -59.70%) and EBFI values (-35.54% and -37.70% versus -23.97% in the youngest age group). Conclusions. This study demonstrated a relationship between oral habits, buccal frenulum, and age-dependent disturbance of gingival microcirculation in children. The findings suggest that chronic traumatization due to oral habits and abnormal mucosal structures lead to increased vasoconstriction and impaired vessel elasticity. Early intervention and management of such category of patients are crucial for preserving optimal gingival microcirculation.