{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T00:21:50Z","timestamp":1767831710803,"version":"3.49.0"},"reference-count":68,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Project LAETA\u2013UIDB\/50022\/2020,","award":["UIDP\/50022\/2020"],"award-info":[{"award-number":["UIDP\/50022\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Specific dentofacial characteristics in wind instrumentalists should be taken in consideration when analyzing physiological and anatomical issues regarding the musician\u2019s embouchure, posture, and biomechanics during musical performance. Objectives: To compare tooth cephalometric characteristics between wind instrument players and string players (overjet, overbite, lower facial height, facial convexity, lower incisor inclination, and interincisal angle). Methods: In total, 48 wind instrumentalists (67%) and 24 string instrumentalists (33%). These musicians performed lateral tele-radiography and the correspondent linear and angular measurements of the dentofacial cephalometric analysis. Statistical comparison of wind and string instrumentalists was made by using an independent t-test. Results: Small variations on the analyzed parameters were found between the wind and string instrument groups. Based on the cephalometric analysis the variable interincisal angle was statistically significant (p &lt; 0.05), when comparing the wind and string instrument group. Conclusions: Knowledge of the overjet and overbite value permits a substantial analysis on the tooth position of wind instrument players, where both of these parameters are increased and greater than the norm value. The cephalometry was an added value on the interpretation of possible factors that lead to the position of the central incisors of wind instruments. Till some extent in this group of musicians the applied forces during the embouchure mechanism on the anterior teeth and the existing perioral forces promote an equilibrium on the vector of forces. This study findings demonstrate that when evaluating the two samples, wind and string instruments there are different dentofacial configurations, however the only statistically significant differences that were found are related to the interincisal angle (p &lt; 0.05).<\/jats:p>","DOI":"10.3390\/ijerph18084306","type":"journal-article","created":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T11:21:38Z","timestamp":1618831298000},"page":"4306","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Tooth Position in Wind Instrument Players: Dentofacial Cephalometric Analysis"],"prefix":"10.3390","volume":"18","author":[{"given":"Miguel Pais","family":"Clemente","sequence":"first","affiliation":[{"name":"Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, 4099-319 Porto, Portugal"},{"name":"INEGI, Laeta, Labiomep, 4200-465 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7226-0715","authenticated-orcid":false,"given":"Andr\u00e9","family":"Moreira","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Dent\u00e1ria, Universidade do Porto, 4200-135 Porto, Portugal"}]},{"given":"Catarina","family":"Morais","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Dent\u00e1ria, Universidade do Porto, 4200-135 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4917-6915","authenticated-orcid":false,"given":"Jos\u00e9 Manuel","family":"Amarante","sequence":"additional","affiliation":[{"name":"Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, 4099-319 Porto, Portugal"},{"name":"INEGI, Laeta, Labiomep, 4200-465 Porto, Portugal"}]},{"given":"Afonso Pinh\u00e3o","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina Dent\u00e1ria, Universidade do Porto, 4200-135 Porto, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4254-1879","authenticated-orcid":false,"given":"Joaquim","family":"Mendes","sequence":"additional","affiliation":[{"name":"INEGI, Laeta, Labiomep, 4200-465 Porto, Portugal"},{"name":"Faculdade de Engenharia, Universidade do Porto, 4200-465 Porto, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/S0003-9993(96)90093-3","article-title":"Musculoskeletal and neuromuscular conditions of instrumental musicians","volume":"77","author":"Bejjani","year":"1996","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1636","DOI":"10.1177\/0269215519852408","article-title":"Assessment of the effects of Kinesiotaping on musical motor performance in musicians suffering from focal hand dystonia: A pilot study","volume":"33","author":"Bravi","year":"2019","journal-title":"Clin. Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"706","DOI":"10.3389\/fpsyg.2014.00706","article-title":"Evidence-informed physical therapy management of performance-related musculoskeletal disorders in musicians","volume":"5","author":"Chan","year":"2014","journal-title":"Front. Psychol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.pmr.2020.08.001","article-title":"Performing Arts Medicine","volume":"31","author":"Currey","year":"2020","journal-title":"Phys. Med. Rehabil. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.arcmed.2005.09.015","article-title":"Reduced Pulmonary Function in Wind Instrument Players","volume":"37","author":"Deniz","year":"2006","journal-title":"Arch. Med. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4055\/cios.2013.5.3.155","article-title":"Musicians\u2019 Medicine: Musculoskeletal Problems in String Players","volume":"5","author":"Lee","year":"2013","journal-title":"Clin. Orthop. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00420-019-01467-8","article-title":"Musculoskeletal disorders and complaints in professional musicians: A systematic review of prevalence, risk factors, and clinical treatment effects","volume":"93","author":"Rotter","year":"2020","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.jmpt.2010.08.006","article-title":"Impairment of Postural Stabilization Systems in Musicians with Playing-Related Musculoskeletal Disorders","volume":"33","author":"Steinmetz","year":"2010","journal-title":"J. Manip. Physiol. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"251","DOI":"10.5664\/jcsm.1906","article-title":"Risk of Obstructive Sleep Apnea Lower in Double Reed Wind Musicians","volume":"8","author":"Ward","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"597","DOI":"10.3389\/fnhum.2015.00597","article-title":"Structural and functional plasticity specific to musical training with wind instruments","volume":"9","author":"Choi","year":"2015","journal-title":"Front. Hum. Neurosci."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ohlendorf, D., Maurer, C., Bolender, E., Kocis, V., Song, M., and Groneberg, D.A. (2018). Influence of ergonomic layout of musician chairs on posture and seat pressure in musicians of different playing levels. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0208758"},{"key":"ref_12","first-page":"1019","article-title":"Playing-related musculoskeletal disorders in musicians: A systematic review of incidence and prevalence","volume":"158","author":"Zaza","year":"1998","journal-title":"Can. Med. Assoc. J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/occmed\/kqy105","article-title":"Preventing musculoskeletal complaints in music students: A randomized controlled trial","volume":"68","author":"Baadjou","year":"2018","journal-title":"Occup. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1111\/joor.12886","article-title":"Temporomandibular disorders, pain in the neck and shoulder area, and headache among musicians","volume":"47","author":"Wiegers","year":"2020","journal-title":"J. Oral Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1111\/joor.12166","article-title":"Is there an association between temporomandibular disorders and playing a musical instrument? A review of literature","volume":"41","author":"Attallah","year":"2014","journal-title":"J. Oral Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/occmed\/kqt148","article-title":"Symptoms of craniomandibular dysfunction in professional orchestra musicians","volume":"64","author":"Steinmetz","year":"2013","journal-title":"Occup. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1093\/occmed\/kqx042","article-title":"Evidence-based review on temporomandibular disorders among musicians","volume":"67","author":"Ahlberg","year":"2017","journal-title":"Occup. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"69","DOI":"10.13075\/ijomeh.1896.00524","article-title":"Prevalence of temporomandibular disorders among junior high school students who play wind instruments","volume":"29","author":"Yasuda","year":"2015","journal-title":"Int. J. Occup. Med. Environ. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"143","DOI":"10.17219\/acem\/37038","article-title":"The Impact of the Long-Term Playing of Musical Instruments on the Stomatognathic System\u2014Review","volume":"23","author":"Kawala","year":"2014","journal-title":"Adv. Clin. Exp. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1177\/0003489420931553","article-title":"Facial Muscle Activity Patterns in Clarinet Players: A Key to Understanding Facial Muscle Physiology and Dysfunction in Musicians","volume":"129","author":"Franz","year":"2020","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/j.1365-2842.2007.01765.x","article-title":"Influence of playing wind instruments on activity of masticatory muscles","volume":"34","author":"Gotouda","year":"2007","journal-title":"J. Oral Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1016\/j.ajodo.2011.06.044","article-title":"Effects of playing a wind instrument on the occlusion","volume":"141","author":"Grammatopoulos","year":"2012","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s00056-018-0128-2","article-title":"Influence of tooth position on wind instrumentalists\u2019 performance and embouchure comfort: A systematic review","volume":"79","author":"Kuitert","year":"2018","journal-title":"J. Orofac. Orthop. Fortschr. Kieferorthopadie"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s00056-020-00223-9","article-title":"Does playing a wind instrument influence tooth position and facial morphology? Systematic review and meta-analysis","volume":"81","author":"Kuitert","year":"2020","journal-title":"J. Orofac. Orthop. Fortschr. Kieferorthopadie"},{"key":"ref_25","unstructured":"Bwire, R. (2013). Malocclusion Patterns among Selected Wind Instrument Player Groups in Nairobi. [Bachelor\u2019s Thesis, School of Dental Sciences, University of Nairobi]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/0002-9416(79)90023-X","article-title":"May Johnny or Janie play the clarinet? The Eastman Study: A report on the orthodontic evaluations of college-level and professional musicians who play brass and woodwind instruments","volume":"76","author":"Gualtieri","year":"1979","journal-title":"Am. J. Orthod."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"152","DOI":"10.4103\/npmj.npmj_71_19","article-title":"The effects of playing wind musical instruments on the occlusal characteristics in a Northern Nigerian Population","volume":"26","author":"Adeyemi","year":"2019","journal-title":"Niger. Postgrad. Med. J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1093\/oxfordjournals.ejo.a035981","article-title":"Dentofacial morphology in children playing musical wind instruments: A longitudinal study","volume":"11","author":"Odenrick","year":"1989","journal-title":"Eur. J. Orthod."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1093\/ejo\/9.3.216","article-title":"Natural lip function in wind instrument players","volume":"9","author":"Fuhrimann","year":"1987","journal-title":"Eur. J. Orthod."},{"key":"ref_30","first-page":"223","article-title":"Little influence on tooth position from playing a wind instrument","volume":"60","author":"Rindisbacher","year":"1990","journal-title":"Angle Orthod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2334\/josnusd1959.20.23","article-title":"A morphological study on the effect of wind instruments on the dento-oral region\u2014With reference to the growing young people","volume":"20","author":"Shimada","year":"1978","journal-title":"J. Nihon Univ. Sch. Dent."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"107","DOI":"10.2174\/1874210601913010107","article-title":"Wind Instrumentalist Embouchure and the Applied Forces on the Perioral Structures","volume":"13","author":"Moreira","year":"2019","journal-title":"Open Dent. J."},{"key":"ref_33","first-page":"316","article-title":"Variation in posture quality across musical instruments and its impact during performances","volume":"24","author":"Vidal","year":"2017","journal-title":"Int. J. Occup. Saf. Ergon."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jbmt.2009.02.004","article-title":"Performing arts medicine--instrumentalist musicians, Part II\u2014Examination","volume":"14","author":"Dommerholt","year":"2010","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jbmt.2009.02.005","article-title":"Performing arts medicine\u2014Instrumentalist musicians: Part III\u2014Case histories","volume":"14","author":"Dommerholt","year":"2010","journal-title":"J. Bodyw. Mov. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1007\/s00420-020-01517-6","article-title":"Infrared thermography of the cr\u00e2nio-cervico-mandibular complex in wind and string instrumentalists","volume":"93","author":"Clemente","year":"2020","journal-title":"Int. Arch. Occup. Environ. Health"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"411","DOI":"10.2174\/1874210601610010411","article-title":"Relationship between Wind Instrument Playing Habits and Symptoms of Temporomandibular Disorders in Non-Professional Musicians","volume":"10","author":"Nishiyama","year":"2016","journal-title":"Open Dent. J."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1500","DOI":"10.3349\/ymj.2016.57.6.1500","article-title":"Clinical Signs and Subjective Symptoms of Temporomandibular Disorders in Instrumentalists","volume":"57","author":"Jang","year":"2016","journal-title":"Yonsei Med. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.ajodo.2016.10.026","article-title":"Longitudinal cephalometric growth of untreated subjects with Class II Division 2 malocclusion","volume":"151","author":"Barbosa","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12880-020-00455-6","article-title":"Craniofacial morphology of wind and string instrument players: A cephalometric study","volume":"20","author":"Clemente","year":"2020","journal-title":"BMC Med. Imaging"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ajodo.2019.03.006","article-title":"Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite","volume":"156","author":"Uzuner","year":"2019","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_42","first-page":"111","article-title":"Cephalometric characteristics of Class II division 1 and Class II division 2 malocclusions: A comparative study in children","volume":"67","author":"Pancherz","year":"1997","journal-title":"Angle Orthod."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.ajodo.2011.04.015","article-title":"Longitudinal growth changes in subjects with deepbite","volume":"140","author":"Baccetti","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1179\/bjo.12.3.158","article-title":"A cephalometric comparison between Angle Class II, division 2 malocclusion and normal occlusion in adults","volume":"12","year":"1985","journal-title":"Br. J. Orthod."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/0096-6347(46)90205-0","article-title":"The relationship between ramus height, dental height, and overbite","volume":"32","author":"Wylie","year":"1946","journal-title":"Am. J. Orthod. Oral Surg."},{"key":"ref_46","first-page":"123","article-title":"Craniofacial characteristics in children with Angle Class II div. 2 malocclusion combined with extreme deep bite","volume":"64","author":"Karlsen","year":"1994","journal-title":"Angle Orthod."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/0002-9416(74)90255-3","article-title":"Overbite depth indicator with particular reference to anterior open-bite","volume":"65","author":"Kim","year":"1974","journal-title":"Am. J. Orthod."},{"key":"ref_48","first-page":"53","article-title":"An investigation of the vertical overbite during the eruption of the permanent dentition","volume":"31","author":"Fleming","year":"1961","journal-title":"Angle Orthod."},{"key":"ref_49","first-page":"3","article-title":"Tooth movements associated with deep overbite correction in Class II division 1 malocclusions","volume":"27","author":"Samuelson","year":"1989","journal-title":"Int. J. Orthod."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jobcr.2019.06.010","article-title":"A new classification of wind instruments: Orofacial considerations","volume":"9","author":"Clemente","year":"2019","journal-title":"J. Oral Biol. Craniofac. Res."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1002\/cre2.214","article-title":"Integrating piezoresistive sensors on the embouchure analysis of the lower lip in single reed instrumentalists: Implementation of the lip pressure appliance (LPA)","volume":"5","author":"Mendes","year":"2019","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_52","first-page":"221","article-title":"Assessment of the impact of tongue size in patients with bimaxillary protrusion","volume":"11","author":"Adesina","year":"2013","journal-title":"Int. Orthod."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3991\/ijoe.v15i13.10961","article-title":"The Functional Interdependence of Wind Instrumentalists\u2019 Embouchure and Their Craniofacial Features","volume":"15","author":"Amarante","year":"2019","journal-title":"Int. J. Online Biomed. Eng."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.ajodo.2012.04.020","article-title":"Deep overbite malocclusion: Analysis of the underlying components","volume":"142","author":"Fayed","year":"2012","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1093\/ejo\/cjm130","article-title":"Overjet as a predictor of sagittal skeletal relationships","volume":"30","author":"Zupancic","year":"2008","journal-title":"Eur. J. Orthod."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1093\/ejo\/25.3.325","article-title":"The effects of overjet on dentoalveolar compensation","volume":"25","author":"Ceylan","year":"2003","journal-title":"Eur. J. Orthod."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"221","DOI":"10.5005\/jp-journals-10005-1761","article-title":"Cephalometric Assessment of Dentoskeletal Characteristics in Children with Digit-sucking Habit","volume":"13","author":"Singh","year":"2020","journal-title":"Int. J. Clin. Pediatr. Dent."},{"key":"ref_58","first-page":"1","article-title":"Breaking the Thumb Sucking Habit: When Compliance Is Essential","volume":"2016","author":"Tanaka","year":"2016","journal-title":"Case Rep. Dent."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1","DOI":"10.21091\/mppa.2018.1002","article-title":"Prevalence of Orofacial Changes in Wind Instrumentalists: A Cross-Sectional Pilot Study in Brazil","volume":"33","author":"Balestra","year":"2018","journal-title":"Med. Probl. Perform. Artist."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/S1808-8694(15)30608-X","article-title":"Electrical activity of the anterior temporal and masseter muscles in mouth and nasal breathing children","volume":"74","author":"Ferla","year":"2008","journal-title":"Braz. J. Otorhinolaryngol."},{"key":"ref_61","first-page":"204","article-title":"Association between oral habits, mouth breathing and malocclusion in Italian preschoolers","volume":"20","author":"Paolantonio","year":"2019","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_62","unstructured":"Proffit, W.R., Fields, H.W., and Sarver, D.M. (2007). Contemporary Orthodontics, Mosby Elsevier."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1067\/mod.2002.121445","article-title":"Duration of nutritive and nonnutritive sucking behaviors and their effects on the dental arches in the primary dentition","volume":"121","author":"Warren","year":"2002","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_64","first-page":"301","article-title":"Non-nutritive sucking habits and their effects on the occlusion in the deciduous dentition in children","volume":"17","year":"2016","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/0002-9416(65)90252-6","article-title":"Measurement of perioral pressures during playing of musical wind instruments","volume":"51","author":"Engelman","year":"1965","journal-title":"Am. J. Orthod."},{"key":"ref_66","first-page":"e555","article-title":"Prevalence of sleep-related breathing disorders in children with malocclusion","volume":"12","year":"2020","journal-title":"J. Clin. Exp. Dent."},{"key":"ref_67","first-page":"209","article-title":"Atypical deglutition: Diagnosis and interceptive treatment. A clinical study","volume":"13","author":"Costacurta","year":"2012","journal-title":"Eur. J. Paediatr. Dent."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1016\/0002-9416(68)90218-2","article-title":"Forum on the tonsil and adenoid problem in orthodontics Respiratory obstruction syndrome","volume":"54","author":"Ricketts","year":"1968","journal-title":"Am. J. Orthod."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/8\/4306\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:49:36Z","timestamp":1760161776000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/8\/4306"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,19]]},"references-count":68,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["ijerph18084306"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18084306","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,19]]}}}