Reasons for development malocclusion, methods early diagnosis and prevention dental anomalies in children.

Many parents, bringing their child to us for an appointment and hearing that their son or daughter has bite problems, often ask questions: “Why do teeth grow incorrectly at such a young age?” Why are there not enough spaces for teeth? Why don’t the teeth close together?...” There is no definite answer to these questions, because... The causes of a particular dental anomaly can be several factors. And, sometimes, one factor can have an impact and lead to a number of troubles, which only an orthodontist can notice.
The dental system is a unique and very complex mechanism. Any disturbance in the functioning of the dental system and, in particular, incorrect location teeth can lead to dysfunction of other organs and systems of the body. Gastritis, cholecystitis and obesity, liver and pancreas diseases, skin and endocrine diseases- here is an incomplete list of problems caused by anomalies of dental development.

Malocclusions can be caused by disturbances in the growth and location of the jaw bones, incorrect position of the teeth and the nature of their closure, the shape of the alveolar arches, as well as disturbances in the functions of breathing, sucking, swallowing, chewing and speech.

Dental anomalies do not arise suddenly; they form, starting with subtle symptoms (smoothed nasolabial folds, downturned corners of the mouth, etc.), and as the child grows, they take on the appearance of a formed anomaly, requiring many years of labor-intensive and expensive treatment. Timely diagnosis early forms anomalies allows you to correct the violation even in the mixed dentition and ensure the normal development of the child’s dental system. That is why the role of early diagnosis and prevention of dental anomalies is extremely important.

Dentomaxillofacial anomalies can be hereditary And acquired:

Hereditary predisposition.

This includes the number and size of teeth, the size of the jaws and other bones of the skull. This determines the similarity between the child and the parents. For example, a gap between the teeth (diastema), anomalies in the size and attachment of the frenulum of the tongue, the absence of tooth buds (edentia), supernumerary teeth, the size of the tongue, or a malformation of the dental system such as a cleft palate can be inherited.

Reasons for the development of non-hereditary (acquired) anomalies:

1.Disturbance of the course of pregnancy and the health status of the mother. It can be viral diseases; various gynecological pathology; fall or injury during 2-3 months of pregnancy; taking antibiotics, salicylates, sulfonamides; malnutrition during pregnancy or unbalanced diet; parental alcohol abuse and smoking; stressful situations in the mother in the first trimester; occupational hazards(working with varnishes, paints, chemicals).

2. Diseases of the child.

Congenital disorders of adrenal function, thyroid gland, parathyroid glands, pituitary gland. At timely treatment This pathology can normalize the development of the dental system.
-Dysplastic processes. They are characterized by the absence of tooth buds or the presence of supernumerary teeth.
-Prematurity.
-Rickets. In this case, there is a lag in the growth of the jaws, a delay in the eruption of teeth and a violation of their mineralization.
-Diseases of the respiratory system. Muscular dystonia (impaired muscle tone)
-Anomalies in the development of the frenulum of the lips and tongue.
-Dental diseases and maxillofacial area. Unfortunately, parents often believe that since the teeth are temporary, they are not worth treating. This erroneous opinion. Chronic periodontitis of a temporary tooth can lead to disruption of the shape or structure of the crown or even to the death of the permanent tooth germ. When a temporary tooth is removed prematurely, adjacent teeth become displaced. Which leads to a lack of space for teething babies permanent teeth. Trauma to a temporary tooth, accompanied by its implantation, can lead to incorrect position, retention or deformation of the permanent tooth.

3. Incorrect feeding.

With natural feeding, the baby has to make an effort to get milk. At the same time, multiple promotion lower jaw stimulates its growth. Artificial feeding from the nipple can disrupt the sucking process. If the hole in the nipple is too large, then the baby does not suck as much as swallows food. And excessive pressure from the bottle on the lower jaw can lead to its deformation. Permanent teeth are larger in size than temporary teeth. In children aged 4 years and older, gaps should appear between primary teeth. This indicates that the jaws are growing and preparing for the appearance of permanent teeth. Not eating enough coarse, hard foods can lead to crowded teeth. Insufficient chewing load can also lead to the fact that primary teeth are not worn down enough, and this leads to uneven distribution of the chewing load and, as a consequence, to improper growth jaws.

4. Bad habits.

Most common bad habits sucking. For example, sucking lower lip And thumb leads to lengthening of the upper dentition, and biting and sucking upper lip promotes lengthening of the lower dentition. Depending on which teeth the child places his finger between, non-closing of the teeth and displacement of the lower jaw are formed. The habit of biting a pencil, nails, or pen leads to the rotation of the front teeth and the appearance of a diastema. Placing the tip of the tongue between the teeth can result in the teeth of the upper and lower jaws not touching in this place. Preservation infantile type swallowing (when, during swallowing, the child separates the teeth and the tip of the tongue rests on the lips) in children over 3 years of age can lead to disruption of the closure of the front teeth of the upper and lower jaws and excessive tilting of the upper front teeth forward. The development of dental anomalies can also be caused by such bad habits as: chewing on one side, after eliminating the causes that caused it, impaired articulation (movements) of the tongue; mouth breathing in the absence pathological changes in the nasopharynx; incorrect position a child while sleeping (in one position with hands under the cheek), in front of the TV, while preparing homework at a table that is inappropriate for height.

Prevention of dental anomalies and deformations.

1.In case of risk of development hereditary diseases consult geneticists.
2.Prevention of maternal diseases during pregnancy, good nutrition, exception alcoholic drinks and quitting smoking.
3. Observation of the child by a neonatologist and then by a pediatrician for the purpose of prevention and early treatment of diseases endocrine system, respiratory organs, rickets.
4.If there is a risk of artificial feeding, monitor the size of the hole in the nipple and the position of the bottle during feeding. Include hard foods in your child's diet. Grind the crowns of temporary teeth if they are insufficiently abraded.
5. Observation at the dentist. First time at the age of 1 year. In the future, it is necessary to show the child to the dentist 2-4 times a year. If caries and its complications are detected, restoration of the crowns of destroyed temporary teeth. If the tooth cannot be treated, it is removed and a temporary prosthesis is made. If deleted permanent teeth V mature age, then to prevent tooth displacement, rational prosthetics or installation of implants is necessary.
6. Elimination of existing bad habits, classes with a speech therapist.
7. Consultation with an orthodontist starting from 5 years of age.

What to do so that the child’s bite (closing of the jaws) is correct and does not manifest itself as facial disorders, even deformities, so that the child’s face is beautiful? Often such disorders in the formation of the jaws are visible only to a specialist, a dentist, and only when they are noticeably manifested are they seen by those around them and by the child himself, as far as he can understand it.

We see an ugly face due to the excessive development of the lower jaw, it is clearly pushed forward (the face of an old person) or it is underdeveloped and sinks back, so the upper jaw appears larger, looks like a beak (a bird's face). There may also be underdevelopment of the upper jaw, then the teeth of the lower jaw, protruding forward, overlap the upper one, like in a bulldog. We often see a child with constant open mouth: he breathes it. We see jaws shifted to the right or left, one in relation to the other (skewed mouth). And these are only the most common violations or anomalies.

What about incorrect pronunciation of sounds (burring speech)? And not for a baby who can’t do everything yet, but for a schoolchild. Here the psyche is already suffering, peers are laughing at me. Often the parents of such children confidently justify this as a hereditary predisposition, sometimes and are proud of it. That’s how it was with her grandfather, with her, with her mother, and with her child. That's how special we are.

This, of course, is a psychologically difficult case, justified by the ignorance (ignorance) of the parents and the lack of their upbringing. But most often the cause of “burr” is a short frenulum of the tongue. This is a muscle cord that is visible when the tongue is raised. When this cord (frenulum) is short, the tongue has little mobility (it is held by the frenulum) and some sounds cannot be made, for example “R”. And in this case, everything is solved simply: the short frenulum of the tongue is trimmed (undercut) by a surgeon-dentist, it acquires the necessary mobility, the child can easily eliminate speech defects on his own or with the help of a speech therapist.

But incorrect pronunciation is the smallest thing that can be disrupted (more later) when viewed at an early age, in a newborn. Besides such bright ones, but unpleasant manifestations, dentofacial anomalies (DFA) include a violation of the number of teeth that have erupted: there are more or less of them, a violation of the shape, size, location and changes in the timing of eruption. Why all these violations? There is more than one reason!

It is customary to highlight internal factors risk. This is a hereditary condition, a disorder intrauterine development, children's diseases early age, violating mineral metabolism, endocrine diseases. True, the consequences of these disorders are often more severe pathologies, but also those that were mentioned at the beginning and external risk factors.

Here it is necessary to draw the attention of parents, first of all, to the method of feeding a newborn, both natural and artificial. A child is born with an underdeveloped lower jaw (this is normal); it looks sunken back. Nature provided her with the opportunity to develop further immediately after birth by putting pressure on her while suckling at her mother’s breast; this is hard work and it is necessary. The tongue, the muscles located under the tongue (the muscles of the floor of the mouth), and the muscles of the lips actively work here. Any working organ grows and develops. By the time of complementary feeding, 6-8 months, the lower jaw is sufficiently developed.

If a child was born with a short frenulum of the tongue, it hurts him to suck and he quits (but there are other reasons for this refusal). Therefore, before switching to artificial feeding, check with your dentist to see if a short frenulum is the cause. If so, then a quick solution to this problem will return the child to natural feeding and there will be no trouble, the jaw will develop in time. In the case when the child is still fed with the help of a nipple, it is important to provide him with the necessary load so that food does not flow out of it, but is sucked out with some effort. Then the development of the jaw will be complete. That is, do not make large holes in the nipple.

In addition, the development of dental anomalies is influenced by the baby’s bad habits: prolonged sucking of a pacifier, finger, tongue, cheeks, incorrect posture, head position during sleep (thrown back or raised high), placing a fist under the cheek. These disturbances help form a bite in which the mouth is open or crooked. When a child tries to constantly keep his mouth open, you need to understand: this is just a habit or the nose is unhealthy and it is difficult to breathe.

You can check this at home without a doctor: invite your child to put some water in his mouth and do something, for example, drawing. If he immediately swallows and opens his mouth, take him to an ENT doctor (his nose is unhealthy, he’s not breathing), if he sits and draws with his mouth closed, then there’s nothing wrong with his nose, it’s just a habit of keeping his mouth open. Get rid of it, otherwise in both cases an elongated, elongated face with an open mouth is formed, which gives it a stupid look, and is simply ugly.

At 3-5 years old, please ask parents to pay attention to speech. By the age of 5, it should be full, and if there are any problems, remember about a short frenulum of the tongue or lips. This can all be fixed. ABOUT normal growth jaws at the age of 6-7 years is indicated by the appearance of gaps between the teeth (they have become more rare), they do not change in size, but the jaws have grown and the gaps have naturally increased. And this is good and correct. But if the teeth are close to each other, and if they have not yet begun to change, then a calcium metabolism disorder is obvious. This is by no means indifferent and is very important for the development of the skeleton as a whole.

Ancient games with children are also useful (“The magpie-crow was cooking porridge ...”), since rotating the finger on the palm massages and thereby develops the muscles of the hand and the child’s speech. Tongue training also helps its development: when he “clicks” with it, depicting “how he does horse while walking. The clopping of hooves, playing the pipe, the harmonica - this develops the muscles of the tongue, and therefore speech. Love your child, when working with him, put a certain meaning into everything. Simply put, do everything with love and intelligence!

Chapter 13. BASICS OF PREVENTION OF DENTAL ANOMALIES. ERRORS AND COMPLICATIONS IN ORTHODONTIC PRACTICE

Chapter 13. BASICS OF PREVENTION OF DENTAL ANOMALIES. ERRORS AND COMPLICATIONS IN ORTHODONTIC PRACTICE

13.1. Features of the prevention of dental anomalies

Dental anomalies are one of the significant factors in the development of caries and periodontal diseases. Therefore, prevention of HFA should be considered as component comprehensive prevention dental diseases. However, it has a number of features.

1. Possibilities for preventing CFA are limited to certain age limits. According to domestic scientists, it is effective in pre-school (up to 3 years), preschool (3 to 7 years) and early school (up to 10 years) age. After 10 years, the effectiveness of preventive measures decreases significantly.

This is explained by the fact that the growth of the jaws in the anterior area (most vulnerable to the formation various anomalies) does not occur at this age, but Negative influence etiological

Chinese factors are minimal. The most important is the pre-school period, which is characterized intensive growth and the development of the dental system, as well as the formation of its main functions - swallowing, chewing, speech. At this age, the maximum effect on the child’s body is unfavorable factors, which can disrupt the normal formation of the dental system. However, high compensatory capabilities child's body at this age, one can count on normalization of growth and development of the dental system, subject to timely elimination of risk factors.

2. Considering the multifactorial nature of PCA, their prevention should be carried out in close collaboration between the orthodontist and other specialists - otolaryngologist, pediatrician (neonatologist), ophthalmologist, speech therapist, endocrinologist, etc.

3. Unlike caries and periodontal diseases, in the prevention of which population and group (collective) methods play a large role, in the prevention of CFA the main thing is individual method. The principle of an individual approach is that in each specific case, the orthodontist determines the scope and content of preventive measures, taking into account the patient’s age and the presence of existing risk factors.

4. In the prevention of HCA exclusively important role plays an important role in improving the medical literacy of parents, pediatricians, preschool workers and teachers primary classes. In our opinion, the main thing actor in working with children is a pediatrician. It is he who should take the initiative in explaining to parents such problems as the correct choice of pacifiers and mode of use, timely identification of bad sucking habits, education of nasal breathing skills, control of the eruption of primary teeth, development of dental care skills, ways to intensify the chewing function, etc. .

Practical experience shows that relatively small labor costs due to the time allocated for sanitary and educational work with parents and staff serving children in nurseries prevent much more labor-intensive and less successful work to eliminate persistent abnormalities of the dental system in preschool children ( Razumeeva G. A. et al., 1987).

The same point of view is shared by T. F. Vinogradova et al. (1987), who believe that timely diagnosis symptoms, causes and risk factors in the occurrence of malocclusions during a period when neither the child nor his parents yet know or assume their existence is very important, because it provides grounds for eliminating these symptoms and risk factors without resorting to

Scheme 2. Main directions of prevention of dentoalveolar anomalies

to complex orthodontic treatment methods. This approach is extremely important in our time, since not all parents have the opportunity to allocate large sums of money from the family budget to correct anomalies with braces.

In organizing the prevention of CFA, it is necessary to be able to clearly define the list of preventive measures in relation to a specific age and taking into account existing risk factors. The main areas of prevention are presented in Diagram 2.

13.2. Medical errors. Complications in orthodontic practice

According to I. A. Kassirsky (1970), errors are inevitable and sad costs of medical practice. The tragedy of medical errors is that they carry the risk of complications that are dangerous both to the success of treatment and to the health of the patient. Therefore, one of the main tasks of a doctor of any specialty is to eliminate the conditions and causes that contribute to the occurrence of errors.

In orthodontic practice medical errors can be allowed at all stages of patient management, including the retention period.

Depending on the cause that caused them, we divide complications into the following groups:

1. Complications associated with the professional diagnostic and treatment activities of a doctor and caused by:

Diagnostic errors (incomplete examination, erroneous diagnosis, incorrect interpretation of research results, etc.);

Errors in treatment planning (lack of oral sanitation, incorrect determination of indications for tooth extraction, inclusion of unrealistic or difficult-to-fulfill tasks in the treatment plan, incorrect choice of device design, lack of complexity, etc.);

Errors in the implementation of the treatment plan (incorrect installation of braces, forced movement of teeth by applying great forces, excessive increase in bite height, non-compliance with the sequence of treatment stages, violation of the rules and timing of activation, unreasonable removal of teeth, etc.);

Incorrect management of the retention period (erroneous choice of design of the retention apparatus, non-compliance with the duration of the retention period, lack of measures to achieve multiple fissure-tubercle contacts, lack of radiological monitoring of treatment results, etc.);

Errors of a technical nature (defects in the manufacture of equipment, the use of low-quality and uncertified materials, etc.).

2. Complications caused by the patient’s inadequate attitude to treatment:

Failure to comply with the rules of oral hygiene and device care;

Failure to comply with the rules for using the device and careless handling of it;

Violation of deadlines for attending appointments and non-compliance with doctor’s recommendations;

Unreasonable termination of treatment without the knowledge of the doctor.

3. Complications caused by individual characteristics body:

The impossibility of complete adaptation to the device due to the imperfection of adaptation mechanisms;

Poor patient adaptability;

Tendency to allergic reactions for plastic and other materials.

Errors that are not directly related to the occurrence of complications deserve special attention, but dangerous loss of confidence in the doctor and the emergence conflict situations. These errors relate to documentation, in particular medical card dental patient. Most frequent mistakes of a similar nature are:

Lack of record of the patient being referred for an X-ray or other examination;

Lack of description of the results of X-ray and other studies;

Lack of record of the patient’s refusal to conduct additional examination;

Abbreviations of special terms, words and phrases;

Lack of diagnosis;

Blank dental formula;

The presence of corrections and entries made retroactively.

Propaedeutic orthodontics: tutorial/ Yu. L. Obraztsov, S. N. Larionov. - 2007. - 160 p. : ill.

Under prevention of dental anomalies imply a set of health measures to prevent and eliminate the causes pathological factors, causing and development of anomalies. Prevention of dental anomalies is an integral part of the overall comprehensive prevention of dental diseases.

A. I. Betelman in prevention and early treatment There are four age periods for deformations of the masticatory system:

• 1) intrauterine;
• 2) the first year of life - lactation;
• 3) from one year to the end of primary occlusion;
• 4) period of mixed dentition.

D. A. Kalvelis, Kh. A. Kalamkarov distinguished general and dental (local) prevention of dentoalveolar anomalies. A.I. Rybakov created a comprehensive system of prevention, and G.N. Pakhomov identified primary prevention from the complex system of prevention.

To perform the main tasks of prevention, F. Ya. Khoroshilkina identified ten age periods of the formation of the masticatory system, taking into account its morphological, physiological and functional changes. At the same time, complexes of preventive measures have been developed for each period, and responsible persons for their implementation have been identified.

IN preventive work by organization optimal mode life (work, study, food, rest) The administration of enterprises, children's and medical institutions is involved in ensuring medical examination (examination rooms, equipment, etc.).

Targeted clinical examination to prevent anomalies is carried out by obstetricians-gynecologists, pediatricians, dentists of all profiles with the active participation of otorhinolaryngologists, orthopedists, endocrinologists, speech therapists, etc.

Basic preventive actions by periods of formation of the chewing system: provision normal conditions labor and life of the expectant mother, medical examination of the pregnant woman in antenatal clinic, good nutrition, hygiene and sanitation of the oral cavity of a pregnant woman. After the birth of a child, it is necessary to provide rational, nutritious nutrition for mother and child, proper hygiene care, correct mode feeding and sleeping, staying on fresh air, rational feeding, and, if necessary, proper artificial feeding, dissection of the shortened frenulum of the tongue. IN lactation period(with the appearance of the first teeth) and up to the age of three, in addition to previously carried out measures, they eliminate bad habits using wrist and elbow bandages, conduct psychotherapy, therapeutic exercises, normalize lip closure, nasal breathing, posture. They also monitor the correct order of eruption of baby teeth, activate chewing (add to the diet solid food), teaching correct articulation. If necessary, a vestibular plate or a sling-shaped bandage with extraoral traction is used to delay the growth of one of the alveolar processes or jaw. Children identified during routine examinations with dentoalveolar anomalies, impaired breathing through the nose, and poor posture are referred for consultation and treatment to specialists. For cleft palate, multiple congenital adentia, and loss of teeth, prosthetics are performed plate prostheses, non-removable preventive devices are used.

During the period of primary occlusion, it is necessary to maintain oral hygiene and timely sanitation.

During the period of mixed dentition, in addition to the listed measures, the sequence of eruption of permanent teeth is monitored, the tubercles of milk teeth are ground off, or teeth are removed according to indications. Macrodentia, mesial shift of the lateral teeth and resulting malocclusions are identified, the crowns of permanent teeth are exposed during their retention, prosthetics are used in case of early loss of milk teeth, the crowns of destroyed permanent teeth are restored, and routine sanitation of the oral cavity is carried out.

During the period of permanent dentition, during routine examinations, diseases of the mucous membranes of the oral cavity and periodontium are detected, and patients are referred for treatment to periodontal offices. They splint the dentition for periodontitis and periodontal disease, eliminate parafunctions, habitual displacement of the lower jaw, and abnormal position individual teeth and their groups with subsequent rational prosthetics.

In the prevention of dental anomalies, planned sanitation of the oral cavity of children and adolescents plays an important role. preschool institutions, schools, secondary and higher educational institutions, as well as active sanitary educational work among the population.

Timely and proper prevention promotes self-elimination of individual anomalies of the masticatory system in childhood without the use of more complex orthodontic measures.

Normal development masticatory apparatus during the neonatal period can be disrupted under the influence of local and general unfavorable factors that can act both during intrauterine development and after the birth of the child. These include, in particular, malnutrition and illness of the mother, birth trauma, improper artificial feeding, incorrect position of the child during sleep, rickets, early childhood diseases, pathology of the ENT organs, bad habits, etc. The effect of these factors can be isolated , and combined.

Prevention of the occurrence of dental anomalies in the age aspect

The problem of preventing developmental anomalies of the eumaxillofacial region is mainly common problem social prevention, including problems of nutrition, housing, improvement of cities and towns, transformation of nature, health improvement external environment and creating the most favorable conditions labor.

Unfavorable conditions for the development of the body in the uterine and post-natal period cause the occurrence of anomalies of the dental system. Of the legislative measures, maternity leave before and after childbirth, exemption of pregnant women from severe physical work and from working the night shift.

Specialized prevention must be carried out according to the periods of growth and development of the child’s body, since during each of them problems may arise. unfavourable conditions for the development of the dentofacial region.

The period of formation and existence of temporary occlusion

Main preventive value during the period of formation of temporary occlusion, the organization of rational nutrition is necessary. Food should contain the optimal amount of proteins, fats, carbohydrates, minerals and trace elements. Special attention should be given to the prevention of rickets. The occurrence of rickets is mainly a consequence poor nutrition child.

Great value in proper development jaws impart to the act of poking. To grasp the nipple and suck, the lower jaw moves forward, which creates the necessary functional irritation that promotes the growth and development of the jaws, chewing and oral muscles and the muscles of the tongue. If incorrect artificial feeding

The growth of the jaws is functionally determined and occurs in three directions: in the sagittal (in the lactation period, from 2.5 to 6 years and at 9-10 years), in width (due to oppositional layering), in height (due to alveolar process due to the process of teething). In addition, two more factors influence the growth of the mandible: enchondral ossification of the articular process, which is the center of longitudinal growth of the mandible, and interstitial growth. The basal part of the lower jaw, which supports the masticatory muscles and some neck muscles, grows much more slowly than the alveolar part.

The growth of the jaw branch in length is intensive from 3 to 4 and from 9 to 11 years and ends by 15-17 years. The growth of the branch is accompanied by a change in the angle between it and the body: from 140° in a newborn to 105-110° in an adult. In this regard, the location of the mandibular foramen changes. From 9 months up to 1.5 years it is 5 mm below the level of the alveolar part of the jaw. In children 3.5-4 years old, the hole is located 1-2 mm below the chewing surface of the teeth. From 6 to 9 years old - 6 mm higher than the chewing surface of the teeth, and at 12 years old and later - 10 mm higher. Knowledge of the topography of the mandibular foramen is important when performing mandibular anesthesia in children.

The upper jaw of a newborn is wide and short. The maxillary sinus is just emerging and is located medially in relation to the alveolar ridge, increasing especially intensively in the first 5 years of a child’s life. The tooth germs are located high under the orbit and are separated from it by a thin bone plate. The development, change in shape and structure of the upper jaw is closely related to the development of the teeth and its sinus. The sockets of the teeth gradually deepen and take a vertical direction, which promotes the growth of the alveolar process and the basal part of the jaw. Maxillary sinus becomes deeper and wider. Its development is facilitated by the eruption of all temporary teeth and permanent molars. During the lactation period, the growth of the upper jaw in length occurs more intensively than in width, which ensures a change in its shape from wide and short to narrow and long. This growth occurs through perichondral ossification in the area of ​​the median palatal suture and the sutures connecting upper jaw with other bones of the skull.

During the period of permanent dentition they grow more intensively distal sections both jaws. The jaws of a newborn cannot be considered “toothless”, since in the thickness of each of them there are the rudiments of teeth. During this follicular, or intramaxillary period of development of tooth germs, the height of the bite is provided only by the gingival ridges, therefore, there is a disproportion between the middle and lower parts of the face.