A child's overbite

An incorrect bite in a child means that the position of the dental row of one of his jaws relative to the teeth of the opposite jaw deviates from the anatomical norm, which leads to a violation of occlusion - the closing of the teeth when the jaws come together.

It is necessary to distinguish between the curvature of the dental row (dental arch) due to the incorrect position of individual teeth and malocclusion in a child.

[ 1 ]

Causes of malocclusion in children

The primary causes of malocclusion in children are genetic: children inherit this anatomical feature from close relatives with malocclusion associated with certain anomalies of the bone structures of the dental system.

Congenital causes of malocclusion in children, that is, the structural features of the jaws of newborns, do not appear immediately. During infancy, the jaws consist mainly of the alveolar process, and their basal parts are still underdeveloped. At the same time, the bones of the upper jaw grow faster than the lower, and the lower jaw has two halves that fuse at about one year of age.

The process of jaw changes affects not only the bones, but also the muscles, in particular, the chewing, temporal and pterygoid muscles. In a newborn, the most developed muscle, which ensures the forward movement of the jaws during sucking, is the chewing muscle. But the lateral and medial pterygoid muscles, as well as the temporal muscles, by the force of which the lower jaw moves up and down and back and forth, are still poorly developed and begin to "catch up" with the chewing muscle after the appearance of the first teeth.

That is, malocclusion in a one-year-old child appears gradually - as the jaw bones grow and the maxillofacial muscles develop. Orthodontists unanimously believe that the factors that contribute to the development of malocclusion are: artificial feeding of infants (it is easier to suck formula from a bottle than from the breast, so the development of the maxillofacial muscles is disrupted); too long use of a pacifier (up to one and a half to two years, when teeth are erupting); the habit of holding and sucking fingers or toys in the mouth; after the eruption of milk molars, the absence of food in the child's diet that he needs to chew.

From the age of five to seven months - when the lower and upper central incisors of infants erupt - temporary (milk) dental rows begin to form. A 4-year-old child should have at least 20 teeth. Moreover, if the teeth are too small or the upper jaw is significantly more developed, the gaps between the teeth (tremas) can exceed 1 mm, and this is a signal of possible problems with the bite in the future.

At the age of three to four years, the bone structures of the child's dental system are actively forming; from the age of five, the roots of baby teeth gradually begin to dissolve and the alveolar processes of the jaws begin to grow. And from the age of six, permanent teeth begin to erupt to replace the baby teeth. In orthodontics, children's dental arches are usually called removable up to the age of 13-14. During this period, the size of the jaws also changes due to the increased growth of their basal part. Experts assure that any deviations during this long and complex process can result in malocclusion. For example, twisting of individual teeth relative to their axis or their eruption in the wrong place - above the dental arch. Therefore, almost the main cause of occlusion disorders in children is considered to be the abnormal shape of the dental arches.

Often, the cause of malocclusion in children is associated with chronic obstruction of nasal breathing due to various ENT diseases (rhinitis, sinusitis, polypous rhinosinusitis, enlarged adenoids) or congenital pathologies of the nasopharynx and nasal septum. In such cases, the child is forced to breathe through the mouth, which remains open during sleep. First of all, this leads to the formation of malocclusion due to the constant tension of the muscles that should lower the lower jaw and the extension of the upper jaw forward. Secondly, there is a change in facial proportions with the formation of the so-called adenoid type.

And pediatric endocrinology specialists note the possible involvement of functional disorders of the thyroid and parathyroid glands in the development of bite defects. In particular, a decrease in the level of thyroxine and thyrocalcitonin entails a delay in the development of bones, including maxillofacial bones, and also slows down the process of eruption of baby teeth in children. With underdevelopment or disease of the parathyroid glands, the production of parathyroid hormone, which regulates the calcium content in the body, is disrupted. Disruption of calcium metabolism leads to demineralization of bone tissue, and this is a direct threat of jaw deformations in childhood.

Symptoms of malocclusion in children

Anatomically or physiologically determined malocclusion almost always has visual signs, and the specific symptoms of malocclusion in children depend on the type of dentoalveolar anomaly.

Malocclusion in children, as in adults, can be distal: maxillary and alveolar prognathism. A characteristic symptom of maxillary prognathism is that the strongly developed upper jaw protrudes forward, the upper dental arch is widened, and the upper teeth overlap the crowns of the lower dental row by more than a third. With alveolar distal occlusion, not the entire upper jaw protrudes forward, but only that part of the bone (alveolar process) where the tooth sockets are located. When children smile, not only the upper teeth but also a significant part of the alveolar region of the gum may be visible.

If the child has a mesial bite, then the more massive lower jaw is pushed forward, due to which the lower row of teeth (wider than the upper dental arch) overlaps the upper one. With this type of bite, the child may have difficulty biting and have certain problems with articulation.

A deep bite (vertical incisor malocclusion) can be seen and heard. With this type of bite, the upper jaw may be too narrow, and the middle of the lower jaw (including the chin) is too flat, so the lower part of the face is usually shorter than it should be. Due to the deep overlap of the teeth of the central part of the lower jaw by the upper incisors, incorrect pronunciation of sibilants is noted. In addition, children may have difficulty biting off a whole piece.

When several chewing teeth (molars) of the upper and lower jaws do not close and there is a significant interocclusal gap in the form of a crack between their surfaces, then an open bite is diagnosed. In children with an open bite, the mouth is almost always open, there are difficulties when biting (since there is no contact between the front teeth), the lower labial fold is practically absent. It is also difficult for the child to hold the tongue in the required position, so significant speech defects are inevitable.

Also, malocclusion in children can be cross-bite, the key symptoms of which are: one-sided underdevelopment of the lower jaw and difficulty in its movements to the right and left, children often bite the soft tissues of the cheeks, and with a significant displacement of the lower jaw, the symmetry of the face is disrupted.

Diagnosis of malocclusion in children

The determination of the presence of pathology of the dental system and the diagnosis of malocclusion in children is the function of orthodontists, who, in addition to examining the child, conduct an examination of his oral cavity.

The doctor will necessarily analyze the proportions of the child's face, including determining the width of the dental arches, the size of the occlusal plane angle, and other parameters. If nasal breathing is impaired, the orthodontist recommends consulting with ENT doctors and treating diseases of the nose, paranasal sinuses, and adenoids so that the child can breathe normally.

To get a complete picture of the number of teeth and their location in the dental row, the relative position of the jaws, the characteristics of muscle tissue and the state of the temporomandibular joint, a panoramic X-ray of the dental system (orthopantomogram) and computer 3D cephalometry are performed.

Such a comprehensive examination allows the doctor to establish the relationship between the width of the upper and lower dental, alveolar and basal arches. In accordance with the anatomical norm, the dental arch of the upper jaw should be wider than the alveolar, and the alveolar arch should be wider than the basal arch (on the lower jaw, it is the other way around). Having determined the individual characteristics of the sizes of all jaw elements, a diagnostic model of the jaws is created, according to which the specialist will be able to absolutely accurately establish the type of deviation of the maxillofacial structures and the type of occlusion disorder in a child.

[ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ], [ 7 ]

Treatment of malocclusion in children

Orthodontic treatment of malocclusion in children is complex and quite lengthy. The choice of treatment method is determined by the type of malocclusion and, in essence, this is the correction of malocclusion in children.

Most articles that popularize the possibilities of orthodontic correction of bite defects note that in young children, teeth occlusion anomalies can be corrected "with the least effort and maximum results", since before the complete replacement of baby teeth, the child's dental system is actively developing. And this is correct. However, the minimization of efforts to treat malocclusion is greatly exaggerated, as is its maximum result.

Most often, attention is focused on the use of removable pre-orthodontic trainers, plates, caps or aligners. The use of soft and hard trainers (they are put on for an hour and a half during the day and at night) helps to wean children aged two to five years from bad habits (sucking the tongue and pushing it between the teeth or biting the lower lip), promotes the correct eruption of teeth and the alignment of crookedly growing front incisors.

Aligners or dental caps - individually made polycarbonate removable dental pads - are used for unevenly growing teeth in children aged 6-12 - when they are crowded or excessively tilted forward or towards the oral cavity. The caps are supposed to be worn for 2-3 hours a day.

Treatment of malocclusion in children with braces - special non-removable structures fixed to the front or inner surface of dental crowns - is used after a complete change of all baby teeth. Their main function is to align the teeth and dental arches due to constant pressure on the alveolar arches of the jaw of special arches, which are fixed in the grooves of the braces. The duration of wearing braces is determined individually and can be 12-36 months, depending on the degree of curvature of the dental arch. After removing the braces, so-called retention plates are installed - to fix the changed position of the teeth. In this case, the retention stage can last for several years.

Orthodontists note that correcting malocclusion in children using braces is possible with alveolar prognathism, but they do not help with other types of occlusion disorders.

What methods are used in clinical pediatric orthodontics to correct distal, mesial, deep, open and crossbite?

Correction of distal bite in children

In addition to correcting the position of the teeth and the shape of the dental arches with the help of braces, in case of distal bite, the development of the apical (top) points of the alveolar and basal arches of the upper jaw is restrained, as well as the growth of the lower jaw is activated.

For this purpose, during the period of loss of baby teeth and during the eruption of permanent teeth, pediatric orthodontists can use: the functional Frankel device (types I and II); the Angle, Ainsworth, Herbst arch devices; the Andresen activator. Removable plates are placed on the dental arch, and a vestibular retraction arch is used to reduce the space. And outside, to give the right direction for the growth of the maxillofacial bones, a facial arch is installed at home (for the time when the child is sleeping, doing homework, or watching TV).

[ 8 ], [ 9 ], [ 10 ], [ 11 ], [ 12 ], [ 13 ]

Correction of mesial bite in children

To really reduce the severity of the mesial bite, it is necessary to correct the forward protrusion of the lower jaw, or to promote the development of the upper jaw. For this purpose, the following are used: a removable Andresen-Goipl device; a Frankel activator (type III); Wunderer or Delaire devices; a Klammt activator; a single-jaw stationary Angle arch; Adams, Nord or Schwartz plates; an orthodontic cap with a sling-like bandage for the chin.

To slow the growth of the lower jaw bone structures, children aged 13-14 years may be recommended to undergo dental surgery to remove the rudiments of the lower eighth teeth (wisdom teeth), which begin to form between the ages of 6-14 years.

[ 14 ], [ 15 ], [ 16 ]

Correction of deep bite in children

To correct a deep alveolar malocclusion in children with a primary (temporary) bite, a lot of effort will be required, because, as the practice of orthodontists shows, after the eruption of permanent teeth, this type of malocclusion is formed again.

Treatment of deep bite involves preschool children performing special exercises aimed at developing the medial and lateral pterygoid muscles, which move the lower jaw forward. To coordinate pressure on the teeth of the lower row, bite plates, the Andresen plate apparatus, the Klammt activator, and other non-removable orthodontic devices of various designs can be installed.

In the process of correcting malocclusion in children with deep overlap of the lower jaw incisors, it should be borne in mind that fixed devices that help correct the dental arch in the central part of the alveolar process of the upper jaw are best suited.

[ 17 ], [ 18 ], [ 19 ]

Correction of open bite in children

With this type of occlusion disorder, a narrowing of the upper jaw is often observed, therefore, with baby teeth, as well as at the beginning of the eruption of permanent teeth, removable expansion plates of various modifications, equipped with a spring or screw, are used in orthodontics.

Also used are structures to increase the anterior parts of the upper alveolar arch, to reduce the lateral parts of the alveolar zones - depending on the nature of the anatomical deviations.

After 12 years - in cases of large divergence of incisors and canines - it is possible to use intermaxillary traction techniques using Angle orthodontic devices with additional traction or by using plastic caps on the front teeth of both jaws.

[ 20 ], [ 21 ], [ 22 ]

Correction of crossbite in children

The main task of orthodontists in correcting this anomaly of dental occlusion is to establish the most correct arrangement of teeth in a row and the position of the child's lower jaw. As soon as the malocclusion in a child with baby teeth is diagnosed as crossbite, it is necessary to carry out the so-called separation of the dental arches - by installing crowns or caps on the molars, as well as plate devices with bite plates - on the lateral teeth.

In the treatment of a cross-type occlusion with a significant lateral displacement of the lower jaw, wearing a chin sling may be necessary. And the expansion of the dental, alveolar and basal arches of the jaws is carried out using the same plate devices adjusted by screws and springs.

[ 23 ], [ 24 ], [ 25 ]

Prevention of malocclusion in children

Prevention of malocclusion in children consists of breastfeeding the baby, and if this is not possible, it is necessary that the hole in the nipple on the bottle with milk formula is small, and the nipple itself is located in the child's mouth at a right angle to the nasolabial plane and chin and does not press on the gums.

The pacifier should have a shape that best matches the anatomical structure of the infant's oral cavity, and it is best if the baby does without it during sleep. The unanimous opinion of dentists: giving a pacifier to a child over one and a half years of age is unacceptable. Do not allow the child to suck fingers and toys, or bite his lips.

To avoid the development of an open bite in children, you should put your baby to sleep so that his head is slightly higher than his body.

Remember: children should sleep with their mouths closed and breathe through their nose! If nasal breathing is difficult (in the absence of a cold or acute respiratory viral infection with a runny nose) - immediately consult an otolaryngologist.

You cannot constantly feed a child with 8-10 teeth food that has been previously ground to a homogeneous state: it is useful for the baby to bite and chew.

In addition, prevention of malocclusion in children after 2.5-3 years can be carried out with the help of myogymnastics - a specially developed system of exercises for the development of the maxillofacial muscles. The method of its implementation is explained to parents by orthodontists, since each type of malocclusion has its own exercises.

Prognosis of malocclusion in children

The prognosis for malocclusion in children - in the absence of adequate measures to correct it - is associated with the most common problems accompanying defects of the dental system.

Among them, it is necessary to note the difficulties of biting and chewing food - especially with mesial, open and crossbite. And insufficient grinding of food in the mouth can give rise to diseases of the gastrointestinal tract.

If children have a distal bite, the back molars will be overloaded, which leads to their premature abrasion and damage to the enamel. Any malocclusion in a child has a negative effect on the functioning of the temporomandibular joints. With significant dental anomalies, pinched nerves may be observed, accompanied by severe pain.

Malocclusion in a child is one of the main causes of articulation defects and lifelong speech impairment.