Incorrect bite in a child

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

It is necessary to distinguish the curvature of the dentition (dental arch) due to the incorrect position of the individual teeth and the wrong bite in the child.

[1]

The causes of malocclusion in children

The primary causes of malocclusion in children are genetically laid: the children are given this anatomical feature by inheritance - from close relatives with an incorrect closure of the dentition, associated with certain anomalies of the bone structures of the dentoalveolar system.

Congenital causes of malocclusion in children, that is, the features of the structure of the jaws of newborns do not immediately manifest. During the infancy the jaws consist mainly of the alveolar process, and their basal parts are still underdeveloped. In this case, the bones of the upper jaw grow faster than the lower one, and the lower jaw has two halves, which grow together approximately at the age of one year.

The process of changing the jaw affects not only the bones, but also the muscles, in particular, chewing, temporal and pterygium. The newborn has the most developed muscle, which ensures the jaws move forward when sucking, chewing. But the lateral and medial pterygoids, as well as the temporal muscles, whose force the lower jaw moves up and down and back and forth, are still poorly developed and begin to "catch up" the chewing muscle after the appearance of the first teeth.

That is, an incorrect bite in a one-year-old child is manifested gradually - as the jawbones grow and the maxillofacial musculature develops. Factors that contribute to the development of malocclusion, orthodontists unanimously believe: the artificial feeding of infants (sucking the mixture from the bottle is easier than the chest, so the development of the maxillofacial muscles is disrupted); too long use of a pacifier (up to a year and a half or two years, when there is a teething, the habit of holding in your mouth and sucking your fingers or toys, after the eruption of milk molars, the absence of food in the ration of the child that he needs to chew.

From the age of five to seven months, when the lower and upper central incisors erupt in the infants, temporary (dairy) dentition begins 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 much more developed, the spaces between the teeth (trema) can exceed 1 mm, and this is a signal about possible problems with bite in the future.

At the age of three or four years, active formation of bone structures of the dentoalveolar system of the child is underway, from five years the gradual dissolution of the roots of the milk teeth and the growth of the alveolar processes of the jaws begin. And with six years to replace the milk teeth begin to erupt permanent. In orthodontics, dental rows in children are usually called replaceable up to 13-14 years. In the same period, the size of the jaws also changes due to the increased growth of their basal part. Experts assure that any deviations in the course of this long and complicated process can lead to a wrong bite. For example, the torsion of individual teeth relative to its axis or eruption of them in the wrong place - above the dentition. Therefore, almost the main cause of violations of occlusion in children is the anomalous form of dental arches.

Often, the cause of malocclusion in children is associated with chronic nasal breathing difficulty syndrome with various ENT diseases (rhinitis, sinusitis, polypsic 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 and foremost, this leads to the formation of an incorrect bite due to the constant tension of the muscles, which must lower the lower jaw, and pulling the upper jaw forward. Secondly, there is a change in the proportions of the face with the formation of the so-called adenoid type.

And experts of pediatric endocrinology 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 thyrecalcitonin entails a delay in the development of bones, including maxillofacial, and also slows the process of eruption of infant teeth in children. In the underdevelopment or disease of parathyroid glands, the production of parathyroid hormone, which regulates the calcium content in the body, is disrupted. Violation of calcium metabolism leads to demineralization of bone tissue, and this is a direct threat of deformations of the jaws in childhood.

Symptoms of malocclusion in children

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

Incorrect bite in children, as in adults, can be distal: maxillary and alveolar prognathia. A characteristic symptom of maxillary prognathy is that the highly developed upper jaw is projected forward, the upper dental arch is widened, and the upper teeth cover the crowns of the lower dentition by more than a third. In the alveolar distal occlusion, not the whole upper jaw is protruded forward, but only that portion of the bone (alveolar process) where the teeth are located. With a smile, children can see not only the upper teeth, but also a significant part of the alveolar region of the gum.

If the child's bite is mesial, a more massive lower jaw is advanced forward, because of which the lower row of teeth (wider than the upper dental arch) comes to the top. With this type of bite, a child may encounter biting difficulties and have certain problems with articulation.

A deep bite (vertical incisive dissoclusion) can be seen and heard. With this bite, the upper jaw can be too narrow, and the middle of the lower jaw (along with the chin) is too flat, so the lower part of the face is usually shorter than it should be. Due to the deep overlapping of the teeth of the central part of the lower jaw, the upper incisors mark the incorrect pronunciation of the sibilants. In addition, it can be difficult for children to bite off a whole chunk.

When several chewing teeth (molars) of the upper and lower jaws do not close and there is a significant interocclusion clearance in the form of a gap between their surfaces, an open bite is diagnosed. In children with an open bite, the mouth is almost always open, there are difficulties in biting off (because there is no contact between the front teeth), there is practically no lower labial fold. It is also difficult for a child to keep his tongue in a necessary position, so significant speech defects are inevitable.

Also, an incorrect bite in children can be cross, the key symptoms of which are: unilateral development of the lower jaw and the difficulty of its movements to the right and left, children often bite soft cheek tissues, and with a significant displacement of the lower jaw, the symmetry of the face is disturbed.

Diagnosis of malocclusion in children

The statement of the presence of the pathology of the dentoalveolar system and the diagnosis of malocclusion in children is a function of orthodontists who, in addition to examining the child, examine the cavity of the mouth.

Without fail the doctor will analyze the proportions of the child's face, including determining the width of the dental arches, the angle of the occlusal plane and other parameters. If nasal breathing is disturbed, the orthodontist recommends consulting with ENT doctors and curing diseases of the nose, paranasal sinuses and adenoids so that the child can breathe normally.

For a full picture of the number of teeth and their location in the dentition, the relative location of the jaws, the features of the muscular tissues and the state of the temporomandibular joint, a panoramic x-ray of the dentoalveolar system (orthopantomogram) and computer 3D cephalometry is performed.

Such a comprehensive examination allows the doctor to establish a 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 - wider than the basal arch (on the lower jaw - all the way around). Having determined the individual characteristics of the dimensions of all the jaw elements, a diagnostic model of the jaws is created, according to which the specialist will be able to determine exactly the type of deflection of the maxillofacial structures and the type of impaired occlusion in the child.

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

Treatment of malocclusion in children

Orthodontic treatment of malocclusion in children is complex and long enough. The choice of treatment is determined by the type of malocclusion and, in fact, this correction of malocclusion in children.

Most articles that popularize the possibilities of orthodontic correction of bite defects, note that children of early age can fix abnormalities of teeth clamping "with the least effort and maximum results," since an active process of forming the dentoalveolar system of the child is going on before the complete change of milk teeth. And it is right. However, minimization of efforts to treat an incorrect bite is greatly exaggerated, however, as is its maximum result.

Most often, attention is focused on the use of removable preorthodontic trainers, plates, cap or elainers. The use of soft and hard trainers (they are worn for an hour and a half a day and for the night) helps to wean children of two to five years from bad habits (suck the tongue and push it between the teeth or bite the lower lip), help the correct teething and align the crooked front incisors.

Elainers or dental kapy - individually made of polycarbonate removable dental lining - used for unevenly growing teeth in children 6-12 years old - with their crowding or excessive tilt anterior or in the direction of the oral cavity. Caps should be worn for 2-3 hours a day.

Treatment of abnormal bite in children with braces - special non-removable structures fixed on the facial or internal surface of the dental crowns - is used after a complete change of all milk teeth. Their main function is to align teeth and dentition due to constant pressure on the alveolar arches of the jaws of special arcs that are fixed in the grooves of the brackets. The duration of wearing braces is determined individually and can be 12-36 months, depending on the degree of curvature of the dentition. After the braces are removed, the so-called retentional plates are installed - to fix the changed position of the teeth. In this retentive stage can last for several years.

Orthodontists note that correction of the malocclusion in children with the use of bracket systems is possible with alveolar prognathia, but with other types of occlusion they do not help.

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

Correction of distal occlusion in children

In addition to correcting the position of the teeth and the shape of the dentition with the help of braces, the distal occlusion restrains the development of the apical (apical) points of the alveolar and basal arches of the upper jaw, as well as the activation of the growth of the lower jaw.

To do this, during the period of baby teeth and during the eruption of permanent teeth, children's orthodontists can use: Frenkel's functional apparatus (types I and II); arc apparatus Engle, Ainsworth, Gerbst; activator of Andresen. On the denture set removable plates, to reduce the three - vestibular retraction arc. And outside - to give the right direction for the growth of the maxillofacial bones - at home (for the time when the child is asleep, busy doing homework or watching TV), a face arc is installed.

[8], [9], [10], [11], [12], [13], [14]

Correction of mesial occlusion in children

To really reduce the severity of mesial bite, you need to correct the advance of the lower jaw, or contribute to the development of the upper jaw. To this end, they use: the removable apparatus of Andresen-Gojpl; Frenkel activator (type III); apparatus Wunderer or Delar; Klammt activator; a single-jawed stationary Angle arc; the plates of Adams, Nord, or Schwartz; Orthodontic cap with a sling-like bandage for the chin.

To control the growth of the mandibular bone structures, children 13-14 years old may be recommended to perform a dental operation to remove the rudiments of the lower eighth teeth (wisdom teeth), the formation of which begins at the age of 6-14 years.

[15], [16], [17]

Correction of deep occlusion in children

To correct deep dental alveolar occlusion disorders in children with a dairy (temporary) bite, it takes a lot of effort, because, as practice of orthodontists testifies, after the eruption of permanent teeth this kind of wrong closure is formed again.

Treatment of deep bite involves the performance by children of preschool age of special exercises aimed at developing the medial and lateral pterygoids, which push the lower jaw forward. To co-ordinate the pressure on the teeth of the lower row, bite plates, Andresen's plate apparatus, Klammt activator, and other non-removable orthodontic apparatuses of various designs can be installed.

In the process of correcting a malocclusion in children with deep overlapping of the incisors of the lower jaw, it should be borne in mind that non-removable devices are best suited, which contribute to correction of the dental arch in the central part of the alveolar process of the upper jaw.

[18], [19], [20], [21], [22]

Correcting open bite in children

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

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

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

[23], [24], [25]

Correction of cross bite in children

The main task of orthodontists in correcting this anomaly of occlusion of teeth is to establish the most correct arrangement of teeth in the row and the position of the baby's lower jaw. As soon as an incorrect bite in a child with milk teeth is diagnosed as a cross, it is necessary to conduct the so-called uncoupling of the dentition - by placing the crowns or cap 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, you may need to wear a chin sling. And the expansion of dental, alveolar and basal arches of jaws is carried out with the help of the same adjustable screws and springs of plate devices.

[26], [27], [28], [29]

Prevention of malocclusion in children

Prevention of malocclusion in children is in breastfeeding the baby, and if it is impossible it is necessary that the hole in the nipple on the bottle with the milk mixture be small, and the nipple is in the child's mouth at right angles to the nasolabial plane and chin and does not press on the gums.

The dummy must have a shape that best fits the anatomical structure of the oral cavity of the infant, and it is best that the baby does without it during sleep. Unanimous opinion of dentists: giving a baby a pacifier at the age of one and a half years is unacceptable. Do not allow the baby to suck fingers and toys, and also to have a bite of the lips.

To avoid forming an open bite in children, you should put the baby to sleep so that his head was slightly above the 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 SARS with a runny nose) - immediately to a consultation with the otolaryngologist.

You can not constantly feed a child with 8-10 teeth, food, previously shredded to a homogeneous state: the baby is useful to bite and chew.

In addition, the prevention of malocclusion in children after 2.5-3 years can be carried out with the help of myogym - a specially developed system of exercises for the development of maxillofacial muscles. The technique of its carrying out is explained to parents by doctors-orthodontists, because for each type of violation of bite their exercises.

Prognosis of malocclusion in children

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

Among them, one should note the difficulty of biting and chewing food - especially with mesial, open and cross bite. A lack of grinding food in the mouth can cause diseases of the digestive tract.

If children have distal occlusion, rear molars will be overloaded, which leads to their premature erasure and enamel damage. Any wrong bite in a child adversely affects the functioning of the temporomandibular joints. With significant dentoalveolar anomalies, there may be a pinched nerves accompanied by severe pain.

An incorrect bite in a child is one of the main causes of defects in articulation and a lifelong violation of diction.