Effect of orofacial myofunctional therapy along with preformed appliances on patients with mixed dentition and lip incompetence.

BACKGROUND: Various preformed early orthodontic appliances for correcting oral habits and training orofacial muscles have emerged on the market. However, there are few reports on the effectiveness of these appliances for orofacial myofunctional training. METHODS: This retrospective study evaluated children with lip incompetence and mixed dentition treated at the Pediatric Dentistry Department of Shanghai Ninth People's Hospital from 2016 to 2018. A total of 109 children (54 males, 55 females; age range: 7-10 years, mean age: 8.2 years) were selected from an overall sample of 870 patients. During the first visit, all patients were instructed to perform active lip and tongue training at home daily and were divided into two groups according to the kind of appliances worn. The first group consisted of 56 subjects (30 females; 26 males), with a mean age of 8.1 years (SD 1.1 years), treated with preformed appliances. The second group consisted of 53 subjects (25 females; 28 males), with a mean age of 8.2 years (SD 1.0 years), treated with conventional early orthodontic appliances (arch expansion devices along with "2*4" local fixed appliances). For each subject in the two groups, initial (pretreatment, T1) and final (posttreatment, T2) intraoral and external photos, dental casts, lateral cephalograms, and orthopantograms were taken, and lip strength was measured. SNA, SNB, ANB, APDI, FMA, U1SN, and IMPA before and after treatment were measured by The Dolphin Imaging Cephalometric Analysis Software. The hyoid bone position was also recorded. Differences between groups were identified with an independent sample t-test (P < 0.05). RESULTS: In the first group, a statistically significant forward movement of the mandible was detected by an increase in SNB of - 1.06 degrees (P < 0.01) and an increase in APDI of - 2.23 degrees (P < 0.01). The increase in IMPA (- 3.21 degrees, P < 0.01) demonstrated a statistically significant protrusion of the lower incisors. Lip strength significantly increased (- 2.44, P < 0.01). The increase in HC3 (- 1 mm, P < 0.01) and HFH (- 2.95 mm, P < 0.01) implied a forward and downward movement of the hyoid bone. In the second group, a statistically significant forward movement of the mandible was also detected by an increase in APDI of -1.96 degrees (P < 0.01). Lip strength also significantly increased (- 1.24, P < 0.01). The increase in HFH (- 2.55 mm, P < 0.01) implied a downward movement of the hyoid bone. Compared with the treatment in the second group, orofacial myofunctional therapy combined with the preformed appliances led to a statistically significant lip strength increase (- 2.30, P < 0.05). Significant differences were observed in SNB and IMPA between the two groups (P < 0.05). CONCLUSIONS: Orofacial myofunctional therapy effectively improved patient lip strength and was a good option for mixed dentition patients with lip incompetence. Preformed appliances could enhance the orofacial myofunctional therapy effect and result in significant improvements in lip strength and forward movement of the mandible, which can optimize the jaw relationship.

Association between sugary drinks consumption and dental caries incidence among Taiwanese schoolchildren with mixed dentition.

OBJECTIVES: Dental caries is a multifactorial disease, and a sugary diet can generate an acidic plaque environment that advances its development. However, the specific effect of sugary drinks on the subsequent oral health of schoolchildren with mixed dentition is unclear. In this study, we investigated the association between the consumption of sugary drinks and 1 year incidence rate of caries in permanent teeth among Taiwanese schoolchildren with mixed dentition. METHODS: A longitudinal 1 year follow-up study was conducted among Taiwanese schoolchildren aged 8-9 years. A questionnaire collected information regarding the parents' oral health status and their children's demographic background, oral health-related behaviours and consumption habits of sugary drinks, including handmade drinks (specifically bubble tea and pearl milk tea) and carbonated drinks. Dental caries was recorded through standardized oral examinations. The number of dental services received was retrieved from the Taiwan National Health Insurance Research Database. Multivariate Cox proportional hazards models and zero-inflated negative binomial models were used to estimate the association between the consumption of sugary drinks and the incidence rate of caries in permanent teeth after 1 year. RESULTS: The study involved 494 children. During the 1 year follow-up period, 117 children developed new dental caries in their permanent teeth, yielding a caries incidence rate of 0.183 per person-year. After adjustments for confounding factors, children who preferred having sugar-rich beverages were associated with having a 4.3 times higher (95% confidence interval [CI] = 1.2-15.7) risk of developing caries than did those who preferred nonsugary drinks (P < .05). Additionally, children who often consumed handmade drinks were associated with having a 1.7 times higher (95% CI = 1.1-2.9) risk of developing caries than those who seldom consumed (P < .05). CONCLUSIONS: The findings suggest that the consumption of sugary drinks during the mixed dentition stage might be a major etiological factor for caries in permanent teeth. These findings could be valuable to paediatricians, dentists, nutritionists and policymakers.

La ortodoncia y la cirugía ortognática como aliadas en el tratamiento / Orthodontics and orthognathic surgery as treatment allied

¿Qué es la estética? Es más que un concepto frívolo. Tiene que ver con la armonía facial, la autoestima, la autoimagen, la percepción de belleza. Es un concepto que involucra al individuo en su totalidad, en su ser, que va más allá de frivolidad estética. Muchos pacientes que vienen a la consulta no expresan inicialmente su real demanda. Expresan problemas funcionales, pero su real preocupación, en la mayor parte de los casos, es estética. Pueden manifestar que no pueden comer bien, masticar un alimento o que no respiran bien o sesean, pero su motivación principal es estética y tiene que ver con su propia autoestima. Las funciones de respiración, deglución, fonación, masticación, oclusión deben estar entre los objetivos a conservarse o restituirse por parte del especialista, pero el tratamiento sería un fracaso si no atendemos la demanda, a veces no bien explicitada, por el paciente y que responde a su profunda necesidad real. Para la OMS, la salud puede definirse como el estado completo de bienestar físico, mental y social. Nuestro objetivo, como agentes de salud, será poder satisfacer la demanda explícita o encubierta con la mayor estética y la mayor funcionalidad (AU)

What is aesthetics? It is more than a frivolous concept. It has to do with facial harmony, self-esteem, self-image, the perception of beauty. It is a concept, which involves the individual as a whole, in his being, which goes beyond aesthetic frivolity. Many patients who come to the office do not initially express their real demand. They express functional problems, but their real concern, in most cases, is aesthetic. They may state that they cannot eat well, chew a food or that they do not breathe well or sedate, but their main motivation is aesthetic and has to do with their own self-esteem. The functions of breathing, swallowing, phonation, chewing, occlusion should be among the objectives to be retained or restored by the specialist, but the treatment would be a failure if we do not meet the demand sometimes not well explained by the patient and responding to their Deep real need. For WHO, health can be defined as the complete state of physical, mental and social well-being. Our goal, as health agents, will be to be able to meet the explicit or covert demand with the greatest aesthetics and functionality (AU)

Effect of orthodontic management and orofacial muscle training protocols on the correction of myofunctional and myoskeletal problems in developing dentition. A systematic review and meta-analysis.

The aim of this review was to evaluate available evidence on the effect of early orthodontic management and myofunctional treatment in the developing dentition children, on anterior open bite correction, as well as on normalization of patterns of mouth breathing, swallowing and tongue resting position and pressure. Electronic searches in MEDLINE, Cochrane and LILACS, without language restrictions were conducted. Additionally, unpublished literature was identified. Randomized controlled trials, or controlled clinical trials, comparing interventions applied to manage anterior open bite and other muscle functions such as breathing/swallowing pattern and tongue resting position and pressure, were considered. Quality assessment was based on the Cochrane Risk of Bias tool. Random effects meta-analyses were conducted to assess treatment effects. From the 265 initial search results, 15 articles were included in the review. Eight were randomized controlled trials (RCTs) and 7 were controlled clinical trials. Treatment outcomes comprised skeletal and dentoalveolar changes recorded cephalometrically, mouth posture and lip closure normalization, improvement of tongue resting position/pressure and modification of swallowing pattern. Quantitative synthesis was possible for only 2 of the included RCTs. There was no evidence to support bonded lingual spurs over banded fixed appliances for the correction of anterior open bite in mixed dentition children presenting nonnutritive oral habits at the onset of treatment (SMD: -0.03; 95%CI: -.81, 0.74; P = 0.94). Although early orthodontic management and myofunctional treatment in the deciduous and mixed dentition children appears to be a promising approach, the quality of the existing evidence is questionable.

An Alternative Method of Intermaxillary Fixation for Simple Pediatric Mandible Fractures.

PURPOSE: Mandibular fractures represent a substantial portion of facial fractures in the pediatric population. Pediatric mandibles differ from their adult counterparts in the presence of mixed dentition. Avoidance of injury to developing tooth follicles is critical. Simple mandibular fractures can be treated with intermaxillary fixation (IMF) using arch bars or bone screws. This report describes an alternative to these methods using silk sutures and an algorithm to assist in treating simple mandibular fractures in the pediatric population. PATIENTS AND METHODS: A retrospective chart review was performed and the records of 1 surgeon were examined. Pediatric patients who underwent treatment for a mandibular fracture in the operating room from 2011 to 2015 were identified using Common Procedural Terminology codes. Data collected included age, gender, type of fracture, type of treatment used, duration of fixation, and presence of complications. RESULTS: Five patients with a mean age of 6.8 years at presentation were identified. Fracture types were unilateral fractures of the condylar neck (n = 3), bilateral fractures of the condylar head (n = 1), and a unilateral fracture of the condylar head with an associated parasymphyseal fracture (n = 1). IMF was performed in 4 patients using silk sutures, and bone screw fixation was performed in the other patient. No post-treatment complications or malocclusion were reported. Average duration of IMF was 18.5 days. CONCLUSIONS: An algorithm is presented to assist in the treatment of pediatric mandibular fractures. Silk suture fixation is a viable and safe alternative to arch bars or bone screws for routine mandibular fractures.

Pain reduced by low-level laser therapy during use of orthodontic separators in early mixed dentition.

OBJECTIVE: The purpose of this work was to investigate whether low-level laser therapy (LLLT) applied at a defined distance from the gingiva has a pain-reducing effect in young patients undergoing orthodontic separation during the early mixed-dentition stage. MATERIALS AND METHODS: A total of 40 children in early mixed dentition (mean age 8.05 years) who required separation of molars were included. The study comprised a group of 20 patients whose treatment included laser application on the day of separation and a control group of 20 patients not receiving LLLT. All patients recorded their maximum pain intensities on the day of separation (day 1) and on the following 4 days. RESULTS: Compared to the control group, pain perception was significantly reduced (p < 0.05) in the LLLT group on day 1 and continued to be reduced on day 2. Equivalent pain levels were recorded in both groups on days 3-5. CONCLUSION: Given our findings of a pain-reducing effect in young patients undergoing orthodontic separation during the early mixed-dentition stage, LLLT is an interesting alternative option of providing analgesia even in very young patients.

Caries recurrence after treatment under general anaesthesia for early childhood caries: a retrospective cohort study.

AIM: To evaluate rates of caries relapse and explore factors affecting relapse rates after comprehensive dental treatment under general anaesthesia (GA). METHODS: A retrospective cohort study of children ≤6 years of age at the time of reference GA (RGA) who were in an anaesthetic low risk category [American Society of Anesthesiologists (ASA) classification 1 or 2], and had completed 36 months follow-up period was conducted. Patients' demographics and dental records were collected. Associations between relapse rate and different factors affecting relapse rates were evaluated. RESULTS: A total of 278 children with mean age of 47 ± 14 months were included. Over 8 % of children had more than one GA, 88 % attended their post-operative follow-up appointment and 45 % returned for all recall appointments over 3 years. During the 3-year follow-up, the relapse rate was 22 %. ASA-2 children and those with less than full primary dentition present at the RGA were more than twice as likely to experience caries relapse as compared to ASA-1 children (OR = 2.46, 95 % CI 1.33-4.56) and those with mixed dentition present at the RGA (OR = 2.74, 95 % CI 1.27-5.91). CONCLUSION: ASA-2 health status and having less than a full primary dentition were major predictors of caries relapse after dental treatment under GA.

Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) May Be an Alternative Preventive Therapy in Children with Cerebral Palsy.

PURPOSE: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on the buffering capacity of saliva and plaque pH in individuals with cerebral palsy (CP). MATERIALS AND METHODS: A total of 15 3- to 8-year-old subjects with CP living in a governmental institution were included in this study. Dental plaque pH and the buffering capacity of saliva were measured at the first visit (baseline) and accepted as control values. CPP-ACP complex (GC Tooth Mousse) was applied to the children twice a day. Measurements were repeated after the 1st, 2nd, 3rd, 4th, 6th and 8th weeks. RESULTS: Plaque indicator data show decreased acidogenicity in the 8-week period. Although there were no significant differences between the baseline and the 1st, 2nd and 3rd weeks' pH scores, a statistically significant difference was observed between the initial and 4th, 6th and 8th weeks' plaque pH scores. Saliva buffer scores were found to statistically significant increase between baseline and the 3rd, 4th, 6th and 8th weeks. CONCLUSION: Daily application of 10% w/v CPP-ACP paste is effectively changes saliva buffering capacity and plaque pH, thus promoting caries prevention in the primary and mixed dentition of CP children.

Long-term stability of anterior open bite correction in mixed dentition with a new treatment protocol.

BACKGROUND: The treatment of choice for skeletal open bite is orthognathic surgery combined with pre and post- surgicalorthodontics; however relapse can be observed and alternative solutions are sought to avoid surgery whenever possible. A case is reported showing an original treatment protocol in order to obtain aesthetic, functional and stable results. CASE REPORT: A 10.2 year old boy with anterior open bite was treated with a Hyrax type rapid maxillary expander on the maxilla (one month) and a lingual arch in the lower jaw; then, grinding of deciduous molars was performed, a lingual grid was positioned and a myofunctional treatment (exercises) was started. The subsequent treatment phase was achieved with a lip bumper and fixed straight wire appliances on both arches. After 24 months of active treatment, retainers were used to maintain the good results achieved, which were unchanged at the long term controls, 3 and 7 years after treatment.

Early treatment with the ALF functional appliance.

The aim of this study is to report five cases of children treated with an interceptive technique utilizing ALF (Advanced Light Force) functional orthodontic appliances in anterior and/or posterior cross bites in primary and early mixed dentition.

Atypical deglutition: diagnosis and interceptive treatment. A clinical study.

AIM: The aim of this study was to evaluate the early treatment of atypical deglutition, by analysing the efficacy of the eruptive guide appliance Habit Corrector™. MATERIALS AND METHODS: The pre- and post-treatment (T1 and T2) cephalometric data of 2 groups of patients (G1 and G2), both consisting of 25 patients each and treated with Habit Corrector™, were compared. The first group included 10 males and 15 females, aged between 4 and 7 years old, with average age 6.17 years, and therefore undergoing the last phase of primary dentition and the first phase of mixed dentition. The second group included 12 males and 13 females, aged between 8 and 12 years old, with average age 9.19 years old, undergoing the second phase of mixed dentition. The overall duration of the treatment was 12 months. RESULTS: The results showed significant differences between the two groups, with respect to overbite, overjet, molar relation, inclination of the upper and lower incisors, position of the jaw. A significant variation between the two groups at T2 was registered for the maxillomandibular relationships: the increase in the growth and degree of mandibular protrusion was of 4.66° in G1 and 2.44° in G2. Significant changes were registered for the position or growth of the upper jaw; the upper facial height almost remained unaltered, with 53.34° for G1 and with 53.96° for G2. A significant variation occurred with the increase in the sagittal relationship between the molars, improved in G1 by 3.14 mm and in G2 by 2.61 mm. A significant decrease of overjet was registered in G1 by 1.94 mm and in G2 by 0.76 m and an increase of overbite in G1 by 3.14 mm and in G2 by 0.88 mm. The inclination of the maxillary and mandibular incisors improved, with an inter-incisive angle of 123° in G1 and 124.2° in G2. CONCLUSION: The clinical results obtained suggest that early intervention in atypical deglutition with Habit Corrector™ is able to produce significant results in primary dentition and in the first phase of mixed dentition, rather than in the late phase of mixed dentition.

Dientes supernumerarios: estudio de 513 dientes supernumerarios en 309 pacientes: revisión de conceptos fundamentales en la bibliografía / Supernumerary teeth: study of 513 supernumerary teeth in 309 patients: basic concepts and review of the literature

Se realizó un análisis y evaluación de la bibliografía con el objetivo de definir exactamente el concepto de diente supernumerario y establecer los criterios prevalentes sobre su etiología y relación con los factores hereditarios. Otros parámetros de importancia, como la frecuencia, el número, el sector maxilar, la incidencia por género, raza, etc.l, así como su vinculación con alguans afecciones sistémicas y la génesis de patologías conexas con su presencia, son también considerados. Las distintas nomenclaturas para designar a los diferentes tipos de piezas supernumerarias, son consignadas según la opinión de varios investigadores y la de los autores. Son mencionados y justificados los signos clínicos a tener en cuenta y los estudios radiográficos aconsejados para el diagnóstico temprano y la planificación del correspondiente tratamiento. Se han encontrado en este trabajo, en el que se estudiaron 513 dientes supernumerarios en 309 pacientes, 57 combinaciones de aspectos diferentes de esta patología, que son expuestos en la tabla adjunta, considerando las formas de las piezas supernumerarias, su cantidad, posiciones de retención o de erupción, las patologías conexas que pueden presentar, la relación con las demás piezas dentarias, sus ubicaciones relativas en las arcadas dentarias y su posición con respecto a las series primaria o permanente, su pertenencia a una u otra y finalmente su presencia formando parte de alguno de los síndromes generales.

Treatment of class II division 1 malocclusion with myofunctional trainer system in early mixed dentition period.

Dentofacial growth interferences, caused by abnormal lip and tongue function in the mixed dentition period are a common clinical condition. The main purpose of the treatment in such cases is to eliminate oral dysfunction, establish muscular balance and correct or diminish maxillary incisor protrusion. The position of the teeth is determined by the lip and tongue pressure. Lip function may have been the cause of forcing teeth in to malposition they occupy. The case report is presented where the myofunctional trainer T4K is used during growth phase.

Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and dentifrice during early childhood.

OBJECTIVES: The authors describe associations between dental fluorosis and fluoride intakes, with an emphasis on intake from fluoride in infant formula. METHODS: The authors administered periodic questionnaires to parents to assess children's early fluoride intake sources from beverages, selected foods, dentifrice and supplements. They later assessed relationships between fluorosis of the permanent maxillary incisors and fluoride intake from beverages and other sources, both for individual time points and cumulatively using area-under-the-curve (AUC) estimates. The authors determined effects associated with fluoride in reconstituted powdered infant formulas, along with risks associated with intake of fluoride from dentifrice and other sources. RESULTS: Considering only fluoride intake from ages 3 to 9 months, the authors found that participants with fluorosis (97 percent of which was mild) had significantly greater cumulative fluoride intake (AUC) from reconstituted powdered infant formula and other beverages with added water than did those without fluorosis. Considering only intake from ages 16 to 36 months, participants with fluorosis had significantly higher fluoride intake from water by itself and dentifrice than did those without fluorosis. In a model combining both the 3- to 9-months and 16- to 36-months age groups, the significant variables were fluoride intake from reconstituted powder concentrate formula (by participants at ages 3-9 months), other beverages with added water (also by participants at ages 3-9 months) and dentifrice (by participants at ages 16-36 months). CONCLUSIONS: Greater fluoride intakes from reconstituted powdered formulas (when participants were aged 3-9 months) and other water-added beverages (when participants were aged 3-9 months) increased fluorosis risk, as did higher dentifrice intake by participants when aged 16 to 36 months. CLINICAL IMPLICATIONS: Results suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.

A model for extending the reach of the traditional dental practice: the ForsythKids program.

BACKGROUND: The authors describe and evaluate the short-term effectiveness of a community-based program for dental caries prevention in children. METHODS: The authors enrolled pupils in the ForsythKids program after receiving informed consent. They targeted children at six Massachusetts elementary schools, grades 1 through 3, with pupil populations at high risk of developing caries. The children underwent examination by dentists using calibrated technique and received comprehensive preventive care from dental hygienists. The authors determined effectiveness by means of comparing results of the initial examination with those of a second examination performed six months later. RESULTS: At baseline, 70 percent of the 1,196 participating children had decayed or filled teeth. More troublingly, 42.1 percent of the primary teeth and 31.1 percent of the permanent teeth had untreated decay. Six months after preventive intervention, the proportion of teeth with new decay was reduced 52 percent in primary teeth and 39 percent in permanent teeth. Furthermore, the percentage of children with newly decayed or restored primary and permanent teeth was reduced by 25.4 percent and 53.2 percent, respectively. CONCLUSIONS: These results indicate that this care model relatively quickly can overcome multiple barriers to care and improve children's oral health. CLINICAL IMPLICATIONS: If widely implemented, comprehensive caries prevention programs such as ForsythKids could accomplish national health goals and reduce the need for new care providers and clinics.

Diagnóstico e estratégiasde tratamento de um dente supranumerário e suas implicações para a oclusão: relato de caso clínico / Impact of sodium hipoclorite and EDTA on the qality sealing of composite resin restoration performed in human dentin

A prevalência de dentes supranumerários na população em geral varia entre 1 e 3%. Devido a essa frequência, o cirurgião-dentista e o especialista devem conhecer os sinais patognomônicos da presença de um supranumerário, assim como o tratamento apropriado. A etiologia dessa anomalia ainda não está totalmente entendida, apesar de a proliferação da lâmina dentária ou fatores genéricos estarem envolvidos. Os dentes supranumerários podem causar atraso ou erupção ectópica dos dentes permanentes, podendo alterar tanto a oclusão quanto a estética facial do indivíduo. Nesse sentido, o diagnóstico precoce do dente supranumerário em desenvolvimento torna-se importante para se aperfeiçoar e minimizar o tratamento necessário, reduzindo a extensão da cirurgia e o tempo de tratamento ortodôntico, bem como suas possíveis complicações. O objetivo do presente artigo foi descrever o tratamento adequado de um dente supranumerário superior e o início da intervenção necessária para o alcance da normoclusão, saúde periodontal, estética favorável e estabilidade do tratamento

Prevalence and development of KIG-relevant symptoms in primary school students from Frankfurt am Main.

OBJECTIVE: To determine the actual need for orthodontic treatment in the late mixed dentition according to the German KIG system (Kieferorthopädische Indikationsgruppen = Orthodontic Indication Groups). By comparing the findings with those of the early mixed dentition, we aimed to evaluate whether a change in the spectrum of malocclusions would occur. SUBJECTS AND METHODS: Dental check-ups took place in schools in Frankfurt am Main, during which the orthodontically-relevant symptoms of 1251 schoolchildren (female 49.5%, male 50.5%) in grades 4 and 5 were recorded and compared with findings documented 4 years earlier in the same classes at the same schools. RESULTS: Of those orthodontic malocclusions in need of therapy and covered by the statutory health insurance, lateral crossbite and enlarged overjet (more than 6 mm) dominated by 9.2% and 8.7%, respectively, among the 9- to 11-year-old children. Of all the malocclusions recorded within the KIG-group showing a treatment need degree > or = 3, category D4 (overjet greater than 6 mm) at 17.4% was the most frequent, followed by K4 (unilateral crossbite) at 15.3%, and M4 (negative overjet up to -3 mm) at 14.9%. 41.4% of all the children examined presented a treatment indication according to statutory health insurance directives (KIG > or = 3). The 10% reduction in treatment cases financed by statutory health insurance has been achieved in any case [1], as mandated by health policy. CONCLUSIONS: Our comparison of results gathered from 2000 and 2004 showed that as the children grew older, the prevalence of already-enlarged overjets increased, as did the frequency of deep bite. We observed fewer frontal open bites and crossbites in late mixed dentition. Treatment need according to current statutory health insurance directives was clearly higher in the late mixed dentition (41.4%) than in the early mixed dentition (8%).