Orthodontic aspects of dental status in prematurely born children (review)

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Медицина и здравоохранение


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UDC 611. 31 — 053.2 (048. 8) L.S. Kryvenko
Kharkov National Medical University, Kharkov, Ukraine
The article presents and analyzes the main published data on the topic of orthodontic status of children born prematurely or with low birth weight. Researchers have identified main changes in the oral cavity in children born prematurely, which include the appearance of changes in the alveolar bone, palatal fissures, enamel hypoplasia, high palate. Such violations may lead to formation anomalies of occlusion. Also it was proven correlation between the time of intubation and severity of abnormalities. Some studies have shown that children aged 3−5 years and 7−10 years revealed the following clinical features as high palate, palatine grooves, cross bite, and at the age of 3−5 years as determined by the asymmetry of the palate.
Keywords: premature children, orthodontic status.
As defined by the World Health Organization (WHO), a premature birth is one that occurs before 37 weeks of gestation or in which the birth weight is below 2500 g. The incidence of premature birth varies widely among different populations and is generally correlated with differences in living conditions between the developing and the developed countries. The incidence ranges between 5% and 10% in Europe, North America, Australia, and parts of South America, whereas it lies between 10% and 30% in many countries in Africa and in Southeast Asia Preterm infants [1]. Prematurity account for 6 — 10% of births in Western society [2]. By definition, neonates weighing less than 2500 g are described as low birthweight infants. The proportion of neonates weighing less than 1500 g (very low birthweight) is approximally 1 — 1. 5% of all newborns [3].
The factors discussed as potential triggers of a premature birth include: high or low age of the mother, low socioeconomic status, inadequate antenatal care, drug, alcohol and nicotine abuse, diabetes, multiple pregnancies, anemia, previous miscarriages or abortions, deformity of the uterus, abnormal presentation of the fetus, endocrine disorders, excessive mental or physical strain on the pregnant woman, stress, hypertension and infections [4,5].
Advances in medicine, combined with the monitoring and technologies used in intensive care units, have provided favorable prognosis with decreased mortality and incidence of damage to premature newborns. The birth of low weight, premature infants (& lt- 37 weeks) is a costly social, family and public health problem. Preventive and health promoting measures are necessary to improve the quality of life of these children.
Thus, knowledge of the risk factors, to which these children are subjected, is of paramount importance in adopting such measures. Low gestational age and low birth weight are among the key factors in determining the incidence of neonatal complications. Among the most prevalent oral diseases in these children are dental enamel opacities and hypoplasias [6].
It has been hypothesized that prematurity and adjunctive neonatal care is '-a priori'- a risk for disturbances of palatal and orofacial development which increases the need for later orthodontic or orthognathic treatment. Mostly it is connected with the need of intubation in preterm infants.
Complications resulting from intubation, however it is performed, are always to be expected: in cases of nasal intubation, potential problems are nasal deformation [7] and subsequent choanal stenosis. Because preterm neonates are nose breathers orotracheal intubation is often preferred to nasal intubation [8]. As the palatal bones of fetuses are spongy and connective tissue interspersed at the midline forms a weakened palatal configuration, oral defects can easily result from the trauma of oral intubation. This may result in the inability of the tongue to meet the palate
correctly and may give rise to considerable functional impairment like sucking problems and impaired middle ear function or articulation disturbances, e.g. in the form of a significantly higher incidence of fair or poor speech intelligibility in contrast to non-orally intubated infants [9].
The following dental complications are described as potential consequences of oral intubation and can be either caused by lack of oxygen, by the larynoscope blade or by the tube itself: enamel hypoplasia in 18 — 70% of preterm neonates, severe disruption of the developing enamel organ and deviation of the crown/root angulation, dilaceration of primary teeth, retarded eruption of primary teeth, impaired amelogenesis, effects on the position of the central incisors. Palatal complications reported in connection with oral intubation are erosion and indentation of the alveolar ridge, notching, a high, and narrow palatal shape, asymmetry of the palate and cleft palate. It was recommend not to use the term clefting, since no oral nasal communication has been demonstrated [10].
Alveolar grooving, and '-palatal grooving'- have also been described, never occuring in combination. The majority of articles dealing with the phenomenon fail to give a definition of palatal grooving [11, 12].
Orotracheal intubation has been reported to be harmful for teeth, tooth eruption, palatal shape and speech as early as 12 hours after intubation. Due to a non-uniform definition and a subjective, nonmetric evaluation in the majority of the studies there is a marked difference in the percentage data on the incidence of palatal grooving in preterm infants (7 -90%).
The following facts have been accused for provoking grooving: head flattening, pressure of an oral tube, pathologic or impeded tongue function and broadening of the alveolar ridges adjacent to the tube. Thickened palatine ridges may give a false impression of palatal height.
Metrically, the palates of intubated preterm babies remain narrower, what has been examined up to the age of 11 years. Thus, an earlier orthodontic control of formerly orally intubated PT infants compared to non-intubated infants is advisable. From the orthodontic point of view, nasal intubation should be favoured.
Contradictory information is given in the literature on preterm infants concerning the correlation of length of intubation time and amount of grooving, the duration of '-grooving'- (which was examined up to the age of ten years), the incidence of crossbites, a possible difference in palatal asymmetry, palatal depth compared to non-intubated babies.
It remained unclear, if gestation or birthweight of preterm infants were related to palatal height, due to confounding with intubation time [13].
Several scientific publications describe correlation between open bite and prematurity. Significant differences
Обзор литературы
Наука и здравоохранение, № 6, 2014
in the incidence of anterior open bite (from left to right canine) was found between the preterm and control groups and between gender and ethnic groups. The prevalence of anterior open bite was nearly 9% in the preterm group and almost 7% in the control group. African Americans (9%) had a significantly greater incidence of open bite than
Generally, girls had a greater incidence
of open bite than boys (8% versus 6%). When the study groups were divided by prematurity, gender, and ethnic group, the prevalence of open bite was increased-especially in preterm African American boys compared to controls (11% versus 8%).
The results showed differences in the development of anterior open bite between ethnic and gender groups. Premature birth may also influence dental occlusal development. Of importance are the patient'-s: general health condition- respiratory infections- inadequate nasaland mouth-breathing- oral habits- and other medical problems. Preterm children may be relatively more predisposed to etiological factors for the development of anterior open bite. [14]
Another group of authors compared arch width, palatal width and palatal depth measured in 8−11 year-old previously intubated premature and low birth weight children with a group of non-intubated gender- and age-matched controls. Significant differences were found between the intubated and non-intubated children. The intubated children had significantly narrower palatal width posteriorly, steeper palatal vaults anteriorly, and exhibited a directional palatal width asymmetry with the left side of the palate measuring consistently wider than the right one.
Two or more malocclusion traits occurred significantly more often in extremely preterm (83. 3%) and very preterm children (73. 0%), compared with the full-term children (51. 2%). It can be mentioned, that six preterm children had between six and eight malocclusion traits compared to none in the full-term group. Deep bite was the most common malocclusion trait in the extremely preterm children and very preterm children group and occurred significantly more in those groups compared with the full-term control group. In addition, the mean overbite value was significantly higher for the preterm children. No significant difference was found for overjet. In addition, significantly more preterm children had spacing. The number of participants with ongoing sucking habit or swallowing with tongue thrust were few, and with no significant differences among the groups. Considering dental stages, no significant differences were found among the three groups. [15]
Group of scientists have made an interesting investigation that concerned mandibular function, temporomandibular disorders, and headache in prematurely born children. Seventy-three preterm children were selected from the Medical Birth Register-one group comprising 36 extremely preterm children born before the 29th gestational week, the other group 37 very preterm children born during gestational weeks 29 to 32. The preterm children were compared with a control group of 41 full-term children matched for gender, age, nationality, and living area. The subjective symptoms of TMD and headache were registered using a questionnaire. Mandibular function, signs, and symptoms of TMD and headache were registered. TMD diagnoses were set per Research Diagnostic Criteria for temporomandibular disorders (RDC/TMD).
No significant differences between groups or gender were found for TMD diagnoses according to RDC/TMD or for headache. The preterm children had smaller mandibular movement capacity than the full-term control group, but when adjusting for weight, height, and head circumference mostly all group differences disappeared. [16]
Scientists performed investigation of sagittal occlusal relationships and asymmetry in prematurely born children- the aim was to examine the effect of pre-term birth on sagittal occlusal relationships. The subjects were 328 prematurely born white and black children and 1804 control children who participated in the cross-sectional study of the Collaborative Perinatal Project (USA) in the early 1960s and 1970s. Dental examinations, including dental casts and photographs, were performed at the age of 6−12 years. The sagittal occlusion of the permanent molars and the canine relationship was recorded by examining and measuring the hard stone casts. The pre-term and comparison groups were divided by sex and race. A significantly greater prevalence of pre-normal canine relationships was found in the pre-term group than in the controls (P & lt- 0. 001). The incidence of a bilateral symmetrical canine relationship was 60.3 per cent in both the pre-term and control groups, but in the pre-term group the girls had better symmetry than the boys. Asymmetry occurred significantly more often on the left side (P & lt- 0. 001), especially in the control boys, but this was not so clear in the pre-term group. The prevalence of mesial molar occlusion was greater in the pre-term group. These results suggest that premature birth and the consequent exceptional adaptation from intra- to extra-uterine nutrition may influence dental occlusal development. This emphasizes the importance of early functional activity and differences in masticatory muscle activity and the largely unknown phenomenon of early catch-up growth. Individual differences in neonatal factors, in the need for intubation and other medical care are also of importance. Pre-term birth may also interfere with the development of symmetry and lateralization. [17, 18]
In some papers prophylactic measures in preterm newborn are described. It is proven that an orotracheal route is frequently the preferred method of intubation for premature infants. Nasal intubation may contribute to airway obstruction and possible hypoxia, further contributing to labored breathing. Additional complications include occlusion of the nasal aperture during a crucial period of development, nasal infections, and hypertrophy of the nasal lining. Oral mucosa is less susceptible to damage than nasal mucosa- however, orotracheal tubes must be stabilized against displacement from tongue and jaw movements to prevent discomfort and subsequent tissue trauma. Problems associated with rehabilitation of very-low-birth-weight neonates and other infants requiring long-term oral intubation include palatal grooving, acquired cleft palate, and damage to the primary dentition. Various intraoral aids have been used to reduce pressure application from intubation and feeding tubes on the palatal tissues. This article presents a rational for design and construction of an intraoral device which protects the palatal tissues and stabilizes the orotracheal tube. [19]
Palatal groove is one of the most often complications of orotracheal intubation in premature infants. Different reports demonstrated an incidence of 48% of palatal groove formation in premature infants which increased to 88% when the duration of intubation was greater than two weeks. A prosthetic intraoral acrylic appliance, which had successfully prevented such a groove formation, had been described by group of authors. [20]
Conclusions. Thus researchers have identified main changes in the oral cavity in children born prematurely, which include the appearance of changes in the alveolar bone, palatal fissures, enamel hypoplasia, high palate. Such violations may lead to formation anomalies of occlusion. Also it was proven correlation between the time of intubation and severity of abnormalities. Some studies have shown that children aged 3−5 years and 7−10 years
revealed the following clinical features as high palate, palatine grooves, cross bite, and at the age of 3−5 years as determined by the asymmetry of the palate.
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Харьковский Национальный медицинский университет, Харьков, Украина
В статье приведены и проанализированы литературные данные по проблеме ортодонтического статуса детей, рожденных преждевременно или с малым весом. Исследователями определены основные изменения в полости рта детей, рожденных преждевременно, к которым относятся появление углублений на альвеолярном гребне, небных борозд, гипоплазии эмали, высокого неба. Подобные изменения также могут проявляться формированием аномалий прикуса. Исследования показали, что у детей в возрасте 3−5 лет и 7−10 лет были определены такие клинические проявления, как высокое небо, появление борозд на небе, перекрестный прикус, асимметрия неба.
Ключевые слова: дети, рожденные преждевременно, ортодонтический статус.
Харьков? лттьщ медициналыц университетI, Харьков ц., Украина
Макалада ку. нбурын немесе аз салмакпен туылган балалардыц ортодонтикалык мэртебес мэселеа бойынша эдеби мэл1меттер келт1р1лген жэне талданган. Ку, нбурын туылган балалардыц ауыз куысындагы нег1зг1 взгер1стер аныкталды, оларга альвеолярлы айдарлардагы, тацдай куыстарындагы ойыктардыц, эмальдег'-1, жогары тацдайдагы гипоплазиялар жатады.
Осындай взгерстер сол сиякты тiстYйiстегi аномалиялардыц шыгуы мYмкiн. 3−5 жастагы жэне 7−10 жастагы балаларда жогары тацдай, тацдайда куыстар, айкаскан тiстYйiс, тацдай ассиметриясы сиякты клиникалык аныктаулар айкындалганын зерттеулер кврсеттi.
Нег'-1зг'-1 свздер:нбурын туган балалар, ортодонтикалык мэртебе.

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