Dental Problems

What are the Potential Problems of Incipient Malocclusion During Predentate Period?

In the present era, dentistry is prevention oriented and the kid in the first year of life is a most desirable patient to recognize the potential problems of incipient malocclusion during predentate period. The following details may be able to elicit some of the anticipated incipient malocclusions. Read on to know more.

Potential problems of incipient malocclusion during predentate period:

I. Predentate period:

  • a. Types of delivery:

    It is observed that the method of delivery at the time of birth is of serious concern for a dentist.

    • A high incidence of cross bite is seen in a group of kids who were born with forceps delivery.
    • An increased asymmetric molar occlusion was observed with traumatic breach delivery.
    • A tendency for abnormal dental arch dimension, larger height of the maxilla and greater length of the mandibular arch was observed to occur as a result of forceps delivery.
    • Fewer bilaterally stable occlusions, corresponding more asymmetric molar and canine occlusions and a tendency for the asymmetric occlusion were found in the difficult forceps delivery group. The kids also had a tendency for a narrower shape of arch, suggesting early constructive forces.
  • b. Preterm birth (Gestational age under 37 weeks):

    • Prematurely born infants are subjected to a variety of metabolic stresses and exhibit a higher prevalence of oral dental disturbances than normal full term infants. These developing problems can be prevented if timely care is provided to the infant.
    • Following may be considered as an index to developing probable malocclusion problems.

    Palatal grooves and cleft formation:

    • A prolonged orotracheal intubation of infants is seen to be associated with airway damage palatal groove formation, defective primary incisors and an acquired cleft palate.

    Primary incisor defects:

    • Incubated infants exhibit a fourfold increase in primary incisor defects, which occur in approximately 85% cases. Nearly 2/3rd of the maxillary incisors affected are located to the left of the midline, corresponding to the greater prevalence of right handed intubation technique.

    Alveolar ridge groove formation:

    • Greenberg and Nowak (1984) reported 47.6% incidence of palatal or alveolar ridge groove formation with orotracheal intubation in preterm infants for a period of 1 to 62 days. Incidence of palatal groove formation increased to 87.5% in infants who were intubated 15 days or more. This palatal grooving can be prevented with the use of an intraoral device that prevents the endo tracheal tube from directly pressing on the palate.

    Delayed eruption of primary teeth:

    • Fadavi (1992) noticed delayed eruption in premature infants.
    • Viscardi (1994) found that first primary teeth erupts at the usual chronologic age in healthy premature infants, but eruption may be delayed in premature infants who require a prolonged mechanical ventilation for neonatal illness or who experience inadequate nutrition.
  • c. Neonatal jaw relationship:

    • Although upper and lower gum pads tough throughout much of the arch circumference, in no way is a precise bite or jaw relationship yet seen.
    • Generally, the forward relationship of the maxillary gum pad seen at birth gets corrected itself with the growth of mandible.
    • But, an anterior open bite associated with it may not be a transient relationship.
    • It is seen that 2% of all neonates have an anterior open bite relationship.
    • The oral habit also has a definite influence on the infant’s gum pads, resulting in a significant increase in the incidence of anterior open bite relationship by the age of 4 months.
    • Sometimes, it may remain with the tongue thrust habit at a later stage also.
  • d. Infantile swallowing:

    • During the normal infantile swallow the tongue lies between the gum pads and the mandible is stabilized by an obvious contraction of the facial muscles.
    • The buccinator muscles are particularly strong in infantile swallow as it is during nursing.
    • The normal infantile swallow is seen in the neonate and gradually disappears with the eruption of the incisors in the primary dentition.
    • It, therefore, is less often seen in the dental examination of children.
    • The cessation of the infantile swallowing and the appearance of the mature swallowing pattern is not a simple on and off phenomenon.
    • Sometimes, they are an intermix of primary dentition and mixed dentition swallowing pattern is as transitional swallow causing an open bite.
    • Therefore, this transition of swallowing should be observed carefully.
  • e. Retained infantile swallowing:

    • This is seen due to persistent presence of this swallowing reflex even after the arrival of permanent teeth.
    • There is a demonstration of very strong contraction of the lips and facial musculature.
    • One thrusts the tongue strongly between the teeth in front and on both sides; particularly noticeable are the contractions of the buccinators muscle.
    • Such patients may have the following indications to develop incipient malocclusion.
    • Inexpressive faces, since the 7th cranial nerve muscles are not being used for the delicate purpose of facial expression but rather for the massive effort of stabilizing the mandible during the swallow.
    • Serious difficulties in mastication, for ordinarily they occlude only on the molar in each quadrant.
    • Their gag threshold is typically low.
    • These kids may restrict to themselves to a soft diet and frankly stating they do not enjoy eating.
    • Mastication often occurs between the tongue tip and palate because of the inadequacy of occlusal contact.
  • f. Inadequate breast feeding:

    • It is observed that in kids whose mothers have introduced an early weaning and who had very short breast feeding, a low impact muscular activity interfered with the normal development of alveolar ridges, hard palate and hence lead to posterior cross bite in primary dentition.
    • Karjalainen (1999) has also suggested that early introduction of bottle feeding is an indication of low muscular activity which may result into developing malocclusion problems.
    • Therefore, early diagnosis of such potential problems may be of great help to the dental practice to guide the child and intervene to break the habit.
    • Sometimes, a prognosis for conditioning of such a primitive reflex is very poor.
    • It may be associated with skeletal craniofacial developmental syndromes and/or neural deficits for which dentist may be the first to recognize the problem to refer the case timely.

The above article discusses about the

potential problems of incipient malocclusion during prenatal period.

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