The growth of the jaws is functionally determined and carried out in three directions: in the sagittal (during the lactation period, from 2.5 to 6 years and at 9-10 years), in width (due to oppositional layering), in height (due to the alveolar process due to with teething). In addition, for growth mandible two more factors influence: enchondral ossification of the articular process, which is the center of longitudinal growth of the mandible, and interstitial growth. The basal part of the lower jaw, which is the support for the masticatory muscles and some muscles of the neck, grows much more slowly than the alveolar.

The growth of the jaw branch in length is intense from 3 to 4 and from 9 to 11 years and ends by 15-17 years. The growth of the branch is accompanied by a change in the angle between it and the body: from 140° in a newborn to 105-110° in an adult. In this regard, the location of the mandibular foramen changes. From 9 months up to 1.5 years, it is 5 mm below the level of the alveolar part of the jaw. In children 3.5-4 years old, the hole is located 1-2 mm below the chewing surface of the teeth. From 6 to 9 years - 6 mm above the chewing surface of the teeth, and at 12 years and later - 10 mm above. Knowledge of the topography of the mandibular foramen is important when performing mandibular anesthesia in children.

The upper jaw of a newborn is wide and short. The maxillary sinus is just emerging and is located medially in relation to the alveolar ridge, increasing especially intensively in the first 5 years of a child's life. The tooth germs are located high under the orbit and are separated from it by a thin bone plate. The development, change in the shape and structure of the upper jaw is closely related to the development of the teeth and its sinus. The tooth sockets gradually deepen and take the vertical direction, which contributes to the growth of the alveolar process and the basal part of the jaw. The maxillary sinus becomes deeper and wider. Its development is facilitated by the eruption of all temporary teeth and a permanent molar. In the lactation period, the growth of the upper jaw in length occurs more intensively than in width, which ensures a change in its shape from wide and short to narrow and long. This growth is carried out by perichondral ossification in the region of the median palatine suture and the sutures connecting the upper jaw with other bones of the skull.

During the period of permanent occlusion, the distal sections of both jaws grow more intensively. The jaws of a newborn cannot be considered as "toothless", since in the thickness of each of them are the rudiments of teeth. In this follicular, or intramaxillary period of development of the tooth germs, the height of the bite is provided only by the gingival ridges, so there is a disproportion between the middle and lower parts of the face.

What should be done so that the child's bite (jaw closure) is correct and does not manifest itself in the form of facial disorders, even deformities, so that the child's face is beautiful? Often such violations of the formation of the jaws are visible only to a specialist, a dentist, and only with a noticeable manifestation they are seen by others and the child himself, as far as he can understand.

We see an ugly face due to the excessive development of the lower jaw, it is clearly advanced forward (the face of an old person) or underdeveloped, sinks back, so the upper jaw seems larger, looks like a beak (a bird's face). There may also be an underdevelopment of the upper jaw, then the teeth of the lower jaw, protruding forward, overlap the upper one, like in a bulldog. Often we see a child with a constantly open mouth: he breathes with it. We see the jaws shifted to the right or to the left one in relation to the other (skewed mouth). And these are only the most common violations or anomalies.

And the incorrect pronunciation of sounds (burr speech)? And not with a baby who can’t do everything yet, but with a schoolchildren. Here already the psyche suffers, peers laugh. Often, the parents of such children confidently justify this with a hereditary predisposition, sometimes they are proud of it. That her grandfather had it like that for her, for her mother, and for her child. That's how special we are.

This, of course, is a psychologically difficult case, justified by the ignorance (ignorance) of the parents and the lack of their upbringing. But most often the cause of "burr" in a short frenulum of the tongue. This is a muscle cord that is visible when the tongue is raised. When this strand (bridle) is short, the tongue is not very mobile (it is held by the bridle) and some sounds cannot be obtained, for example, "P". And in this case, everything is solved simply: a short frenulum of the tongue is cut (cut off) by a dentist surgeon, it acquires the necessary mobility, the child easily eliminates speech defects on his own or with the help of a speech therapist.

But mispronunciation is the least that can be broken (more on that later) when overlooked at an early age, in a newborn. In addition to such vivid, but unpleasant manifestations, dentition and jaw anomalies (ZCA) include a violation of the number of erupted teeth: there are more or less of them, a violation of the shape, size, location, and changes in the timing of eruption. Why all these violations? There is not only one reason!

It is customary to single out internal risk factors. This is a hereditary condition, a violation of intrauterine development, diseases of children early age that violate mineral metabolism, endocrine diseases. True, the consequence of these disorders is more often more severe pathologies, however, those that were mentioned at the beginning and external risk factors.

Here it is necessary to draw the attention of parents, first of all, to the method of feeding a newborn, both natural and artificial. A child is born with an underdeveloped lower jaw (this is the norm), it looks sunken back. Nature provided her with the opportunity to develop immediately after birth by stressing her while suckling her mother’s breast, this hard work and it is necessary. The tongue, the muscles located under the tongue (the muscles of the floor of the mouth), the muscles of the lips are actively working here. Any working organ grows and develops. By the time of feeding 6-8 months, the lower jaw is quite developed.

If the baby was born with a short frenulum of the tongue, sucking hurts him and he quits (but there are other reasons for this refusal). Therefore, before transferring to artificial feeding, make sure, after consulting a dentist, whether the frenulum is short or not. If so, then fast decision this problem will return the child to natural feeding and there will be no trouble, the jaw will develop in time. In the case when the child is still fed with a nipple, it is important to provide him with the necessary load so that the food does not pour out of it, but is sucked out with some effort. Then the development of the jaw will take place fully. That is, do not make large holes in the nipple.

In addition, the development of dentoalveolar anomalies is affected by bad habits of the baby: prolonged sucking of a pacifier, finger, tongue, cheeks, poor posture, head position during sleep (upturned or raised high), putting a fist under the cheek. These interferences help form an overbite, in which the mouth is open or skewed. When a child tries to constantly be with his mouth open, you need to understand: this is just a habit or the nose is unhealthy and it is difficult to breathe.

At home without a doctor, you can check this: invite the child to take some water in his mouth and do something, for example, drawing. If he immediately swallows and opens his mouth - take him to an ENT doctor (his nose is not healthy, he does not breathe), if he sits and draws with his mouth closed, then everything is in order with his nose, just the habit of keeping his mouth open. Get rid of it, otherwise in both cases an elongated, elongated face with an open mouth is formed, which gives it a silly look, and it's just ugly.

At 3-5 years old, ask parents to pay attention to speech. By the age of 5, it should be complete, and in case of violations, remember the short frenulum of the tongue or lips. We'll fix it all. The normal growth of the jaws at the age of 6-7 years is indicated by the appearance of gaps between the teeth (they have become more rare), they do not change in size, and the jaws have grown and the gaps have naturally increased. And this is good and right. But if the teeth are close to each other, and if they have not yet begun to change, then there is a violation of calcium metabolism. This is by no means indifferent and is very important for the development of the skeleton as a whole.

Ancient games with children are also useful (“Magpie-crow cooked porridge ...), since rotating a finger in the palm of your hand massages and thereby develops the muscles of the hand and speech of the child. Training of the tongue also helps her development: when he “clicks” with him, depicting “how he does horse while walking. The clatter of hooves, playing the tube, harmonica - this develops the muscles of the tongue, and hence speech. Love your child, study with him, put a certain meaning into everything. Simply put, do everything with love and mind!

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Dental anomalies (DNA) are conditions that include hereditary disorders of the development of the dentition and acquired anomalies, expressed in anomalies of the teeth, jaw bones and the ratio of the dentition varying degrees gravity.

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Measures to ensure the prevention of dentoalveolar anomalies clinical examination of children (identify and diagnose dentoalveolar anomalies, eliminate predisposing factors for their development; identify groups for dispensary observation and draw up a plan for preventive and therapeutic measures (for pediatricians of all profiles of a specialized service);

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timely referral of children with formed anomalies to the doctor for treatment; control over the elimination of identified causal factors for the occurrence of anomalies in children; organizing and conducting training of children, their parents, pedagogical and medical personnel in the methodology of hygiene measures in children's groups.

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Preventive actions should be built taking into account age periods child development preschool age child. In the period of mixed dentition, preventive measures become less effective. In children with permanent occlusion, formed dentoalveolar anomalies are diagnosed that require labor-intensive treatment.

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Intrauterine and postnatal risk factors. 1. Prenatal period: Endogenous: - genetic condition (complete or partial adentia, supernumerary teeth, individual micro- or macrodentia, violation of the structure of tooth enamel, micro- or macrognathia, pro- or retrognathia, anomalies in the size and attachment of the frenulum of the tongue, lips)

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Exogenous: mechanical (trauma, bruising of a pregnant woman; tight clothing of the expectant mother) chemical (alcoholism and smoking of future parents); occupational hazards (work with varnishes, paints, chemical reagents); biological (past diseases of a pregnant woman: tuberculosis, syphilis, rubella, mumps, some forms of influenza, toxoplasmosis); mental ( stressful situations mother); radiation factors

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Postnatal risk factors Violation of the correct artificial feeding of the child; Violations of the functions of the dentoalveolar system - chewing, swallowing, breathing and speech; Bad habits - sucking on a pacifier, fingers, tongue, cheeks, various items, incorrect posture and posture; Transferred inflammatory diseases of the soft and bone tissues of the face, temporomandibular joint; Injuries of teeth and jaws; Cicatricial changes in soft tissues after burns and removal of neoplasms of the oral cavity and jaws;

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Dental caries and its consequences; Insufficient physiological abrasion of temporary teeth; Premature loss of temporary teeth; Premature loss of permanent teeth; Delayed loss of temporary teeth (landmark - the timing of eruption of permanent teeth); Delayed eruption of permanent teeth (landmark - the timing of eruption of permanent teeth); The absence of three and diastema by the age of 5-6 years of the child.

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Activities for prenatal prevention are carried out in the antenatal clinic by improving the body of a pregnant woman: Elimination of occupational hazards Establishment of a rational daily regimen and nutrition Treatment infectious diseases, the fight against toxicosis Sanitation of the oral cavity Dental education

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Postnatal prophylaxis depends on the age of the child Children of the first year of life: Etiological factors: artificial feeding - this does not require significant muscle efforts and the state of infant retrogeny persists, a tendency to distal occlusion is created, swallowing rather than sucking function prevails. incorrectly carried out artificial feeding - the use of a hard and long nipple, which can cause injury to the oral mucosa or a very soft one with one large hole at the end - does not require the child to make efforts when feeding; when a child is left alone with a bottle - at the same time, it puts pressure on the alveolar process with a neck, deforming it;

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birth trauma - forcible removal of the fetus by the lower jaw - while the growth zone suffers - the condylar process; past diseases - rickets - the result of which can be deformations of both the upper and lower jaws

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hematogenous osteomyelitis - the causative agent of this disease settles mainly in the growth zones - on the upper jaw of the zygomatic and frontal processes, on the lower jaw - in the articular processes; pustular diseases of the skin breathing through the mouth due to insufficient cleanliness of the nasal passages from crusts or due to partial or complete atresia

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Preventive measures: Natural feeding - the act of sucking is a powerful stimulator for bone growth. When sucking, the lower jaw changes position in the anterior-posterior direction due to muscle contraction. The pressure is transferred to the bone beams and blood vessels feeding them. As a result, the growth zones receive an impulse and physiological process growth. During breastfeeding, pressure is exerted on the palate, which ensures growth and an increase in the volume of the upper jaw.

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Proper artificial feeding of the nipple on the bottle should be of a physiological shape, be elastic, resilient, have several small holes. The optimal time to suck out a portion of food from a 200.0 ml bottle is at least 15 minutes. A shorter duration leads to underdevelopment of the lower jaw. When feeding, you need to hold the baby at an angle, as when breastfeeding. The bottle is also placed at an angle so that it does not put pressure on the baby's lower jaw.

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The flat part of the nipple ensures the correct position of the tongue, identical to the natural one during breastfeeding

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The correct position of the child during sleep. The newborn should sleep without a pillow on an orthopedic mattress. It is also necessary to turn the child on the left, right side and lay it on the stomach to prevent retraction (prevention of distal occlusion) and displacement of the lower jaw to the right or left (crossbite) prevention of rickets (carried out by pediatricians) prevention of pustular skin diseases compliance with the rules of hygiene of the maxillofacial area;

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From 5-6 months of age, complementary foods are introduced from a spoon, so that during the capture of food, the lower jaw moves forward, as well as muscle tension in the chin, mandibular and cervical region, which will further ensure normal function swallowing, movement of the lower jaw and movements in the TMJ. Starting from 6 months. age, it is necessary to introduce coarser food (meat, vegetables) into the child's diet, which allows you to form the skills of biting, chewing and evenly distributing food throughout the oral cavity. In this case, the lips should be closed, the tongue is located behind the teeth, and during swallowing, the muscles of the perioral cavity should not strain.

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timely lengthening of the shortened frenulum of the tongue; use of a "dummy" nipple - no more than 15-20 minutes after eating, during sleep, wakefulness - the use of a "dummy" nipple is not recommended. Prolonged use of a pacifier (more than 1-1.5 years) leads to the formation of an open bite. The critical time for using a pacifier is 6 hours per day. prophylactic pacifier with the thinnest neck (1) and flat head (2), model "Dentistar".

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Children of the 2nd and 3rd year of life (the period of formation of temporary occlusion) Etiological factors: Bad habits (sucking fingers, pacifiers, various objects, eating with a pacifier); Rickets - lack of vitamin "D"; Lack of hard food in the child's diet; Difficult nasal breathing;

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Preventive measures: Elimination bad habits Balanced diet, use when chewing hard food Pediatric correction of rickets correct formation speech functions; Formation of skills in oral hygiene.

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preventive vestibular plate "Stoppy", designed to wean from sucking a pacifier or a finger, regular use for 1-2 hours during the day, as well as during sleep, allows you to correct the bite in a natural way, because. the design of the plate does not prevent the incisors from closing and prevents the tongue from getting between the upper and lower dentitions. The plate is recommended for children from 2 to 5 years old.

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Children aged 3-6 years (the period of formed milk occlusion) Etiological factors: Violation of the function of nasal breathing - manifests itself in the form of mixed or oral breathing. Depending on the combination with other factors, it contributes to the formation of various anomalies - open, progenic, deep, prognathic bites and anomalies of the dentition. Dysfunction of swallowing - infantile swallowing Dysfunction of chewing - - is an active factor in the formation of open, cross, progenic and other types of pathological occlusion.

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Violation of the physiological abrasion of milk teeth The abrasion of temporary teeth is due to functional loads due to the development of the chewing function and changes in the structure and properties of the enamel of temporary teeth caused by resorption of their roots. The first signs of physiological abrasion appear on the incisors at the age of 3, by the age of 4-5 it spreads to the canines and molars. Due to the erasure of the tubercles of temporary teeth, a smooth sliding of the lower dentition in relation to the upper one is ensured, optimal conditions are created for full chewing and the formation of the correct bite.

Chapter 13 ERRORS AND COMPLICATIONS IN ORTHODONTIC PRACTICE

Chapter 13 ERRORS AND COMPLICATIONS IN ORTHODONTIC PRACTICE

13.1. Features of the prevention of dental anomalies

Dental anomalies are one of the essential factors in the development of caries and periodontal disease. Therefore, the prevention of ASA should be considered as constituent part comprehensive prevention of dental diseases. However, it has a number of features.

1. Opportunities for the prevention of ASA are limited to certain age limits. According to domestic scientists, it is effective in pre-school (up to 3 years), pre-school (from 3 to 7 years) and early school (up to 10 years) age. After 10 years, the effectiveness of preventive measures is significantly reduced.

This is due to the fact that the growth of the jaws in the anterior region (the most vulnerable to the formation of various anomalies) does not occur at this age, but Negative influence etiological

ski factors is minimal. The most important is the pre-school period, which is characterized by intensive growth and development of the dentition, as well as the formation of its main functions - swallowing, chewing, speech. At this age, the child's body is affected by a maximum of adverse factors that can disrupt the normal formation of the dentoalveolar system. However, the high compensatory capabilities of the child's body at this age allow us to count on the normalization of the growth and development of the dentoalveolar system, provided that risk factors are eliminated in a timely manner.

2. Taking into account the multifactorial nature of AF, their prevention should be carried out in close cooperation between the orthodontist and other specialists - otorhinolaryngologist, pediatrician (neonatologist), ophthalmologist, speech therapist, endocrinologist, etc.

3. Unlike caries and periodontal diseases, in the prevention of which population and group (collective) methods play an important role, the individual method is the main one in the prevention of AF. The principle of an individual approach is that in each case, the orthodontist determines the scope and content of preventive measures, taking into account the age of the patient and the presence of existing risk factors.

4. In the prevention of AF only important role plays increasing medical literacy of parents, pediatricians, workers preschool institutions and teachers primary school. In our opinion, the main actor in working with children is a pediatrician. It is he who should take the initiative in explaining to parents such problems as the correct choice of nipples and the mode of using them, the timely detection of bad sucking habits, the development of nasal breathing skills, the control of eruption of temporary teeth, the formation of dental care skills, ways to intensify the function of chewing, etc. .

Practical experience shows that the relatively small labor input, due to the time allotted for health education with parents and staff serving children in the nursery, prevents much more laborious and less successful work to eliminate persistent preomalies of the dentoalveolar system in preschoolers (Razumeeva G. A. et al., 1987).

The same point of view is shared by T.F. Vinogradova et al. (1987), who believe that timely diagnosis of symptoms, causes and risk factors in the occurrence of malocclusion in a period when neither the child nor his parents still know and do not assume about their existence is very important, because it provides grounds for eliminating these symptoms and risk factors without resorting to

Scheme 2. The main directions for the prevention of dentoalveolar anomalies

to complex orthodontic treatments. This approach is extremely important in our time, since not all parents have the opportunity to allocate large sums of money from the family budget to correct anomalies with bracket systems.

In organizing the prevention of ASA, it is necessary to be able to clearly define the list of preventive measures in relation to a specific age and taking into account the existing risk factors. The main directions of prevention are presented in Scheme 2.

13.2. Medical errors. Complications in orthodontic practice

According to I. A. Kassirsky (1970), mistakes are the inevitable and sad costs of medical activity. The tragedy of medical errors is that they carry the risk of complications that are dangerous both for the success of treatment and for the health of the patient. Therefore, one of the main tasks of a doctor of any specialty is to eliminate the conditions and causes that contribute to the appearance of errors.

In orthodontic practice, medical errors can be made at all stages of patient management, including the retention period.

Complications, depending on the cause that caused them, we divide into the following groups:

1. Complications associated with the professional diagnostic and treatment activities of a doctor and caused by:

Diagnostic errors (incomplete examination, erroneous diagnosis, incorrect interpretation of research results, etc.);

Errors in treatment planning (lack of sanitation of the oral cavity, incorrect determination of indications for tooth extraction, inclusion of unrealistic or difficult tasks in the treatment plan, incorrect choice of apparatus design, lack of complexity, etc.);

Errors in the implementation of the treatment plan (incorrect installation of braces, forced movement of teeth by applying great forces, excessive increase in bite height, non-compliance with the sequence of treatment stages, violation of the rules and terms of activation, unreasonable extraction of teeth, etc.);

Improper management of the retention period (incorrect choice of the design of the retention apparatus, failure to meet the deadlines for the duration of the retention period, lack of measures to achieve multiple fissure-tubercle contacts, lack of radiological control of treatment results, etc.);

Errors of a technical nature (defects in the manufacture of equipment, the use of low-quality and non-certified materials, etc.).

2. Complications caused by the patient's inadequate attitude to treatment:

Failure to comply with the rules of oral hygiene and machine care;

Failure to comply with the mode of use of the device and careless handling of it;

Violation of the terms of appearance at the reception and non-compliance with the recommendations of the doctor;

Unreasonable termination of treatment without the knowledge of the doctor.

3. Complications due to individual features body:

The impossibility of full adaptation to the apparatus due to the imperfection of adaptation mechanisms;

Poor adaptability of the patient;

prone to allergic reactions on plastics and other materials.

Particularly noteworthy are errors that are not directly related to the occurrence of complications, but carry the risk of losing confidence in the doctor and causing conflict situations. These errors relate to record keeping, in particular medical card dental patient. The most common mistakes of a similar nature are:

Lack of a record of the patient's referral for X-ray or other examination;

Lack of description of the results of X-ray and other studies;

Absence of a record of the patient's refusal to conduct an additional examination;

Abbreviations special terms, words and phrases;

No diagnosis;

Unfilled dental formula;

The presence of corrections and records made retroactively.

Propaedeutic orthodontics: tutorial/ Yu. L. Obraztsov, S. N. Larionov. - 2007. - 160 p. : ill.

To implement the main tasks of the prevention of AF, it is necessary to be able to establish an unambiguous relationship between morphological features and functional signs of physiological occlusion, to be able to correlate physiological occlusion with various stages of its formation.

Bite - the ratio of the dentition (teeth) when they meet with the largest number contacts. Therefore, the norm is the concept of correct position teeth, the shape of the dentition and the ratio of the jaws, according to the type of occlusion and the period of its development until the full formation of a permanent occlusion.

Preventive measures are divided into pre- and postnatal.

Activities for prenatal prevention are carried out in the antenatal clinic by improving the body of a pregnant woman.

The objectives of the prevention of AF during this period are the elimination of occupational hazards, the establishment of a rational regimen for the day and nutrition of a woman, the treatment of infectious diseases, the fight against toxicosis, sanitation of the oral cavity, and dental education. During this period, it is possible to identify a number of hereditary factors, however, methods of influencing the processes of heredity are at the research stage.

Postnatal prophylaxis is carried out from the moment of birth of the child and its content depends on the age.

From birth to the eruption of the first milk teeth (0-6 months)

- detection of congenital pathology in the maxillofacial region;

Prevention of acute purulent diseases in a newborn;

Dissection of the shortened frenulum of the tongue;

Proper artificial feeding of the child (posture, selection of nipples);

Identification of prematurely erupted teeth and determination of indications for their removal.

Milk bite formation period (6 months - 3 years)

- observation of teething (timing and sequence, pairing, quantity, symmetry, shape, position, type of closure);

Plastic surgery of a shortened frenulum of the tongue;

Prevention of caries and its complications;

Balanced diet, use when chewing hard food;

Prevention of somatic diseases;

Sanitation of the respiratory organs;

Prevention of bad habits (sucking fingers, pacifiers, nipples, foreign objects);

Observation of the function of the tongue during swallowing (the dentition is closed, the tip of the tongue is located in the region of the upper front teeth on the palatal side).

The period of the formed milk bite (3 years - 6 years)

- plasty of a shortened or incorrectly attached frenulum of the tongue;

The presence of hard food in the diet;

Identification and removal of erupted supernumerary teeth;

Prevention of deformations of the dentition in case of defects in the dentition (primary adentia or extraction of teeth according to clinical indications) by prosthetics;

Observation of the growth of the jaw bones (the appearance of physiological three and diastema by the age of 5-6 years of the child);

Selective grinding of unworn tubercles of milk teeth (usually fangs);

Observation of the ratio of the dentition, the shape of the dental arches;

Identification of violations of the nature of speech articulation;

Complexes of myogymnastics - to normalize the closing of the lips, the location of the lower jaw and tongue at rest and during function.

Teeth change period (6 - 12 years)

- prevention of dental caries and its complications;

Monitoring the resorption of the roots of milk teeth;

Observation of the eruption of permanent teeth (timing, sequence, pairing, quantity, symmetry, shape, position, type of closure);

Removal of erupted supernumerary teeth;

Determination of indications for surgical treatment associated with low frenulum attachment upper lip, which was the cause of diastema, short frenulum of the lower lip, tongue and small vestibule of the oral cavity;

Restoration of destroyed crowns of the first permanent molars and / or incisors by prosthetics after their injury, carious lesions or enamel hypoplasia;

Replacement of missing teeth, including those with adentia, by prosthetics;

Elimination of bad habits (sucking lips, cheeks, tongue, foreign objects);

Selective grinding of unworn tubercles of milk canines and molars;

Myogymnastics to normalize the closing of the lips, nasal breathing, posture.

The period of the emerging permanent occlusion (12-18 years)

- treatment of maxillofacial anomalies in order to reduce their severity;

Prevention of dental caries and its complications;

Prevention of periodontal diseases;

Extraction of individual teeth for orthodontic indications;

Removal of erupted or impacted supernumerary teeth, odontomas, cysts;

Rational prosthetics;

Plastic surgery of a shortened or incorrectly attached frenulum of the tongue, lips, deepening of the small vestibule of the oral cavity.

The period of the formed permanent occlusion (18 years and older)

- sanitation of the oral cavity and observance of the basics of hygiene;

Restoration of crowns of destroyed teeth;

Replacement of missing teeth by prosthetics;

Elimination of parafunctions (bruxism);

Splinting of teeth in periodontal diseases;

Prevention of overload of abutment teeth during prosthetics;

Preservation of tissues of the prosthetic bed.

In the clinic, we most often meet with combined bite anomalies. Diagnosis of early symptoms is associated with the identification of etiological factors that determine them. clinical characteristics and prognosis of pathology development.

For the development of the dento-jaw system is of great importance functional state muscles of the maxillofacial region, which either contribute to the normal development of the bite, or disrupt it. Artificial feeding of children in the first year of life does not create the necessary functional load. In children with this method of feeding, swallowing rather than sucking function predominates.

For the prevention of AAF associated with artificial feeding, a wide range of nipples are recommended for infants of various ages from 0 to 12 months, which mimic the mother's nipple. The shape of the nipple depends on its purpose, so for water, milk, juice, porridge they are produced differently. Special nipples are designed for feeding children with congenital pathology.

Given the different state of the muscles of the maxillofacial region during sleep and wakefulness, pacifiers are day and night. Each feeding of the child contributes to the training of chewing, facial muscles and the growth of the lower jaw in length, i.e., the formation of the physiological ratio of the jaws.

Restoration of normal muscle function is achieved with the help of special gymnastics. The principle of the prevention of AF with the help of myogymnastics is to train underdeveloped muscles, which allows you to normalize the function of the muscles of antagonists and synergists.

Gymnastic exercises for the muscles surrounding the dentition as a method of orthodontic prophylaxis were proposed by Rogers back in 1917.

Exercises are chosen taking into account the age of the child. They should not be too difficult, understandable, it is desirable to turn them into a game. Children can do gymnastics both individually and collectively, in kindergartens and schools. Control over the implementation of exercises is assigned to parents or educators and medical personnel.

A set of myogymnastic exercises

1. In case of violation of posture and for training the correct way of breathing - morning gymnastic complex;

2. To normalize swallowing:

a) the lips are closed, the teeth are clenched, the tongue is raised up - press it against the anterior part of the hard palate in the region of the dental tubercles of the upper front teeth, and then swallow the saliva;

b) the same exercise with a sip of water;

c) clatter;

d) yawning;

e) gargling;

3. Training of the circular muscle of the mouth:

a) with closed lips, puff out your cheeks, then slowly squeeze out the air with your fists through clenched lips;

b) close the lips, while preventing this with the little fingers in the corners of the mouth;

c) playing children's wind instruments;

e) exercises with devices:

Vestibular plate of Schoncher;

Dass activator;

Friel's disc (interlabial);

Manual turntable.

4. Exercises for the muscles that put forward the lower jaw:

The lower jaw is slowly moved forward to the incisal overlap;

The same with turning the head to the right, to the left.

5. Exercises for the muscles that lift the lower jaw:

The lips are closed, the teeth are compressed, increase the pressure on the teeth by contracting the masticatory muscles in the central occlusion;

The same with resistance (wand, eraser). In combination with therapeutic exercises, massage has a beneficial effect, through which

in the area of ​​the alveolar process and improperly located teeth, you can install them in the dentition if there is an appropriate place. Massage of the alveolar process in the area of ​​impacted teeth stimulates their eruption.

Examination of the dental status of children in the first year of life and during the formation of temporary and permanent occlusion is necessary for objective evaluation and specific recommendations for the prevention and early treatment of malocclusion.