Measures to ensure the prevention of dental anomalies Clinical examination of children (identify and diagnose dental anomalies, eliminate predisposing factors for their development). Determination of groups for dispensary observation and drawing up a plan of preventive and therapeutic measures (for pediatricians of all profiles of a specialized service).

Timely referral of children with formed anomalies to the doctor for treatment. Monitoring the elimination of identified causative 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.

Preventive measures should be built taking into account age periods child development preschool age child.

Prenatal and postnatal risk factors 1. Prenatal period: 1. Prenatal period: 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, attachment of frenums of the tongue, lips)

Mechanical (trauma, bruising of a pregnant woman) Chemical (alcoholism and smoking of future parents) Occupational hazards (work with varnishes, paints, chemicals) Biological (past diseases of a pregnant woman: tuberculosis, syphilis, rubella, mumps, some forms of influenza, toxoplasmosis) Mental ( stressful situations at mother)

Postnatal risk factors Violation of the correct artificial feeding of the child. Bad habits - sucking on a pacifier, fingers, tongue, cheeks, various items, wrong 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.

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. Delayed eruption of permanent teeth. The absence of three and diastema by the age of 5-6 years of the child.

Birth trauma (perinatal period) - forcible extraction 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 mandible.

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. Breathing through the mouth due to insufficient cleanliness of the nasal passages from crusts or due to partial or complete atresia.

Preventive measures: - Natural feeding - the act of sucking is a powerful stimulator for the growth of bone tissue. Proper artificial feeding (the nipple on the bottle should be of a physiological shape, be elastic, resilient, have several small holes) The optimal time for sucking 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.

The use of a "dummy" nipple - no more than 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.

The correct position of the child during sleep. A 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).

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 nipple) Rickets - lack of vitamin D Lack of hard food in the child's diet. Difficult nasal breathing.

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.

Children aged 3-6 years (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 abnormal bites. Swallowing dysfunction - infantile swallowing. Chewing dysfunction. Violation of the physiological abrasion of temporary teeth.

: Preventive measures: Regulation of respiratory function. Prevention of dental caries or its complications. Grinding of tubercles of milk teeth (especially canines) Dental prosthetics in the presence of defects in the dentition. Identification and removal of erupted supernumerary teeth.

Children 7-13 years old (period of mixed dentition) Etiological factors: Functional disorders (breathing, swallowing, chewing, speech) Delay in erasing tubercles of milk teeth. Violations in the order of change of teeth. The presence of supernumerary teeth. Low attachment of the bridle upper lip, short frenulum lower lip, tongue and small vestibule of the oral cavity. The presence of defects in posture, curvature of the spine.

: Preventive measures: Prevention of dental caries and its complications. observation of the eruption of permanent teeth (terms, sequence, quantity, symmetry, shape, position, type of closure) Removal of erupted supernumerary teeth. Restoration of destroyed crowns of the first permanent molars and / or incisors by prosthetics.

The period of emerging permanent occlusion (12-18 years), prevention 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. Treatment of maxillofacial anomalies in order to reduce their severity.

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 be an underdevelopment of the upper jaw, then the teeth of the lower jaw, protruding forward, overlap the upper one like 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, 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 influenced by bad habits baby: prolonged sucking of a pacifier, finger, tongue, cheeks, incorrect 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 it like 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 stupid 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.

The old games with children are also useful (“The magpie-crow cooked porridge ...), since the rotation of the finger in the palm of the hand massages and thereby develops the muscles of the hand and the speech of the child. The 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 pipe, 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!

1 slide

2 slide

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.

3 slide

Measures to ensure the prevention of dental anomalies clinical examination of children (identify and diagnose dental 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);

4 slide

timely referral of children with formed anomalies to the doctor for treatment; monitoring the elimination of identified causative 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.

5 slide

Preventive measures should be built taking into account the age periods of the child's development. The most favorable for the prevention of dentoalveolar anomalies is the period of active growth of the jaws associated with the formation of a milk bite, which coincides with the early preschool and preschool age of the child. During the interchangeable bite preventive actions become less efficient. In children with permanent occlusion, formed dentoalveolar anomalies are diagnosed that require labor-intensive treatment.

6 slide

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)

7 slide

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 in the mother); radiation factors

8 slide

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 objects, 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;

9 slide

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.

10 slide

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

11 slide

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;

12 slide

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

13 slide

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

14 slide

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.

15 slide

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.

16 slide

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

17 slide

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;

18 slide

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.

19 slide

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".

20 slide

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;

21 slide

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

22 slide

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.

23 slide

Children aged 3-6 years (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.

24 slide

25 slide

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 preschool (up to 3 years), preschool (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 an increase in the medical literacy of parents, pediatricians, workers of 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 gives 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 device 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.

Under prevention of dental anomalies imply a set of recreational measures to prevent and eliminate the causes of pathological factors that cause the occurrence and development of anomalies. Prevention of dental anomalies is an integral part of the overall comprehensive prevention of dental diseases.

A. I. Betelman identified four age periods in the prevention and early treatment of deformities of the masticatory system:

• 1) intrauterine;
• 2) the first year of life - lactation;
• 3) from one year to the end of the milk bite;
• 4) the period of mixed dentition.

D. A. Kalvelis, X. A. Kalamkarov singled out general and dental (local) prevention of dental anomalies. A. I. Rybakov created a comprehensive system of prevention, and G. N. Pakhomov singled out integrated system prevention primary prevention.

F. Ya. Khoroshilkina identified ten age periods for the formation of the masticatory system, taking into account its morphological, physiological and functional changes, to fulfill the main tasks of prevention. At the same time, complexes of preventive measures have been developed for each period, and responsible persons for their implementation have been identified.

In preventive work on the organization of the optimal mode of life (work, study, nutrition, rest) , the administration of enterprises, children's and medical institutions is involved in providing medical examinations (premises for examinations, equipment, etc.).

Targeted clinical examination for the prevention of anomalies is carried out by obstetricians-gynecologists, pediatricians, dentists of all profiles with active participation otolaryngologists, orthopedists, endocrinologists, speech therapists, etc.

The main preventive measures for the periods of formation of the chewing system: provision normal conditions work and life of a future mother, medical examination of a pregnant woman in a antenatal clinic, good nutrition, hygiene and sanitation of the oral cavity of a pregnant woman. After the birth of a child, it is necessary to provide rational nutrition for the mother and child, proper hygienic care, correct mode feeding and sleep, stay on fresh air, rational feeding, and if necessary - correct artificial feeding, dissection of the shortened frenulum of the tongue. In the lactation period (with the appearance of the first teeth) and up to the age of three, in addition to the previously carried out measures, they eliminate bad habits with the use of wrist and elbow bandages, conduct psychotherapy, therapeutic exercises, normalize lip closing, nasal breathing, and posture. They also observe the correct sequence of eruption of milk teeth, activate chewing (add solid food to the diet), training correct articulation. If necessary, a vestibular plate, a sling-like bandage with extraoral traction is used to retard the growth of one of the alveolar processes or the jaw. Children identified during routine examinations with dentoalveolar anomalies, impaired breathing through the nose, posture are sent for consultation and treatment to specialists. With cleft palate, multiple congenital adentia, loss of teeth, prosthetics are carried out with lamellar prostheses, fixed prophylactic devices are used.

During the period of milk bite, it is necessary to observe oral hygiene, its timely sanitation.

During the interchangeable dentition, in addition to the above measures, the sequence of eruption of permanent teeth is monitored, tubercles of milk teeth are polished off, or teeth are removed according to indications. Macrodentia, mesial shift of lateral teeth and malocclusion caused by them are revealed, crowns of permanent teeth are exposed in case of their retention, prostheses are made in case of early loss of milk teeth, crowns of destroyed permanent teeth are restored, planned oral cavity sanitation is carried out.

During the period of permanent occlusion, during scheduled examinations, diseases of the mucous membranes of the oral cavity and periodontium are detected, and patients are referred for treatment in periodontal rooms. There they carry out splinting of the dentition in periodontitis and periodontal disease, eliminate parafunctions, the usual displacement of the lower jaw, the abnormal position of individual teeth and their groups, followed by rational prosthetics.

In the prevention of dentoalveolar anomalies, the planned sanitation of the oral cavity of children and adolescents in preschool institutions, schools, secondary and higher educational institutions, as well as active sanitary and educational work among the population.

Timely and correct prevention contributes to the self-elimination of individual anomalies of the masticatory system in childhood without the use of more complex orthodontic measures.