Children’s dentistry

“Most of the malocclusions can already be found in deciduous teeth” said Professor Giuseppe Marzo, president of the Italian Society of Child Dentistry (Sioi – www.sioi.it), which he organized for Friday 8 March in Florence ‘scientific meeting “The orthodontics of the child dentist”. “The purpose of this meeting – underlines the president Sioi – is to provide an all-round update of the fascinating chapters of orthodontics of deciduous and mixed dentition with which the child dentist is confronted on a daily basis”. Italian Dental Journal met with Professor Giuseppe Marzo to discuss the topic more in depth and to take stock of the situation on the activities of the scientific society, which in 2013 will have to confirm the great participation of last year, when the quota has been exceeded. 1,000 registered members. The most important appointment for pediatric dentistry remains the Sioi national congress, scheduled for Friday 22 and Saturday 23 November in Rome.

Professor Marzo, what are the reasons for the choice that led the Sioi board of directors to investigate the topic of child dentistry orthodontics? This topic is much debated both in pediatric dentistry and in orthodontics. Pedodontics deals with all branches: conservative, endodontic, periodontology, orthodontics. And orthodontics is an important aspect in the care of young patients, because it allows for early interception of pathologies, outlining an initial diagnosis and implementing some interventions capable of guiding the stomatognathic system towards proper development.

What age group are we referring to when we talk about child orthodontics? Orthopedodontics is aimed at the child in the age of development, between 11-12 years of age. It should not be forgotten, however, that when we talk about children, the chronological age takes on a secondary meaning compared to the biological age, which is what really matters in the clinical setting. For example, there are patients in whom some treatments must be administered in advance, because they are earlier in biological development.

With others, however, the opposite reasoning applies. What are the main “bad habits” in pediatric age and their importance in the development of malocclusions? The abuse of the pacifier, which can lead to an anterior open bite or a cross bite, in some cases can also be the cause of atypical swallowing. In the case of oral breathing, it is useful to ask for a consultation with the ENT, which can confirm or deny the obstruction of the airways as a cause of the phenomenon. If there is no obstruction, we are faced with a spoiled habit and it is necessary to proceed with a re-education in physiological breathing.

What are the main parameters that need to be checked during the first orthopedic visit? Even before the child sits on the chair, it is good to observe the relationship he has with his parents and then evaluate his ability to relate to us dentists. This is an important phase of the meeting with the little patient, because it tells us a lot about what the clinical content of our intervention could be and what kind of collaboration we can expect from that child. We know that in case of treatment with removable appliances, your participation in the therapy will be essential. Starting the visit, the more general aspects must first be investigated, starting with the analysis of the child’s body development with respect to his or her age. Particularly evident situations of posture and facial asymmetry must then be highlighted and the trophism of the lips and perioral muscles assessed in relation to the type of breathing and swallowing. Once the dental age of the child has been identified, the two arches are evaluated, then the soft tissues: frenula, tongue mobility, labial competence. Also pay attention to the presence of particularly destructive caries that may have changed the normal inter-arch and between arch relationships. Oral hygiene habits are also carefully evaluated. In the analysis of the relationship between the two arches, it is worth remembering that in mixed dentition the normal and physiological relationship is that of neutral occlusion: with the exchange of the lateral sectors the relationship should reach the optimal 1st class condition. In general, however, attention must be paid to all the variables that can hinder a harmonious development of the oral cavity. The presence of diastemas in deciduous dentition in the anterior sectors, sometimes unwelcome to mothers, is instead a positive aspect, because it indicates that probably that child will not have dental crowding. If, on the other hand, the teeth are already clenched with one another or even are already crowded with deciduous dentition, dental crowding is certainly foreseeable in the future.

In case of malocclusion, is pediatric orthodontics always necessary? In genera, is the indication for orthodontics broad or limited? Giving general indications is always difficult, because each case must be evaluated in its specificity. Not all patients need to be treated orthodontically and before deciding whether a treatment is necessary it is important to evaluate all the variables of the case. However, we can certainly say that treatments at an early age, when necessary, are very important and lead to great results. The interceptive treatment, however, in this phase must not be seen as a decisive intervention, but as an interlocutory moment, with which one takes advantage while awaiting the final resolution.

In short, orthodontic treatment in children is not always necessary, but often useful. In your opinion, is the category doing well in this area? As I have often had the opportunity to point out, I believe that Italian dentistry is truly excellent and also in the pediatric field, colleagues in the area have increased their experience and expertise over the years. What remains to be done today is to insist on the concepts of prevention: both operators and the population must become aware that children must be seen very young. In fact, already in early childhood it is possible to identify the onset of an oral disease and therefore alert parents to keep the situation under control, to intervene if necessary at the appropriate time.

What are the next appointments with Sioi? After the congress in Florence, some regional events will take place, the first of which will be in Naples on March 16th. All these events will culminate in the national congress, which will be held on 22 and 23 November in Rome. We have foreseen the participation of Italian and international speakers, identifying the top experts for each area: traumatology, anesthesia, conservative surgery, etc. In the meantime, the collaboration with pediatricians continues: the agreement signed between the Italian Federation of pediatric doctors (Fimp) and the Italian Society of Child Dentistry (Sioi) provides in particular for the inclusion of a higher education course in pediatric dentistry within the mCapri Fimp Campus 2013 (Capri, 11-14 April), a course that will be held by us Sioi dentists. The goal is to complete the training of the basic pediatrician, who is in contact with the infant population, thus increasing the social impact of the prevention and interception strategies of oral diseases in young patients. Andrea Peren