Article

Auswirkungen eines Schnullers mit besonders dünnem Saugerhals auf die Okklusion im Milchgebiss – Ergebnisse einer randomisierten klinischen Studie

Authors:
  • Zahnmedizinisches Fortbildungszentrum (ZFZ) Stuttgart
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Abstract

Ziel Evaluierung der Auswirkungen eines Schnullers mit besonders dünnem Saugerhals auf die Okklusion im Milchgebiss bei Kindern mit zuvor diagnostiziertem frontal offenen Biss (FOB) und vergrößertem Overjet (horizontalem Überbiss). Methoden Durchführung einer prospektiven randomisierten klinischen Studie in der Abteilung für Präventive Zahnheilkunde und Kinderzahnheilkunde am Universitätsklinikum Jena, Deutschland. 86 Kleinkinder (Durchschnittsalter 20,3 Monate) mit Schnuller-assoziiertem offenen Biss oder Overjet von ≥2 mm wurden randomisiert einer von 3 Gruppen zugewiesen: Gruppe I (n=28), Interventionsgruppe, Umstellung auf Schnuller mit besonders dünnem Saugerhals; Gruppe II (n=30), Kontrollgruppe, Weiterverwendung des bisherigen Schnullers (konventioneller oder physiologischer Schnuller); und Gruppe III (n=28), Interventionsgruppe, Gold Standard, Abgewöhnung des Schnullers. Die Kinder wurden über einen Zeitraum von 12 Monaten beobachtet. Ergebnisse Nach 12 Monaten wurden die Daten von 63 Kindern (mit einem Durchschnittsalter von 33,1 Monaten) analysiert (I: n=24; II: n=22; III: n=17). Dabei zeigte sich zwischen den Gruppen ein signifikanter Unterschied in Bezug auf Overjet und Overbite. Kinder, die den Schnuller mit besonders dünnem Saugerhals verwendeten, hatten signifikant bessere Ergebnisse bezüglich Overjet und Overbite als Kinder mit konventionellem oder physiologischem Schnuller. Kinder, denen der Schnuller abgewöhnt worden war, wiesen die besten Messergebnisse auf. Schlussfolgerung Die Verwendung eines Schnullers mit besonders dünnem Saugerhals resultierte im Vergleich zur weiterführenden Benutzung eines konventionellen oder physiologischen Schnullers in besseren klinischen Messergebnissen für Overjet und Overbite.

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This study analyzed the occlusions of 489 children at the onset of the mixed dentition period (mean age 5.1 years, range 4.0-7.8 years). These children participate in an ongoing clinical trial that is investigating the effects of orthodontic intervention in the early mixed dentition. The aim was to report the occlusal findings at the baseline. The frequencies of mesial step, flush terminal plane, and distal step were 19.1%, 47.8%, and 33.1%, respectively. The canine relationship was Class I in 46.1%, Class II in 52.4%, and Class III in 1.5% of the sides examined. An asymmetrical canine relationship was found in 30.1% of the children, significantly more often on the right side than on the left (P <.001). Overjet ranged from -2 to +10 mm with a mean of 2.9 mm. Overbite ranged from -5 to +8 mm with a mean of 2.8 mm. Excessive (> or =4 mm) overjet was found in 26.7% and overbite in 33.8% of the children; in 15.5% of the children, both variables were 4 mm or more. Anterior crowding was detected in the maxillary arch in 11.6% and in the mandibular arch in 38.9% of the children. Girls showed mandibular crowding more often than boys (P <.01). A posterior crossbite was found in 7.5% of the children, unilaterally in 6.4% and bilaterally in 1.1%. Scissors-bite was detected in 1.1% and an anterior crossbite in 2.2% of the children. The mean maximal opening was 40.3 mm. Joint sounds were registered in 5.2% of the children. The prevalence of malocclusion was between 67.7% and 92.7%, depending on the values of unacceptable parameters used for each occlusal characteristic.
Article
The purposes of the study were to determine prospectively the duration of nonnutritive sucking behaviors of children between 1 and 8 years of age and the effect of persistent habits on selected occlusal characteristics in the late deciduous dentition. Sucking behavior data were initially collected from 797 children who were followed longitudinally from birth; the data came from periodic questionnaires completed by the parents. In addition, study models were obtained for 372 children at 4 to 5 years of age and assessed for posterior crossbite, anterior open bite, and overjet. The subjects were grouped according to the duration and type of habit (pacifier or digit, for less than 12 months or more than 48 months). Children with nonnutritive sucking of less than 12 months were further grouped according to the duration of breast-feeding. The McNemar nonparametric test was used to compare the changes in the incidence and effect of the habits with time. There was a significant (P = .001) decrease in the incidence of pacifier habits between 1 and 5 years of age, from 40% to 1%. There was a significant (P = .01) decrease in the incidence of digit habits between 1 and 4 years of age, from 31% to 12%. Between 4 and 7 years of age, the decrease in the incidence reached a plateau--ie, the decrease continued but at a slower rate. Between 7 and 8 years of age, there was an additional significant (P = .008) decrease in the incidence of digit habits, but 4% of the children were, to various extents, still sucking fingers. Children who had pacifier or digit habits lasting less than 12 months did not have significantly different occlusal characteristics than children who were breast-fed for 6 to 12 months. Prolonged pacifier and digit habits caused significant changes in the occlusal characteristics in the late deciduous dentition, and the effects of pacifier habits were different from those of digit sucking. To intercept the development of crossbites and functional shifts, the developing occlusion should be observed in the deciduous dentition in children with prolonged digit or pacifier habits. The transverse occlusal relationship, particularly in pacifier-sucking children, should be evaluated between 2 and 3 years of age. If there are interfering contacts of the deciduous canines, the parents should be instructed to reduce pacifier-sucking time, and appropriate treatment should be rendered, if required.
Article
Pacifier use and its effects on the developing cranio-facial structures has long been debated and filled with controversy. The aim of this meta-analysis is to investigate whether pacifiers have a harmful effect on the developing dentition, and if so, what those effects are and at what age they begin. The existing literature was researched using PubMed and NLM for articles published in English between Jan-Feb 1992 and Oct 2003. The search utilized the words or phrases "pacifiers," "nonnutritive sucking", "pacifiers and malocclusion", "effects ofpacifiers", and "pacifier sucking". The book Essentials of Facial Growth by Enlow and Hans was also included because of the classic research on growth and development. Several articles showed that pacifier use beyond age 3 has an increasingly harmful effect on the developing dentition. The most notable changes are an increase in the prevalence of an anterior open bite, posterior cross bite, narrow intercuspid width of the maxillary arch, and a high narrow palate. If the pacifier was used beyond the age of 5, the effects became more severe. Pacifier use is prevalent in most countries and does not alter the dentition if its use is stopped by age 2 to 3. Pacifier use beyond the age of 3 contributes to a higher incidence in anterior open bite, posterior cross bite and narrow intercuspid width. The greater the longevity and duration ofpacifier use, the greater the potential for harmful results.
Article
Most previous research on non-nutritive sucking habits has been cross-sectional in nature. This study determined the prevalence of non-nutritive sucking habits and the effects on the developing dentition within a longitudinal observational cohort. The Children in Focus group of the Avon Longitudinal Study of Pregnancy and Childhood study was studied. Questionnaire data on non-nutritive sucking habits were collected on the children at 15 months, 24 months, and 36 months of age. Dental examinations were performed on the same children at 31 months, 43 months, and 61 months of age. At 15 months, 63.2% of children had a sucking habit, 37.6% used just a dummy, and 22.8% used a digit. By 36 months, sucking had reduced to 40%, with similar prevalence of dummy and digit sucking. Both habits had effects on the developing dentition, most notably in upper labial segment alignment and the development of anterior open bites and posterior crossbites. The majority of children had non-nutritive sucking habits up until 24 months of age. Both digit and dummy sucking were associated with observed anomalies in the developing dentition, but dummy-sucking habits had the most profound influence on the anterior and posterior occlusions of the children.
Pacifier-sucking habit duration and frequency on occlusal and myofunctional alterations in preschool children
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Thumbsucking: literature review
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Johnson ED, Larson BE. Thumbsucking: literature review. ASDC J Dent Child 1993;60:385-91.