It Is Necessary To Cure, And Not Just Cut Off The Inflamed Organ

It is necessary to cure, and not just cut off the inflamed organ

Malocclusion is not only an aesthetic problem. As a result of this dental pathology, many organs and systems are affected - from joints to the gastrointestinal tract. In children, the first consequences of malocclusion are diseases of the ENT organs, which, until recently, were treated mainly by surgery. Today, the view on this problem is changing.

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Malocclusion is not only an aesthetic problem. As a result of this dental pathology, many organs and systems are affected - from joints to the gastrointestinal tract. In children, the first consequences of malocclusion are diseases of the ENT organs, which, until recently, were treated mainly by surgery. Fortunately, today the view of this problem is changing.

A new study by scientists of the Federal State Budgetary Institution "Scientific and Clinical Center of Otorhinolaryngology of the FMBA of Russia" is devoted to the methods of preventing oral diseases associated with malocclusion. The Chief Researcher of the Center, an expert of the League of the Health of the Nation, Ph. D. Galina Tarasova.

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Operation or trainers

Galina Dmitrievna, how common is the problem of malocclusion?

- Malocclusion occurs in more than 70% of people. It can be both congenital and acquired - due to prolonged sucking on the nipple, finger or other objects, improper position of the head during sleep. Malocclusion is accompanied by poor posture, improper position of the tongue, high palate, problems with swallowing and speech, as well as inharmonious development of the face - forward extension of the lower jaw or oblique underdeveloped chin. In case of malocclusion, dysfunction of the muscles of the face and especially the perioral cavity develops.

What is it fraught with?

- Often, mouth breathing becomes a consequence of malocclusion, which does not allow the child to close his lips, the presence of which is evidenced by even a small gap between the lips. At the same time, the size of the nasal cavity and nasopharynx decreases, which creates a predisposition to impaired breathing through the nose and creates the impression of an increase in the pharyngeal tonsil (adenoids), which is often not actually there.

In addition, as a result of our study, we found that in case of malocclusion, dysfunction of the auditory tube develops, which can lead to exudative otitis media (fluid in the middle ear cavity) and hearing loss

At the same time, the use of our approach to the elimination of oral breathing makes it possible not to perform adenotomy (removal of adenoids) and middle ear bypass surgery. That is, surgery is not needed: elimination of disocclusion leads to the restoration of the functions of the auditory tube and the release of exudate through it from the middle ear.

What is your approach?

- If a child breathes through his mouth, this does not mean that he cannot breathe through his nose. It is possible to eliminate malocclusion and oral breathing with the help of orthodontic trainers and other devices (braces are not always necessary), special gymnastics. Trainers are a kind of mouthguard in which teeth are placed, they wear it for one hour during the day and during a night's sleep. When treating a child, several doctors are involved: otolaryngologist, orthodontist, myotherapist. And the children themselves perceive the wearing of trainers and special gymnastics as a game, they often like it.

As our study showed, after 3 months of wearing the trainer, oral breathing is eliminated, swallowing, nasal breathing is restored, the nasopharyngeal cavity expands, and the adenoid tissue makes breathing less difficult, despite the fact that it may not even decrease in absolute size. In this case, correct swallowing is formed, the cavity of the nose and nasopharynx increases (and this increases the volume of inspiration, which was shown by the objective data of the device - rhinomanometer). In addition, the supply of oxygen to the body improves, hearing is restored, speech develops faster (the correct pronunciation of sounds is quickly formed).

At what age should treatment start?

- Bite correction by trainers has the greatest effect at the age from 3 to 9 years old - the period of early mixed bite. And if parents see that the teeth or dental arches in a young child are not located correctly, then they should immediately go to the specialists. Do not trust the orthodontists who are not familiar with the trainers and say that it is too early to be treated and you have to wait 5 years. This is not true!

Adenomotomy or conservative treatment

But the increase in adenoid tissue has a number of reasons. And this disease, common in childhood, has always been associated with their removal

- There is nothing superfluous in the body, and the pharyngeal tonsil is an important immune organ. But often the doctor, seeing that the child is either often ill or has severe difficulty in nasal breathing, recommends adenomotomy. For some time after the operation, there really is relief. So, nasal breathing is restored only in 11.5% of cases. But very quickly everything returns to normal. After all, the increase in the pharyngeal tonsil does not occur by itself, but due to the inflammatory process (allergic or caused by a bacterial infection). So it is necessary to heal, and not just cut off the inflamed organ. Moreover, today there is such an opportunity - many drugs have been developed that affect the inflammatory and allergic process.

And there are situations when you still can't do without surgery?

- In rare cases, which, moreover, are associated with the fact that for a long time the parents did not go to any doctor at all, the child cannot breathe through his nose at all. And then emergency help is needed. There is also such a problem when the pharyngeal tonsil is very large in size, and a situation of sleep apnea occurs, that is, the child stops breathing. In general, the global trend is such that it is better to treat adenoids conservatively.

Vasoconstrictor drops or saline

Your other research concerns the treatment of nasal breathing difficulties in children with acute rhinosinusitis

- Yes. We carried out a study in which we compared what is more effective in eliminating difficulty in nasal breathing in acute rhinitis and rhinosinusitis in children: vasoconstrictor drops or nasal lavage with hypertonic saline solution. Comparison of xylometazoline solution and hypertonic saline sea water.

The study involved 100 children aged 6 to 14 years, with initial symptoms of acute rhinosinusitis (MS). Their condition was assessed by clinical symptoms: the amount and nature of nasal discharge, the degree of nasal congestion and difficulty in nasal breathing, the presence of cough, edema and hyperemia of the mucous membrane of the nasal cavity, as well as the results of an objective study of rhinomanometry.

The results of the study confirmed that vasoconstrictor drops initially relieve swelling of the nasal mucosa and restore nasal breathing to a greater extent than hypertonic saline solution. However, after 3 days of treatment, more persistent restoration of nasal breathing took place in patients who used saline solution, and in patients using xylometazoline, the degree of difficulty in nasal breathing increased according to rhinomanometry results. This is due to the side effect of vasoconstrictor drops, which is especially pronounced with prolonged use. The conclusion is obvious: to eliminate edema in acute respiratory infections, allergic inflammation, etc., a hypertonic saline solution should be used, and not vasoconstrictor drops, which, in addition, have many systemic side effects and contraindications.