Conditions Diagnosed and Corresponding Treatments

Conditions diagnosed and corresponding treatments

1. Condition: Ankylglossia (Tongue-Tie), lip-tie

https://www.mayoclinic.org/diseases-conditions/tongue-tie/symptoms-causes/syc-20378452

Ankylglossia refers to the condition at birth, whereby the tongue’s range of motion is constricted.  An abnormally short lingual frenulum binds the floor of the mouth the base of the tip of the tongue.  Without the ability to elevate and extend the tongue, articulation and breastfeeding are impeded. With this, the positive contributions of breastfeeding can also be affected.  These include proper jaw development, range of motion and nutritional benefits etc. Feeding assessments can help differentiate between the functional and anatomical impairments of the tongue-tie.  Such assessments can then help determine whether or not surgical or nonsurgical intervention is necessary.

https://sciencebasedlife.wordpress.com/2011/06/27/its-impossible-to-swallow-your-tongue/

Treatment: Tongue-Tie Release (Lingual Frenectomy)

Traditional clipping or cutting to release infant tongue-tie can lead to bleeding.  However, many pediatric dental offices offer a minimally-invasive Waterlase Laser Frenectomy by “Biolase.”  In mild cases, it may not be diagnosed until a child has a speech impediment. So, it is important that parents take infants to the dentist at an early age (as early as 4-6 months).  Left untreated, other implications include nutritional issues, improper airway development and possibly, sleep-disordered breathing.

Further Reading/Links to Research:

• “Tongue Tie- Is it Related to Gastrointestinal Problems?”- Nyoni et al,- 2017

• https://www.bjoms.com/article/S0266-4356(17)30487-4/pdf

• “Evaluation of Patient Perceptions After Frenectomy Operations: A Comparison of Carbon Dioxide Laser and Scalpel Techniques” – Haytac et al- 2006

• https://onlinelibrary-wiley-com.proxyhu.wrlc.org/doi/abs/10.1902/jop.2006.060043

• “Conclusions: This clinical study indicates that CO2 laser treatment used for frenectomy operations provides better patient perception in terms of postoperative pain and function than that obtained by the scalpel technique. Considering the above advantages, when used correctly, the CO2 laser offers a safe, effective, acceptable, and impressive alternative for frenectomy operations” (Haytac, et al 2006) .

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• “Clinical Study of Laser Treatment for Frenectomy of Pediatric Patients”- Komori S,et al- 2017

• https://www-ncbi-nlm-nih-gov.proxyhu.wrlc.org/pmc/articles/PMC5661042/
• “Conclusion: Retrospective study of pediatric patients with frenulum abnormalities demonstrated the usefulness of the CO2 laser in performing frenectomy and offered suggestions regarding the timing of this procedure” (Komori S et al 2017)

2. Condition: Thumb-Sucking/Tongue-Thrusting

Thumb-sucking normally ends between the ages of two and four.  Once primary teeth have erupted, the negative implications of this act increase.  The constant pressure applied by thumb-sucking, during a time of rapid growth causes deformities in jaw and tooth development, thus impeding growth.  

Subsequent condition: Tongue-Thrusting

Tongue-thrusting occurs when the tongue pushes through the teeth and often causes separation of the mandibular anterior teeth.  This is most evident during speech, food consumption and when the tongue is at rest.

Treatment:

• Apparatus: Fixed Palatal Crib: this is a metal appliance that faces lingually.  The set of semicircular wires (that form the “crib) block the thumb from contacting the gums, on the lingual surface of the anterior teeth.  It will prevent the pleasure reception of thumb-sucking and eventually reduce the habit.
• Myofunctional Therapy (please refer to “Emerging Trends” Tab) .  Thumb-sucking prevents proper tongue movement, swallowing and acts of proper mastication.  Myofunctional therapy seeks to address these issues. So, a pediatric dentist may refer a thumb-sucking child to a myofunctional therapist.

3. Bottle Decay

Many factors lead to decay.  In children 2 and under, a common cause is extended exposure of deciduous teeth to sugar-containing drinks.  Too often, bottles are given to babies as pacifies or as they are laid to rest. Tooth decay can also be transferred by the passing of saliva between the caretaker and the infant (via feeding spoon or rubber pacifier).  

Treatment:

• Partial prosthetic to replace decayed anterior teeth until permanent teeth erupt
• Silver nitrate (please refer to “Emerging Trends” Tab)
• Fillings (amalgam or composite)
• Extraction
• Stainless Steel Crowns
• Veneers

Prevention:

• Promote nutritious/healthy eating
• Try to prevent the use of pacifiers.  However, if child must use a pacifier, parents should don’t dip them in honey or sugar-containing substances (for teething).
• Prevent the transfer of saliva through feeding spoons and wipe the child/infant’s gums.
• Apply fluoride toothpaste to child’s teeth.
• Avoid placing sugar-containing juices and soft drinks in bottle.  Only fill bottles with breast/formula milk.
• Oversee the child’s brushing techniques at least until age 8.

Research:

• “Lactose Cariogenicity with an Emphasis on Childhood Dental Cariees” – Aimutis et al- 2011.  (https://www.sciencedirect.com/science/article/abs/pii/S0958694611002482_
• “Early Childhood Caries- An Insight” – Kumar et al- 2010
• “Parental Awareness, Habits and Social Factors and Their Relationship Between Bottle Tooth Decay” – Febres et al, 1997

4. Premature Loss of Teeth

https://www.colgateprofessional.com/education/patient-education/topics/orthodontics/why-your-child-may-need-a-space-maintainer

Premature loss of teeth can result from trauma, decay and premature eruption of permanent teeth.  Left untreated teeth, malocclusion will occur.

Treatment: Space Maintainers

Space maintainers are custom appliances that can be fabricated by pediatric dentists (or general dentists or orthodontists) .  They can be made of acrylic or metal and can be removable or fixed (cemented into the child’s mouth). Primary teeth are vital for proper jaw bone development and associated muscular development.  They also provide positional guidance for growing permanent teeth. If the space is left unmaintained, the teeth migrate towards the open space, leading to malocclusion. Because every situation is different, consultations are required to evaluate the need for space maintainers.  

• Types of Appliances: Space maintainers can be described by their mobility (fixed or removable) or quadrant (position) in the mouth
• Mobility:
• Fixed: cannot be moved; more commonly used, cemented in place, often using bands that surround the permanent molars
• Removable: made of acrylic; clasps are used to hold the appliance in place
• Quadrant/Position: all Images https://www.roqueortholab.com/wp-content/uploads/photo-gallery/spaceman/thumb/5.jpg

Type	Condition	Description	Image
Lingual space Maintainer	More than one missing tooth	Bilateral Cemented to molars Wire connects lingual side of mandibular anterior teeth
Distal Shoe Space Maintainer	Unerupted first permanent molar	Inserted along gingival line to prevent closure of space
Unilateral Space Maintainer	One missing tooth	wire around tooth’s crown wire links crown to metal loops
Crown and Loop Space Maintainer	One missing tooth	Fabricated crown Crown is attached to a loop Crown covers the tooth surface

5. Ectodermal Dysplasia

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442425/   - images from here as well

Ectodermal Dysplasia is a genetic disorder whereby ectodermally-derived organs (ie, hair, nails, teeth, sweat glands) grow abnormally.  One such disorder that affects dentists is hypodontia. Hypodontia is the absence of one or more teeth from birth. Other associated disorders may be a reduced number of sweat glands (person will display intolerance to heat or elevated bod temperature and even fever).   Teeth number and size may be reduced. In these cases, the tooth buds of absent teeth do not form, resulting in alveolar bone hypoplasia and thus reduced vertical dimension. This leads to an aged appearance (see adjacent photograph)

Treatment: (Treatments may not occur in isolation.  A combination of the treatments, below, may be ideal).

• Removable partial prosthetics for anterior teeth
• Restoration of peg-shaped teeth by Composite Resin
• Maxillary and Mandibular overdentures: A preliminary impression is made for custom trays.  Then, final impression are made with elastomeric material. A wax rim is the used to establish ideal VDO (vertical dimension of occlusion)
• Hawley appliance to address crossbite
• Other prosthetic treatment during development

Research:

• “Dental Management of Ectodermal Dysplasia: Two Clinical Case Reports”- Hekmatfar et al- 2012

• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442425/
• Discussion:
• “The most common treatment plan is removable prosthesis. Implant-supported denture is also suggested as the ideal reconstruction modality for adolescents over 12 years” (Hekmatfar, et al 2012) .
• “Treatment of young edentulous patients with removable partial or complete denture is an acceptable, available and cost effective modality, which improves function, speech, aesthetics and psychosocial condition” (Hekmatfar, et al 2012) .

Other Conditions and Treatments

• Impacted Teeth
• Various Conditions for which Restorations are Needed
• Narrow Palates
• Fractured deciduous teeth
• Enamel hypocalcification
• Pulpotomies