Odborna praâce ORTODONCIE

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SpolupraÂce ortodontisty a pedostomatologa.

InterceptivnõÂ leÂcÏba.

Cooperation of orthodontist and pedodontist.

Interceptive orthodontic treatment.

*MDDr. Hana RÏehaÂcÏkovaÂ, *Doc. MUDr. PavlõÂna CÏernochovaÂ, Ph.D., **Mgr. KaterÏina LangovaÂ, Ph.D.

* Ortodonticke oddeÏlenõÂ, Stomatologicka klinikaFN u sv. Anny aLF MU v BrneÏ

* Department of Orthodontics, Clinic of Stomatology, University Hospital of St.Anne, Masaryk University Brno ** UÂstav leÂka rÏske biofyziky, LF UP Olomouc

** Department of Medical Biophysics, Medical Faculty, Palacky University Olomouc

Souhrn

CõÂlem studie bylo formou dotaznõÂkoveÂho sÏetrÏenõ zmapovat indikace, celkovy zaÂjem a zkusÏenosti s jednotlivyÂmi ortodontickyÂmi anomaÂliemi vhodnyÂmi k interceptivnõ leÂcÏbeÏ z pohledu praktickeÂho zubnõÂho leÂkarÏe. Do studie bylo zahrnuto 448 dotaznõÂkuÊ, ktere se tyÂkaly konkreÂtnõÂch ortodontickyÂch anomaÂliõÂ, vhodne doby jejich odeslaÂnõ na kon-zultaci k ortodontistovi, leÂcÏebnyÂch postupuÊ a mozÏnyÂch duÊsledkuÊ v prÏõÂpadeÏ zanedbaÂnõÂ. Na zaÂkladeÏ nasÏeho sÏetrÏenõ bylo v prevenci a profylaxi ortodontickyÂch anomaÂliõ ze strany osÏetrÏujõÂcõÂch zubnõÂch leÂkarÏuÊ zjisÏteÏno mnoho poteÏsÏu-jõÂcõÂch vyÂstupuÊ, ale zaÂrovenÏ i rÏada nedostatkuÊ(Ortodoncie 2014, 23, cÏ. 4, s. 228-234).

Abstract

The purpose of the questionnaire survey was to map the indications, overall demand, and experience with in-dividual orthodontic anomalies suitable for interceptive treatment from the viewpoint of a general dentist. The survey included 448 questionnaires focused on specific orthodontic anomalies, appropriate time of the first con-sultation with an orthodontist, therapeutic approaches, and possible consequences due to neglect. Our study brought about a number of satisfying outcomes regarding prevention and prophylaxis of orthodontic anomalies provided by general dentists, however, we also found some deficiencies(Ortodoncie 2014, 23, No. 4, p. 228-234). KlõÂcÏova slova:Interceptivnõ leÂcÏba, ortodonticke anomaÂlie, spolupraÂce ortodontisty a pedostomatologa Key-words:Interceptive treatment, orthodontic anomalies, cooperation of orthodontist and pedodontist

UÂvod

InterceptivnõÂleÂcÏba,tedyleÂcÏbazahaÂjenaÂvdocÏasneÂm cÏi smõÂsÏeneÂm chrupu, je staÂle velmi kontroverznõ teÂma av odborne literaturÏe se muÊzÏeme setkat se dveÏmaodlisÏnyÂmi naÂzory natuto problematiku. CÏaÂst leÂka rÏuÊ za -staÂva naÂzor, zÏe jsou ortodonticke anomaÂlie, u nichzÏ je vhodne zapocÏõÂt leÂcÏbu jizÏ v docÏasneÂm cÏi smõÂsÏeneÂm chrupu. CõÂlem takove leÂcÏby je uÂprava existujõÂcõ nebo vyvõÂjejõÂcõ se odchylky acelkove zlepsÏenõ funkce orofa-ciaÂlnõÂho komplexu jesÏteÏ prÏed prorÏezaÂnõÂm staÂle dentice [1]. NeÏktere brzke intervence zabranÏujõ rozvoji

anomaÂ-Introduction

Interceptive treatment, i.e. treatment commenced in deciduous or mixed dentition, has been a rather con-troversial issue. There exist two contrary views in the literature. One view believes that there are orthodontic anomalies which should be solved as early as in deci-duous or mixed dentition. The purpose of such treat-ment is to solve already existing or developing anoma-lies, and to improve the function of orofacial complex before permanent teeth erupt [1]. Some early interven-tions prevent an anomaly development. However, we

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lie, ale je nutne pocÏõÂtat s tõÂm, zÏe veÏtsÏinaprÏõÂpaduÊ bude vyzÏadovat jesÏteÏ naÂslednou, druhou faÂzi leÂcÏby beÏhem dospõÂvaÂnõÂ. VhodneÏ na cÏasovana leÂcÏbatedy muÊzÏe snõÂzÏit zaÂva zÏnost probleÂmu, ale neeliminuje potrÏebu dalsÏõ ko-rekce ve staÂleÂm chrupu [2]. LeÂka rÏi, kterÏõ interceptivnõ leÂcÏbu nepodporujõÂ, varujõÂ, zÏe dvoufaÂzova leÂcÏba muÊzÏe zbytecÏneÏ veÂst k vycÏerpaÂnõ spolupraÂce pacienta i jeho rodicÏuÊ, k prodlouzÏenõ celkove doby leÂcÏby azvyÂsÏeneÂmu riziku posÏkozenõ tkaÂnõÂ.

DuÊlezÏityÂm aspektem uÂspeÏsÏne ortodonticke leÂcÏby je vzaÂjemna spolupraÂce ortodontisty apedostomato-loga. Prakticky zubnõ leÂka rÏ cÏi pedostomatolog by meÏl zajistit nejen pecÏlivou sanaci chrupu deÏtskeÂho pa -cienta, ale i depistaÂzÏ jednotlivyÂch ortodontickyÂch ano-maÂliõÂ. V prÏõÂpadeÏ zjisÏteÏnõ jakeÂkoliv odchylky od fyziolo-gickeÂho vyÂvoje, by meÏl zubnõ leÂka rÏ dõÂteÏ vcÏas odeslat na konzultaci na specializovane ortodonticke pracovi-sÏteÏ azpeÏtneÏ se o vyÂsledek teÂto konzultace zajõÂmat [3, 4]. Prvnõ seznam znakuÊ, naktere by se meÏl zubnõ leÂka rÏ beÏhem preventivnõ prohlõÂdky zameÏrÏit, byl vytvorÏen na celostaÂtnõÂm sjezdu vsÏech vedoucõÂch ortodontickyÂch pracovisÏt' v roce 1957 ve Svratce. Tato smeÏrnice, tzv. Svratecky program, obsahuje 9 zaÂkladnõÂch boduÊ [5, 6]. Mezi anomaÂlie, ktere by nemeÏly byÂt v deÏtskeÂm veÏku prÏehlõÂzÏeny, muÊzÏeme podle odborne literatury zarÏadit zkrÏõÂzÏeny skus s nucenyÂm vedenõÂm, zaÂkus aobraÂceny skus, prÏevisly skus, otevrÏeny skus, zlozvyky, vyÂraznou protruzi hornõÂch rÏezaÂkuÊ, primaÂrnõ steÏsnaÂnõÂ, prÏedcÏasne ztraÂty docÏasnyÂch zubuÊ, vyÂrazne diastema a poruchy erupce zubuÊ (hlavneÏ retence) [7, 8, 9, 10, 11].

MateriaÂl a metodika

DotaznõÂkove sÏetrÏenõ bylo zameÏrÏeno naprakticke zubnõ leÂka rÏe, jejichzÏ alesponÏ minimaÂlnõ procento klien-tely tvorÏõ deÏtsÏtõ pacienti. Osloveni byli zubnõ leÂka rÏi ze vsÏech krajuÊ CÏeske republiky. PozÏaÂdaÂno o spolupraÂci prÏi vyplneÏnõ dotaznõÂkuÊ bylo 1150 zubnõÂch leÂka rÏuÊ, tedy 14,5 % z celkoveÂho pocÏtu leÂka rÏuÊ, kteryÂch bylo ke konci roku 2013 dle RocÏenky LKS [12] evidovaÂno 7931. Cel-kovy soubor spraÂvneÏ vyplneÏnyÂch astatisticky pouzÏi-telnyÂch dotaznõÂkuÊ v konecÏneÂm soucÏtu tvorÏil 448 dota-znõÂkuÊ, naÂvratnost dotaznõÂkuÊ cÏinõ 36 %. DotaznõÂk obsa-hoval 24 otaÂzek, naktere zubnõ leÂka rÏi odpovõÂdali zcela anonymneÏ. U neÏkteryÂch z otaÂzek, bylo mozÏne zvolit võÂce odpoveÏdõÂ. DotaznõÂk byl vytvorÏen v programu Google Chrome ana sledneÏ s pruÊvodnõÂm dopisem elektronicky rozeslaÂn nana hodneÏ vybrane emailove adresy zubnõÂch leÂka rÏuÊ ze vsÏech 14 krajuÊ CÏeske repu-bliky. SbeÏr dat probeÏhl v obdobõ od zacÏaÂtku cÏervence 2013 do konce listopadu 2013.

KromeÏ zaÂkladnõÂho zpracovaÂnõ do tabulek a grafuÊ, byly z nejzajõÂmaveÏjsÏõÂch odpoveÏdõ vybraÂny a naÂsledneÏ statisticky vyhodnoceny neÏktere hypoteÂzy. Ke stati-stickeÂmu zpracovaÂnõ byl pouzÏit statisticky software

should take into account that in majority of patients there will be required the second phase of treatment during their adolescence. Well timed treatment thus may lower the problem severity, but it does not elimi-nate the need for intervention in permanent dentition [2]. The other view warns that a two-phased treatment may result in the exhaustion of both patients and their parents, in the prolongation of the treatment time, and in higher risk of tissue damage.

The cooperation of orthodontist and pedodontist is an important aspect influencing the success of ortho-dontic treatment. General dentist or pedodontist should provide not only proper care of a children den-tition, but also screening of individual orthodontic ano-malies. In case of any deviation from physiological de-velopment, the child should be sent to orthodontic sur-gery in time, and the dentist should be provided the feedback [3,4]. The first list of traits that should be the focus of any routine check-up was set up in the na-tional meeting of heads of orthodontic departments in Svratka in 1957. The directive, the so-called Svratka Programme (Svratecky program) included 9 basic po-ints [5, 6].

Among the anomalies that should not be neglected in children there are crossbite with forced bite, anterior crossbite and reversed occlusion, cover bite, open bite, bad habits, strong protrusion of upper incisors, primary crowding, premature loss of temporary teeth, distinctive diastema, and problems in teeth eruption (especially impaction) [7, 8, 9, 10, 11].

Material and methods

The questionnaire survey focused on dentists with aproportion of children among their clients. Dentists from all regions of the Czech Republic were addressed. We asked for cooperation 1150 dentists, i.e. 14.5% of all the dentists listed in LKS Statistical Yearbook of 2013 [12]; the total number of dentists was 7931 at that time. The sample of correctly filled in and statistically usable questionnaires included 448 forms, i.e. 36% of que-stionnaires were returned. There were 24 questions to be replied anonymously. In some questions it was po-ssible to choose more options. The questionnaire was created in Google Chrome, and together with a cover letter it was sent via e-mail to randomly chosen addres-ses of dentists from the 14 regions of the Czech Repu-blic. The data were collected from the beginning of July 2013 till the end of November 2013.

The answers were processed and summed up in form of tables and charts; the most interesting replies were chosen and there were statistically evaluated some hypotheses based on the answers. Statistic software SPSS, version 15, SPSS Inc. Chicago USA was used. Charts were made in Microsoft Excel 2010.

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SPSS verze 15, SPSS Inc. Chicago USA. Grafy byly vy-tvorÏeny v programu Microsoft Excel 2010.

VyÂsledky

U 172 leÂka rÏuÊ (39,1 %) tvorÏõÂ deÏti 11 - 30 % klientely a55 leÂka rÏuÊ (12,5 %) odpoveÏdeÏlo, zÏe deÏti v jejich praxõÂch zastupujõÂ võÂce nezÏ 30 % klientely (Obr. 1).

BeÏhem preventivnõÂch prohlõÂdek sleduje ortodon-ticke anomaÂlie 96,2 % leÂka rÏuÊ, pouhyÂch 2,3 % leÂka rÏuÊ sleduje ortodonticke anomaÂlie neÏkdy a1,7 % leÂka rÏuÊ tuto problematiku prÏehlõÂzÏõ uÂplneÏ.

Naprosta veÏtsÏinazubnõÂch leÂka rÏuÊ (99,5 %) ma v do-stupne vzdaÂlenosti (30 km) mozÏnost konzultace cÏi odeslaÂnõ dõÂteÏte naortodonticke pracovisÏteÏ.

NaotaÂzku, zdazubnõÂ leÂka rÏi u dõÂteÏte zhotovujõÂ z pro-fylaktickyÂch duÊvoduÊ OPG odpoveÏdeÏlo 436 leÂka rÏuÊ, z toho 100 leÂka rÏuÊ (22,3 % ) odpoveÏdeÏlo, zÏe ano a zaÂro-venÏ uvedli veÏk, ve ktereÂm zhotovenõÂ rentgenu indikujõÂ. DalsÏõÂch 285 leÂka rÏuÊ (65,4 %) zhotovuje OPG pouze v prÏõÂ-padeÏ, kdy je to pro dõÂteÏ prÏõÂnosem a51 leÂka rÏuÊ (11,4 %) OPG z profylaktickyÂch duÊvoduÊ nezhotovuje vuÊbec (Obr. 2).

MozÏnost uvedenõ veÏku dõÂteÏte, ve ktereÂm zubnõ leÂka rÏi nejcÏasteÏji indikujõ zhotovenõ OPG, vyuzÏilo celkem 100 leÂka rÏuÊ, z cÏehozÏ 41 leÂka rÏuÊ (41 %) zadalo veÏk 6 let dõÂteÏte, 15 leÂka rÏuÊ (15 %) odpoveÏdeÏlo, zÏe OPG zhotovujõÂv 7 av 8 letech dõÂteÏte a 9 leÂka rÏuÊ (9 %) OPG indikuje v 10 letech av 9 letech dõÂteÏte. JizÏ v 5 letech dõÂteÏte nechaÂva OPG zhotovit 5 leÂka rÏuÊ (5 %) adalsÏõÂch 5 leÂka rÏuÊ (5 %) pote zhotovuje OPG azÏ ve 12 letech dõÂteÏte. Pouze 1 leÂka rÏ (1 %) uvedl, zÏe OPG zhotovuje azÏ v 15 letech (Obr. 3). NaotaÂzku, zdazubnõ leÂka rÏi vysÏetrÏujõ palpacõ prÏõÂtom-nost hornõÂch sÏpicÏaÂkuÊ, odpoveÏdeÏlo celkem 420 leÂka rÏuÊ, z toho 229 leÂka rÏuÊ (54,5 % ) povazÏuje toto vysÏetrÏenõ za soucÏaÂst preventivnõ prohlõÂdky a191 leÂka rÏuÊ (45,5 %) leÂ-karÏuÊ uvedlo, zÏe prÏõÂtomnost sÏpicÏaÂkuÊ nevysÏetrÏujõÂ.

Naota zku, kdy zubnõ leÂka rÏi odesõÂlajõ deÏtskeÂho pa -cientase zkrÏõÂzÏenyÂm skusem anucenyÂm vedenõÂm na konzultaci k ortodontistovi, naprosta veÏtsÏinaz leÂka rÏuÊ (393 leÂka rÏuÊ, 87,7 %) uvedla, zÏe odesõÂla jizÏ v docÏasneÂm

Results

In 172 dentists (39.1%) the proportion of children-clients is between 11-30%; in 55 dentists (12.5%) the proportion of child patients is more than 30% (Fig.1).

During routine check-ups 96.2% of dentists moni-tor orthodontic anomalies regularly, 2.3% sometimes, and 1.7% of dentists do not pay attention to orthodon-tic problems at all.

Most dentists (99.5%) can send a child patient to orthodontic practice that is within reach (30 km).

The question whether dentists make OPG in their child clients for prophylactic reasons was answered by 436 respondents. 100 dentists (22.3%) answered in positive and gave the age when they indicate OPG. 285 dentists (65.4%) make OPG only if a child benefits from it. 51 dentists (11.4%) do not make OPG for prophylactic reasons (Fig. 2).

100 respondents gave also the age of a child in which they usually indicate OPG: 41 dentists (41%) stated 6 years, 15 (15%) 7 and 8 years, 9 dentists (9%) indicated OPG at the age of 10 and 9, respecti-vely. 5 (5%) respondents indicated OPG as early as in 5 year olds, and 5 dentists (5%) made the second OPG at the age of 12. Only one respondent (1%) made OPG as late as at the age of 15 (Fig. 3).

The question whether dentists make palpation exa-mination of upper canines presence was answered by Obr. 1.ProcentuaÂlnõ zastoupenõ deÏtske klientely

Fig. 1.Proportion of children within dentists' clientele Obr. 2.Fig. 2.OPG takingZhotovenõÂ OPG

Obr. 3.ZhotovenõÂ OPG podle veÏku pacienta

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cÏi smõÂsÏeneÂm chrupu apouhyÂch 41 leÂka rÏuÊ (9,4 %) tento probleÂm rÏesÏõÂ a zÏ po prorÏezaÂnõÂ staÂleÂho chrupu.

Jako nejcÏasteÏjsÏõ jednotlivy duÊvod pro odeslaÂnõ dõÂ-teÏte s vyÂraznou protruznõ vadou na konzultaci, leÂka rÏi uvaÂdeÏli prÏõÂtomnost hlubokeÂho skusu (275 leÂka rÏuÊ, 64 %), daÂle duÊvody esteticke cÏi psychologicke (230 leÂ-karÏuÊ, 53,5 %), zveÏtsÏeny incizaÂlnõ schuÊdek (137 leÂka rÏuÊ, 31,9 %), prevence traumatu (112 leÂka rÏuÊ, 26 %) cÏi duÊ-vod foneticky (79 leÂka rÏuÊ, 18,4 %) (Obr. 4).

V prÏõÂpadeÏ zjisÏteÏnõ otevrÏeneÂho skusu, z jednotlivyÂch postupuÊ 333 leÂka rÏuÊ (76,2 %) nejcÏasteÏji volilo variantu, zÏe sledujõÂ, zdanenõÂduÊvodem prÏõÂtomny zlozvyk. Ostatnõ mozÏne postupy jsou uvedeny v Obr. 5.

Naota zku, jak zubnõ leÂka rÏi postupujõ u pacienta s prÏevislyÂm skusem, naprosta veÏtsÏinaleÂka rÏuÊ (371 leÂ-karÏuÊ, 85,9 %) odpoveÏdeÏla , zÏe odesõÂla nakonzultaci k ortodontistovi jizÏ ve smõÂsÏeneÂm chrupu. PouhyÂch 61 leÂka rÏuÊ (14,1 %) nepovazÏuje zanutne tuto anomaÂlii ode-slat na konzultaci k ortodontistovi.

NaotaÂzku, zdazubnõ leÂka rÏi navsÏteÏvujõ odborne orto-donticke kurzy cÏi prÏednaÂsÏky, 284 z nich (65 %) uvedlo, zÏe neÏkdy, 98 leÂka rÏuÊ (22,4 %) takove kurzy nenavsÏteÏ-vuje a55 leÂka rÏuÊ (12,6 %) se o odbornou ortodontickou teÂmatiku zajõÂma aktivneÏ.

Diskuse

VzaÂjemna spolupraÂce obou stomatologickyÂch obo-ruÊ ortodoncie apedostomatologie je pro uÂspeÏsÏnou profylaxi, zachycenõ a prÏõÂpadnou leÂcÏbu ortodontickyÂch anomaÂliõ naprosto nezbytnaÂ. VhodnyÂm prÏedpokladem tohoto uÂspeÏchu je i ochotaobou oboruÊ zajõÂmat se nejen o sve primaÂrnõ zameÏrÏenõÂ, ale i o nove metody, po-stupy aproblematiku jinyÂch stomatologickyÂch odveÏtvõÂ. PoteÏsÏujõÂcõ je, zÏe 65 % leÂka rÏuÊ odpovõÂdajõÂcõÂch na otaÂzku, zda se zajõÂmajõ a navsÏteÏvujõ kurzy s ortodontickou teÂ-matikou, odpoveÏdeÏlo, zÏe neÏkdy ano.

Podstatnou podmõÂnkou spolupraÂce je dostupnost ortodonticke peÂcÏe v dane oblasti. Na otaÂzku, zdamajõ zubnõ leÂka rÏi mozÏnost odesõÂlaÂnõ akonzultace s ortodonti-stou maximaÂlneÏ do vzdaÂlenosti 30 km, 99,5 % leÂkarÏuÊ odpoveÏdeÏlo, zÏe ano. Stejny vyÂsledek prezentovala

Kli-420 dentists. 229 respondents (54.5%) consider the examination an integral part of a routine check-up, 191 respondents (45.5%) said they did not check the canines presence.

The question whether dentists send achild patient with crossbite and forced bite to orthodontic practice was answered as follows: majority of them (393, i.e. 87.7%) send children even with deciduous or mixed dentition to an orthodontic department. Only 41 den-tists (9.4%) deal with the problem only after permanent dentition erupts.

Among the most frequent reasons for orthodontic consultation in case of children with strong protrusion are the following: deep bite (257 dentists, i.e. 64%), esthetic and/or psychological reasons (230 dentists, i.e. 53.5%), increased overjet (137 dentists, i.e. 31.9%), trauma prevention (112 dentists, i.e. 26%), or phonetic problems (79 dentists, i.e. 18.4%) (Fig. 4). In case of open bite, 333 dentists (76.2%) observed whether a bad habit is the reason for the anomaly. Ot-her approaches are given in Fig. 5.

Majority of dentists (371, i.e. 85.9%) said that pa-tients with cover bite are sent to orthodontic practice as early as in mixed dentition. Only 61 respondents (14.1%) do not consider the orthodontic consultation necessary.

The question whether dentists attend orthodontic workshops or lectures was answered as follows: 284 dentists (65%) sometimes, 98 dentists (22.4%) never, 55 dentists (12.6%) take active part in instructions on orthodontic problems.

Discussion

Cooperation of orthodontist a pedodontist is ne-cessary for succesful prophylaxis, timely detection and possible treatment of orthodontic anomalies. Both areas orthodontics as well as pediatric dentistry -should be interested not only in their primary focus, Obr. 4.VyÂskyt nejcÏasteÏjsÏõÂch duÊvoduÊ k odeslaÂnõÂ pacienta s vyÂraznou

protruzõ hornõÂch rÏezaÂkuÊ na konzultaci. a) fonetickyÂ; b) prevence trau-matu; c) zveÏtsÏeny inicizaÂlnõ schuÊdek; d) esteticky cÏi psychologickyÂ; e) prÏõÂtomnost hlubokeÂho skusu

Fig. 4.The most frequent reasons for orthodontic consultation in pa-tients with strong protruded upper incisors; a) fonetic problems; b) trauma prevention; c) increased overjet; d) esthetic and/or psycho-logical reasons; e) deep bite

Obr. 5.VyÂskyt postupuÊ u dõÂteÏte s otevrÏenyÂm skusem. a) s odeslaÂnõÂm nakonzultaci k ortodontistovi vycÏkaÂvaÂm do obdobõ staÂleÂho chrupu; b) povazÏuji zanutne leÂcÏit co nejdrÏõÂve aodesõÂla m ihned po zjisÏteÏnõ k ortodontistovi; c) sleduji, zdase stejnaÂanomaÂlie nevyskytuje i u ro-dicÏuÊ; d) odesõÂlaÂm nakonzultaci; e) sleduji, zdanenõ duÊvodem prÏõÂ-tomny zlozvyk

Fig. 5.Way of management in children with open bite. a) I wait till per-manent dentition to send to orthodontist; b) I consider to treat early and I send immediately to orthodontist; c) I follow if the same ano-maly is in parents; d) I send to consultation; e) I observe whether a bad habit is the reason

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mesÏova [4]. NazaÂkladeÏ jejõÂho dotaznõÂku ma ortodontistu v dostupne vzdaÂlenosti (20 km) 94 % dotaÂzanyÂch leÂka rÏuÊ. V dotaznõÂku naÂs zajõÂmalo, jake je procentuaÂlnõ za-stoupenõ deÏtske klientely v praxõÂch zubnõÂch leÂka rÏuÊ. Z vyÂsledkuÊ sÏetrÏenõ lze konstatovat, zÏe u nejveÏtsÏõÂho po-cÏtu odpovõÂdajõÂcõÂch leÂka rÏuÊ (172 leÂka rÏuÊ) tvorÏõ deÏti maxi-maÂlneÏ trÏetinu klientely. TeÂmeÏrÏ stejny pocÏet leÂka rÏuÊ (147) ma zastoupenõÂdeÏtske klientely pouhyÂch 6 - 10 %. KontroverznõÂm teÂmatem je, zda u deÏtõ z profylaktic-kyÂch duÊvoduÊ nechaÂvat zhotovit rentgen OPG cÏi takto cÏinit pouze v prÏõÂpadeÏ podezrÏenõ naurcÏitou odchylku. Natuto otaÂzku v dotaznõÂku veÏtsÏinaleÂka rÏuÊ (285) odpo-veÏdeÏla , zÏe OPG zhotovuje pouze, je-li to pro dõÂteÏ prÏõÂno-sem, 100 leÂka rÏuÊ, kterÏõ zhotovujõ OPG z profylaktickyÂch duÊvoduÊ, zaÂrovenÏ uvedlo veÏk dõÂteÏte. NejcÏasteÏji zubnõ leÂ-karÏi zhotovujõ OPG z profylaktickyÂch duÊvoduÊ u deÏtõ ve veÏku mezi 6 - 8 lety. Stejnou otaÂzkou se ve sve ate-stacÏnõ praÂci zabyÂvala i KlimesÏova [4]. Z vyÂsledkuÊ jejõÂho dotaznõÂkoveÂho sÏetrÏenõ vyplyÂvaÂ, zÏe 22,8 % leÂka rÏuÊ zho-tovuje OPG v prvnõ faÂzi vyÂmeÏny chrupu, 17,9 % leÂka rÏuÊ takto cÏinõ ve 2. faÂzi smõÂsÏeneÂho chrupu acelkem 50 % leÂka rÏuÊ zhotovuje OPG pouze v prÏõÂpadeÏ, zÏe ma dõÂteÏ neÏj-aky probleÂm.

DalsÏõ anomaÂliõÂ, kterou je nutne vcÏas odhalit a leÂcÏit je retence staÂlyÂch rÏezaÂkuÊ a sÏpicÏaÂkuÊ. Dle neÏkolikastudiõÂ, bylo chybeÏnõ cÏi retence hornõÂho rÏezaÂku uvaÂdeÏno jako vyÂznamny faktor v porusÏenõ zubnõ aoblicÏejove estetiky ajako prÏispõÂvajõÂcõ faktor k poruchaÂm rÏecÏi [13]. CõÂlem vcÏasne leÂcÏby retinovaneÂho rÏezaÂku je eliminace funkcÏ-nõÂch aestetickyÂch probleÂmuÊ, zpuÊsobenyÂch neprorÏeza-nyÂm zubem [14]. PonechaÂnõ retinovaneÂho sÏpicÏaÂku bez leÂcÏby cÏi jineÂho, i kdyby kompromisnõÂho rÏesÏenõÂ, muÊzÏe zpuÊsobit rÏadu komplikacõÂ. Zubnõ leÂka rÏ by meÏl sledovat symetrii prorÏezaÂvaÂnõ anaerupci druhostranneÂho zubu vycÏkaÂvat maximaÂlneÏ 3 - 6 meÏsõÂcuÊ. V 9 letech veÏku dõÂ-teÏte by meÏla byÂt nedõÂlnou soucÏaÂstõ preventivnõ pro-hlõÂdky palpace prÏõÂtomnosti symetrickeÂho vyklenutõ al-veolu v hornõÂm vestibulu. Z celkoveÂho pocÏtu odpovõÂda-jõÂcõÂch leÂka rÏuÊ jich 229 (54,5 % ) prÏõÂtomnost sÏpicÏaÂkuÊ vysÏetrÏuje a191 leÂka rÏuÊ (45,5 %) nikoliv.

Mnoho otaÂzek v dotaznõÂku bylo zameÏrÏeno nakon-kreÂtnõÂanomaÂlie. ZkrÏõÂzÏeny skus s nucenyÂm vedenõÂm pa-trÏõ mezi anomaÂlie, u kteryÂch se doporucÏuje zahaÂjit leÂcÏbu co nejdrÏõÂve. Mezi mozÏne duÊsledky neleÂcÏeneÂho zkrÏõÂzÏeneÂho skusu patrÏõ naprÏõÂklad posturaÂlnõ probleÂmy, trvaly posun dolnõ cÏelisti v duÊsledku asymetricke sva-love aktivity cÏi muÊzÏe mõÂt trvaly dopad na ruÊst a vyÂvoj zubuÊ a cÏelistõ anaÂsledne asymetrie [15, 16]. VeÏtsÏinaleÂ-karÏuÊ povazÏuje (87,7 %) zanutne odeslat a rÏesÏit tuto anomaÂlii jizÏ v docÏasneÂm cÏi smõÂsÏeneÂm chrupu. Ostatnõ leÂka rÏi (41, 9,2 %) sdõÂlejõ naÂzor, zÏe tuto anomaÂlii postacÏõ odeslat a leÂcÏit a zÏ po prorÏezaÂnõ staÂleÂho chrupu.

V prÏõÂpadeÏ ponechaÂnõÂ protruze hornõÂch rÏezaÂkuÊ bez zaÂsahu se mohou vyskytnout fonetickeÂ, funkcÏnõÂ cÏi

pa-but also in new methods, approaches and problems of other areas of dentistry. The positive outcome is that 65% of dentists are interested and sometimes take part in workshops, etc., focused on orthodontic is-sues.

The important condition of cooperation is the avai-lability of orthodontic care in the given locality. 99.5% of respondents stated that an orthodontic prac-tice is within 30 km from their office. The same result was reported by KlimesÏova [4]: 94% of respondents had an orthodontic practice within 20 km from their office.

We asked about the proportion of child clients in dentists' offices. In most respondents (172) the pro-portion was up to one third. Almost the same number of respondents (147) gave 6-10%.

There is acontroversy in whether to take OPG for prophylactic reasons or whether to take it only when there is an anomaly suspected. Most respondents (285) opt for OPG only in case a child benefits from it; 100 dentists taking OPG for prophylaxis gave the age of the child patients - the most frequent being 6-8 years. The same problem was solved by KlimesÏova in her postgraduate diploma dissertation [4]. Her fin-dings are the following: 22.8% of dentists take OPG during the first phase of dentition change, 17.9% du-ring the second phase of mixed dentition, and 50% of dentists decide for OPG only in case a child patient has a problem.

Another anomaly requiring timely detection and treatment is impaction of permanent incisors and cani-nes. Several studies cite missing upper incisor as the important factor disturbing dental as well as facial esthetics, and as the factor contributing to impaired speech [13]. The aim of timely treatment of impacted incisors is to eliminate emotional involvement of the child due to functional and esthetic problems caused by amissing tooth [14]. To neglect the condition may result in anumber of complications. A dentist should observe symmetry of teeth eruption and wait for the eruption of the opposite counterpart for the maximum of 3-6 months. In nine year olds the palpation of sym-metric convexity of upper alveolus should be an inte-gral part of a routine check-up. 229 respondents (54.5%) examine the canines presence, 191 (45.5%) do not make this examination.

A number of questions focused on individual ano-malies. Lateral crossbite with forced bite belongs to anomalies that should be treated as early as possible. The consequence of neglected crossbite include po-stural problems, permanent shift of the mandible due to asymmetry of muscles activity, permanent impact on teeth and jaws growth and development, and the resulting asymmetry [15,16]. Majority of dentists

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rodontologicke probleÂmy. DaÂle je nutne myslet napsy-chologicky aesteticky aspekt teÂto anomaÂlie. Velmi podstatnyÂm duÊvodem k leÂcÏbeÏ pote muÊzÏe byÂt i nebez-pecÏõ uÂrazu vykloneÏnyÂch rÏezaÂkuÊ. DõÂteÏ s vyÂraznou pro-truzõ rÏezaÂkuÊ je k ortodontistovi praktickyÂm zubnõÂm leÂ-karÏem odesõÂlaÂno hlavneÏ z duÊvodu hlubokeÂho skusu a z duÊvodu estetickeÂho apsychickeÂho dopadu teÂto anomaÂlie nadõÂteÏ (Obr. 4).

PonechaÂnõ otevrÏeneÂho skusu bez leÂcÏby s sebou nese mnoha rizikav podobeÏ mozÏnyÂch budoucõÂch zÏvyÂ-kacõÂch a fonacÏnõÂch probleÂmuÊ, estetickyÂch probleÂmuÊ cÏi v dopadu na sebeveÏdomõ pacienta [17]. DyÂchaÂnõ uÂsty prÏi stavu neustaÂle otevrÏenyÂch uÂst, muÊzÏe daÂle zpuÊsobit onemocneÏnõ krku cÏi zaÂneÏty hltanu. VeÏtsÏinaleÂka rÏuÊ (76,2 %) se shodla, zÏe u teÂto anomaÂlie je nutne paÂtrat po mozÏneÂm zlozvyku azaÂrovenÏ odeslat dõÂteÏ nakonzul-taci na ortodoncii (Obr. 5).

PrÏevisly skus Angle definoval jako distaÂlnõ polohu dolnõ cÏelisti, nedostatecÏny vertikaÂlnõ ruÊst oblasti pod nosem aexcesivnõ hloubku skusu. V takoveÂm prÏõÂpadeÏ stolicÏky nemohou dostatecÏneÏ prorÏezat do sve nor-maÂlnõ deÂlky, dolnõ rÏezaÂky pote mohou prÏijõÂt do styku s gingivou napatrÏe ainciznõ hrany hornõÂch rÏezaÂkuÊ prÏesahujõ gingivaÂlnõ hranici rÏezaÂkuÊ dolnõÂch [18]. U pa-cientamuÊzÏe dochaÂzet k patologickeÂmu zranÏovaÂnõ uÂponu gingivy u dolnõÂch frontaÂlnõÂch zubuÊ a na sledneÏ k ruÊznyÂm parodontopatiõÂm a chronickyÂm zaÂneÏtuÊm [19]. VeÏtsÏinazubnõÂch leÂka rÏuÊ (83 %) povazÏuje zanutne leÂcÏit tuto anomaÂlii jizÏ ve smõÂsÏeneÂm chrupu.

ZaÂveÏr

NazaÂkladeÏ na sÏeho sÏetrÏenõ bylo zjisÏteÏno neÏkolik za-jõÂmavyÂch skutecÏnostõÂ. NaprÏõÂklad rentgenove vysÏetrÏenõ ve smyslu OPG mnoho leÂka rÏuÊ indikuje pouze v prÏõÂpadeÏ, zÏe ma podezrÏenõ namozÏnou odchylku cÏi problematika vysÏetrÏovaÂnõ prÏõÂtomnosti sÏpicÏaÂkuÊ v hornõÂm vestibulu, ktere nebyÂva rutinnõ soucÏaÂstõ preventivnõ prohlõÂdky dõÂ-teÏte ve veÏku okolo 9. roku. PozitivnõÂje, zÏe veÏtsÏinaleÂka rÏuÊ vzÏdy beÏhem vysÏetrÏenõ sleduje i ortodonticke anomaÂlie. Mnoho leÂka rÏuÊ si uveÏdomuje maximaÂlnõ cÏasovy odstup pro vycÏkaÂvaÂnõ v prÏõÂpadeÏ neprorÏezaÂnõ druhostranneÂho zubu. PrÏi prÏedcÏasnyÂch ztraÂtaÂch docÏasnyÂch molaÂruÊ cÏi sÏpicÏaÂkuÊ, leÂka rÏi znajõ riziko posunu sousednõÂch zubuÊ do mezery cÏi mozÏny prÏesun strÏedu zubnõÂho oblouku.

VzaÂjemna spolupraÂce nejen stomatologickyÂch obo-ruÊ je pro zdravy vyÂvoj aplnou funkci zÏvyÂkacõÂho sy-steÂmu dõÂteÏte nezastupitelnaÂ. DeÏti jsou nedõÂlnou sou-cÏaÂstõ populace, je trÏebase jejich specifickyÂmi pro-bleÂmy zabyÂvat v plneÂm rozsahu a vcÏasnyÂm zaÂchytem ortodontickyÂch anomaÂliõ prÏedchaÂzet mozÏnyÂm kompli-kacõÂm vyplyÂvajõÂcõÂm z jejich pozdnõ leÂcÏby.

AutorÏi nemajõ komercÏnõÂ, vlastnicke nebo financÏnõ zaÂjmy na pro-duktech nebo spolecÏnostech popsanyÂch v tomto cÏlaÂnku.

(87.7%) believe that the anomaly should be solved as early as in deciduous or mixed dentition. The rest (41, i.e.9.2%) conclude that the anomaly may be trea-ted only after eruption of permanent dentition.

Untreated upper incisors protrusion may result in phonetic, functional or periodontal problems. We should also bear in mind psychological and esthetic aspects of this anomaly. The risk of injury of protruded incisors is one of the most essential reasons of treat-ment. Children with distinctive protrusion of incisors are sent to orthodontic practices especially due to deep bite, and for esthetic and psychological impact on achild (Fig. 4).

Neglected open bite may lead to masticatory and phonetic problems in the future, as well as to esthetic problems that may affect patient's self-confidence [17]. Mouth breathing, when the mouth is always open, may lead to sore throat and pharyngitis. Most dentists (72.6%) agreed on that in case of this anomaly it is ne-cessary to find out whether a bad habit is not the cause, and to send a child to an orthodontic practice (Fig. 5).

Angle defined cover bite as a distal position of the mandible, insufficient vertical growth of the area under the nose, and excessive overbite. Molars cannot erupt to their normal length, lower incisors may touch the gingiva on the palate, and incisal edges of upper inci-sors exceed gingival level of lower inciinci-sors [18]. Gingi-val ligament of lower anterior teeth may be pathologi-cally damaged, which may lead to various periodontal problems and chronic inflammations [19]. Majority of dentists (83%) believe the anomaly should be solved as early as in mixed dentition.

Conclusion

Our survey proved several interesting facts. E.g. OPG is indicated by many dentists only in case an ano-maly is suspected; examination of upper canine's presence is not an integral part of a routine check-up of children around the age of 9. The good news is that most dentists pay attention to orthodontic anomalies. A lot of them are aware of the maximum time gap bet-ween the eruption of atooth and its opposite counter-part. In case of premature loss of deciduous molars or canines, the dentists know about the risk of shift of ad-jacent teeth into the space, or about possible shift of the dental arch centre.

Cooperation of different specialists is indispensable for healthy development and fully functional masticatory system of a child. Children make the integral part of po-pulation, therefore it is necessary to focus on their spe-cific problems and through timely identification of ortho-dontic anomalies prevent their potential complications.

The authors have no commercial, proprietary or financial interest in products or companies mentioned in the article.

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1. Graber, T.M.; Vanarsdall, R.L.; Vig, K.W.L.: Orthodontics: Current principles and Techniques. 4th edition, St. Louis: Elsevier, 2005.

2. Proffit, W.R,; Fields, H.W.; Sarver, D. M.: Contemporary orthodontics. 4th. edition, St. Louis: Mosby Elsevier, 2007.

3. Kot'ovaÂ, M.: Kdy poslat dõÂteÏ naortodonticke vysÏetrÏenõÂ. 2. cÏaÂst. LKS. 2008, 18, cÏ. 3, s. 76-82.

4. KlimesÏovaÂ, H. SpolupraÂce ortodontisty apedostomato-loga. AtestacÏnõÂ praÂce ke specializacÏnõÂ zkousÏce z oboru Ortodoncie. OddeÏlenõÂ ortodoncie arozsÏteÏpovyÂch vad Stomat. kliniky 3. LF UK v Praze. Praha, 2010.

5. KamõÂnek, M.; SÏtefkovaÂ, M.: Ortodoncie I. Olomouc: Uni-verzita PalackeÂho, 2001.

6. KamõÂnek, M.: CÏeska Ortodoncie ve 20. stoletõÂ. Ortodon-cie 1999, 8, cÏ. 4, s. 17-22.

7. Kot'ovaÂ, M.: Ortodonticky pruÊvodce praktickeÂho zubnõÂho leÂka rÏe. Praha: Grada Publishing, 2006.

8. KamõÂnek, M.; SÏtefkovaÂ, M.: Ortodoncie II. Olomouc: Uni-verzita PalackeÂho, 1991.

9. Kot'ovaÂ, M.: Kdy poslat dõÂteÏ naortodonticke vysÏetrÏenõÂ. 1. cÏaÂst. LKS. 2008, 18, cÏ. 2, s. 46-53.

10. Abari, R.F.: Problems to watch for in seven year old. V [online]. [cit. 2014-04-13]. Dostupne nainternetu: http://www.drabari.com/seven-year-olds.pdf. [online]. 11. AlarcoÂn, J.A.; Martin, C.; Palma, J.C.: Effect of unilateral

posterior crossbite on the electromyographic activity of human masticatory muscles. Amer. J. Orthodont. dento-facial Orthop. 2000, 118, cÏ. 3, s. 328-334.

12. Zubnõ leÂka rÏi v CÏeske republice: RocÏenka2013. LKS. 2014, 24, cÏ. 3, nestr.

13. Yaqoob, O.; O' Neill, J.; Gregg, T.: Management of une-rupted maxillary incisors. V [online]. [cit. 2014-04-13]. Dostupne nainternetu: http://www.rcseng.ac.uk/fds/ publications-clinical-guidelines/clinical-guidelines/do-cuments/ManMaxIncisors2010.pdf.[online].

14. Rizzatto S.M.; Menezes, L.M.; Allgayer, S.; Batista E.L.: Orthodontically induced eruption of a horizontally im-pacted maxillary central incisor. Amer. J. Orthodont. dentofacial Orthop. 2013, 144, cÏ. 1, s. 119-129.

15. Martin, C.; AlarcoÂn, J.A.; Palma, J.C.: Kinesiographic study of the mandible in young patients with unilateral posterior crossbite. Amer. J. Orthodont. dentofacial Orthop. 2000, 118, cÏ. 5, s. 541-548.

16. PetreÂn, S.; Bondemark, L.: Correction of unilateral po-sterior crossbite in the mixed dentition : A randomized controlled trial. Amer. J. Orthodont. dentofacial Orthop. 2008, 133, cÏ. 6, s. 790.e7-790.e13.

17. Torres, F.C.; Almeida, R.R.; Almeida-Pedrin, R.R.; Ped-rin, F.; Paranhos, L.R.: Dentoalveolar comparative study between removable and fixed cribs, associated to chin-cup, , in anterior open bite treatment. J. Appl. Oral. Sci. 2012, 20, cÏ. 5, s. 531-537.

18. Arvystas, M.G.: Nonextraction treatment of severe Class II, Division 2 malocclusions: Part I. Amer. J. Orthodont. dentofacial Orthop. 1990, 97, cÏ. 6, s. 510-521.

19. Adam, M.: Ortodoncie. 4. vydaÂnõÂ. Praha: Avicenum, 1976.

MDDr. Hana RÏehaÂcÏkovaÂ

Stomatologicka klinika FN u sv. Anny PekarÏska 53, 656 91 Brno

Ryze česká firma

Materiály pro stomatologii a ortodoncii Mojmírovců 799/45, 70900 Ostrava www.beldental.cz, obchod@beldental.cz T.: 596 638 222-3, 777 727 031, 800 100 793

PrÏehled chystanyÂch domaÂcõÂch akcõÂ 2014:

18. 04. 2015 prof. COZZANI Mauro

Praha ¹Neviditelna rovnaÂtka ALL INª± certifikacÏnõ kurz

8.±9. 5. 2015 MUDr. SÏTEFKOVAÂ Marie, CSc.

Olomouc ¹Role sestry prÏi jednotlivyÂch etapaÂch ortodonticke leÂcÏbyª± prakticky kurz

29. 5. 2015 MUDr.DUBOVSKAÂ Ivana

Olomouc ¹NeprÏõÂme lepenõ zaÂmkuÊ a 2D technikaª± prakticky kurz

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