インターセプティブ矯正歯科：意識と予防が最初の治療法です

Interceptive orthodontics: awareness and prevention is the first cure.

抄録

乳歯列と混合歯列の正しい発達が、小児患者の口腔の健康にとって最も重要であることは、科学的な歯科界で広く認識されています。この点で、インターセプティブ矯正歯科はそのプロセスにおいて基本的な役割を担っています。具体的には、小児歯科医は幼児期から口腔内の状態を観察し、それぞれの特徴に応じた3つの年齢層を区別して介入します。また、小児科医、婦人科医、産科医、言語療法士など、幼い患者やその母親をさまざまな角度から治療する他の専門家が、貴重な情報を共有してくれることも望まれます。以下は、インターセプティブ矯正に関する重要な条件と重要な情報を簡単にまとめたものです。対象年齢0～3歳：生後数ヶ月の母乳育児は、顎の発達に良い影響を与えることが分かっています。その後、乳歯の萌出によって促進される固形食への移行が、その成長をさらに促進します。この時期には、筋緊張低下や低位舌の姿勢を観察し、それを阻止することが推奨されます。また、お子様の生理的な成長と口腔の健康を守るために、適切な食事や生活習慣をご両親に指導することが重要です。4～6歳：乳歯列と上下の上顎骨の発達に注意を払い、おしゃぶり、指しゃぶり、口呼吸、非定型嚥下などの悪い習慣を速やかに阻止・修正する必要があります。6歳以上：この段階では、歯列弓のスペース、乳歯の自然な剥離、永久歯の萌出とその咬合関係、そして顎関節の関係を注意深く観察することが重要である。必要であれば、危険因子を取り除くだけでなく、患者の咬合状態や骨格の状態に応じて、上記の段階、特に第2、3段階において固定式または移動式の矯正装置を使用することも可能です。不正咬合の早期診断は非常に重要であり、また、子供を扱う他の臨床医やその両親と情報を共有し、子供が必要とする可能性のある様々な治療法について情報を得る必要があります。小児歯科医は、不正咬合や、呼吸、睡眠、咀嚼、摂食などの口腔機能に影響を及ぼす疾患と関連するその他の症状が、早ければ就学前、最初の乳歯が生えるずっと前に最初の兆候を示すことが多いことを理解してもらうために、家族に直接働きかけることができるのです（この時期は、通常最初の歯科訪問を予約する時期なのです）。そして、小児歯科に携わるすべての人、患者さん、専門家に伝えなければならないメッセージは、「意識と予防が最初の治療法」です。

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.