OVREDNOTENJE LEGE IN FUNKCIJE JEZIKA V PREVENTIVI ARTIKULACIJSKIH MOTENJ ODPRTEGA GRIZA SEKALCEV PRI PREDŠOLSKIH OTROCIH S TRIDIMENZIONALNO ULTRAZVOČNO PREISKAVO

Lah Kravanja, Sanda (avtor), Ovsenik, Maja (mentor), Hočevar Boltežar, Irena (komentor)

Namen in cilji. Z namenom izdelati priporočilo za nacionalni preventivni program glede uporabe funkcionalne diagnostike v preprečevanju odprtega griza mlečnih sekalcev (OGS) in artikulacijskih motenj (AM) pri predšolskih otrocih, s poudarkom na preiskavi jezika s tridimenzionalnim ultrazvokom (3DUZ), smo sledili ciljem: ugotoviti pogostost OGS v mlečnem zobovju in AM v ciljni skupini opazovancev, oceniti povezanost OGS in AM z orofacialnimi in otorinolaringološkimi (ORL) odkloni, ovrednotiti lego jezika pri otrocih z in brez OGS in AM ter primerjati lego jezika pri otrocih z in brez OGS in AM ter pri otrocih brez teh nepravilnosti. Preiskovanci in metode. V epidemiološko in klinično raziskavo je bilo vključenih 446 predšolskih otrok, starih od 3 do 7 let, 236 dečkov in 210 deklic v raziskovalni in kontrolni skupini. Zgradba raziskave je bila razdeljena na štiri ločene študije. Otroci so bili ortodontsko pregledani v vrtcih v Posočju, starši so z odgovori v vprašalnikih podali podatke o orofacialnh in ORL odklonih, boleznih, razvadah in AM. Pri otrocih z OGS v mlečnem zobovju so bili v kliničnem delu opravljeni čeljustnoortopedski in ORL pregled z akumetrično preiskavo sluha ter logopedski pregled artikulacije. Naredili smo obrazne in intraoralne fotografije, registracijo zagriza v vosku ter odtise zobnih lokov za izdelavo mavčnih študijskih modelov. S 3DUZ je bila ovrednotena lega jezika pri otrocih z OGS in v kontrolni skupini brez OGS. Za posnetke je bil uporabljen 3DUZ sistem Voluson 730, za analize, obdelavo in rekonstrukcijo program 4D View verzija 5.0. Lego jezika so neodvisno pregledale specialistke radiologije, ORL ter čeljustne in zobne ortopedije. Za statistično analizo je bil uporabljen R-program, metode opisne statistike, Mann-Whitney in hi-kvadrat oz. Fisherjev eksaktni test za primerjave parametrov, McNemarjev test in metoda logistične regresije. Meja statistične značilnosti je bila na p=0.05. Rezultati. Pogostost OGS je bila 7,2 %, pogostost AM je bila 30,2 %. AM so bile prisotne pri večini otrok z OGS, predvsem sigmatizem in rotacizem ter njune kombinacije. Skupini otrok z OGS in kontrol sta se značilno razlikovali glede nepravilne lege jezika in glede AM. Pri otrocih brez AM iz obeh skupin je bila nepravilna lega jezika ugotovljena manj pogosto kot pri otrocih z AM. Po starostni prilagoditvi je regresijski model pokazal, da je pri otrocih z nepravilno lego jezika večja verjetnost za OGS kot pri drugih. Med nepravilno lego jezika in AM je močna povezanost. S 3DUZ vrednotenjem smo odkrili največje število otrok z nepravilno lego jezika, čeprav med kliničnimi pregledi ni bilo statistično značilne razlike. Zaključki. 3DUZ ovrednotenje lege jezika je otroku prijazna, hitra, neškodljiva, ponovljiva, zanesljiva in objektivna metoda za vrednotenje nepravilnosti ter zgodnje rehabilitacije. Interceptivni ukrepi za preprečevanje OGS in AM naj bodo vključeni v vse tri nivoje preventivnega ortodontskega programa in v publikacije NIJZ o ustnem zdravju. Starše je priporočljivo zgodaj seznaniti o pomenu drže zaprtih ust, dihanju skozi nos, pravilne lege jezika, zgodnji odpravi razvad, izboljševanju orofacialnih in ORL odklonov ter izvajanju miofunkcijskih vaj takoj po izrasti mlečnih zob. Priporočamo čeljustnoortopedski pregled, dosledno izvajanje logopedskega programa PLP 5 ob pregledih pred vstopom v šolo ter zgodnjo napotitev k zobozdravniku, specialistu čeljustne in zobne ortopedije ter logopedu, kadar so poleg funkcionalnih prisotni tudi morfološki odkloni in artikulacijske motnje.

• Jezik: Slovenski jezik
• Ključne besede: odprti griz sekalcev, lega jezika, tridimenzionalni ultrazvok, pogostost, klinično ovrednotenje, razvade, artikulacijske motnje
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2019
• PID: 20.500.12556/RUL-112970
• COBISS.SI-ID: 4056596
• Datum objave v RUL: 27.11.2019

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: THREE-DIMENSIONAL ULTRASOUND ASSESSMENT OF TONGUE POSTURE AND FUNCTION IN PREVENTION OF ANTERIOR OPEN BITE SPEECH DISORDERS IN PRESCHOOL CHILDREN

Izvleček

Background and aims. The aims of this study were to assess the prevalence of anterior open bite (AOB) and articulation disorders (AD) in deciduous dentition and their association with low tongue posture, orofacial disorders and impaired ENT condition. The aim was to assess the resting tongue posture in subjects with and without AOB and AD using a three-dimensional ultrasonography (3DUS) and to compare the method to orthodontic and ENT assessment. These findings would allow us to supplement basics of national preventative protocol for early developmental interception of both, AOB malocclusion and AD. Subjects and methods. The subjects were 446 children aged 3 - 7 years, 236 boys and 210 girls visiting local kindergartens in Posočje, Slovenia. The survey has 4 different studies. The subjects were orthodontically examined for AOB malocclusion, orofacial and ENT impairment, oral habits, AD and questionnaires were answered by their parents. Participants presenting AOB in deciduous dentiton were allocated to the research group, the rest were included to the control group (CG). Further orthodontic clinical examinations, facial and oral photographs and dental casts were obtained in AOB subjects only. An experienced ENT specialist the ENT condition and a speech therapist examined the AD. A 3DUS assessment of resting tongue posture was assessed by an experienced radiologist and an orthodontist independently. The device used was 3DUS Voluson 730 (General Electrics Healthcare). The 3DUS data were analysed by 4D View Programe 5.0. The R-Programe was used for collated data statistical analysis with descriptive statistic, Mann-Whitney, chi-square or Fisher's exact test, McNemar test and the multiple logistic regression model. Statistical significancy was set at p < 0.05. Results. The 32 preschool children aged 3.5 -7 years (mean 5.0 years ± 0.9 y) presented AOB in the deciduous dentition; the prevalence of AOB was 7.2 % and the prevalence of AD was 30,2 %. The subjects with AOB presented higher occurrence of orofacial and ENT irregularities and AD, mostly sigmatism, rhotacism and their combinations. In children without AD from both groups, the improper tongue posture occured less frequently than in children with AD. The 3DUS detected the highest number of AOB subjects with low tongue posture and there was no significant difference among the three clinical assessments. Conclusions. The results confirmed a strong relationship among AOB, low tongue posture and AD. The 3DUS assessment is objective, reliable, non-invasive, radiation free, no time consuming and child-friendly method for functional assessment of the tongue posture in preschool children and should become a useful tool in everyday clinical practice for functional diagnostics, prevention of the development of dentofacial deformities, and for treatment planning of early rehabilitation in preschool children with AOB and AD. The child and his/her parents should get the early information about the proper resting tongue posture, lip closure and nasal breathing. In this way, an optimal condition in the oral cavity for proper orofacial and articulation development can be created. Preventative procedures for early AOB development interception should be included into all three levels of national preventative protocol to enhance early interception of sucking and non-sucking habits, orofacial or ENT impairment and a timely PLP 5 screening for referrals to orthodontists and speech therapists.

• Ključne besede: anterior open bite, tongue posture, three-dimensional ultrasound, prevalence, clinical evaluation, oral habits, articulation disorder