China News Weekly reporter/Yuan Suwen intern/Yu Haoqing
Published in the 1042nd issue of "China News Weekly" on May 2, 2022
When he was three years old and four months old, he put on braces.
It is a removable removable brace, scientifically called a hyperbolic reed jaw pad appliance.
Mother He Cai was worried that her daughter's lower teeth were covering her upper teeth. The common name for this symptom is "underworld" and the scientific name is "underbite". She stuck the appliance in her daughter's upper teeth and told her to stick to it every day. Wear it for 12 hours and try not to take it off during sleep.
Looking back after more than four months, the appliance has pushed out the curled upper teeth. When the little girl laughed, her upper and lower front teeth were touching.
For this effect, He Cai paid 10,000 yuan, and Juan Juan paid the pain.
Because her posterior molars were raised, her upper and lower incisors could not be fully occluded in the early stage of wearing braces, revealing gaps, resulting in slow eating, "like an old woman without teeth".
When sleeping with braces on, she couldn't close her mouth, and her tongue was between her upper and lower teeth. She also used her tongue to push out the appliance and bite the appliance.
The volume is still too small to express how I feel.
But He Cai was satisfied with the effect. The doctor told her that the earlier the underbite is treated, the shorter the course of treatment, and basically there will be no recurrence in the future.
The doctor He Cai consulted was from a private children's dental hospital in Xiamen, and the store opened in a shopping mall.
In recent years, in the boom of teens and adults, some businesses have set their sights on the dental market for young children.
In first-tier cities and the eastern coastal areas, chain clinics for children's oral cavity can be seen everywhere.
"China News Weekly" reporters visited and found that in such children's dental clinics, young-age orthodontic treatment has become common practice, and it is even recommended that children one and a half years old wear braces. And the lower the money cost, the "basically no recurrence".
According to the results of an epidemiological survey conducted by Fu Minkui, a major in the oral field at the beginning of this century, the prevalence of malocclusion in Chinese children and adolescents is about 70%. However, in the opinion of authoritative experts, the concept of "early detection and early treatment" is wrong in the field of children. of.
Many Chinese and foreign studies have shown that the best correction period for all types of malocclusion is after the age of 8. Some people have better correction effects after the age of 8, and some people have the same effect of correction at the age of 4 as at the age of 8. Humane care for young children does not advocate premature correction.
Anxiety for mother and baby bloggers
He Cai is a full-time mother born in the 1990s.
Usually, she likes to share her life with her daughter Juanjuan on social software, and has hundreds of fans.
One day in July 2021, she received a private message, the other party claimed to be a promoter of a local children's dental clinic, inviting her to bring her daughter to the store to experience free teeth cleaning, full-mouth fluoride application and facial screening, as well as try-on invisible braces. The opportunity and 100 yuan reward, just help to post a promotional note on social software afterwards.
In today’s internet celebrity economy era, it’s common for mother and baby bloggers to follow up on promotions.
"It's quite normal for private clinics to carry out this kind of propaganda similar to visiting stores. At the same time, there are people who promote them like me." He Cai said.
Searching the Internet, it is easy to find traces of this promotion of recruiting local mother and baby bloggers to "explore the store".
The video notes made by He Cai later were included in the social account of this children's dental clinic. As of April 6, 2022, there were 15 similar notes under his account. These notes were published from July 23 to August 26, 2021. , lasts about a month, an average of 2 to 3 days.
The authors of the notes are all local mother and baby bloggers. The current number of fans ranges from a few hundred to 80,000. Most of them have other behaviors of bringing goods on social media.
In the 15 notes, a total of 16 young patients received the services of this children's dental clinic (one of the notes is a dragon and phoenix). The items include cleaning, fluoride application and ten comprehensive screenings. The young patients are three and a half years old. Up to six years old.
Except for the video notes of He Cai and Juanjuan, the rest are all graphic notes, involving the four local stores of this dental clinic.
The reporter found that the copywriting of these notes is similar, such as the popular science of "mouth breathing", "mouth breathing will affect the teeth, jaws and facial shape"; for the standard of children's golden orthodontic period, "5~12 years old is the child's orthodontic treatment. "Golden period"; and the propaganda caliber of a dental clinic: "The post-sale period of their family runs through the child's entire tooth replacement period, and it will continue until the child has finished changing his teeth."
The similarity in copywriting is not accidental.
When contacting He Cai, the promoter provided her with a document for her reference.
"There is no special requirement to write in detail, and there is no special emphasis on what must be written." He Cai said that the promoters only proposed sharing directions, such as popular science, experience records, etc.
Including He Cai, at least 8 notes expressed the idea of "immediately arrange correction for the child in this clinic", and some even emphasized "the transparent model was chosen".
However, except for He Cai who did put on the appliance for the juan, the rest of the bloggers did not publish the follow-up progress.
He Cai is full of anxiety about her daughter's face.
She told reporters that as early as when she was more than one year old, she posted a curly smile in the circle of friends, and some friends left a message reminding that "the baby is a bit underjawed".
At that time, Juanjuan had just grown 10 teeth, and when he smiled, he showed 6 teeth, and the middle 4 teeth were all lower teeth covering the upper teeth.
After the child fell asleep at night, He Cai checked the information on his mobile phone, and Baidu showed that the child's underbite "is more suitable for correction at the age of three".
"I found out earlier, I thought about going back to see my child when he was three years old, but in fact, I didn't know where to go to see a doctor at that time." He Cai said that the idea of taking her daughter to see a doctor was shelved for a while until she received a private letter from the promotion staff. .
The promoted children's dental hospital is very close to He Cai's home. It is in the shopping mall where she often visits. The experience process is also very comfortable. He Cai said that private clinics are not like hospitals in the usual perception. The theme of Frozen, in the waiting area, dolls, picture books and cartoons are readily available, and the staff service is also in place, making her feel "warm and caring".
When considering taking her daughter for correction, He Cai first ruled out public hospitals.
She believes that the public hospital is "cold", noisy and the service is impatient, and her daughter will feel uncomfortable and rejected during the correction process.
The only channel for He Cai to obtain information is the Internet. After searching, she found that this clinic is operated in a chain in the province, and is "more professional" for children's oral problems, which made her finally make up her mind to let her daughter be treated in this clinic.
In September 2021, when Juanjuan was three years and four months old, he was diagnosed by a doctor in the clinic as anterior crossbite, a "dental problem". The doctor suggested that he should be corrected immediately while he was young, which is relatively quick and the effect is expected.
As a result, a pair of hyperbolic reflex jaw pads entered the rolling mouth. It was a pink transparent gel-like solid covered with tortuous steel wires, which were placed behind the upper teeth and could not be seen from the front.
In the process of normal wearing, after the appliance is pushed up with the thumb, the steel wire is stuck on the upper incisors, and a "click" can be heard.
Doctors recommend wearing orthodontics for half a year, then observe for half a year, and follow up once a month.
The hyperbolic reflex jaw pad appliance is an oral movable appliance that was widely used in the correction of deciduous teeth and crossbite during mixed dentition in the early 1990s.
The reporter searched the HowNet with the keyword "hyperbolic reed jaw pad appliance" and retrieved 11 papers.
A paper published in "Journal of Practical Stomatology" in 2002 introduced that the hyperbolic reed is one of the most commonly used devices for the force part of the oral movable appliance, which can make the teeth move on the lingual or palatal side, mainly used in the jaw. Reed appliances correct the underbite of teeth.
In the late 1990s, with the development of fixed orthodontic technology, the use of such removable orthoses has become less and less.
The above-mentioned paper mentioned that in clinical application, it was found that the hyperbolic reed has disadvantages such as excessive force, fast decay, easy to break, and short time interval between follow-up visits.
Another paper published in "Stomatology" in 1998 introduced that the obvious disadvantage of movable appliances is that they rely on the cooperation of the patient, and because it is difficult to produce the two-point contact required for complex tooth movement, it is difficult for the teeth. Movement is limited.
Therefore, the relevant research mostly focuses on improvement, and some studies insist on its effectiveness in early childhood correction, but the number of studies is relatively limited, and the research quality is relatively low.
Correction of children is not the sooner the better
Many experts interviewed believe that orthodontic treatment of young children is not necessary.
He obtained a double doctorate degree in orthodontics from Peking University and is currently working in the Sunshine Dental Clinic of Saide. The best time for early childhood correction is between 8 and 10 years old, which is the peak of children's development. "The plasticity of bone growth and development is particularly Fast”, and the root of orthodontic treatment lies in the remodeling of bones, so orthodontic treatment during this period can achieve twice the result with half the effort.
Correction before peak growth, although sometimes effective, increases the child's treatment cycle.
"The correction that could have been completed in half a year, if it was started earlier, it is likely to be delayed for two years." Caring believes that if a child's childhood is spent in the pain of straightening teeth, it will reduce the child's quality of life and harm the parent-child relationship. .
She suggested that it is best to wait for the child to wake up on his own. "Let the child know that correction is beneficial, so that he can voluntarily perform correction."
Concerning introduction, in the peak development period of 8 to 10 years old, it is suitable to correct abnormal bone development, such as underdevelopment or overdevelopment of the upper and lower jaws, or too narrow dental arch.
"It can be said with certainty that early intervention at this time, even if subsequent treatment is required, will greatly reduce the difficulty of treatment and improve the effect of treatment." She pointed out that the more common intervention in early treatment is the intervention of "suburban" , For children with concave nasal bases, bone traction at this time will achieve better results, or the mandible is too small. At this time, stimulate it and the chin will grow.
Backbiting means "earth-covered sky", and China has conducted research on its early intervention nearly 30 years ago.
Xu Baohua, chief physician of Beijing China-Japan Friendship Hospital, told China News Weekly that in 1995, he had studied the early correction of underbite.
At that time, he found that foreign studies have proved that the final effect of correcting a 4-year-old child is the same as starting the correction at the age of 8. Therefore, developed countries do not recommend starting the correction at the age of 4.
"The child is so young, it is difficult to cooperate, and the psychology is not mature. Correction is a painful experience."
Xu Baohua's research started in 1995 and ended in 1998. The results of the research repeated the conclusions of foreign countries. He then added a comparative study on the correction of 8-year-old and 12-year-old children.
In the end, it was found that the development of the maxilla is the most active in children when they are eight to ten years old, and it is the best time to do anterior traction for the treatment of bony underbite. At this time, the correction is multiplied with half the effort. "The effect is not ideal if it is done early."
Children who require anterior traction are mainly identified as "bone underbite" with underdevelopment of the maxilla.
In addition, there are some children with dental and functional underbite. Xu Baohua believes that for these children, although early correction can also be intervened, the effect of 4-year-old correction is the same as that of 8-year-old correction. At the age of correction, due to the psychological maturity of the child, the compliance is better, and the effect may be better.
"So the overall result is that whether it is bone, dental or functional, it is best to start at the age of 8." He suggested that the first time each child sees an orthodontist should be after the age of 8.
Xu Baohua said his research found that the underbite of more than half of the children is bony.
"This means that more than half of the children, even if the underbite problem is resolved at the age of two or three, will eventually relapse." He explained that the reason for skeletal underbite is that the maxilla grows slowly and the mandible grows faster. "It's like two people running, one runs faster and the other runs slowly. At the age of two or three, the gap is not that big, but as the age increases, the gap will become larger." Therefore, it is recommended that skeletal Underbite, especially in children with depression in the middle of the face and underdevelopment of the maxilla, it is recommended to start treatment at the age of 8 to 10.
Children's orthodontics at a younger age
At the beginning of April 2022, a reporter from China News Weekly got in touch with the customer service of the dental clinic for the correction of the volume.
"The specific correction plan varies from person to person." He said that underbite correction is usually divided into three stages: the correction period of three months to half a year, the maintenance period of about half a year, and the regular review every three months thereafter.
"The younger the child, the fewer problems to deal with, and the bigger the problem, the more the child suffers."
When asked about the recurrence, the customer service introduced that the possibility of recurrence of small underbite patients is 50%, but many cases of underbite performed by their dental clinic have not recurred so far.
The customer service also showed two cases to prove this, but the reporter found that it has only been one to two years since the two children finished their treatment.
The reporter's inquiry found that the business registration time of this dental clinic was November 26, 2019.
According to some introductions, this dental clinic was established in 2016, and the clinic has 7 chain stores, all located in a province on the southeast coast.
For example, according to the establishment time in 2016, its earliest case is only 6 years ago, and it is too early to assert that "there will be no recurrence".
In the northern region, there are also some chain children's dental institutions.
The reporter consulted a large chain of children's dental clinics in Beijing as a customer, and the quotation for the orthodontic treatment for young children was also around 10,000 yuan.
A person who calls himself a physician's assistant said that if a parent has an underbite, children can also inherit it.
"The first treatment cycle is preferably 3 to 5 years old, which can prevent changes in facial shape." For hereditary underbite, it will be recommended to continue two cycles of treatment at 6 to 8 years old and 12 to 17 years old. "It can improve face."
These views surprise regular orthodontists.
Concerning told "China News Weekly" that she has often seen very young children in the past two years.
Just a few days ago, she saw a patient who brought her three-year-old baby to see the doctor, and said that the doctor of a pediatric clinic said that the child had an occlusal problem and needed to be corrected.
But Care was surprised to find that the child had "completely normal deciduous teeth".
"I'm shocked, you know? I just thought, under what kind of profit drive, can you ruthlessly suggest corrections for a three-year-old child?" Care pointed out that some children's dental clinics exaggerate the condition of young children, "Trafficking anxiety "When the braces are successfully put in the child's mouth, if they eventually relapse, they will shirk their responsibility and say that it is because the child is too young and the parents have not managed it well.
"Actually, these institutions will not teach parents to manage their children's behavior. They just say that it is impossible to wear them. In the end, the intervention fails. At this time, the clinic says that the children are still too young, and they will continue to intervene when they are older."
Concern pointed out that the excessively young age of the orthodontic market is worth vigilant, "the market for children is indeed huge, because parents may not be willing to spend money on themselves, but they are willing to spend money on children, and many bad medical institutions are caught Living with the psychological characteristics of parents, I want to take the parents’ money out of my pocket.” But whether it is a child or an adult correction, it is a medical behavior and should follow the medical standards and norms.
"China News Weekly" 2022 Issue 15
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