During dental check-ups for children, we not only assess the state of their dental health, but paediatric dentists go much further. And, as we have said on other occasions, the mouth is not an isolated component in our body, but what affects one affects the other and vice versa. We are, after all, a perfect machine full of gears connected to each other in ways that are still being researched today.
Paediatric dentists are closely connected with several referral specialists and we refer children on an ongoing basis when we feel it is necessary.
I give you some examples based on a list of specialities:
Otolaryngologist
When a child appears to be an oral breather, i.e. they breathe through their mouth instead of their nose, they do so with a certain malocclusion, with their lips open even at rest, snoring, dry mouth, dark circles under their eyes, a long face or tartar from a very early age. This oral breathing is usually caused by vegetations or hypertrophic tonsils, which is why we refer the patient to the otolaryngologist, who will be in charge of checking the airways and clearing them for correct nasal breathing as he or she sees fit. If you want to know more about the contraindications of oral breathing, you can read more about it here.
Psychologist
Sometimes some children do not have good eating habits, not so much because of the quality of the food (where the intervention is directly to the parents), but because they have trauma due to choking and stop chewing, because they eat mashed food so that they do not perceive certain flavours or directly because due to their special needs swallowing is more complicated for them.
This is a problem, because the bones and muscles of the jaws need good chewing to tone the muscles for a good lip seal during swallowing, and chewing of hard, dry and fibrous foods for proper bone expansion and dragging of food debris.
Otherwise, crossbites, narrow palates and tartar appear in unusual chewing areas and lead to more frequent caries.
Therefore, in these cases we refer to a psychologist specialised in eating disorders to treat the root of the problem.
Speech therapist
Swallowing in babies is different from that of adults, for obvious reasons, and the transition is usually innate and natural. However, on some occasions, some children do not manage to modify this behaviour, which causes the front teeth to tilt or not close when biting, due to the continuous pressure that the tongue exerts against the wrong place.
With the help of a speech therapist specialising in myofunctional therapy, we can modify this way of swallowing and the bite will be able to close naturally without any help other than its own growth, in which a good diagnosis at an early age is essential.
Physiotherapist
Although in adults it is somewhat more complex, in young children bruxism may be due to physiological factors or be caused by premature contact of a malocclusion. In these cases we refer to physiotherapists specialised in TMJ while we try to resolve the physical cause.
Surgery
Although in our case this would be an internal referral within the clinic itself, as Fernando García Vélez would be the surgeon in charge of the case, other paediatric dentistry clinics do not have a surgery service, which is why I include it in the list. There are numerous cases of lingual ankyloglossia (a very short frenulum of the tongue) or labial ankyloglossia from birth. In these cases, because the frenulum is too short, it makes sucking difficult during the breastfeeding phase, the baby does not latch on to the breast and causes pain to the mother. In other cases where the child is older, it can cause an open bite or make it difficult to pronounce 'R' words. In these cases a frenectomy should be performed. Here is a recent example of one performed in our clinic.
Maxillofacial
Some children have quite extreme asymmetric growth between the size of the maxilla and the mandible. So much so that even early detection cannot prevent more invasive techniques. In these cases where more complex appliances are needed, we need the help of an expert, in this case the maxillofacial surgeon.
Paediatrician
Of course, there are many situations that can lead to referrals between the dental clinic and the doctor's office. In our case, for numerous sores, lesions or blisters that deserve to be checked because they may be due to a lowering of the immune system. Or on the contrary, earaches or sore throats can be caused by a dental cause.