Can the physiological process of teething in infants be pathological?

Author:

• Golonova Yulia Yurievna

  otorhinolaryngologist, clinic director

3.00 (Votes: 4)

In the first year of a child’s life, when his first milk teeth are cutting, a fairly common picture is swelling of the gums at the site of teething, profuse salivation, the child’s capriciousness, the desire to put everything in his mouth and chew in order to relieve itching and discomfort from the gums. Due to excessive salivation, coughing and even (very rarely) vomiting are possible, when there is really a lot of saliva and the child chokes on it.

But should the process of teething also be accompanied by a runny nose and nasal congestion?

No, such manifestations should not happen. And if nasal congestion is still present during teething, then first of all it is necessary to exclude the parallel development of a respiratory infection, as well as an allergic reaction, especially if you introduce complementary foods or new foods to the child, or if there is an increased number of respiratory allergens in the house, for example, the presence of domestic animals.

If there is neither one nor the other, then the vessels of the child’s nasal mucosa are really dilating and swelling appears due to such a provoking factor as teething, which should not normally be the case. Therefore, many otorhinolaryngologists are inclined to conclude that this is one of the signs of a child’s possible predisposition to vasomotor rhinitis. This vasomotor reaction usually goes away within 2-3 days after eruption.

Runny nose during teething

Due to the fact that nasal congestion is still considered atypical for the teething process, and especially if the nasal congestion has not gone away within 3-4 days, the child should be shown to a specialist otolaryngologist in order to exclude the infectious and allergic nature of the disease, and also to make sure that nasal congestion does not provoke inflammatory changes in the tympanic cavity, which, unfortunately, can be completely asymptomatic. In a specialized ENT clinic, using a video endoscope, an otolaryngologist will examine the nasopharynx for hypertrophy of adenoid vegetations, which, although rare, still occurs at such an early age; If ear pathology is suspected, a tympanometry study will be performed. All these methods are safe and are used in children from birth.

Remember, if a child has a runny nose during teething and other symptoms that worry you, it is better for the child to be examined by a specialist otolaryngologist in a specialized ENT clinic, where conditions have been created and all the necessary equipment is available for monitoring children, and where you will be provided with assistance and prescribed treatment in a timely manner .

An effective way to relieve teething problems for children

Summary. In some children, the eruption of primary teeth has a negative impact on their general condition. This physiological process often gives the child discomfort - pain, hyperemia of the mucous membrane, hypersalivation, burning, itching in the mouth, and an increase in general body temperature. Teething symptoms can be relieved at home. Dentists recommend the use of special gels and ointments that have not only an analgesic effect, but also antiseptic properties. The purpose of this work was to evaluate the effectiveness of using a gel based on Boswellia serrata resin extract, aloe vera leaf juice and chamomile flower extract during the eruption of primary teeth in children. The article discusses the issue of using the gel during the eruption of primary teeth in children. At the Department of Pediatric Dentistry and Orthodontics, Institute of Dentistry named after. E.V. Borovsky First Moscow State Medical University named after. I.M. Sechenov observed 67 children aged from 5 months to 3 years (the period of eruption of primary teeth). A special gel was prescribed as an auxiliary drug to relieve pain during teething. Based on the results of clinical changes in local and general symptoms associated with the eruption of primary teeth in 67 children, a significant reduction in symptoms was observed already on the 3rd day of using the gel in 30-50%, on the 5th day – in 50-80%, on the 7th – 90-100%. According to a survey of parents, the effectiveness of the gel used is 91% of respondents who used the gel during the eruption of primary teeth, which corresponded to a high level of effectiveness of the drug.

Teething in children is one of the common problems in both pediatrics and pediatric dentistry. This physiological process is closely related to the general condition of the child. Typically, pain symptoms appear 4 days before tooth eruption and decrease 3 days after tooth eruption [1]. During this period, in the gingival fluid during primary teething, the concentration of inflammatory cytokines - interleukins (IL-1, IL-2, IL-8) and tumor necrosis factors α (TNF-α) increases, which explains the clinical manifestations of both local and general nature associated with teething [2].

Thus, the eruption of primary teeth occurs at the age of 6 months and ends by 2.5-3 years, however, this period can begin at the 3rd month of a child’s life, depending on the individual characteristics of the structure and formation of tooth germs. In some cases, teething is not accompanied by any complaints or complications, either local or general [3]. However, in some children this physiological process has a negative impact on their general condition. Irritability, biting of hands, lips or objects, restlessness and tearfulness have been found to be associated with teething, and there is often a sudden increase in the incidence of respiratory infections, middle ear infections, and specific infections such as herpetic gingivostomatitis and herpetic infections [4]. .

Teething is preceded by inflammation of the gums in the corresponding area with the formation of hyperemia and edema [3-4]. The period of eruption of one tooth lasts on average from 3 to 8 days, followed by the appearance of the crown part of the tooth.

This physiological process often gives the child such unpleasant sensations as pain, burning and itching in the oral cavity, accompanied by hyperemia of the mucous membrane, hypersalivation, and an increase in general body temperature [5].

Often, the symptoms of some common somatic diseases are perceived by parents and doctors as teething syndrome, which entails a number of complications and consequences. This is primarily due to the low level of awareness of pediatricians about the manifestations of common somatic diseases, as well as insufficiently complete collection of anamnestic data analysis. It is important to understand that at the time of teething, in addition to local manifestations in the oral cavity, a violation of the child’s general condition occurs, which is also possible with various infectious diseases. That is why it is especially important to conduct a thorough differential diagnosis in children to exclude infectious and inflammatory diseases.

In addition, for correct diagnosis and identification of symptoms, it is necessary to remember the timing of the eruption of primary teeth. Thus, the eruption of the first teeth - the central incisors of the lower jaw - occurs at 4-6 months, the central incisors of the upper jaw - at 5-7 months, and by the age of two years a child should normally have 20 temporary teeth.

It should also be understood that the appearance of primary teeth is an important stage in a child’s life, since from this moment on he can eat more solid foods. Along with this, the formation and development of dental arches occurs, which is directly related to the development of the maxillofacial system as a whole.

That is why it is especially important to pay due attention to the period of teething, as well as the symptoms accompanying this physiological process.

At the time of primary teeth eruption, in addition to pain in the child, hyperemia and swelling of the gums, copious amounts of saliva are produced, which can lead to skin irritation and the development of perioral dermatitis. Also, some children may have a deterioration in appetite, which can lead to disorders of the gastrointestinal tract (GIT) and weight loss. In rare cases, this also leads to dyspeptic disorders. Teething is often accompanied by sleep disturbances in the child, irritability, lethargy, drowsiness and crying. All these symptoms lead to the fact that not only the child becomes irritable and restless, but also the parents experience nervous tension [6].

In turn, some teething symptoms can be relieved at home with the help of special aids such as teething rings and toys filled with coolant. In addition, dentists recommend the use of special gels and ointments that have not only an analgesic effect, but also antiseptic properties [7, 8].

In this regard, the issue of using auxiliary local medications in the oral cavity in order to reduce both local and general pain in a child is becoming increasingly relevant.

Materials and research methods

At the Department of Pediatric Dentistry and Orthodontics, Institute of Dentistry named after. E.V. Borovsky First Moscow State Medical University named after. I.M. Sechenov observed 67 children aged from 5 months to 3 years (the period of eruption of primary teeth).

Dentinale® natura gel was prescribed as an auxiliary drug to relieve pain during teething in order to evaluate the effectiveness of its use. The main active ingredients of this drug are boswellia serrata resin extract, aloe vera leaf juice, chamomile flower extract. Boswellia extract has an analgesic effect, aloe vera juice has an antiseptic effect, chamomile extract soothes and promotes healing of irritated oral mucosa. It should be noted that this drug does not contain lidocaine (which can cause allergic reactions), as well as sugar and parabens.

The use of this drug was recommended according to the following scheme: squeeze a small amount of gel onto the tip of a clean finger and apply with massaging movements to the child’s gums, apply 3-5 times a day. For 20-30 minutes after applying the gel, refrain from eating or drinking to avoid premature removal of the gel from the gums.

Dentinale® natura gel forms a protective film on inflamed gums, reduces sensitivity, irritation and inflammation of the gums, helping the child cope with teething more easily without resorting to analgesics and anesthetics.

The effectiveness of using Dentinale® natura gel during teething was assessed on the 1st, 3rd and 7th day of use. Local symptoms of damage to the alveolar mucosa (hyperemia, swelling, bleeding, submucosal hematomas, hemorrhages), the presence of general symptoms of intoxication of the child’s body (increased body temperature, anxiety with sleep and appetite disturbances, hypersalivation, digestive disorders) were taken into account. To evaluate these eruption symptoms, they were divided according to the severity of the manifestations (mild changes, moderate and severe). At the end of the observation period, parents were asked to fill out a questionnaire to subjectively assess the criteria for the effectiveness of the gel during teething in children and satisfaction with the use of the product. Parents assessed the ease of use, the effect on the child’s behavior (anxiety), the effect on the oral mucosa, the organoleptic properties of the gel and gave a general assessment by answering the questions: “yes” - 1 point, “no” - 0 points.

results

During the treatment and observation of 67 children with difficult eruption of primary teeth, it was revealed that mild changes in the alveolar mucosa were in 31% (n = 21), moderate manifestations - in 57% (n = 38), severe - in 12% (n = 8).

Treated with symptoms:

• swelling and redness of the gums – n = 67 (100%);
• decreased appetite – n = 64 (96.4%);
• indigestion – n = 31 (46.67%);
• increased temperature – n = 59 (88%);
• irritability and tearfulness – n = 63 (94.34%);
• increased salivation – n = 67 (100%);
• restless sleep – n = 63 (94.34%).

In general, during the medical examination, there was a positive trend in all symptoms (Table).

In children with mild changes in the mucous alveolar part of the gums during teething, a decrease in local symptoms was noted on the 3rd day of using Dentinale® natura gel in 48-62% of cases, on the 5th day - in 86-90.5%, on 7- On the 1st day, symptoms were practically absent. General symptoms decreased on the 3rd day by 56-70%, on the 5th day - by 86-90.5%, and on the 7th they were practically absent.

In children with moderate changes in the mucous membrane of the alveolar part of the gums during teething, there was a decrease in local symptoms on the 3rd day of using the gel by 35-53%, on the 5th day - by 76-87%, on the 7th day - by 96% . General symptoms decreased on the 3rd day by 27-60%, on the 5th day - by 90.1%, and on the 7th they were practically absent.

In children with moderate changes in the mucous membrane of the alveolar part of the gums during teething, a decrease in local symptoms was noted on the 3rd day of using the gel; local symptoms on the 3rd day of using the gel decreased by 10-50%, on the 5th day - by 50-75 %, on the 7th day – by 75-100%. General symptoms decreased on the 3rd day by 50%, on the 5th day - by 75%, on the 7th - by 75-100%.

The most pronounced was increased salivation throughout the 7-day observation, swelling and sharp hyperemia of the gums, fever, sleep disturbances and appetite were completely relieved, other symptoms had minimal manifestations by the 7th day of observation (Table).

According to the study, there were no undesirable reactions, including allergic reactions, when using the gel.

We have also observed that the gentle effect of Dentinale® natura gel on the oral mucosa, instant cooling and pain relief allow parents to perform this procedure frequently and for a long time. We assume that therefore it is not difficult for parents to use the gel 3-5 times a day using finger massage and rubbing it in for 20-30 seconds, which in turn significantly speeds up teething and thereby quickly eliminates the negative symptoms associated with this process .

After use, a parent survey was conducted, with the help of which we obtained an assessment of the use of the gel and the characteristics of the drug used. Questionnaires were generated in which the main questions were devoted to the relevant topic and were scored.

Questions about efficiency:

1. Has a sedative effect (yes/no).
2. Quickly relieves pain (yes/no).
3. When applied, it does not cause additional irritation to the mucous membrane (yes/no).
4. After application, the child does not try to spit out the gel (yes/no).
5. Active relief of the inflammatory symptom of the mucous membrane occurs when using the gel after 3 days (yes/no).

Questions about the properties of the drug:

The positive characteristics of Dentinale® natura are that the product:

1. Without lidocaine (yes/no).
2. No sugar (yes/no).
3. Paraben free (yes/no).
4. Has a pleasant taste for a child (yes/no).
5. When applied, it forms a protective film on inflamed gums (yes/no).
6. Harmless if swallowed (yes/no).
7. Has no age restrictions (yes/no).

Based on the results of the survey, the following interpretation of the sums of assessment points was established for children with difficulty teething: “yes” – 1, “no” – 0.

Points from 0.8 to 1 – high level of effectiveness of the gel. Scores from 0.5 to 0.8 are a good level. Points from 0.2 to 0.5 – satisfactory. Scores from 0 to 0.2 – low.

When analyzing the questionnaires completed by parents, a trend was identified for a rapid decrease in symptoms of gum inflammation (5 ± 2.5 days).

Of 67 parents, 91% of respondents whose children used Dentinale® natura gel during the eruption of primary teeth scored an overall assessment of the use of the product with an average score of 0.8-1, which corresponded to a high level of effectiveness of the drug.

An average score of 0.5-0.8 was scored by 8.08% of children, which corresponded to a good level of effectiveness of the gel.

An average score of 0.2-0.5 was scored by 0.92% of children, which corresponded to a satisfactory level of effectiveness of application.

No one scored an average score of 0-0.2.

All observation participants noted the good tolerability of the product (there were no adverse reactions), its pleasant organoleptic characteristics and immediate effect, as well as from the words of parents: “The child almost immediately after application forgets about bothering teeth and starts playing merrily...”

Clinical example: child 8 months old, difficult teething 5.1, 6.1.

Complaints of swelling and redness of the gums, decreased appetite n = 64 (96.4%), increased temperature, especially in the evening up to 38? C, irritability and tearfulness, increased salivation, restless sleep.

Objectively: in the area of ​​​​the projection of teeth 5.1, 6.1 - sharp hyperemia of the gums with pronounced swelling and sharp pain on palpation, increased salivation, the child is anxious and tearful.

Conclusion. K00.7 Eruption syndrome.

Clinically: moderate disruption of the gingival mucosa in the area of ​​eruption.

Recommended topically: use of Dentinale® natura gel. Squeeze a small amount of gel onto the tip of a clean finger and apply with massaging movements to the child’s gums, apply 3-5 times a day. For 20-30 minutes after applying the gel, refrain from feeding the child and do not give him liquid in order to avoid premature removal of the gel from the gums.

Clinical evaluation of the use of the gel: there was no swelling of the gums on the 3rd day of use, on the 4th day the appearance of the edge of tooth 5.1 was observed, pain on palpation and hyperemia of the gums on the 5th day, the appearance of the edge of tooth 6.1, restoration of appetite on the 5th day , normalization of temperature - on the 3rd day, a significant decrease in salivation and normal sleep - on the 5th day.

Result: the assessment of the effectiveness of the gel according to the parent questionnaire was 1 point, which corresponded to a high level of effectiveness of the drug.

Discussion

On the modern market of various pharmaceutical companies there is a wide variety of products that can reduce the pain sensitivity of the oral mucosa and stimulate painless teething [9]. However, most of the drugs on the market contain an analgesic or anesthetic as the main component, the use of which has a high risk of adverse reactions. A scientific study found that over-the-counter use of benzocaine anesthetics in the form of gels and liquids in the oral cavity in children under 2 years of age can lead to serious complications [10]. The American Food and Drug Administration (FDA) has found that the use of benzocaine can lead to methemoglobinemia, manifested by pale and bluish skin of the lips and nail beds, shortness of breath, rapid heartbeat, and confusion [10].

Elizabeth Super (2021) recommends the use of Tylenol children's gel to reduce gum pain [11]. It is worth noting that Tylenol gel is widely used in pediatric dental practice, however, the American Academy of Pediatricians states that this gel has significant side effects, manifested by numbness of the oropharynx and, as a result, difficulty swallowing [11].

In turn, we recommend the use of Dentinale® natura gel, since its analgesic effect is achieved through boswellia extract, which is safe when swallowed and does not cause side effects such as numbness of the oropharynx and confusion. Boswellia has unique medicinal properties that have been known for a very long time and are successfully used in the treatment of many diseases. First of all, these are anti-inflammatory properties: boswellic acids act in such a way that the synthesis of leukotrienes is blocked, resulting in an effect similar to non-steroidal anti-inflammatory drugs, but without side effects.

M.D. Velikoretskaya (2017) in her study divides teething gels into 4 groups:

• with an anesthetic effect based on an anesthetic;
• based on anti-inflammatory or antiseptic agents;
• on a homeopathic basis;
• based on extracts of medicinal plants [12].

Having analyzed each group of drugs, the author found that the use of a gel based on plant extracts allows not only to facilitate teething in children of the first and second year of life, but also to avoid unwanted complications that are possible when using drugs containing chemical anesthetics and anti-inflammatory substances [12, 13].

Based on the results of the study, Dentinale® natura gel, the main active ingredients of which are boswellia extract, which has an analgesic effect, aloe vera juice, which has an antiseptic effect, and chamomile extract, which has anti-inflammatory and wound healing effects, is the most effective and safe remedy for children of this age group.

There is also Ashton and Parsons baby powder, the active ingredient of which is a tincture of matricaria with the addition of chamomile. It should be noted that this drug has a sedative effect, relieves tension, anxiety and irritability, without having an anesthetic effect [14-16].

Preparations with lidocaine and sugar adversely affect the general condition of the child, causing serious side effects. The main disadvantage of these drugs is hypersensitivity to lidocaine with the subsequent development of an allergic reaction in the form of localized swelling, accompanied by minor difficulty breathing or a generalized rash.

It should be noted that Dentinale® natura gel does not contain lidocaine, sugar and parabens, since the base is made of plant components. The ability of the gel to have an anti-inflammatory, antiseptic and wound-healing effect is also due to the formation of a protective film on the inflamed gums, which reduces sensitivity, irritation and inflammation of the gums, helping the child to more easily endure the period of teething, without resorting to analgesic and anesthetic drugs.

conclusions

Thus, based on the results of clinical changes in local and general symptoms associated with the eruption of primary teeth in 67 children using Dentinale® natura gel, already on the 3rd day a significant reduction in symptoms was observed in 30-50%, on the 5th day – in 50-80%, on the 7th – in 90-100% of infants.

According to a survey of parents, the effectiveness of the Dentinale® natura gel is 91% of respondents who used it during the eruption of primary teeth, which corresponded to a high level of effectiveness of the drug, since the use of a plant-based gel not only facilitates the process of teething, but also avoids complications which occur when using products containing anesthetics, analgesics and anti-inflammatory drugs.

One of the main advantages of the drug is its antiseptic, wound-healing and safe effect on painful teething in children.

CONFLICT OF INTEREST. The authors of the article have confirmed that there is no conflict of interest to disclose.

CONFLICT OF INTERESTS. Not declared.

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A. A. Mamedov1, Doctor of Medical Sciences, Professor A. A. Skakodub, Candidate of Medical Sciences O. V. Dudnik, Candidate of Medical Sciences A. S. Chertikhina A. R. Beznosik

Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after. I. M. Sechenov Ministry of Health of Russia, Moscow, Russia

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An effective way to alleviate the condition of children during teething / A. A. Mamedov, A. A. Skakodub, O. V. Dudnik, A. S. Chertikhina, A. R. Beznosik For citation: Mamedov A. A., Skakodub A. A., Dudnik O.V., Chertikhina A.S., Beznosik A.R. An effective way to alleviate the condition of children during teething // Attending Doctor. 2021; vol. 24 (9): 16-20. DOI: 10.51793/OS.2021.24.9.003 Tags: children, baby teeth, temporary teeth, pain relief