This blog describes the rationale behind early orthodontic treatment in young children, generally aged 7 to 9. Orthodontic treatment can be divided into two phases:
- Phase 1 treatment or early orthodontic treatment, which will be discussed in depth in this blog. This treatment is usually for children aged 7 to 9 and has a number of benefits as will be mentioned.
- Phase 2 treatment or treatment around puberty, once all of the adult teeth are present.
Every child is different and depending on the severity of the issues, some children may require only phase 1 treatment, other children may require both phase 1 and phase 2 treatment to achieve an ideal result.
What are the benefits of starting orthodontic treatment early?
There are a number of benefits to starting orthodontic treatment early:
– it gives a better chance of getting a full correction
– it allows us to complete treatment that may avoid surgery
– it allows us to use growth to fix teeth
– it makes it less likely that we will have to extract permanent teeth
– younger children tend to co-operate better than older patients
– there is a better chance of getting full correction in phase 1, without the need for phase 2 treatment
What does early orthodontic treatment consist of?
The American Orthodontic Association recommends an orthodontic consultation for all kids by the age of 7. Early orthodontic treatment consists of intervention to allow the face and jaws to grow properly. This gives a better chance of full correction of any orthodontic issues as well as prevents relapse of the teeth following treatment. Early orthodontic treatment focuses on addressing any habits and establishing a proper pattern of breathing and swallowing to allow the face and jaws to grow in an ideal way.
Addressing any Habits
The first part of early orthodontic treatment is addressing any habits in order to get a neuromuscular balance to be able to address any orthodontic issues and to prevent relapse of the teeth following treatment. These habits mainly include:
- thumb or finger sucking
- tongue thrust (which can usually be detected by a child having a lisp with S sounds)
- using a pacifier for an extended period of time
All of these habits promote a low forward tongue posture which contributes to malpositioning of the teeth, they can also cause changes in the roof of the mouth. With these habits, frequency is more important than the habit, more than 6 hours will cause malposition of the teeth including a crossbite (where the lower teeth sit in front of the upper teeth), crowding and an open bite (where the front teeth don’t touch).
With using a pacifier, adverse dental effects may occur after 24 months of pacifier use, the effects are more significant after 48 months. Therefore, pacifier use should be discouraged after four years of age.
Thumb or finger sucking can be addressed with appliances such as a Bluegrass appliance that gets glued into the mouth and stops a child being able to position their thumb on the roof of their mouth.
A tongue thrust can be corrected with a device such as a Myomunchee, which promotes chewing and swallowing with the lips together in order to teach the tongue to position itself correctly (up in the palate instead of forwards) and thus correct the tongue thrust habit.
The next part of treatment is to correct any breathing issues such as mouth breathing.
There are three main causes of mouth-breathing:
- Infantile swallowing pattern that was never out-grown
- Thumb sucking, tongue thrusting or use of a pacifier
- Airway and breathing problems
The most common cause of airway and breathing problems is enlarged tonsils or adenoids, but other factors such as allergies, asthma, sinus problems and deviated septums can contribute.
How does Mouth Breathing Cause Orthodontic Issues?
Mouth breathing causes orthodontic issues by promoting a more vertical growth pattern rather than a horizontal growth pattern. When the mouth is open, it drags everything downwards and backwards, resulting in a narrow upper jaw which leads to crowding and can lead to anterior and posterior crossbites (the upper teeth sitting behind the lower teeth). A narrow upper jaw causes restriction to the growth of the lower jaw as well. It also drags the chin downwards and backwards, causing the jaw joint to shift into an incorrect position which leads to bite dysfunction, with symptoms of headaches and facial pain. Finally, your lips are your face’s braces, so open lips encourage the front teeth to flare out.
What Other Issues Can Mouth Breathing Cause?
Crooked teeth can be a symptom of something larger. Mouth breathing can contribute to more holistic issues such as sleep-disordered breathing (snoring, obstructive sleep apnea) and as these issues can have a significant impact on overall health, it is important that they are treated as early as possible. Sleep-disordered breathing can have a flow-on effect to other areas of a child’s life, poor concentration in school is a significant effect, with children with sleep-disordered breathing will have 10-20 fewer IQ points, on average 5 IQ points per year that this is happening. Other effects can be irritability, bed wetting, hyperactivity and attention deficit disorder.
Correcting the Bite and Making Room for the Adult Teeth
Correcting the bite can consist of:
- Expanding the palate
- Partial braces
Expanding the palate is best done early, as at 8 years old, the face is 90% of its adult proportion but by puberty, the face is 100% of its adult proportion. We are able to to get more expansion of the palate (20-25mm) in children 6-8 years, this drops down to less than 12mm in children 12 years old. Expanding the palate helps to make room to move the teeth to correct crowding as well as assists in correcting the bite.
Expanding the palate is achieved with a device known as a banded or bonded hyrax, which is glued on to the upper teeth. It has a screw across the middle which is turned at regular intervals to slowly expand the palate. Once the palate is expanded to a reasonable amount, the appliance is left in the mouth for a few months to prevent relapse. This phase usually takes 4-5 months.
The next step is partial braces on the 4 front teeth and 2 back teeth, which usually are worn for 12-18 months. Partial braces can be used to correct any rotated or incorrectly angulated front teeth, closing space between front teeth and correcting any crossbites of the front teeth as well.
For children with overbites, 2×4 braces will often be combined with a MARA appliance, to encourage the jaw to grow in the correct position and hence correct the overbite.
For children with underbites, facemask headgear will be used in combination with 2×4 braces to encourage the upper jaw to grow whilst simultaneously restricting the growth of the lower jaw. Using facemask headgear can have the added benefit of increasing the airway space to improve breathing.
Following this treatment, retainers get provided for the child which are worn until all of the adult teeth have come through, at which point, we can assess whether the child will need phase 2 braces.
Who can provide orthodontic treatment?
Orthodontic treatment can be provided by a general dentist who has undergone extra training to be able to deliver orthodontic treatment. In more difficult cases or cases requiring surgery, your general dentist may refer you to an orthodontist for treatment.