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Early Treatment

You probably know that it's never too late to begin orthodontic treatment — but when it comes to your youngster's teeth, did you know that earlier may be better than later? According to the American Association of Orthodontists, kids should have an initial orthodontic screening at age 7. What makes early evaluation — and potentially, early treatment — so important?

 Orthodontic Problems.

There are several ways that kids can benefit from seeing an orthodontist at an early age. But it's important to recognize that early evaluation isn't necessarily followed by early treatment; in most cases, if orthodontic work is needed, we simply monitor your child's growth patterns until we see that it's time for treatment to begin. This gives us an opportunity to get the best results in the most efficient way, and to help prevent future problems.

Although every child's development is different, in most kids the first adult molars have typically started to emerge by around age six. This, along with other developmental markers, lets us get a handle on the basic alignment of the teeth, from front to back and side to side. It may also be possible at this point to determine whether there is adequate room in the mouth for all of the permanent teeth — and, if not, to take action.

When Earlier Treatment Is Better

Treatment for common orthodontic problems typically begins around age 9-14, when all of the baby teeth are gone and many of the permanent ones are in place. But there are some conditions that are much easier to treat if they're caught at an early age, when a child's natural growth processes are going full speed ahead.

Crossbite.One is severe crossbite, a condition where the upper teeth close inside the lower teeth. To treat this problem, a device called a palatal expander can be used, which gradually and painlessly widens the upper jaw; it's especially effective when the jaw itself hasn't fully developed. If we wait too long, a more complicated treatment — or even oral surgery — might be required to correct the problem.

 

Crowding.Another condition that may benefit from early treatment is severe crowding. This occurs when the jaws are too small to accommodate all of the permanent teeth. Either palatal expansion or tooth extraction may be recommended at this point, to help the adult teeth erupt (emerge from below the gums) properly. Even if braces are required later, the treatment time will likely be shorter and less complicated.

 

Protruding teeth.Early intervention may also be helpful in resolving several other problems. Protruding teeth, especially in front, can be prone to chipping and fractures; they may also lead to problems with a child's self-image. A severe underbite, caused by the lower jaw growing much larger than the upper jaw, can result in serious bite problems. Orthodontic appliances, including braces and headgear, can be successfully used to correct these problems at this stage, when the child's development is in full swing, thereby increasing the chances that surgery can be avoided.

Correcting Bad Habits

 Dangers of Thumb Sucking.

At one time or another, anyone may pick up a bad habit. But there are some situations where a youngster's parafunctional (detrimental to health) habits can actually influence the development and function of his or her teeth, jaws and mouth. Some examples of these are persistent thumb sucking, tongue thrusting and mouth breathing.

The sucking reflex is natural in early childhood; it usually disappears between ages 2 and 4. But if it persists much later, the pressure of the digit on the front teeth and the upper jaw can actually cause the teeth to move apart and the jaws to change shape. This can lead to the orthodontic problem called “open bite,” and may impair speech. An open bite can also be caused by the force of the tongue pushing forward against the teeth (tongue thrusting).

 Child sucking thumb.

Children's jaws, rich in blood supply and growing rapidly, are relatively soft and flexible — especially in kids under the age of eight. So it really isn't hard for the constant pressure of a thumb or finger to deform the soft bone around the upper and lower front teeth. Children who are particularly vigorous thumb suckers are even more likely to change the growth patterns of the teeth and jaws.

 This can result in misalignment of the teeth, an anterior open bite (where the front teeth fail to close together), collapse of the upper jaw causing crossbite, or other problems. That's why it is important to stop the behavior at an appropriate time, before damage occurs.

Various orthodontic treatments are available to help correct parafunctional habits — and the sooner they're taken care of, the less damage they may cause. But these potential problems aren't always easy to recognize. That's one more reason why you should bring your child in for an early orthodontic screening.

Controlling Thumb or Finger Sucking

Like many potentially harmful behavior patterns, thumb sucking can be a difficult habit to break. Through the years, parents have tried a variety of home remedies, such as having the child wear gloves, coating the digits with a bitter-tasting substance — and even reasoning with their toddlers. Sometimes it works — but in other cases, the allure of thumb sucking proves very difficult to control.

Fixed palatal crib.

If your child has a thumb or finger sucking habit that has persisted past the age of three, and you've been unable to tame it, then it may be time for you to visit our office. We will consider treating your child with a “habit appliance” such as a fixed palatal crib or a removable device. This crib isn't for sleeping — it's a small metal appliance worn inside the mouth, attached to the upper teeth.

How does it work? The semicircular wires of a palatal crib keep the thumb or finger from touching the gums behind the front teeth. Simply preventing this contact seems to take all the enjoyment away from the thumb sucking habit — and without that pleasurable feedback, a child has no reason to continue the behavior. In fact, the device is often successful the first day it's worn.

Getting and Using a Habit Appliance

If your child could benefit from a habit appliance, the first step is to get a thorough examination, which may include taking X-rays, photographs and dental impressions. If it's recommended, a crib will then be custom-fabricated to fit your child's mouth, and placed at a subsequent appointment. Afterwards, your child will be periodically monitored until the appliance is removed — typically, a period of months.

Although wearing the crib isn't painful, your child may experience some soreness in the upper back teeth for a few hours after it's first installed. He or she may also have a little trouble falling asleep for a day or two afterward. Plenty of extra attention and TLC are usually all that's needed to make everything all right. While the appliance is being worn, it's best to avoid chewing gum and eating hard, sticky food that might cause it to come loose.

A Word About Tongue Thrusting

Like thumb sucking, tongue thrusting is a normal behavioral pattern in young children. It's actually part of the natural infantile swallowing pattern, which will normally change on its own — by the age of six, in most children. If the pattern doesn't change, however, it can lead to problems similar to those caused by thumb sucking: namely, problems with tooth alignment and skeletal development. Fortunately, this problem can be successfully treated with a habit appliance that's very similar to a fixed palatal crib.

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