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Orthodontic problems and treatment in young children

Crooked teeth can develop very early in childhood, but surprisingly few children will benefit from orthodontic treatment before all the adult teeth have grown through. However, early treatment is important for a limited number of specific conditions to prevent damage to the adult teeth or to limit the effects of a developing growth problem. One of our guiding principles at North Sydney Orthodontics is to keep the amount of treatment required to produce a great smile to an absolute minimum. We only recommend orthodontic treatment for children that we believe has a definite benefit, and if the problem can wait until the adult dentition is established without damaging the health or function of the dentition, then that is what we recommend.

When should orthodontic treatment start?

The Australian orthodontic society  recommends a first assessment by an orthodontist around the age of 6-7 years, because this is the age when the first of the adult teeth typically appear and when some of the more important problems of dental development can require treatment.   Treatment for young children is usually aimed at dealing with functional problems that immediately threaten the health of the teeth.  Braces for young children usually lasts less than 1 year, and may shorten or simplify definitive orthodontic treatment later on but will result in a longer treatment time in total. The conditions that we treat in early childhood are problems of tooth eruption, teeth biting the wrong way round (crossbite), overcrowding, jaw growth problems, snoring, thumb sucking, tongue thrust and open bite.

An orthodontic practice for your kids

Any medical procedure can be worrying for young children, so we have designed our practice environment to relax and entertain our young visitors.  We have a separate games and movies area which is located so you can keep an eye on your precious ones while still enjoying the grown up comforts of the main waiting area.  Our treatment rooms are light filled and spacious and we welcome parents into the treatment area at any time.

Tooth eruption : orthodontic treatment of impeded incisors

The permanent  teeth start to enter the mouth around the age of 5 to 6 years of age. Sometimes there is a problem with the normal eruption of the teeth.  Early diagnosis and treatment maximizes the chance of a full correction.

The problem most commonly affects the upper incisors though other teeth can also be affected.  The cause of the problem can be due to the presence of an obstruction such as an extra tooth (supernumerary tooth) or occasionally if there has been an injury to the primary teeth. Treatment involves (surgical) removal of any obstruction and usually orthodontic traction to deliver the tooth into the mouth using partial fixed braces. The aim of treatment is simply to deliver the incisor tooth into a functional position. Perfecting the alignment of the teeth often requires full braces once all the adult teeth have grown in around 11-12 years of age. This case shows an impacted upper right incisor tooth that has been obstructed by the growth of an extra tooth shown by red arrow in the x-ray picture. The baby tooth is still present. Treatment involved extraction of the baby tooth and orthodontic traction to bring the buried tooth into the mouth.

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click here to see more information about impeded incisors or more treatment cases

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Space maintenance

When a primary tooth is prematurely lost (i.e. extracted due to decay),  adjacent teeth may drift into the space, and leave insufficient space for alignment of the permanent teeth.  An orthodontist’s opinion is required  to assess whether a space maintaining device is of value.  Space maintaining devices can be fixed or removable and the correct design will be determined by the particular situation.

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In this case primary teeth had been extracted on the patient’s right side (blue arrow) allowing the back (adult) tooth to move forward, potentially causing crowding of the side teeth.You can see that the canine on the patient’s left (yellow arrow) is already crowding. Notice that the remaining primary teeth (marked x) are bigger than the adult replacement teeth (marked Y). By placing a lingual bar appliance the space was preserved resulting an a very nice alignment of the lower teeth without full braces.

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Dental crowding and treatment to avoid tooth extractions

If dental crowding is noted in a young child, orthodontic treatment may be started around 9 or 10 years of age to expand the dental arches or maintain premolar spaces to avoid dental extractions later on.  This can usually be achieved initially with simple appliances but treatment is often then continuous until all the teeth have erupted and fixed appliances have completed the alignment.

In this case only a simple upper plate was used to develop the upper arch to a very acceptable (though not perfect) alignment.

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Problems of snoring and low tongue position

Childhood snoring is a possible sign of partial airway obstruction and is a potentially serious problem, which can affect a child’s daytime mood, educational development and growth of the face. Occasionally the problem is due to narrowness of the upper jaw and early expansion may  help to improve nasal airflow and restore normal sleep patterns.  We carry out orthodontic treatment for childhood snoring in conjunction with advice from Ear, Nose and Throat specialists and a Children’s Sleep Specialist.

Crossbite

Crossbite is a common problem where one or more of the upper teeth bite inside the lower teeth.  This can cause damage to the gum attachment of the affected teeth and excessive wear of the enamel.  Often there is also a deviated path of jaw closure which may strain the jaw joints or cause teeth to erupt into aberrant positions. Careful timing of the treatment is needed to correct the problem with the minimal amount of orthodontic therapy and without prejudice to the developing permanent teeth germs. When the upper jaw is narrow, early orthopaedic expansion will assist the correction of dental crowding as well as correcting the crossbite.

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Orthodontic treatment of jaw growth problems in children

For some children an imbalance in the growth between the top and bottom jaws (the maxilla and the mandible) makes it impossible to bite the teeth together correctly. This is often an inherited problem.  Expansion and forward growth of the upper jaw can be useful when there is a small upper jaw, and recent studies have indicated that an early start around the age of 6-8 years on this type of procedure is advantageous.

Another common problem is a small lower jaw for which many different types of functional appliance have been suggested.  North Sydney Orthodontics favours the use of the Twin block appliance for this type of problem . The best time to be using this kind of appliance around 9-11 for girls and 11-13 for boys.

Orthodontic treatment of finger or thumb sucking

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Prolonged finger or thumb sucking habits after the age of 5 can stop the normal growth of the front teeth or move them forward into a prominent and vulnerable position. Our preferred method of correcting this behaviour is with counseling and motivation of the child to give up thumb sucking themselves as early as possible which has proved 95% successful.  For those children continuing the sucking habit various devices can be designed to interfere with the comfort derived from the habit.

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