Tooth Tales Clinic

Orthodontic Care

Preventive Orthodontics-Space Maintainers

Space maintainers are used to keep teeth from drifting into an empty tooth space due to early loss of primary teeth which actually act as a guide for the eruption of the permanent teeth. A space maintainer is a combination of bands and biocompatible stainless steel wires designed to hold the remaining teeth in a position that will allow the future permanent tooth to erupt in the proper location. A space maintainer is typically placed where a back tooth is lost. Space loss does not usually occur when front teeth are lost, therefore space maintainers are usually not recommended for front teeth.

Advantages

Prompt placement of a space maintainer will give the permanent tooth the best chance of erupting in the mouth in the correct location. This will minimize future orthodontic problems caused by premature loss of a baby tooth and shifting of teeth.

Disadvantages
Your child will need to wear the appliance until the permanent tooth erupts. If not kept clean, decay can occur under the bands. This can be minimized by good oral hygiene at home and periodic review with us.

Alternatives
If a space maintainer is not placed, the teeth will shift into the open area, making it difficult, or in some cases impossible, for the permanent tooth to erupt. This requires orthodontics to remedy the situation.

Interceptive Orthodontics- Early/Mixed dentition orthodontics

Interceptive orthodontics or early/Mixed dentition orthodontics may be recommended to correct certain dental malocclusions that develop early.  Crossbites, narrow dental arches, issues created by habits such as thumb or pacifier use, overbites and underbites are some of the conditions that may benefit from interceptive orthodontics. In addition, early interceptive orthodontics may help avoid the removal of permanent teeth in the final phase of orthodontic treatment.

Parents should be aware that interceptive care is usually an early phase of full orthodontics that may be needed in the future.  Interceptive care can help make further orthodontic care less involved requiring less treatment time.  In some cases it could help avoid any further orthodontic care also.

Some examples of interceptive orthodontics are expansion of the upper jaw to correct a crossbite, early removal of baby teeth to facilitate the proper eruption of the permanent teeth, maintaining space for permanent teeth after a premature loss of a baby tooth, intercepting bad oral habits, bringing forward the lower jaw, serial extraction and reducing protrusion of upper front teeth to decrease the likelihood of fracture from trauma.

At Tooth Tales, we strongly advise that children should have their first orthodontic screening no later than age 7. This orthodontic evaluation is used to identify jaw irregularities and developmental complications that could indicate the need for orthodontic treatment in the future. Early screenings make it possible to get early treatment, with some children beginning progressive orthodontic treatments as early as age 7.

BRACES/ORTHODONTIC TREATMENT:

Kids can need braces/full orthodontic treatment for any number of reasons, including crooked, overlapping, or overcrowded teeth, or a “bad bite” (known as malocclusion) at 13-14 years of age. Sometimes tooth and jaw problems can be caused by losing baby teeth too soon, accidents, or habits like thumb sucking. But often they’re inherited, so if you or someone in your family needed braces, it’s likely that your kids will, too.

Often, your child’s dentist will be the first to notice problems during a regular visit and recommend that you see an orthodontist (a dentist who specializes in correcting jaw and/or teeth alignment problems). The orthodontist can decide whether your child does indeed need braces and which type would be best.

As mentioned before, there’s no set age for a child’s first orthodontist visit — some kids go when they’re 6, some kids go when they’re 10, and some go while they’re teens. Even adults can need orthodontic treatment. Many orthodontists say kids should see an orthodontist once their permanent teeth start coming in, around age 7. At this age, issues such as uneven bite and overcrowding will become apparent.

Starting the process early doesn’t mean a child will get braces right away. It just means the we as pediatric dentists and/or orthodontist will be able to find problems at early level and decide the best time to start the treatment.

Type of Braces

Braces correct alignment problems by putting steady pressure on the teeth, which eventually moves them into a straighter position.

Most kids just need braces with brackets, wires, and rubber bands. The brackets attach to the teeth and are connected by a wire and rubber bands. The wire is tightened bit by bit over time to slowly help line up the teeth properly. The rubber bands come in fun colors that kids can pick. Though metal braces are still used, so are clear or white ceramic braces, which are much less noticeable and much more popular in today’s kids. Some even go behind the teeth (lingual braces).

Clear removable braces that move teeth with plastic trays called aligners (rather than wires and rubber bands) are the most popular choice now as they are extremely convenient, easy to use, kids can place themselves, reduces multiple visits to orthodontist, eliminates food lodgment and subsequent decay and most importantly, hardly noticeable and hence very esthetic. Digital impressions are used to fabricate them and one can see the final outcome even before initiating treatment.

In some cases, the orthodontist also might recommend that your child have one or more teeth removed to create more space in his or her mouth. Once the braces are on, your child will have to visit the orthodontist every few weeks for monitoring and adjustments. How long your child will need to wear braces depends on the problems the orthodontist is trying to fix, but the average is about 2 years. After that, your child might wear a specially molded retainer — a small, hard piece of plastic with metal wires or a thin piece of plastic shaped like a mouthguard. Retainers keep the teeth from wandering back to their original places.

Mouth Breathing-Airway Orthodontics

One of the most potent and silent epidemics of our times is breathing from mouth and at Tooth Tales, we consider it more serious than any other thing as it is not only affecting dental health but also general/medical health. If a child is a mouth breather their tongue won’t rest in the roof of the mouth, which often results in an underdeveloped upper jaw and restricted forward growth of the lower jaw.  As well as affecting jaw and facial development, the medical profession now recognizes that mouth breathing is abnormal and is also one of the main contributors of Sleep Disordered Breathing (SDB) problems. Symptoms include snoring, morning tiredness and learning difficulties with extreme cases stopping breathing at times during the night. This is the medical condition called Obstructive Sleep Apnoea – OSA. If left untreated, SDB can lead to significant and serious health problems that cause poorer quality of life in adulthood.

Symptoms commonly associated with Sleep Disordered Breathing (SDB) can include:

  • Developmental and behavioral problems
  • Snoring Early evaluation for the signs of poor jaw development is increasingly becoming a
  • Gasping
  • Obstructive Sleep Apnea
  • Interrupted sleep

At Tooth Tales, when you come to us, we try to examine the child more holistically and look for any early/abnormal signs of breathing and improper jaw development. We encourage parents to read more about it and then have a constructive discussion employing strategies like oral myofunctional exercises at home, evaluation with ENT, myofunctional appliances coupled with expansion of upper arch followed by forward placement of lower jaw by twin block. Sometimes, child needs tongue evaluation and frenectomy. Functional pediatric dentistry is not any more a future. It is a very important reality.

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