Pediatric Orthodontics
Growing children often have irregularities in their ‘bite’ due to hereditary factors, the early loss of primary (milk) teeth, and poor oral habits such as Mouth Breathing (most common), Thumb Sucking and Tongue Thrusting. The irregularities may be apparent from birth or during early childhood and could result in tooth decay or periodontal disease. Early Age Ortho Correction plays a very important role in the correction of oral irregularities like improper bite and malocclusions due to crooked or crowded teeth.
Importance of Early Orthodontic Intervention
Orthodontic irregularities can mostly be spotted early on in children. With periodic dental checkups from an early age, the Pediatric Dentist is able to monitor the child’s oral development and plan for orthodontic interventions early, which helps in proper jaw growth and development, better alignment and spacing of teeth, reduces risk of impacted adult teeth, bruxism, cavities, tooth decay and periodontal disease, better speech development, and enhanced self-confidence with an aesthetically pleasing appearance.
Common Orthodontic Problems in Children
Orthodontic issues occur due to misalignment between the upper and lower jaws / teeth or malocclusions . They usually become apparent by the time the child’s permanent teeth are ready to erupt.
Overbite
An overbite is a malocclusion where the upper teeth protrude or extend much beyond the lower teeth due to the irregular shape/size of the jaw and lack of space in the jaw area to accommodate all teeth. This causes issues with breathing, improper chewing and digestion, cavities, tooth decay, speech impediments or temporomandibular disease (TMD).
Underbite
An underbite is caused due to the lower teeth protruding much beyond the upper teeth and due to the irregular shape/size of the jaw and lack of space in the jaw area to accommodate all teeth. They cause almost the same problems as an overbite.
Crossbite
When a child has a crossbite, his / her upper teeth sit inside the lower jaw when biting down, leading to irregular shape/size of the jaw and reduced space in the jaw area to accommodate all teeth. Discomfort caused due to crossbites makes children shift their jaw to one side, causing lasting changes in the teeth alignment, facial structure, and jaw joints.
Open Bite
A malocclusion where the teeth of the upper and lower jaws do not overlap when the mouth is closed, resulting in a gap between the upper and lower arches. Chewing, digestion, and speech are affected due to open bite issues in children. They also develop habits like tongue thrusting or thumb sucking.
Crowding
When all the teeth in the mouth cannot be accommodated in their right positions due to the jaw size not being proportionate to the teeth, they tend to grow displaced or twisted. This makes it difficult to clean the teeth leading to the risk of developing cavities, dental decay, and gum disease. Premature loss of milk teeth due to decay or injury increases the risk of teeth crowding.
Diastema
Diastema is an orthodontic irregularity where there is a gap or excessive spacing between adjacent teeth. The most common diastema noted in children is Midline Diastema, when there is a gap between the front two teeth. The gap can affect the aesthetics of the child’s smile, affecting his/her confidence. Food particles can get stuck in the gaps between teeth and may be difficult to remove even with brushing.
Orthodontic Appliances for Children
Orthodontic appliances are used to facilitate effectivetooth movement, ensuring support for proper growth and development of the jaws and holding space for the permanent teeth to grow in the right place.
Braces & Aligners
Children between the ages of 8-14 years are ideally suited for dental braces since their facial bones and jaw structure are still amiable to resetting into a new position. Braces come in different varieties – metal or plastic brackets that are bonded to the teeth, brackets that attach to the back of the teeth and are not visible from the outside, metal bands that wrap around the teeth, and clear, invisible aligners that can be removed from the teeth. The Pediatric Dentist will advise which type of braces are best suited for the child depending on the extent of correction needed and the age of the child.
Myobrace®
The Myobrace® treatment is an effective solution to many orthodontic problems in children. It consists of intraoral appliances that are worn for an hour every day and while sleeping at night. The Myobrace® system helps to expand the arch form while exerting mild pressure to align the teeth and jaws. Depending on the child’s age and extent of the orthodontic problem, separate appliances may be used. Myobrace®Activities is a patient education program that further corrects myofunctional habits through a series of exercises for the lip, cheek and tongue, and for breathing and swallowing. This helps the child to breathe better through the nose, swallow correctly, correct the tongue’s resting position, and keep the lips together, thus optimizing facial development.
Fixed & Removable Appliances
Fixed orthodontic appliances are fixed to the teeth for the duration of the treatment and are commonly used on younger children who may try to take the appliance out of their mouths due to discomfort. Fixed appliances help to ensure progress at a more predictable rate than removable appliances. Habit modification appliances for thumb sucking or tongue thrusting are also fixed appliances where a thin metal wire goes behind the teeth in a way that is not visible from the outside and does not cause hindrance while eating. Removable appliances provide more comfort to the wearer as they can be removed while eating and cleaning the mouth. They ensure oral hygiene since the teeth and gums can be cleaned better after removing the appliance.
Functional Appliances
When children have serious bite issues, the Pediatric Dentist may recommend the use of Functional Appliances like Activator, Bionator, Twin Block and Herbst appliances. Functional appliances may be fixed in the mouth like braces or may be removable and work by repositioning the lower mandible in a way that helps the bite develop in a better orientation. The appliances are most effective when used on children since their jaw is still in the developing stage. Functional appliances may incorporate palatal expanders and may sometimes be used as an alternative to dental Headgear.
Expansion Appliances
Palatal Expanders are orthodontic appliances used to correct the width of the upper jaw in case of posterior crossbite or severe crowding of teeth or bite issues. Children who have sleep-disordered breathing or misalignment of the lower jaw may also be recommended for the use of expansion appliances. They are generally used in younger children who are still in the stage of growth. The most common types of Palatal Expanders used are Bonded expanders, Hyrax expanders, Hass expanders, and Quad Helix expanders.
Managing Patient Compliance in Pediatric Orthodontics
Patient compliance requires discipline, cooperation with the treatment procedures, and willingness to follow through with good oral hygiene practices as well as the instructions given by the Pediatric Orthodontist. While it is important even in the case of adults, ensuring compliance becomes particularly important in the case of children, mainly because they are still developing these skills. Parents play a very important role in enabling patient compliance in Pediatric Orthodontics. Oppositional child behaviours, such as stubbornness, throwing tantrums, lack of motivation or anxiety regarding the progress of the treatment can all be hindrances to patient compliance and the parents and the Pediatric Dentist need to work together to manage these behaviours.
