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– Dr. Rob Veis, Dentist, Lecturer and
CEO, Appliance Therapy Group

The American Association of Orthodontists recommends that every child have an orthodontic examination by the age of 7. This early examination and diagnosis of bite irregularities and potential dental concerns in growing children is vital to their lifelong dental health and proper development.

For example, an undiagnosed airway problem in a growing child can cause an abnormal bite, abnormal facial growth, inability to breathe normally, behavior problems at school, a misdiagnosis of ADHD, sleep apnea as a child and later on as an adult.

In this article (Part I in a series), I hope to provide parents with a better
understanding of what they need to know to be prepared for their child’s first orthodontic exam. I want to present you with an overview of what to expect when it comes to diagnosing and treating some of the problems associated with children in what is known as the mixed dentition phase – where both primary (”baby” ) teeth and permanent (”adult”) teeth are present.

• • • •

The First Orthodontic Examination

The purpose of an early examination during the mixed dentition years is to determine whether there is a need for some orthodontic measures that will allow for the proper growth of all the permanent teeth. If we can intercede early, we may be able to prevent the occurrence of major orthodontic problems later on. The sooner a problem is diagnosed and corrected, the better off younger patients will be as they continue to grow.

Primary to Permanent
The first thing you need to know is that a child’s chronological age does not follow their dental age, nor does it correlate with their height, weight or mental development.

The “mixed-dentition mouth” has both primary and permanent teeth. Primary dentition ends with the first “eruption” (emergence) of a permanent tooth. It is not age-dependent. The mixed dentition phase ends and becomes “permanent” when there are no longer any “baby” teeth in the mouth.

In the mixed dentition stage, some of the permanent teeth are positioned just below the primary teeth. The primary teeth act as placeholders for these permanent teeth to come in. The primary teeth also act as a guide for these permanent teeth to follow when emerging from their position.

The Importance of Space
It is essential that children be evaluated for missing primary teeth to determine if any space maintenance is necessary. As a general rule, all space created by a missing primary tooth should be maintained. This is to ensure that the permanent teeth grow in straight and true. If there is an early loss of a primary tooth a dental appliance will usually need to be placed to allow the adult teeth to grow in normally.

Early examination can also detect “delayed eruption” – a condition usually the result of earlier trauma to the region — where a single tooth is not growing through. It can also reveal the condition known as “over-retained teeth” – the failure of some primary teeth to grow out and make room for the permanents. We don’t know exactly why this occurs, but when it does, it can be corrected. If we observe a primary tooth with no “mobility” and the permanent successor stuck beneath it, extraction of the primary allows normal growth to take place.

Deleterious Conditions and Environmental Influences

Harmful Habits
Practitioners should examine all children for signs of habits and repetitive actions that may change the way an individual child’s teeth and mouth mature. The habits of children (both nocturnal and daytime) can alter tooth position and skeletal development in some cases..

Digit problems (finger and/or thumb sucking) are best solved by using appliances. In the instance of tongue thrusting or related tongue positioning problems, the corrective appliance can be either fixed or removable. And don’t panic…children do adapt quickly to speaking normally when an appliance is in place. After approximately six to eight months, the dentist will remove the appliance and evaluate whether the problem has been resolved. Because habits are tenacious, it is necessary to evaluate the patient within three months to make sure that the habit is actually broken.

Environmental Influences
In some instances, excessive environmental forces (like playing a musical instrument) can alter the dentition if the forces are applied over extended periods of time. In addition, children with airway obstruction caused by enlarged adenoids or tonsils, should be evaluated for surgical removal. If your dentist suspects your child may have an obstructive airway he or she may recommend that the patient see a sleep specialist for a prescription for a sleep study, to evaluate breathing during sleep. The dangers of obstructive sleep apnea are well-documented in both children and adults, and your dental practitioner may well be the first line of defense in diagnosing this condition.

Speech Problems
Attempting to correct a speech problem later in life is very difficult. Therefore, any initial oral assessment should begin with determining if there are any underlying speech problems. If such problems are diagnosed, therapy should begin right away. Once again, early diagnosis is critical here, and often leads to successful results.

Dental Records: An Absolute Must.

As a parent, it is important for you to understand that in order for a dentist to perform a proper evaluation, records need to be taken. When performing this early orthodontic examination, the following records are needed:

• Study Models
  These three-dimensional models of the mouth are useful for evaluating irregularities such as abnormal wear patterns and crossbites.

• Radiographs (x-rays)
  Using a panoramic radiograph is like viewing the world through a wide-angle lens, as compared to looking through a small looking glass. This x-ray is useful for seeing permanent teeth waiting to emerge; crowding of teeth; space (or the lack of it) between teeth.

  A side-view x-ray (lateral head film)is necessary when evaluating dental-facial
  proportions in growing children. As teeth grow in, relationships within the jaws
  and skull are part of a much bigger picture that is only visible through x-rays. It
  is invaluable in recognizing overbite, underbite, open bite or an airway problem.

• Photographs
  It is recommended that a full series of orthodontic photographs be taken for all children. Standard orthodontic photographs include pictures of the face and the teeth from numerous views.

These are some of the basic early considerations that you as a parent must be aware of in the interest of ensuring your child’s continued dental health. Left untreated, early bite irregularities – whatever their cause — do not get better on their own. There are, in fact, numerous potential treatment problems and conditions that need to be evaluated early and ideally avoided. We can treat them successfully with early detection. It’s really up to you.

Dr. Rob Veis is a practicing dentist, world-traveled lecturer and teacher and CEO of The Appliance Therapy Group. Headquartered in Chatsworth, CA, The Appliance Therapy Group is celebrating its 51st year of service – more than half a century of sharing innovative appliances, information and insights with dental patients and practitioners all over the world.

For more information on today’s dental treatments and technologies, visit www.TheATPA.com or call 800.423.3270

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