If your child has seen the dentist regularly, and brushed and flossed daily, there's a good chance they've avoided advanced tooth decay. But another problem might already be growing right under your nose—a poor dental bite (malocclusion).
A dental bite refers to the way the upper and lower teeth fit together. In a normal bite the teeth are in straight alignment, and the upper teeth slightly extend in front of and over the lower when the jaws are shut. But permanent teeth erupting out of position or a jaw developing abnormally can set the stage for a malocclusion.
Although the full effects of a malocclusion may not manifest until later, there may be signs of its development as early as age 6. If so, it may be possible to identify a budding bite problem and “intercept” it before it goes too far, correcting it or reducing its severity.
Here are 6 signs your school-age child could be developing a malocclusion.
Excessive spacing. If the spacing between teeth seems too wide, it could mean the size of your child's teeth are out of proportion with their jaw.
Underbite. Rather than the normal upper front teeth covering the lower, the lower teeth extend out and over the upper teeth.
Open bite. There's a space or gap between the upper and lower teeth even when the jaws are shut.
Crowding. Due to a lack of space on the jaw, incoming teeth don't have enough room to erupt and may come in misaligned or “crooked.”
Crossbites. Some of the lower teeth, either in front or back of the jaw, overlap the upper teeth, while the rest of the upper teeth overlap normally.
Protrusion or retrusion. This occurs if the upper front teeth or jaw appear too far forward (protrusion) or the lower teeth or jaw are positioned too far back (retrusion).
Besides watching out for the preceding signs yourself, it's also a good idea to have your child undergo a comprehensive bite evaluation with an orthodontist around age 6. If that does reveal something amiss with their bite, intervention now could correct or lessen the problem and future treatment efforts later.
Even the simplest, everyday things can be challenging for a child with special needs. Dental care is no exception.
If you have a child with a chronic condition that affects their physical, intellectual or behavioral abilities, you know how difficult keeping up with dental care practices can be. Here are 4 tips to help make dental care easier and ensure your child has healthy teeth and gums.
Take an active role in hygiene. Depending on their abilities, you may need to take a more active role in daily teeth cleaning. If you have to brush their teeth for them, it's usually easier to have them face you “knee-to-knee.” You can also use a second brush to keep their mouth propped open if they tend to bite or clench down while brushing.
Model behavior. If your child could eventually brush for themselves, it may still be a long training road. It can be an easier task if you make a habit of brushing your teeth together, or have them brush with a sibling. Not only does this allow you to monitor their progress, their learning process may be easier watching another person brush and then mimicking their actions.
Find the right dentist. Many children with special needs are subject to anxiety surrounding healthcare visits, including going to the dentist. Choosing the right dentist, skilled in the technical aspects of treatment for a special needs child and providing a “kid-friendly” environment, can make all the difference in the world. A pediatric dentist is often a good fit for children with chronic conditions.
Coordinate medical and dental care. A special needs child could have underlying health problems that complicate dental care, so keep your dentist well-informed about their overall health. Do likewise with their medical providers, particularly if their condition or treatments impact dental health, as in the case of medications they're taking that could inhibit saliva flow.
Ongoing dental care for a child with a chronic health condition can be difficult. But keeping their teeth and gums healthy is an important part of fostering greater overall health.
If you would like more information on dental care for special needs children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Managing Tooth Decay in Children With Chronic Diseases.”
The monarchs of the world experience the same health issues as their subjects—but they often tend to be hush-hush about it. Recently, though, the normally reticent Queen Elizabeth II let some young dental patients in on a lesser known fact about Her Majesty's teeth.
While touring a new dental hospital, the queen told some children being fitted for braces that she too “had wires” once upon a time. She also said, “I think it's worth it in the end.”
The queen isn't the only member of the House of Windsor to need help with a poor bite. Both Princes William and Harry have worn braces, as have other members of the royal family. A propensity for overbites, underbites and other malocclusions (poor bites) can indeed pass down through families, whether of noble or common lineage.
Fortunately, there are many ways to correct congenital malocclusions, depending on their type and severity. Here are 3 of them.
Braces and clear aligners. Braces are the tried and true way to straighten misaligned teeth, while the clear aligner method—removable plastic mouth trays—is the relative “new kid on the block.” Braces are indeed effective for a wide range of malocclusions, but their wires and brackets make it difficult to brush and floss, and they're not particularly attractive. Clear aligners solve both of these issues, though they may not handle more complex malocclusions as well as braces.
Palatal expanders. When the upper jaw develops too narrowly, a malocclusion may result from teeth crowding into too small a space. But before the upper jaw bones fuse together in late childhood, orthodontists can fit a device called a palatal expander inside the upper teeth, which exerts gentle outward pressure on the teeth. This encourages more bone growth in the center to widen the jaw and help prevent a difficult malocclusion from forming.
Specialized braces for impacted teeth. An impacted tooth, which remains partially or completely hidden in the gums, can impede dental health, function and appearance. But we may be able to coax some impacted teeth like the front canines into full eruption. This requires a special orthodontic technique in which a bracket is surgically attached to the impacted tooth's crown. A chain connected to the bracket is then looped over other orthodontic hardware to gradually pull the tooth down where it should be.
Although some techniques like palatal expanders are best undertaken in early dental development, people of any age and reasonably good health can have a problem bite corrected with other methods. If you are among those who benefit from orthodontics, you'll have something in common with the Sovereign of the British Isles: a healthy, attractive and straighter smile.
Dental patients have amazing options for tooth replacement. Dental implants, for example, can replace the entire tooth, root and crown, giving patients a new tooth nearly as good as the old one.
Nearly—but not exact. Even implants can't match the full benefits of a natural tooth, including one in less than perfect shape. Our first goal as dentists, then, is to save a diseased tooth if at all practical before considering replacing it.
That often involves a root canal treatment to address decay threatening a tooth's interior. The procedure requires drilling into the tooth to access its innermost pulp, cleaning out the pulp and root canals, and then filling the empty spaces. Since all dentists are trained in basic root canal treatment, your general dentist may be able to perform it.
But some dental situations call for more advanced endodontics, the dental specialty for treating disease and other problems inside a tooth. So, in what situations would you see an endodontist?
When your dentist refers you. Your dentist wants you to receive the level of treatment necessary to save your tooth. After examination, they may determine your situation would be better served by the advanced training, equipment and techniques (including surgery) of an endodontist.
When your tooth has complications. Patients often need an endodontist when existing factors complicate treatment of advanced tooth decay. A patient may have dental pain that's difficult to pinpoint, requiring the diagnostic resources of an endodontist. It's also common for a tooth's root canal network to be highly intricate, and which respond better to treatment with specialized endodontic tools and techniques.
When root canal treatment fails. Most root canal treatments are successful in protecting the tooth from further infection. That said, it's still possible for a root-canaled tooth to become re-infected or develop more problems. Again, an endodontist and their “tool chest“ re-treating a root-canaled tooth may be the best option for saving it.
You also don't have to wait for a referral—you can see an endodontist if you believe they would be best to treat your decayed tooth. You can find one near you by visiting an online endodontist directory at www.aae.org/find. An endodontist may be the lifesaver your diseased tooth needs.
Before we begin correcting a malocclusion (poor dental bite), we need to ask a few questions: How extensive is the malocclusion? How far must we move the teeth to correct it? How might the patient's jaw size impact treatment?
Answering these and other questions help us develop an effective treatment plan. And depending on the answers, we might need to look at other procedures before we install braces—like removing one or more of the teeth.
This isn't a subject to approach lightly: All teeth play an important role in dental function and smile appearance, and ordinarily we want to preserve teeth, not remove them. Sometimes, however, it may be a necessary action to achieve our goal of an improved dental bite.
For example, it might be necessary for correcting a malocclusion caused by severe teeth crowding. This occurs when one or both of the jaws hasn't grown to a sufficient size to accommodate all of the teeth erupting on it. As a result, some of the teeth could come in out of their proper alignment.
If caught early before puberty, we may be able to use other techniques to alleviate crowding, like a device called a palatal expander that influences an upper jaw to widen as it grows. If successful, it could provide later teeth more room to erupt in their proper positions.
But even if additional jaw growth occurs, it may not be enough to avoid a malocclusion or treatment with braces. Alleviating further crowding by removing teeth in little noticed areas could help with subsequent orthodontics.
Removing teeth may also be the answer for other problems like an impacted tooth, in which the tooth has not fully erupted and remains submerged in the gums. It's sometimes possible to use a technique to “pull” the tooth down where it should be; but again, that will still require jaw space that may not be available. The more effective course might be to remove the impacted tooth.
Whether or not tooth extraction will be needed can depend on a thorough orthodontic evaluation and full consideration of all the available options. Even though the ideal situation is to correct a bite with all teeth present and accounted for, it may be for the better good to sacrifice some.
If you would like more information on orthodontic techniques, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Removing Teeth for Orthodontic Treatment.”
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