Orthodontics

Four Reasons for Orthodontics

1. A more natural and balanaced appearance of the teeth and smile
2. A better more stable bite
3. The potential for a better airway, and therefore less risk for sleep apnoea
4. A healthier jaw joint

Crowding is not about big teeth, but it’s about facial growth.

What Are the Early Signs?

So many attractive children grow up to be plain teenagers.

The most important thing is for parents to be aware that the growth of the face can go wrong and that this can be avoided if early action is taken. If your child’s face does not look quite like the other children’s be concerned. Watch for flattening of the cheeks or an unusual shape around the mouth because these will almost certainly get worse.

Hanging the mouth open.

This is probably the most important single factor. As you can read further on, open mouth postures will cause the face to grow down to an extent that a child may have difficulty in closing their lips at all. Once this has happened, it can be very difficult to correct other than by surgery. From a young age try to persuade your child to keep their mouth closed.

Most people hang their mouth open more than they think. If you sometimes wake up in the morning with a dry mouth, you fall into this group and your face and teeth are likely to show the consequences. If the mouth is kept closed, the jaw bones will grow correctly creating an attractive face with straight teethbut habits such as hanging the mouth open or sucking the thumb will cause the face to grow vertically.Typically, the upper and lower jaws will fail to grow horizontally. They drop down and back. If the lower drops more than the upper, it can look like upper front teeth “stick out.” But normally, they are also too far back in the face, and need to be corrected by being brought up and out. The upper jaw also needs widening to form a palatal shape that will accommodate normal tongue posture, up against the roof of the mouth.

Adverse Growth.

The downward (vertical) growth of the face tends to set the jaw back and restrict the size of the throat. In order to breathe more easily, the head is tilted back. Try dropping your jaw an inch and you will see why this is. To restore the balance of the spine the neck is tilted forward. This unbalances the whole vertebral column and osteopaths, physiotherapists and chiropractors find this is a common cause of headaches, neck aches, and long term back trouble.

In the diagrams below of a horizontally growing face and a vertically growing face, note how the head is tilted back to enable them to breath.

This is well illustrated by the following images – Notice how his face has lengthened, his lower lip is thickened and his eyes and nose now appear to be protrusive. These are the first signs of incorrect growth and are due to the upper jaw failing to grow forward.

Sucking Habits

If your child’s face does not look quite like the other Childrens’ do seek advice. Strange sucking habits, or swallowing with the tongue showing, can also distort the teeth and jaws, and may precipitate a speech impediment. Remember that the only thing that guides the teeth into position are the lips, the cheeks, the tongue and the other teeth and any faults in these will be reflected by irregularity of the teeth, followed later by facial disfigurement.

Spaces.

At the age of five there should be spaces between the front teeth. Their permanent successors which should arrive about the age of six, are a lot larger, and if there is no space they will crowd. It is easier to prevent crowding by creating space than to correct it afterwards.

Unattractive Eyes.

If the top jaw grows down, the eyes look prominent and the outer corner of the eyelids will sag making them look tired with too much white-of-eye showing. The lower eyelid will develop a ridge rather than slope smoothly into the cheek.

Weak Chin.

Look at your child sideways and see if you like the position of the chin. It is likely to be set back if their mouth is open a lot and they will have a double chin.

Excessive Gum.

You will notice that good looking people do not show a lot of gum when they smile. The more gum that shows the less attractive the face. If a young child shows a lot of gum their face is growing downwards.

Speech.

The tongue should be in the palate for most sounds and if it protrudes sideways or forwards between the teeth, they are likely to become displaced. A lisp usually indicates that the tongue is between the teeth. The lips should come into contact between most syllables. Ask your child to count up to five and see how far apart their lips are after the ‘five’. If it is more that 3mm there is a mild problem if more than 7mm a severe problem.

 Eating Habits.

Many children avoid hard foods this will allow their muscles to become weak and can be a principal cause of vertical growth. These habits often develop when the child is first weaned, try to encourage them to chew hard things but remember that too much persuasion can have the reverse affect.

Where should the teeth be?

According to Dr John Mew to measure the correct position of the upper front teeth simply put a pencil mark on the forwardmost point of the nose, and measure from there to the edge of the upper front teeth. Ideally it should be 28mm at the age of five and increase one mm each year until puberty, when it should be 36mm for a girl and 38mm for a boy. Average children in industrial countries are 3 or 4mm more than this. If it is more than five millimetres over this there will be some irregularity of the teethindicating top jaw underdevelopment and disfigurement of the face.

This then reflects on the lower jaw, which will tend to a more normal growth pattern and find adapting to a small top jaw difficult. Mostly the lower jaw swings down and back.

This then takes the tongue down and back partly blocking the airway… ever heard someone snoring?

When the mouth is more difficult to close and keep lips together, the tongue doesn’t press so often or so hard on the roof of the mouth and thereby develop it.  So it remains narrow especially across the front half.  That’s why you get crooked teeth.As can be seen in the following diagram orthodontic proceedures are used to widen the above jaw, allowing room for teeth , but more importantly, allowing room for the tongue to move forward and not restrict the airway.

 

 

 

 

 

Case A: Age 9  before starting –looking at the upper arch reflected in a mirror there is no room for #2 , and can you see the eye teeth bulging under the gum?

Have they got any chance of fitting in?

And now with orthodontic care almost completed

Case B:  Top teeth crowded across the front, already no room for the #2’s

The braces were removed as the tooth-brushing had not been ideal so the gums are swollen and levels not perfect, but a big improvement.

Case C: Mother was concerned by her son’s hyperactivity, lack of social acceptance and mouth breathing.

 

 

 

 

Orthodontic treatment was used to widen the arch and allow room for his tongue.

Due to the above results, the larger arch allowing space to accommodate his tongue, all the hyperactivity seen before hand and which had also continued into treatment until width had been developed went in the space of a few days.  School results improved along with sleep and a better ability to focus.

Some science:- narrow mouth =narrow airway = poor breathing = poor quality sleep

• Higher dental arches (roof of mouth) occurs more often in ADHD children.
• Snoring in young predicts later hyperactivity in older children [ approx 13%] (Dr Chervin)
• Those who snore, hold their breath, mouth-breath have more adverse behaviour between 4 & 7 years old. Dr.Karen Bonuk showed after surveying 11,000 families that this pattern was widespread. Poor oral size meant less effective sleep and less effective schooling.
• Tonsils and Adenoids may be best removed. [578 children studied aged 3-11 years old dropped AHI from 21 to 4 incidents per hour after Tonsils & Adenoids removed]
• SDB (sleep disordered breathing) leads to increased brain-cell death [Simmonds & Clark JADA]

Case D: Before starting

End of active treatment

Now the top front teeth have been moved forwards and the whole top arch, and therefore the lower arch can spread out.
This gives the tongue space to lie comfortably in the base of the mouth – not blocking the airway.
Check your own – look in the miror and you should be able to see past the uvula and look at your throat.