If your child has an irregular jaw formation or lack of room for all the teeth, your dentist will advise you at the correct time about the treatment that will be required. He may be able to do the necessary correction himself but many general dentists will refer you to an orthodontist— a specialist in the regulation (straightening) of teeth (mostly of children, although orthodontists now straigthen the teeth of adults when this is considered feasible).
Malocclusion
An irregular jaw or crooked teeth may be inherited One well-documented example is the Habsburg jaw which was a dominant facture in the Spanish royal family of the Habsburgs, with the enormously protruded lower jaw. Some children grow with jaws that are too small to accommodate their teeth which become crowded and crooked.
Acquired defects
Malformations of growth can be acquired by sucking and pulling on poorly designed artificial nipples in feeding bottles or the lack of stimulation casued by too easy feeding from bottles where the hole has been enlarged. Other deformities can occur by thumb-or finger-sucking if continued past the age of five or six. The forward projection of the top front teeth and backward inclination of the lower front teeth caused by thumb-sucking often corrects itself if the habit is stopped early.
All too often thumb-sucking is a sign of anxiety; therefore do not increase the anxiety by threats. Kindness, consideration, advice and help from the dentist will usually solve the problem. Another cause of mal-formation is the habit of tongue-thrusting through the front teeth. This leads to a gap between these teeth. The tongue-thrusting habit is difficult to correct. Too early loss of the primary teeth due to decay will allow the remaining teeth to close up and there will be no room for the succeeding teeth to come through into the correct position.
Thus the parent can be involved in preventing much malocclusion by seeing that the primary teeth are cared for and are retained until the secondary teeth are ready to erupt. However, if a primary tooth is, through some misfortune, unsavable the dentist will consider the necessity of inserting the space maintainer previously mentioned. Trouble can be caused by mouth breathing and it is then wise to have the nasal passages checked—occasionally adenoids can almost block them.
With regular attendance at the dentist any over-prolonged habits, such as thumb-sucking or other tendency to push the teeth out of alignment, will be carefully watched and the time for interception to prevent deformity will be decided by the dentist, who may then construct a simple appliance or refer to an orthodontist. Sometimes a simple remedy for a crowded mouth may be the extraction of a permanent tooth or teeth in order to make room. Parents are sometimes horrified that a dentist has recommended the loss of four Permanent (and good!) teeth in order to correct a crowded mouth.
The reason for four teeth is that by removing one tooth from each quadrant of the mouth, upper right and left, lower right and left, there is an even amount of space created all round the mouth. Otherwise, if space is created on one side of mouth only, the teeth may be spaced out on that side and there is a danger that the front teeth will be off-centre. The consideration of malocclusion and crooked teeth is a very individual one and depends on careful assessment and knowledge by the dentist, but the regular attendance and concern of the parents is most important. Neglect of the dentist’s advice at the stage when simple treatment will suffice may condemn the child to much more difficult treatment with appliances at a later time. It is difficult to understand the attitude of some parents.
If your child needs to attend for orthodontic advice your dentist may refer him or her to a specialist orthodontist at a dental hospital or one of the specialized orthodontic departments in various parts of the country, or you may decide to have a private consultation with an orthodontist.
The first consultation will consist of a very thorough examination with impressions taken for the construction of models of the mouth and jaws for study by the dentist. X-rays and facial profile registration may also be taken. A great deal of planning will be done before treatment is started. The orthodontist may also delay the treatment until the correct time. This may be governed by the state of eruption of the teeth. Many different appliances are constructed for different conditions. Some appliances are fixed to the teeth so that the wires and springs which guide the teeth into the correct positions are attached and are removable only by the dentist. This has certain advantages which the dentist will explain if he considers such a fixture necessary.
Modern improvements have almost eliminated the unsightly banding of the teeth and many of the attachments (brackets), often transparent, which hold the wires are directly bonded to the enamel with the new remarkable adhesive techniques, one disadvantage is that very careful cleaning by the young wearer is imperative because food and plaque are easily trapped in all this apparatus which cannot be removed for cleaning. Special small brushes are provided for this purpose. A careful check must be kept by the parent on this cleaning, otherwise the risk of decay or gum disease is very high. Fixed appliances have many advantages. However treatment is more certain and cannot easily be upset by the patient ‘forgetting’ to wear his or her plate.
Other appliances are removable and thus more readily cleansable. Removable appliances are not always so certain in their action because of the possibility that they may not be worn or may be lost or broken, sometimes by being sat on! There are other treatments which may involve wearing a headcap, with wires gently pulling on the jaws to alter their relative positions.
Parents maynot understand that orthodontists do not repair teeth and thus they omit visits to the family dentist, sometimes with disastrous results. The parent’s influence must be very positive when orthodontic treatment is started because the young adolescent, principally for social reasons, may not want to continue wearing appliances. Encouragement by a parent with the help of instructional and educational material obtainable either from the dentist or orthodontist is an important feature of success in orthodontic treatment.
Foods to Avoid While Wearing Orthodontic Appliances
Very hard foods may bend or break the delicate tubes or wires of the orthodonitc appliances which are fixed to the teeth. Sticky foods, e.g. toffee, may loosen the bands and attach to the wires and teeth. Avoid sweets, chewing gum, hard nuts, hard rolls, etc.