A couple of years ago, Dr Anton Bass was invited to take part in a Mum’s Net interview to answer many questions about your orthodontic treatments. He answered questions on a range of orthodontic treatments looking at children, thumb sucking, teenagers and adults, amongst other orthodontic topics.
One of the subjects he tackled was orthodontics for younger patients and so we thought it would be good to post some of the questions and answers regarding children’s orthodontics and teenage orthodontics on our own website. Orthodontics in young children has a major emphasis here at our practice in central London. This is commonly known as preventive orthodontics and involves treating young children with a view to preventing tooth alignment and jaw problems later on in life.
This is done with a technique known as orthopaedic orthodontics where we work with your child’s growing facial structure and bone growth to ensure that the adult teeth develop in the correct position as your child moves from childhood, to teenage years and finally through to their adulthood. Unfortunately not everyone has the opportunity of seeing an orthodontist at a young enough age, leaving many teenagers then looking to have orthodontic treatment. The following questions are specifically designed to answer the questions of this group of society.
Orthodontics for Children
Q. Will my eldest son’s teeth ever fall out? He’s 13 in November and he still has all his primary molars and his canines. He also has a gap that’s been there for two years and only now seems to have a tooth coming through. Why are his teeth so lethargic?
A. Anton Bass: There is great variation in the timing at which the baby teeth are lost and adult teeth grow in. Yes, 12 is the average age for all the remaining baby teeth to be lost and most of the adult teeth to come in, but there is a range of about two years either side of 12 year olds in which is it perfectly normal.
Q. My daughter has just had twin block braces fitted. She will be unable to close her mouth or to smile for six to nine months. Can this be necessary? Is there a more humane treatment available?
A. Anton Bass: The twin block brace is very widely used, however there are always alternatives, such as the Bionator or the Dynamax. Personally, I find the Dynamax orthopaedic appliance not only the most effective in bringing the lower jaw forward, but the most streamlined and comfortable appliance, too. It allows the mouth to fully close and rarely stops my patients from smiling.
Q. Can braces help with teeth grinding? My daughter’s orthodontist says that they may help her bruxism but at huge cost, over £3,000. She would need the brace for 18 months, plus a retainer for a further two years. She actually has nice teeth except that they are being worn down. Our dentist has doubts, but suggests we have a nightguard made instead (£400). What would you advise?
A. Anton Bass: Bruxism is a fairly complex issue as the cause isn’t yet fully understood and, unfortunately, it seems to be getting more common these days. The fit of the teeth may only be one theoretical cause, another may be stress or that it is a simple habit, like cracking your knuckles. I would always advise a patient that tooth grinding may persist after orthodontic treatment. You should start with the nightguard, which would at least protect her teeth from damage and if it stops the bruxism, this may be an indication that the fit of the teeth is a key cause, which the orthodontist can improve. Indeed, I often start with nightguard therapy before starting with orthodontic treatment in the case of bruxism or jaw ache.
Q. My nine year old has protruding front teeth and is teased about it. I’ve discussed it with our dentist and her view is that 12 is about the right age to address this. Do you think this is a normal approach? I can imagine that it’s something to do with jaw development, but would you take account of the teasing as a reason for earlier intervention?
A. Anton Bass: I’m a strong believer in early intervention for many reasons, not only for psychological ones like teasing, but if the upper teeth are protruding, there is a greater risk that they can become damaged by trauma – I know what kids are like in the playground.
There is also the consideration that dental problems at this age may be a sign that there is an issue with the jaws, not just the teeth, which can usually be remedied if dealt with at this age, or even earlier. Protruding front teeth may indicate that the lower jaw isn’t growing quick enough to catch up with the upper jaw, therefore the front teeth appear to be forward relative to the lower teeth and jaw. I think nine is an ideal age to encourage the growth of the lower jaw with an orthopaedic appliance, and that waiting until the age of 12 is often too late.
“There is the common misconception that children don’t need to see the orthodontist until all their baby teeth have fallen out. I encourage patients from as early as six to assess for crowding and jaw development.”
Q. My daughter had a removable brace for a year when she was eight to widen her upper palate and correct a cross bite – we paid for it privately (ouch!) as we were advised that correcting it then would reduce the need for extractions when older. Now she’s almost 11, her teeth are almost all in and she hasn’t had to have the trauma of removing any. It strikes me that doing work earlier could cut down costs and upset for a lot of children!
A. Anton Bass: There is the common misconception that children don’t need to see the orthodontist until all baby teeth have fallen out at around 12 years. I encourage patients from as early as six, when the first adult teeth start coming in, to assess for crowding and jaw development.
There are many treatments available before the age of 10, such as space management and enhancing jaw growth, which can make future treatment much more simple, reduce the need for extracting adult teeth and sometimes negate the need for treatment at all. So, as you say, doing work earlier could cut down cost and upset for a lot of children.
Q. My 10-year-old son has a cross bite. How will this be treated, and have we left it too late? How long will it take to correct?
A. Anton Bass: A cross bite is often caused by the upper jaw being narrow in relation to the lower jaw, making the upper side teeth sit inside the lower teeth, which is the reverse of the normal relationship. This can be treated in boys up to about 12 years and in girls until about 10 years, depending on individual growth. However, the earlier the better.
This can easily be remedied with a simple appliance fixed to the upper teeth, called a rapid palatal expander (RPE). The RPE enhances the growth in the width of the upper jaw over about two to four weeks and the device is kept in place for a further six months to a maintain the result.
This is usually beneficial on two levels: first, it corrects the cross bite, allowing for a healthier bite; second, it gives more space for the upper adult teeth to grown in, thus reducing the likelihood of upper crowding and the need to extract upper adult teeth.
Q. Do you have any advice for my eight-year-old son? We’ve just found out that he is missing his two bottom front teeth – so his milk teeth there won’t be pushed out. Is there anything in particular we should do? My dentist doesn’t seem bothered.
A. Anton Bass: You should consider having the two milk teeth removed, when the remaining milk teeth have been lost, and closing the space, by bringing the adult teeth forward. He may even have potentially crowded teeth anyway, so it could be an advantage to be missing two teeth.
The bottom line is that this will need some careful planning, so I do advise that you seek an orthodontist in the next year or so.
Q. My daughter (aged seven) has an open bite and so far the dentist has said ‘see how things go’ as she grows. I am concerned that we are missing an opportunity to deal with this while she is young enough and may only be left with a surgical option later if things are not improving. The same dentist seemed to think this was all caused by prolonged bottle and dummy use, but she didn’t use a dummy and was off bottles by 16 months, so I don’t have very much faith in their decision making.
A. Anton Bass: There are many causes of open bites – from thumb sucking and strong tongues to genetics. In one case I’ve seen, a severe open bite was caused by a comfort blanket which spent a long time in the mouth! The solution was to cut the blanket in half every week until it disappeared, the open bite soon disappeared too.
In your daughter’s case, it could be simply that her front teeth haven’t yet fully grown in. But if there is another cause, it should be stopped sooner rather than later, so you should have this checked by an orthodontist soon.