7.3 When and How to imply early-age orthodontic treatment

                                                                                                                              

⑴ Cross bite

Keypoints:

    ◆ Anterior crossbites may interfere with normal skeletal growth, as well as causing  tooth abrasion and gingival  recession.

   ◆ The best time to correct in primary dentition is 3.5-4.5 years old.

⑵ Deleterious oral habits

Keypoints:

     ◆ Definition: habits that frequently children acquire which may temporarily or permanently be harmful to  dental occlusion and their supporting tissues.

     ◆ Etiology: psychoanalytic schools; behaviorists schools.

● Sucking habits

Keypoints:

   ◆ Nutritive sucking: breast feeding; bottle feeding;

   ◆ Nonnutritive sucking: thumb or digit sucking; pacifier sucking; other (blanket);

   → Normal nonnutritive sucking:
       ① It is considered normal during 1st &2nd  year of life.
       ② Disappears as the child mature.
       ③ Does not generate any malocclusion.

  → Abnormal nonnutritive sucking
       ① Persist beyond the preschool period.
       ② Deleterious effect to the dentofacial structures.

 → Effects of chronic thumb or digit sucking:

      ① Dental effects：increased overjet due to incisor flaring ；anterior open bite；interdental spacing；posterior crossbite；mandibular incisor crowding；lingual tipping of mandibular incisors；overeruption of posterior teeth；Class II molar relationships；narrow (V-shaped) anterior maxilary arch.

      ② Skeletal effects: counterclockwise maxillary rotation; clockwise mandibular rotation; increased anterior facial height; increased Class II relationship.

     ◆ Treatment of sucking habits:

     → Age of intervention: 4 or 5 years old.,but should be considered earlier if  high-intensity and long   duration.

     → Treatment approaches for thumb or digit sucking habit: reminder therapy; reward therapy; appliance therapy.

● Mouth breath

Keypoints:

    ◆ Etiology; nasal airway blocked; allergies; adenoids or tonsils hypertrophy; nasal turbinate, hypertrophy; deviated septum.

    ◆ Effects of Mouth breath:
    → Dental and soft tissue: maxillary incisor proclination; Open bite; nnarrow maxillary arch; dry lips; dark circles under the eyes.

    → Skeletal: clockwise rotation of mandible; increased facial height; long, narrow face; antegonial notching; increased mandibular steepness.

    ◆ Treatment of Mouth breath:

    → The best time: immediately.

        ① E.N.T department: medical or surgical treatment of respiratory dysfunction, such as adenoidectomy;

        ② Maxillary expansion;

        ③ Mouth tape, oral screen.

● Forward tongue posture

Keypoints:

   ◆  Tongue thrusting swallowing:

   → Tongue thrusting is predominant swallowing pattern in infants, and gradually transit to normal swallow pattern;

   → Too short a duration to have an impact on tooth position;

   → Tongue posture may be a factor, but swallow itself is not.

● Lip biting

Keypoints:

    ◆ Lip biting habbits:

    → The pressures from lips will protrude the upper incisor and retrude the lower incisors with crowding, deep overbite, retrude mandible.

⑶ Space maintenance

Keypoints:

    ◆ Space maintenance:

    → Space maintenance is a procedure performed in the primary and mixed dentitions to preserve the available space before any closure occurs in the arch length.

    ◆ Design and consideration:

    → Endentulous area;

    → Anchorage teeth;

    → Fixed or removable;

    → Successor teeth development.

    ◆ Space maintainers:

    → Band and loop;

    → Lingual arch;

    → Transpalatal arch;

    → Nance arch;

    → Removable denture.

⑷ Growth modification

Keypoints:

    ◆ For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment.