Our dentists and orthodontists at Jungle Roots see a multitude of conditions that are not so uncommon. Treating these conditions is what we do! Orthodontic needs impact many children. Regular appointments are the first step to identifying, monitoring, and addressing these issues. We will discuss a few teeth configurations that may need attention to allow your child to have their best smile!
Malocclusions
The word "malocclusion" encompasses many of the most seen problems with crooked and crowded teeth and "bad bites." Children may struggle with one or multiple issues when their teeth come in. It is often the result of their genes or environment and can develop more as the child grows. It may also be caused by trauma to the jaw. Stanford Medicine Children's Health states that children who suck their thumbs or fingers after the age of five have a greater chance of developing malocclusion. A child with minimal space between their primary (baby) teeth or crowded teeth when the permanent teeth appear are at risk, too, as they need more space to erupt (1). Only an orthodontist can evaluate and treat these irregularities. They will decide if x-rays are required to see the internal tissues, the bones, and your child's teeth. The orthodontist may take impressions, or imprints of your child's teeth may be made with a mold to assess the malocclusion and decide if it needs to be fixed.
Malocclusions can cause your child to have problems with eating or speaking and can contribute to them grinding their teeth or being mouth breathers. Jaw joint problems such as TMJ (temporomandibular joint) disorders can start or progress, as well as loss of teeth too soon or very late, tooth decay, or gum disease as a result of malocclusion.
Malocclusions are classified by type and severity and may need x-rays to determine in what class it falls.
- Class 1: In this class, the upper and lower jaws are relatively well aligned with the skull, but the other teeth are either too far apart or too crowded.
- Class 2: This is seen when the lower jaw is underdeveloped. Overbites are common class 2 malocclusions.
- Class 3: Underbites that are severe in nature are Class 3. In this class, the lower jaw is larger than the upper jaw (2).
These misalignments are most commonly treated with the same or similar modifications by our orthodontists.
Here are some of the most common orthodontic issues and treatments most often recommended. Be aware, though, that every child is unique and some may need varying treatments to create the healthiest possible smile. These are best treated in children seven to ten years of age or their teen years:
Crowded Teeth
Crowded teeth may happen when your child's teeth, whether primary or permanent, don’t fit well in their jaw. Sometimes a permanent tooth appears before the baby tooth comes out, which does not allow enough space for both. Some genetic conditions may also affect the jaw and the teeth's formation.
Treatment: A palatal expander may be required, and your child may also need braces or a retainer to align the teeth or keep them in place. In certain instances, one or more teeth may need to be removed to treat the crowding of teeth. In rare cases, surgery may be necessary when the jaw bones are affected (1).
Too Much Space Between Teeth
The technical term for this irregularity is diastema (a gap between the teeth). This gap does not usually cause any oral health issues but can be attributed to missing teeth or teeth that are too small. In addition, the band of tissue that connects the lips to the gum (the frenum) can be oversized and cause this opening in the teeth. Another cause may be an abnormal swallowing reflex. This happens when your child presses their tongue against their front teeth instead of the roof of their mouth when swallowing. Repeating this act can produce a gap to form over time from the pressure.
Treatment: Braces can align the teeth and move them closer together. We may recommend a frenectomy to release the thick connective tissue between the lip and gums. Dental bridges or implants can be added to fill a gap caused by missing teeth (3).
Missing Permanent Teeth
Much like diastema, when a child is missing one or more of their permanent teeth, it can be caused by genetic disorders. Hypodontia is when your child is born missing one to six teeth. It may interfere with the child's ability to eat and speak. Usually, the orthodontist can diagnose this disorder with x-rays.
Treatment: Braces are used to re-align the teeth in some cases. Other possibilities include partial dentures, dental bridges, and implants (3).
Overbite
Most people have a small overbite, and it usually is not a problem. However, when your child's upper teeth protrude out too far over their lower front teeth, it needs to be corrected. This malocclusion is usually minor, but a severe uncorrected overbite can lead to breathing challenges, difficulty chewing, jaw pain (TMJ), and speech problems. It can contribute to tooth decay and gum disease. An overbite can be genetic, especially if a familial trait is related to jaw shape. Other causes can include bruxism (tooth grinding), thumb or pacifier sucking, or a condition called nonnutritive sucking behavior (NNSB) occurring past the age of three. Tongue-thrusting is another cause; the tongue presses too far forward into the mouth. To prevent an overbite, limit pacifier use and discourage thumb-sucking in older children.
Treatment: Correcting your child's overbite may involve using a palatal expander, which modifies growth to reposition the jaw. Braces can move the alignment of the teeth slowly to correct an overbite. Retainers keep the teeth aligned after braces (4).
Underbite
An underbite is sometimes a genetic condition or might be caused by mouth trauma. Excessive use of an oral device such as a pacifier can also lead to an underbite. It can lead to a higher risk of TMJ, mouth breathing, heavy snoring, and sleep apnea.
Treatment: Because the jaw is still somewhat moldable as it grows, an underbite can be treated much like we've discussed with the other malocclusions. Braces, retainers, and palatal expanders are options for treatment.
Open bite
An open bite malocclusion is when the front top and bottom teeth do not meet and are both angled at an outward slant when the child's mouth is closed. Reasons for an open bite include thumb or pacifier sucking, tongue thrusting, a bone development problem, or TMJ.
Treatment: The remedy for an open bite can be as simple as a behavioral modification when your child has baby teeth and starting to get permanent teeth. Discouraging extended thumb-sucking or pacifier use can eliminate this issue if this action is the cause. If there is another basis for an open bite, braces or another oral device may correct this issue.
Ectopic Teeth
An ectopic tooth erupts in an unusual place away from its normal location, or is misaligned in the normal place. This includes teeth that sit too high in the gum or that point out toward the lip. It is fairly common for canine teeth to erupt out of place, but molars, incisors, and wisdom teeth can also be ectopic. Sometimes, an ectopic tooth can be left alone, other times, it will need treatment as they can cause pain, tooth decay, gum disease, poor bite, and misalignment of other teeth.
Treatment: Treatment depends on the severity of the problem and which tooth is affected. Ectopic canines usually need to be treated with braces and/or palatal expanders. Early treatment of ectopic canine teeth is vital, as their positioning impacts many other teeth and the jaw. Many cases of ectopic molars are easily corrected by orthodontic separators, but severe cases may require the extraction of a tooth or surgical treatment. Ectopic wisdom teeth will often be removed.
Closing the Gaps
Malocclusions are typically detected by the dentist when your child starts seeing them after their baby (primary) teeth start coming in or as their permanent teeth are erupting. Our orthodontists may be consulted at this time to help modify or correct the malocclusion or give instructions for you to discourage behaviors that may cause the misalignment. Untreated malocclusions can be detrimental to the child’s dental health as they increase the chance of developing cavities or gum disease because the teeth are more challenging to keep clean. Early treatment can help correct a condition before it worsens.
It is important to set up your child’s first dentist appointment when their primary teeth start to erupt and schedule regular six-month appointments after that. This allows us to identify and monitor any condition that may develop and, when necessary, provide treatment before it worsens. Our dental and orthodontic staff look forward to helping your child enjoy a lifetime of healthy teeth!
References
- Malocclusion in Children. Stanford Medicine Children's Health. Accessed November 14, 2022. https://www.stanfordchildrens.org/en/topic/default?id=malocclusion-90-P01860
- Malocclusion. Cleveland Clinic. Last reviewed November 8, 2021. Accessed November 15, 2022. https://my.clevelandclinic.org/health/diseases/22010-malocclusion
- Diastema. Cleveland Clinic. Last reviewed July 15, 2022. Accessed November 14, 2022. https://my.clevelandclinic.org/health/diseases/23477-diastema
Overbite. Cleveland Clinic. Last reviewed March 1, 2021. Accessed November 15, 2022. https://my.clevelandclinic.org/health/diseases/21473-overbite
