Preventive orthodontics: An ounce of prevention…

By Dr Kirankoora, MDS (Paedodontics)
Since I will be discussing preventive orthodontics in this article, I will first explain what the term orthodontics means. Orthodontics is a division of dentistry dealing with prevention and correction of abnormally positioned or aligned teeth.

Most parents of young children are shocked when their doctor or health care provider suggests that they should consult a dentist about their child’s teeth. “But she’s only six years old and still has her baby teeth – why would we see a dentist at this point?”

As your child grows, certain tooth problems like malocclusion (bad bites), spacing between teeth, overbite, extra teeth, missing teeth, crooked teeth may become apparent during their regular examination at the dentist. This is mainly due to genetics, poor nutrition, trauma, thumb/finger sucking, poor oral hygiene, and ultimately leads to early onset of orthodontic problems finally affecting a person’s appearance, speech, and/or ability to eat.

Preventive procedures are undertaken in anticipation of the development of a problem. Interceptive procedures are undertaken when the problem has already manifested itself.

Hence, though many of the procedures are common in preventive and interceptive orthodontics, the timing is very different. The steps leading up to these decisions involve examination, history and X-rays. This will usually lead to a correct diagnosis from which a treatment plan or referral can be made. Some of the procedures undertaken in preventive orthodontics include parent education, tooth cavity control, extra teeth and missing teeth space management amd oral habits.
Parent education

Paedodontists are largely responsible for prevention in orthodontics, and prevention should ideally begin much before the birth of the child.  The expectant mother should be educated about facts such as nutrition to provide the ideal environment for the developing baby.  Soon after birth, the mother should be educated about proper nursing and care of the child.  The mother may be advised about the use of a physiologic nipple and not the conventional nipple.  The conventional nipples are non-physiologic and do not permit sucking by movement of the tongue and the lower jaw.  They result in various orthodontic problems with the teeth.  The physiologic nipples on the other hand, are designed to permit sucking of the milk which more or less resembles the normal functional activity as in breast feeding.  The parents should also be educated on the need for maintaining good oral hygiene.  The parents should be taught the correct method of brushing the teeth, and the importance of milk teeth should be explained.
Cavity control

Diet counselling, oral hygiene instructions, fluoride applications and pit and fissure sealants also play an important role in the prevention of caries.
What is a pit and fissure sealant? The top surfaces of your teeth, where chewing takes place are not smooth and flat. They are crisscrossed with tiny hills and valleys called pits and fissures. These are places where plaque can build up, and where your toothbrush can’t reach and clean. Some of the pits and fissures are so narrow that even a single bristle from your toothbrush can’t get deep enough to clean them out. This special sealant seals off the pits and fissures. Sealants are a clear, acrylic-like material that helps protect the chewing surfaces of the teeth from decay-causing bacteria.
Recommended age for pit and fissure sealants:
3 to 4 years of age for milk teeth
6 to 7 years of age for first permanent molars
11 to 13 years of age for second permanent molars and premolars
Extra teeth

The most common site for extra teeth is the upper front tooth area. The occurrence of extra teeth in several members of the same family has been observed, which indicates a familial pattern or genetics. Extra teeth can be responsible for a variety of irregularities in the milk and permanent dentition.  In the upper front tooth region in particular, they may prevent the eruption of adjacent permanent teeth leading to crooked or crowding teeth. The surgical removal of an extra tooth is often the required treatment.
Space management

Early loss of teeth sometimes requires a special appliance to hold the space open for the permanent tooth that is still developing in the jaw. If a space maintainer is not used, the space may close due to other teeth drifting into that space.
Oral habits

Thumb-sucking is one of the most common problems encountered in an orthodontic practice. Many young children suck their thumbs, presumably as a way to cope with stress or anxiety. Thumb-sucking can be soothing, and can make a child feel safe. Thumb-sucking is considered ‘normal’ during the first and second year of life because it does not generate malocclusion or ‘bad bite.’ When it persists beyond the pre-school period then it should be considered ‘abnormal’ because it may cause deleterious effects on the teeth and the jaws.

It causes the upper front teeth to tip forward. If the habit is severe enough, it may move the upper jaw forward permanently and make the palate deep.

Most childhood habits get better without intervention. However if thumb-sucking continues, psychological therapy may be given with positive reinforcement (without any dental treatment). Reward your child with an extra bedtime story or other favourite treat when he or she doesn’t suck the thumb. Be generous with the praise, too.

Help to eliminate anything causing anxiety or stress. If a psychological approach does not work then an appliance may be used, which can be inserted in your child’s mouth making it difficult for your child to continue with thumb-sucking.
Early detection and treatment

Early detection can correct problems before they progress and therefore prevent expensive surgical correction in the future.
Protect protruding front teeth from the risk of injury.
Improve oral hygiene and habits.
Help your child avoid self-esteem issues by avoiding being made fun of by their peers.
Guide permanent teeth into their proper position to avoid spacing/crowding issues.
Monitor and direct jaw growth and development.
In conclusion, early, preventive orthodontics can save your child’s smile and save you considerable time and money.

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