By not stopping a thumb-sucking habit by the time that the permanent teeth erupt, the child will not swallow properly. This causes a dreadful muscle imbalance which affects the direction and growth of the jaw bones and the final placement of the teeth. The upper arch tends to be long and narrow since the tongue tends to thrust forward with each swallow. The lower jaw will tend to be smaller because the tongue will usually be swallowing forward. Once the thumb-sucking habit is stopped, the orthodontic problems persist since the muscles are in imbalance. When orthodontic treatment is done, the muscle imbalance and swallowing issues must be addressed or else rapid relapse can occur. Things such as myofunctional therapy or tongue exercises are best instituted before any orthodontics is started. This will allow for a much more stable result.
Another common situation where a permanent tooth is not in its normal path of eruption is when the first molars (six year molars) are attempting to come in too far forward thus resorbing the roots of the baby tooth that is ahead of it. If this situation is allowed to continue, then it will cause the baby tooth to be lost prematurely. The offending permanent molar will then erupt too far forward, thus leaving no room for the bicuspid to erupt later. I have found that by pushing the molar back before the baby tooth is lost, then the baby tooth can be retained until its normal time to come out. The procedure is call distalization. I connect orthodontic bands on a couple of molar teeth and connect them to a spring. I then bond a hook on the chewing surface of the offending tooth and engage the spring. This pushes the tooth back into its normal position. I remove the spring and allow the tooth to erupt normally. The process takes from two to four months.
An orthodontic evaluation during routine dental examination is very important for children. In many cases, early treatment of orthodontic problems can make subsequent phases much easier, less expensive, or may even eliminate the need for further treatment. Many parents think that one has to wait until all of the baby teeth come out and the permanent teeth are in before starting orthodontic treatment, however, many problems – such as lack of space or crossbites – can be corrected early while there are still baby teeth present. The results can be much more stable when done early. The muscle tone of the lips, cheeks, and tongue are still in a states of flux in a young child. The muscle tone usually doesn’t become set for life until all of the permanent teeth come in. That gives a little window of time that the size of the jaw can be changed and the result will be relatively stable, whereas, doing it later in will have a high rate of relapse.
As the big day approaches to get ones braces on, there is usually a quick step that precedes that appointment. With modern technology, the newer braces can be made in small dots making them much more esthetic. These are bonded to the teeth by etching the enamel surface with acid. However, the molar teeth bear quite a bit of brunt of the bite, so bonding brackets onto those teeth can be frustrating because they can become debonded under normal chewing. Thus, many times it is helpful to go back to the old style bands for those molars. To seat the bands comfortably, there needs to be a small gap between the teeth. Therefore, separators must be placed ahead of time to create that space. A separator can be an elastic “donut” or a twisted wire. They are placed about a week before the big appointment. This will allow the bands to be slipped on with minimal fuss. They usually will make ones teeth sore for a day or two – nothing that a little ibuprofen wouldn’t take care of. But it is sure well worth it because otherwise, the bands would have to be forced on.
Crowded teeth are a very common problem affecting many people. To straighten these teeth orthodontically, a dentist needs to make room in the mouth to fit all of the teeth in a nice straight line. Many times, the crowding is so severe that teeth have to be removed to make room. However, it is preferable to keep all of the teeth (except for the wisdom teeth) if possible. This way, it is easier to get teeth to mesh properly. The other alternative is to reduce the size of the teeth.
Teeth are coated with enamel, the hard white substance that we see in our pearly whites. It has no nerve endings, just like hair and fingernails, so it can be smoothed and shaped without the need for local anesthetic. A quarter of a millimeter can be safely removed from each side in between the teeth without causing an increase in decay. That doesn’t sound like much, but when that small increment is added up over an entire arch of teeth, that can amount to a few millimeters which can be enough to allow for an adequate amount of space to makes ones teeth picket fence straight.