Early Treatment
Dental concerns frequently observed in children that benefit from early (phase 1) orthodontic treatment are presented. Beginning as early as seven years of age, children may benefit from an orthodontic evaluation of tooth eruption. This observation period may end at about 16 years of age.
Thumb or finger sucking
A thumb or finger sucking habit that persists beyond 6 years of age is often associated with the deformation of bone and teeth. The amount of deformation is closely associated with the intensity and duration of the sucking habit. The older the child is when the habit is stopped the more likely the deformation will not resolve without treatment. This 8-year-old patient has an anterior openbite (not able to touch the front teeth together; arrow).
A thumb or finger sucking habit that persists beyond 6 years of age is often associated with the deformation of bone and teeth. The amount of deformation is closely associated with the intensity and duration of the sucking habit. The older the child is when the habit is stopped the more likely the deformation will not resolve without treatment. This 8-year-old patient has an anterior openbite (not able to touch the front teeth together; arrow).
Unusual erupting upper first molars
The permanent upper first molar does not replace a baby tooth. However, as seen in the X-ray of a 6-year-old patient, the first permanent upper molar (arrow) is not able to erupt because it is stuck under the baby tooth. If untreated, this results in the loss of space and crowding of the permanent teeth.
The permanent upper first molar does not replace a baby tooth. However, as seen in the X-ray of a 6-year-old patient, the first permanent upper molar (arrow) is not able to erupt because it is stuck under the baby tooth. If untreated, this results in the loss of space and crowding of the permanent teeth.
Extra teeth
More than 90 percent of extra (supernumerary) teeth are found in the upper jaw, with the vast majority located by the upper incisors. These extra teeth may block the upper incisors from erupting. Therefore, their presence must be ruled out when upper incisor eruption is delayed or if the lateral incisors erupt before the central incisors. This 8-year-old patient’s upper left central incisor erupted normally whereas the upper right central incisor did not erupt due to the presence of an extra tooth (arrow).
More than 90 percent of extra (supernumerary) teeth are found in the upper jaw, with the vast majority located by the upper incisors. These extra teeth may block the upper incisors from erupting. Therefore, their presence must be ruled out when upper incisor eruption is delayed or if the lateral incisors erupt before the central incisors. This 8-year-old patient’s upper left central incisor erupted normally whereas the upper right central incisor did not erupt due to the presence of an extra tooth (arrow).
Missing permanent teeth
Approximately 2-7% of the population has missing permanent teeth other than wisdom teeth. Lower second premolars, upper lateral incisors, and upper second premolars are the most frequently missing teeth. Decisions often need to be made early to achieve optimal results. The 18-year-old patient shown here has a missing upper left lateral incisor (arrow) and a unusually shaped upper right lateral incisor.
Approximately 2-7% of the population has missing permanent teeth other than wisdom teeth. Lower second premolars, upper lateral incisors, and upper second premolars are the most frequently missing teeth. Decisions often need to be made early to achieve optimal results. The 18-year-old patient shown here has a missing upper left lateral incisor (arrow) and a unusually shaped upper right lateral incisor.
Ankylosis of a deciduous tooth
Upper baby (deciduous or primary) molars tend to ankylose (fuse with bone) at 6 years old, while the lower baby molars ankylose at about 7 to 8 years old. Though the openbite tends to increase over time, treatment is usually not needed. No treatment was required in this 8-year-old patient with ankylosed baby upper right first molar and lower right first and second molars (arrows).
Upper baby (deciduous or primary) molars tend to ankylose (fuse with bone) at 6 years old, while the lower baby molars ankylose at about 7 to 8 years old. Though the openbite tends to increase over time, treatment is usually not needed. No treatment was required in this 8-year-old patient with ankylosed baby upper right first molar and lower right first and second molars (arrows).
Crowding
Severe crowding may result in the early loss of one or both baby canines. After the eruption of the lower incisors, the amount of crowding may be estimated to determine the need for treatment to maintain space for the remaining permanent teeth. This 8-year-old patient has lost both lower baby canines early (arrows).
Severe crowding may result in the early loss of one or both baby canines. After the eruption of the lower incisors, the amount of crowding may be estimated to determine the need for treatment to maintain space for the remaining permanent teeth. This 8-year-old patient has lost both lower baby canines early (arrows).
Soft tissue obstruction
If the eruption of a permanent tooth is delayed and clinical and radiographic findings are normal, then soft-tissue or bony interferences to eruption need to be considered. This picture reveals the presence of upper incisors (arrows) in a 9-year-old patient that should have erupted a year before.
If the eruption of a permanent tooth is delayed and clinical and radiographic findings are normal, then soft-tissue or bony interferences to eruption need to be considered. This picture reveals the presence of upper incisors (arrows) in a 9-year-old patient that should have erupted a year before.
Unusual tooth bud position
The position of a developing permanent premolar may improve after the baby tooth is removed. If the position of this lower left second premolar (arrow) in this 10-year-old patient does not improve after a year, the baby tooth may be removed.
The position of a developing permanent premolar may improve after the baby tooth is removed. If the position of this lower left second premolar (arrow) in this 10-year-old patient does not improve after a year, the baby tooth may be removed.
Crossbites
When posterior crossbites involving baby teeth or permanent teeth result in an abnormal shift of the lower jaw upon closing, the crossbites should be corrected. Also crossbites of anterior permanent teeth should be corrected as soon as possible to reduce the possibility of their fracture. This 10-year-old patient has both upper lateral incisors in crossbite (arrows).
When posterior crossbites involving baby teeth or permanent teeth result in an abnormal shift of the lower jaw upon closing, the crossbites should be corrected. Also crossbites of anterior permanent teeth should be corrected as soon as possible to reduce the possibility of their fracture. This 10-year-old patient has both upper lateral incisors in crossbite (arrows).
Ectopic eruption of maxillary canines
Researchers recommend early detection of impacted upper permanent canines because of the damage they can do to the roots of the upper lateral incisors. This damage is usually not seen in patients less than 10 years of age. The path of the upper canine’s eruption is not predictable from x-ray before 10 years of age. The possibility of upper canine impaction is increased in patients with missing upper lateral incisors. This 13-year-old patient’s upper left canine erupted abnormally. Removing the baby canine would have permitted (arrow) the permanent canine to erupt in a better position (arrows).
Researchers recommend early detection of impacted upper permanent canines because of the damage they can do to the roots of the upper lateral incisors. This damage is usually not seen in patients less than 10 years of age. The path of the upper canine’s eruption is not predictable from x-ray before 10 years of age. The possibility of upper canine impaction is increased in patients with missing upper lateral incisors. This 13-year-old patient’s upper left canine erupted abnormally. Removing the baby canine would have permitted (arrow) the permanent canine to erupt in a better position (arrows).
