By James M. Kennedy, DDS
Early orthodontic treatment can be started while some of the primary teeth (baby teeth) are still present in the mouth. An evaluation can be done as early as 6 years old to determine if the jaws are growing properly to develop enough room for all the permanent teeth. Normally you should see spaces between the primary upper and lower front teeth. The permanent front teeth will be larger in size than the primary teeth and the spaces allow room for the permanent teeth to erupt correctly into the mouth. If there are not any spaces between primary teeth then the jaws are too small and the permanent front teeth will not have enough room. This may result in delayed eruption of the permanent teeth or they will come in crowded and misaligned.
When the four permanent front teeth do not have enough room to erupt into the mouth they may push out six of the primary teeth to gain room to erupt. The jaws will not develop correctly and there will not be enough space for the remaining permanent teeth to erupt later. If left untreated at this time, extraction of permanent teeth may be needed in the future to straighten the teeth.
Underdeveloped jaws may cause many other problems other than just crowded teeth. Headaches, jaw joint pain (TMJ), ear and neck pain can result from a misalignment of the bite resulting from crowded teeth. The palate of the upper jaw is the floor of the nasal cavity. A narrow underdeveloped palate can contribute to poor nasal breathing causing the child to become a mouth breather. In order to swallow properly the tongue must rest against the palate and if the palate is narrow and underdeveloped swallowing will be affected. The tongue may then push forward and prevent the upper and lower front teeth from touching. This is called an open bite and can affect speech. The tongue could drop backwards into the throat compromising the airway. This can result in snoring and sleep apnea. Sleep apnea occurs when a person stops breathing for short periods of time during sleep. This can be a serious medical condition causing daytime sleepiness, accidents, poor concentration and it can contribute to ADHD and poor performance in school.
Correction of all these problems should begin as soon as possible, ideally between 6-8 years old. At the age of nine, the roots of the primary molars may be too short to support the appliances needed to correct the problems. Small wire appliances (shown in the picture) are fit over the primary molars. These are left in 24/7 and removed at each appointment and activated to expand the size of the jaws. These appliances are comfortable, hygienic and do not interfere with the loss of primary teeth or the eruption of the permanent teeth. Treatment time is usually 12-18 months. This treatment is orthopedic and develops the jaws to their normal dimensions in width, height and forward growth.
A second phase of orthodontic treatment is usually needed between 11-13 years old, when all the primary teeth are lost and the permanent teeth have erupted into the mouth. Treatment time is approximately 12-20 months and utilizes fixed braces or other appliances to finish aligning the teeth and the bite.
The goals of early orthodontic treatment are to:
1) Develop the jaws to make room for all the permanent teeth.
2) Improve tongue function to correct swallowing, breathing and speech.
3) Eliminate headaches, TMJ pain, ear and neck pain that is caused by the bite.
4) Correct sleep apnea.
By James M. Kennedy, DDS
Many people suffer for years with headaches, facial pain, jaw joint (TMJ) pain, neck and shoulder pain, chronic ear congestion and pain, sinus pain and tooth problems. No reason has been found for their symptoms and pain medication must often be taken to get through the day. There can be an undiagnosed reason for all of these symptoms – TMJ DYSFUNCTION.
TMJ is short for the "TemporoMandibular Joints". These are your jaw joints and they are located in front of the ears. You can feel your jaw joints move by placing 2 fingers over the area in front of the ears and open and close your jaw. If you place your index fingers in the ear canals you may be able to feel popping or clicking in one or both jaw joints. You may hear grating or grinding noises from your jaw joints. These are all signs that the jaw joints are not functioning properly.
All the symptoms that can result from jaw joint problems are collectively called TMJ DYSFUNCTION. Sometimes the symptoms and pain occur somewhere else in the head, face and neck area and then are not initially associated with TMJ problems. This is because when the jaw joints are not functioning properly the muscles that move the jaw are overworked and become tired, tight and go into spasm. These muscle spasms cause a lot of the pain that people experience and depending on where they attach to the head or neck the pain can be felt in areas that are far away from where the problem originates.
When TMJ DYSFUNCTION occurs the lower jaw (mandible) moves off center from its normal relationship with the upper jaw (maxilla) and this alters the bite of the teeth. The teeth will feel like they do not bite together properly and may contact only on one side. The reverse situation can also occur. The bite of the teeth can change or shift because of extractions, wearing down of the teeth from grinding, worn out dentures or by improperly fitting dental work including crowns and bridges. These changes in the bite can cause compensations in jaw joint mechanics resulting in TMJ DYSFUNCTION.
Trauma from blows to the head, neck or jaw, whiplash from car accidents, falls or sports injuries can cause TMJ problems to develop. Even traumas that occurred years ago may have caused compensations or adaptations in posture that result in increased symptoms as time goes on.
The good news is there are effective treatments to help relieve the pain and symptoms of TMJ DYSFUNCTION. In our practice we combine dental appliances (splints) with cranial manipulation, infrared therapy and orthodontics to realign the jaw with the head and neck allowing the TMJs to return to normal function, relaxing the muscle spasms and reducing pain and headaches. Other modalities are often used to support our treatment and these include: physical therapy, massage, chiropractic and osteopathic manipulations.
The majority of patients we treat, regardless of how long they have had the symptoms, get resolution to their problems without surgery. If surgery is needed then applying conservative treatment before surgery and afterwards while the joints heal results in much better outcomes than in the past.
Even if you have tried dental splint treatment in the past we can help you. We utilize splints and other dental appliances that are smaller and less invasive and therefore easier to wear. A wide range of different adjustments and changes to the splint are utilized to achieve our treatment goals. Please call our office for a consultation and exam to properly diagnose your condition and see if we can help you with your pain and problems.