Adult and children have very different risk factors. And knowing that children are growing and actively developing their nervous, cardiovascular, and other important systems, we have become increasingly more observant to problems that may arise early on. We work with other health professionals to increase our understanding of growth and development even beyond the teeth.
At Pediatric appointments, not only do we perform routine dental exams and hygiene treatments, but we also use measurements like the Mew line and Bolton norms to relate the child's growth to any issues observed. Issues may include dental crowding, overbites and over-jets, and "gumminess". We also assess and monitor myofunctional habits and breathing factors which may be affecting poor growth. If a child is generally healthy and displays the ideal growth patterns within a range, then we will continue to monitor them. If a child displays lack of horizontal growth, lack of forward growth in one or both jaws, and/or excessive vertical growth, we will inform the parents and discuss different options in getting that child back on track. The cause could be something simple like having a tongue tie, playing an instrument like a trumpet, thumb sucking, or having a soft diet. On the other end of the spectrum, it could be multi-factorial and more complex which would require further investigation. For example, we have seen cases of birth trauma which may have contributed to other signs and symptoms. We work with physicians and other allied health professionals in our community who share the same view. It is important to note that a child's mid-face and jaws will rapidly grow until approximately age 9-10. We would like to see facial growth to generally occur down and forward, following the numbers of the Mew formula and the Bolton norm. In many children, we see the lack of lateral growth (leading to narrow jaws) and the lack of forward growth in one or both jaws. Cases more difficult to correct are excessive vertical growth usually caused by excessive mouth breathing and/or open mouth posture. Children with allergies and asthma symptoms, and large tonsils and adenoids generally have their mouths habitually open. A child with untreated excessive vertical growth will usually grow a long face. A child with a large overjet usually has an undergrowth of the lower jaw. A weak and pointed chin can also be a sign of excessive vertical growth. Undergrowth of both jaws may lead to generalized lack of primary spaces, dental crowding, and a smaller face. Functional problems can create poor facial aesthetics. More importantly, these negative facial growth patterns may detrimentally reduce the size of the airway and contribute to functional problems outside the need for orthodontics. Beyond genetics, the habits of a child heavily affect their growth and development pattern. Therefore, we will inform families about what constitutes good habits to maximize the potential of proper growth and development.
Photos courtesy of AAGO and Brian Hockel, DDS
Our Pediatric care can start as early as pregnancy. We frequently advise our expectant mothers on topics such as weight gain, diet and exercise, quality sleep, sleep positioning, stress, and epigenetics. Sleep apnea has become a more well known and prevalent disorder. It is especially vital to address this issue during pregnancy since the lack of oxygen and/or poor quality sleep may cause changes that put the baby at greater risk for health problems. We also share and discuss with expecting families about important concerns which may be controversial in the medical and dental communities. Such topics include epidurals, labor induction with pitocin, frenectomies (tongue tie release), immunizations, C-sections, Cranial-Sacral Osteopathic Care, birth trauma, thumb sucking, pacifier use, lactation care, baby lead weaning, pumping, bottle feeding, formula, allergies/asthma symptoms, sleep disorders, pediatric snoring, mouth breathing, bedwetting, ADD/ADHD, special needs, dental crowding in the primary dentition, teeth extraction, cause of narrow and deep palates, Orthodontics and Orthotropics, and Myofunctional therapy. We feel it is crucial to discuss the importance of these subjects and why they are controversial.
In this day and age, we observe that over 90 percent of all children in our communities have teeth and bites that would require traditional orthodontics (braces) based on the standards defined by our dental industry. The old explanation of inheriting Dad's teeth and Mom's mouth to explain dental crowding does not make any sense. Our position is that with good body posture and resting oral posture, a good swallowing pattern, and nasal breathing (opposed to mouth breathing), a child can grow up with straight teeth, form strong cheekbones and a good mid-face, have room for all the adult teeth (including wisdom teeth), and develop a healthy/attractive profile. The best orthodontic/orthopedic appliance is already built into everyone. It is called the tongue. By the time a dentist or orthodontist tells you that your child needs braces, much wasted time has already passed by. If function were corrected earlier on, then the need to straighten teeth and undo major crowding with traditional orthodontics could have been prevented. We also believe that certain orthodontic forces used to straighten teeth and fix bites towards the standards defined by our dental community may actually be harmful to the growth and development, posture, and airway. Teeth extraction and retractive orthodontic forces have become controversial topics as more data is coming out regarding sleep disordered breathing (SDB), airway, TMD, and growth and development. We work with physicians (MD's and DO's) who believe that taking out four bicuspids and retracting or restricting the growth of the jaws should be avoided.
Mouth breath and poor posture and poor oral posture can negatively affect the growth of the face, jaws, airway, and, and teeth.
Photos courtesy of Orthodontist John Mew DDS
Everyday, in private practice we see growth and development patterns of faces which concern us. As the upper and lowers jaws of each child is far from being congruent, it is not surprising that all of these patients have teeth and bites that will need Orthodontics defined by our Dental community. Beyond the teeth, we have much larger concern of function, posture, and airway which will impact the health of all of these children for the rest of their lives.
Photo courtesy of Barry Raphael, DDS
This is a seven year old child treated with Crozats Orthotropics to help support lateral growth and forward growth of the upper and lower jaw. She straighted her own teeth with her tongue, proper oral posture, breathing and swallowing pattern.
This 4 year old child has generalized dental crowding of her baby teeth resulting from the undergrowth of her upper and lower jaw. If she does not correct her function, she will likely need to have some adult teeth extracted in the future. We believe this would be harmful to her health as it would negatively affect her face, airway, breathing and posture.
This 4 year old child has been treated with Biobloc Orthotropics to the ideal Bolton Norm and cosmetic line. She had sleep apnea, allergies, reflux, shortness of breath and frequent colds.
This child is now nine years old and is being monitored at each hygiene visit to make sure the Bolton norms and cosmetic line is still tracking to ideal as well as that she is in good health.
Keira began treatment for her massive underbite at the age of two. Because we treated her at such a young age the bite was corrected in less than three months.
Profile of boy with both upper and lower jaws underdeveloped. In this case the child also has large adenoid tissue and breathing problems which have contributed to the lack of adaquate growth of his jaws. Small faces can result from frequently contracting and the lip and/or facial muscles combined with a weak mid and posterior tongue.
This boy has excessive vertical growth of his face is caused by poor posture and chronic open mouth. Notice the long lower face, pointed chin and obtuse angle of his nose and upper lip, and poor posture and head/neck angle. Long face growers frequently have large tonsils and adenoids.
This boy has adaquate growth of his lower jaw but insufficient growth of his upper one. This growth pattern is cause by the lack of tongue position to the roof of the mouth and the deflection of the lower teeth against the outside of the upper teeth.
5 year old girl with very large tonsils and adenoids and severe sleep apnea. By the time this child turned seven years old, she had an extremely long and narrow face directly resulting from her mouth breathing/open mouth posture and tongue functioning.