Dentofacial orthopaedics in growing children employs fixed or removal appliances to correct the size and position the facial structures and jaws so that teeth can be aligned.
When the face, jaws and teeth are in harmony, it also helps to improve the health, function and appearance of an individual.
The best time to commence treatment to correct the upper jaw position and prevent tooth crowding is usually between the ages of 7-9 years. Normal growth of the lower jaw is dependent on the proper position and size of the upper jaw, and so the lower jaw is usually addressed later. When the child’s jaws have stopped growing, then this type of treatment is not as effective.
For this reason we support the American Association of Orthodontists' recommendation that an evaluation of facial and dental development as early as problems are recognised and no later than age 7.
Dentofacial orthopaedics plays an important part of our comprehensive orthodontic approach.
This early treatment often eliminates the need for extractions to create space for teeth to straighten, and the potential need for jaw surgery in future.
It often results in reduced time in full braces or eliminates the need for future treatment altogether.
The 2 main goals of treatment
OUTCOME 1: A fully developed upper jaw.
This is because a narrow, underdeveloped jaw is associated with some or all of the following problems.
insufficient bone structure to support the size of the teeth, and the appearance of tooth crowding or impacted teeth.
crooked teeth which leads to uneven wear and oral hygiene issues
a receded chin as the lower jaw is restricted from growing forward as it is trapped by a narrow upper jaw
reduced breathing capacity as the upper jaw forms the floor of the nasal passage way
narrowness of the smile and unbalanced facial contours
the potential for crossbites where the lower teeth sit outside of the inside teeth and jaw joint and muscle dysfunction as the teeth come together.
The video below highlights how a narrow upper jaw is linked with snoring and how expanding the jaw can improve breathing and have wider benefits.
OUTCOME 2: PROPER FORWARD POSITION OF THE LOWER JAW
Once the upper jaw has been fully developed, it acts as the template for the normal forward positioning of the lower jaw.
The lower jaw tends to go through it's peak growth later than the upper jaw. Many lower jaws tend to spontaneously translate into a more normal forward position once the palate has been expanded to it's full genetic potential. Therefore it is not as necessary to intervene as early with retruded lower jaws compared to narrow palates.
A lower jaw repositioning appliance can an option to help redirect growth of the lower jaw at a later stage.
This helps to avoid the following problems of lower jaw retrusion including;
social implications as it has been shown people associate this with a passive or weak personality
poor head posture
poor airway space
increased risk of obstructive sleep apnoea.
Dr Shereen Lim is regularly involved in the management of adult patients with Obstructive Sleep Apnoea by referral from sleep physicians. She provides Oral Appliances that help stop snoring and manage sleep apnoea by holding the lower jaw forward to open up the airway during sleep.
She believes treating early in the growing child to encourage the normal growth and forward positioning of the lower jaw in the face reduces the future likelihood of the lifelong need for dental appliances that reposition the lower jaw forward, the more cumbersome option of Continuous Positive Airway Pressure (CPAP) or the very succesful but invasive bimaxillary jaw surgery (that moves both the upper and lower jaw and face forward) to manage the increasingly prevalent conditon of Obstructive Sleep Apnoea.
Taking the next step
The first step is to book an initial consultation with Dr Lim. If this treatment is suitable for your child, you will be offered another appointment where records will be taken to assess your child’s facial and dental development and formulate a personalised treatment plan.
Record taking involves a;
thorough medical and sleep history
photographs – facial and dental
assessment of jaw joint function
impressions for study models
referral for x-ray films including a Cone Beam CT (CBCT)
CBCT is the most advanced imaging technology for orthodontic diagnosis and airway assessment at a relatively low radiation. Please feel free to read Unlocking Airway, TMJ and Growth with CBCT As The Key. This article is written by an orthodontist who demonstrates the usefulness of CBCT in assessing for airway obstructions and measuring the improvement in his child’s airway size with orthodontics.
It is also very helpful if you become familiar with your child’s typical posture during sleep. If they mouth breathe, snore, tend to move a lot during, grind their teeth or have any pauses in breathing, you are welcome to bring a photo or video video to demonstrate this.
Our blog on Functional Jaw Orthopaedics will provide more information on the philosophy of this early interceptive option including a video interview with Dr Derek Mahony, one of the world's leaders in the field. It will also contain several links that promote the associated health benefits of early treatment.
To request an appointment, please fill in the "Make an appointment form" or visit our contact us page.