The American Association of Orthodontists recommends that all children see an orthodontist by at least age seven and sooner if something is obviously wrong before age seven. Fortunately, most young patients don't need anything more than observation while the permanent teeth are growing into place.

Many young patients have problems, which will not, or should not wait. Most orthodontic problems are inherited and cannot be totally prevented; however something can usually be done before these problems become more difficult and more expensive to manage.

It is advisable to consult with an orthodontist prior to having your dentist remove any baby teeth or permanent teeth. To ensure the best overall dental and facial development, all patients should have an orthodontic consultation sometime between the ages of four and seven.

Dr. Bock offers early examinations and observation consultations. Contact us to schedule a complimentary consultation.

Classifications of Teeth

The classification of bites is divided into three main categories: Class I, II, and III. This classification refers to the position of the first molars, and how they fit together.

Class I
Class I is a normal relationship between the upper teeth, lower teeth and jaws or balanced bite.


Class I normal



Class I crowding

 

Class I spacing
 

 

Class II
Class II is where the lower first molar is posterior (or more towards the back of the mouth) than the upper first molar. In this abnormal relationship, the upper front teeth and jaw project further forward than the lower teeth and jaw. There is a convex appearance in profile with a receding chin and lower lip. Class II problems can be due to insufficient growth of the lower jaw, an over growth of the upper jaw or a combination of the two. In many cases, Class II problems are genetically inherited and can be aggravated by environmental factors such as finger sucking. Class II problems are treated via growth redirection to bring the upper teeth, lower teeth and jaws into harmony.

 

 
Class II division 1

 
 
Class II division 2

 

 

Class III
Class III is where the lower first molar is anterior (or more towards the front of the mouth) than the upper first molar. In this abnormal relationship, the lower teeth and jaw project further forward than the upper teeth and jaws. There is a concave appearance in profile with a prominent chin. Class III problems are usually due to an overgrowth in the lower jaw, undergrowth of the upper jaw or a combination of the two. Like Class II problems, they can be genetically inherited. Class III problems are usually treated via surgical correction of one or both jaws.

 
Class III functional or dental

 
 
Class III skeletal

 

 

Orthodontic Problems

 
Overjet
Upper front teeth protrude


 
 
Deep bite
Upper front teeth cover lower front teeth too much

 
 
Underbite
Lower front teeth protrude


 
 
Open bite
Back teeth are together with space between the front teeth


 

Crowding
Upper and/or lower teeth are crowded


 

Excess Spacing
There is excess space between teeth


 

Mid-Line Misalignment
Mid-lines of upper and lower arches do not line up

 

Crossbite
Upper back teeth fit inside lower teeth

Phases of Treatment

Phase I: Treatment usually takes 12 to 18 months and is done between the ages of 7-9. A variety of appliances may be used to correct specific problems.

Maintenance / Recall Phase: During the time between the first and second phase the patient will be seen every few months per year. This is to monitor the eruption of the permanent teeth and exfoliation of primary teeth.

Phase II (if required): During the first phase of treatment Dr. Bock has no control over 16 unerupted permanent teeth. If they grow in and problems still exist, further treatment, known as Phase II, will be required. A separate fee will be quoted at that time. Treatment usually takes 12-24 months.

Full Treatment: If you decide to wait, treatment will be started when all permanent teeth have erupted. Full treatment usually takes 18-30 months. The length of treatment depends on the severity of malocclusion and orthodontic problems.

Proper Braces Care and Brushing Techniques

Brushing and flossing your teeth can be challenging when wearing braces but it is extremely important that you do both consistently and thoroughly.

 
 
 


Foods to Avoid During Treatment: Eating proper foods and minimizing sugar intake are essential during orthodontic treatment. Your braces can be damaged by eating hard, sticky, and chewy foods.

  • Hard foods : Nuts, Candy, Hard Pretzels
  • Crunchy foods : Popcorn, Ice, Chips, etc.
  • Sticky foods : Gum, Chewy Candy (Skittles, Taffy, Gummy Bears, Caramel, etc.)
  • Chewy foods : Bagels, Hard Rolls, etc.
  • Foods you have to bite into : Corn on the Cob, Apples, Carrots (cut these foods up into smaller pieces and chew on back teeth)
  • Chewing on Hard Objects (for example, pens, pencils or fingernails) can damage the braces. Damaged braces will cause treatment to take longer.

Hard Foods

 

Soft Foods

 

Cleft lip and cleft palate.Cleft lip and cleft palate are among the most common birth defects, estimated to affect around one in 700-800 babies born in North America. Both problems result from the incomplete formation of anatomical structures (the lips and the palate, or “roof of the mouth”) which develop during early pregnancy. These conditions may occur separately or together, and they can have a wide variation in severity. With proper treatment, however, in most cases the child has an excellent chance of leading a healthy, normal life.

Besides the noticeable irregularity in appearance, a cleft lip or palate can cause difficulties with feeding and speech. Both conditions are also associated with ear infections, hearing loss and dental problems. To fully address these problems, a child may require several surgical procedures, performed at different times. That's why a team approach is often used to treat this complex condition. Members of the medical team may include an oral surgeon, a pediatric dentist, an orthodontist, a plastic surgeon, and other specialists.

In general, the first goal of treatment is to repair or “close” the gap in the lip and/or palate as soon as it is practical for the child — as early as 2 to 9 months of age. Follow-up treatment may be needed to restore the appropriate form and function of the lips, teeth, and jaws (for proper speech, eating, etc) and to correct hearing problems. These procedures may include plastic surgery, orthodontics, orthognathic (jaw) surgery and speech therapy.

Surgical Treatment for Cleft Lip or Palate

Cleft lip or palate surgery is usually performed in a hospital setting, and may be done when an infant is 6 to 12 weeks old. Intravenous sedation or general anesthesia is used, so your child won't experience any pain. In cleft lip surgery, an incision is typically made on each side of the cleft. This creates several “flaps” of tissue, which are then sutured (stitched) together to close the gap. Suture lines are generally planned to follow the facial contours, so that the surgical scar will be as unobtrusive as possible.

Cleft palate treatment involves rebuilding the roof of the mouth, including soft tissue, muscle and bone. The initial surgery is often performed between the ages of 6 and 18 months. Like cleft lip surgery, it relies on specialized “flap” techniques to reposition soft tissues and close the gap. Before or after surgery, your child may need to wear a special appliance such as an obdurator (artificial palate) or a nasal alveolar molding device (NAM), a type of retainer.

Follow-Up Treatment

Depending on how complex the child's condition is, additional procedures may be required after the initial treatment to fully correct any defects. A child's treatment plan will often include pediatric dental examinations beginning around age one. Bone grafts to repair the hard palate may be recommended at age 8-11 years, when the cuspid teeth are developing. To correct problems with the alignment of teeth, orthodontic care may be needed beginning around age 12. In some situations, orthognathic surgery is recommended to address more severe jaw problems.

Handling a child's cleft lip or palate can be a challenge for caregivers and family members — but it's important to keep in mind that this relatively common birth defect can be successfully treated. Many who have this condition have gone on to become well-known performers, politicians, sports stars… as well as moms and dads, friends and neighbors.

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