Children are a special case because they are growing. Because their bones are relatively soft and pliable and always growing and changing, it is easy to guide bone growth in children. There is some argument about whether the movement of children's teeth is actually faster than that of adults, but there is no argument about the ease of movement due to the growth factor.

As every mother knows, their children grow faster at some ages than at others. Therefore, orthodontists want to time their treatments for the ages when a child is mature enough to cooperate with treatment, and also when the bone is growing most rapidly. The optimum age for beginning treatment depends upon the specific deformity, but the best age for the first evaluation is age 7, because that is the age when both factors tend to coincide for the treatment of certain skeletal deformities. A major growth spurt takes place at puberty, and the orthodontist likes to take advantage of this as well. When deformities are assessed early and treated prior to the time that they have fully developed, we have "intercepted" the problem and this is referred to as interceptive orthodontics.

* The American Association of Orthodontists recommends that all children get a check-up with an orthodontist (specialist) no later than age 7.

A check-up may reveal that your child’s bite is fine. Or, the orthodontist may identify a developing problem but recommend monitoring your child’s growth and development, and then, if indicated, begin treatment at the appropriate time. In other cases, the orthodontist might find a problem that can benefit from early treatment.

What are the benefits of early treatment?

For those patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity to:

• Guide the growth of the jaws.
• Preserve or gain space for permanent teeth that are developing (coming in).
• Guide incoming permanent teeth into desirable positions.
• Reduce the likelihood of impacted permanent teeth (teeth that cannot come in due to crowding and/or an aberrant path of eruption).
• Lower the risk of trauma (accidents) to protruded upper incisors (front teeth).
• Correct harmful oral habits, such as thumb- and/or finger-sucking.
• Reduce or eliminate abnormal swallowing or speech problems.
• Regulate the width of the upper and lower dental arches (the arch-shaped jaw bone that supports the teeth). Improve personal appearance and self-esteem.
• Early treatment may prevent or intercept more serious problems from developing and may make treatment at a later age shorter and less complicated.
• In some cases early treatment can achieve results that may not be possible once the face and jaws have finished growing.
• Improve the stability for later corrective-orthodontics.
• Through an early orthodontic evaluation, you will be giving your child the best opportunity for a healthy, beautiful smile.

The congenital skeletal deformities

Congenital skeletal deformities are conditions occurring at birth and are usually caused by genetic factors. In order to understand what constitutes a deformity, however, it is necessary to understand what constitutes the generally accepted standards of normality.

Class I
In the diagram, the image illustrates an esthetically pleasing (Class I) profile, with balance between the upper and lower jaws, and a functionally and an esthetically desirable (Class I) bite or occlusion (correct orientation between the top and bottom teeth).

The detail of the teeth within the circular area of the illustration shows how the first molars line-up for various bites (i.e., Class I, Class II, Class III). From the standpoint of appearance, the class I occlusion generally yields a well balanced profile. Class I deformities are generally the result of crowding, extra space, or from developmental deformities (e.g., thumb-sucking and lip habits, physical errors such as an inability to breathe through the nose due to sinus and allergy problems, or the failure of some of the teeth to develop).

Class II
This illustration depicts a typical Class II profile. In the United States, this is the most common skeletal deformity (deviation from "normal"). With a Class II (convex) facial profile, the chin most often appears set-back, retruded or weak. Extreme cases give an "Andy Gump" appearance. But, mild facial convexity can be quite attractive for some women; it can have the overall effect of drawing attention to the eyes, and can account for the "all eyes" attractiveness that some women possess.

No matter what you think of the appearance of the profile, this occlusion (or bite) does leave the patient with functional problems involving the position of the teeth. The lower incisors frequently do not touch the upper incisors when the back teeth are together, and this allows the lower incisors to erupt up into the gums at the roof of the mouth. Also, this causes the upper incisors to over-erupt into an unattractive gummy smile, with the upper front teeth appearing unusually long and extending well beyond the edge of the upper lip. Last but not least, the improper alignment of the front and back teeth can lead to clenching, grinding, TMJ symptoms (clicking, popping, degenerative arthritis and pain within the jaw joints), difficulty chewing and digesting food, and more.

Class III
deformities yield a prognathic or "strong-chin" appearance. This could be caused by over-development of the lower jaw, under-development of the upper jaw, or both. The Class III facial profile is generally not considered attractive. The comedian Jay Leno is a classic example of an individual with this facial presentation.

It is associated with the "tough guy" or "bulldog" image projected by the 1940's movies, and gives a singularly masculine appearance that we associate with football players today. As with class II occlusions, this profile is associated with similar functional and esthetic problems.

Since the lower incisors are located in front of the upper incisors, they, too, can erupt to unattractive lengths. There is also a tendency not to show the upper front teeth when talking or even when smiling. And, in extreme cases, biting can be a real problem for these people, because, while people with class I and II profiles can stick their lower jaws out further to bite off a piece of food, it is impossible for the individual with a class III profile to draw his lower jaw back to make the front teeth meet.

The developmental deformities

Developmental deformities treated by orthodontists (specialists) are caused by environmental factors, such as thumb-sucking and lip habits, and physical errors such as an inability to breathe through the nose due to sinus and allergy problems, or the failure of some of the teeth to develop. These deformities are often associated with narrow upper dental arches, and/or an open anterior bite, such as that seen in the image of the thumb-sucking habit below. This category also includes crowded, crooked teeth, due to a discrepancy between the size of the teeth and the space available in the dental arches to accommodate them. Of course, all these problems often occur in combination and there is frequently no neat division between them in any given case. As such, every patient is unique and should be evaluated by a specialist and managed with an individualized treatment approach.

Thumb-sucking

Thumb-sucking is a habit that will generally subside on its own. By the time the child is in grade school he or she wants to stop because it has already become a social liability.

If stopped by age 6 or 7, most open bites will typically revert back to normal. Upon occasion, a child will want to stop, but be unable to break the habit. Under these circumstances, it can be helpful to insert a fixed (not removable) habit-breaking device as a "reminder" not to put the thumb into the mouth. These work well provided that the child wants to stop the habit. If the habit persists past the age of 12, the skeletal deformity you see on the left can persist for the rest of that person's life.

This image illustrates a child with a thumb-habit who has developed a crossbite, anterior open bite, and a persistent tongue-thrust-habit, which is similar to the habit of "reverse swallowing" in which the tongue is pushed out between the teeth every time the child swallows. Note also that the habit of persistently biting or sucking on the lower lip can produce similar deformities. These habits are all treated with their own habit-breaking appliance designs.

Mouth breathing

The normal development of the oral structures depends upon the ability of a child to breathe through the nose without obstruction. Chronic obstruction of the nasal airway due to a deviated septum, persistent allergies or other anatomic abnormality will tend to cause the roof of the mouth (the hard palate) to rise and the back teeth to collapse (move) toward each other. This condition is called a constricted dental arch. Note: This does NOT mean that if your child gets an occasional cold (a short-term condition) and can't breathe through his nose that he will grow up with oral abnormalities.

Due to the constriction of the dental arches, a mouth breather will frequently have a narrow smile that shows mostly the two prominent front teeth, with the others in shadow. Additionally, mouth breathers often present with dental crowding, crooked teeth, crossbites and gingivitis.

Crossbites

In most instances, the constriction of the upper arch is accompanied by some degree of constriction in the lower arch, caused by the tilting of the lower teeth toward the tongue. However, the degree of lower constriction is not enough to keep the upper and lower back teeth in the correct relationship with each other. This produces a condition known as a crossbite in which the top back teeth close to the inside of the lower back teeth (note the location of the arrow in the image) instead of to the outside, which is the normal relationship.

Crossbites like this can have a pronounced effect on the overall facial appearance, especially when they are unilateral (on one side of the mouth only). When a unilateral posterior crossbite is present in a child, it can cause asymmetric development of the facial muscles and the jaw joint, which means that one side of the face may grow larger than the other. Also, due to the narrowing of the dental arches, the tongue is typically displaced and speech is affected.

Crowded and missing teeth

Nature tries to fit the teeth into the space available. The teeth always end up in their most stable position within the dental arch, whether they are crowded, or have extra space between them; stability is the name of the game. There is always a balance between the various forces that affect any given tooth, as well as the amount and position of bone available that helps determine where that tooth is most stable. If a dentist tries simply to move the teeth into better looking positions without taking account of other factors, nature will move them right back where they started. This is why an orthodontist (specialist), who has 2-3 years of specialty training beyond dental school, must be enlisted. He or she can make sure the local forces affecting each tooth will cancel each other out after treatment, so that the teeth will stay put once moved. Further, this is also why the orthodontist usually treats both upper and lower teeth, even if only the appearance of the top teeth is of concern to the patient. Unless the position of the lower teeth coincide with the position of the uppers, the biting forces produced by the ill-fitting lowers will create instabilities that will move the uppers back into crooked positions over time. This is also the reason that the orthodontist, on occasion, will order the extraction of some teeth. The extra room created by the removal of these teeth changes the stability equation in favor of the preferred new tooth positions.

If your child is older than 7 it is certainly not too late for a check-up. Because patients differ in both physiological development and treatment needs, the orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time.

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• A discrepancy between the size of the jaws and the size of the teeth, resulting in crowding or spacing
• Extra or missing teeth
• Jaw growth problems; when one jaw grows more or less than the opposing jaw
• Cleft palate and other jaw or face irregularities

• Premature loss of primary or permanent teeth
• Dental disease
• Thumb or finger sucking
• Tongue thrusting
• Breathing problems caused by enlarged tonsils and/or adenoids?

• to correct jaw disproportion before aligning teeth
• to prevent injury to protruded front teeth
• to manage crowding and prevent permanent tooth extraction, whenever possible
• to eliminate damaging oral habits
• to improve a child's psychological self-image and self-esteem/self-confidence

• Is there an orthodontic problem and, if so, what is it?
• What must be done to correct the problem?
• Will any permanent teeth need to be removed?
• How long will the treatment take to complete?
• How much will the treatment cost?