Early Orthodontic Treatment and functional treatment

Many people mistakenly believe that the work of an orthodontist cannot begin until all child’s adult teeth are present. But to give your child the best prospect of a beautiful smile, this simply isn’t the case….The American Association of Orthodontists recommends that children should attend their first orthodontic check-up by the age of seven. 

At Starlight we also believe in early treatment for children.  The teeth may appear straight, but underlying problems could easily be present with jaw growth issues and emerging teeth while some baby teeth are still in place. Requent monitoring of the child’s growth and development helps avoid major treatment later, and ensures that any necessary work will be recommended at the appropriate time.  

Two types of children’s orthodontic treatment: 

Interceptive treatment (Early Treatment or Phase 1 treatment):  this is early treatment aimed to prevent or intercept more serious problems. Delivered between the ages of 7 and 10 ( for some case like crossbite it is even better to see the child earlier at 5 years old), treatment typically lasts between 10 and 18 months. It often makes later treatment much less complicated. 

Phase 1 treatment. We will use various removable appliance like palatal expander, Headgear, ELN, Pendulum, Face mask…  to helps us to: 

  • Guide jaw growth
  • Reduce the risk of trauma to protruded front teeth
  • Improve appearance
  • Guide permanent teeth into a more favourable position
  • Create a more pleasing arrangement of teeth, lips and face
  • Correct harmful oral habits ( Functional Education) 

The Functional education is an important part of the interceptive treatment. The aim of Functional Education Therapy is to remove excessive forces of muscles on the alveolar bone and teeth, to correct:the position of the tongue, to center the mandible to be in harmony with the maxilla, to train the children to have correct swallowing and correct breathing. 

The role of the tongue 

For many years, scientific studies have drawn attention to the role that the tongue plays in the positioning of the teeth and jaw. 

However, the correction of the tongue is not something that is frequently undertaken, and therefore  orthodontics primarily relies on the movement of teeth using force applied to fixed braces. Recent research has shown that for treatment to be effective we should not rely solely on orthodontic devices, but should also focus on the role of the tongue. Dentists are more aware than ever that the positioning of the teeth is not only a result of anatomy but also a result of the other roles that the tongue and teeth have. 

We are therefore able to systematically deduce that any dental abnormalities are a result of genetics (inherited), acquired factors (trauma, illness) or functional factors (thumb sucking, bad habits). 

The tongue, which is comprised of 17 muscles, causes many dental anomalies. In the following we will see its importance in swallowing and breathing. 

The development of children is also influenced by growth hormones that are primarily secreted during sleep. Rehabilitation should therefore also lead to a good night’s sleep. 

Swallowing 

This includes the swallowing of food or saliva. This act is repeated more than 2,500 times a day. Therefore, poor swallowing can explain the bad positioning of the teeth and poor development of the jaws. This is mainly due to the fact that a baby with no teeth swallows differently to a child or adult with developed sets of teeth.  

Before teething, babies only drink. Their tongue is used to suck the milk and to swallow it. To do this the baby's’ head must be supported so that the milk is directed to the back of the throat. The lips are then closed and the tip of the tongue rests behind them, between the gums. 

However with the development of teeth, a child from about 8 years old closes the teeth to swallow and the tongue rests on the palate to help push the food back. This is adult swallowing.  

A baby closes their lips and rests their tongue between the gums. Children and adults close their teeth and positions the tongue on the palate. It is possible to see if a child has retained infantile swallowing without looking inside their mouth, because they close their lips when swallowing. 

If the child retains infantile swallowing: 

  1. Their tongue rests between their incisors making it difficult to bite food (open bite problem)
  2. Their tongue does not stimulate the palate: it becomes narrow
  3. The tongue can push the upper teeth: the upper jaw and the teeth move forward
  4. The tongue can push on the bottom teeth: the teeth and lower jaw widen and move forward  

Breathing

Breathing is usually done through the nose with the tongue slightly raised in the mouth. However some people breathe through the mouth. These are usually people with nasal obstructions. Children who breathe with their mouths open can actually affect their treatment. This is because when a person breathes through their mouth, the tongue tends to drops down to allow airflow. 

Nasal breathing can be encouraged with exercise.  

Nasal breathing: mouth closed, tongue high in the mouth 

Mouth breathing: mouth open, tongue behind lower incisors or between the teeth  

If the person breathes through their mouth 

  1. Their nose doesn’t work effectively and neither does the mouth
  2. They lose some of their sense of smell
  3. They may snore, leading to disturbed sleep
  4. Their mouth becomes dry, which can lead to diseases of the gums 

The tongue may extend beyond the mouth, putting pressure on the teeth and jaws, resulting in anatomical abnormalities. 

Functional Education appliance 

Functional Education:    https://www.youtube.com/watch?v=FtdVMTMSUSA 

Functional Education exercices:

 

Care of your appliance:       https://www.youtube.com/watch?v=BsdELJjFKSw 

FAQ question about functional Education: 

How long does Functional Education therapy lasts? 

The minimum time for Functional Education therapy is 6 months of everyday use. After successfully wearing the appliance daily for 6 months, wearing time can be reduced.  

Can the appliance cause pain while being worn? 

Each patient has a different arch form and tooth positions. Some patients may experience pressure on teeth or an uncomfortable feeling during the first few days of treatment. This is natural since the patient is adjusting. Continuing to wear the appliance during the prescribed time will help alleviate the pressure or discomfort.  

How long should the EF appliance be worn 

An EF appliance should be worn daily, for at least 2 hours with breathing/muscle exercises during daytime and overnight while sleeping. If these wearing recommendations are not followed, the therapy may take longer than 6 months.  

Comprehensive treatment (Phase 2 treatment) :  this is usually carried out when the jaws and face have finished growing, typically commencing from the age of 11. Phase II treatment may be less complex due to the benefits of the earlier treatment phase I. Most commonly children wear fixed braces for a period of 12-36 months, depending on the complexity of their bite. Retainers are fitted to ensure a long-lasting smile.