"Opportunities are easily lost" or "overcorrection"?

This is the 4281st article of Da Yi Xiao Hu

Malocclusion in children is one of the three major oral diseases announced by the World Health Organization (WHO). Its incidence rate is increasing year by year in my country, which not only affects the facial appearance of children, but also seriously affects their oral and mental health.

As parents' awareness of oral health care increases, early correction and intervention of children's malocclusion is becoming more and more of a priority for parents. During the past winter vacation, many anxious parents rushed into our orthodontics department with their children.

Is it better to start orthodontic treatment for children as early as possible? The answer is NO! Not all malocclusion corrections are better as early as possible.

At present, there are more and more publicity and advertisements for orthodontic treatment in society, which are "a mixed bag" and difficult to distinguish. Many publicity parties take advantage of parents' mentality of "catching problems early and getting twice the result with half the effort" and blindly expand the indications for early correction, causing many patients who do not need early correction to wear various orthodontic appliances, which results in physical and mental exhaustion for doctors, children and parents.

There are three basic principles for children’s correction: “timely”, “appropriate” and “moderate”. For a long time, the early correction discussed in the field of orthodontics refers to the early stage relative to general correction, that is, the correction of malocclusion during the deciduous and replacement dentition periods. Below we will briefly introduce several common types of malocclusion in children that are “easy to lose” and “overcorrected” for non-professionals and parents to understand.

1. Types of malocclusion that can be intervened early

01

Abnormal function

(1) Mouth breathing

Long-term mouth breathing in childhood can lead to malocclusion, which is manifested as narrow dental arches, high arched palate, narrow and long face, open lips and exposed teeth, etc. To correct mouth breathing, the cause should be addressed first, nasopharyngeal obstruction should be relieved, and nasal ventilation should be restored. For patients whose nasal ventilation has not yet been restored, blindly using orthodontic means to forcibly correct mouth breathing will not achieve good results.

(2) Abnormal tongue function

It includes two major categories: abnormal tongue position and tongue sticking out habit. Clinically, it can be combined with tongue lifting training and the use of devices such as tongue basket and tongue stinger to intervene in the tongue sticking out habit at an early stage.

(3) Abnormal lip function

Long-term active lip closure training can achieve better results, and some orthodontic tools can also be used clinically to assist in eliminating primary factors, such as deep overjet of anterior teeth.

(4) Occlusal dysfunction

Introversion deep overbite

Serious deep coverage

Improper width of upper and lower dental arches

Anterior crossbite or tooth collision

Occlusal interference or trauma caused by misalignment of individual teeth

02

Bad habits among children and adolescents

03

Tooth replacement disorder

Diseases, early loss, and retention of deciduous teeth during the edentulous period, early eruption, delayed eruption, abnormal eruption direction, abnormal eruption order, and imbalance in tooth and bone volume, tooth and bone age, etc. can cause various malocclusions and lead to serious consequences, which require early correction and active intervention to block them.

04

Health needs

(1) Serious oral hygiene problems

Due to crowding, gaps, and misaligned teeth, patients are unable to effectively maintain oral hygiene and have risk factors such as severe tooth caries and periodontitis. Based on a full evaluation, sequential extraction of deciduous teeth may be used as appropriate.

(2) Severe psychological disorders

Some patients may suffer from serious psychological disorders due to the impact of malocclusion on appearance. In this case, early correction can improve appearance as much as possible and promote the patient's psychological health development.

2. Early correction should not be carried out

01

Temporary malocclusion in children during the period of tooth replacement

① A small gap between the upper central incisors is caused by the compression of the central incisor root by the lateral incisor tooth germ, which is relieved as the lateral incisor erupts;

② Lateral incisor oblique axis, caused by canine tooth germ compressing the lateral incisor root, relieved as the canine erupts;

③ Mild crowding of the dentition, caused by the mismatch between tooth age and bone age, which is alleviated with the growth of the jaw and the adjustment of the space between the posterior teeth;

④ Mild distal relationship of molars, caused by the development of maxillary before mandibular, which gradually eases with the development of mandibular;

⑤ Mild deep overbite of the anterior teeth, caused by insufficient height of the posterior teeth and alveolar sockets, which is gradually relieved by the eruption of subsequent teeth;

If the above temporary malocclusion is not accompanied by other problems, there is no need for early intervention and regular check-ups are sufficient. Even if it is not alleviated, it can be better improved during the subsequent comprehensive orthodontic treatment in the permanent dentition period.

02

Various functional problems whose causes have not been eliminated

① Mouth breathing caused by blocked nasal airway

② Abnormal tongue function caused by short frenulum

③ Crowded dentition due to insufficient bone mass

Direct orthodontic treatment for the above malocclusions without resolving the primary cause will not achieve stable and reliable results, and clinical treatment should not be carried out blindly.

We hope that parents and children will understand that in the setting of early correction goals, the degree of tooth arrangement and the occlusal relationship of the upper and lower jaws are not the main and main goals at this stage. In fact, only a small number of special malocclusions can be prevented, and although early blocking correction can reduce the severity of the deformity to a certain extent, it is a short-term treatment. In the subsequent early permanent teeth or mid-to-late permanent teeth, children still need to receive comprehensive orthodontic treatment.

References:

1. Bai Yuxing. Timely, appropriate and moderate early prevention and treatment of malocclusion[J]. Chinese Journal of Stomatology, 2022, 57(8): 789-793. DOI: 10.3760/cma.j.cn112144-20220726-00409.

2. Fang Bing. Early correction of malocclusion in primary dentition[J]. Chinese Journal of Stomatology, 2022, 57(8): 800-804. DOI: 10.3760/cma.j.cn112144-20220426-00217.

3. Zhao Zhihe. Early correction of bad oral habits[J]. Chinese Journal of Stomatology, 2022, 57(8): 815-820. DOI: 10.3760/cma.j.cn112144-20220411-00170.

4. Xie Xianju, Li Song, Bai Yuxing. Early correction of malocclusion in the transitional period[J]. Chinese Journal of Stomatology, 2022, 57(8): 805-810. DOI: 10.3760/cma.j.cn112144-20220416-00185.

Written by: Chen Hong, PhD, West China School of Stomatology, Sichuan University, Orthodontist, Tongji University Affiliated Stomatological Hospital

Reviewer: Liao Chongshan, Department of Orthodontics, Affiliated Stomatological Hospital of Tongji University