At what age should children see an orthodontist?

I am concerned about the way my child's teeth are coming through but they still have some baby teeth. Is it too early to see an orthodontist?

Many people have the opinion that it is not worth visiting an orthodontist before all the baby teeth have fallen out. This is because, the traditional fixed (train-track type) braces can only be used for adult teeth. 

However, there are situations where it is better to see an orthodontist earlier. 

The adult teeth start coming through from around 6 years old and if there are any concerns an orthodontic assessment can be done between the age of 7-9 years.

For some orthodontic problems treatment can be started before all the adult teeth have come through.

Which orthodontic problems may be suitable for early diagnosis and treatment?

• Baby teeth removed early - other teeth may tilt into or take up the vacant space, causing the permanent teeth to come through crooked. Using a space maintainer can prevent more complicated and costly treatment later on.

• Protruding front teeth - which can be prone to accidental injury.

• Open bites - teeth not meeting when biting together.

Upper incisor tooth in "cross-bite" behind lower incisor

• Cross bites - upper teeth coming through behind the lower teeth.

• Difficulty in biting or chewing.

• Growth discrepancies of the jaws and/or teeth out of proportion.

• Some cases of crowding - not enough space for all the adult teeth.

• Missing teeth - sometimes teeth are absent from birth (they just do not grow). An x-ray would be needed to confirm the tooth or teeth are missing. A decision can be made to either close the space or maintain the space for dental implants later.

• Adult teeth under the gum that do not come through within the normal age range - the cause can be investigated and treated. 

• Large gap between the upper front teeth (diastema) - investigation and treatment is often more successful if done earlier.

• Asymmetrical smile

• Persistent thumb or finger-sucking habits - see previous blog for more information. 

What are the goals of early orthodontic intervention?

• Make room for permanent teeth to come through and guide them into the correct position.
• In the case of jaws which are out of proportion, functional appliances can guide the growth of the jaws and correct certain bite problems.
• For simpler problems, later orthodontic treatment may be avoided.
• Potentially simplify and shorten later comprehensive orthodontic treatment  for more complex cases.
• Improve personal appearance and self esteem.

If you are unsure, it is best to see your dentist for a check-up first - they will be able to advise you whether your child would benefit from an early assessment with an orthodontist.

How can I stop my child sucking their thumb?

Is thumb sucking normal?                                                                                                                                             

At what age does it become a problem if my child has not stopped the habit?                                                                                                                                                       I'm concerned that thumb sucking is affecting my child's teeth - what can be done?                                                                                                                                                                                                                                                                                                                                   

       

Why do children suck their thumbs?                          

Thumb or finger sucking is perfectly normal for babies. In fact, some babies even start in the womb! The sucking reflex is necessary for feeding but babies also have a natural instinct to suck when they are not feeding as a way of self-soothing.

Babies and small children may suck their thumb or fingers or a pacifier when they are anxious, unwell, bored or as a way to get to sleep. Many children give up the habit on their own between 2 and 4 years old.

When does thumb-sucking become a problem?

If a child sucks their thumb, finger or pacifier intensely and regularly or for long periods of time it can affect their front teeth, causing them to be pushed forwards and creating a gap between the upper and lower front teeth. This can sometimes cause speech problems. In young children, unless there is some other factor causing the teeth to be crooked, the teeth will usually move back to their normal position spontaneously once the habit is stopped

If a child continues the habit after 4 or 5 years old then it may start to affect the position and appearance of their adult teeth as they come through. The longer the habit continues after 6 years old, the more likely that orthodontic treatment (braces) will be required to correct position of the adult teeth. 

What can I do to help my child stop?

• Don't nag or punish your child for sucking their thumb. Many children suck their thumbs when they are stressed or anxious, so this will only make the problem worse.
• Talk calmly with your child to try to find out why they suck their thumb. 
• Explain that the habit can cause teeth to become crooked. Ask if they would like help to stop.
• Reassure your child that as they are maturing and growing up they will be able to stop - discuss some things they used to do as a baby which they no longer do now.
• If there are particular situations that trigger the habit try to offer distractions or something to keep their hands busy.
• If your child is sucking their thumb when anxious or stressed discuss the issues and try to find other solutions for reassurance or comfort.
• Use positive reinforcement. You could make a chart where you can give a star for each day your child goes without sucking their thumb. You could agree on a reward or treat after a number of days or weeks.
• For some children, it is a subconscious habit and just reminding them (without nagging!) when they are doing it can help them stop.
• For others, putting something on the thumb, such as a small bandage, can act as a reminder. 
• If you find your child is using thumb-sucking as a way of getting attention you may be better to start ignoring it instead.

What if I have tried these ideas and it has not worked?

Firstly, visit you dentist. They can assess your child's teeth and give advice.

For those children who have real difficulty giving up the habit, a habit breaker appliance can be used. This would involve first making a mould of the teeth, so that the appliance can be made in a dental laboratory.

Habit-breaker Appliance

A habit breaker appliance is fixed to the back teeth and has a blunt wire which sits behind the upper front teeth. This does not cause any pain but it makes trying to the suck the thumb uncomfortable and therefore takes away the pleasure of the habit. Even if your child still puts their thumb or finger in their mouth they will not be able to create  the suction force which causes pressure on the teeth.

The same day a habit breaking appliance is fitted, a child may experience initial discomfort around the back teeth. Speaking and eating but be a bit more difficult for the first few days but should soon return to normal. Advice is given on care and cleaning of the appliance.

The appliance is usually worn for 6-12 months, with regular checks at the dentist. It has found to be very successful in breaking the habit and allowing the teeth to return to their normal position.

If you have any other questions, please make a comment below or visit your dentist.