Is your child’s chin too forward, or does the lower lip protrude in front of the upper lip? This is an orthodontic problem.

Around five percent of the population has an underbite, where the lower teeth are too forward compared to the uppers. It is easy to spot, because of the distinctive face appearance. It does not usually provoke teasing from the schoolmates, but rather is usually spotted and referred by dentists.

It is routine for orthodontists to treat underbites early, sometimes as early as age four, but more often at age eight after the permanent incisors have grown in. The reasons treatment is done early are that the teeth and face bones are more easily moved at a younger age, and it is easier to get a child to wear the necessary devices (braces etc.) at an earlier age. It is assumed that they will still need orthodontic treatment again in a second stage at age 12 or so, but the early treatment is felt to give them a result that would not have been attainable if they had waited.

Treatment of underbites will often involve upper jaw expansion in order to loosen the bone sutures, and simultaneous facemask headgear to pull the upper jaw forward. In eight-year-old children who wear the facemask 12 hours per night, underbites can be corrected in less than a year. They are sometimes overcorrected in anticipation of relapse and partial return of the underbite.

Years ago it used to be taught that underbites should not be treated until growth was complete (age 18), and then jaw surgery would correct the underbite. It is now preferred to treat children early while the sutures are immature, but with the understanding that two stages will be needed.

Does your child’s chin deviate to one side? An orthodontist is trained to look for this.

The usual reason the chin is not directly under the center of the nose is that it has shifted to one side in order for the upper

and lower teeth to fit together better, due to a narrowness of the upper jaw.  The upper jaw, being just a little too narrow,

does not bite well against the lower, so a slight shift of the lower jaw to the right or left makes the bite normal on one side

and full crossbite on the other, providing more tooth contact and a sense of stability.

 

If allowed to remain, the chin may permanently grow into that unsymmetrical position.  Orthodontists are usually quite

alert to this occurrence and recommend widening the upper jaw immediately.  Once the upper jaw is widened sufficiently,

the lower jaw will usually seek equilibrium with it and the chin re-centers itself.  The widened upper jaw is best maintained

with a holding wire for an extended time, since the cause of the narrow arch may still exist.

An orthodontist invites you to look. Does your child’s chin pucker in order for the child to close their lips together?

It is common for the upper incisors to protrude. When a child swallows, the lips normally come together to form a seal,

but this seal is hard to achieve if the upper teeth protrude excessively.  The chin muscle then puckers in order to push the

lower lip up far enough to meet the upper lip, and the resulting facial expression is somewhat unattractive.

 

The  puckering of the chin muscle in order to extend the lower lip up to form a lip seal causes the lower lip muscle

to increase in size.  This increase in bulk of the lower lip will cause crowding of the lower incisors.  It can be avoided

by referral to an orthodontist experienced in treatment of young children. Treatment may include expansion of the jaws

to reduce the incisor protrusion. Or treatment may consist of correcting the incisor protrusion by advancing the lower jaw. 

 Sometimes removal of 2 or 4 teeth is desirable.  The faces created are better than if untreated and the stability of the

results is remarkable once correct jaw posture and tongue posture have been created.

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Do the upper front teeth protrude beyond the lips, or is the lower lip behind the upper incisors, or does the lower lip curl downward? Time to see an Orthodontist.

Protruding incisors are at risk for being fractured or knocked out by any of the common activities and accidents of childhood.  Even if they somehow avoid damage, they can be the object of considerable teasing from other children.

A common cause for protruding upper incisors is thumb or finger sucking, which if done long enough will make the upper front teeth flare forward and will tip the lower front teeth backward. 

 

Most children stop thumb/finger sucking once they get into the social pressure environment of school, but if they have already created a deformity in tooth position with the thumb, the deformity will be maintained even after stopping the thumb habit by the tongue protruding into the anterior open bite, and worse, the lower lip parking behind the upper incisors will push them even further forward horizontally.

Most parents are aware of the chili pepper sauce on the thumb regimen, but it does not always work well.  Another treatment involves taking a sock, folding its top down and sewing it into a channel through which is passed a shoestring to be used as a drawstring, and the sock is tied onto the hand at bedtime (sometimes both hands have to be so covered, individually).  For younger kids, the sock can have a face drawn or sewn onto it and the sock can become a personality, such as “Mr. Wizard,” who helps the child.  The sock prevents the thumb or any finger from being extended to be sucked.  It takes considerable discipline from the parent to do this every night for several months (and possibly daytimes after school), but it can work, especially for the child who only sucks at bedtime.

Another fun therapy that can be piggybacked onto that one (or which can stand alone) is to play a game where any day and night that no thumbsucking happened, a happy face sticker is put onto a calendar, and 5 happy faces in a week earns a trip to 31 Flavors, and 25 happy faces in a month earns a trip to Chuck E. Cheese with a friend!

 

A tried-and-true orthodontic therapy, for those who need it, is to place a permanent wire screen device in the mouth, soldered to bands which are cemented to the upper molars, and which forms a physical barrier to keep the thumb and fingers out and to keep the tongue from protruding forward.  It must be left for several months, because if removed too soon the habit has been seen to return.  While the device is in place, the front teeth will usually erupt and the open bite will usually close.  If the upper incisors are flared severely forward, they may need a brief period of braces to upright them, but care must be used not to tip them back into the unerupted permanent canines.

Are Your Childs Lips Apart?

Lips are normally closed together when not speaking.  If the lips are seen to be constantly apart, chances are that the nasal airway is impaired and the child

is mouth-breathing.  If they are, it is possible that specific face changes will happen.  When the mouth is held open to breathe, the tongue drops down

because the tongue is attached to the inside of the lower jaw, so it no longer rests against the roof of the mouth.  The absence of tongue pressure on the

roof of the mouth causes the upper jaw not to widen from growth.  This is made worse by the tightness of the cheeks against the outside surfaces of the

teeth caused by holding the mouth open, pushing inward on the upper teeth and causing them to narrow.  Constant mouth-breathers tend to have narrow

upper jaws, which are easily recognized because one or both sides will be in crossbite, biting inside the lower teeth instead of outside.

 

Mouthbreathing may be because the nose if stuffy from allergies, or the nasal septum is deviated, or the adenoids are large, or the tonsils are large, or the

soft palate/uvula is oversized.  Dentists can recognize long soft palate/uvula and large tonsils by depressing the tongue with a mouth mirror and telling the

child to say “Ahh”. 

 

Large adenoids can be detected by the nasal sound of the speech, and can be viewed easily with an x-ray of the head.  Parents can notice if the child snores,

which often accompanies throat airway problems. 

 

It is not usually helpful to take a child’s airway problem to a pediatrician, because they are taught that tonsillectomy and adenoidectomy are to be avoided in

order to preserve a child’s ability for immunity in adulthood.  They are taught little about the growth of the face and the adverse effect of a blocked airway

on the shape of the jaws and appearance of the face.  It is often effective, however, to take a child to an ear-nose-throat specialist, because in general these

doctors will consider tonsil and adenoid surgery if medication does not suffice to keep the airway open.

 

 

If mouthbreathing has resulted in a narrow upper jaw, the jaw can be widened by an orthodontist using palatal expansion.  It has been shown that widening

the upper jaw also widens the base of the nose and reduces nasal resistance, improving nasal airflow, and the most common reason orthodontists widen the

upper jaw is to correct crossbite(s) caused  by a narrow upper jaw.

 

Mouthbreathing left undetected and untreated may result in a long thin face, with the chin more backward, and with the roof of the mouth apparently high

and narrow due to the failure of the jaw to widen because the tongue is too low.

 

                                                                     ©2011  James E. Eckhart, D.D.S.,  Inc.

                                                                                                   www.eckhartorthodontics.com

                                                                                               1101 N. Sepulveda Blvd,  Suite 202, 

                                                                                          Manhattan Beach,  Ca.  90266  (310) 546-4724

                                                                                21210 Anza Ave., Torrance, CA 90503 (310) 540-5911  

Are Braces Expensive?

It may save you money in the long run - less dental care, less time off work. Nothing is too expensive if you want it bad enough or if you have to have it. Straight teeth for the balance of one's life, assuming 60 years left, is only $50 a year, or $0.15 a day.   Many people regard this as a better use of their money than a trip to Mexico. Orthodontists don't like to see money get in the way of your health. They adapt the payment plan to your particular needs and come up with an affordable solution.  Of all medical services, orthodontic treatment has gone up the least.  Shorter treatment time and greater efficiency has reduced the cost.   Even people of limited means are getting their teeth straightened too, including secretaries, single parents, etc.  It may actually make you money; with the increased self confidence you may gain from knowing your teeth look their best.  The doctor doesn’t live in Beverly Hills, he lives and works locally and is in touch with what local people can afford.

 

 

Copyright 2004  James E. Eckhart, D.D.S.,  Inc.

1101 N. Sepulveda Blvd,  Suite 202, 

Manhattan Beach,  Ca.  90266  (310) 546-4724

21210 Anza Ave., Torrance, CA 90503 (310) 540-5911

 

Am I to old for Braces or aren't Braces for kids?

Around 50% of Orthodontic patients are adults.  A lot of adults are looking for long term solutions rather than settling for "quick fixes" or "patches".  For adults, the main dental disease is breakdown of the gums, not cavities.  By aligning your teeth, you not only improve your appearance, but also improve your hygiene because brushing and flossing is now easier and more effective, This can save the health of your gums.If you lose your teeth, you'll look even older. 

Many adults are realizing that now that their children have finished braces, and that they can afford braces for themselves understand its value, they are entering treatment too.  Some adults needed orthodontic treatment as a child but it was unavailable to them, so now that they have the means they pursue it.  Nobody is really too old.  If a person assumes that they are going to live the next 2-3 years anyway, they might as well harness the time, get their teeth straight, and enjoy the results the rest of their life.

©2011  James E. Eckhart, D.D.S.,  Inc.

www.eckhartorthodontics.com

1101 N. Sepulveda Blvd,  Suite 202, 

Manhattan Beach,  Ca.  90266  (310) 546-4724

21210 Anza Ave., Torrance, CA 90503 (310) 540-5911