A) Space Maintainers

Did you know that baby teeth are actually very important for your child’s development? Until the adolescent years, they will not only help your youngster bite and chew (i.e., get proper nutrition) and speak correctly but also help guide the permanent teeth underneath them into proper position. In fact, one of the most important functions of baby teeth is to hold space for the adult teeth that will eventually push them out and thereby, end up in the proper position.

At least that’s how it’s supposed to work; sometimes, however, injury or disease can cause a baby tooth to be lost prematurely. When that happens, the permanent teeth that are coming in on either side can actually drift into the space that was reserved for another tooth. This can cause teeth to erupt out of position or to be blocked entirely, and it may result in crowded or crooked teeth, ultimately causing bite problems.

Fortunately, if your child loses a tooth prematurely, there’s a dental appliance your orthodontist will use to hold the space open for the permanent tooth that is meant to fill it. The device is called a “space maintainer” or a “space maintenance appliance.” Made of metal and/or plastic, space maintainers can be fixed (cemented) or removable, but either way their purpose is the same: to help your child develop the best bite possible and hopefully avoid the need for braces later on.

Space maintainers are also useful when one or more permanent teeth are congenitally missing — in other words, they have never existed at all. In cases like this, which are not uncommon, permanent dental implant teeth are often recommended for adolescents or adults to replace a tooth they weren’t born with. But timing is very important with dental implants — they can’t be placed in a growing child. Therefore, we may use a space maintainer with a false tooth on it until jaw growth is complete and an implant can be appropriately placed. It’s a simple, non-invasive way we can avoid a malocclusion (bad bite) with some timely intervention.

The two different spacing options are described here:

• Fixed Appliances: are cemented onto adjacent teeth. They are made in many different designs: One consists of a band that goes around a tooth and then a wire loop that extends out from the band to hold the space; another feature a loop attached to a stainless-steel crown, which goes over a nearby tooth. In either case, the loop extends just to the point where it touches the next tooth. Fixed space maintainers are often preferred with younger children, because they are less easy to fidget with, break, or misplace than appliances that can be removed.
• Removable Appliances: Removable appliances look like the type of retainer that is worn at the end of orthodontic treatment. It can have a false tooth on it, which is particularly useful when the lost tooth was visible in the mouth. Older children can usually handle the responsibility of wearing this appliance and caring for it properly.

When the best choice of appliance is made for your child, we will take impressions of his or her mouth and make a custom-made appliance to fit their unique mouth. The appliance will be worn until x-rays reveal that the permanent tooth underneath is ready to erupt naturally. While your child wears the space maintainer we’ll be recommending they keep up good oral hygiene at home as well as come in for professional dental cleanings.

B) Palatal Expanders

One of the most compelling reasons to start orthodontic treatment early in a child’s life is that the natural growth process allows for easier and faster changes when a child is young. This is especially evident when the treatment involves widening the upper jaw. A palatal expander is the appliance your orthodontist utilized to gradually make more room for teeth in the upper jaw.

The upper jay develops as two separate shelves to achieve its adult width. Palatal expanders are necessary because the upper jaw has reached its adult wideness by the age of 7. From there, the two separate halves work to fuse together and this fusion is complete around puberty. Your orthodontist is able to affect gentle separation and stabilization of the upper jaw over a period of several months by using a palatal expander. Palatal expanders are easy and not scary at all!

The three situations that call for doing maxillary (upper jaw) expansion are:

• Crossbite – If the upper jaw is too narrow to fit correctly with the lower jaw, the back top teeth will bite inside of the lower teeth instead of outside. This is corrected by expanding the upper jaw with the palatal expander.
• Crowding – When your child is examined, we will be able to determine if there will be a challenge to accommodate the adult teeth (permanent) coming soon. Widening the upper jaw creates the necessary space and can prevent the need for tooth extractions.
• Impacted Teeth – Sometimes we will discover a tooth hasn’t come in yet (erupted) and is blocked by other teeth. Widening the upper jaw allows the tooth the space it needs to arrive, right into place! We find this most often happens with the “canine” or “eye teeth”.

 Aside from the functional advantages noted above, expansion of the upper jaw can have other benefits. For example, expanding the upper jaw can broaden the smile in an aesthetically pleasing way and even improve breathing. Use of a palatal expander when called for, can shorten overall orthodontic treatment time, meaning your child might see less time in braces!

How Expanders Work

The palatal expander will be custom made for your child and fits over the teeth in the back of the mouth. The appliance has two halves that are connected in the middle with a screw. Parents turn this screw 1 time every 24 hours for approximately 1 month. This induces tension at the junction of the two palatal bones, causing them to gradually move apart. Once the desired expansion is achieved, we will leave the appliance in for a few more months to allow new bone to form in the gap and stabilize the expansion.

What to Expect

Most kids say they can feel some soreness or a feeling of pressure for a few minutes after the key is turned, but activating an expander actually causes less discomfort than having braces tightened. At Silver Smiles, we use the smallest appliance possible, so that speaking and eating feels as normal as possible. During the expansion, it is completely normal to see a gap develop between the front teeth. This shows that the expander is having the desired effect- creating more space! When all is said and done, your child’s permanent teeth will be beautifully aligned with neither too much nor too little space between them. Beautiful results in a few months is what you can expect!

C) Thumb and Finger Appliances

Everyone is familiar with the image of a baby, asleep sucking his or her thumb. Did you know that they even do this in the womb? Thumb or finger sucking is perfectly natural as it helps relax and comfort babies and even toddlers. But as a child grows, it’s a habit from which they must graduate. It isn’t just a rite of passage that must be checked off, socially awkward if you can imagine an older child doing it. A much more compelling reason to help your child move on in the process of growing up is the possible harm to oral health that later thumb sucking can cause.

In most children, thumb sucking stops on its own between the ages of two and four years. But if the practice persists after the primary (baby) teeth have erupted, it can drastically change the growth patterns of the jaw and cause significant misalignment of the teeth. Parents are often surprised that the habit can create problems, but truly it’s an important issue for some kids.

Children’s jaws, rich in blood supply and growing rapidly, are relatively soft and flexible — especially in kids under the age of eight. So, it really isn’t hard for the constant pressure of a thumb or finger to deform the soft bone around the upper and lower front teeth. Children who are particularly vigorous thumb suckers are even more likely to change the growth patterns of the teeth and jaws.

If the thumb sucking habit persists, it can result in the upper front teeth flaring out and the lower ones moving back and inward. It can also hold back the growth of the lower jaw, while causing the upper jaw to be thrust forward. This can result in misalignment of the teeth, an anterior open bite (where the front teeth fail to close together), collapse of the upper jaw causing crossbite, or other problems. That’s why it is important to stop the behavior at an appropriate time, before damage occurs.

Controlling Thumb or Finger Sucking

Like many potentially harmful behavior patterns, thumb sucking can be a difficult habit to break. A lot of home remedies have been tried by frustrated parents. Efforts such as having the child wear gloves, coating the thumb or finger with a bitter-tasting substance — and even reasoning with their toddlers have been tried. Sometimes it works — but in other cases, the allure of thumb sucking proves very difficult to control.

If your child has a thumb or finger sucking habit that has persisted past the age of three, and you’ve been unable to tame it, then it may be time for you to visit our office. We will consider treating your child with a “habit appliance” such as a fixed palatal crib or a removable device. This crib isn’t for sleeping — it’s a small metal appliance worn inside the mouth, attached to the upper teeth.

How does it work? The palatal crib has semicircular wires that keep the thumb or finger from touching the gums behind the front teeth. Simply preventing this contact seems to take all the enjoyment away from the thumb sucking habit — and without that pleasurable feedback, a child soon loses interest in keeping up the habit. In fact, the device is often successful the first day it’s worn.

Getting and Using a Habit Appliance

If your child could benefit from a habit appliance, the first step is to get a thorough examination, which may include taking X-rays, photographs and dental impressions. The palatal crib will then be custom-fabricated to fit your child’s mouth and put into place at a subsequent appointment. Afterwards, your child will be periodically monitored until the appliance is removed — typically after a period of months.

Although wearing the crib isn’t painful, your child may experience some soreness in the upper back teeth for only a few hours after it has been put into place. He or she may also have a little trouble falling asleep for a day or two afterward. Plenty of extra attention and TLC are usually all that’s needed to overcome a little fussiness and make everything all right. While the appliance is being worn, it’s best to avoid chewing gum and eating hard, sticky food that might cause it to come loose.

A Word About Tongue Thrusting

Like thumb sucking, tongue thrusting is a normal behavioral pattern in young children. It’s actually part of the natural infantile swallowing pattern, which will normally change on its own — by the age of six, in most children. If the pattern doesn’t change, however, it can lead to problems similar to those caused by thumb sucking. Problems with tooth alignment and skeletal development can occur. Fortunately, this problem can be successfully treated with a habit appliance that’s very similar to a fixed palatal crib. Your orthodontist can help you make a determination and recommend what’s best for your child.

For many of our patients, we recommend treatment around ages 11-14, when all of the baby teeth are gone and many of the permanent teeth are in place. Sometimes there are conditions that are easier to treat when detected early as mentioned above during the initial evaluation at around 7 years of age. Your child’s natural growth processes are moving at full speed and the orthodontist is able to get results easier in these cases. Below are some examples where earlier treatment can really help the corrective process:

• Severe Crossbite: A condition where the upper teeth close inside the lower teeth. Your orthodontist will use a palatal expander to gradually and painlessly widen the upper jaw. Waiting too long complicates the treatment, many times causing the jaw to grow asymmetrical, even possibly creating a need for oral surgery – where one of the jaws is broken and moved into the correct position.
• Severe Crowding: Crowding occurs when the jaws are too small to accommodate all of the adult teeth. Palatal expansion may be utilized to create space for the permanent teeth to emerge from below the gums properly. Even if braces are needed later, the treatment time will be less complicated and likely shorter.
• Other problems, such as protruding teeth, which can lead to chipping and fractures can work against a child’s self-image. Even serious bite problems caused by the lower jaw growing much larger than the upper jaw are more easily corrected when treated early. This is especially important because the orthodontist can utilize appliances like braces and other appliances, that work well, instead of risky and often more painful surgery.