Early intervention and habit correction to address crooked teeth

Who would not want their children to have a healthy smile with perfectly aligned teeth? The good news is that with early intervention, it could be possible. Here we bring all you need to know about what crooked teeth are, how to identify crooked teeth and how early intervention and habit correction can result in healthy and straight teeth. 

Let us first understand how to identify crooked teeth in children

 Once children get their baby teeth during the primary dentition phase, some parents may notice that the baby teeth seem to be neatly arranged but eventually appear disarranged when the adult teeth erupt. It usually is because there is less space in the dental arches for the adult teeth to fit in resulting in an overall appearance of crooked teeth.

What is craniofacial growth, and how it impacts the alignment of a child's teeth

Craniofacial growth involves the complex formation of the head and face, which include the upper and lower jaws where the teeth are placed. The key factors that influence craniofacial growth can be broadly categorized into genetic factors and environmental factors.

Genetic factors determine the nature of the child’s craniofacial growth formation. However, other non-genetic or environmental factors play an important role in influencing and moderating this process that results in the final cranial and facial base.

Here are some of the common environmental factors (non-genetic factors) that influence craniofacial growth in children: 

  1. Nasal breathing. Continuous airflow through the nasal passage during nasal breathing induces a constant stimulus for the lateral growth of maxilla (upper jaw) and for lowering the roof of the mouth. Together with other functions such as mastication and swallowing it allows for proper development of the craniofacial complex. 
  2. Nutrition is an essential aspect of human growth. Sufficient nutrition contributes to normal development. However, malnutrition results in decreased calories and food elements that will impact a child’s natural growth.  
  3. Orofacial muscles. Muscles of mastication which move the lower jaw during chewing and tongue are part of the orofacial muscles. These muscles influence in chewing, swallowing and speech and are attached to their respective bones providing mechanical stimulation to bone remodelling and growth. As such, the proper function of these muscles together with nasal breathing has an impact on the craniofacial development and teeth alignment. 

How early intervention in managing these non-genetic factors can help in the prevention of crooked teeth.

The early intervention aims to identify inappropriate habits that impact active craniofacial development phase in a child and address them early. 

Breathing is one of the most important environmental factors of all. In the event of an obstruction in the nasal airway, breathing is inevitably done by mouth. This pattern of mouth breathing is commonly associated with changes in the functions of other orofacial muscles that can cause undesirable changes in facial growth. 

Such changes in facial growth affect the proper development of mid-face, upper and lower jaws resulting in discrepancies in upper and lower jaw relationships. It also gives rise to underdeveloped jaws making them too small to accommodate all the adult teeth when they erupt.

Most often, parents tend to assume that this is a result of adult teeth being too big and therefore the teeth become crooked, whereas the actual reason could be that the upper and lower jaws are underdeveloped.

Adverse effects that can be prevented by early intervention

Delay or failure to identify and correct mouth breathing and improper orofacial muscle function may lead to undesirable facial profile and crooked teeth.  

By the time all adult teeth have come through, one would typically have a longer-shaped face and retruded chin. This issue occurs when the tongue is not in the proper position resting against the roof of the mouth, resulting in narrowing of the dental arches and underdeveloped midface. Therefore, early intervention would encourage proper craniofacial development. 

This intervention will result in a desirable face with mandible and maxilla (upper jaw and lower jaw) in proper relationship and adequate space for the adult teeth to come through evenly. Even in the case where the adult teeth are crooked, the treatment would generally be faster and easier as it would be a matter of aligning teeth and not involving correcting jaw relationships. 

Sometimes the discrepancy would be so severe, that it has to be surgically corrected. Improper habits like mouth breathing can affect the growth and development of a child beyond just face and crooked teeth.  

Studies have also found that mouth breathing is one of the main contributors of Sleep Disordered Breathing (SDB) and can induce obstructive sleep apnea (OSA) by increasing airway collapse and nasal resistance. 

Symptoms include snoring, grinding and morning tiredness. A systematic review has also shown that mouth breathers are more likely to have learning difficulties than nasal breathers.

When should a child see a dentist?

A professional recommendation is that a child’s first visit should be when the first tooth erupts in the mouth, no later than age one to two. 

These early visits would familiarise children to a dental setting and the examination process from a young age. It involves touching sensitive areas such as the mouth and tongue that could be personal and intrusive to a child. 

The dentist will be able to do a quick examination, identify early decay, check the gums, jaw, and bite, frenum issues, mouth breathing tendency and improper oral habits that may affect teeth alignment or speech patterns.

Early intervention with habit correction therapy

Habit correction aims to restore and maintain proper oral habits which include:

  • Establishing nasal breathing
  • Competent lips at rest
  • Upward tongue resting posture against the roof of the mouth
  • Better mindfulness of chewing/swallowing habits

Habit correction is achieved by retraining the orofacial muscles to restore their functionality through a series of exercises. These corrected oral habits help to develop an acceptable form of craniofacial structure.

For a child who is too young to start habit correction therapy, changes can be made via dietary habits. Modern diet which is highly processed and soft in texture does not stimulate jaw development as there would be minimum chewing. Aim to give your child food high in nutrition and are more solid in texture to encourage optimal jaw and facial growth.

Early intervention with Invisalign to develop dental arches. 

There are instances despite all efforts in encouraging the child to breathe through the nose; they find it impossible due to anatomical obstruction/problems—E.g. enlarged tonsils or due to the severely narrowing of dental arches.

In this instance, referral and co-managing with the ENT may be necessary. 

For a child with severely underdeveloped jaws, early intervention with Invisalign can be used in children as young as six years old to help expand and develop very narrow dental arches and facilitate oral habit correction and encourage proper craniofacial growth.

In summary, nasal breathing together with proper oral and dietary habits strongly affect craniofacial development.

These findings also give us a whole new perspective on the importance of early intervention and habit correction to have a desirable face and straight teeth as well as in preventing Sleep Disordered Breathing (SDB ) which can lead to serious health problems that cause poorer quality of life in adulthood.

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