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Dental Care: Malocclusion (Bad Bite) In Children

Malocclusion means "bad bite." It's when the upper and lower teeth are not meeting correctly, or when the teeth and jaws are not positioned for good dental health. This condition affects jaw growth, speech development, facial appearance, gum tissue health, and the ability to clean teeth properly.

What Causes Bad Bite In Children?

Many malocclusions are inherited. This includes crowding of teeth, too much space between teeth, extra or missing teeth, or irregularities in the jaws, face, and teeth.

Malocclusions also can be environmental in nature, caused by accidents, thumb sucking or sucking on a pacifier, obstruction by tonsils and adenoids, dental disease, or premature loss of primary (baby) teeth.

Why Is Dental Treatment Important?

If dental care is delayed or not taken, many problems get worse and more complicated (and expensive) to remedy. Malocclusion can cause excessive wear of tooth enamel, poor chewing, stress on both the gums and jawbone that support the teeth, chronic headaches, and facial and neck pains. Correcting the malocclusion can improve overall oral health and eliminate other potential problems.

Does the Pediatric Treatment Involve Removal of Some Teeth?

Sometimes when permanent teeth are crowded and their spacing and proper positioning is being affected by the primary teeth, removing primary or baby teeth is necessary. Otherwise, the severely crowded permanent teeth will either remain "stuck" (impacted) and unable to erupt, or they will erupt in an undesirable position.

Treatment of a malocclusion involves a thorough evaluation of your child's specific condition by a pediatric dentist and/or orthodontist. This may include recommendations for removal of some primary or permanent teeth because some malocclusions cannot be treated successfully without doing so. Extraction of some teeth in severely crowded conditions enhances proper alignment, function, and appearance, too.

How Is a Diagnosis of a Malocclusion Performed?

Each child's specific condition dictates the diagnostic procedures, but they often include several or all of the following:

• Clinical exam.
• Medical and dental history.
• Impressions of the teeth for making plaster models.
• Photographs of the face and teeth to provide a record of the child's facial appearance prior to treatment.
• Panoramic X-rays showing all the upper and lower teeth in biting position, and teeth that are not yet visible.
• Lateral (cephalometric) X-rays of the entire head showing the relationship of the teeth and jaws to the face and skull.

How Long Does Dental Care Treatment Take?

Each condition is unique and must be treated individually. The actual time is dependent on the growth of the child's mouth and face, the severity of the problem and the cooperation of the child in following instructions. Mild correction problems or early treatment may take only a few months. Treatment for more complex malocclusions range from one to three years.

An attractive smile, proper alignment, and healthy teeth are valuable rewards gained from a custom-designed treatment program made for smile after smile!

by Brian J. Gray, DDS, MAGD, FICO

Pediatric Dentist and Tooth Decay FAQs

Q. Should you give a baby a fluoride supplement?

A. Babies living in areas where the water supply is fluoridated do not need fluoride supplements. If the water supply is not fluoridated, or if the baby is breastfed, the physician or pediatric dentist may recommend supplements starting at the age of six months.

Besides tap water, and often bottled water as well, fluoride also is found in juices (especially cranberry juice) and baby foods (especially chicken). These sources may provide enough fluoride without the need for supplements, so discuss the need for fluoride supplements with your child's physician and/or pediatric dentist

Q. What causes "baby bottle tooth decay"?

A. Frequent, long-term exposure of a child's teeth to sugary liquids (including breast milk, formula, and milk) causes baby bottle tooth decay. The sugars in these liquids pool around the teeth and feed the bacteria in plaque.

Q. When should an infant's oral hygiene begin?

A. Even without teeth, oral hygiene should begin soon after birth. After each feeding, wipe your baby's gums, inside the cheeks, tongue, and roof of the mouth with a clean, damp washcloth or wet gauze pad. This removes plaque, the sticky film containing decay-causing bacteria.

Q. What are the white patches sometimes found in a newborn's mouth?

A. Yeast infections in the mouth occur frequently in newborns. White patches can spot the tongue, cheeks, gums, or roof of the mouth. If they are removed, some bleeding will occur. Treatment is usually unnecessary; however, your doctor should be notified of this condition.

Q. What is the condition known as "tongue-tie"?

A. A piece of tissue connects the tongue to the bottom of the mouth, and if it's too short, a condition known as ankyloglossia results. This is common in newborns and usually resolves itself over time. The only reason to have the tissue cut is if the infant cannot nurse.

Q. When do babies start getting primary teeth?

A. The average age for the first primary tooth is five to six months; however, there is great variation.

Q. What are the signs of teething?

A. Fussiness, excessive drooling, rash, diarrhea, changes in sleep and feeding patterns, and fever can signal a baby's discomfort. However, don't assume that a fever or these changes are caused just from teething. They also can be symptoms of other health conditions. Check with your doctor to ensure your baby receives proper medical care.

Q. What remedies are recommended for teething pain?

A. Your children's dentist or pediatrician may recommend a pacifier, teething ring, or a special numbing ointment for the gums. Some teething rings and pacifiers can be chilled to extend their numbing effect. Older children will enjoy the soothing relief that popsicles provide.

Q. How can you help your child's teething pain?

A. To help your child's teeth pain, gently massage the infant's gums with a clean, wet finger, a small, cool spoon, or a clean, wet gauze pad. This often soothes the child's teeth pain and irritation. A cold rubber teething ring also helps.

Q. Can decay-causing bacteria be passed to an infant?

A. Yes, babies are exposed to bacteria from a variety of sources, such as a caregiver blowing on food to cool it, tasting food, sharing utensils, kissing the infant on the mouth, sharing a cup, or sucking on the baby's fingers. Care should be taken not to expose the infant to bacterial exposure from these sources.

Q. How should you care for a child's primary teeth?

A. As soon as the first tooth erupts, with a clean, wet washcloth or wet gauze. The gums also should be gently wiped. If a toothbrush is used, it should be an appropriate size.

Q. When should you start caring for your child's teeth?

A. As soon as primary teeth appear, they are at risk for decay and need to be brushed twice daily with a soft-bristled brush. Do not use toothpaste until your child is two years old.

Q. How can you prevent baby bottle tooth decay?

A. You can prevent baby bottle tooth decay by wiping the child's teeth and gums with a clean, moist washcloth after each feeding to remove plaque. You should never let your child go to sleep with a bottle containing a sweetened liquid. Among these are milk (including breast milk), formula, fruit juice, and other sweetened liquids. Constant use of a sipping cup containing sweetened liquids also can cause baby bottle tooth decay.

Q. Why is it important to care for primary (baby) teeth, since they will fall out anyway?

A. Primary teeth serve as the foundation for a healthy mouth, including the gums and the proper positioning of permanent teeth. They serve as natural space maintainers, holding the space open until the permanent teeth are ready to take their place.

If primary teeth become broken or decayed and are not properly treated, problems can occur with permanent teeth, which may contribute to other health problems. The result can be costly orthodontics and other pediatric dentistry treatments.

Q. Can juices hurt your child's teeth?

A. Because of the sugar content, juice and juice products have much greater potential to cause decay. Apple juice may cause staining of the teeth and should be diluted with water. Any beverage other than water has the potential to cause tooth decay, especially if the child drinks it frequently.

Q. What problems occur from baby bottle tooth decay?

A. To repair the decay, extensive treatment or extraction of the teeth may be required. Because the children are usually around 18 months to 2 years of age, hospitalization with general anesthesia is often required to perform these procedures.

Q. Is sucking harmful for teeth?

A. While sucking is a natural reflex, sucking on thumbs and pacifiers can cause problems after the permanent teeth erupt. Continued sucking after this time affects the proper growth of the mouth, alignment of teeth, and the development of the roof of the mouth that can result in the need for orthodontic treatment and other pediatric dentistry treatments in the future.

Q. How can parents encourage a child to stop thumb sucking?

A. Set a positive tone and praise the child when they're not sucking. Thumb sucking is a stress-reliever and offers comfort. Look for any factor that might be causing discomfort or anxiety and seek solutions to correcting them, rather than focusing on sucking as the issue.

Reward the child when he or she doesn't fall back into the habit, especially during stressful situations. Schedule an appointment with the child's pediatric dentist to talk about what is likely to happen if the habit continues.

Q. What can parents do if a child has difficulty breaking a thumb sucking habit?

A. Finding ways to take away the pleasure of thumb sucking reduces or eliminates the satisfaction gained from it. Bandage the thumb or put a sock over the hand at night. A pediatric dentist or pediatrician can prescribe a bitter-tasting medication to coat the thumb. A mouth appliance can be used to block the ability to suck.