IMPORTANCE OF
EARLY STAGE ORTHODONTICS
Shaping Healthy Smiles, Improving Sleep, and Ensuring Lifelong Wellness
Early Interceptive and Orthopaedic Orthodontics
Dr Biju Krishnan has undertaken extensive training in treating children while they are still growing and still have their first set of teeth present.
The world of children’s oral health offers a spectrum of options beyond traditional braces. Early orthodontic treatment, often referred to as Interceptive Orthodontics, can have several important implications for both health and sleep in children.
Terms like Orthopaedic Orthodontics, Dentofacial Orthopaedics, and Orthotropics may sound new, but they unveil exciting possibilities for guiding young smiles towards optimal growth and function.
Instead of waiting for problems to arise and become established, these approaches proactively guide the development of jaws, teeth, and facial muscles, aiming to prevent future imbalances and promote a harmonious oral ecosystem.
Orthopaedic Orthodontics, for instance, focuses on influencing jaw growth patterns using specialised appliances, creating ample space for teeth and potentially avoiding the need for extractions later.
Dentofacial Orthopaedics delves deeper, incorporating principles of facial muscle function and growth into the treatment plan, aiming for not just a straight smile, but a balanced and aesthetically pleasing facial profile.
And then there’s Orthotropics, the holistic approach that views the teeth and jaws as part of a larger craniofacial system. Through gentle guidance and functional exercises, it encourages optimal growth and development of the entire system, potentially influencing not just teeth and jaws, but also breathing patterns and even posture.
This proactive approach to oral health intervenes before permanent teeth fully erupt, typically between the ages of 6 and 10. Think of it as gentle nudging, using specialised appliances to influence jaw growth and tooth positioning, laying the groundwork for a lifetime of dental harmony.
Here are some key points highlighting the importance of early orthodontic intervention:
Facilitation of Proper Jaw Growth: Interceptive orthodontics can guide proper jaw growth and development in children. Addressing issues such as malocclusions or misalignments early on can help in steering the natural growth of the jaw and preventing more severe problems later.
Prevention of Dental Issues: Early orthodontic treatment can prevent or address dental problems, such as overcrowded or misaligned teeth, which may contribute to difficulties in maintaining good oral hygiene. Straighter teeth are generally easier to clean, reducing the risk of cavities and gum disease
Improvement in Breathing and Airway: Orthodontic issues, particularly those related to jaw and palate development, can impact a child’s airway and breathing. Some orthodontic problems may contribute to mouth breathing, which can affect sleep quality and lead to other health concerns.
Correction of Bite Problems: Malocclusions, crossbites, and overbites can affect a child’s bite function. Early orthodontic treatment can correct these issues, promoting proper chewing and swallowing, which can have positive effects on digestion and overall health.
Reduction of Sleep-Disordered Breathing: Certain orthodontic problems, such as a narrow palate or jaw, may contribute to sleep-disordered breathing conditions like snoring or sleep apnea. Early intervention can address these issues and potentially improve a child’s sleep quality.
Prevention of Speech Issues: Malocclusions or misalignments can sometimes contribute to speech difficulties. Early orthodontic treatment can help in preventing or correcting these issues, promoting clear and effective communication.
Enhancement of Facial Aesthetics: Beyond functional benefits, early orthodontic treatment can also contribute to improved facial aesthetics. This can positively impact a child’s self-esteem and overall well-being.
Establishment of Healthy Habits: Introducing orthodontic care early helps children and their parents develop good oral hygiene habits and understand the importance of orthodontic health. This sets the stage for a lifetime of dental wellness.
The Impact of Inadequate Oral Posture on Facial and Dental Development
Poor oral habits, including mouth breathing, open mouth posture, and issues with tongue positioning or tongue tie, can significantly harm the facial development of a child. The absence of proper tongue support on the palate leads to a three-dimensional deformation of the upper jaw, resulting in the following orthopedic and orthodontic effects:
- Elevated and narrow palate
- Deviation of the septum
- Narrowed jaws
- Mid-face deficiency
- Flattening of the face
- Forehead slope
- Elongation of the lower face, leading to “long face syndrome”
- Facial narrowness
- Thin lips
- Receded chin and retracted lower jaw
- Sunken cheeks
- Insufficient space for permanent teeth in small jaws
- Temporomandibular joint (TMJ) pain and dysfunction
- Obstructive Sleep Apnea
- Headaches, shoulder and neck pain, and poor posture
- Dental crowding and malocclusion
Recognising and addressing these issues early is crucial for the proper orthopaedic and orthodontic development of a child.
Dr Krishnan works closely with specially trained Cranial Osteopaths and Myofunctional Speech therapists to maximise the effects of treatment in developing the jaws and face to reach their ideal potential.
RESEARCH & RESOURCES
I have organised below various articles, research papers and videos which justify and explain the importance of early treatment of the jaws and the wider impact this has on the overall health and well being.
Articles
- An article from the American Association of Orthodontists summarising the importance of early orthodontic screening. “Kickstarting a Lifetime of Beautiful Smiles: The Benefits of Early Treatment”.
- An article from Dental Press Journal of Orthodontics claiming that early short-term interceptive orthodontic treatment with simple appliances can efficiently correct certain malocclusions and help to either reduce the complexity or even avoid the necessity of complex and expensive procedures during puberty. “Very early orthodontic treatment: when, why and how?”.
- This is an important paper from the Journal of Dental Sleep Medicine suggesting that preliminary studies show that early orthodontic treatment may be effective in treating children with sleep breathing disorders. Early treatment of sleep disordered breathing in children may reduce their risk of having similar issues when they are adults by up to 70%. JDSM-Skeleta Malocclusion and Genetic Expression
- This is an insightful and detailed article in Bioscience Journal looking at the origins of dental malocclusions or crooked teeth and how modern approaches in early interceptive orthodontics can play a significant positive role in preventing this. “The Jaw Epidemic: Recognition, Origins, Cures, and Prevention.”
- Although in its early stages, there is growing evidence to support that epigenetics has a significant role to play in, amongst many things, how the face and jaws develop. So, what is Epigenetics? Well, imagine your genes are like the blueprints for building your body. Epigenetics is like the foreman on this construction site, deciding which parts of the blueprint get used and how. It doesn’t change the blueprint itself, but it can influence how your body builds things, like your teeth and jaws. So, while some dental traits might be inherited, epigenetics can add its own twists and turns to the final outcome.
Although the mechanism is still unclear, we can use this to our advantage in early stage orthodontics, using custom made appliances, to help guide growth (or using the above analogy, influence the foreman) on how the face and jaws are bult while the child is still growing.
While the articles showcase growing interest in the potential role of epigenetics, they emphasize the need for further research before drawing definitive conclusions. - “Epigenetics: a new frontier in dentistry”;
- “Epigenetic influence of KAT6B and HDAC4 in the development of skeletal malocclusion.”
- An excellent paper in the Journal of Orthodontics which shows that the use of reverse pull facemask or headgear when used on children between the ages of 7-9 reduced the need for surgery by over 66%. “Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial.”
- An important article in The Angle Orthodontist showing that early treatment of patients with small (retruded) lower jaws had similar results than those having surgery to correct this problem later in life. A control group that had no treatment did not self-correct. “Dentoskeletal effects of functional appliances vs bimaxillary surgery in hyperdivergent Class II patients.”
- Oral myofunctional therapy (OMT) is a type of treatment that focuses on re-training the muscles of the face, mouth, and throat to improve swallowing, breathing, and speech. Combined with early interceptive orthodontics, evidence suggests it may play an important role in correcting unfavourable growth patterns, as this paper published in the European Journal of Orthodontics explains- “The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study.”
- From the International Journal of Paediatric Otorhinolaryngology, another important bit of research showing that bringing the upper jaw (maxilla) forward using devices such as reverse pull headgear has an important role to play in preventing sleep breathing disorders in children and in enlarging the airwat space. “Effects of maxillary protraction appliances on airway dimensions in growing class III maxillary retrognathic patients: A systematic review and meta-analysis.”
- This paper published in the Journal of Orthodontic Science proves that functional appliances used in early childhood can significantly increase the size of the airway – Effect of functional appliances on the airway dimensions in patients with skeletal class II malocclusion: A systematic review. “Effect of functional appliances on the airway dimensions in patients with skeletal class II malocclusion: A systematic review.”
- The purpose of this study, published in the Journal of Orthodontics and Dentofacial Orthopaedics, was to understand if children who had a Class 2/1 malocclusion (a situation where the lower jaw is small and the upper teeth stick out more that normal) would naturally correct itself if left untreated. The results show that this was not the case and in some instances the situation actually got worse. Given this finding, and with the understanding that the majority of jaw growth has finished by the age of 12, it would make sense to treat these cases earlier to correct the growth discrepancies. “Longitudinal growth changes in untreated subjects with Class II Division 1 malocclusion.”
- From the European Journal of Paediatric Dentistry, this paper shows that in a study of young children below the age of 12, if there was the presence on at least one dental misalignment such as a large overjet, a deep overbite or a crossbite, then there is a 60% probability that the child also has a sleep disordered breathing problem. Prevalence of malocclusion in preschool and primary school children with habitual snoring and sleep-disordered breathing. “Prevalence of malocclusion in preschool and primary school children with habitual snoring and sleep-disordered breathing.”
Videos
Aimed at parents, this is a very informative talk from two health organisations explaining the importance of screening for small jaws and poor breathing. An excellent place to start when considering early orthodontic treatment.
World leading and eminent orthodontist Dr Derek Mahoney explains how habits such as thumb, sucking and poor tongue posture can affect dental development and why early treatment of this is important.
Internationally renowned neuroscientist, Dr. Jerald Simmons, explains why the size of peoples mouths hold the key to good sleep. He connects the importance of good sleep to better health later in life and the importance of early detection and treatment.
Introductory video from Myobrace explaining how mouth breathing and poor function of the tongue has a big impact on jaw development and the position of the teeth. The Myobrace system has proven to be very effective in correcting poor habits that can led to misaligned teeth.
A very good podcast from Dr Kevin Boyd, one of the pioneers in early interceptive orthodontics, explaining that misaligned or crooked teeth are not just genetic and that the environment has a significant impact on the way the face, jaws and as a result, the teeth, develop.
The importance of early screening for breathing and jaw development by Dr Kevin Boyd.
DR BIJU KRISHNAN
Dr Biju Krishnan was first introduced to early interceptive orthodontics in 1994 by Dr Skip Truitt, a pioneer of treating children early to help optimise growth and development, to improve airway function and avoid the need for orthdontic extractions.
Since then he has undertaken extensive training in treating children while they are still growing and still in their primary and mixed dentition.
He has trained with and worked alongside acclaimed educators such as Dr Skip Truitt, Dr Derek Mahoney, Dr Patrick Grossman, Dr Tasha Turzo, Dr Simon Wong and Dr Mo Almuzian amongst others.
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