Early Orthodontic Intervention

This podcast is made possible thanks to Extra-Oral Healthcare Program. The ADA supports chewing sugar-free gum like extra. Hello and welcome to Watch Your Math, an oral health education podcast, where toothbrushes matter, flossing is non-negotiable, and we're all rather partial to a visit to the dentist. Brought to you by the Australian Dental Association, Watch Your Math is the place for you to find up-to-date, useful oral health advice to help keep you and your family's teeth and mouth as healthy as can be. Well hey there everyone it's Jimmy Rees here again, back on Watch Your Math. The podcast will be talk all things teeth, the mouth, dental onyx, I'm just making up words now. But today we're talking about orthodontics and kids, and I've got Dr. Noor Tyraff here with me today. How are you? I'm very well thanks, good to be here. It's great to see you. Now I have kids who are, I was just explaining to you before, I've got twin two-year-olds and I've also got a five almost six-year-old as well. So we're right in the, I'm in the zone of absorbing information about dental hygiene, all things to do with the teeth and the mouth. I had a conversation before on another episode of this very podcast about pacifiers and what impact that can have on kids teeth. I've learnt a heap about the teeth so far. And what I've noticed is that, you know, there's not really a handbook until you go to the dentist. There's not heaps of information, you know, I've been a parent for almost six years now and I'm still learning things. So it's been a great wealth of information. So thanks for joining us today. Let's kick things off about, I guess, orthodontics you might think of crooked teeth or a crowded crowded mouth. In children, if we, if we notice these crooked teeth or a crowded mouth in the baby teeth, does that mean they'll have crooked teeth when they're adult or what do we need to look out for in our kids mouth from a, from a young age? Okay, well, I mean, I probably want to start to maybe also just give it a little bit of an explanation about actually what orthodontics is because a lot of the time it's sort of the idea that orthodontics equals dealing with crooked teeth. But if we actually look at a lot of what we do, and we do a lot of what's called dental facial orthopedics as well. So because the teeth are a part of the jaw and if we looked at the jaw, you'll find that the upper jaw and the lower jaw combine, they actually form the most part of the face. Basically, the lower two thirds of the face is actually the teeth and the jaws combine. And in what a lot of what we do, we can actually influence that whole complex, if I may say. So yes, obviously looking at the teeth is an indicator a lot of the time on things that are going on in the whole jaw and sometimes the whole face. Yeah, wow, amazing. So I've got, you know, I've got two year olds and you can see really see their teeth forming. They're totally different. Twin boys once got really quite neat and tidy top teeth. And these little smile looks kind of like a little, you could take a picture and like, oh, hang it up on the wall in a dental office in your orthodontics, but it looks, it looks really clean. My other son, he's taped a little more spaced out. And, you know, they're so different even though they're twins. So what are we looking at? And when should we go and see the orthodontist? You know, I think I'm a spoken about dentistry a fair bit on this podcast and when to go and see the dentist. When do we need to consider seeing an orthodontist? Okay, so at first, the comparison that you made is actually quite a good one because we hear that a lot. When you have children sort of under the age of five, they're probably going to have baby teeth or what we call the primary teeth. So they're just going to have the baby teeth, milk teeth, have we want to call them. And it's not so common to see a lot of big problems at that age. But when you say the teeth are neat, they're all nicely together versus the comparison with the twin brother where the teeth are a little bit gappy. Actually, the gaps are usually a good thing. And what we're looking for at that age is actually the gaps. The gaps is a nice thing because that means that there is more room for the adult teeth. The adult teeth are usually significantly larger than the baby teeth, especially in the front. And so having gaps is considered the good and the normal to have. Having no gaps is usually an indicator that maybe the adult's front teeth may not fit inside that space when the adult, when the baby front teeth fall out. Paul Mack. Now, something that is a good thing to look at for parents is particularly if the baby teeth are crooked. So if the baby teeth are a little bit crowded, that's almost a definite that this child is going to have crowded teeth when they start to get their adult teeth. And some of those children are actually it's worthwhile seeing them a little early whilst they still have their baby teeth to start having a look at what could be potential reasons for that. Paul Mack. Interesting. Is there, do we go and see the orthodontist? Is it, is it wise and would you advise getting a checkup from an orthodontist rather than a dentist? Is there an age that we should go and say, or we're looking for, or were the dentist refer a son, or how does that whole process work? Paul Mack. So if we looked at, for example, what the Australian Association of Orthodontists would recommend and the same recommendation for the American Association of Orthodontists, the recommendation is that an assessment should be considered around between the ages seven and nine years old. And at coincides with basically the same time that the adult front teeth are starting to come in. Because at that time, a lot of the problems with the size of the jaw, the growth of the jaw can become quite obvious because of the difference in size of the teeth coming through. But as I said, there are some situations where it might be prudent to seek an opinion earlier than that. So the recommendation would be, you know, seven to nine years old should be checked for, you know, need for orthodontics. But if you have someone with baby teeth and they have an obvious discrepancy between the upper and lower jaw, especially situations like an underbite where the lower jaw is sitting in front of the upper jaw, that's really something that requires an early intervention. Something like already the presence of crowding, such early on in the primary, the additional and the milk teeth, we don't necessarily have to treat them at that age, but knowing it helps time the treatment correctly. And we can prevent issues. Then the one, the big one is the continuation of sucking habits. Yeah. So if you've got a child who's still using a dummy or sucking their thumb, we know that beyond the age of four years old, continuing that habit will lead to changes in the jaws that won't recover when the habit stops. So they can be sort of almost permanent alterations. So ideally those habits, if you have a child that has a persistent habit at that young age, maybe some advice would be sought on how to break that habit once they get, you know, age three and a half for you four years old, don't let it go beyond that for too long. And we did a whole episode on, you know, dummy sucking, a thumb sucking and dummies. Is there any other, is there from an orthodontics point of view? Is there any other bad habits that, you know, we might not think of, you know, you know, sticking a thumb in your mouth and having a dummy in all day long, it kind of makes sense that that could have an impact after a while if we don't look to sort of, you know, dialing that back or stopping that completely by the age of four, as you mentioned. Yeah, is there anything else that we should keep an eye out for? Actually, yes. I mean, one of the things that a lot of time goes unnoticed is the effect of the breathing and the airway on the development of the jaws. And then by sort of inference, then what happens to the teeth as a consequence to that. A lot of the things that we see on the teeth are usually a consequence to something to do with the jaw size or the jaw position. So mouth breathing, if you have a child who's really having a hard time breathing through their nose, the nose and the upper jaw are actually part of the same structure. So they're very closely into related. So a lot of the time, they'll be a narrow upper jaw associated with mouth breathing. Now a lot of that can indicate lots of, lots of issues, things like, you know, problems with allergies, could be top problems with tonsils and adenoids. But all of them basically fall under the category of problems with breathing, especially whilst asleep. Yeah, I'm actually just recall a friend of a friend having something similar. And yeah, I think it was an adenoid or something there. Yeah, they just noticed that he would wake throughout the night a lot because he was breathing through his mouth a lot and then ended up being, yeah, going to see the orthodontist and getting some rectification there. But it was something that took a while for them to diagnose. So I guess it's when your kids asleep at night, tell me, think, oh, thank goodness. but it took them a while to understand why and he would wake up and they didn't, it put a monitor in his room actually because he kept getting up but they didn't even know so and he would not be in this really, really deep sleep. So that's interesting you mentioned that. That's, I mean, I think this is probably one of the very important things to be looking at. And obviously you can have a discussion with your dentist about that and the dentist can then refer you on but you don't necessarily need a referral if you have doubts or anything you want to see in orthodontics. You can just ring up and see. The thing is breathing and jaw development are very closely related. And so orthodontics alone may not be able to rectify the situation but it plays a part because what when I said initially a lot of what we do is actually jaw development or dental facial orthopedics. One of the things that can be done very effectively in growing children is to develop the upper jaw and make it grow bigger. That way it can accommodate more teeth but also that helps then create a larger channel for breathing through the nose and more room for the tongue. And these are all things that can help with things like mouth breathing provided. There is also, we can't ignore that there could be medical causes for these things. And in my practice we involve, you know, as a throat specialist for a lot of discussions, we have sleep physicians and pediatric sleep physician in particular, play a very big role. And then also then allergy. Yeah, all things to keep an eye out for. Just genetics play a part. You know, my father's teeth are similar to my bottom teeth. They're all a little bit sort of here and here and there. And I'm assuming I talked about twin one, you know, who had who has kind of neat top teeth. These little teeth down the bottom are a little sort of crooked at this stage of his life. These genetics are a big thing. Do we look at mum and dad and then think, oh yeah, we could have some issues here. Oh, absolutely. I mean, if we look at, I mean, I think it's when you look at families and you'll see the facial resemblance. This way, we belong to the same family. So, like I said, the jaws and the teeth, they actually form two thirds of the face. There was bound to be some similarity there. So a lot of a lot of things are inherited. So things that are, you know, for example, underbites, small upper jaws and large lower jaws tend to run in families. And there's many genetic studies that have shown that. So, if we know that a parent had complicated orthodontic treatment as a teenager, perhaps the children in that family could benefit from actually being seen early because a lot of this complicated intervention that's required in the future can sometimes be reduced or prevented if we intervene at a time where the jaws are growing in a way we can still manipulate. What are the most common, what are the things that you see the most in a, you know, when you assessment of a child who's come to you for the first time at that seven, eight sort of nine between seven and nine age, what's the most common thing that you see and what's the most common sort of treatment that gets done as a consequence? Well, I would say, I mean, obviously you'll find this is going to be skewed, but as per orthodontist and areas that they have interest in, we tend to have a lot of interest in early treatment. So we tend to see a lot of children, especially those who require the development of the upper jaw. So those with severe jaw crowding, underbites due to small upper jaw and those who struggle to, you know, breathe well through their nose because of a narrow upper jaw nose complex. We tend to see a lot of that and a lot of our dental colleagues now are very aware of what the need for early intervention to minimize the need for, let's say for example, tooth extractions or complicated jaw surgery in the future if early intervention is done in a timely manner. So we see a lot of those and a lot of the parents are now very, very aware of this because some of them have had orthodontics themselves. So I know I've had 40th out and I really would like my children not to have that or I needed to have jaw surgery or anything we can do to my kids that. So if that's the case, then ideally we need to see these kids a bit early and we see a lot of those, especially the crowding situations that can benefit from early intervention. As a person who hasn't had orthodontics, maybe I should off who knows. What are some of the things that you do? You know, I don't, if I'm just talking to you, I don't know too much about orthodontics. I don't know what kind of trip you know, the things that pop into my head of abrasives and and and aligning teeth in a certain in a certain way. What are those other, what I'm saying is you know, you talk about manipulating the jaw. How is that done? I'm just intrigued, you know, in some of the different methods. There's a lot of, especially in the in the recent years, especially there's been a lot of development. I mean, we've known that we can manipulate the growth of the jaws for decades in the middle of centuries and if you look at, you know, 150 or 200 years back, there were already people that were trying to manipulate the growth of the jaws. And things, for example, simple things like jaw expanders. They're very effective because in children, the jaw isn't fused. The bone to the jaws are not fused together. So there is ability just by applying gentle pressure to actually simulate that jaw to grow wider or to grow deeper or to grow downwards and forwards more to give more mid-face support, for example. And when we widen the jaw, the side effect of that is actually creating more room for the teeth. So you create a wider circumference. The teeth can then come through. And if that is done in a timely manner, a lot of the time those teeth tend to come through in a reasonably good position, which then minimizes sort of complicated interventions. It's very hard to promise, you know, we are going to do an early intervention, never need treatment in the future. But you can certainly be confident now with all the literature that we have that we can definitely create wider jaws. We can create more space for the teeth. And we can correct some of the abnormalities of growth of the jaw. So excessive lower jaw growth, for example, we have means like, you know, the face masks and upper jaw traction, for example, that can be worn at nights that can help simulate growth of the upper jaw and restrain that of the lower jaw. Or when you have a kid with a big overbite, the exact opposite simulate the growth of the lower jaw and try and hold back the upper jaw. So this is what I'm calling sort of the dentophacial orthopedic sign of what we do. It's not just braces. I would say probably 50% of our workload doesn't involve braces. Yeah, I know. It's just the first thing it pops into your mind and I'm sorry, you get it all the time. Is it a problem? Do you look around? Can you look at someone's face and go, oh, look at a child's face out and go, oh, maybe we should do something. Is this a big problem? Is it something that we really should be looking at more? I know a lot of people kind of put the dentist off for a bit, you know, and then it might not lead them to orthodontics because, you know, there is a stigma that's expensive and that it might be, but you know, is this a problem from your point of view? Is this, do we see this a lot? Yeah, I think I'll tell you one of the one of the problems that we see sometimes. I don't know if it's getting better, but one of the one of the issues is there is a misconception that you wait for all your adult teeth to come in and then you go and see the orthodontics. Unfortunately, in many cases, it's actually too late to have a chance because that child is probably going through puberty at the moment or even past it and there's not a lot of growth remaining. So that's one of the misconceptions and I think that's potentially a problem. Another problem that I sometimes face is we see lack of attention being paid to the importance of the healthy baby teeth. What we need to understand is those baby molars and fronty, they're holding the space or the grown up tooth to come through. If we don't look after those teeth, we get holes and then we have to lose them too early. Well, what happens is we lose a lot of the space that this tooth was holding for the grown up tooth and that can lead to significant problems and crowding and other issues in the future. Yeah, I know it's just thinking about, you know, your kids you want to do the best for them. And I think I honestly believe that, you know, a podcast like this and getting this out there to people, it's I think it comes from perhaps a generational thing, you know, like if my parents really had really good dental hygiene and saw the dentist a lot and took us to the dentist a lot, then we're going to continue that on. And we have the owners for our kids to start doing that for them. And you know, I think it's hard because people might not, if that's not a routine for them, then they might not go and seek dental orthodontics as well. So I think it's really great information and it's something that we we often might not think about in the first instance. You know, you get a cold, you go to the doctor, you get to think these things are a little longer term and they might be brewing slowly. And it's harder to notice when things gradually come in. So yeah, thank you for your time today. Is there anything else that you had for us that A little gem for us to look out too. - Well, I would say, if I was to try and sort of say that what's the summary, I think the summary is that early orthodontic assessment and intervention in some cases in children can really be quite helpful in reducing the need or even eliminating the need for complicated treatment later. Orthodontics is not just about pretty straight teeth. It's, there's a lot of having good functional bite has a lot to do with not just straight, beautiful looking teeth but good jaw function, good breathing function and overall facial harmony. They all come together. - Well, I think that as a parent, wanting your kid to, you know, be out of breath properly if that doesn't hit home. I don't know what does. Thanks for your time today. I've learned hapes and I continue to throughout this podcast series. Dr. Neur Tyraff, thank you very much. - Thank you so much for having me. (upbeat music)