Sunday 4 September 2016

ALLERGIES, HABITS AND MALOCCLUSION IN YOUNG CHILDREN - WHAT HAPPENS OVER TIME?

Some clinicians advocate very early treatment in the primary (~ages 3-5) dentition and recommend interventions claiming they will prevent future orthodontic problems. But what if we did nothing and observed them? This very interesting article from Sweden followed 277 children from age 3 to age 11.5 and evaluated the presence of malocclusion, sucking habits, breathing problems, allergies and trauma over time.

There was quite a high prevalence of malocclusion at age 3 of 71% and although this improved by age 7 to 56%, it worsened again to 71% by age 11.5. However ~45% of subjects were considered in severe or moderate 'need' of treatment so ~55% had minor or no need. Many advocates of early treatment suggest intervention for open bites but interestingly this was one of the malocclusions that tended to self-correct as found by previous authors. Conversely deep bites did tend to worsen. As with previous studies trauma to the top front teeth was ~2.2 times more likely with increased protrusion/overjet.

Another re-emerging (previously in 1930's then 1960-70's) claim in orthodontics is the influence of habits and allergies on malocclusion and that early intervention is required to prevent adverse growth effects. This long-term observational study found sucking habits had little or no association with anterior open bite or posterior crossbite in the permanent dentition. As I have discussed in a previous Blog, many children stop the habits themselves as they get older and an open bite can improve spontaneously so treatment may not be indicated except in those that persist longer term.

Similarly allergies at age 3 had NO association with any future malocclusion at age 11.5. There are many good reasons for allergy, tonsil and adenoid treatments but to prevent abnormal facial growth is not one of them. I have personally had an ENT tell my wife that our 9 y.o. daughter (who suffers from allergies) required a turbinectomy otherwise she will undergo abnormal jaw growth - you can probably guess my response to that! My daughter has normal horizontal and vertical facial growth with mild crowding and although she will require some orthodontic treatment once all adult teeth have erupted for the mild crowding, her growth is proceeding just fine without the surgery. I feel sorry for those parents that do not have the knowledge of normal facial growth that I do as they may be 'scared' into having procedures for their children that they may otherwise think twice about. This article helps contribute to that knowledge so thanks to this Swedish team for following this group and presenting their findings.

Dr Peter Miles is the orthodontist at Newwave Orthodontics in Caloundra, Australia and teaches orthodontics part-time at the University of Queensland and is a visiting lecturer at Seton Hill University in the USA. Peter is one of the editors and authors of the orthodontic textbook, 'Evidence-Based Clinical Orthodontics'. Importantly, he has no financial interest in any products mentioned in these Blogs.

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