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.

WHAT TO DO ABOUT THUMB SUCKING AND TONGUE THRUST?

Open bites or front teeth not overlapping can be caused by habits with fingers, lips or the tongue placed between the teeth but how should we treat them? Habits can often be corrected early with minimal intervention. We prefer to see the habit reducing as the adult incisors erupt, about age 6, but even those at ages 9-10 stopping the habit results in improvement of the #openbite. Many children stop themselves by age 6 as they interact with their peers and decide it is not as socially acceptable.

Those that persist beyond age 6 we suggest initially trying reminder and reward strategies as in this case on the right. Remind the child in a non-threatening manner and set a goal e.g. praise them when they have refrained and perhaps have a small reward if they have stopped for a week (to involve the child in treatment). Reminders can be physical such as a sock, mitten or hand puppet at night. An elastic elbow support over the elbow to make it harder to bend the elbow to suck the thumb could be considered. Thumb ‘paints’ work for some but others will simply suck it off. If these attempts do not work, then a more intrusive reminder such as a thumb crib/habit appliance can be fixed in place by an orthodontist. Some persist due to emotional issues and the habit is a comforting device so when the child is upset, they are more likely to suck and it is more difficult to correct as the underlying cause is still present. Scolding them will simply make this worse.

A long held concept is that a tongue thrust swallow is the cause of open bites but it is actually an adaptation to an open bite (to swallow you need a seal at the front and so the tongue is placed between the teeth). We swallow about 600-1000 times per day for 1 second each (~10-17 minutes per day) which is not enough time to cause the open bite, it takes hours to move teeth not minutes. However, ‘habits’ such as thumb sucking or forward resting posture of the tongue between the teeth can be of sufficient duration to cause an open bite. Some may need help with exercises to retrain the tongue to position itself correctly and a Speech Pathologist can help with this. If these strategies are not working, then consult your orthodontist to consider placing a thumb or tongue crib as a final resort.