The General Dentist, a key element in the detection of malocclusions in children
Submitted by Michel Champagne, Denis Massé on
By Michel Champagne, Denis Massé - Michel Champagne, DMD, MAGD, IBO, Speaker & Mentor-Ortho & Denis Massé, Consultant, Speaker & Program Director-Ortho
« The role of the 'orthodontist' is to intelligently assist nature in the process of skeletal development, and in doing so, allow the normal development of bones and teeth. » Edward H. Angle 1911
Angle couldn't say it better! However, we must not forget the role of the general dentist who, given his privileged position in working with children, is in the best position to detect anomalies as soon as they appear in order to direct the young patient towards the right treatment at the right time. This is where the concept of interceptive orthodontics takes shape, which consists of detecting and correcting interferences or interlocks to allow for optimal development of the occlusion. A lock is defined as any blockage that could interfere with the optimal development of the cranio-facial complex.
Examples of locking include exaggerated vertical overhang due to a lack of posterior vertical growth, or conversely, exaggerated incisor eruption. Other examples include anterior open bite secondary to poor oral habit or mouth breathing, anterior or posterior cross bite and any antero-posterior offset.
Lack of vertical posterior growth can be corrected by stimulation of the molar eruption, often by prefabricated or individualized removable appliances. Excessive anterior dental overbite (deep bite) is easily treated with minimal and simple fixed mechanics. Anterior open bite with or without oral habit usually benefits from a functional exercise approach with removable or fixed appliances. As long as it is oral, it should be considered as soon as possible and an ENT specialist should be consulted.
Posterior crossbite requires special attention. As it is often accompanied by a deviation of the medians, it is important to evaluate the differences between the occlusal dynamics and the static position, the shape and position of the condyles as well as the symmetry of the arch in both the maxilla and mandible. A posterior crossbite occlusion may appear to be unilateral whereas it is often a postural adaptation in response to occlusal interference. Following differential diagnosis, correction and elimination of interference, if any, should be considered as soon as possible.
The anterior cross bite requires an individualized approach and it is necessary to distinguish the true Class III from the pseudo Class III. It should be remembered that an untreated pseudo Class III may evolve into a more severe Class III. Pseudo-Class III is treated by interception with simple dental movements accompanied by, or not, transverse development as necessary. The true Class III with maxillary deficiency will probably require a correction of the transverse development followed by maxillary traction with a face mask and/or a removable Frankel III type appliance. Several possibilities exist.
With regards to cases of excessive horizontal overhang of Class II division 1, some authors1 claim that 80% of Class II offsets are related to mandibular retraction and would benefit from being treated by interception. The same is true for Class II division 2 malocclusions, which most often presents problems of vertical dimension and antero-posterior displacement.
Cases of crowding could often be prevented with proper management of the Nance spaces and adequate supervision of the eruption sequence of the permanent teeth. Some even argue that crowding can be resolved in 85% of cases if treated in late mixed dentition2. The General Dentist must therefore have a keen eye for the detection of developing malocclusions in children at all stages of their dentition.
1 James A. McNamarra Jr.: Professor in the Department of Orthodontics and Pediatric Dentistry, University of Michigan School of Dentistry; Professor of Cell and Developmental Biology, University of Michigan School of Medicine; and Research Scientist, Human Growth and Development Center. He has authored more than 190 scientific articles, written, edited or otherwise contributed to 53 textbooks, and has lectured in 43 countries.
2 Anthony Gianelli: Orthodontist graduated from the Harvard School of Dental Medicine. He became an orthodontic researcher at Harvard in 1963 and was appointed Associate Professor of Orthodontics at Boston University in 1967. He received his Ph.D. in Biology and Biochemistry from Boston University in 1967 and received his medical degree from Boston University School of Medicine in 1974. He also became a full-time professor at Boston University School of Medicine in 1974.