Early orthodontic treatment is when treatment measures need to be taken to prevent or eliminate habits that are harmful to the dentition (habits, orofacial dyskinesias) or for abnormalities of the teeth or jaws before the age of 9 years. Only rarely is it necessary to start treatment before the age of 4. Early treatment focuses on breaking habits because this may eliminate the need for later orthodontic intervention. What all habits have in common is that they can affect tooth position as well as the development of the upper and lower jaws and their positional relationship. If weaning off the habit is no longer sufficient to reverse the influence on teeth and jaws, early treatment measures with orthodontic appliances will also be necessary. In the case of cleft lip and palate or other extreme anomalies of the facial skull, the start of treatment with appliances is already in infancy. They will not be discussed further below.
Indications (areas of application)
I. Early treatment to stop habits is among the most common interventions. Harmful habits include:
- Sucking: Thumbs and other fingers act like an orthodontic device in the mouth. Upper incisors get pressure labially (forward), change their position and pull the front area of the upper jaw along. The lower incisors can correspondingly tilt orally (towards the oral cavity). Together with them, the position of the lower jaw deviates backward (dorsally) and at the same time its growth is inhibited. A so-called lutschoffener bite can develop, in which the upper and lower incisors no longer have contact with each other and the tongue can lie between the rows of teeth forward.
- Pacifiers: have a similar effect to sucking, but have the small advantage that they are easier and earlier to train off
- Incorrect swallowing pattern: in the so-called visceral swallowing, the tongue is pressed against the incisors during each swallow, instead of attaching to the palate, as in the so-called somatic swallowing. As a result, the upper and lower incisors move out labially (forward).
- Cheek biting and sucking: the teeth are inhibited on the corresponding side in their longitudinal growth, the jaws can develop laterally unequal due to the muscle movement directed to one side.
- Embedding of the lower lip: either a consequence of sucking or independent habit: similar to sucking upper and lower incisors give way, the lower jaw growth is inhibited, the lower jaw backward displaced
- Lip sucking, pressing, biting: the upper incisors get pressure from labial (from the lip) and react with tilting orally (towards the oral cavity), if not all incisors have erupted yet, which in turn can mean a breakthrough obstacle for the still following incisors; in addition, the lower jaw gets into a forced recline caused by the steep position of the upper incisors
- Speech disorders such as lingual sigmatisms (tongue-related s sound malformations): sigmatism interdentalis (interdental lisping), addentalis (bumping into the incisors) and lateralis (lateral lisping); also labiodental (lip function-related) sigmatisms affect the dental system via the malfunction of the musculature
- Habitual (habitual) mouth breathing; this is to be distinguished from mouth breathing in the case of anatomically disturbed nasal breathing; as a consequence, however, it may also come to obstruction of nasal breathing, since the nose is exposed to less growth stimulus
- Chewing on fingernails, pencils, etc.: has a similar effect as sucking.
II. early treatment with the help of orthodontic appliances is required when the harmful habits have already left permanent traces or when, for example, the following dysgnathia (jaw maldevelopment) without the influence of a habit:
- Reversed anterior overbite (positive anterior step, mandibular overbite); can be tooth-related, but also due to the mismatch between an underdeveloping maxilla with normal mandibular development or too large a mandible with normal maxillary growth
- Forced position of the lower jaw due to lateral crossbite (reversed dentition in the posterior region).
- Severe mandibular retraction: due to maxillary micrognathia (upper jaw too small) or mandibular macrognathia (lower jaw too large); as a result, the lower lip becomes lodged between the incisors, leading to an increase in the anomaly
- By tilting the upper incisors to oral (towards the oral cavity).
- Collapse of the support zones due to early loss of lateral milk teeth.
- Supernumerary teeth
- Accidents
The procedures
I. Stopping Habits.
Habits should be stopped as early as possible to minimize the effects on the orofacial system and to avoid later orthodontic treatment if possible. 1. measures against sucking the thumb and other fingers should therefore be successful by the age of 4 at the latest. The following procedures, for example, are helpful:
- Weaning off the thumb by offering a soother.
- This in turn can then later be easier abtrainiert
- In the pharmacy available nail polish with bitter substances
- Prefabricated or custom-made oral vestibule plate: is positioned in the oral vestibule (space between the lip and teeth), keeping the thumb and its action away from the teeth; at the same time, the pressure of the plate moves the upper incisors back to their original position
- Sucking calendars and other reminders: are designed to illustrate feelings of success and thereby bring about behavior change
2. measures against incorrect swallowing pattern: visceral swallowing exposes the incisors to incorrectly applied muscular forces thousands of times a day. As early measures can be used:
- Oral vestibular plates: ready-made or custom-made, which work passively with tongue grids or actively with rotatable beads positioned in the palatal space, which are intended to train the tongue into the correct position during swallowing
- Logopedic treatment (speech and swallowing therapy): targeted tongue exercises are intended to reprogram the misdirected swallowing pattern; regular home training is essential.
3. measures against mouth breathing: the consequences of habitual (habitual) mouth breathing for the orofacial system are far more serious than one might first suspect. The patient is more susceptible to infections due to the lack of filtering and warming effect of the nose, and more susceptible to caries due to lack of lip activity and more viscous saliva because it has dried up. Lack of growth stimuli on the upper jaw and nose and the backward displacement of the lower jaw with almost permanent mouth opening have a negative effect on jaw growth. Finally, there is also an imbalance of musculature between the tongue and lips, as the lips are untrained; however, the teeth depend on a balance of forces between the inside and outside for correct tooth position. The following treatment attempts are therefore indicated:
- Oral vestibular plate: reduces the possibility of breathing through the mouth, thus increasing the nose again as a natural alternative
- Logopedic treatment: to train the lip muscles and conscious behavioral change.
4. measures against speech disorders: logopedic treatment.
II. early treatment with orthodontic appliances.
1. support zones collapsed after early milk teeth loss are prevented from further narrowing by gap retainers: these are removable or fixed, the latter making oral hygiene somewhat difficult, but guaranteeing a daily wearing time of 24 hours. 2. inverted anterior overbite: an individually fabricated so-called inclined plane guides the teeth into the correct position. In case of different growth tendencies in the upper and lower jaw, the lower jaw must be restrained in its growth by removable plate appliances, while the upper jaw must be encouraged. 3. in case of severe mandibular retraction, the maxillary dental arch is extended transversely (transversely) with a removable appliance to provide space for the mandible to advance.
