The follow-up of the dental structure of children is very important in terms of the health of the permanent dentition that will ocur in the future. The fact that the deciduous teeth are temporary often leads to their negligence and early extractions. It is very important that the deciduous teeth remain in the mouth until the completion of their natural replacement period in terms of both the development of jaw bones, and being the basis for a proper dental closing. With the odontisis of the first deciduous teeth in children (about the age of 3 years), teeth brushing should be started by the mother, and caries should be prevented by preventive procedures in deciduous teeth. The orthodontic examination in children should be around the ages of 6-7 when the first permanent dentition starts. Both the closure problems that may occur in the teeth, and the skeletal disorders of the jaws can be identified by the examination made at this age. The orthodontic problems may also occur as a result of the tonsils, adenoid, mouth breathing or atypical (infancy) swallowing. The main objective in the children’s orthodontics is to eliminate the cause of orthodontic problems. Sometimes, the orthodontic disorders can be stopped by simple measures applied very easily without inserting any braces or dentures. If the cause is eliminated by taking appropriate measures in children, the orthodontic and orthopedic problems can improve at a certain level.
Dentition in infants begins between the months 3-6 with the teething of the incisors. This process continues until the age of three. There is no change in dentition between the ages of 3-6. And, the permanent dentition beginning with the teething of the permanent incisors and the first big molars at the ages of 6-7, ends with the teething of the dog teeth at the ages of 12-13. One of the most important points to be considered in childhood is the protection of the first big molars teething at the ages of 6-7. These teeth are often confused with the deciduous teeth and neglected. The first big molars are the cornerstones of dentition, and guide the other teething permanent teeth. One should be very careful about the cleanness of these teeth and the teeth should be protected against caries by fissure sealing applications (the covering of the natural fractures on the chewing surfaces of the teeth).
Some problems that may occur in children also can be identified by families.
Considerations Include:
• The tooth are too far ahead or behind,
• The teeth do not cover each other, and the tongue gets out during swallowing,
• Sleeping mouth open,
• The teeth are too seperate or tight,
• The teeth on the left and right do not teethe simultaneously,
• The thumb-sucking and baby bottle sucking habits continue,
• The lower or upper jaw is on the front or behind to be visible from also outside of the mouth.
The ideal treatment time in orthodontics is determined by the orthodontic specialist, depending on the type and severity of the problem. The treatment of the simple dental problems is usually postponed until the age of 12 when all dentition ends. However, especially the problems related with the first big molar teeth, the problems emerging as a result of the early loss of deciduous teeth, and the skeletal problems of the jaws enter the list of problems that should be treated at an earlier age. Especially, the treatment of the problems related with the locations of the lower and upper jaws is started about the ages of 7-8, as they are corrected by using the child’s growth potential, and the treatment is ended about the ages 11-12.
What are the Treatment Methods?
There are many methods and apparatus used in the correction of the orthodontic and orthopedic problems in children. The primary orthodontic treatment principle is the elimination of the cause of the problem. For example, the first method to be used in the treatment of a child with a gap in his front teeth due to mouth breathing, is to find the reason of mouth breathing (help can be received from the ENT specialists for this purpose) and prevent. The elimination of the cause would stop the severity and progress of the gap. Simultaneously, the gap is corrected by using dentures and tongue exercises to control the tongue habits. Similarly, every problem has a special treatment approach.
Generally, two types of apparatus are used in orthodontic treatment. These are intraoral and extraoral devices. The extraoral devices (such as devices installed on the jaw and back of the neck) are usually used to support the devices used in correcting skeletal problems or intraorally. And, the intraoral devices are of 2 types, namely removable apparatus (dentures), and fixed devices (braces, brackets). While the dentures are generally used in jaw tightnesses or as placeholders, the brackets are used in more detailed treatments such as the closing of the gaps and adjustment of the axis inclinations of the teeth.
In some cases when the orthodontic problems are accompanied by orthopedic (skeletal) problems, extraoral devices such as devices installed on the jaw and back of the neck can also be used. These devices can direct the growing skeleton in the right direction, and they are highly successful at preventing surgical interventions that may occur in adulthood. These devices generally are fitted around 18 hours a day and act both orthodontically and orthopedically.
Another method used in the children’s orthodontics are the fixed devices (braces, brackets). The brackets are pasted on the teeth with a special glue and they remain there during the treatment. The advantage of these devices is the provision of a faster movement of teeth. The orthodontic specialist will decide on what kind of a treatment mechanics will be used with your child.
What Should Be Considered During Treatment?
The orthodontic treatment process is tolerated more easily by the children compared with the adult patients. The children receiving treatment can study, play games, and join in sports and arts activities. Although there may be pain and a feeling of tightness during the first few days of the treatment process, the teeth and the oral tissues get used to them over time, and there becomes an adaptation as if there were no braces at all. The improvement in teeth not only provides aesthetic and functional benefits, but also helps the elimination of the children’s psychological distress due to the appearance of their teeth.
How Long Does the Orthodontic Treatment Last?
The most important thing to note when using fixed devices is to ensure a proper oral care. The brackets have recesses and projections that make it difficult to clean the teeth. While the time required for the proper brushing of the teeth under normal circumstances is about 2 minutes, the patients wearing braces should brush their teeth for 3-4 minutes. Consumption of hard foods during the treatment may lead to the breaking and corruption of the braces. In order to prevent this, especially the seeds of the fruits should be removed, and the hard foods should be consumed by slicing. The support of the parents is very important for the easy adaptation of the children to orthodontic treatment. The first thing to be done is to give the children the habit of tooth brushing. In addition, the wearing of the dentures at the required times should also be followed up by the parents.
Treatments in children usually act with growth. While the treatments of the skeletal disorders may last about 1-3 years, the treatment of simple strictures or distortions may take less time. The patient usually comes to the appointment once every 4-6 weeks within this period, and the necessary interventions are made to the braces.
In order the devices that can be removed by children (such as dentures and devices installed on the jaw and back of the neck) to be effective, they have to be worn about 18-20 hours a day. The orthodontic specialist will determine the required certain amount of time depending on the size of the problem. Wearing the apparatus shorter than the required time will lead to slow improvement in teeth and sometimes to the hindering of the treatment. The patient compliance in orthodontic treatment is very important in this respect. And, one of the problems frequently encountered in the use of removable apparatus is the losing of the dentures. When the dentures are removed during meals, they must be put in their case, and certainly should not be wrapped in a napkin and placed in pocket.
