Common Problems

Sometimes there are strategies to help to make space for the adult teeth to come through more favourably while there are still some baby teeth left, which subsequently may avoid extractions later. This is why it is important for an orthodontist to see children while they are still growing and before they have lost all of their baby teeth. However, there are also some situations where extractions of adult teeth are necessary to enable the healthy and long-term stable alignment of the teeth. Dr Meyer looks at extractions as a last resort, but she is also sensible when it comes to balancing out the long-term health and stability of the teeth with this decision.

Spacing can be unaesthetic and in severe cases, can cause issues with speech. Orthodontic treatment can help to close the spaces with either braces or a plate – depending on the cause and severity of the spacing.

It is not uncommon to see patients with this dental relationship to have a history of accidents involving the bottom of pools, tarmac, trampolines or even during friendly tussles with siblings. The lower front teeth can also sometimes over-erupt and damage the gum behind the top front teeth. The treatment for this type of bite can often commence during a specific time in a child’s growth (sometimes before all the adult teeth are through), which is why it is important for children to see an orthodontist at an early age. If appropriate, early treatment of these cases can often result in definitive treatment being made simpler and can also sometimes eliminate the need to extract adult teeth later on. However, extremely severe cases may require the consideration of combining orthodontic treatment with jaw surgery.

There are many causes for the development of this type of bite, but it is often due to a genetic discrepancy in the relationship of the top and bottom jaws. A strong family history (other family members having a similar bite) is often seen with this type of bite. Depending on the individual cause of this bite, it is sometimes appropriate to intervene orthodontically at an early age – which is why it is important to have an assessment with an orthodontist while the child is still growing. However, in severe cases with a strong family history, a combined approach of orthodontics with jaw surgery may need to be considered to gain a stable and facially acceptable result.

Sometimes, a bite can be so deep that the bottom front teeth are not seen at all when a person is biting. This can cause severe wear of the lower front teeth as well as damage to the gums behind the top front teeth. It is sometimes appropriate to undertake a simple intervention with this type of bite while a child is still growing which has the benefit of not only starting to reduce the deep bite early on, but will also protect the lower teeth from further wear. Studies have shown that if a deep bite is corrected during growth that the correction is more stable in the long-term.

There are various causes of an open bite – it may be genetic (where the growth of the jaws are inherently in a direction away from each other), or it may be caused by a habit such as thumb sucking. It may also be caused by a forward resting tongue position or a habitual tongue thrust when speaking or swallowing. Depending on the severity of the open bite, treatment could consist of either orthodontics alone, or orthodontics in combination with jaw surgery.

This can manifest in localised dental anomalies such as an open bite, crossbites and protruded top front teeth. The good news is that if this habit is stopped early enough, these dental issues usually self-resolve. However, it can sometimes be very difficult for a child to stop – we all know how difficult it is to stop a habit. This is why it is important for a child to see an orthodontist early to assess the damage that has been done to the teeth and jaws, to encourage the child to stop and if necessary, intervene with appropriate treatment to gently help them to cease the habit.

Crossbites can either be present on both sides of the mouth or just on one side. This type of bite can cause uneven wear of the teeth and can also interfere with normal jaw closure. It is often important to correct these bites early to avoid these problems exacerbating in the future.

Common missing teeth include the upper lateral incisors (the second teeth back from the central two teeth) and the second premolars (the teeth just in front of the molars). The mode of orthodontic treatment and the timing to start treatment depends on the location of the missing teeth and the overall dental and growth make-up of an individual. Sometimes it is better to close the spaces, other times (often for facial considerations) it is better to open spaces and substitute the missing teeth with a prosthetic replacement. Every case is different – the treatment decision for each individual is complex and requires careful analysis of all associated growth, facial and dental factors.

This can cause a snowball of events – the impacted adult tooth causes the baby tooth to fall out prematurely, which then results in space loss and further impaction of other teeth along the way, leading to even more crowding in the mouth. An early assessment of a child can pick up these types of impactions early and if necessary, the appropriate orthodontic treatment can be carried out to avoid the snowball effects (and thus also avoiding more complex treatment) in the future.

It is often possible for these teeth to be brought into the mouth and into the correct position with braces. Each individual is assessed on a case by case basis.