At our clinic, which specializes in treating children under medical sleep, our pediatric dentists and I, as an orthodontist, see children of various ages with multiple dental problems every day. Our youngest patients are only a year and a few months old. We always work as a team because any decayed, severely decayed, prematurely extracted or lost tooth can be a precursor to the development of orthodontic malformation if the necessary measures are not taken on time.
When caries develops on the lateral dental surface, over time the tooth in that area begins to decay, a hole develops and the tooth loses some of its width. After a certain period of time, if it isn’t treated, either the decayed tooth or the one behind shifts forward, depending on which side the destruction is. The bigger the lost part of the tooth, the greater the displacement. If it is a temporary tooth, the bud of the permanent tooth moves with it. This, in turn, creates improper contact between the upper and lower teeth. The speed with which the teeth can move forward depends on whether or not there are contacts between them. This process can also occur very quickly, over several months in the mixed dentition period when the sixth teeth erupt.
When there are large cavities affecting all the chewing teeth on all sides, the result can be loss of bite height, which can change the aesthetics of the face of the child. In this case, the teeth must be restored to their normal volume in order to correct the problem and avoid future orthodontic deformities associated with it.
If one or more teeth need to be extracted and it is not time for their physiological replacement, a space maintainer must be placed. Before a decision is made whether or not one should be made, a small x-ray should be taken to see at what development stage the bud of the permanent tooth is. This examination is indispensable because the time frame for replacing each of the temporary teeth with permanent ones varies over a very wide range, which can be up to a year or a year and a half. If a space maintainer is not placed, complete closure of the space from the extracted tooth can be observed. In this case, due to the large displacement, a crossbite can also occur (when the lower teeth are in a more outward position with regard to the upper teeth). In cases of extraction of the four upper front teeth, the jaw remains underdeveloped and there is no room for the permanent teeth when they erupt, resulting in the need for orthodontic treatment.
Sometimes, due to the larger size of the permanent teeth, when they erupt two milk teeth may fall out instead of one. The symmetrical one on the other side should be taken out as well no later than three to four months afterwards, so that the midline does not become distorted. In cases when this happens with one of the canine teeth, a space maintainer may also be necessary to avoid loss of space. The teeth should fall symmetrically on the left and on the right, over a period of no more than three to four months. If this does not happen, it is a good idea to see a dentist, determine the cause and decide if something needs to be done.
Every child should see their dentist regularly, every four to six months.
The child's first appointment with the orthodontist should be between the third and fourth year, then as a rule when the four incisors in the upper jaw erupt, and the last important point is BEFORE the last temporary teeth are replaced with permanent ones. These are also the most favorable years to start orthodontic treatment if necessary, as they are associated with growth peaks. An orthodontist should also be seen at any time if a problem is noticed by the parent or the treating dentist.
Dr. Angela Stoimenova – Orthodontist
Dental Clinic Petar Duchev Ortho
Dental Clinic Petar Duchev Kids
