Dr. Karen Benitez, founder & designer, board certified pediatric dentist at Chevy Chase Pediatric Dentistry will be writing a series of guest posts related to adolescent dentistry and questions she frequently receives from patients that may be of interest to you. If you have a topic you’d like to see her feature, leave it in the comments.
The first post was one that many parents wonder about; whether it is necessary for your child to visit a pediatric dentist and how the experience will differ from just taking them to the dentist you see. The second post addresses the topic of why x-rays are important for your child to have. This third post explains why your child may be referred to an orthodontist at what may seem like a young age.
Keeping in line with Why do my kids need x-rays? post, it seems only fitting to introduce the subject of an orthodontist. Most kids approximately 7-8 years old will be advised to have a radiograph taken: the panoramic image. This is the image I mentioned in the last blog; used to determine the development and angulations/eruption paths of the permanent teeth. It is a key tool in a pediatric dentist’s treatment plan consideration to determine dental age, cavity treatment options and whether your child is advanced or delayed in the exfoliation process.
The panoramic image is also a key radiographic tool for both the pediatric dentist and orthodontist to collaborate and devise a treatment plan for your child to maximize growth and development potentials. I know what you are thinking—”It seems rather young for my 7-year old to be looking into braces, doesn’t it”? Well, let’s clarify that this referral is not met with all children in this age group beginning in braces following this referral. Collaboration with orthodontic colleagues helps to make sure a critical growth period is not missed in aiding for best overall arch and skeletal tooth orientations.
The age group of 7-10 is one of significant changes. Children will have teeth in transition. Some very obviously loose baby teeth with varying eruption levels of the permanent teeth. Pronounced, serrated edges of the newly erupted, less pristinely white, permanent teeth and non-scalloped gum lines, rather rounded and bulbous, call attention to many parents in a worrisome manner. This is the typical appearance for your young child newly entering what we call the early transitional dentition stage. Some parents note that there is a gap between their top and bottom arches where it appears that one jaw is significantly shorter than the other. A cross-bite may become more evident, be it a full side or a single, front tooth. For all of these visible growth and skeletal variations that may be more evident to a parent now, I provide a friendly reminder that this is truly normal and is the age of orthodontic evaluation precisely to address such variances.
This age group of referral to see the orthodontist generally is in consideration of jaw growth patterns, compromised angulations of permanent teeth as seen on the panoramic image, any habits that may be potentiating a jaw discrepancy, tonsillar/adenoid and tongue posture concerns that may be affecting the arch structures and breathing/snoring intertwined. Most children are prescribed the use of a functional appliance or limited braces. Treatment time is of a shorter duration and maintains an annual assessment into later years to evaluate for comprehensive braces, if needed. The practice of early orthodontic correction also includes the hope to decrease treatment time in the future, if needed.
There also exists a practice of myofunctional therapies, where exercises are used to activate muscles groups (yes, all the cute cheeks, lips and chin are muscles groups!) to correct a soft tissue imbalance to allow more fluid, passive growth potentials of the arches and tongue posturing that might have been stunted by their additional force or compression.
The discussion of all the varying options would be endless. I have selected a few commonly seen images below. These are of the more pronounced clinical observations I would certainly refer for. The appropriate treatment options are not shown, as this is respectfully not my specialty. The determination of treatment options is more complex of a selection process than this forum could erroneously reflect. I leave that discussion up to my orthodontic colleagues. This blog subject calls attention to the reasoning for an early referral and only to show select images of what a parent would recognize as a situation needing treatment.
The first image is that of an isolated cross-bite. A single tooth of the top and bottom arches is in incorrect position, compromising the gum line of the lower, more narrow tooth. Isolated cases of a cross-bite, may be early signs of further underlying concerns and really should not be overlooked.
This image demonstrates a deep overbite (Class II malocclusion) in which the top teeth fully cover the bottom teeth.Skeletal assessments would be performed using another radiographic image pertinent to an orthodontist, a lateral cephalometric imae.
This image is of an anterior open bite. Your child may develop this based on genetic background or due to prolonged sucking habit once permanent teeth are coming in. You can recognize that the back molars are in occlusion, but there is a gap in the front teeth; an opening.
The final image shows an underbite. This is when the lower arch is in a more 
advanced, forward position than the top arch. It is clinically referred to as a Class III malocclusion.
I hope this helps you better understand why I suggest a visit with my friendly orthodontic colleague. We all share in the interest of best results for your child! Keep an eye out for the fourth blog post: “So My Child Has Cavities. Now What?”
We at Chevy Chase Pediatric Dentistry welcome your child to come in and have a look. It would be our pleasure to have you!
You can also find us as Bethesda Magazine’s Face of Pediatric Dentistry, view our Top Docs video and read our stellar reviews on Yelp, GoogleandZocDoc. Follow us on Facebook to learn more about what Chevy Chase Pediatric Dentistry is all about…Focusing on your kids.
-Dr. Karen Benitez, DDS
Location: 8401 Connecticut Ave #650 Chevy Chase, MD. 20815
Phone: 301-272-1246
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