Keep Them Smiling
As parents, we do everything we can to see our children smiling. We read pre-natal manuals and take parenting classes, too. So much information is available to help us develop our child’s healthy body and mind. In all this, though, matters of dental care are often glossed over, perhaps because we adore the gap-tooth grins of our babies. But what happens when our children’s baby teeth are long gone, and their wide toothy grins become self-conscious, tight-lipped smiles?
It helps to be reminded that the world of peadiatric orthodontics is not the same world we grew up in … and over the generations, new types of problems can emerge. For example, a little neighbour of mine showed me that her new adult teeth were growing in as predicted, but right behind her deciduous “baby” teeth. A quick trip to her dentist with her alarmed mother – and some pliers – remedied the situation, and the dentist suggested the girl eat an apple a day to make sure her baby teeth were getting the normal amount of wear and tear needed to avoid repeat visits. That is a simple fix, of course, but parents need to be on the lookout for potential problems even before our children’s adult teeth grow in, because remedial work can often require long-term strategies.
I was introduced to the world of missing lateral incisors with my second child. Her baby teeth were dropping out and growing in as expected until, one day, the tooth next to her top-left-front came out… and we waited. Over the next six months, my daughter’s neighbouring bicuspid and premolars parted ways. (Actually, she got good at pulling them out herself.) Adult teeth grew in, albeit slowly. But that space right next to the top-left-front remained vacant. Eventually I asked my daughter to tilt back her head so I could inspect her gums. There was no longer an opening where her baby lateral incisor had been; the gums had healed over. I had to accept the probability that there was nothing ‘waiting in the wings’ so to speak. I vaguely recalled my little brother having a small tooth somewhere — and our vexatious older brother teasing him by naming it “Peggy”. I went onto Google and delved into the fascinating world of “missing lateral incisors”. This just happens to be one of the most common genetically-inherited traits. (And, by the way, the technical word for “Peggy” is microdont.)
We broached the subject with our family dentist. She x-rayed my daughter’s teeth and with, I will admit, more than a little nervousness, I waited for the verdict. The dentist placed the x-ray film on the lightboard, examined it for mere seconds, then turned to me. “I don’t see it,” she said. The observation was delivered matter-of-factly, and not the least bit apologetically. It sounded like no big deal. I knew she was referring, not to the one that I knew wasn’t going to show, but to the one on the other side, which still had the baby tooth in its place. She was telling me that nothing was going to come down there, either. I seemed to recall later on that, in addition to my little brother’s top-left microdont, my father had had one missing lateral incisor. In due course, my daughter’s orthodontist and I would have a chuckle over the fact that my daughter had been blessed with the ‘whole nine yards’ version of a hereditary fluke from my side of the family — two congenitally missing teeth. It wasn’t great news, but it wasn’t the end of the world either, and mixed in with these feelings was a sense of wonder about the human body, the miracle of reproduction, and all its idiosyncracies. I am not joking. My daughter and I are now fully-versed in the wide variety of methods that can be employed, when the time is right, to ‘normalise’ her smile: orthodontic work can shift her teeth to close the gaps, and the teeth can then be filled to mimic the shapes of the incisors (and cuspids). Or we can try a cantilevered prosthetic tooth, which would then be replaced years down the line with an implant. Orthodontists love to post videos of corrective procedures on Youtube. The fact is, my daughter is feeling very empowered about the whole scenario. She is accepting herself for who she is. And she doesn’t hold anything against Grandpa. It’s all good…
Dr. Derek Baram, Specialist in Orthodontics, and founder of Central Smile (CHECK) suggests that parents take their child for their first orthodontic check-up at seven or eight years old. “Most will be told to come back when they have all their permanent teeth, but the early check allows for faster intervention for those who require treatment before braces.” My story shows that our own past histories with dental issues may be good predictor of what your child may face, and the shape of the face may give an early indication that remedial work will be necessary. “With underbites, overbites, crossbites, severe crowding or other bite issues, early correction can treat many problems quickly to prevent them developing later. And some issues like underbites may not be correctable at an older age.”
Dr Baram says that although there is no age limit to braces, there are two ‘golden periods’: from ages 7 to 10, for early correction; then from ages 12 to 13, when most children have their braces. “Teeth respond better to braces before ages 16 to 18, when the jaw typically stops growing. Kids have softer bones and faster metabolisms than adults, and teeth will begin to move into line almost immediately after treatment starts. Risks associated with treatment are also generally less in children compared to adults.” He points out that the main benefit of applying braces earlier has much to do with social acceptance. “Your child’s friends are likely to have braces at that age as well. With strength in numbers, it’s easier for kids to feel confident about the metal in their mouth and gives them plenty of friends with whom they can share their experiences.” Recent studies have found up to a third of all kids wear braces in developed countries like the US and Australia. Baram says that in Hong Kong, 13 per cent of local Chinese children will have braces even though the treatment need is around 60 per cent. “This is an unfortunate fact and hopefully more children in Hong Kong can benefit from orthodontic treatment at a younger age.”
Perhaps your teen or tweenie may come to you to discuss more modern methods of remediation, or maybe you yourself have tried out the transparent brand of “braces” called Invisalign. (I have, and recommend it when middle-aged teeth start to shift.) “Invisalign is an American company that uses customised clear pieces of plastic (aligners) to align teeth. The user is usually asked to change their aligners once a week and the teeth straighten by 0.25mm with each new aligner. Previously it was reserved for adults who wanted to avoid braces. However, Invisalign has developed so far that it is now often the treatment of choice for children aged 7-10 years old. Its advantage over other appliances is its accuracy and gentle force. It is very interesting to see how Invisalign develops its appliances for younger children over the next few years.” Says Dr Baram.
Whichever way you look at it, the majority of people these days eventually avail themselves of the services of orthodontists, and perhaps even prosthodontists, in addition to the ever-faithful family dentist. As the variety of procedures become more accessible, more “normal” among your child’s peer group, less invasive, and cheaper too, there is hardly any reason for any child to dread having their teeth checked. If you’re especially lucky, the idea might even put a smile on their face.
Breakout box: Useful Info
Dr. Derek Baram
Specialist in Orthodontics
BDS (HK), FRACDS (Aus), MSc (Ortho) (Lond), M Ortho RCS (Eng), M Orth RCS Ed, AdvDipOrth (HK), FHKAM (Dental Surgery), FCDSHK (Orthodontics)
Central Smile Limited
12/F Manning House, 48 Queen’s Road Central, Hong Kong
T +852 2816 1608 | F +852 2816 7868 | M +852 6680 6638
[email protected] | centralsmile.com
