Healthy Spaces

Get these big, bad bites fixed

An open bite (above) caused by thumbsucking.
An open bite (above) caused by thumbsucking. PHOTO: ASSOCIATION OF ORTHODONTISTS
A Twin Block is used to correct a deep overbite (above) by positioning the lower jaw more forward
A Twin Block is used to correct a deep overbite (above) by positioning the lower jaw more forwardPHOTO: ASSOCIATION OF ORTHODONTISTS
A Twin Block (above) is used to correct a deep overbite by positioning the lower jaw more forward
A Twin Block (above) is used to correct a deep overbite by positioning the lower jaw more forwardPHOTO: NATIONAL DENTAL CENTRE OF SINGAPORE
A removable appliance is used to push out the upper teeth to correct an anterior crossbite (above).
A removable appliance is used to push out the upper teeth to correct an anterior crossbite (above). PHOTO: ASSOCIATION OF ORTHODONTISTS
A removable appliance (above) is used to push out the upper teeth to correct an anterior crossbite (top). An open bite (above) caused by thumb- sucking. A Twin Block (above) is used to correct a deep overbite (top) by positioning the lower jaw more f
A removable appliance (above) is used to push out the upper teeth to correct an anterior crossbite.PHOTO: NATIONAL DENTAL CENTRE OF SINGAPORE
A fixed appliance is used to widen the upper jaw to correct a posterior crossbite  (above).
A fixed appliance is used to widen the upper jaw to correct a posterior crossbite (above).PHOTO: ASSOCIATION OF ORTHODONTISTS
A fixed appliance (above) is used to widen the upper jaw to correct a posterior crossbite.
A fixed appliance (above) is used to widen the upper jaw to correct a posterior crossbite.PHOTO: NATIONAL DENTAL CENTRE OF SINGAPORE

Early treatment for children can help prevent irregular teeth from sprouting

Your child's permanent teeth may not have all erupted yet, but that does not mean he is not due for orthodontic treatment.

The treatment helps to prevent irregular teeth from sprouting and also fixes existing ones.

In fact, children should get their first orthodontic evaluation by the age of seven so that potential problems can be identified early, said Dr Geraldine Lee, president of the Association of Orthodontists (Singapore).

Bad bites, or malocclusion, can be treated orthodontically with oral appliances to prevent them from getting worse.

These children, who still have many of their baby teeth, are usually treated between the ages of seven and 11 to take advantage of their continuing growth.

Correction may not be possible when the patient is older.

Dr Lee said that early treatment means that fewer teeth need to be extracted.

It also reduces the complexity and duration of braces treatment to straighten the teeth at a later age.

These are some of the signs that your child may need orthodontic treatment:

  •  Early or late loss of baby teeth
  •  Difficulty in chewing or biting
  •  Breathing through the mouth instead of the nose
  •  Sucking on the thumb, finger or pacifier
  • Crowded, misplaced or blocked-out teeth
  • Jaws that shift, make sounds, protrude or are recessed
  • Speech difficulty
  • Biting the cheek or biting into the roof of the mouth
  • Protruding teeth, teeth that meet in an abnormal way or do not meet
  • Facial imbalance or asymmetry
  • Grinding or clenching of teeth

OPEN BITE

WHAT IT IS: The upper teeth do not overlap the lower teeth, thus the teeth do not meet when the mouth is closed. It can occur at the front teeth (anterior open bite) or at the sides.

CAUSES: Prolonged thumb or pacifier-sucking can cause anterior open bites. More severe open bites are due to an underlying skeletal reason, such as the vertical growth of the jaws.

Children can go through a phase with an anterior open bite. This occurs when the baby incisors have dropped and the permanent incisors have yet to erupt.

WHEN TO TREAT: When the per- manent incisors erupt at six or seven years old. Sucking may cause problems with the proper growth of the jaws and alignment of the teeth.

TREATMENT: Begin by helping the child break the habit of thumb or pacifier-sucking.

Children often suck their thumbs when they feel insecure or need comfort. Focus on correcting the cause of the anxiety.

Let the older children decide on the method of stopping the habit, such as bandaging the thumb or putting a sock over the hand at night when thumb-sucking usually occurs.

Bitter medication to coat the thumb is available.

If the thumb-sucking persists, seek help from an orthodontist, who can custom-make a habit appliance where parts of it extend behind the upper front teeth to prevent the thumb from pressing or resting on the teeth.

Habit appliances can effectively close the majority of anterior open bites which arise from thumb- sucking. If the open bite persists, braces will be needed at a later age to close the bite and align the teeth.

COST: Habit appliances cost from $650 at the National Dental Centre of Singapore. In the private sector, they cost between $1,000 and $1,500.

Joan Chew


DEEP OVERBITE

WHAT IT IS: The upper front teeth reach too far down over the lower front teeth.

This can cause the lower teeth to bite into the roof of the mouth. In severe cases, it can damage the gums around the upper incisors.

The upper incisors are commonly protruded and flared, resulting in a "buck teeth" appearance and an increased risk of trauma to the upper incisors. This is known as a Class II malocclusion.

CAUSES: There is an imbalance in the jaws or a malalignment of the teeth, resulting in the upper teeth overlapping the lower teeth, sometimes even covering the lower teeth completely.

If there is traumatic overbite, a simple upper removable bite plate can be used to protect the upper gums.

WHEN TO TREAT: When the bad bite starts to damage the gums on the palate behind the upper front teeth. The ideal time for treatment of a Class II malocclusion is during the pubertal growth spurt.

TREATMENT: If there is traumatic overbite, a simple upper removable bite plate can be used to protect the upper gums.

In Class II malocclusion cases, treatment is usually started early if the child with protruding front teeth is extremely accident- prone.

A functional appliance (a type of brace) is worn to position the lower jaw in a more forward position.

A second phase of treatment with braces is necessary at a later age, though it may be less complicated.

COST: At the NDCS, simple appliances such as an upper removable bite plate cost from $650 and functional ones cost from $865.

In the private sector, the cost is between $850 and $1,200 for a simple appliance and between $1,200 and $2,000 for functional ones.

Joan Chew


ANTERIOR CROSSBITE

WHAT IT IS: When a person bites down, the upper front teeth fall behind the lower front teeth.

CAUSES: A lack of space for the permanent incisors or, sometimes, this could be due to the skeletal imbalance of the jaws where the lower jaw is more forward in position compared to the upper jaw.

WHEN TO TREAT: Between six and eight years old when the permanent incisors have erupted.

If not treated, this may cause wearing down of the teeth and gingival (gum) recession, resulting in the lower teeth being mobile or shaky.

If there is insufficient space in the mouth, fixed braces on the front four incisors may be required.

This can also affect the normal growth of the lower jaw.

TREATMENT: For simple cases, an upper removable plate with springs can push out the upper teeth.

For very mild cases, biting on an ice cream stick to encourage tipping of the upper teeth forward and the lower tooth teeth inward will help.

If there is insufficient space in the mouth, fixed braces on the front four incisors may be required.

In more severe cases where the crossbite is due to an underdeveloped upper jaw, a face mask may be required.

This special appliance pulls the upper jaw and teeth forward to encourage growth of the upper jaw. This is also known as a reverse pull headgear.

COST: At NDCS, simple upper removable appliances cost from $650 and from $865 for more complex treatments.

In the private sector, it is between $850 and $1,200 for simple upper removable appliances and between $1,200 and $2,000 for complex treatments.

Joan Chew


POSTERIOR CROSSBITE

WHAT IT IS: When a person bites down, the upper teeth at the side of the mouth fall inside the lower teeth, instead of over them. This can happen on one or both sides of the jaw. Posterior crossbites may promote asymmetrical growth of the jaws.

CAUSES: This occurs when the upper jaw is narrower than the lower jaw. It is caused by habits such as finger or pacifier-sucking, or if the child has an upper airway obstruction due to enlarged adenoid tissues or a nasal allergy.

The pressure of the sucking action, which varies according to the frequency and intensity of the sucking, causes the upper jaw to narrow.

Upper airway obstructions result in a person breathing through the mouth instead of the nose. This can affect the development of the face, jaws and teeth.

Early treatment allows for expansion of the upper jaw, which is easier in young children than in adults.

WHEN TO TREAT: Around eight to 10 years old. Early treatment allows for expansion of the upper jaw, which is easier in young children than in adults.

Expanding the upper jaw in younger children - such as preschoolers- with heavy forces and at too frequent a rate may lead to undesirable changes in the nose.

Consult an orthodontist on the ideal time for treatment and the best type of appliance.

TREATMENT: A palate expander is used to widen the upper jaw for several months.

This can be a removable appliance, such as an expansion plate, which is removed only when eating, brushing the teeth and playing sports. It can be a fixed appliance like a quad-helix, which is for the upper teeth and is cemented in the mouth.

COST: At NDCS, removable appliances cost from $650 and fixed appliances cost from $890.

In the private sector, removable appliances cost between $850 and $1,200. Fixed appliances cost between $1,000 and $1,500.

Joan Chew

A version of this article appeared in the print edition of The Straits Times on May 31, 2016, with the headline 'Get these big, bad bites fixed'. Print Edition | Subscribe