Malocclusion in a Child — Signs, Causes, and Treatment

Malocclusion in a child is a disorder of the occlusion between the teeth of the upper and lower jaws. Considering defects in tooth growth as merely a cosmetic problem is fundamentally incorrect.

In this article, we will discuss not only the types of pathologies in children, but also complications, treatment methods at different ages, and prevention.

Why Malocclusion Develops in Children

There are many reasons for the development of malocclusion in children:

• hereditary factor — genetic features in the structure of the dentoalveolar apparatus, for example, a very narrow jaw or absence of the buds of certain teeth;
• incorrect latching of the baby to the breast or very prolonged breastfeeding;
• use of a bottle nipple with a large opening, or mismatch between the nipple size and the child’s age;
• harmful habits — from constant sucking of a pacifier or finger to the habit of supporting the head while sitting at a table;
• congenital pathologies — incorrect tongue position, shortened frenulum of the tongue or lip — and injuries sustained during childbirth;
• absence of solid food in the diet;
• developmental pathologies of the musculoskeletal system, such as scoliosis, as well as pathologies of the respiratory organs and endocrine system, including diabetes mellitus and thyroid diseases;
• rickets;
• late or premature loss of baby teeth.

If, at the time of tooth eruption, the child has at least one of the listed predisposing factors, it is advisable to consult a doctor. The doctor will provide recommendations that will help prevent possible bite problems.

Symptoms

There are several types of malocclusion in children:

• distal occlusion — the teeth of the upper row do not overlap the lower incisors, but seem to hang over them;
• mesial occlusion — the lower jaw is protruded forward;
• open bite — the teeth of the upper and lower rows do not meet when the mouth is closed;
• deep bite — the teeth of the upper jaw overlap the lower teeth by more than half;
• crossbite — in different areas of the dental arch, there is uneven overlapping of the lower and upper teeth.

In addition, various anomalies of tooth growth are also referred to as malocclusion:

• diastema — a large gap between two adjacent teeth;
• dystopia — growth of a tooth in the wrong direction or in the wrong place.

The following signs may indicate abnormal bite development:

• the teeth in the row are crooked, “look” in different directions, overlap one another, or are crowded;
• visible gaps between the teeth;
• in one or several areas of the dental arch, the teeth do not contact one another when the jaws are closed;
• when closing the mouth, the lips do not close;
• when the jaw moves, the temporomandibular joints click;
• the child cannot open the mouth normally;
• the gums often bleed under mechanical influence, and dental plaque forms quickly on the teeth;
• noticeable asymmetry of the lips or face;
• if an imaginary line is drawn through the middle of the face, the central line of the dental row does not coincide with it;
• speech disorders are observed, such as lisping;
• posture disorders.

Any of the listed symptoms is a significant reason to take the child for an examination and consultation with an orthodontist.

Why Malocclusion Is Dangerous

Malocclusion is not only an aesthetic problem, but first and foremost a problem of dysfunction of the dentoalveolar apparatus. For example, due to malocclusion — absence of contact between the upper and lower teeth in certain areas of the dental arch — the chewing load is distributed incorrectly between the teeth, which may lead to the following consequences:

• development of a wedge-shaped defect — destruction of the tooth at the border with the gum;
• recession — reduction in the volume of the gums, which leads to exposure of the neck and root of the tooth;
• enamel wear;
• hyperesthesia — increased tooth sensitivity;
• premature tooth loss;
• dysfunction of the temporomandibular joint, due to which it may be painful for the child to open the mouth or chew;
•  headaches.

Malocclusion in the lateral areas of the mouth has the following complications:

• trauma — biting of the cheeks or tongue; chronic trauma is a prerequisite for changes in the mucous membrane and the
• development of tumors;
• difficult chewing, which affects the digestive system;
• facial asymmetry.

What Crowding of Teeth Affects

1. It complicates the process of brushing the teeth, which creates optimal conditions for bacteria, plaque formation, and tartar formation.
2. High bacterial activity leads to the development of inflammatory processes, such as caries, gum inflammation, bleeding, gingivitis, and periodontitis.

One of the most unpleasant consequences is that children experience their external imperfections very painfully from a psychological point of view, especially when malocclusion becomes the cause of facial disharmony or speech defects.

Bite Correction at Different Ages

Before discussing the age and methods used to eliminate bite defects, it is necessary to understand how the bite is formed.

The formation of the bite in children occurs in several stages:

1. Up to 6 months — sucking skills contribute to proper growth and development of the jaws.
2. From six months, from the appearance of the first tooth, to 3 years — formation of the bite of baby teeth.
3. 3–6 years — laying the foundation for the eruption of permanent teeth, with intensive growth of the jawbone.
4. 6–12 years — the period of replacement of baby teeth with permanent teeth. During this period, the jaw continues to grow actively.
5. 12–16 years — the final stage of formation of the permanent bite.

Bite Correction in Infants — Up to 1 Year

At this stage, none of the bite correction methods can be applied. It is also too early to speak about an accurate diagnosis of the problem. The doctor can only assume the likelihood of a disorder if the parents have a similar problem.

The only active treatment method used in children under 3 years of age is plastic surgery of the frenulum of the lips and tongue.

Mainly, only preventive measures are used:

following the schedule for introducing complementary foods, including thicker and firmer food;
using orthodontic pacifiers;
correcting habits — it is necessary to make sure that during sleep the child does not support the cheek with the hand and does not throw the head back.

It is also important to be monitored at a dental clinic: from the moment the first tooth appears, the child should be regularly taken for examination by a pediatric dentist, and caries of baby teeth should be treated in a timely manner.

Bite Correction at 3–6 Years

From the age of three, orthodontic treatment already involves active correction methods:

• combating harmful habits, such as weaning from the pacifier;
• facial exercises;
• use of a vestibular shield — a plate that helps support and develop the muscles, prevents the child from putting a pacifier,
• foreign objects, or fingers into the mouth;
• prosthetic replacement of prematurely lost baby teeth.

7–16 Years

When the child turns 7, to correct irregularities of the dental row, the doctor may suggest using various orthodontic trainers: removable appliances, aligners, or splints.

Aligners or braces are recommended to be placed at the age of 12–13, when the teeth are not yet fully formed and are more responsive to correction. However, in some cases, braces can be placed earlier.

What Is the Safest and Most Effective Method for a Child?

Only an orthodontist can answer this question after an examination and comprehensive diagnostics. The first and most important stage of orthodontic treatment is diagnostics.

To assess the bite in dentistry, the following diagnostic methods are used:

• examination and medical history taking;
• functional tests;
• instrumental diagnostics, such as orthopantomography and computed tomography.

The purpose of diagnostics is to create a complete clinical picture — assessment of the clinical, functional, biometric, and anthropometric features of the dentoalveolar apparatus — which will allow the doctor to develop an optimal treatment plan.

Conservative and surgical methods are used in treatment. Conservative methods include treatment with removable and fixed orthodontic appliances. In modern dentistry, the following are used:

• vestibular shields, or plates, which help combat the child’s harmful habits, such as weaning from a pacifier or thumb sucking;
• orthodontic plates — self-regulating plastic appliances with metal elements for fixation to the teeth, used during the replacement of baby teeth;
• trainers — devices for correcting minor defects in order to change the position of one tooth in the row;
• aligners or mouthguards — silicone appliances that gently align the dental row;
• braces — fixed appliances that allow correction of the most complex irregularities and defects of the dental row;
• extraoral appliances — structures used in severe pathologies that do not allow treatment with braces.

The basis for choosing the appropriate appliance for bite correction and elimination of defects is the nature and severity of the pathology, as well as the patient’s age. Conservative treatment is effective in treating most cases of malocclusion.

Surgery is indicated only in severe developmental anomalies of the maxillofacial apparatus, such as:

• severe facial asymmetry;
• absence of the chin;
• severe bite disorders;
• various deformities of the facial bones.

The recovery period after surgery may last up to six months.

Prevention of Malocclusion in Children

The success of orthodontic treatment depends on a number of factors. One of the most important is early diagnosis and timely treatment. In addition, in most cases, there is a real possibility to prevent developmental disorders of the dentoalveolar apparatus.

Dentists and orthodontists recommend following these preventive measures:

• during pregnancy, carefully monitor the health of the expectant mother;
• follow the correct breastfeeding technique;
• timely eliminate the causes of defects, for example, plastic correction of a shortened frenulum of the tongue or lip;
• use only orthodontic pacifiers and bottle nipples, and after 1–1.5 years, wean the child from these devices;
• monitor the condition of the ENT organs and the child’s nasal breathing, and carry out prevention and timely treatment of otolaryngological diseases;
• monitor the condition of the oral cavity, visit the dentist regularly, and treat caries of baby teeth in a timely manner;
• do physical exercises with the child to form correct posture, and make sure the child does not slouch;
• learn and regularly perform myogymnastics with the child — a set of exercises for the muscles of the maxillofacial area.

Malocclusion in a child is a problem that, in addition to cosmetic defects, carries risks of diseases of various organs and systems of the child’s body. Therefore, it is very important not to miss the right moment and to correct the problem in time.

If you suspect that your child has a disorder, you must make an appointment with a doctor. Even if the child’s teeth are growing normally and there are no visible deviations, it is necessary to visit the dentist every 3 months so that, if needed, the teeth can be treated in time.

This article does not replace a medical consultation. For complete and personalized information, please consult your dentist.