What To Look for in Patients With Mixed Dentition

Many patient complaints about bite or sleeping problems could have been resolved in early childhood if they had received Phase I orthodontics. Fortunately, with today’s orthodontic continuing education for general dentists and the promotion of the importance of oral health, patients are receiving earlier orthodontic treatment and avoiding unnecessary long-term problems like crowding, speech problems, sleep apnea, and self-esteem issues.

Dental schools have a limited portion of orthodontics in their curriculums, leaving dentists without the tools they need to identify, diagnose, and treat issues through orthodontics in the mixed dentition stage. This is one of the primary reasons that Williams GP Orthodontic Seminars pushes the limits of orthodontic education for both general and pediatric dentists.

Since general and pediatric dentists are essentially the dental “primary care providers” for children and adolescents, they should have the background to identify time-sensitive issues that can benefit from early treatment. “In orthodontics as in all areas of dentistry, it makes sense that the less complex cases would be selected for treatment in general or family practice, while the more complex cases would be referred to a specialist,” said William R. Proffit, DDS, MS. Whether the dentist chooses to provide orthodontic treatment in-house or not, the benefit of orthodontic continuing education for general dentists is unmatched. It lays the necessary foundation to be a competent and confident dental provider.

When you take orthodontic training for general dentists, the course and networking is invaluable as you will be able to identify warning signs in the mixed dentition to help younger patients avoid unnecessary dental problems. Here are some common warning signs you should look for to determine when orthodontic intervention is needed:

1. Spacing

Inadequate spacing is commonly seen in early childhood. It is a trend to see crowding in the mandibular or maxillary arch that doesn’t allow all permanent teeth to properly erupt or that causes delayed eruption for posterior teeth.

Inadequate spacing can lead to problems like impacted teeth, difficulty brushing and flossing due to crowding, and an increased risk of tooth decay. Whether you treat cases of severe crowding, or even unusually large gaps in the teeth, in-house or refer out to specialists, you are providing comprehensive care for your patients by identifying this issue and taking action accordingly.

2. Ectopic Eruption

Ectopic eruption occurs when a permanent tooth erupts in the mesial direction or in an unusual path compared to the traditional erupted pattern. An ectopic permanent molar can cause resorption of the primary second molar, which in turn causes inefficient spacing and blocks adult premolars from erupting.

It is important to take action early on to avoid further space loss. Of all permanent first molar ectopic presentations, around 66% will self-correct. Common recommended treatment for ectopic eruption is monitoring for self-correction or extracting the primary tooth and using a Nance appliance to hold the permanent teeth in place to avoid further mesial drift.

3. Crossbites

Crossbites occur when the upper teeth do not overlap the lower teeth but instead sit on the inside. A crossbite can be unilateral or bilateral, but its cause is still a narrow upper jaw with insufficient space for permanent teeth to erupt. A crossbite is never an ideal occlusion since the teeth are sitting in a way that negatively affects how the patient chews and bites down.

Studies show that crossbites are also linked to airway issues, which can eventually lead to problems like obstructive sleep apnea. When you take orthodontic continuing education for general dentists and  practice general dentist orthodontics, you know how to fabricate a palate expander to help widen the upper jaw and avoid problems like impacted teeth or crowding in the permanent dentition.

4. Open Bite

An open bite occurs when the front teeth do not overlap the lower teeth. The significance of this is that it can affect speech, eating, and self-esteem. It can occur spontaneously but is typically linked to prolonged thumb-sucking or pacifier use.

Another possible cause of an open bite is a tongue thrust, which is when a patient’s tongue sits between the teeth and affects the bite. It is often linked to allergies, mouth breathing, and speech problems.

The best course of action is to stop the toxic habit and create a habit-breaking appliance that helps the patient prevent their tongue or finger from sitting behind the front teeth. It can be challenging to treat because some cases require more than an orthodontic appliance. Oftentimes speech therapy or myofunctional therapy is beneficial to help prevent further issues by retraining the muscles and tongue if the open bite is linked to a tongue thrust.

5. Crowding

General and pediatric dentists often see crowding in the mixed dentition, but when is it appropriate to intervene? The American Association of Orthodontists recommends that every patient get an orthodontic evaluation by age 7, which means if you haven’t referred your patient but don’t have the proper training to identify malocclusions yourself, your patient could be going without needed orthodontic care.

Crowding is common, but it is more involved than just an overlap of teeth. When there is significant crowding, you need a panoramic radiograph to determine the angulation and root development of permanent teeth. This will help you determine if interventions like early extractions are necessary to help permanent-tooth eruption. When you take an ortho course with Williams GP Orthodontic Seminars, you will gain a foundation in orthodontics and learn when it is necessary to treat, refer, or monitor mixed-dentition cases.

Now is the right time to expand your skill set.

Perfect your ability to recognize these warning signs in the mixed dentition and more by pursuing continuing education in orthodontics. If you didn’t receive a strong orthodontic background in dental school, it is never too late to specialize in orthodontics by taking a course through Williams GP Orthodontic Seminars and helping your patients prevent avoidable dental problems. Sign up for one of our upcoming courses today.