Bite Opening in Children

Eighty percent of the jaws of a child develop before the age of 10. Modern trends in jaw and tooth development show that children still suffer from early childhood decay (ECC), and the jaws are not developing to their fullest potential during these critical early years. Basically, the genes we have for large jaws are not being properly expressed. Call it environmental influence, call it lack of proper diet and function, call it allergies. I will not discuss that issue here. However, I will discuss the terrible consequences as it relates to dental and general health.

First, an analogy.

Consider the room in the mouth as an actual room. The oral cavity of a child with a small jaw size (and consequently no spaces between baby teeth) can be compared to a small room where you find it hard to fit in or move around.

The oral cavity of a child, on the other hand, with worn down teeth and a deep bite can be compared to a room with a low ceiling. You can’t even walk in it upright.
A deep bite in children is confirmed if you cannot see the lower incisors when they bite down.

Who are we talking about? The tongue! The tongue grows to its genetically determined full size regardless of how much space is allowed within the oral cavity. Its functions, besides tasting, include phonetics (speech pronunciation), swallowing, and indirectly, keeping the airway open.

Place the tongue in a room with smaller dimensions (constricted jaw), OR a low ceiling (deep bite), OR both, it will not fit comfortably and cause serious long-term consequences.

Here is a list of these consequences as it relates to each of the tongue’s functions.

Phonetics: children will tend to lisp due to a combination of insufficient space for the tongue and an altered programming of the muscles.
Swallowing: Children will exhibit tongue thrust. The tongue just cannot find enough room to accommodate itself and protrudes between the teeth every time a child swallows – around 1000 to 2000 times a day. This repeated action causes the teeth to spread apart and develop a gap (open bite). This in turn will cause an occlusal (bite) probem not to mention bad esthetics.
Airway: The most serious consequence of all, a blocked airway will result due to the tongue falling back and obstructing the already narrow airway in the back of the throat. This is known as childhood sleep apnea, which is hardly diagnosed by paediatricians or general dentists unless they know which signs to look for. The signs, ironically, to look for in children, are different than those in adults.
1. increased hyperactivity with an inability to concentrate during the day,
2. grinding of teeth at night
3. dark circles under the eyes.
4. bedwetting.
5. frequent earaches.

Grinding and snoring in children is not normal. If the child is 4-7 years old, grinds and snores, and exhibits some of the abovementioned signs, and has a small jaw size, a deep bite, or worn down lower incisors, then the first step we take is to build up the vertical dimension on their baby molars. This in itself will be sufficient for this early age, without resorting to removable appliance therapy, to provide a sound solution for improving airway and function. It will have a permanent orthopedic effect on the jaw as the permanent teeth erupt to a restored vertical dimension and even alleviate some future crowding. After age 7, arch development can still be initiated with appliances if there is an arch deficiency.

Bite opening procedure: a bite key is constructed to fit behind the top incisor teeth. This is adjusted to create the desired vertical space between the back lower baby molars (two on each side). Their fissures are cleaned out t(to prevent future cavities), they are then primed and bonded with composite. Before the composite is cured, the child is instructed to bite into the upper key to mold the still soft composite into the correct shape and vertical dimension. After all composites are placed, they are adjusted and polished. These children adapt surprisingly fast to their new bite and by the time these baby teeth are lost, the jawbone and the permanent molars coming in behind them will have grown to consolidate that position.

Before (top) and after (bottom) the bite opening procedure

Front and side view after another bite opening procedure.

To read more about jaw development and jaw orthopedics, please read more in these links:

One-sided Crossbite in Children

The one-sided (unilateral) cross-bite in children, is a condition that should be immediately addressed or at least as early as possible. As a rule, the upper teeth should overlap the lower. When, however, the upper jaw does not develop properly, the upper arch holding the teeth will be smaller than normal. The lower teeth will not fit under the upper in the usual manner. In order to do so, the jaw, in an attempt to cause the maximum number of teeth to come together, will shift the jaw slightly to one side, causing a one-sided crossbite, in which only on one side the lower teeth are brought to overlap the upper teeth.

This condition should be addresses immediately, as the consequences are as follows:

Results in asymmetrical growth of the lower jaw, and thus the face.
Restricts the growth of the upper jaw.
Increases the risk for jaw joint (TMJ) problems in the future.
Causes insufficient space for the tongue, resulting in an increased risk for childhood sleep apnea and lisping.
Esthetically compromised appearance.

Parents, pediatricians, ENT specialists, and general physicians should be able to spot this condition and refer to a dentist or orthodontist who has experience in functional jaw orthopedics or appliance therapy. Treatment can be initiated as early as age 5, and involves a simple removable appliance that encourages growth of the upper jawbone (maxilla).

Mouth Breathing

Mouth breathing is a serious matter. In children of growing age, it may have devastating effects on general health and growth. Many seemingly unrelated conditions are related to mouth breathing.

CAUSES:
Chronic allergies, tonsil hypertrophy, nasal polyps, deviated nasal septum, constricted upper airways, a backward positioned lower jaw caused by thumb sucking, excessive pacifier use or insufficient suckling as an infant.

Signs in Mouth Breathers

Long, narrow face
Difficulty breathing through nose
Retarded physical growth
Dry lips
Dark circles under eyes
Excessive creases between lower lip and chin
Allergies
Smaller jaws with crowded teeth
Swollen tonsils

Consequences of Mouth Breathing

Jaw deformity
The jaws and subsequently the whole facial structures grow in an altered fashion, resulting in long faces, constricted arches, tooth crowding, a narrowed nasal airway passage, and an altered head posture. The lower jaw remains too far behind in its growth, producing a small chin, dental malocclusion, a large overjet, and an unfavorable profile. If the mouth breathing is addressed, these children can often be treated for their malocclusions and skeletal growth discrepancies by a dentist or orthodontist who follows a functional-orthopedic approach.
Compromised airway
Caused by: 1. the lower jaw being positioned too far back, along with the tongue, thereby constricting the upper airway. 2. Enlarged tonsils and adenoids due to chronic allergies may be the primary cause for mouth breathing, however mouth breathing in itself will also cause a further increase in tonsil size, thus constricting the airway to such an extent, that normal nasal breathing becomes an impossibility.
Altered head, neck and body posture
The unnatural and unphysiological process of breathing through the mouth, which in many children looks like they are “gasping” for air, produces a reflex forward head posture. This puts a large load on the upper back and neck muscles, which if sustained, will cause permanent posture changes, such as abnormal curvatures in the cervical and thoracic vertebrae, and an altered shoulder posture. Ultimately, we see a domino effect affecting hips, knees and feet. In adults, Jaw joint dysfunction (TMJ problems).
Bad breath and gum disease
Caused by the shift in the bacterial flora in the mouth.
Lowered immune system and poor health
Nasal breathing produces a tissue hormone that regulates normal blood circulation. It also filters, warms and moisturizes the air. The lack of oxygen in mouth breathers, who usually snore at night and struggle for air, weakens the immune system, disrupts deep sleep cycles, and interferes with growth hormone production.
Obstructive sleep apnea (OSA)
In newborns, this is thought by many researchers to be related to SIDS, or Sudden Infant Death Syndrome. In children, this is manifested as snoring, bed-wetting, poor quality of sleep, obesity, and ultimately behavioral symptoms resembling ADHD.
In adults, OSA is a silent killer. Snoring is a manifestation of a blocked airway, which in essence is a milder version of sleep apnea. Most snorers, however, may not be aware that they may be suffering from OSA. On average, snorers are more likely to suffer from cardiovascular disease and stroke, and carry an increased risk for obesity, high blood pressure, stroke, severe obstructive sleep apnea, and diabetes.
Poor performance
The same lack of oxygen and other hormonal factors make these children tend to be overweight, tired, and not perform well at school. Physically they are not athletic.

Mouth breathing in children should be addressed as soon as possible by consulting a physician, a dentist, a myofunctional therapist or an ENT specialist, who are experienced in treating this condition.

For recommendations to handle mouth breathing please view and download the article Recommendations for Mouth Breathers.