PEDIATRIC PATIENTS: Early Treatment & Correction of Crossbites By Purvi V. Shah, MS Nutrition, DDS, DAAPD, FAAPD, DAOS, FOM Early diagnosis and treatment of abnormalities can aid patients in achieving the goal of a stable, functional and esthetic occlusion. Treatment of developing malocclusions can have both short-term and long-term benefits while achieving the goals of occlusal harmony, function and dentofacial esthetics. M anagement of developing dentition and occlusion as part of a comprehen-sive oral health care plan in pediatric patients is a best practice assertion and it is essential. Guidance of eruption and development of the primary, mixed and permanent denti-tions is thus an integral component of comprehensive oral health care for all pediatric dental patients. Such guidance should and can contribute to the development of a permanent dentition that is in a stable, func-tional, esthetically acceptable occlu-sion and normal subsequent dentofa-cial development. Before we look at two case exam-ples of early Phase I orthodontic treatment, here are some important things to note about crossbites: b Crossbite can be dental, skeletal, or functional. b Crossbite in primary teeth are not self-correcting and if left untreated the permanent teeth are also likely to erupt in crossbite. b Early crossbite correction is thought to enhance normal jaw growth and permanent tooth eruption. b Crossbite treatment must always be considered in the context of the patient's total treatment needs. b Anterior crossbite correction and posterior crossbite correc-tion both can: 1,2,3 1) reduce dental attrition, 2) improve dental esthetics, 3) redirect skeletal growth, 4) improve the tooth-to-alveolus relation-ship, 5) increase arch perime-ter, 6) help avoid periodontal damage, and 7) prevent the potential for TMD issues. b Primary teeth posterior cross-bite correction can also improve the eruptive position of the permanent teeth b Early correction of primary teeth posterior crossbite with a mandibular functional shift has been shown to improve functional conditions signifi-cantly and largely eliminate morphological and positional asymmetries of the mandible. 4,5,6 b Functional shifts from poste-rior crossbite should be elimi-nated as soon as possible with early correction to avoid TMD and/or asymmetric growth. 7,8 b Results from a study on the relationship between craniofa-cial and condyle path asym-metry in unilateral crossbite patients published in the Euro-pean Journal of Orthodontics also stress the importance of early treatment of lateral crossbites. 9 In this study, the degree of asymmetry in cran-iofacial and condyle path was found to be twice as great as in the untreated group. The facial asymmetry parameters describing the position of the mandible showed the strongest correlation with condyle path asymmetry. b A study published in the Euro-pean Journal of Orthodontics on bite force in children with unilateral crossbite suggests there are differences in the muscle function associated with unilateral crossbite which lead to a significantly smaller bite force in the cross-bite group as compared with the control group. Further, muscle function difference did not diminish with age and development. The study also found that the number of teeth in contact was signifi-cantly smaller and the frequency of muscle tender-ness was significantly higher in the crossbite group than in the control group. The study findings indicate that early treatment of unilateral poste-rior crossbite is advisable to optimize conditions for func-tion. 10 b Unilateral posterior crossbites produce morphological and 20 Spring 2022 JAOS
Journal of the American Orthodontic Society Spring 2022: Page 20
