Addressing Aesthetic and Functional Goals Together

Addressing Aesthetic and Functional Goals Together

* The interplay between orthodontic forces and periodontal tissues in young patients.

Okay, so we're talking about the whole "beauty is as beauty does" thing, but applied to, say, a kid with a slight speech impediment or a wonky walk. Early intervention, right? It's easy to think of aesthetics as purely superficial – the perfect smile, symmetrical features, the "right" body type. But what if I told you tackling seemingly small functional issues early on could actually lead to better, more natural aesthetics down the road?


Think about it. A child with a tongue thrust – pushing their tongue forward when swallowing – might develop crooked teeth. Ignoring that functional issue early on means years of potential orthodontic work, and even then, the underlying cause might not be addressed, leading to relapse. Braces work by gently applying pressure to move teeth into place Pediatric orthodontic care deciduous teeth. But early intervention with a speech therapist or myofunctional therapist could correct the swallowing pattern, preventing the crooked teeth in the first place. Suddenly, the "aesthetic" problem is solved, and the solution feels organic, not forced.


Or consider posture. A child with poor core strength might slouch, leading to rounded shoulders and a less confident stance. Years of this can actually reshape the spine and ribcage. Physical therapy and targeted exercises early on not only improve core strength and posture, but they also cultivate a more physically confident and aesthetically pleasing presence. It's about building a strong foundation, literally and figuratively.


The point is, aesthetics often flow from function. When we prioritize addressing underlying functional problems early, we're not just "fixing" something; we're actually guiding natural development in a way that can positively impact aesthetics organically. We're not chasing a fleeting ideal; we're fostering healthy, balanced growth. And that, in the long run, often leads to a more genuine and lasting kind of beauty. It's about looking good because you feel good, because you move well, because you function well. It's a holistic approach, and frankly, it makes way more sense than just chasing the surface.

Orthodontic treatment isn't just about a pretty smile; it's often a crucial tool for resolving common functional issues that can plague children. Think of it this way: if the teeth don't fit together properly, it's like a poorly constructed machine. You might get it to run, but it won't run efficiently, and it's likely to break down sooner or later.


Among the most frequent functional problems orthodontics can tackle is difficulty chewing. Misaligned teeth, especially severe overbites or underbites, can make it hard for a child to properly grind and process food. This can lead to digestive issues and even nutritional deficiencies. Similarly, speech impediments are sometimes linked to jaw malformations or improperly positioned teeth. Certain sounds require specific tongue placement against the teeth, and if that alignment is off, clear articulation becomes a challenge.


Breathing problems, particularly mouth breathing, can also be addressed. Sometimes, a narrow upper jaw forces a child to breathe through their mouth, which can contribute to dry mouth, increased risk of cavities, and even altered facial development. Orthodontic expansion can widen the upper jaw, allowing for easier nasal breathing. Finally, and perhaps less obviously, orthodontic treatment can alleviate temporomandibular joint (TMJ) disorders. While not always the primary cause, a poor bite can put undue stress on the TMJ, leading to jaw pain, clicking, and headaches. By correcting the bite, orthodontics can help to redistribute that stress and ease the symptoms. So, beyond the cosmetic improvements, orthodontic treatment plays a vital role in ensuring proper oral function and overall well-being for children.

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* Preventive measures to maintain periodontal health during orthodontic treatment.

Okay, let's talk about kids' teeth. As dentists, we're obviously focused on the health and function of those pearly whites. But let's be real – parents often come in with aesthetic concerns too, and that's completely understandable. They're thinking about their child's smile, not just in terms of chewing, but also how it affects their confidence and how they're perceived.


Maybe it's a gap between the front teeth, a slight crowding, or even just the color. Parents might worry about teasing, self-esteem issues, or even future opportunities if their child's smile isn't "perfect." I get it. We all want the best for our kids, and that includes a smile they can be proud of.


The good news is, we don't have to choose between function and aesthetics. In fact, often they go hand-in-hand. Straightening teeth, for example, not only improves the look of a smile but can also make it easier to clean, reducing the risk of cavities and gum disease. Addressing an overbite or underbite can improve chewing function and dramatically enhance facial aesthetics.


The key is open communication. As a dentist, it's my job to listen to your concerns, understand your goals for your child's smile, and explain all the options available. We can discuss how different treatments will affect both the appearance and the health of their teeth, so we can work together to create a plan that addresses everything. It's about finding that sweet spot where we're creating a healthy, functional bite and a beautiful, confident smile. Because ultimately, we want your child to be happy and healthy, inside and out.

* The role of oral hygiene instructions for children and parental involvement.

Okay, so you're looking at fixing something – maybe it's a wonky nose, a scar that pulls, or even just something that plain bugs you every time you look in the mirror. Thing is, sometimes these problems aren't just about looks. Maybe that nose makes it hard to breathe, that scar restricts movement, or that "little thing" is actually impacting your confidence and how you interact with the world. That's where treatments that tackle both the aesthetic and the functional come into play.


We're not just talking about a quick nip and tuck here. We're talking about solutions that understand the body as a whole. Think about reconstructive surgery after an injury. It's about restoring appearance, sure, but it's also about rebuilding function – getting things working right again. Or consider treatments for things like ptosis (drooping eyelids). Lifting those lids isn't just about looking younger; it's about improving your field of vision.


The key is finding experts who get this. Doctors who appreciate that the way something looks and the way it works are often deeply intertwined. They'll look beyond the surface and consider the underlying causes and how to address them in a holistic way. It's about finding a solution that not only makes you feel better about your appearance but also improves your quality of life in a tangible, functional way. It's about hitting two birds with one (carefully aimed and expertly delivered) stone.

* Early detection and management of periodontal problems during orthodontic care.

Let's be honest, orthodontics isn't just about straightening teeth. It's about crafting a confident smile, sure, but it's also about proper bite function, protecting long-term dental health, and, let's not forget, making sure everyone – the orthodontist, the child, and the parents – are on the same page. That last part, the communication, is absolutely crucial for achieving the best possible outcome, especially when juggling aesthetic desires with functional needs.


Think of it like this: the orthodontist brings the technical expertise, understanding the biomechanics of tooth movement and the nuances of jaw development. The child, well, they're often the ones who have to actually wear the braces or aligners, day in and day out. And the parents? They're the cheerleaders, the enforcers (of brushing, flossing, and appliance wear), and the financial backers. If these three groups aren't communicating effectively, things can quickly derail.


Imagine a scenario where the child is primarily concerned with the appearance of their teeth, wanting that "Hollywood smile" ASAP. The orthodontist, however, sees a significant overbite that needs correction for long-term joint health and stability. If the orthodontist doesn't clearly explain the functional benefits of the treatment plan to both the child (in age-appropriate language, of course) and the parents, the child might be less motivated to comply with the necessary elastics or wear retainers diligently. The parents, unsure of the long-term consequences of neglecting the functional aspect, might not push the child as much as they should.


Conversely, perhaps the parents are laser-focused on correcting a malocclusion they perceive as impacting their child's speech or self-esteem. The child, on the other hand, might be resistant to braces, feeling self-conscious about wearing them. Open communication allows the orthodontist to address these concerns, perhaps by exploring more discreet treatment options like Invisalign or ceramic braces, and by helping the child understand the positive impact a straighter smile can have on their confidence.


Ultimately, successful orthodontic treatment is a collaborative effort. It requires the orthodontist to be a skilled communicator, patiently explaining the treatment plan, addressing concerns, and motivating both the child and parents. It requires the child to be honest about their feelings and challenges. And it requires the parents to be supportive, understanding, and actively involved in the process. When everyone is communicating openly and honestly, the chances of achieving both aesthetic and functional goals, and creating a truly happy and healthy smile, increase dramatically.

* Collaboration between orthodontists and periodontists for optimal outcomes.

Okay, so you're thinking about braces, right? Or maybe your kid is. And the big question always is: will they look good afterwards? That's the aesthetic piece, and it's totally valid. But what about the function? I mean, sure, straight teeth look great in selfies, but they also have to, you know, work.


Here's the thing: addressing both aesthetics and function during orthodontic treatment isn't just about a pretty smile today. It's an investment in the future, a long-term game. Think about it. When your teeth are properly aligned, you're less likely to grind them down at night. That means fewer headaches, less jaw pain, and you're preserving the enamel that protects your teeth from decay. Nobody wants to deal with expensive dental work down the road.


And it's not just about avoiding problems. Proper bite alignment also makes it easier to chew your food thoroughly. Better digestion? Absolutely. Easier to clean your teeth? You bet! Less chance of developing cavities and gum disease.


So, yeah, a beautiful smile is a fantastic outcome. But when your orthodontist focuses on both aesthetics and function, you're getting more than just straight teeth. You're getting improved oral health, better overall well-being, and quite possibly, a lot less dental bills later in life. It's kind of like getting a two-for-one deal that keeps paying off for years to come. Worth thinking about, isn't it?

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Crossbite
Unilateral posterior crossbite
Specialty Orthodontics

In dentistry, crossbite is a form of malocclusion where a tooth (or teeth) has a more buccal or lingual position (that is, the tooth is either closer to the cheek or to the tongue) than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.[1][2]

Anterior crossbite

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Class 1 with anterior crossbite

An anterior crossbite can be referred as negative overjet, and is typical of class III skeletal relations (prognathism).

Primary/mixed dentitions

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An anterior crossbite in a child with baby teeth or mixed dentition may happen due to either dental misalignment or skeletal misalignment. Dental causes may be due to displacement of one or two teeth, where skeletal causes involve either mandibular hyperplasia, maxillary hypoplasia or combination of both.

Dental crossbite

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An anterior crossbite due to dental component involves displacement of either maxillary central or lateral incisors lingual to their original erupting positions. This may happen due to delayed eruption of the primary teeth leading to permanent teeth moving lingual to their primary predecessors. This will lead to anterior crossbite where upon biting, upper teeth are behind the lower front teeth and may involve few or all frontal incisors. In this type of crossbite, the maxillary and mandibular proportions are normal to each other and to the cranial base. Another reason that may lead to a dental crossbite is crowding in the maxillary arch. Permanent teeth will tend to erupt lingual to the primary teeth in presence of crowding. Side-effects caused by dental crossbite can be increased recession on the buccal of lower incisors and higher chance of inflammation in the same area. Another term for an anterior crossbite due to dental interferences is Pseudo Class III Crossbite or Malocclusion.

Single tooth crossbite

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Single tooth crossbites can occur due to uneruption of a primary teeth in a timely manner which causes permanent tooth to erupt in a different eruption pattern which is lingual to the primary tooth.[3] Single tooth crossbites are often fixed by using a finger-spring based appliances.[4][5] This type of spring can be attached to a removable appliance which is used by patient every day to correct the tooth position.

Skeletal crossbite

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An anterior crossbite due to skeletal reasons will involve a deficient maxilla and a more hyperplastic or overgrown mandible. People with this type of crossbite will have dental compensation which involves proclined maxillary incisors and retroclined mandibular incisors. A proper diagnosis can be made by having a person bite into their centric relation will show mandibular incisors ahead of the maxillary incisors, which will show the skeletal discrepancy between the two jaws.[6]

Posterior crossbite

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Bjork defined posterior crossbite as a malocclusion where the buccal cusps of canine, premolar and molar of upper teeth occlude lingually to the buccal cusps of canine, premolar and molar of lower teeth.[7] Posterior crossbite is often correlated to a narrow maxilla and upper dental arch. A posterior crossbite can be unilateral, bilateral, single-tooth or entire segment crossbite. Posterior crossbite has been reported to occur between 7–23% of the population.[8][9] The most common type of posterior crossbite to occur is the unilateral crossbite which occurs in 80% to 97% of the posterior crossbite cases.[10][3] Posterior crossbites also occur most commonly in primary and mixed dentition. This type of crossbite usually presents with a functional shift of the mandible towards the side of the crossbite. Posterior crossbite can occur due to either skeletal, dental or functional abnormalities. One of the common reasons for development of posterior crossbite is the size difference between maxilla and mandible, where maxilla is smaller than mandible.[11] Posterior crossbite can result due to

  • Upper Airway Obstruction where people with "adenoid faces" who have trouble breathing through their nose. They have an open bite malocclusion and present with development of posterior crossbite.[12]
  • Prolong digit or suckling habits which can lead to constriction of maxilla posteriorly[13]
  • Prolong pacifier use (beyond age 4)[13]

Connections with TMD

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Unilateral posterior crossbite

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Unilateral crossbite involves one side of the arch. The most common cause of unilateral crossbite is a narrow maxillary dental arch. This can happen due to habits such as digit sucking, prolonged use of pacifier or upper airway obstruction. Due to the discrepancy between the maxillary and mandibular arch, neuromuscular guidance of the mandible causes mandible to shift towards the side of the crossbite.[14] This is also known as Functional mandibular shift. This shift can become structural if left untreated for a long time during growth, leading to skeletal asymmetries. Unilateral crossbites can present with following features in a child

  • Lower midline deviation[15] to the crossbite side
  • Class 2 Subdivision relationships
  • Temporomandibular disorders [16]

Treatment

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A child with posterior crossbite should be treated immediately if the child shifts their mandible on closing, which is often seen in a unilateral crossbite as mentioned above. The best age to treat a child with crossbite is in their mixed dentition when their palatal sutures have not fused to each other. Palatal expansion allows more space in an arch to relieve crowding and correct posterior crossbite. The correction can include any type of palatal expanders that will expand the palate which resolves the narrow constriction of the maxilla.[9] There are several therapies that can be used to correct a posterior crossbite: braces, 'Z' spring or cantilever spring, quad helix, removable plates, clear aligner therapy, or a Delaire mask. The correct therapy should be decided by the orthodontist depending on the type and severity of the crossbite.

One of the keys in diagnosing the anterior crossbite due to skeletal vs dental causes is diagnosing a CR-CO shift in a patient. An adolescent presenting with anterior crossbite may be positioning their mandible forward into centric occlusion (CO) due to the dental interferences. Thus finding their occlusion in centric relation (CR) is key in diagnosis. For anterior crossbite, if their CO matches their CR then the patient truly has a skeletal component to their crossbite. If the CR shows a less severe class 3 malocclusion or teeth not in anterior crossbite, this may mean that their anterior crossbite results due to dental interferences.[17]

Goal to treat unilateral crossbites should definitely include removal of occlusal interferences and elimination of the functional shift. Treating posterior crossbites early may help prevent the occurrence of Temporomandibular joint pathology.[18]

Unilateral crossbites can also be diagnosed and treated properly by using a Deprogramming splint. This splint has flat occlusal surface which causes the muscles to deprogram themselves and establish new sensory engrams. When the splint is removed, a proper centric relation bite can be diagnosed from the bite.[19]

Self-correction

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Literature states that very few crossbites tend to self-correct which often justify the treatment approach of correcting these bites as early as possible.[9] Only 0–9% of crossbites self-correct. Lindner et al. reported that 50% of crossbites were corrected in 76 four-year-old children.[20]

See also

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  • List of palatal expanders
  • Palatal expansion
  • Malocclusion

References

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  1. ^ "Elsevier: Proffit: Contemporary Orthodontics · Welcome". www.contemporaryorthodontics.com. Retrieved 2016-12-11.
  2. ^ Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F (October 2009). "Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children". European Journal of Orthodontics. 31 (5): 477–84. doi:10.1093/ejo/cjp031. PMID 19477970.
  3. ^ a b Kutin, George; Hawes, Roland R. (1969-11-01). "Posterior cross-bites in the deciduous and mixed dentitions". American Journal of Orthodontics. 56 (5): 491–504. doi:10.1016/0002-9416(69)90210-3. PMID 5261162.
  4. ^ Zietsman, S. T.; Visagé, W.; Coetzee, W. J. (2000-11-01). "Palatal finger springs in removable orthodontic appliances--an in vitro study". South African Dental Journal. 55 (11): 621–627. ISSN 1029-4864. PMID 12608226.
  5. ^ Ulusoy, Ayca Tuba; Bodrumlu, Ebru Hazar (2013-01-01). "Management of anterior dental crossbite with removable appliances". Contemporary Clinical Dentistry. 4 (2): 223–226. doi:10.4103/0976-237X.114855. ISSN 0976-237X. PMC 3757887. PMID 24015014.
  6. ^ Al-Hummayani, Fadia M. (2017-03-05). "Pseudo Class III malocclusion". Saudi Medical Journal. 37 (4): 450–456. doi:10.15537/smj.2016.4.13685. ISSN 0379-5284. PMC 4852025. PMID 27052290.
  7. ^ Bjoerk, A.; Krebs, A.; Solow, B. (1964-02-01). "A Method for Epidemiological Registration of Malocculusion". Acta Odontologica Scandinavica. 22: 27–41. doi:10.3109/00016356408993963. ISSN 0001-6357. PMID 14158468.
  8. ^ Moyers, Robert E. (1988-01-01). Handbook of orthodontics. Year Book Medical Publishers. ISBN 9780815160038.
  9. ^ a b c Thilander, Birgit; Lennartsson, Bertil (2002-09-01). "A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition--occlusal and skeletal characteristics of significance in predicting the long-term outcome". Journal of Orofacial Orthopedics. 63 (5): 371–383. doi:10.1007/s00056-002-0210-6. ISSN 1434-5293. PMID 12297966. S2CID 21857769.
  10. ^ Thilander, Birgit; Wahlund, Sonja; Lennartsson, Bertil (1984-01-01). "The effect of early interceptive treatment in children with posterior cross-bite". The European Journal of Orthodontics. 6 (1): 25–34. doi:10.1093/ejo/6.1.25. ISSN 0141-5387. PMID 6583062.
  11. ^ Allen, David; Rebellato, Joe; Sheats, Rose; Ceron, Ana M. (2003-10-01). "Skeletal and dental contributions to posterior crossbites". The Angle Orthodontist. 73 (5): 515–524. ISSN 0003-3219. PMID 14580018.
  12. ^ Bresolin, D.; Shapiro, P. A.; Shapiro, G. G.; Chapko, M. K.; Dassel, S. (1983-04-01). "Mouth breathing in allergic children: its relationship to dentofacial development". American Journal of Orthodontics. 83 (4): 334–340. doi:10.1016/0002-9416(83)90229-4. ISSN 0002-9416. PMID 6573147.
  13. ^ a b Ogaard, B.; Larsson, E.; Lindsten, R. (1994-08-01). "The effect of sucking habits, cohort, sex, intercanine arch widths, and breast or bottle feeding on posterior crossbite in Norwegian and Swedish 3-year-old children". American Journal of Orthodontics and Dentofacial Orthopedics. 106 (2): 161–166. doi:10.1016/S0889-5406(94)70034-6. ISSN 0889-5406. PMID 8059752.
  14. ^ Piancino, Maria Grazia; Kyrkanides, Stephanos (2016-04-18). Understanding Masticatory Function in Unilateral Crossbites. John Wiley & Sons. ISBN 9781118971871.
  15. ^ Brin, Ilana; Ben-Bassat, Yocheved; Blustein, Yoel; Ehrlich, Jacob; Hochman, Nira; Marmary, Yitzhak; Yaffe, Avinoam (1996-02-01). "Skeletal and functional effects of treatment for unilateral posterior crossbite". American Journal of Orthodontics and Dentofacial Orthopedics. 109 (2): 173–179. doi:10.1016/S0889-5406(96)70178-6. PMID 8638566.
  16. ^ Pullinger, A. G.; Seligman, D. A.; Gornbein, J. A. (1993-06-01). "A multiple logistic regression analysis of the risk and relative odds of temporomandibular disorders as a function of common occlusal features". Journal of Dental Research. 72 (6): 968–979. doi:10.1177/00220345930720061301. ISSN 0022-0345. PMID 8496480. S2CID 25351006.
  17. ^ COSTEA, CARMEN MARIA; BADEA, MÎNDRA EUGENIA; VASILACHE, SORIN; MESAROÅž, MICHAELA (2016-01-01). "Effects of CO-CR discrepancy in daily orthodontic treatment planning". Clujul Medical. 89 (2): 279–286. doi:10.15386/cjmed-538. ISSN 1222-2119. PMC 4849388. PMID 27152081.
  18. ^ Kennedy, David B.; Osepchook, Matthew (2005-09-01). "Unilateral posterior crossbite with mandibular shift: a review". Journal (Canadian Dental Association). 71 (8): 569–573. ISSN 1488-2159. PMID 16202196.
  19. ^ Nielsen, H. J.; Bakke, M.; Blixencrone-Møller, T. (1991-12-01). "[Functional and orthodontic treatment of a patient with an open bite craniomandibular disorder]". Tandlaegebladet. 95 (18): 877–881. ISSN 0039-9353. PMID 1817382.
  20. ^ Lindner, A. (1989-10-01). "Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite". Scandinavian Journal of Dental Research. 97 (5): 432–438. doi:10.1111/j.1600-0722.1989.tb01457.x. ISSN 0029-845X. PMID 2617141.
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