Part Two: A Child’s Clinical Orthodontic Evaluation

When evaluating a child’s mouth, the orthodontist looks at four major areas.

1) Evaluation of Dental Development

The orthodontist checks to see how the permanent teeth are growing and coming into the mouth. There are lots of things that fall under the heading of dental development. These include:

• • Does the patient have all the permanent teeth in the mouth or plainly visible on the x-ray?
  • Are the developing permanent teeth pointed in the right direction?
  • Are the permanent teeth coming in properly or are they impacted?
  • Does it appear that there’s room for all the permanent teeth?
  • Are baby teeth being lost at the appropriate time?

All of these factors have an impact on the timing and the need for orthodontic treatment. This is where the benefits of bringing your child in by age seven become the most relevant. By identifying problems as early as possible, oftentimes interceptive measures can be used to make individual orthodontic treatment much easier and less expensive.

Question: How can a parent know if his child’s teeth are coming in normally?

Answer: There is no such thing as a normal time for teeth to come in. They may come in early or late, and still be considered normal. Just like some kids have a growth spurt early or late, it all falls within the range of “normal”. If all teeth seem to be on about the same schedule and none are out of sync with what’s happening in the rest of the mouth, the child’s development will most likely be just fine.

There are certain signs that parents can learn to recognize that something’s significantly off about their child’s dental development.

1. A baby tooth comes out, but a permanent tooth does not come in within 7-14 days.
   Ideally, permanent teeth should be visible in 1-2 days after a baby tooth is lost.
2. A tooth on the left side comes in, but the same tooth on the other side is nowhere to be seen.
   The eruption of the teeth on either side of the mouth should be generally symmetrical in timing.
3. The middle of the upper teeth don’t line up with the middle of the lower teeth or neither one lines up with the middle of the face.
   When midlines are off, it usually indicates the failure of teeth on one side of the mouth to be coming in properly.

To accurately determine how dental development is proceeding, a panoramic x-ray is essential. This x-ray shows all of the teeth and their basic relationships to each other. A panoramic x-ray is often taken at no charge as part of the initial consultation and evaluation. Any orthodontic evaluation without a panoramic x-ray should be considered incomplete.

2)    Evaluation of the Bite

Orthodontists evaluate the bite of the back teeth and the bite of the front teeth. Age seven is the ideal time to see patients because there are enough teeth present to accurately evaluate both parts of the bite. Usually, by age seven all four incisors, as well as the upper and lower six-year molars, completely erupted in the mouth.

The molars tell the orthodontist how the bite in the back of the mouth is developing, while the front teeth (incisors) tell him or her how the bite in the front of the mouth is developing. At this age, a panoramic x-ray will reveal all of the developing permanent teeth if they are present and if they are growing in the right direction.

Question: Can the growth of the mouth change some of the issues that are visible at age seven?

Answer: Surprisingly, the answer is no, because all of the growth in the jaws takes place behind the back teeth. The amount of space available essentially remains unchanged after the age of seven. This is how orthodontists can make accurate predictions of orthodontic needs at an early age.

These are just two of the four components evaluated during a child’s orthodontic consultation. We will discuss the final two points next week, so stay tuned!

Ready to schedule your consultation with Dr. John McDonald? Call (503) 585-5400 today!