Common Misconceptions about Braces and Invisalign (Part 1)

Everyday at Meadows Orthodontics, we explain to our patients how braces and Invisalign work. There are a number of common misconceptions that keep coming up, so I thought I would write an article with a list that addresses these issues.

  1. “As an adult, I am too old to get my teeth straight, or my bite fixed”.  This is not the case! There are a number of skeletal issues that are best treated as child, but most tooth alignment issues can be treated fully, or significantly improved as an adult. In fact, over 20% of our new patients are over 30 years old!
  2. abo logo“All orthodontists are Board Certified, right?”  Absolutely not! In fact, just over one in three are Board Certified by the American Board of Orthodontics (ABO). Dr Rejman is one of the few Orthodontists that are board certified in Douglas County. Finding a board certified orthodontist helps to ensure they are committed to the very highest standards of the profession. To learn more, visit AmericanBoardOrtho.com, which includes a list of board certified orthodontists when you enter your zip code.
  3. “Braces are so expensive that I cannot afford them”. We understand the that this may be the thought when considering braces or Invisalign, but we offer fantastic, interest free, in house financing to get that smile you have been wanting. We also participate with most insurances, which combined with flex and HSA plans can reduce fees by over half!
  4. “I had braces, then when my wisdom teeth erupted, they caused misalignment of my front teeth”.  This is one that I hear all the time.  Research has shown that wisdom teeth DO NOT push the teeth in front of them forward and cause crowding. In fact, even if you never had braces, teeth tend to crowd as you age (especially the lower teeth).  Teens also tend to stop wearing retainers around college age as they get out of site from their parents- this coincides with the age that wisdom teeth normally try to erupt. It is the lack of retention that is to blame, not the wisdom teeth erupting! Which leads us to…
  5. ©Blue Moon Studio, Inc.“After several years of retainer wear, my teeth will stay straight and stable“.  Every day we let our patents know that to maintain straight teeth, retainers must be worn for life! The good news is that do not need to be worn during the day, and as you get older several nights a week of routine wear is usually adequate.
  6. “I described to my child what braces felt like when I was a kid/teen. Sorry mom or dad… your child’s treatment will be a much more comfortable and fun experience than when you has orthodontic treatment! Advanced in braces, wires, digital technology that replaces the goopy impressions of old, many fun color choices…the improvements since we were kids goes on and on. The orthodontic version of “When I was a kid, I walked uphill to school both ways!”.

Dr. Dan Rejman and his wonderful staff are setting the standard in quality and fun in Castle Rock and the surrounding areas when it comes to Braces and Invisalign. Please contact us if you have any questions.

A Guide for Halloween Candy and Braces

jack-o-lanternHalloween is such a fun time for children, with costumes and candy. For kids with braces, it can be tough to judge what candy may harm their braces. I tell my patients that for this night, it is OK to enjoy some treats, but to follow some guidelines. Here is a list of common candies that are acceptable and not recommended.

Absolute No- No’s:     Candies on this list are either really hard, extremely chewy, or have a consistency that will likely damage your braces.

  • Jolly Ranchers or hard candy
  • Taffy or hard caramels
  • Starburst
  • Now and Laters
  • Tootsie rolls
  • Sugar Daddies
  • Pay Days (or anything with full nuts)

Acceptable as Treats:     These candies are acceptable (as limited treats only!), especially if they are broken into smaller pieces.

  • Chocolate, Hershey’s Kisses
  • Most soft candy bars (Milky Ways, Three Musketeers, and Snickers and Twix in small pieces)
  • Fun dips
  • Lolly Pops- just don’t bite into them!
  • Reese’s Peanut Butter Cups

In general, break things into small pieces, chew lightly, and consume sugar in moderation!

 

Dr. Dan Rejman is a Board Certified Orthodontic specialist, and is the owner of meadows Orthodontics in castle Rock, CO.

Deciding what Type of Retainer to Wear

When the time has come to where you have almost completed treatment with  braces (or Invisalign), Dr. Dan will help you decide which retainers will be best for you and your bite. There are three main types of retainers that we offer (four including Invisilign Vivera retainers), and each has distinct advantages that different people prefer. Her is a description of each type to help you decide which retainer is best for you!

  • essix-header1Vacuum formed retainers:  Vacuum formed retainers are what is referred to as  “essix”clear retainers”, or “clear trays” by most patients. This retainer is made by vacuum forming clear plastic over a stone model of your teeth. Besides being comfortable, the advantage of this type of retainer is its clear appearance. Both upper and lower trays can be worn without them being seen (unless people are REALLY up close!). Kids and teens seem to really like wearing this type of retainer because of the way they look, and how easy they are placed. A relative downside compared to other retainer types is that longevity is usually less than the ones listed below.
  • A subset of vacuum formed retainers are Vivera Retainers, which are made by the Invisalign company. These are clear vacuum formed trays, but they come in a package with 4 sets of retainers, which addresses the longevity issue. When one set wears out, you move right to the next one. Vivera can be a nice option for people that grind their teeth at night, as there is full coverage over the biting surface.
  • Hawley retainers:  This type of retainer is the traditional type that usually comes to mind when picturing a retainer. Hawley retainers are Hawleymade of acrylic that is custom formed to the palate and inside of the upper teeth, and along the inside surface of the lower teeth. There is usually a metal “bow” that is formed to the outside surface of the upper and lower teeth. Hawley retainers have several advantages. They can be modified to stay in your mouth really well if this is an issue with the vacuum formed retainers, and they are very durable (they should last for years id well cared for). Depending on personal preference, some people like the feeling of their teeth being more “free”, as Hawley retainers do not fully cover the teeth like vacuum formed retainers. The acrylic can also be customized in any color, design, with glitter… the choices are endless! Relative downsides of this retainers is the visible metal bar across the front of the teeth, and a fuller feeling on the tongue side of the teeth.
  • BLR Intra oralBonded retainers:  Bonded lingual (which means tongue side of the tooth) retainers are tiny wires that bond permanently to the inside surface of the front teeth. Bonded retainers can almost always be used on the lower teeth, but due to the way teeth fit together, often they cannot be used on the upper teeth (Dr Dan will let you know where they will work for you). The main advantage of this type of retainer is that it is always on, and stays for years. Lower front teeth are notorious for crowding as people age whether they have had orthodontics or not, and bonded retainers will prevent this from happening. The disadvantage to bonded retainers is also that they are permanent and bonded to the back of the teeth- and this makes it more difficult to clean and floss around them. Because of this, I only recommend them for teens and adults who have great oral hygiene.

I hope this helps with the decision of choosing a retainer!

 

Dr. Dan Rejman is one of the few orthodontists that are Board Certified in Douglas County, Colorado. Meadows Orthodontics is located in the Meadows in Castle Rock, and will soon be opening another location in the Founders Marketplace in East Castle Rock.

What to expect with Early (Phase 1) Orthodontic Treatment

In the last blog, I addressed why early treatment (often called Phase 1 treatment) may be recommended, and the conditions that often require early intervention. As a summary, early treatment has been recommended by Dr. Rejman only if a window of opportunity will be missed pinterest-child-need-braces(due to age and skeletal growth patterns) that will negatively affect a child’s facial structure, bite, esthetics, or periodontal support (tooth stability).  Orthodontists undergo years of study focused on craniofacial growth and development, and there is considerable variation in age regarding dental and skeletal maturity between children.  Dr. Rejman will inform you when we can best take advantage of this growth, and will let you know when the optimal time is to begin treatment. Orthodontic treatment and a child’s growth
should complement each other if it is timed properly.

If early treatment has been recommended for your child, here is what to expect:

• Because early treatment occurs during the mixed dentition (when both “baby” and “adult” teeth are present), treatment does not involve a full set of braces. We often use a limited number of braces to achieve the desired correction, in conjunction with other devices such as an expander and appliances designed to improve the relationship the child’s upper and lower jaws. It is sometimes advantageous to have several baby teeth removed if there is a severe issue with spacing or improper tooth eruption.

200265569-001 Because Phase 1 is problem focused, we like to be as efficient as possible, and remove the appliances and limited braces once the problem has been addressed. Phase 1 treatment can be as short as 6 months (for dental based interceptive issues), to more than a year for more difficult skeletal issues (such as underbites).

• Retainers will be fit to maintain the correction that has been achieved while we wait for the permanent teeth to erupt. We use a number of different retainers to maintain the correction of different problems. The nice thing for kids is that retainers are usually only worn at night while they are sleeping.

• Often retainers will stop fitting correctly as more permanent teeth continue to erupt, and retainers after Phase 1 are relatively temporary for this reason. Dr. Dan checks the patient’s bite every four to six months during this period and will let you know when it is time to stop wearing this retainer (this is usually when they are ready for the full set of braces).

• Early treatment is very problem focused, and Phase 1 is only meant to address a specific concern that needs immediate attention, not align the entire dentition.  We use the name “Phase 1”, because it implies that there will usually be a “Phase 2” when a full set of braces is used to align the full set of adult teeth when they have erupted. This usually occurs between the ages of 10-14 years old (there is considerable variation in physical and dental maturity and development in children!).
I hope this answers many of the questions that you may have regarding your child’s development, and early treatment if it has been recommended.

 

Dr. Dan Rejman is a Board Certified Orthodontic Specialist, and is the owner of Meadows Orthodontics in Castle Rock, Colorado.

 

About Phase 1 Orthodontic Treatment

A while back I wrote an article titled, “Why do I see so many eight year-olds in braces these days?” I believe it is imperative that a parent knows why early treatment has been recommended by an orthodontist, as there should be a clearly defined reason that treatment cannot wait for one comprehensive phase when the majority of the permanent teeth have erupted.

The questions I ask myself when evaluating a younger child’s facial and dental development before all of their permanent teeth have erupted are:

  • If I do not treat this patient now, will a window of opportunity be missed that will negatively affect their facial structure, bite, or esthetics in the future?
  • If we do two phases of braces, will I achieve a better or more stable result than if we treated with one phase?
  • Will the patient look or function differently as an adult if we treated in one phase versus two?

If the answer to any of these questions is “yes”, then early, or phase 1 treatment may be indicated. Whenever possible, I prefer to treat patients in a single phase of treatment (this is not always the case with all orthodontists), because a second phase is usually needed to fully align the teeth when the child is older. When early treatment is recommended, I like parents to know exactly why. Here are the most common reasons (it important to note that I see many of these cases, but they are not the most common types of jaw/dental orthodontic problems- more about that later!)

  • Posterior-Crossbite3Posterior crossbites with a functional shift.  Posterior crossbites are when the back teeth are biting on the wrong side of one another, usually due to an upper jaw that is too narrow compared to the lower jaw. Why is early treatment recommended?  Early treatment is recommended if the lower jaw is shifting to one side for the child to find a comfortable bite. If left untreated, this can result in permanent asymmetric lower jaw growth to one side. If your child has a posterior crossbite without a shift, I will discuss the magnitude of the problem with your family- not all posterior crossbites require early treatment!
  • underbite-beforeAnterior crossbites due to skeletal growth issues.  Anterior crossbites are when the lower front teeth are located in front of, or edge to edge with the lower teeth. If this is caused by the lower jaw growing too much or the upper jaw not enough, early treatment is almost always recommended for these cases (unless it is so severe that facial surgery is the only option). Teeth will often tip to try to compensate for this growth, and it is possible to not have full crossbites, but have the skeletal pattern detected early (my youngest daughter has this  skeletal pattern).This type of bite is one of the most complicated and difficult types of treatment, and is distinctly different than teeth that have merely erupted in the wrong place. Why is early treatment recommended?  Underbites that are skeletal in nature usually become more severe as children enter their adolescent growth spurt. We try to reduce or eliminate the need for a surgical correction, or identify surgical cases as early as possible.(Please ask about previous articles that I have written about the complications with this type of skeletal pattern).
  • crowding 4Severe crowding that leads to impacted teeth, severe misplacement, or compromises the periodontal (gum) structures hold the teeth stable.  Crowding and misaligned teeth are the most common reasons that patients seek orthodontic treatment, but only a minority need early or phase 1 treatment. This is where it is up to the ethics and integrity of the orthodontist to properly guide the family, and not to treat early because it is good for the practice’s bottom line. But at times, teeth cannot even enter the mouth due to crowding, and treatment is indicated. Why is early treatment recommended? If teeth cannot enter the mouth, or are in extreme positions, Phase 1 treatment may be needed. Examples include canines that are becoming impacted (an would need a future surgery to correct without intervention), incisors and premolars that cannot enter the mouth properly, loss attachment (gums and bone) on the lower front teeth, or severely protruding upper teeth (often from thumb sucking) that is a clear trauma risk. Other reasons can include severe deep bites where the lower teeth are biting against the top of the mouth, severe open bites or permanent teeth that are becoming excessively worn at an early age. I will show parents the specific problems present, and relate them to the three Phase 1 criteria listed above if I believe that phase 1 treatment is needed for these reasons.

Now, just as importantly, things that should not require early, or Phase 1 treatment:

  • crowding 3 Most crowding, spacing and misalignment of teeth at an early age. As stated above, these are the most common reasons children are brought in for an exam, and the vast majority do not need early treatment for this reason. Why not?  Simply put, most crowding, spacing and misalignment is most efficiently, and just as effectively treated when the majority of permanent teeth have erupted (usually ages 10-13 for girls, and slightly later for boys). If possible, less time in braces is healthier for the teeth and gums, reduces family stress (retainers are needed to hold phase 1 corrections until kids are ready for full braces), and reduces “burnout” from being in treatment too long. Also, space can be gained from skeletal maxillary expansion anytime before the maxillary suture fuses, near the end of the adolescent growth spurt (early teens for girls, mid-teens for boys). Again, proper, well informed guidance is needed to not treat too early, or at times too late– once the maxillary suture fuses expansion is no longer possible.
  • overjet 2Excessive overbites (Orthodontists and dentists refer to this as “Overjet”).  Overjet is actually the term for how far the upper teeth stick out forward from the lower teeth, and this is the second most common concern I see for young kids in my practice. The vast majority of kids with this issue do not need phase 1 treatment. Why not? Vast amounts of research have shown that correction of this issue is most efficiently treated in one phase of treatment, usually during the adolescent growth spurt, and when most of the permanent teeth have erupted. Now, I do see a number of kids each year where the overjet is severe and they are having social problems, and there is a clear risk of trauma to the upper teeth and lips. In these relatively few cases, early treatment is certainly indicated.
  • opgggUpper canines (and other teeth) that are erupting at an angle when seen on a radiograph.  I often hear parents say this was the reason their kids received early treatment, but this is usually not an indication for phase 1 treatment. Why not?  Early treatment should only be started for this reason when the canines have started to actually cross over the roots of the neighboring incisor teeth, or are otherwise severely off course. Canines that are erupting at an angle is usually age appropriate.

My next article will explain what to expect from Phase 1 treatment if it is needed, what to expect immediately after the treatment (retainers), and how early treatment is related to full braces when your child is older.

Dr. Dan Rejman is the owner of Meadows Orthodontics, a private specialty practice in Castle Rock, Colorado. He has treated over 6,000 patients with braces and Invisalign, and has been Board Certified since 2007.

Starting with a Rapid Palatal Expander (RPE)

Kuhlberg - RPE 1A rapid palatal expander (RPE), is very commonly used in orthodontics as a means to gain space for crowded teeth, and to correct crossbites. This device may look a bit intimidating, but treatment with an RPE is actually very gentle and is usually quite comfortable for the patient. Here is what to expect if Dr. Dan recommends an expander for your child.

  • Placing separators: Dr. Dan will check if there is enough space between the upper molars to comfortably and accurately fit bands around these teeth. If the teeth are really tight together, we will place “separators” in between the back teeth to create a small space. Patients often describe separators as feeling like there is food caught between their teeth for several days. If the separators fall out with several days off being placed, let us know-you may need new ones placed. If it is only several days until the next appointment, you don’t need to call us!
  • Band fitting appointment:  Bands are like “rings” around the upper molars, and act as an anchor to keep things in place and stable. We will find the exact band that is the right size for your teeth. We will then take an impression of your teeth with the bands on them, remove the bands, and send everything to a lab where your expander is created. Your expander is custom for your mouth only, and it takes about two weeks make.
  • Appointment for placing the expander: At this visit, your expander will be delivered by cementing or bonding it to your upper teeth. We will teach parents how to turn the expander at home, and let them know how many turns are needed. We will also discuss hygiene and diet tips for keeping the expander secure and clean.
  • First expansion check appointment: After a week or two (depending on the amount of expansion Dr. Dan determines is needed) you will return, and Dr. Dan will check to make sure the amount of expansion is just right. Sometimes he will ask for several more turns to be made.
  • Your RPE will stay in place (without turning) for 6-9 months: This gives the maxilla, or upper jaw, time to remodel and make the changes remain after the expander is removed. We often slightly over-expand to account for relapse that usually occurs after the expander is removed.

Common questions and concerns

Kids are usually surprised that there is relatively little discomfort associated with the above appointments. Separators usually cause soreness for several days after they are placed, and there is a pushing sensation when we fit the bands. Patients most commonly report a “tight” sensation for several minutes after their parents turn the expander, but pain is relatively rare. Also, expect a small space to form between the front teeth (a sign that the upper jaw is expanding!).  If your “S” sounds are a bit slurred when speaking, read out loud as often as you can, and in several days your original speech will be very close! If you have any concerns at all, give us a call- we are always happy to answer any questions you may have!

Dr. Dan Rejman is the owner of Meadows Orthodontics, and is a board certified specialist in orthodontics and dentofacial orthopedics. Meadows Orthodontics serves patients from Castle Rock, Castle Pines, Franktown, Elizabeth, Larkspur, Parker, Highlands Ranch and Lonetree.

How to finish your braces faster!

Kids are generally really excited to get started with their braces, but about half way through their treatments, they get just as excited to finish and have the braces removed. I get asked, “Is there anything that you can do to get the braces off sooner?”  Here are some tips to help get you finished up as quick as possible.

  • Wear your rubber bands (elastics) exactly as directed by your orthodontist! This is by far the elasticslargest contributor to moving along as planned, and getting your braces off as quick as possible. If I ask you to wear elastics 22-23 hours a day, and they are only worn an average of 12 hours, treatment will likely take over twice as long as it normally would. That means what would have taken 18 months may take over 2-3 years! Start off immediately with great rubber band wear, and often you will finish faster than what I estimated at the start.
  • Related to this…doubling up your rubber bands will not make things move faster. In fact, just the opposite occurs, as too heavy a force placed on teeth can make them move slower! I usually see this after rubber bands were not worn for several weeks, and kids are attempting to “catch up” before their next appointment. Your orthodontist wants things to move as efficiently as possible, and will direct you to wear the elastic that is most ideal for you.
  • Keep your teeth and mouth really clean! A really clean mouth has less images4inflammation, and this can help your teeth move faster. Cleanliness leads to gums that do not bleed, which helps the braces stay on the teeth better, resulting in less broken brackets and less emergency appointments (along with better breath and less permanent staining on teeth).
  • Come to your appointments as scheduled! If you miss appointments, you are delaying the next step in your treatment. Sometimes life happens and you have to miss an appointment. We understand this – but try to re-schedule as soon as possible.
  • Be careful what you eat, and how you eat with your braces on. Eating foods on the “no-no list” can cause the brackets to come loose and temporarily stop tooth movement until it can be repaired. Avoid really sticky, crunchy foods, and slow down while you are eating meals to ensure less breakage!

Do your best to follow the above tips, and you will be out of your braces with an amazing smile in no time!

Dr. Dan Rejman practices and lives in Castle Rock, Colorado. He is the owner of Meadows Orthodontics, and has been Board Certified by the ABO since 2007.

“Why does my child grind their teeth at night?”

images (2)During the course of an initial orthodontic consult, we discuss whether parents notice if their children grind their teeth at night. Surprisingly, a large percentage of parents report that they can actually hear their kids grinding, which can often be alarmingly loud. I remember being able to hear my daughter grinding her teeth from outside her room when she was 8-9 years old! It is normal to wonder if this is something to be concerned with, and if it will do any short or long term damage.

Bruxism, or bruxing, is the medical term for grinding teeth, and sleep bruxism is grinding teeth at night. Ginding at night is considered a sleep-related movement disorder, and although a large percentage of the population grinds their teeth at night, the frequency and severity varies from mild to severe. Signs and symptoms of bruxing include teeth with enamel wear or chipped edges, sore jaw muscles, headaches or what may feel like an earache, and tooth sensitivity. Sometimes their are no symptoms, and other household members just hear the grinding! There is not a well established link between bruxing and long term TMJ disorders, but it certainly can be a contributing factor.

images (1)The causes of bruxing are not completely understood, but the following may be causes or triggers: Emotionalcauses such as stress, anxiety and anger; A response to pain such as headaches or teeth erupting; Abnormal alignment of the teeth such as severe crossbites; genetic causes and related sleep disorders such as sleep apnea and snoring; sometimes there is no apparent cause at all. Bruxing is most common in young children, and most kids will outgrow it as they age. However,if you feel that the grinding is excessive and is becoming a concern, options include:

  • Informing your dental professional at your next visit. I check for signs of tooth wear, sore “chewing” muscles, and a history of headaches in the early morning upon waking.
  • Identifying causes of stress and anxiety. Addressing these issues can often reduce the frequency and intensity of grinding.
  • For adults, try reducing caffeine, smoking and alcohol intake.
  • In severe cases, we can make a splint, or night guard, to protect your teeth. Wearing a night guard before all the permanent teeth have erupted is often difficult, as kids go through stages of loosing and gaining new teeth. This makes fitting a night guard that will fit securely in their mouth difficult to impossible depending on their dental development.
  • If a bruxer is currently in braces or orthodontic treatment, teeth are actively moving and they often have to wait until the braces are removed to get a night guard that will stay secure long-term. Once the braces are removed, I will review special retainer options for my patients who are bruxers. Night guards can be incorporated into retainers quite nicely!
  • Orthodontic treatment itself may not always reduce the amount of grinding, but it certainly can help reduce wear on teeth that are wearing or chipping. I will determine if any teeth are wearing excessively or disproportionately (patients can often see uneven wear on their front teeth before starting treatment), and I will make a plan to move teeth to minimize wear. You may hear me checking for “canine guidance” and “interferences”… I will let you know that that means if you are interested!

Dr. Dan Rejman is an orthodontic specialist in Castle Rock, Colorado. He is the owner of Meadows Orthodontics, and has been Board Certified by the American Board of Orthodontics since 2007.

 

 

The Genetic Influence of Facial Structure and Tooth Development

I just returned from the College of Diplomates of the American Board of Orthodontics annual summer meeting. I attended four days of speakers presenting research related to how genetics influences the treatment of our orthodontic patients.  Topics included the genetic influence on temporomandibular disorder (TMD), obstructive sleep apnea (OSA), missing and malformed teeth, external apical root resorption (roots of DNA - Molecule of Lifeteeth becoming shorter during braces), and the latest research on a possible connection between missing upper lateral incisor teeth and an increased risk of ovarian and colorectal cancer. I will write a separate blog about several of these topics individually, but below are some interesting points about genetics.

  • The human genome contains 3.2 billion (!!) base pairs, or chemical nucleotides.
  • There are approximately 25,000-30,000 human genes, which are the smallest units of “instructions”.
  • 99.9% of the human genome sequence is the same!
  • Genetic variation can often arises from what is called a SNP (“snip”), a single nucleotide polymorphism. One nucleotide change within a gene can result in no discernible change, or can result in a change in phenotype (an observable trait, characteristic, shape, etc…)
  • Tooth development, or odontogenesis, involves over 300 genes.
  • Sporadic changes, or snips, in the genome can cause dental agenisis (failure to develop, or missing teeth), or a change in the size or number of teeth.
  • About 2-9% of the U.S. population has hypodontia, or teeth that are developmentally missing.
  • Genes such as AXIN2 and PAX9 have been identified as genes that can contribute to a family history of teeth that are missing.

I will follow up with an article on the genetic influence on obstructive sleep apnea, and its ramifications on orthodontic treatment.

Dr, Dan Rejman is a Board Certified Orthodontic Specialist. He practices in Castle Rock, Colorado, and treats children and adults with braces, clear braces, and Invislaign.

Early Orthodontic Correction of Posterior Crossbites

I see many young patients who have what is called a posterior crossbite, and it is important for parents to understand why certain crossbites should be corrected at an early age. Basically, a posterior crossbite means that the back teeth are located on the wrong side of one another. As an orthodontist, I determine what the cause of this problem is, if the crossbite is causing the lower jaw to shift to one side, and if this issue needs early correction before they are ready for a full set of braces. Usually a crossbite that is causing a shift should be corrected as early as it is detected (when the permanent teeth start to erupt), and I like parents to know why.

Constriction-palatine-glissement-fonctionnel-KaVe-iof-en-RC-orthodontiste-Chamberland-QuebeccrossbiteA common cause of crossbite is an upper jaw (maxilla) that is narrow in contrast to the lower jaw (mandible). As the lower jaw and it’s teeth close in a straight path, it contacts the upper teeth and they do not “fit” correctly. This is an uncomfortable feeling, and the child shifts their jaw to one side to find a comfortable place to bite. We call this a “unilateral posterior crossbite with a functional mandibular shift.” Several issues to note about this shifting:

  • The shift to one side becomes habitual, and the child’s neuromusculature becomes adapted to the new position.
  • This new shifted position causes the condyle (the uppermost portion that is apart of the TMJ) of the lower jaw to push upward and backwards on the side of the crossbite, whereas the condyle on the other side is pushed forward and downwards.
  • This change of position causes compression (pressure) on the crosbite side, and tension (pulling) on the non-crossbite side.
  • If left long enough in this position, remodeling of the condyle (upper portion of the lower jaw) and glenoid fossa (the “socket” portion of the skull and TMJ) can occur. Specifically, less bone grows on the crossbite side, and more bone grows on the other side.
  • This asymmetric mandibular growth can cause facial disharmony and functional changes in the masticatory (chewing) muscles. Other than the obvious aesthetic and facial symmetry issues, the effects on TMJ disorder are still being researched.

It is interesting to note that the correction of the lower jaw’s asymmetric response to the narrow upper jaw is to symmetrically widen the upper jaw. If treated young enough (before the upper jaw’s mid-palatal suture fuses), the lower jaw will go back to biting in line with the middle of the upper. Unfortunately, I see older patients in their mid to late teens and adults who no longer can be corrected with orthodontics alone, and jaw surgery is the only way to correct the skeletal imbalance that has occurred. If there is any question at all about your child’s bite, give me a call an I will be glad to take a look and discuss if early treatment is indicated.

Dr. Dan Rejman lives and practices as a Board Certified Orthodontic Specialist in Castle Rock, Colorado. He is a proponent of treating children with braces at the proper age (some younger, some later!), dependent on their unique facial and dental relationships.