Part One of a Two-Part Series
Early orthodontic evaluation allows us to guide growth, redirect eruption, and prevent more complex problems later. Below are two of the most important issues to identify early—paired with the interventions that make a difference.
Anterior Open Bites & Habit / Airway Intervention
What to Watch For:
- Persistent open bite in the primary or mixed dentition
- Thumb, finger, or tongue habits
- Mouth breathing or suspected poor sleep and breathing
- Lack of incisal contact even with proper closure
Why It Matters:
Anterior open bites can affect vertical growth and facial development. Airway concerns and habits often coexist and may worsen skeletal patterns over time.
What Early Treatment Looks Like:
- Habit-breaking appliances or targeted habit intervention
- Myofunctional therapy when indicated
- Airway screening and ENT collaboration as needed
- Early open-bite correction to reestablish normal function and growth patterns
Case Example:
Patient presented at age 8 with persistent thumb habit with tongue thrust, creating a narrow maxilla with anterior openbite and poor maxillary incisal show when smiling. Phase I treatment included a maxillary expander with thumb crib, followed by maxillary and mandibular limited braces. After 10 months of treatment, both the thumb habit and anterior-open bite were resolved. She may not require any further treatment.
Click on images to see full size.
Posterior Crossbites & Early Skeletal Correction
What to Watch For:
- Single-tooth or multiple-tooth crossbites
- Functional shifts or mandibular deviation
- Narrow maxilla in mixed dentition
- Asymmetric wear patterns
Why It Matters:
Crossbites often indicate underlying skeletal imbalance. Left untreated, they can contribute to asymmetric facial growth, worsening occlusion, and long-term TMJ strain.
What Early Treatment Looks Like:
- Maxillary expansion (RPE or appropriate device)
- Functional shift elimination
- Establishing symmetric growth patterns
Case Example:
Patient presented at age 10 with unlateral posterior crossbite with midline shift. Dental midline and facial midline assymetries were noted. She was treated with a maxillary expander and braces to correct transverse discrepancy. After 7 months of treatment, both dental and facial midlines are improved and symmetric growth is expected to occur.
Click on images to see full size.
A Final Note on Referrals
No referral is a bad referral. All children should be evaluated before age 9, even with a normal-appearing occlusion. Underlying concerns—airway problems, skeletal growth discrepancies, or eruption pathway issues—may show no obvious intraoral signs early on.
Evaluating eruption pathways early is essential. When permanent teeth are congenitally missing, an early orthodontic–restorative plan can reduce the need for extensive restorative work later and lead to the best long-term outcome.
Case Example:
Patient presented at age 11-5 with no clinical signs of crowding. On panoramic radiograph, it is clear maxillary canines are likely to be impacted with no intervention. I recommended removal of the primary canines with no other orthodontic intervention. 6 months later, the eruption pattern was favorable so continued monitoring was appropriate. After 1 year, canines were fully erupted and comprehensive orthodontic treatment was initiated.
Click on images to see full size.
Additional Early Problems & How We Treat Them
Read Part Two on this Series.