CONFUSED WITH YOUR KIDS DENTITION....... WE WILL ACKNOWLEDGE YOU ABOUT THE NEED FULL

Good evening all,,, warm greetings to you all…. We are back with a new topic which will mostly sort out the issues related to your children’ oral health.

 

                                            MIXED DENTITION

·         Dentition containing both primary and adult secondary teeth.

·         Usually occurs between 6 and 13 years of age also called “transitional dentition.”

Now let’s discuss the features of mixed dentition and what’s normal and abnormal in children’s dentition and some frequently occurring doubts in parents mind about their children’s dentition………

Is spacing is normal in your child’s teeth?

The answer is exactly yes…..  Spacing is normal between the anterior teeth in the deciduous    dentition. Lack of spacing in the deciduous dentition may be a cause for concern, since crowding of the permanent dentition is a likely sequel.

The transition from deciduous to mixed dentition……….

The transition from the deciduous to the mixed dentition begins at around the age of six with the eruption of the lower central incisors of the first group of permanent teeth to erupt, the most likely to go astray is the upper central incisor. The permanent incisors and canines are usually larger than the corresponding deciduous teeth, whereas the premolars are smaller (leeway space). The combined mesio-distal widths of the upper permanent teeth are about 3mm greater than the deciduous teeth; the lower permanent teeth are about 1mm larger than their deciduous predecessors. The extra size of the permanent teeth is accommodated in three ways:

i) Spacing of the deciduous dentition.,

ii) Growth of the alveolus and

 iii) The eruptive path of the upper incisors.

“Crooked teeth………”    WORRY about that

In the majority of children, the permanent incisors erupt into mildly crowded positions and anxious parents first become aware of CROOKED TEETH. Their alignment frequently improves with subsequent alveolar growth. Reassurance may be all that is required at this stage.

There are other aspects of normal development that can occur in some individuals:

i)                    More severe lower incisor imbrication may improve following the exfoliation of the deciduous canines and in most cases it is too early to consider the extraction of deciduous canines.

ii)                  The "Ugly Duckling" stage: described as "a fanning out of the crowns of the upper permanent incisors, particularly the lateral incisors, sometimes with a median diastema". It is caused by the position and convergence of their roots prior to the eruption of the permanent canines. The spacing usually closes spontaneously following eruption of the canines.

It is important for the general dental practitioner to recognise these characteristics of normal development so that the patient and their parents can be reassured. It is important to differentiate between a median diastema associated with the “ugly duckling” stage and other possible causes of median diastema (listed below).

 These may prompt further investigations:

i) Family/racial characteristic

 ii) Unerupted supernumeraries

 iii) Basal narrowness of maxilla

 iv) Small teeth, large jaws

v) Developmentally (congenitally) missing

 vi) Misplaced due to crowding

 vii) Peg-shaped

viii) Proclination

 ix) Abnormal fraenum

Mixed dentition period is between six to twelve years of age during which both deciduous and permanent teeth are present. During this period one can make accurate and specific prediction of future dental development and also can assess whether there will be spacing or crowding of teeth in the dental arch. In interceptive orthodontics treatment planning, it is important to predict space required and available for unerupted canine and premolars in the arch and this determination of tooth size must be done before eruption of canine and premolars by a method called Mixed Dentition Space Analysis

WHAT TO REFER FOR SPECIALIST ADVICE OR TREATMENT

The types of problems that specialists namely would prefer to see early (i.e. at 7-9 years of age), rather than late, are listed below:

1. Delayed eruption of permanent incisors, whether or not related to supernumerary teeth. Always refer to an orthodontic professional.

 2. Supplemental incisors - if you are unsure which tooth to extract.

 3. Developmental (congenital) absence: commonly affects lower central and upper lateral incisors and second premolars. Consideration must be given to the eventual position of the upper canines, if lateral incisors are absent.

4. One or more upper incisors in crossbite. This may indicate a developing Class III jaw relationship which would benefit from early orthopaedic treatment.

 5. Impaction or failure of complete eruption of one or more first permanent molars.

 6. Severe crowding.

7. Severe skeletal discrepancies - especially Class II (small lower jaw) and Class III (small upper jaw) children.

POSSIBLE INTERCEPTIVE MEASURES ……. What can be done at best….

Interceptive treatment is often the first stage of a more complex treatment plan. The aim is to aid the development of an ideal occlusion and minimize any deviation from normal. Inappropriate intervention may, in fact, complicate matters, especially if excessive space loss has been allowed to occur. If in any doubt, seek further advice.

1. Extract deciduous teeth displacing their permanent successors.

2. Balance the loss of one deciduous canine with the extraction of the contra-lateral tooth to prevent the centre line shifting to the side of the missing tooth.

3. Observe the effects on centre lines of the loss of first deciduous molars. Consider extracting the contra-lateral deciduous canine if this occurs.

4. Appliances to discourage thumb sucking at this stage are found to be less valuable than gentle discussion, encouragement and advice.

Early orthodontic assessment is used to monitor:

 1. Normal eruption of permanent incisors and first permanent molars and to investigate causes of failure of eruption. A tooth will normally erupt within six months of its contra-lateral number.

2. Presence of malocclusion i) Crowding of incisors ii) Significant displacement of incisors labially or lingually (incisors inside the bite) iii) Posterior crossbites iv) Coincidence of upper and lower centre lines v) Severe skeletal discrepancies – especially Class II cases; these may be suitable for functional appliance treatment in the late mixed or early permanent dentition.

3. Long term prognosis of first permanent molars

 4. Trauma to permanent incisors

 5. Persistent thumb or finger sucking habits

Finally, we discussed the common problems encountered with your children and for any other quires please contact the below number.

Regards,

Dr.Dilip Kumar BDS, MDS (Oral and Maxillofacial Surgeon)

Certified Implantologist (Noble Bio-care Germany)

Certified Smile Care Dentist (New York University)

Hyderabad Smiles Dental Hospital

Phone Number: 9247864642.