The very first orthodontic consultation has to fulfil several purposes. First of all, patients’ general dental health and oral hygiene are evaluated, malocclusions manifesting as abnormal jawbone growth and development are detected, tooth alignment and facial profiles are analysed during childhood, adolescence and adulthood.
The first orthodontic consultation ought to take place between four and five years of age while primary teeth are fully grown, since several pathologies can be diagnosed early and their evolution can be monitored.Early diagnosis is fundamental to check and eliminate certain types of malocclusions or to prevent them from deteriorating.
Early detection refers to secondary prevention aimed at neutralising or containing the negative effects produced by risk factors already affecting patients.
The following malocclusions require early detection:
- Negative overjet or underbite (third class) which leads to an abnormal mandibular growth preventing the correct mechanical growth and development of the upper jawbone.
- Unilateral cross bite. During growth, this causes a vertical and transversal maxillary asymmetry.
Other pathologies can be diagnosed during dentition (deciduous or permanent):
- Lack of space: early loss of primary teeth is likely to prevent the correct permantent teeth alignment because the surrounding teeth move along the arch where space is available causing crowding.
- Overjet: requires treatment during mixed dentition when it’s caused by skeletal imbalances necessitating orthopaedics devices.
- Overbite or deep bite: when the upper front teeth protrude over the lower front teeth more than 3 mm. Severe cases require orthodontic consultation.
- Open bite: an insufficient vertical overlap of the teeth casued by incorrect oral habits.
Orthodontic therapies can be divided in two phases: the first phase constists of detecting skeletal and dental imbalances which may otherwise require more complicated and longer treatment in the future. Such early treatment phase does not eliminate the potential need for further orthodontic treatments when permanent dentition is complete; however, it makes them easier and improves their results.
Generally, when malocclusions of skeletal origin occur, the later treatments are undertaken, the less successful they will be. Indeed, dental orthopaedics is most successful during developmental age, wheras when development is complete the number of available treatments is considerably limited.
However, severe malocclusions can be treated through maxillofacial surgery. The American Association of Orthodontists recommends an orthodontic check up for children under seven years of age so that orthodontists may determine whether crowding or other types of malocclusions may occur when permanent dentition is complete.
In case of early orthodontic treatment, the latter can work so as to preserve or create the necessary space for erupting teeth and breaking potentially bad oral habits.
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