Diastema

Definition Aspacebetweenadjacentteeth

Etiology Normaldevelopment Geneticfactors Toothsizediscrepancies Racialfactors/characteristics Inferiorlydisplacedlabialfrenum Pathologicconditions Orthodontictreatment Otherfactors

NormalDevelopment Primarydentition

o Generalizedanteriorspacing Maxillaryprimaryteethare23mmsmallerthantheirpermanentsuccessors

o PrimateSpaces Spacesnormallypresentintheprimarydentition

70%prevalence NDBquestion:Wherearetheprimatespaces?

Mesialtoprimarymaxillarycanines Distaltoprimarymandibularcanines

Mixeddentitiono UglyDucklingStage

Frequentparentalconcern Commoninchildren913y/o

EruptionofLItipsCIcrownsawayfromeachother Thisspaceusuallyselfcorrectsasthecanineserupt

GeneticFactors Localized

o SmallPeglaterals LIthatareundersizedand/orabnormallyshaped

o Congenitallymissing/impactedteeth LIthataremissing

2ndmostcommonlymissingteeth(after3M) Spacesappearbetweenanteriorteeth,oftenwithamidlineshift

Mandibular2PM 3rdmostcommonmissing

Impactedpermanentcanine Posteriorand/oranteriorteethmaydriftdiastema Trytoteelthepermcanineinbuccalvestibuleby9y/ocantfind

getpanoifoverlapping1canineEXT Generalized

o Microdontia Syndromes

o Normalsizedteethinalargearcho Boltontoothsizediscrepancies

Affectsapprox5%ofpopulationo Iatrogenicdiscrepancy

Resultsfromvariousorthoextractionpatterns Todeterminifdescrapancyexists

o DoBoltonanalysiso Diagnosticwaxup

RacialFactors/Characteristics IncisorDiastemaprevalence

o AA>Asian>Whiteo Relatestoraciallynormativeskeletalpatterns(NHANES)data

InferiorlyDisplacedLabialFrenu Labialfrenumisattachedtoincisivepapillaatbirthmigratesapically Ifmigrationdoesnotoccur

o Thickfibersremainthroughtoincisivepapillao NotchingmaybeseenonPAo Blanchtest(notdiagnostic)

EmbryologicFactors Clefts

o Imperfectfusionofpremaxillaatmidlineo Mayresultinfailureofdevelopmentof1ormoreincisorso Adiastemaiscommonamongthesepatients

PathologicConditions Severecaries Periodx

o Reducedalveolarbonesupport Cysts

DiastemasAssociatedw/OrthoTreatment Teetharetippedintoanextractionspace

o Rootswilleventuallyneedtobeuprighted Ifnot,spacewillopenupafterbracesareremoved

RapidPalatalExpanderso Separationofthemidpalatalsuturewillcreateatemporarydiastemao Spacewillspontaneouslyclose

Distalizingapplianceso DistalizingmaxMcreatesspacePMdriftdistallyAnteriordiastemataappear

OtherFactors Rotatedteeth

o Causespacinginadjacentsites Supernumeraryteeth

o Mesiodensmaycausespacingand/orimpededCIeruption Habits

o Disruptequilibriumoftheteetho Mayproduceananterioropenbitew/generalizedspacinginmaxillaryanteriorteeth

TongueSize/Postureo Pushesagainstlingualsurfacesofteetho Shiftsequilibriumofteethbuccallyo Generalizedspacingoccurs

Diagnosis FormationofProblemList

o Isspacinglocalizedorgeneralizedo Counttheteeth(eruptedandunerupted)o Isdentaldevelopmentnormalorabnormalo Boltonsanalysis:measuretoothsizes/archperimeterandcomparew/Boltnsratioso Checkforlowfrenumattachmento Ispatientundergoingorthotreatment?

TreatmentConsiderations Small(

Considerations

Retention RemovableorFixedRetainer

o Removable Complaincedriven

o Fixed Morepermanent,butdifficulttoclean

OcclusalEquilibrationo Prematurecontactsbetweenupperandlowerincisorsgeneratesocclusalforcesthat

maycausethereopeningofspaces

TreatmentofSkeletalClassIIMalocclusion

FacialFeaturesofClassII Convexprofileasaresultof

o Mandibularretrognathism(mostcommon)o Maxillaryprognathism(occasionally)o Combination

SundayBiteo Definition:posturingmandibleforwardtomasktheskeletalanddentalmalocclusiono BesuretomanipulatethemandibleintoCRduringevaluationoftheprofileand

skeletalrelationship LipEntrapment

o Lowerlipiscaughtinupperincisors MentalisStrain

HabitualMouthBreathing Dueto

o Chronicallergieso Chronicairwayinfectionso Enlargedadenoids

Breathingthroughmouthchangespostureofhead,jaw,andtonguealteredequilibriumofpressuresonthejawandteethaffectsjawgrowthandtoothposition

Posturalchangesseeno Loweredmandibleo Loweredtongueo Headtiltedback

Skeletal/dentalchangesseeno Faceheightincreasedo Posteriorteethsupraeruptingo Mandiblerotatesdownandbacko Openanteriorbiteo Increasedoverjeto Narrowingofmaxillacrossbite

Increasedpressurefromstretchedcheeks Lowtonguepostures

DentalFeatureso AlmostallclassIIskeletalptshaveClassIImolarrelationship

ClassIIFurtherDivisionsDiv1 Div2

MaxCI Proclined RetroclinedMandibularPlane High/Stee Low

Angle pFaceheight Long ShortOther Deepbitecommon

WhydoSkeletalClassIIneedtobetreated? Theyworsenovertimeifnottreated Goodtotreatduringgrowthofchild

BenefitsofOrthoTreatment Lessdiscriminationduetofacialappearance Fewerproblemswithoralfunction

o Masticationo Speech

Lesssusceptibletoo Traumao Periodz

Betterairway

WhendoSkeletalClassIIneedtobetreated? Phasing

o 1stphase(aka:earlytreatment) Maybebeneficialforsomepts Occursinlatemixeddentitionw/eruptionofpermanent1M

o 2ndPhase(aka:fulltreatment) Eruptionofallpermanentdentition

Orthopedic(ie:nonsurgical)Correctiono Canonlybeattemptedinagrowingpatient(youonlyget1chance)treatbeforethe

majorityofgrowthiscomplete Priortopeakheightvelocity

Females=12 Males=14

MixedDentitionSignsofClassIISkeleton DistalStepinPrimary2M

o Relationshipoftheperm1Maredeterminedbyprimary2Mo Withgrowththereisusuallycusptransitioninthemolarrelationshipatthetimethe

primary2Marelosto Adistalstepwithgoodgrowthandshiftofthemolarswillatbestfinishasendonclass

II,butisunlikelytofinishasClassI

TreatmentOptionsforClassIITreatment(SkeletalCorrection) Orthopedic

o Goal Improveskeletalrelationshipbtmaxandmandthroughdifferentialgrowth

MaxgrowthrestrictedAPmandiblecatchesupw/normalmandibulargrowthduringadolescence

o Types HeadGear

Restrainsmaxgrowthtoallowmandibletocatchup Noeffectonmandteeth

o Canbegoodorbad Distalizesmaxdentition Unesthetic/somewhatuncomforatable(complianceissues)butstill

widelyused

Typeso CervicalPull

UsedforshortornormalfaceheightsduetolowerMPA

o Combo Usedforaveragefaceheight

o Highpull UsedforlongfaceheightduetohighMPA

Functionalappliances(ie:Herbst) Forcespatientstopositionthemandibleforwardtoenhance

growth Herbstiscementedintoplacenocomplianceissues

o Activator,frankel,andtwinblockareremovable Orthodontic

o Involvestheremovalof2maxillarybicuspidsClassIImolarrelationshipatendoftxo IsdentalmaskingofaskeletalproblemdoesNOTcorrectskeletoncanonlydo

w/relativelyacceptableprofileso UsuallydonewhenlittleornogrowthremainsCommonadulttreatmento Bestindicatedwith

Maxillaryprotrustion Excessiveoverjet Excessivemaxillarycrowdingw/minimalmandibularcrowding

Surgicalo Mandibularadvancemento Slidinggenioplastyo Maxillarysetbacko Maxillaryimpactiono Combinationo Extractionosteogenesis

WhichTXoption? Dependsonlotsofthings

IncidenceofMaloclusionNormal 30%ClassI 54%ClassII 15%ClassIII

1%

Summary ClassIIptspresenta3Dskeletalproblem(vertical,AP,andtransverse) Treatmentoptions

o Orthopedic Headgear Functional

o Orthodontic CamouflageviaEXT

o Surgical

DiagnosisandTreatmentofCrossbites

ClassificationsofCrossbites

Alwaysdefinedbytherelationshipofthemaxillaryteethtothemandibularteeth Types

o Anteriorvsposterior Posterior

BilateralLingualCrossbiteo Nomandibularshifto Midlinesgenerallycoincidento Lookforconstrictedmaxillaorexpandedmandibularteeth

Unilateralo Muchlessprevalentthanfunctionalcrossbiteduetoshift(ie:

rare)o Midlinesareono Causesusuallyunilateraldentoalveolarconstriction

AnteriorCrossbite TypicallyanAPproblem

o Skeletalordentalo Unilateralorbilateral

BuccalCrossbite(aka:BrodieBiteorScissorBite)o Bilateral

Theentirearchtelescopesoutandoverthemandibulararch

PtisusuallyclassIIdeepbiteo Unilateral

Unilateralmaxillaryexpansionw/orw/omandibularconstriction

Supraeruptionofmaxillaryteethverticalmaxillaryexcess

o Dentalvsskeletal Dental=malpositionofteeth(singleormultiple)duetoectopiceruptionor

crowdingoutofarch Skeletal=transverseand/orsagittaldiscrepancies

o Relativevsreal Relative:ClassIIptdoesnotnormallyhavecrossbite,butwhenplacing

molarsinClassIposition,acrossbitedevelopso FunctionalvsPseudo

Functional=alteredpostureofthemandiblefromCRcausedbyocclusalinterferencesormildmaxillaryconstrictionwhichcausesthepatienttoslideinonedirectiontointercuspateoravoidinterferences

Isthemostcommoncrossbiteinchildreno #1causeis1canines

CanalsobecausedviamaxFcuspsduetomildmaxillaryconstriction InCRmidlinescoincidentandOJisnominal InCOmidlinesoffandptdisplayssometypeofcrossbite(aka:

pseudocrossbite) Considerations

Doesthischildhaveocclusalinterferences?o ManipulatechildintoCRandwatchforshiftintoMIo Yesequilibrateocclusion

DoesthischildhaveClassImolarocclusionandnormalskeletalgrowthbuttheappearanceofmildmaxillaryconstriction?

o MayneedRPE Earlytreatmentiswarrantedtoavoiddevelopmentofskeletal

asymmetry Growthisaffectedbilaterally

o Condylaranddentoalveolarremodelingmayoccur

AdvantagesofTreatingCrossbites Improvesocclusion AllowsfornormalTMJfunction Esthetciandpsychologicalimprovement Allowsfornormaleruption Maypreventdevelopmentofamajorskeletalmalocclusion

TreatmentOptionsforCrossbites SimpleCrossbitelimitedtx

o Needtohave SufficientspaceMD Sufficientoverbitetoretaintooth Rootinnormalposition Normalcuspid/molarocclusion

o Ifabovearenotmetorpthasskeletalmalocclusionneedmorecomprehensivetxo Options

Full/limitedorthotx Crossbiteelastics/biteraisers

Hawleyretainerw/fingerspring/biteplate Usedforcorrectionof12teeth Maybeusedasaretainer

Anteriorinclinedbiteplate Idealforinterlockedincisors Shouldengagetoothat45angle Cementedw/temporarycementforeasyremoval Closemonitoringneedtoevaluatesupraeruptionoftheposterior

dentition Tonguebladetherapy

Notusedmuchanymore Requirescompliance,parentalencouragementandguidance Teethmustbeininitialstageoferuptionw/minimalinterlocing Place10mins/hourrapidresults(daysweeks)

o NeedtocorrectanteriorsingletoothcrossbitesASAP PosteriorCrossbite

o Usepalatalexpansion Mustbedoneearly(beforeage1518)bcbonyinterdigitationsform

o RPE 1accomplishedw/toothborneappliances Periodof16weeksofactivation 1turn/day(ormore)

0.25mmperturn Attemptstominimizedtoothmovementwhilemaximizingskeletal

displacement Typicallylose2533%oftotalexpansiontorelapse

Importanttoretainfor35monthstoallowsuturetoreorganizeandformnewbone

Typesofappliances Hyrax(aka:hygienic)

o Toothborne Haas

o Providesmorepalatalsupportduringexpansion/retentiono Tissueandtoothborn

o Lesshygienic Bonded

o Biteplaneeffecto Mixeddentitiono 1extracteduponremoval

TemporaryDiastemaformation Isapositivesignthatsutureformationhasoccurred Usuallyclosesspontaneouslyin12weeks Ftippingofteeth Biteopening Excessivedentalexpansion(vsskeletal)cancausefenestrationof

PMandMrootsthroughtheFcorticalbone

SkeletalClassIIIMalocclusions

TreatmentoptionforGrowingPt Attempttotxw/expanderand/orfacemaskinprepubertalyearshopethatcorrectionwill

bemaintainedo Protractionfacemask

Orthopedicappliancewhichexertsdownwardandforwardforcetomaxillausingchinandforeheadforanchorage

8oz1lbpressureperside UsuallypreceededbyRPEtoloosensuturespromotemaxillary

protraction Acceptthatskeletalgrowthpatternispredeterminedwaitforgrowthtostoptxw/

orthodontic/orthognathicsurgicalapproach

AdvantagesofTreatingEarly Helpalleviatepsychologicaltrauma Eliminateionofanteriorcrossbitesmaypreventabherrantskeletalgrowthpatterns Prognosisfororthopediccorrectionworsenspostpuberty,sotreatbeforepuberty(butNOTin

primarydentition)o Someptswhoaretxearlywilloutgrowtheirtxandwillrequiresurgerylateron

TreatmentoptionforAdultsorNonGrowingPts Dentaland/ormildskeletalclassIII

o ClassIIIelasticso Lowerincisorextraction

SkeletalCorrectiono Maxillaryadvancementormandibularsetbacko Maxillarydowngraftandtransversesurgicalexpansion(SurgicalAssistedRPE)

Orthopedicexpansioninnongrowingpt Indicatedwhenmorethan10mmexpansionisneeded MidlineosteotomyandLeFortI(minusdownfracture)

o Justuseretainerw/oexpandero Adultusuallyrequiresurgery

SpaceManagementIntheTreatmentofPreadolescentChildren

FunctionofPrimaryTeeth Mastication Esthetics Spacemaintenance

CausedofPrematureSpaceLoss Caries

o Mostcommoncause Trauma

o Maxincisorsmostcommon Ectopiceruption

o Maxillary1Mmostcommon Resorbsdistalof12Mearlyloss

Ankylosis(leadingtoEXT)o Fusionofbonetotootho LackofPDLonradiographo Clinicalpresentation

Toothappearstobesubmerging Metallicsoundtopercussion

o Morecommonwhensuccedaneousteetharemissingo Tx=EXTofankylosedtoothspacemaintenance

Congenitallymissingteetho Mostcommonnotincluding3M

MaxLI>Mand2PMo TXoptions

Maintain1teeth Replacemissingteeth EXTspaceclosure(viadriftingorothodontics)

RoleofRadiographs DetermineDentalage IDsequenceoferuption Determineamountofbonecoveringuneruptedteeth IDcongenitalabsenceofpermanentteeth

SpaceMaintenance Indications

o Preventmesialmovementofposteriorteeth(espperm1M)o Preventlingualmovementofincisors(espmandincisors)

Contraindicationso Wheneruptionofpermteethareeminentandspacemaintainerwouldimpeded

eruptiono GrosscrowdingEXTinsteado Permteetharecongenitallymissingandspaceclosureisdesired

Attributeso MaintainMDdimensionso DoNOTinterferew/eruptiono DoNotinterferew/occlusiono Simpleindesigno Easytoclean/maintain

TypesofSpaceMaintainers Fixed

o Unilateral

BandandLoop Bandprimary2Morperm1M Indications

o Maintainsspaceofprematurelost1molaro Wireloophaslimitedstrengthonlyholds1tooth

Contraindicationso PermanentincisorsareeruptedLLAisindicatedo Morethan1toothlostw/opermincisoreruptionRPD

CrownandLoop Sameindications/contraindicationsasbandandloop IndicatediftoothneedsSSC

DistalShoe Intraalveolarbladeextends1mmbelowMMRoferuptingtooth Indications

o Whenprimary2Mislostbeforeeruptionofperm1Mo PlaceverysoonafterEXTofprimary2Mo Onlyforreplacementof1Mperside

TranspalatalArch Design

o RunsacrossthevaultdoesNOTtouchthesofttissue Indications

o When1sideofarchisintactandseveral1teetharemissingontheotherside

Contraindicationso Notforbilateralspacemaintenance

o Bilateral LowerLingualArch

Preventsanteriormovementofposteriorteethandviceversa Design

o 1.5mmoffsofttissueo ATcingulumofincisorso SteppedawayfromPMs

Indicationso Bilaterallossofmandibularmolars

Contraindicationso NotfordeepbiteuseNance

MaxillaryLingualArch NanceHoldingArch

Designo Isamaxillarypalatalarchwithacrylicbuttono DoesNOTcontactanteriorteethusespalataltissueto

provideresistancetoanteriormovementofposteriorteeth Removable

o Transpalatalarch CanberemovedbyDr.notpt

o LowerLingualArch Adjustmentloopcanbeactivatedtoadvancelowerincisors

o Retainer/PartialDenture(aka:pedopartial) Usedforanteriortoothreplacement Estheticreplacement,sometimesnecessaryforspacemaintenance Indications

Whenyoucantuselingualarch Mostusefulforbilateralposteriorspacemaintenanceandperm

incisorshavenotyeterupted

Helpsreplaceocclusalfunction Goodptcomplianceandseveralclaspsareneeded Acrylicneedstoberemovedperiodicallytoallowforeruptionof

teeth

ManagementofArchLengthDeficiencies(aka:Crowding) Maintainleewayspace

o CDEexceedsthatof3,4,5(orthonumbers) Maxilla=1.5mm/side Mandible2.5mm/side

Advance/flareincisorso Maybeunstableteethhavetobeinequilibriumwithtongue/lipso Indications

Uprightincisors Crossbites

Distalizemolarso Maxillaappliances

Pendulumappliance Distaljet Nance+coilspring

o MaxillaHeadgear Distalizesmolarsw/oprotrusionofanteriorteeth Orthopediceffect Compliancedependent

o MandibleAppliances LipBumper

Removedlippressureandallowsincisorstomovefacially Alsotipslowermolarsdistally

Expansiono Maxilla

RPE Splitsthemidpalatalsuturetowidenarchgainspace 1mmexpansionisneededfor0.7mmarchcircumferencegained

o Mandible Lipbumper SchwartzPlate

Canbeunstable Limitedindicationsbcaccentuatescurveofwilson

Interproximalenamelreductiono Tools

Airrotorstipping Diamonddisk Abrasivestrips(byhand)

o Cangain34mmofspace Serialextraction

o Indicatedwhenyoucannotgainrequiredspacethroughothermethods(severecrowding)

ALD6mmEXT

o Necessaryifnonexttxwouldbedamagingtofacialprofile/periodontium Eg:lipincompetence,bimaxprotrusion,mucogingivaldefects

o Occursinmixeddentition Allowspermanentteethtoeruptoverthealveolusandthroughkeratinized

L

tissueratherthanbeingdisplacedForLo Sequence=CD4(orthonumbers)

C=allowsincisoralignment D=speeds1PMeruption

Needto1PMrootdevelopmentfirst 4=canineseruptinto1PMspace

VerticalComponent

3DimensionsofSpace Vertical

o Dimensionthathasmostamountofgrowthafterpuberty Horizontal(aka:Transverse) AP(aka:Sagittal)

InfluencesonVerticalDevelopment SpecificCauses

o Disturbancesinembryologicdevelopment Rare(

o Facialmusclesaffectjawgrowthby Formationofboneatpointofmuscleattachment Musclesroleaspartofthesofttissuematrixdirectsjawgrowthdownand

forwardo Decreasedmusclestrength

Dueto MD,cerebralpalsy,othermuscleweaknesssyndromes

Mandibledropsdownandbackexcessiveeruptionofposteriorteethandnarrowingofmaxillaanterioropenbite(usually,butnotalways)

o Alterationindiet/musclesstrengtheningexercisesaresometimesincludedaspartoftxregimen

RespiratoryPatterno Respiratoryneedsare1determinantofjaw,tongue,andheadposturealtered

respiratorypattern(ie:mouthbreathing)loweredmandible/tonguepositionchangedequilibriumofpressuresonjawandteeth

o ChronicairwayobstructionChanges Dentofacialchanges

Gingivitis Drymouth Protrudingmaxincisors Lowtongueposture Posteriorcrossbitew/vshapedmaxillaryarch

Craniofacialchanges Openmouthpostures Incompetentlips

o Shortupperlipo Evertedlowerlip

Verticalexcessinlowerfacial1/3 Cephfindings

o SteepMPA Linealonginfborderofmandible

Hitsocciputnormal Aboveocciputsteepabnormalvertical

growth Belowocciputflatabnormalforward

growtho Shortramuso Obtusegonialangle

AdenoidFacieso Isthecommontermusedforthefamiliarfacialpatternto

obstructingadenoidtissueo Inreality,anytissuecausingchronicrespiratoryobstruction

couldleadtomorphologybettertermedthelongfacesyndrome

GeneralSymptoms Restlesssleeptiredness Vacantfacialexpression Snoring Lackofscholarlyprogress Lackofwellbeing

o Etiology Adenoidhypertrophy Deviatedseptum Hypertrophicturbinates

Tonsillarhypertrophy Prolongednasalmucosainflammation(ie:chronicallergies)

o Research Airwayobstructioncausesgrowthchangesbutitisnottheonlyfactorandwe

dontknowifitiseventhemostimportantfactoro Txoptions

RefertoENT/allergist Havetoresolveairwayissuesbeforeorthotx Cantreatmedicallyorsurgicallyordonothing

Mostlikelytodoadenoidectomyastx SkeletalGrowth

o Verticalgrowthisinherited Anterioropenbites:AA>whites Deepbite:whites>AA

o VerticalExcess Ptsgenerallyhaveexcessiveeruptionofposteriorteethgoals

Controlverticalthroughmangementofposterioreruption Growthreductionthroughmandibularautorotation

TxOptions HighPullHeadGear

o 14hrdayo ControlMx1M

HPHGtoMaxsplinto Verticalcontroltoallmaxillaryteeth(notforopenbite)

Functionalappliancesw/biteblocks Surgery TADs

o VerticalDeficiency Ptsgenerallyhavereducedfacialdimensionsanddeepbites Txoptions

Incisorintrusion Posteriorextrusion Surgicalintervention

o Leforto Mandibularosteotomies

Habitso Thumb/digitsuckingo TongueThrusting

OpenBitesandHabitControlinthePreadolescentPatient

Etiology SpecificCauses

o Disturbancesinembryologicaldevelopment Ie:cleftpalate

o SkeletalGrowthdisturbances

Hemimandibularhypertrophyo ChildhoodJawfractures

75%ofchildrenw/earlyfracturehavenormalgrowth

Linguallypositionmandibularincisorso Posteriorteetheruptasjawispositioneddownwardo Anterioropenbitedevelops

Suckinghabitsaresignificantcontributortomalocclusionbutitwillnotcreateseveremalocclusionunlessitpersistswellintomixeddentitionyears

o Preschoolisagoodtimetostop Theearlieritisstopped,theeasieritistofix

o Ifstoppedin1dentitionnormallipandcheekpressurewillrestoreteethtousuallyposition

o ConstrictedmaxillaryarchistheleastlikelythingtocorrectspontaneouslymayneedRPE

Historyo Importanttofindouthowlongthishasbeeoccurring,duration,frequencyand

intensityofhabito Assesschildswillingnesstostopo Mostchildrenstopbyage34

Behaviormodificationiskey Kidhastowanttostopforbehaviormodificationtowork

Alsohavetohaveenoughduraction ExtraOralExam

o FingersandHands Checkforredness,wrinkling,andcleanlinessofdigitsinvolved

o Facialprofile Flaredincisorscancauseaprotrusiveprofileinmaxillaryregion

o Lipsandfacialmuscles Istherelipincompetenceatrest? Swallowing

IntraOralExamo FlaringandspacingofMaxillaryanteriorteetho Lingualltippedmandibularincisorso Excessoverjeto Anterioropenbiteo Assessposterior

Molarrelationship Crossbite

CephExamo Importanttodistinguishbetweendentalandskeletalproblemso Cantcorrectskeletalproblemsw/habitapplianceo Itispossibletohavehabitandskeletalproblems

ManagementofSuckingHabits Determinematurityofpt

o Ifptdoesntnotwanttostophabit,donotbegintxo Useexplanation,reason,andreward

Interventionremindertherapyo Bandaidorthumbguardo Mittens,AceBandage,SocksorGloves

ApplianceTherapyo Usepalatalcribo Removableapplianceiscontraindicatedduetolackofcompliance

PalatalCrib Preventsdigitplacementinusualpalatalposition

o Blockssensorygratificationstimuli

Preventsfurtherdistortionoftoothpositionoralveolarprocess Restrainstonguefromthrustingintoanterioropenbite Thesearereminderappliances,butifpatientdoesntwanttostop,theywont TherapeuticConsiderations

o Obtainchildsconsent/cooperation Itisimportantthatthechildunderstandsthattheapplianceisservingasa

reminder,notpunishmento Expectsomeshorttermspeech,sleeping,andeatingdifficulty

Appliancesshouldremaininplacefor6monthsafterhabithasceasedtoensureithastrulystopped

Openbitesassociatedw/suckingoftenresolveafterhabitstopsandtheremainingpermanentteetherupt

o Furtherorthotxmayberequiredthough Openbitesthatpersistalmostalwayshaveasignificantskeletalcomponentandrequirea

carefuldiagnosisandtreatmentplan

TongueThrust Definedasplacementofthetonguetipforwardbetweentheincisorsduringswallowing Isamisnomersinceitimpliesthatthetongueisforcefullythrustforwardduringswallowing

o Usuallyitisjustadifferentposition Isaphysiologicaladaptationforandindividualwithanopenbite

o Necessarytosealofffrontofmouthduringswallowingtopreventfood/liquidsfromescaping

Occursin2circumstanceso Youngerchildrenduringtransitionalswallowstageo Inpeopleofanyagewhohavespacebetweentheirteeth

Developmento InfantileSwallow

Jaw(gumpadsareapart) Lipscontracted Tonguecontactslowerlip

Usedforsucklingreflexinordertoreceivemilko TransitionSwallow

Lipscontracted Separationofposteriorteeth Forwardprotrusionoftonguebetweenteeth

o AdultSwallow Teethtogether Lipsrelaxed Tonguepositionedinpalate Presentinthemajorityofkidsbyage6

1015%ofpopulationisabnormal Tonguepressuresduringswallowingarenotveryinfluentialontoothposition

o Typicalswallowis