A Q&A with Happy Kids Dental’s Specialist Orthodontist, Dr Stephanie Oiknine
When we think of orthodontics, we often visualise teenagers wearing train tracks on their teeth. But modern orthodontics has evolved to not only offer many options besides the traditional metal braces, but also to start treatment much younger, and potentially drastically reduce the amount of intervention required. We spoke with Dr Stephanie Oiknine, the Specialist Orthodontist at Happy Kids Dental in Marylebone, to learn more.
We often hear parents wondering when they should bring their child to the orthodontist for the first time. What’s your advice?
The answer is – it varies! Currently, both the British and American Academy of Orthodontics recommend that children should see an orthodontist at age 7. Age 7 is the cut-off where we can still make changes to ensure a correct development of the jaws and the teeth. If we start monitoring children at this age, we can correct deformities before they fully develop and become permanent. We are not only talking about crooked teeth and crowding, but also jaw position and functional problems such as breathing and snoring. For these reasons, we like to see children for early orthodontic assessment from age 5-7 . However, sometimes you as a parent can make that judgement as well – if, for example, you know your child is a mouth breather or sucks their thumb.
Why so early?
A: By identifying any problems and addressing the issue, we can correct your child’s habits, crowding and jaw deformities before they cause malocclusion or before the deformities become permanent thanks to functional treatments/functional educators that address the root cause. Examples might include mouth breathing and snoring, incorrect tongue position, incorrect swallowing, poor lip posture, thumb sucking and poor chewing habits.
Why is mouth breathing a problem?
Mouth breathing isn’t normal and has long-term consequences for health. Nasal breathing is central to proper jaw and teeth development, as it provides the forces that expand the jaw. That is why if your child is a mouth breather, you may see that their face lacks cheek bone prominence, looks long and thin and their palate (roof of the mouth) might be quite narrow and almost V-shaped.
This may sometimes be associated with snoring and sleep apnea
You mentioned tongue position and incorrect swallowing how are these problematic and what should parents look for?
With proper tongue posture, the tip and back of the tongue should be pressed upwards to the palate. This activates all the muscles that connect to the jaw, the base of the skull, the spine and the throat. One of the best times to check your child’s tongue posture is when they are watching television. What do they do with their tongue? Can you see it? Do they poke it out? A low and forward tongue posture indicates that your child’s tongue isn’t being pressed up against the palate correctly. Parents can start with a very simple exercise: place a bit of cream cheese on the palate as far back as the molar teeth, then ask the child to close their mouth. They will then lick their palate and swallow at the same time, while the tongue is still placed against the palate. They will learn correct tongue positioning and the correct swallowing pattern. Swallowing is related to tongue position, as the most common form of incorrect swallow is a tongue-thrust swallow. This is where the tongue comes forward between the teeth during the swallow instead of against the palate. During correct swallowing, the tongue should perform a wave motion across the palate. The motion exerts a widening, forward and upwards force, expanding the jaw. A child should have straight spinal posture, closed lips and nasal breathing when eating, swallowing and at rest. Watch your child’s normal swallow. Can they swallow food comfortably with their teeth together? If it looks uncomfortable for them, it is likely they have some form of incorrect swallow.
What about proper chewing habits?
Yes, they’re very important and tell us a lot about the child’s diet as well. When there is a balanced chewing and balanced diet, we should see symmetrical wear of the teeth. It’s important to encourage children to chew hard food – on both sides of their mouth – from an early age, as this will cause even tooth wear and proper tooth and jaw development. At Happy Kids Dental, we recommend parents encourage eating foods with texture – raw carrots for example. Chewing on one side only may result in asymmetrical occlusion.
Finally, you mentioned something that’s a worry for many parents – thumb sucking. Is that a definite no-no?
Many parents ask if dummies or thumb sucking can make their baby’s teeth crooked. The answer is yes! Dummies can cause an open bite, narrow upper arch, cross bite with or without displacement of the jaw (this may also affect the jaw joints) and protruded teeth. But the good news is that there’s plenty of time to correct oral behaviours in your child if you start addressing it on time. If you’re in any doubt, bring them in to see us at Happy Kids Dental and we’ll be able to conduct a thorough assessment.
Concerned about your child’s smile? Book an early orthodontic consultation today with Happy Kids Dental’s team of specialist and consultant orthodontists on 020 7078 0822.
