29/03/2022

Dr. Nicole Ann Lee: What is “growth modification”, the interceptive option all parents with young children should be aware of?

Dr. Nicole Ann Lee

It’s always better to be early than late – and this saying applies for treating your child’s teeth too. Previously, I shared the impact tooth decay in baby teeth can have on adult teeth - the gist is that baby teeth pave the way for adult teeth, and good oral habits since young are essential if you want your child to have a beautiful set of teeth. 

But apart from the usual brushing and checking of cavities, did you know that paediatric dentists can also guide the growth of a child’s jaws? This is through a procedure known as growth modification. This allows us to minimize or in some cases even preliminarily rectify common orthodontic problems such as harmful crossbites, teeth crowding, excess spacing, jaw growth discrepancies or protruding teeth. 

Please allow me to explain the importance of growth modification for growing children, and signs that your child may benefit from it!

What is growth modification?

Illustration of Growth modification
Source: https://www.innovaortho.com/about-tx/orthodontic-appliances/twin-block/

As its name suggests, “growth modification” alters the growth of the jaw bones during the child’s active growing period. Children typically get their first few permanent teeth between 7-8 years old - this period is when you want to be extra active with your child’s dental visits, as it is when we can determine if there are signs of over- or under-development of your child’s jaws and bite. 

If your child has been diagnosed with such issues, we may attempt to lessen the severity of or even correct this skeletal imbalance, which potentially reduces the need for orthodontic treatment (in the form of braces) or perhaps even orthognathic surgery down the road.

Think of it as planting a garden - in order for the trees and flowers to grow properly, we must first ensure the seeds are scattered nicely in place. Likewise, for teeth to erupt beautifully, we must catch discrepancies early and gradually make adjustments so that teeth can fit into the mouth and jaw correctly.

 

 

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What is the difference between “growth modification” and “interceptive orthodontics”?

You may sometimes come across these two terms. Growth modification is actually a subset of interceptive orthodontics. 

Depending on whether the problem lies only in the teeth positions or jaw positions or both teeth and jaw positions, various options best suited to help correct each individual case are available.

Type of interceptive treatment (ie. fixed or removable) and duration of active treatment may also vary subject to the complexity of your child’s case and age of your child. 

Most of the time, interceptive orthodontic treatment done at this stage has specific primary goals that may differ from that of comprehensive orthodontic treatment done at a later stage of life. It takes into consideration the growth tendency of the child, based on what is found clinically and radiographically during your consultation/examination visit as well as family history such as that of their siblings, parents or relatives.

What can growth modification correct?

The main benefit of growth modification is early intervention that could stave off your child needing more long-drawn complex treatments later on in their life. These treatments are usually meant to help with issues such as: 

Overbite or “bugs bunny teeth” or “protruding upper jaw”

Top front teeth extend beyond the bottom front teeth, resulting in abnormal tongue placement. 

Underbite or “protruding lower jaw”

Lower jaw juts out past the top front teeth, affecting facial shape and impeding speech.

Crossbite 

Upper teeth fit inside of lower teeth, impacting facial symmetry. 

Open bite 

Upper and lower teeth do not touch when the jaw is closed, causing pain and oral hygiene issues. 

Other benefits include:

  • Better periodontal musculature health of erupting teeth
  • Better facial symmetry and alignment
  • Re-adjusting crooked or crowded teeth
  • Better appearance and higher self-esteem in your child

How is growth modification treatment carried out in Singapore?

Each dentist may do things differently but generally growth modification at our clinic involves a detailed comprehensive consultation and examination. This involves: 

  • Taking measurements and records i.e. photos, scans, moulds and even X-rays to determine the cause of the problem
  • Obtaining the child’s medical history and noting down the child’s pre-treatment condition
  • Asking a bit about the background of the child’s family and relatives

Once we’ve weighed and discussed options (together with the child if he’s old enough), we can start treatment. The number of treatment sessions and appliance(s) used will depend on factors like your child’s age, teeth condition and compliance. 

Some appliances we may use include:

Facemask therapy

To stimulate upper jaw growth and correct underbites caused by a small upper jaw

Little boy with mouthguard
Source: https://www.sylvainchamberland.com/en/appliances/protraction-facemask/

Twin block

To promote lower jaw growth and correct overbites caused by a small lower jaw

Palatal expander

Palatal expander

To correct crossbites and overcrowded teeth by gradually widening the width of the jaw

They may sound scary, but don’t worry - when done in the hands of an experienced and nurturing orthodontist or paediatric dentist, the process can be very safe and even enjoyable for your child!

Family Dentistry at An Dental

Misconceptions Of Growth Modification Treatment in Singapore

Some parents might have the mindset of, “Since my child’s teeth will change anyway, there isn’t a need to spend so much time and money on them now.”

To add on, some orthodontists may prefer to push back the procedure by a few years to sort the patient out when he/she is in full permanent dentition instead of a mixed dentition after growth has tapered down.

However, if you know there is already a tendency towards a discrepancy, why not give it the chance to perhaps be reduced or corrected at the early stages? With interceptive treatment done right, we could potentially help reduce the complexity of future treatment needs. 

Several studies1 have also demonstrated the importance of early intervention. In a particular cohort2 study which followed children who did growth modification treatment in their early dentition stage, almost half had incisor crowding before treatment but 98% showed good alignment of their incisors several years later.

Signs Your Child May Need Interceptive Orthodontics

Here are some signs that your child may require interceptive treatment:

  • Imbalance in facial appearance such as sunken midface, short or compressed lower face
  • Difficulty chewing and/or biting
  • Speech impediments
  • Breathing through the mouth
  • Abnormal habits like thumb sucking or tongue thrusting that could potentially lead to open bite
  • Early or late loss of baby teeth (your child should typically start losing teeth around age five, and will have all permanent teeth around age 13)
  • Protruding teeth or teeth that do not align properly
  • Shifting of the jaw when your child opens or closes his or her mouth (crossbites)
  • Crowded front teeth 

Do you have any concerns about interceptive treatment or think your child could benefit from this procedure? Feel free to drop me a message and I’ll be more than happy to help! 

References 

  1. Tzemach, M., Aizenbud, D., & Einy, S. (2014). Refu'at ha-peh veha-shinayim (1993), 31(1), 25–61.
  2. Keski-Nisula, K., Hernesniemi, R., Heiskanen, M., Keski-Nisula, L., & Varrela, J. (2008). Orthodontic intervention in the early mixed dentition: a prospective, controlled study on the effects of the eruption guidance appliance. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 133(2), 254–328.e2. https://doi.org/10.1016/j.ajodo.2006.05.039 
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