The orthodontist's assessment
It happened! After several years of patiently waiting, our son's first date with the orthodontist finally arrived. As expected, she quickly confirmed the severity in which thumb-sucking has impacted his teeth; however, she also took the time to explain her diagnosis and the future treatment options available.
We are pleased to say she was lovely throughout, significantly alleviating our son's anxiety by respecting his need for clear communication rather than surprises before he is touched. It also came as no surprise to my husband and me that his teeth and jaw urgently need correction.
Measuring his malocclusion
Categorized as a malocclusion, we have known for some years that our son has an overbite (where the upper teeth overlap the lower teeth). An overbite is referred to as a malocclusion when the overlap by the top teeth is significant. At first, the problem was only apparent to our family dentist. Over time, however, it became a challenge to miss the issue. While a slight overbite is common, our boy's teeth began to protrude further over his lower teeth every year until finally, he could no longer bite food. As the orthodontist explained, an overbite greater than 2mm is considered a cause for concern. But, alarmingly, at this visit, our son's overbite measured a staggering 18 mm!
An overjet explained
Having confirmed the need for treatment, the orthodontist further explained that our son actually has what is known as an overjet. An overjet refers to how far forward the upper teeth sit in front of the lower teeth, whereas an overbite is measured by how far down the upper teeth cover the lower teeth. In addition, teeth in an overjet tend to present horizontally. In the case of an overbite, the teeth remain vertical. Therefore an overjet is not the same as an overbite, and the condition requires different treatment. The problem for our son is that even with his teeth returned to a vertical position; he will still retain a significant overbite.
Of course, thumb sucking is not the only cause of an overbite or an overjet. Many factors can create or worsen the condition, these include
- teeth grinding
- temporomandibular joint disorders
- over use of pacifiers and feeding bottles
However, in our son's case, it is confirmed that his myofunctional habit caused and further damaged his wrongly positioned bite.
Dentists use the term myofunctional when discussing the role of muscles within the mouth. Myofunctional habits are habits that cause oral muscles to behave incorrectly. Myofunctional habits include actions such as
- regular nail-biting
- prolonged thumb or finger sucking
- pen or pencil chewing
- overuse of bottles, toddler cups with sipping spouts and pacifiers
- tongue thrusting
A recessive chin
A third issue resulting from our son's persistent thumb sucking is that the habit has prevented his lower jaw from developing correctly. My son's thumb-sucking addiction has forced his upper teeth and jaw forward while applying pressure on his lower jaw, pushing it back towards his neck. As a result, he has developed a recessive chin. His recessed chin is likely to require surgery if it is to be corrected. Orthodontists can attempt to improve his bite using plates instead, but this is unlikely to improve things significantly because of the severity of the malocclusion.
Lips, speech and self-esteem
Regarding the severity of his malocclusion, the orthodontist then highlighted the fourth issue. Our son cannot press his lips together correctly because the lower lip sits behind his upper teeth when his mouth is closed. Having his upper teeth and gum constantly sit outside his mouth is a cause of enormous discomfort for our son. In addition, the sensation that his upper teeth and gum are always dry irritates him and has triggered a relentless habit of lip curling. In contrast, because his lower lip sits within his mouth, it remains constantly wet. Worse still, because his lower lip rests behind his upper teeth, his lip continually presses his teeth forward, effectively continuing where his thumb left off after he stopped thumb sucking.
Further adding to the above, our son's overjet has negatively impacted his eating and speaking abilities. He cannot bite food with his front teeth or speak correctly because his tongue and teeth cannot interact to form certain sounds. As expected, all the issues mentioned above are huge factors in our son's low self-esteem.
The next steps
Before any treatment can occur, we still have to wait for our son's final adult teeth to cut through. In the meantime, scans and x-rays are required. These are to confirm the position of his teeth while checking the condition of their root system. A weak or short root system could result in broken or damaged teeth when using plates or braces. In addition, he may need some teeth removed to create the space for his remaining teeth to enter their correct position.
In summary, depending on the x-rays and scan results, three options are available to correct our son's bite. The possibilities include plates, surgery on his bottom jaw, and braces. Using a combination of the three options is likely to produce the best outcome for our son. His upper teeth require repositioning into a vertical alignment before pulling them back to reduce the bite. Surgery will pull his chin forward, correcting the profile of his face. Regardless, he is facing months of pain and discomfort.
A $7000 habit
We do not live in a country where such dental treatment is free either. Treatment for our son will take a minimum of two years (not counting the time for surgery and recovery, which will occur when he is a little older). The cost of our son's treatment will be upwards of $7000 NZD, beginning with a hefty deposit of $1200 and further charges of $300 for the scans and x-rays.
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