The position of the teeth, even as early as 2 years old, can indicate insufficient jaw size, poor airway development and be a symptom of poor myofunctional habits that can lead to Sleep Disordered Breathing and Obstructive Sleep Apnea. The earlier the signs are recognized and treated, the healthier your child will be.

A normal and healthy bite with all the primary teeth present will appear to have SPACES between all the baby teeth. This is a good indication that the tongue is correctly placed on the roof of the mouth and is acting like a “scaffold” for proper tooth position and palate size development. Permanent teeth that come in after the baby teeth fall out are much bigger and wider than the baby teeth they replace and need the extra room spacing provides. No spaces between your child’s baby teeth usually indicate not only that the adult teeth are going to be crowed or even “crowed out completely”, but also indicate that the dental arches are too narrow and can lead to poor facial growth and unhealthy airway development. Early intervention and treatment can not only prevent the need for braces which will likely be inevitable, but can also prevent poor airway development that can lead to poor heath and sleep.

When the teeth look “flattened, ” worn-down, short or chipped, it can indicate tooth grinding or bruxism and point to a potential airway problem. If a child is having a hard time getting enough oxygen while sleeping, the body will unconsciously respond to try and make breathing easier. One way the body accomplishes this is by moving the lower jaw forward (like the “jaw thrust” in CPR) to automatically open the airway. With repeated movement of the lower jaw coming forward, not only will you hear “tooth grinding” sounds, you will see damage to the teeth. Hearing or seeing evidence of tooth grinding means that your child is likely struggling to get enough oxygen while sleeping and treatment should begin as early as possible to cure this serious problem.

Front top and bottom teeth that do not overlap at all when the back teeth are touching and have a large gap or space between them (for example you could stick the tongue “through” the gap) are usually the result of a habit such pacifier or thumb sucking. Often it appears that the canine teeth are “longer”, when in fact the upper front 4 teeth are actually pushed “up” higher than the rest of the teeth. Unfortunately, this “open bite” leads to poor myofunctional issues like an open mouth posture and low tongue position, a tongue thrust, mouth breathing and further constriction of the palate leading to poor jaw growth and airway development compromised. Even though sucking and soothing habits are “normal” for babies and infants, the sooner they are addressed and stopped, the better. Early corrective and conservative treatment should be the goal in order to put the growth pattern of the face, jaws and teeth back on track and the correct any poor myofunctional habits that often coexist.

A cross-bite involving the front teeth: if the lower teeth are biting in front of the upper teeth, it is a situation that demands immediate intervention. The condition will prevent the upper jaw from growing forward and as the teeth grow longer with time, it will be harder to reverse the cross-bite.

A cross-bite involving the side primary molars means that the top jaw is smaller than it should be and is an indication of a constricted palate which is a risk factor for poor airway development and should receive immediate intervention.

Around age 8, as the baby upper lateral incisors are shed, if the palate is constricted, there will be very little space or no for the permanent laterals to erupt. These teeth need at least 7 mm of room to come into the mouth properly. Unless the palate is expanded and room is made, the loss of space will not be regained. In addition to severe tooth crowding, a constricted palate is a sign of unhealthy air way development and improper jaw growth. Early treatment around age 7 or 8 is vital.

Although the top teeth may look like they are way too forward and should be “pulled back”, its actually the opposite. The top teeth may look “buck”, but they are actually positioned in the maxillary arch correctly and the trouble lays with the underdevelopment of the lower jaw. This lower jaw “protrusion” is also known as a “retrognathic mandible.”

This type of “bite” and jaw position puts a child at extremely high risk for developing a constricted airway and Obstructive Sleep Apnea. Treatment to help guide the lower jaw forward should begin as young as possible knowing that the jaw basically stops growing around the time all the permanent teeth come in, usually around age 12. The earlier treatment for this condition begins, the more conservative and effective it can be. Waiting too long can result in unfavorable treatment options, including jaw surgery and if not addressed at all, will likely lead to OSA and poor health.

If lateral incisors are fully erupted around age 9, and they look like they are flared sideways, this is a warning that there is impending crowding. Due to a lack of space, the underlying canines are pushing against the roots of these laterals and shifting their position. This can be detected with early screening and good imaging, preventing potential damage to the permanent lateral tooth roots as well as creating room for the permanent canines to erupt in a more normal path.

Around age 11, the upper canines will appear. Among all the permanent teeth, these travel the longest path before they emerge. They start their journey from the space right next to the nose, almost under the eye, and travel down over many years. If there is insufficient space due to a constricted palate, they will emerge “ectopically,” or sideways, or they will be impacted within the palate. Complications and lengthy treatment time can be avoided with early treatment.

If the tongue is restricted and unable to touch and rest on the upper palate, a simple Frenectomy procedure may be necessary to improve your child’s health and dental issues.