• Crossbite and Anterior Open Bite in a Young Child

    by Catherine Koo, DDS and Victoria Burfield, RDA
    on Mar 3rd, 2016

When my son, Jadon, was 1 YO, I noticed that his lower front teeth were in front of his upper teeth. That’s the wrong way- think Sling Blade underbite. But I’m getting ahead of my blog article and I’ll finish this story a quarter of the way through this article…

If a parent notices a crossbite or open bite in their young child, how should they approach it? Well, the easiest way is to have your child’s regular dentist evaluate and treatment plan any dental problems.

But, it’s also nice to have some background knowledge. Let’s consider an instance when you’re hanging out with your 2 YO and you start to hone in on their teeth because something just seems off; they may have a crossbite or open bite of their teeth. Here are pictures of two common dental problems in children’s teeth- The Crossbite: When the upper and lower teeth overlap the wrong way and The Anterior Open Bite: When the upper and lower teeth in the front don’t come together upon biting.

(Keep in mind, the range of problems can be from simple to severe. Severe would involve skeletal problems, not just the teeth positions. And, repositioning the maxilla and mandible take a lot more than repositioning just the teeth. That can require a series of orthodontic appliances and/or surgeries.) 4 For this blog, I’ll be reviewing a simple crossbite of just 1 or a few teeth and an open bite that involves just the anterior teeth and not conditions with an underlying skeletal problem.
 
Often times a simple crossbite of the teeth will spontaneously correct itself, but if it doesn’t by 6 YO, it’s time to think about an orthodontic appliance. Actually, both my boys had a crossbite when they were 1 YO. I got stressed out when I saw that their lower teeth were in front of their upper teeth. I tried to manually apply pressure and push them back and kept a fretful eye on their teeth with a mind towards an orthodontic consultation in the near future. But, by 2 YO their teeth had autocorrected and the lower teeth were behind the front teeth when biting like they should be. Huge sigh of relief! And studies find that most crossbites do resolve by themselves in many cases.
 
However, if a crossbite condition persists, the best time for correction is between the ages of 8-11YO. The reason for this is that the teeth are in a transitional state and permanent teeth are in an active state of root formation and the primary teeth are erupting. It should be noted that if treatment for a crossbite is delayed to a later stage of maturity, treatment may become more complicated.
 
So, how is a simple crossbite corrected? When the skeletal relation is normal, a simple lower inclined bite plane can be used to correct the crossbite of 1 or a few teeth. It is an appliance worn for about 3 weeks. And, usually, after those short 3 weeks, the appliance comes off and the crossbite has been corrected. 1
 
So, that leaves common dental problem #2. The anterior open bite. This is when the front teeth yawn open, even when the back teeth are biting down. This opening usually correlates with a culpable pacifier or finger and kids who suck on these for comfort have a habit called non-nutritive sucking. The open bite condition usually corrects itself as the child’s age increases most likely due to them leaving behind the “thumbsucking” or other non-nutritive sucking habit. And, it is observed that the correction of the open bite happens quickly as the problem habits are dropped, but it’s important that those habits are, indeed, dropped. 5 Problems that a child may encounter with an open bite are difficulty with biting food, speech problems and issues with esthetics. 3 A study of 1,308 urban, Brazilian children 2.5-4.9 YO found a prevalence of open bite at 30.4%. This is a rate that matches similar studies in other urban areas. In this particular study, the main factors associated with anterior open bite were revealed to be a non-nutritive sucking habit (sucking on pacifier and/or finger) and a young child being predominantly bottle fed as opposed to breastfed. 5
 
Treatments for simple open bite are habit control over the non-nutritive sucking habits and orthodontic appliance such as a tongue crib. The Brazilian study led to public health policies to decrease the incidence of anterior open bite consisting largely of promoting longer durations of breastfeeding. Breastfeeding is shown to be a protective factor against anterior open bite as the process of sucking to obtain breast milk is different from sucking from a bottle and leads to the proper development of jaws and strengthening of the proper muscles. The link is made, derived from empirical data, that increased breastfeeding reduces the development of non-nutritive sucking habits and therefore, incidence of anterior open bite. This study, also, found a need to investigate the mother-child relationship as associated with developing non-nutritive sucking habits. 5
 
This study corroborates other similar studies that report the prevalence of non-nutritive sucking habits to be high in children in industrialized societies. The subjects of the study cited here come from Recife, Brazil which is a large urban center with it’s economy concentrated on industry, commerce and services – the pattern similar to other large industrial centers in the world. 5 So, parallels can be drawn for other urban audiences that increased breastfeeding helps reduce negative habits like thumb or finger sucking or excess use of pacifier and this leads to a decrease in the occurrence of anterior open bites. Therefore, it behooves parents to be aware of these facts and aim for an eventual cessation of non-nutritive sucking habits in their young kids. I hope this information was helpful to you!
 
This technical paragraph is added in order to balance the information:
(Anterior open bites can be classified into simple and severe. The simple open bite involves just the anterior or front teeth. The severe open bite involves skeletal growth abnormalities often associated with a long face or excess lower facial height. Open bites originating from skeletal problems would have to be addressed by complex surgical procedures.) 3 There are other proposed but less studied factors that could contribute to open bite and they are nasal airway obstruction, allergies, septum problems, enlarged tonsils and adenoids. As already mentioned, skeletal abnormalities or “long faces” are often suspected of having an airway obstruction. If airway obstruction is suspected, a proper otolaryngology consultation is warranted. 3
 
References:
 
1. “Anterior Cross bite Correction in Early Mixed Dentition Period using Catlan’s Appliance: A Case

          Report” by Prashanth Prakash and B.H. Durgesh. ISRN Dentistry Volume 2011 (2011), Article             ID 298931, 5  pages doi: 10.5402/2011/298931     
 
2. “Treatment Effects in an Anterior Open Bite Class II Malocclusion with Two Different Functional              Appliances” by Anita Fekonja. Orthodontic Cyber Journal.                                                                          
 
3. “Open bite: A review of etiology and management” by Peter Ngan, DMD, Henry W. Fields,

          DDS,MS,MSD. American Academy of Pediatric Dentistry.                                                                                   
 
4. “Angle Class I malocclusion, with anterior open bite, treated with extraction of permanent teeth”                by Mirian Aiko nakane Matsumoto. Brazilian Board of Orthodontics and Facial Orthopedics                  (BBO).         
 
5. “Non-Nutritive Sucking Habits, Anterior Open Bite and Associated Factors in Brazilian Children               Aged 30-59 Months” by Flavia Maria Nassar de Vasconcelos, Andreza Christina de Lima                       Targino Massoni, Monica Vilela Heimer, Angela Maria Brito Ferreira, Cintia Regina Tornisiello               Katz, Aronita Rosenblatt. Department of Preventive and Community Dentistry, Dental School,           University of Pernambuco, Camaragibe, PE, Brazil.

Author Catherine Koo, DDS and Victoria Burfield, RDA

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