A crossbite occurs when the top teeth don't align correctly with the bottom teeth. A posterior crossbite involves the back teeth, and can lead to uneven growth of the jaw (mandibular asymmetry) as well as chewing problems. In many cases an appliance, such as the quad-helix, is used to widen the dental arch and correct the crossbite. In children older than seven years of age, a palatal expander is often used because older children can tolerate it better. The treatment time for either appliance is six to nine months.
An extremely narrow upper dental arch will often lead to crowding of teeth and irregular dental alignment when a child is older. The older a person is, the more difficult it can be to correct a very narrow upper dental arch. In a case of severe bilateral maxillary constriction, a palatal expander call a Hyrax appliance can be used to improve the shape of the upper dental arch. The Hyrax appliance changes the dental arch from a "U" shape to a more normal, wider, ovoid shape.
An anterior crossbite of the adult teeth occurs when one or more of the top front teeth bite behind the lower front teeth. This crossbite can lead to excessive wear of the front teeth, as well as prevent the normal growth of the lower jaw (mandible). An anterior crossbite can also cause recession of the gums around the lower front teeth. An anterior crossbite can be corrected either with braces, or with an appliance such as a palatal arch with finger springs. Either appliance is worn for a few months - until the crossbite is corrected.
An article published in the May 2000 issue of the Journal of the American Dental Association reviews the topic of early orthodontic treatment:
Kluemper GT, Beeman CS, Hicks EP: Early orthodontic treatment:What are the imperatives? JADA, Vol 131:613-620, May 2000.
Surgeon General's Report On Oral Health: Implications For Children
The recent, first-ever, Surgeon General's Report on Oral Health is a milestone for oral health in America. The report explains the meaning of oral health, and why it is so important for overall health and well-being. The report stresses that oral health and general health are inseparable. It concludes by presenting a framework for action - which emphasizes building partnerships to enhance education, oral health care, research, and the elimination of barriers to care.
The National Institute of Dental and Craniofacial Research (NIDCR), directed by Harold C. Slavkin DDS, took the lead in the development of this report. The NIDCR, a component of the National Institutes of Health since 1948, is on the cutting-edge of oral, dental, and craniofacial research. The goal of the NIDCR is the resolution of all craniofacial diseases - from dental caries to oral cancer.
The Surgeon General's Report is based on a review of all of the scientific literature published in the English-language. The twelve chapters in the report were based on scientific papers submitted by subject-matter experts in various areas of craniofacial health and disease. Independent peer review was conducted for all sections of the report. The report focused on five important questions, which were used to organize it into five parts.
Good oral health does not just mean healthy teeth, but also a healthy mouth - which in turn affects overall well-being throughout life. Oral health and general health cannot be separated from one-another. Oral health means being free of oral-facial pain, oral cancer, oral disease, and craniofacial birth defects. The report noted that the genes which control the development of the head, neck, face, and mouth (the craniofacial complex) have counterparts in simpler organisms - like yeast, fruit flies, zebra fish, and mice. It is the evolutionary conservation of these genes which have facilitated research in craniofacial development and disease. The reports also noted that several components of saliva protect the oral tissue through antimicrobial agents, chemical buffering compounds, and minerals which remineralize enamel and keep it healthy.
The report stated that microbial infections are the primary cause of most oral diseases. Examples include dental caries (bacterial infection), periodontal disease (bacterial infection), herpes labialis (viral infection), and candidiasis (fungal infection). Furthermore, the causes and development of disease affecting the mouth, head, and neck (the craniofacial structures) are complex - involving genetic, environmental, and behavioral factors. Despite improvements in the oral health status of most of the nation, the differences in oral health between some population groups is alarming. Those who suffer the most include poor children. Children who are medically compromised, or who have disabilities are also at greater risk for oral disease than the rest of the population. Tooth decay (dental caries) is the most common chronic childhood disease - five times more common than asthma. Poor children have twice as much dental caries as other children, and the disease is more likely to go untreated. Twenty-five percent of poor children have not been evaluated by a dentist before starting kindergarten. About 26 million American children lack dental insurance. Uninsured children are 2.5 times less likely to receive dental care than insured children. Fewer than twenty percent of Medicaid-covered children receive a dental visit in any given year. Finally, more than 51 million school hours are lost each year due to dental problems.
Many systemic diseases have oral manifestations. The report gives examples of how the mouth may signal the presence of disease, and how cells from the mouth or samples of saliva, may be used as diagnostic tools for fighting disease.
In spite of the importance of water fluoridation for oral health, over 100 million people in the U.S. have no community water fluoridation. The report also states that achieving and maintaining oral health requires appropriate self-care, complemented by professional care and community-based health activities. Children need appropriate diet, nutrition, oral hygiene, and health-promoting behaviors. Expenditures for dental services alone make up 4.7 percent, $53.8 billion, of the nation's health expenditures.
The report found that anticipatory guidance provided during early dental visits, as well as risk assessment and management, are beneficial for children. The report proposed a framework for action, which included:
The citation for the Executive Summary is: U.S. Department of Health and Human Services. Oral health in America: A Report of the Surgeon General - Executive Summary. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000 and may be viewed at http://www.nidcr.nih.gov/sgr/execsumm.htm
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