By Dr Anthony Shields, Orthodontist
Children can often be the foundation stone of a successful dental practice as how you treat and look after someone’s child will often influence the attendance patterns of the parents and other family members. Being able to answer queries and give appropriate information on topics ranging from oral hygiene to normal development stages of a child’s dentition is imperative to gain the trust and acceptance of families.
Appropriate examination and assessment must be made of all children in order to diagnose and plan the timing of any treatment that may be required. From an orthodontic perspective you may wish to consider the following ages of dental development and consider management of the points raised:
Age 6-8 years:
Emergence of the first permanent molars as well as maxillary and mandibular incisors
- Crowded deciduous anteriors or missing deciduous teeth
- Ectopic permanent molars
- Lack of emergence or missing permanent incisors
- Anterior and/or posterior crossbites
- Anterior open bites - query digit-sucking habits
Age 9 years:
Stable in the mixed dentition but maxillary permanent canines should begin to be palpated buccally
- Same cases already mentioned
- Anterior open bites - consider digit-sucking habits
- Overjets greater than 6mm
- Gross crowding
- Ectopic canines - often associated with a diminutive lateral incisor
- Suspected absent premolars
Age 10 years:
Splayed/spaced incisors “Ugly Duckling Stage” - this is not unusual but you must be wary of the presence of a potential mesodens
- Same cases already mentioned
- Ankylosed/infra-occluding deciduous molars
- Asymmetrical emergence of teeth greater than six months
Age 11 years:
May only have Es to exfoliate
- Buccal segments greater than ¼ unit Class II or III
- Asymmetrical buccal segments
- Centre line discrepancies
- Increased overbites (greater than 50%)
With 3-5% of children having missing teeth and 2-4% having ectopic canines an OPG at age 9 is a highly recommended diagnostic tool.
The dentolegal adviser's perspective
Dr Annalene Weston, Brisbane office
There can be no doubt that delayed diagnosis or failure to diagnose altogether not only features highly in complaints regarding treatment of children and adolescents and any orthodontic complaint in general, but also that there is often validity in this allegation. Regretfully, it is all too easy to overlook assessing the development of a child patient in our quest to assess active disease and underlying risk factors such as oral hygiene and diet, and this failure to identify what can become a pivotal issue will lead to significant scrutiny and criticism from third parties such as the regulatory body.
Naturally in order to identify issues and concerns, we need to be mindful of what we’re looking for and the normal ranges of developments.
Dental Protection is grateful to Dr Shields for providing this synopsis for your review and use.
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