“Time and tide wait for no man”, yet “there is a tide when taken at the flood leads on to prosperity”, so the right time for things to happen is important and no more so than in orthodontics. As the development clock ticks, things that are supposed to happen on time can be interfered with causing a delay with many unintended consequences. Many critical events must happen correctly before birth, so prenatal health is paramount which means the mother’s health is paramount. Weight gains, smoking, alcohol, and combinations of medications contribute to infant health problems. Premature births face a host of issues that full term babies don’t have to contend with. Breast feeding or formula feeding spell success or failure for proper oral development, unfortunately, nature’s way has been supplanted by food industry’s marketing altered essentials in a different container. Then who knows all the environmental issues that impact children’s health? We have had contaminated water supplies on military bases as well metropolitan cities, toxic products from China, contaminated playgrounds, stagnant air traveling US Air and genetically altered food. It’s a wonder anyone is healthy, but we have a remarkable body that has a master plan of healing if we take life seriously.
My motive for posting this blog is to improve the observation of early signs of trouble and a quick look at the way a new born is breathing, sleeping and nursing will give many clues. Mouth breathing, snoring and night time arousals will have deleterious effects in preschool children. Enlarged tonsils and adenoids restrict proper nasal breathing and tongue thrust swallowing insures that a malocclusion is developing, so the signs of the tide show its time to act.
The next stage of facial development where problems can be identified is age 7. If kids have not seen a dentist by then it is past time and I believe all 7 year olds should have a panoramic X-ray taken plus cavity detecting films. It is amazing how many missing or displaced teeth one finds on these important films. Teeth need to come in on time and for that to happen they need room. It is many times necessary to remove primary teeth to allow room for the lower and upper four incisors to erupt to their proper place. This method of borrowing space is a loan that must be paid back later at the next stage of development, age 10 -11. The eight year old child with jaw relation issues be they horizontal, vertical or transverse, is at an ideal age for corrective intervention. Their cooperation is at an all-time high as they want to please (not necessarily so with teenagers). We also want them sleeping properly and breathing correctly at the youngest of ages.
The 10 – 11 year olds are coming of age with their permanent dentition and it is critically important that the dentist know the pattern of eruption of the upper and lower canines as these teeth can do destructive harm to any tooth in their way. They must have clear passage and have erupted before age 12.
That one fact alone could save so much grief with orthodontic problems if someone is paying attention. Growth is about to kick off at its highest velocity at puberty and this is probably the most important tide and time for comprehensive orthodontic treatment. It is kind of a middle school rite of passage to wear braces, but it makes sense biologically. One dental truth all should know is that by 13, all permanent teeth except the wisdom teeth should be functioning, but the sad truth is that far too many patients are seen where this is not the case and the tide and time have come and gone.
Now orthodontist have to go to work without all the natural help proper timing avails. The adult patient is one that for valid reasons did not get the benefit of an earlier solution and they are a growing percent of orthodontic practices the world over. Even though there are limitations because of no growth, still there a wide variety of options available to recover nature’s intent. Very often adults need team partners involved in oral rehabilitation. The orthodontist, periodontist, endodontist, prosthodontists and oral surgeon are valued team partners who can offer the best and most suitable solution. There is a rising tide of interdisciplinary cooperation that bodes well for today’s adult patient. So the tide waits for no man, but it continuously ebbs and flows and the future tide can also be the best time to decide on improving the most valuable asset anyone carries with them – a beautiful smile.
John B. Harrison DDS, MSc
