PREVENTIVE
ORTHODONTICS
Dr.Abdul Shamal
Senior Lecturer
Dept of orthodontics and dentofacial orthopedics

 Parent and Patient Education
 Caries control
 Care of deciduous dentition
 Eruption Problems
 Alteration in sequence of eruption
 Ankylosed primary teeth
 Supernumerary teeth
 Ectopic eruption
 Occlusion equilibration
 Management of abnormal frenal attachment
 Space maintenance
 Relation of oral habits to prevention of malocclusion
 Preventive orthodontics and sports activities.
 Conclusion

Introduction
• The word orthodontics is derived from the Greek
word ‘Ortho’ or ‘opeo’s meaning ‘right’ or
‘correct’, and ‘dontos’ or ‘d’so’vtos meaning
‘tooth’.
Definition
• By British Society in 1922.
• Orthodontics includes the growth and development
of face and jaws particularly and the body generally
as influencing the position of the teeth; the study of
action and reaction of internal and external
influence on the development and the prevention
and correction of arrested and perverted
development.

• ORTHODONTICS (DENTOFACIAL –
ORTHOPEDICS)
ii. Definition by “AAO”.
• American Association of Orthodontics” defines as
the area of dentistry concerned with the supervision,
guidance and correction of the growing and mature
dentofacial structure, including those conditions that
require movement of teeth or correction of
malrelationships and malformations of related structures
by the adjustment of relationships between and among
teeth and facial bones by the application of forces and /
or the stimulation and redirection of the functional forces
within the craniofacial complex.

iii. Preventive orthodontics
• is defined as the action taken to preserve the integrity
of what appears to be normal at a specific time or age;
Preventive orthodontics means a dynamic, ever
constant vigilance, or routine, a discipline or both the
dentist and the patient.
• It requires a continuing, long range approach.
Without this, the complex time table of growth,
development tissue differentiation, resorption,
eruption under the influence of continuous functional
forces, cannot be assured.

Parent and Patient Education
It is essential that a proper rapport be
established between the dentist, child and
parent.

• THE AMERICAN ACADEMY OF PEDIATRIC
DENTISTRY HAS PUBLISHED GUIDELINES
CONVENING THE PERIODICITY OF
EXAMINATION, PREVENTIVE DENTAL
SERVICES AND ORAL TREATMENT.
• Birth to 12 months
• Complete the oral examination and appropriate
diagnostic test to assess oral growth and development
and oral pathologies
• Provide oral hygiene counseling for parents.
• Assess child systemic “F” and Topical “F” and
provide counseling about F.
• Provide dietary counseling related to oral health.

• Provide counseling related to oral habits.
example: Digit sucking and pacifiers.
• Provide anticipatory guidance for
parent/guardian.
• Provide age appropriate age injury prevention,
Counseling for orofacial trauma.
• 12-24 month
• Repeat 6-12 month procedure every 6 months
or as indicated by patient needs.
• Review patient fluoride status; provide topical
“F”.

• 2-6 years
• Repeat 12 to 24 month procedure every “6” months.
• Provide age appropriate oral hygiene instruction.
• Complete a radiographic assessment pathology
growth and development.
• Scale and clean the teeth every 6 months
• Provide pit and fissure sealants for primary and
permanent teeth.
• Provide assessment / treatment or referral of
developing mal occlusion as indicated by the
individual patient needs.
• Assess speech and tongue development.

• 6-12 years
• Repeat 2 to 6 years procedure.
• Provide injury prevention counseling / service
for orofacial trauma
• Provide substance abuse counseling.
• 12-18 years
• Repeat 6 to 12 year procedure.
• At an age determined by the patient, parent
and dentist, refer the patient to a general
dentist for continuing oral care.

CARIES CONTROL
• In spite of various successful preventive
measures available, dental caries is still a
chronic, prevalent disease.

• Among various preventive strategies available, more
research work is presently concentrated on “CARIES
VACCINATION”. According to the WHO
GLOBAL ORAL DATA BANK , caries is on the
increase in south and central America ,asia, india,
africa and the middle east countries.
• Protection against dental caries by immunization can
be achieved by protective antibodies from serum; by
IgA antibodies in saliva or by a combined effect of
serum and salivary components.

• Most of the children in United States will manifest atleast one
carious lesion by 17 years of age. Professional topical fluoride
application can be considered as a part of the routine annual
recall dental examination for all children.
• Xylitol chewing gum consumption by children between 3-5
years of age reduced the incidence of dental caries.The
expected daily consumption level of xylitol was around
4.05gm without any side effects. Xylitol is also effective in
preventing acute otitis media & reducing the antibiotic use.
Fluoride containing chewing gums, dentifrices, tablets &
mouth rinses also reduces the risk of dental caries.
• Studies have reported that children with early childhood caries
who were treated with 5% NaF varnish every 3 months,
reduced the incidence of caries onset.
Reference: Journal of American academy of pediatric
dentistry(JOAA,Feb2001)

• Care of deciduous dentition
The deciduous teeth are excellent natural space
maintainers until the developing permanent
teeth are ready to erupt into the oral cavity.
Thus all efforts should be taken to prevent
early loss of deciduous teeth.

Schematic drawing of the measurement of space.
x, Space between the first molar and the
adjacent tooth (the first premolar in this figure).
a, Mesiodistal crown diameter of the tooth
corresponding to the space (the second
premolar). y, Space deficiency at this part of
dental arch.
REFERENCE
AJO,1983 MAY (428-434).16

LEEWAY SPACE
• It is the difference between total width of c,
d, e and the total width of 3,4,5
• Upper arch =0.9mm.
• Lower arch =1.7mm.

‘E’ Space
• It is the difference between deciduous
second molar and the second pre-molar
• Upper = 2.5mm.
• Lower = 2.9mm.

• DIAGNOSTIC AIDS
• Radiographs
• Study casts
• Photographs

• 1. Radiographic examination is very essential. It helps in
evaluation of the teeth and oral structures.
• Bitewing radiographs helps to detect proximal caries.
• A panoramic intraoral radiograph is valuable for orthodontic
evaluation at any age. It gives a view of the mandibular
condyles.
• Radiographs of the temporomandibular joint (TMJ) is
indicated for patients having symptoms of dysfunction of the
joint that may be related to internal joint pathology.

2. Study casts
• Study casts help in measurement of overbite, overjet, arch
width, available space or erupting teeth etc more accurately
than directly measuring in the mouth
3. Photographs
• Facial photographs in general show the relationship of various
parts of face. Example: maxillary protrusion. Facial harmony
and balance are considered important therapeutic objectives by
the orthodontist.

ERUPTION PROBLEMS
• There should not be more than 3 month’s difference in
shedding of deciduous teeth and eruption of permanent teeth in
one quadrant as compared to other quadrant.
• Delay in eruption may be due to one of the following
factors.
• Presence of over retained deciduous teeth or roots.
• Supernumerary teeth
• Cysts
• Over hanging restoration in deciduous teeth.
• Fibrous gingiva.
• Ankylosed primary teeth.

Management of Ankylosed teeth
• Ankylosis (tooth fused to the alveolar bone).
Ankylosis means joining of root of the teeth to bone
by absence of periodontal membrane.
• An ankylosed tooth appears to submerge over a
period as the other teeth continues to erupt, while it
remains at the same vertical level.

The ankylosed teeth do not get resorbed and
therefore either prevent the deciduous teeth from
erupting or deflect them to erupt in abnormal
location. These ankylosed teeth should be diagnosed
and surgically removed at an appropriate time to
permit the permanent teeth to erupt.
+

Supernumerary teeth
• Supernumerary or extra teeth result from disturbances during
the initiation and proliferation stages of dental development.
The most common supernumerary tooth appears in the
maxillary midline and is called as a mesiodens.

ECTOPIC ERUPTION
• According to Proffit, occasionally malposition of a
permanent tooth bud can lead to eruption in the
wrong place. This condition is called ectopic
eruption and is more commonly seen in maxillary
first molars and incisors.

OCCLUSAL EQUILIBRATION IN THE
PRIMARY AND MIXED DENTITION.
• Occlusal equilibration or occlusal adjustment is the
systemic reshaping of the occlusal anatomy of teeth to
minimize the role of occlusal interference in reflexly
determined mandibular occlusal position.
• All functional prematurities should be eliminated as they
can lead to deviations in the mandibular path of closure
and also predisposes to bruxism.

Role of 2nd deciduous molar
• The primary second molar not only reserves space for
the permanent second premolars, but its distal root also
guides the erupting permanent first molar into position.
If the primary second molar is lost prematurely, the
permanent first molar will usually migrate mesially
within the bone even before it emerges into the oral
cavity.

MANAGEMENT OF ABNORMAL FRENALATTACHMENT
• A normal frenum inserts into the attached gingiva superior to the
central incisors.
• The maxillary labial frenum is a fold of tissue, extending from the
maxillary midline area of gingiva into vestibule and mid portion of
upper lip. It originates as a post eruptive remnant of the dentolabial
bands which are embryonic structures appearing at approximate
months inutero and connecting the tubercle of upper lip to palatine
papilla.
• According to John Edward, the failure of the attached frenal fibres to
migrate apically resulting in a residual band of tissue between the
maxillary central incisors, which has been implicated as an important
corrective factor in persisted midline diastemas.

BLANCH TEST
• Blanch test: when the upper lip and frenum are
stretched, the tissue between the central incisors
moves and is blanched.

Treatment
• The frenectomy must be carried out in a way that will produce
a good esthetic result and must be properly co-ordinated with
orthodontic treatment.
• To correct the midline diastema, the incisors may be bracketed.
A slot wire is ligated into place and the teeth pulled together
by ligatures or cross elastics. A removable appliance with
finger springs was also used to close the diastema.

PRESENCE OFANKYLOGLOSSIA
• Fusion of the tongue and floor of the mouth is called
ankyloglossia.
• Ankyloglossia (tongue – tie)
• prevents normal functional development due to lowered
position of the tongue and abnormalities in speech and
swallowing. This condition should be surgically treated to
prevent full fledged malocclusion.

SPACE MAINTAINERS
• Space maintainers are the devices used to
maintain the space created by the loss of
deciduous dentition.

CLASSIFICATION OF SPACE
MAINTAINERS
1. According to Finn
• Removable or fixed or semi fixed.
• With bands and without bands.
• Functional or non functional
• Active or passive
• Combination of above
2. According to Nakata and Stephen based on anchorage and space
available.
a. Semi fixed type space maintainer
i. Crown distal shoe space maintainer.
ii. Crown - loop
iii. Band – loop

b. Fixed type space maintainers
i) Lingual holding arch space maintainer
ii) Nance holding arch space maintainer.
c.Removable type space maintainer
3. According to Raymond C Throw :
i.Removable
ii.Complete arch
iii.Lingual arch
iv.Extra oral anchorage
v.Individual tooth
4. According to Hinrichsen
a. Fixed space maintainers
Class I (a) Non- functional types
i) Bar type
ii) Loop type
(b) Functional types
(i) Pontic type
(ii) Lingual arch type
Class II - Cantilever type (distal shoe, band and loop)
b. Removable type space maintainers – acrylic space maintainers

Indications for space maintainers
• Miyamoto, Chung and Le observed the effects of
early loss of deciduous canines and first and second
molars on occlusion of permanent dentition.
• A tooth is maintained in its correct relationship in the
dental arch as a result of action of a series of forces.

Planning for space maintainer
1. Time elapsed since loss.
2. Dental age of patient
3. Amount of bone covering the unerupted tooth
4. Sequence of eruption of teeth
5. Delayed eruption of permanent teeth
6. Congenital of absence of permanent tooth

SPACE MAINTAINERS for the first PRIMARY MOLAR AREA
Crown and Loop Band and Loop
CROWN and LOOP SPACE MAINTAINER
•The crown and loop consist of a loop made from a metal wire that
is soldered to a primary metal crown to maintain the space.

Indications
• Premature loss of first primary molars.
• Premature loss of a second primary molar after the adjacent first
permanent molar has erupted or even after distal shoe has been
removed.
• In cases here other space maintainer may not be suitable as in
cases of premature bilateral loss of primary molars.

Band and Loop space maintainers
• The function of a band and loop is similar to that of
crown and loop space maintainer, but anchorage to
abutment tooth is via the band.
• This is only indicated in cases in which the period of
space maintenance is short and the abutment tooth is
intact.
• Fabrication is same as that for the crown and loop.

• Before eruption of the permanent incisors, if a single
primary molar has been lost bilaterally, a pair of band
and loop maintainers are recommended instead of
lingual arch that would be used if patient were older.
• This is advisable because the permanent tooth buds
are lingual to the primary incisors and often erupt
lingual to their predecessors.
• This band - loop does not cause any interference for
its eruption.

Crown and distal shoe maintainers
(Willet – space maintainer - 1932)
(Intra alveolar or eruption guidance appliance)
• The distal shoe is the appliance of choice when a
primary second molar is lost before eruption of the
permanent first molar.

• Measurement on the radiograph: The outline of the
distal shoe is designed on radiograph. The mesio-distal
length of the horizontal position of the distal shoe
should be as long as the maximum width of the second
primary molar and vertical height should be about 1
mm under the mesial contour of the unerupted first
permanent molar

The distal shoe space maintainer: chair side fabrication &
clinical performance
• Reference:journal of pediatric dentistry (dec 2002)
• This appliance was introduced by Gerber & extended by Croll.
Fabrication:
• The first primary molar is prepared for a stainless stall crown and
the crown is fitted in the usual manner. The primary second molar
is extracted, while hemostasis is being achieved, the female
attachment of the appliance is welded, using an electric spot
welder, to the distal of the crown.

• The male attachment is inserted into the tube of
the female attachment. The crown is seated & the
male attachment extended to the most distal aspect
of the extraction socket. A radiograph is taken to
verify the position of the distal shoe blade with
respect to the first permanent molar.

• The appliance is removed & the legs are welded
immobile prior to being cemented into place.

After the molar erupts the blade can be removed and the
appliance can be converted to a crown and loop or the
attachment can be disengaged from the crown and either a
unilateral or bilateral space maintainer can be placed for
maintenance of the permanent molar in its position in the arch

• Contra indications of Distal shoe.
– If several teeth are missing, there may be lack of
abutments to support a metal appliance.
– Poor oral hygiene and lack of parental and
patient co-operation.
– Medically compromised patient.
• Blood dyscrasias.
• History of Rheumatic fever
• Coronary heart disease
• Diabetes.

Modification
• Roche distal Shoe to provide bilateral space
maintainence and eruption guidance for 1st
permanent molar should be about 1 mm under the
mesial contour of the unerupted first permanent
molar.

Garcia-Godoy space maintainer
Contralateral deciduous molar
can be used as additional
abutment tooth.
REFERENCE
Bookmarks -
1989 Aug 529 - 531 Fig. 2
Taken from the JCO on CD-ROM (Copyright © 1997 JCO, Inc.), Volume
1989 Aug(529 - 531): Case Report- Space Maintenance with the Garcia-
Godoy Appliance - SHERYL B. HUNTER, D, Fig. 2.--------------------------------
Contralateral deciduous molar can be used as additional abutment tooth.
After six
months with
Gracia-
Godoy
appliance in
place, lower
left first
permanent
molar has
erupted in
good
occlusal
relationship
with upper
left first
permanent
molar.

BONDED SPACE
MAINTAINER
Cast showing early loss of
upper right deciduous second
molar.
Space maintainer in
position on cast prior to
template formation.
Completed
template with
material over the
maintainer arms
removed to
facilitate
template
removal.
Space
maintainer
bonded in
place by
indirect
method.
Space maintainers
bonded in place by
direct method.
DIRECT
INDIRECT

Lingual arch space maintainers.
• A lingual arch space maintainer is indicated for space
maintenance when multiple primary posterior teeth are
missing and the permanent incisors have erupted.
• This appliance helps to maintain the dental arch
circumference by fixing both ends of a lingual arch to the
farthest distal tooth, such as 2nd primary molars and first
permanent molars.

• Indications
• In cases with eruption of succedenuous tooth
expected within a short time.
• Indicated to preserve the spaces created by multiple
loss of primary teeth.
• In cases with poor co-operation and non-compliance
in the use of a removable space maintainer.

Nance holding arch space maintainer.
• This is used in maxillary dental arch similar to the lingual arch
in the mandible. The anterior part of the appliance should not
be in contact with the incisal edges of lower teeth when
occluded.

Removable space maintainer
• It is like a partial denture
• It is indicated when there is loss of more than 2
primary teeth, loss of more than 2 primary teeth
bilaterally and loss of anterior teeth.

• The advantages are it maintains both the mesiodistal and
vertical space, the masticatory function are restored and it
helps in the prevention of tongue thrusting habit into the
extraction space.
• Clasps can also be incorporated in cases where no tooth
exists in the distal end and there is unilateral loss of
primary molars.
• The main disadvantage is reliance on patient co-operation.

Trans palatal
• Trans palatal arch space maintainer is a maxillary fixed non
functional appliance.
• It runs directly across the palatal vault, avoiding contact with
the soft tissues.
Indications
• It is best indicated when one side of the arch is intact and
several primary teeth are missing on the other side.
Advantages
• When maxillary molars move anteriorly, they rotate
mesiolingually around the large lingual root. This is prevented
by transpalatal arch.
Drawbacks
• Failure to adequately maintain the space.
• Failure of appliance to remain passive if the appliance is not
passive, unexpected vertical and transverse movements of the
permanent molars can occur.

ORAL HABITS
Definition
• Habits have been defined by many people in many
ways.
• Butter Worth (1961) defined habit as a frequent or
constant practice or acquired tendency which has
been fixed by frequent repetition.
• Maslow (1970) defined habit as a formed reaction
that is resistant to change, whether it is useful or
harmful, depending on the degree of which it
interferes with a children’s physical, emotional or
social function.
• Dorland (1981) - habit is a constant or fixed practice
established by frequent repetition.

• CLASSIFICATIONS:
• A. According to Sim and Finn:
a.-- Compulsive
Non-compulsive
b.-- Primary
Secondary
• B. Kleino classification
– Intentional (meaningful habits)
– Uninternational (Empty Habits)

C. Functional classification
I. i. Functional – Mouth breathing
ii. Muscular – lip and check biting
iii. Combination of muscular and functional action – Thumb
sucking
iv. Postural habits – e.g.1. Chin Propping
2. Face leaning on hand.
II. Pressure effect – Pressure habits
- Non-pressure habits.
D. Anderson (1963)
1)-Normal
-Abnormal
2)-Physiologic
-Pathologic
3)-Functional
-Non functional

THUMB AND DIGITAL SUCKING
• Thumb sucking is defined as placement of the thumb
or one or more fingers in varying depths into the
mouth.
• A number of theories have been put forward to
explain why thumb sucking occurs.
FREUDIAN THEORY
• He suggested that a child passes through various
distinct phases of psychological development which
the oral and the anal phase are seen in the 1st 3 years
of life, the oral phase; the mouth is believed to be an
oro-erotic zone. The child has the tendency to place
his fingers or any other object into the oral cavity.

BENJAMINS THEORY
• He suggested that thumb sucking arises from the
rooting or placing reflex seen in all mammalian
infants. Rooting reflex is the movement of the infants
head and tongue towards an object touching his
cheek.

A RETROSPECTIVE STUDY OF THE USE OF
“BLUEGRASS” APPLIANCE IN THE
CESSATION OF THUMB SUCKING
HABITS.
• (reference: Pediatric dentistry, Dec 2003 by
Stephen Greenleaf & John Mink.)

• The “Bluegrass’ fixed dental appliance composed of a
hexagonal Teflon roller on a palatal wire. It is a non
Punitive appliance that reminds the child to keep
away his finger out of his or her mouth.
• The advantage of this appliance is the roller.The
smaller size of the appliance due to the roller allows it
not to be seen from outside the mouth. An additional
advantage is that the roller can act as a neuromuscular
stimulant for the tongue which can aid patients in
speech therapy.
• The disadvantages are the eating & speech difficulties
associated with initial placement of the appliance,
which usually subsides within 2-3 weeks. The
treatment is expensive.

• Cribs: the crib may consist of a wire embedded
in a removable acrylic appliance similar to
Hawley’s retainers or it may be “functional” too,
added to upper lingual arch and used as a fixed
appliance it will help.
– To break the suction and force to the anterior
segment.
– To distribute the pressure to the posterior
teeth as well.
– To remind the patient that he is including the
habit.
– To make the habit inpleasurable…..

RAKES
• Rake may be removable or fixed. It has blunt tines and spurs
projecting from the cross base or acrylic retained in the
palatal vault. The tines discourage not only thumb sucking
but tongue thrusting and improper swallowing habit.
3. Oral shields

TONGUE THRUSTING HABIT
• It is defined as placement of tongue lip forward between
the incisors during swallowing.
Or
• The abnormal positioning of tongue – anteriorly to varying
degrees has been termed tongue – thrusting.
• I. Classification
• According to Braucer, Townsend and Holtz
• Type I - Non deforming tongue thrust.
• Type II – Deforming anterior tongue thrust.
• Sub groups
• Anterior open bite
• Anterior open bite with associated protrubency of anterior
teeth.
• Associated posterior cross bite.
• Type III – Deforming anterior and lateral tongue thrust.

II. According to Moyers
Simple tongue thrust habit
Definition
• Tongue thrust with a teeth together swallow
It shows
– Contractions of the lips, mentalis muscle and mandibular elevators.
– Teeth are in occlusion as the tongue protrudes into an open bite.
– The so called tongue thrust is simply an adaptive mechanism to
maintain an open bite created by something else, usually thumb –
sucking.
– The open bite is well circumscribed
– History of chronic digital pacifier sucking may be seen.
– Hypertrophied tonsil may be seen.

COMPLEX TONGUE THRUSTING
Definition
• It is defined as a tongue thrust with teeth – apart
swallow.
• Patients show –
– Lack of contraction of mandibular elevators.
– Contraction of lip, facial and mentalis muscle.
– Open bite is more diffuse and difficult to define.
– Occlusal interference in the retruded contact position.
– They are likely to be mouth breathers and have a history
of chronic naso-respiratory diseases or allergies.

Retained infantile swallowing
Definition
•It is defined predominant persistence of the infantile
swallowing reflex after the arrival of permanent teeth. They
have very stong contraction of lip and facial musculature.
Even a massive grimace. The tongue thrust strongly between
the teeth in front and on both the sides. Such patient may have
in expressive faces, since the seventh cranial nerve is not used
for facial expression but for stabilizing the mandible. Patients
have serious difficulties in mastication for they occlude only
on one molar in each quadrant.
•Prognosis is poor. True retained infantile swallow is rare.

b. Transferal of New swallow pattern to subconscious level
use of fruit drop on the tip of tongue
TREATMENT
1.for simple tongue thrust
a.learning of new reflex at the conscious level
-acquaint the patient with index finger
-use of small orthodontic elastics at the tip of the tongue

Tongue thrust appliance
Taken from the JCO on CD-ROM
(Copyright © 1997 JCO, Inc.),
Volume 1968 Mar(138 - 138): A
Practical Approach to the Tongue
Thrust Problem - JACK Y. LITTMAN,
The patient is instructed to wear the
appliance at all times, and its
cleaning and care, removal and
insertion are demonstrated. Then
the patient is given instructions on
the placement of the tip of the
tongue into the pear-shaped
opening prior to closing the
posterior teeth and swallowing. This
is repeated and observed carefully
until it is ascertained that the tip of
the tongue remains in the opening
after each swallow. Instruct the
patient to do this as an exercise 25
times, 3 times a day.

We can use –
• The Hyrake - Row of prong usually 4-6 in
numbers. It makes tongue thrust so painful that
patient will stop the behaviour.
• The Café – Not sharp prongs but 6-12 in No.
• The Fence – ‘V’ shaped lines are in criss cross.
• The curtain
Habit reminding appliance
Walter and Collins suggested a transpalatal
wire from maxillary cuspids. The patient is
instructed to keep the tongue behind the wire.
• Double oral screen

Complex tongue thrust
• Treat the occlusion first. When the orthodontic treatment is in
its retentive stages careful occlusal equilibration is completed.
Treatment of muscle training is same.

Finger Nail Biting (Onychophagy)
• Nail biting ordinarily is not seen until after a child is 3-4
years of age. Psychologists think it is a reflection of
anxiety or personality maladjustment. The habit reaches its
peak during the teens. This does not produce malocclusion
but in certain cases a marked attrition of lower anterior
teeth has been seen.

•— Abnormal pillowing
position— chin leaning on
forearm (unintentional
extraneous or extrinsic
pressure). (Humphrey,
1927.8)
• Abnormal pillowing
position— face and chin
leaning on hand
(unintentional extraneous or
extrinsic pressure).
(Humphrey, 1927.8)
Abnormal postural habits
•Taken from the AJO-DO 1952 Aug (569-587):

Postural Habits
• Poor posture may accentuate an existing malocclusion like
child resting his head on his hand for four hours each day or
sleeping on his arms or wrist each night.
• Taken from the AJO-DO
1952 Aug (569-587):
• Face leaning and effect
on the mandible and
maxillary arch
• Cross bites and
improper interdigitation

Lip sucking habit
Lip-sucking, the cushioning of the lower lip to the
lingual aspect of the maxillary incisors during both
rest and active function, and hyperactive mentalis
muscle activity (lower center) enhance malocclusion
and prevent normal deglutition. (From Mayne,
Warren, in Graber, T. M.: Orthodontics, Principles
and Practice, Philadelphia, 1961, W. B. Saunders
Company.)
Taken from the AJO-DO 1963 Jun (418-450):
Lip-habit appliance. A 0.040 inch bar is soldered to full metal crow
on second deciduous or first permanent molars. Bar may cross from
lingual to labial either mesial or distal to canine, depending on
occlusion and anterior spacing. The operator should be sure that
labial assemblage is 2 to 3 mm. anterior to labial aspect of lower
incisors.

MOUTH BREATHING
• Most normal people indulge in mouth breathing
when they are under physical exertion.
• Mouth breathers are those who indulge in mouth
breathing even during restful conditions.
• Respiratory needs are the primary determinant of
the posture of the jaws and tongue.

• During oral respiration 3 changes in posture
occurs
• Lowering the mandible
• Positioning the tongue downwards and forwards.
• Tipping back of head.

• Mouth Breathers may be classified into 3
categories.
• 1. Obstructive - causes – deviated nasal septum
– Nasal polyp.
– Localized benign tumor
– Inflamed mucosa.
– Obstructive Adenoids.
• 2. Habitual - A deep rooted habit performed
unconsciously
• 3. Anatomical - Short upper lip and does not permit
complete closure of mouth.

• CLINICAL FEATURES
• According to Proffit
• Face height increases and posterior teeth would supra
erupt.
• Unless there was unusual vertical growth of the
ramus. The mandible would rotate down and back,
opening the bite anteriorly and increasing the overjet.
• Lower border of the mandible runs at a steeper angle.
• Crowing of upper and lower arch.
• Buccinator mechanism is affected as the tongue
posture is missing. Thus increased pressure from the
cheeks may cause narrow maxillary arch. This will
lead to unilateral or bilateral posterior cross bite.

• This facial appearance is typically described as
“Adenoid facies.”

Clinical examination
• Mirror test:
• Cotton test:
• Water test :
• Snort:
The ‘simultaneous naso-oral respiratory test’ or snort was
introduced by Gurley and vig in 1982. This test is done with
the help of an instrument known as “Sphygmomanometer
Spyrometer”. The recording of nasal and oral breathing is done
in the form of waves and transferred in the form of electrical
signals for further use.

Management
• Removal of abstraction: Nasal or pharynx obstruction
should be removed by referring the patient to ENT
surgeon.
• Oral screen: It prevents breathing completely as it fills
the entire oral cavity. Few holes can be made in the
anterior part during the initial days and the holes can be
reduced in the subsequent visits. This will prevent
sudden obstruction of breathing by oral screen.

Oral screen
Lip training with the oral screen
An oral screen.
Increases lip activity in incompetent lips.
Retracts uppers incisors & protracts lower incisors.
Habit breaking in mouth breathers.

• Lip exercise: The simple lip exercise like
stretching the lips will help to increase the tone of
orbicularis oris muscle.
• Rapid maxillary expansion.

Lip bumper therapy
Pretreatment and post treatment
occlusal views of patient showing
increased arch length for tooth
alignment.

BRUXISM
• Bruxism has been defined as clenching or grinding of the
teeth during non-functional movements of masticatory
system.
Etiology
• Occlusal related (i.e. interference)
• Psychological or psychogenic stress
• CNS problems.
• Over anxieties
• And also seen in organic diseases such as epilepsy,
meningitis etc.

TREATMENT
• i. Adjunctive therapy
• Psychological therapy such as behavioural
modification, stress management programs etc can be
very effective. It includes noctural and diurnal bio-
feed back, relaxing exercise and physiotherapy.
• ii. Occlusal adjustment therapy
• Using bite plates and splints. The purpose is to stop
bruxism by eliminating occlusal interferences and the
restrict jaw movements and break the habit of
bruxism.
• Bite plates provides muscle relaxation.
• Vinyl plastic bite-guard that covers the occlusal
surfaces of all teeth, plus 2 mm of the buccal and
lingual surfaces, can be worn at night to prevent
continuing abrasion.

PREVENTIVE ORTHODONTICS AND SPORTS
ACTIVITIES.
• To prevent injuries to teeth and jaws occurring during various
sporting activities – Mouth protectors are used. Three types of
mouth protectors are usually considered.
• Stock pre-fabricated vinyl protectors
• Protectors with individual modification in the mouth.
• Individually fabricated mouth protectors.
• Protective mouth guards.

THE PROBLEM
Children with
Myofunctional problems
have poor facial growth
and Malocclusion.
Orthodontics does not
correct this, resulting in
UNATTRACTIVE
FACES, RELAPSE
and TMD
Myofunctional Research Co has
developed a unique range of appliances
to assist in correction of these problems
before, during and after orthodontics
and for TMD.

The Pre-Orthodontic TRAINER
• Tooth Positioning
• Tooth Channels
• Labial Bows
• Myofunctional Training
• Tongue Tag
• Tongue Guard
• Lip Bumpers
• Jaw Positioning
• Edge to edge CI jaw position
• Prevention of mouth breathing

The Pre-Orthodontic TRAINER®
Stretches Overactive Mentalis
Corrects Tongue Position
Stops Mouth Breathing
Corrects Jaw Position
Aligns Erupting Teeth A simple daily program
A simple daily program

Orthodontists rely on education,
experience, and research

NO FUTURE ORTHODONTIC TREATMENT CAN BE STABLE UNLESS
THESE MYOFUNCTIONAL HABITS ARE CORRECTED
THE POSITION OF THE TEETH IS DETERMINED BY
THE LIPS AND TONGUE

TREAT Children with a
developing malocclusion NOW
FACIAL
DEVELOPMENT OF
THE GROWING
CHILD WILL BE
SEVERELY
COMPROMISED
UNLESS THE
MYOFUNCTIONAL
PROBLEMS ARE
CORRECTED.
ORTHODONTIC TREATMENT CANNOT
BE STABLE UNLESS MYOFUNCTIONAL
CAUSES ARE CORRECTED

• NEW CONCEPT IN MALOCCLUSION
Upper Crowding
Lower Anterior Crowding
INCORRECT ARCH FORM CAUSES CROWDING
NOT BIG TEETH IN SMALL JAWS

THE TRAINER SYSTEM
Bent Wire System
TRAINER for Alignment
Pre-Orthodontic TRAINER® TRAINER for BRACES®

CONCLUSION
According to kannada saying : “Minchi hoda
kalakke chintisi phalavilla”.
• Prevention is better than cure. Preventive
orthodontics is concerned with the patients and
parents education, supervision of growth and
development of dentition and the cranio-facial
structure and the treatment procedure instituted to
prevent the onset of malocclusion.

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