Orthotown September 2019 - 50

Do you have any thoughts
regarding removal of primary
teeth?
CV: This often can be beneficial to prevent permanent tooth impaction, particularly
maxillary canines. If the patient requires
deep sedation or general anesthesia to tolerate
primary teeth extractions, I often consult
with the orthodontist to see if an alternate
treatment plan is an option. Early orthodontic
intervention can usually prevent removal of
permanent teeth. I prefer treatment plans
with no removal of permanent teeth, but I
also understand there are situations where
removal is needed.
RM: I think that in certain situations,
the removal of primary teeth has its place
in facilitating the eruption and spacing of
permanent teeth. That is a talk I'll commonly
have with parents when reviewing the panos
when I see severe crowding or canines that
aren't lining up well. I always make sure to
let them know that removing baby teeth is
in conjunction with braces in the future. For
permanent teeth removals, I'd say there are
times that it seems appropriate, but I have
definitely seen far fewer premolar extractions
with the increase of early expansion.

How about occlusion? Have you
been schooled on what to look
for in a finished orthodontic
treatment?
CV: Yes, but also with continuing
education.
RM: Over time, you get a good sense
of occlusion and how teeth should work
together. It's pretty easy to tell which
orthodontists pay attention to that detail
and which ones don't.

How about lingual and
labial frenectomy?
CV: Yes-address before and during
orthodontic intervention, then refer to
therapist.
RM: In my experience, this is something
that's becoming more important in a pediatric
practice and in orthodontics. We're starting

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SEPTEMBER 2019 // orthotown.com

to do more early evaluations for tongue/lip
restrictions in infants to not only help with
nursing and feeding but also in other areas.
As kids get older, we then assess for speech
patterns and will work with myofunctional
therapists to help facilitate.

How about airway and sleep
issues? Do you screen?
CV: Yes.
RM: I don't screen for airway directly,
but it is a conversation I have with parents
if their kids are excessive grinders, have
inflamed tonsils or some other underlying
concerns that arise. Our orthodontist can
use the 3D cone beam in our office to screen
for airways, and I have seen the benefits that
can come from it.

Do you think orthodontics may
benefit some of these patients?
Do patients bring up the topic of
orthodontics?
CV: Yes.
RM: Every day, with a different way
to approach it with each individual. With
that said, everyone has their own view of
orthodontics and when they think kids
should have or not have braces. I have parents
who are concerned about braces on their
4-year-olds, while others fight the idea for
a teenager who has severe crowding with
impacted teeth. Orthodontics is something I
bring up at an early age in a general concept,
and then gauge the parents over time to find
the best solution.
[Editor's conclusion: This Q&A was
eye-opening and encouraging. It's apparent
that both pediatric dentists take their duty
and obligation to refer to orthodontists very
seriously. I found it interesting that some little
things, like the design of a referral pad, could
be a factor or tipping point in the decision to
refer for orthodontics!
It behooves us as orthodontists to do what
we can to meet the demands and expectations
of our pediatric dental colleagues, to help keep
the discussion open.] ■
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Orthotown September 2019

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