Open bites remain one of our most difficult problems to correct. We will discuss open bites in non-growing patients in the next newsletter- as we do have some new tools to help us (such as tads to intrude molars and even some promising new invisalign results with open bites). However, today’s topic is open bites in young patients.
Open bites in young patients may be due to many factors. Thumb and finger habits contribute to open bites. Airway deficiencies may be a contributing factor as well. Tongue thrusts and tongue habits are certainly a contributing factor. Let’s review these.
A tongue habit may start with the early loss off a deciduous incisor or even a chipped incisor. A tongue thrust will be present with any open bite. A thumb habit, finger habit or airway deficiency that causes an open bite will have a tongue habit.
Thumb and finger habits. If I see a patient in the early mixed or deciduous dentition that has an open bite due to a finger or thumb habit I would first advise the parents of ways to stop the habit. There are many things that may work. They can purchase thumb guards that are placed every night. There are ointments they can put on the thumb. Parents have had success with socks and ace bandages. Studies show that if the causative factor is removed the open bite will self-correct over 80 % of the time.
In patients 6 or 7 years of age and the upper central incisors and lateral incisors are fully erupted but they have a thumb or finger habit, I will probably advise a habit appliance. Most thumb and finger habits contribute to a narrow maxilla so I may start with an expansion appliance and then place the habit appliance after expansion is complete, or I may combine the two appliances.
An open bite in any patient that has an airway deficiency needs an ENT evaluation. If they can’t breathe through their nose we cannot correct the open bite.
An open bite in an older adolescent patient or teenager is a little more difficult. The treatment is based on the cause of the open bite. Often the digit or thumb habit has stopped but they now have a tongue habit. If the posterior teeth have over-erupted then intrusion is ideal. With tads we have the ability to intrude posterior teeth. If the anterior teeth need eruption that is much easier. If you close an open bite with anterior eruption (that should be intrusion) it is very unstable. A tongue appliance can help with tongue positioning as you close the bite. As a rule of thumb an open bite and tongue thrust is something we want to catch early.