Introduction:
Individuals have three sets of dentition in their lifetime. First is primary dentition or deciduous dentition, second is mixed dentition, and third is permanent dentition. Children have 20 teeth as baby teeth or primary teeth. Permanent dentition has 32 teeth. Mixed dentition has both dentitions, primary as well as permanent teeth in that phase.
Primary teeth eventually fall out and are replaced by successor permanent teeth. This phase of shedding of deciduous teeth and eruption of permanent teeth takes about six years that is between 6 to 12 years of age. The mixed dentition phase begins when a child gets his or her first permanent tooth and continues until the last deciduous tooth has been lost, which is usually around 12 years of age.
Permanent molars erupt behind the primary molar by lengthening the jaw posteriorly and making space to accommodate them. Bicuspid erupts as a successor of primary molars.
What Problems Are Encountered During the Mixed Dentition Phase?
There are some problems that are encountered during the mixed dentition phase, such as:
1) Saw-Shaped Edges
These saw-type edges get smoothen over a period of time by the process of chewing. When it persists for a long period and does not smoothen naturally, one should visit a pedodontist.
2) Midline Diastema
Another issue you may encounter is a gap in between central incisors. This gap is there because of the phase called the ugly duckling stage. After that stage, that space automatically gets corrected when the permanent canine erupts. If it persists even after the eruption of the permanent canine, one needs to consult a pedodontist or orthodontist.
Midline diastema may be caused because of thick labial frenum that is causing interference in the closure of the gap between the incisors. In that case, a frenectomy is advised, but as there are chances, after the ugly duckling stage, that gap gets automatically corrected, so frenectomy should be undertaken after the age of 12 to 13 years of age, that is, after the eruption of permanent maxillary canines if it is necessary.
3) Over-Retained Deciduous Teeth
Another most common issue is over-retained deciduous teeth. In normal situations, baby teeth get replaced by succeeding permanent teeth. But if it is over-retained even after the eruption of a permanent tooth, one should visit a dentist to prevent further complications regarding malocclusion.
Parents need to take their children to the dentist or pedodontist for periodic observations to determine developmental trends. A few issues in mixed dentition get self-corrected, called self-correcting anomalies, and are transient in nature which are there during the transition from one phase of the dentition to another phase of dentition.
What Procedures Can Be Done as a Part of Early Interventions?
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Growth modification procedures.
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Correction of anterior crossbite.
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Serial extraction.
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Habit-breaking procedures.
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Intervention with surgical procedure - Growth modification procedures.
Growth Modification Procedures
When the child is having skeletal problems, such as a protrusive or retrusive jaw, they are best treated during the growing age of the child. When they are encountered at an early age, then they may be treated without the need for extraction or need of surgery. It is necessary to evaluate for missing deciduous teeth or over-retained deciduous teeth in order to detect any requirement for space maintenance.
When there is an over-retained deciduous tooth even after the eruption of the successor permanent tooth, it needs to be managed as earliest possible as it may lead to crowding or irregular position of the permanent tooth.
When there is early loss of primary molar, there are chances of permanent molar to shift mesially, and eventually, it leads to loss of leeway space and ultimately may lead to loss of leeway space. So, in that case, lingual arch appliance or palatal arch is placed before extraction of primary molar to preserve leeway space.
Correction of Anterior Crossbite
When there is a crossbite in anterior teeth, it is a dental emergency kind of situation as it hampers the growth of jawbones. It restricts the growth of the maxilla and alters the growth of the mandible.
Serial Extraction
This refers to planned extraction of teeth to intercept developing arch length deficiency. It should be carried out after evaluation of the arch length, skeletal pattern, root development, and space requirement of that case. Serial extraction is contraindicated in skeletal class II and skeletal class III patterns and in cases of oligodontia. It is usually carried out around eight years of age.
Habit-Breaking Appliance
If children have the habit of thumb sucking, nail-biting, tongue thrusting, and mouth breathing, it should be corrected as soon as possible as it may lead to malocclusion. Parents should consult a dentist and plan for a habit-breaking appliance. Habit-breaking appliances are removable or fixed.
Correction of Vertical Skeletal Problems
When children have a vertical growth pattern or maxilla rotated downward and posteriorly, it needs to be corrected in growing age only with the help of high pull headgear as it will modify the direction of growth and, to some extent, restrict vertical growth pattern. A horizontal growth pattern is also managed with early intervention by opening the bite with maxillary anterior bite planes or cervical pull headgear.
Correction of Horizontal Skeletal Problems
Horizontal skeletal problems may lead to posterior crossbite that leads to a lateral functional shift of the mandible, producing an alteration in normal growth pattern that may result in skeletal facial asymmetry. The orthopedic arch expansion allows more space for alignment for permanent dentition and to relieve the potential crowding, and alleviates sagittal discrepancy.
Conclusion:
Nowadays parents do not accept the answer given by the orthodontist as no treatment is indicated at this age and the patient is young and needs to be evaluated after the complete eruption of permanent teeth. Still, as we have seen earlier, there are few cases where we have to wait and watch till the eruption of permanent teeth as few anomalies are self-correcting.
When it is a skeletal problem or crossbite case, then your orthodontist will do the needful at that time only to intercept it. Same for skeletal problems, growing age is ideal for modifying the growth pattern to prevent future surgical procedures. Functional improvement gives psychological benefits also for treating potentially challenging problems during the mixed dentition phase. So a dental visit during the mixed dentition period is important to prevent further complications.
