In this part 2, Orthodontist Dr Andrew Chang discusses:

Treatment Options:

1. No treatment
2. Interceptive Treatment now: Functional Appliances with U maxilla expansion + referral to speech therapist.
3. Wait till permanent dentition, then camouflage with upper arch extractions, U expansion is less effective.

Treatment Timing:

1. Is it too early? Primary dentition?
2. 1. If have habits eg: thumb sucking or dummy, best to cease habit first
3. Mixed dentition: best time for maximum orthopedic effect (CVMS 2: Baccetti 2002): Shape of vertebral bodies of C2-4 and inferior borders of C3-4
4. Adult. Is it too late? What happens with functional appliances? Compliance and success rate (due to temporary speech disruptions), greater lower incisor proclination. Jaw surgery and risks of morbidity.
5. Adv & Disadv of Early Treatment- Gingival trauma, Upper incisor trauma, psychosocial.
6. Adv & disadv of Late mixed dentition or Permanent dentition Tx: Orthopedic effects best retained.

What should dentists be looking out for?

1. Age and Dental Status. Mobile D's and E's at 10-11 yrs may be difficult to retain functional appliances.
2. Habits - ask about thumbsucking, dummy, mouth breathing etc.
3. Signs of Risk Factors manifesting as gingival trauma, narrow jaw, Upper Incisor trauma.
4. Assessing risk factors through their lifestyles and habits ie: sports, mouthbreathing
5. >7mm Overjets and referral to orthodontist
6. My experience has been parents would prefer to do a combined functional appliance + teeth alignment that address root causes, rather than orthodontic camouflage and adults are not keen on jaw surgery procedures due to significant risks.