As more and more patients eat soft diet and soft processed food, arches and dental skeletal structures are getting smaller and smaller. Also, due to allergies, large tonsils and poor airway, many young patients develop a low and forward tongue position. This results in a high angle skeletal development and often an open bite, and or a long face appearance. As the jaw drops down as a result from the airway problems, large tonsillitis and the low and forward jaw position, the buccal cheek muscles exert a pressure inward on the upper and lower arches. This inward pressure creates an even more narrow upper and lower arches, resulting in more open bite and more narrow crowded arches.
So, many of the patients today, are becoming more and more crowded from the process descried above. Often we see patients during a hygiene exam with very little space for the erupting teeth, or with impacted, missing teeth. We used to see patients with erupted wisdom teeth, or at least second molars, but it is common today to see patients with totally impacted wisdom teeth, and even impacted lower and upper second molars. Many of our patients today have little room for second molars and often even the canines are blocked in. Unless, these problems are detected early, after the growth is complete very little can be done in cases of severe crowding and malocclusion but to do extractions and or surgery.
So, it is imperative that we all learn to identify, diagnose and learn to treat these mixed dentition problems early and effectively. So, let’s look at an example case here that exhibits some of the problems that we described above.
What can we tell from just a panorex? Let’s look at a mixed dentition case where such problems present.