13: Anterior open bite

13 Anterior open bite

Summary

Gerald is 11 years old. He presents with no contact of his incisor teeth (Fig. 13.1). Identify the cause(s) and discuss the treatment options.

image

Fig. 13.1 Anterior occlusion at presentation.

History

Complaint

Gerald complains that his front teeth do not meet. This embarrasses him when eating as he cannot bite into food. His parents are also concerned by this and by lisping during speech, which they attribute to the position of his front teeth. They are anxious for treatment.

History of complaint

Gerald’s parents report that his primary incisors did not meet either, but the space between the upper and lower permanent incisors appears to have increased in the past year. His lisp has also become more noticeable. He has no history of thumb or digit sucking.

Medical history

Gerald is fit and well.

Dental history

Gerald is a regular attender at his general dental practitioner and has cooperated well with previous dental treatment.

Examination

Extraoral

image Gerald’s facial profile is shown in Figure 13.2. What do you notice?

Gerald has a mild Class II skeletal pattern with increased FMPA and increased lower anterior facial height. The lips are competent.

image

Fig. 13.2 Profile.

There was no facial asymmetry. Mouth opening was within normal dimensions and there was no temporomandibular joint tenderness or crepitus. No masticatory muscle tenderness was noted.

image What other features should you assess? Explain why

1 The swallowing pattern. Where there is a space between the upper and lower anterior teeth, swallowing is likely to be achieved by forward positioning of the tongue between the anterior teeth to achieve an oral seal. This is particularly so where the vertical facial proportions are increased as the likelihood of lip incompetence is greater. Although such behaviour of the tongue is in most cases adaptive, in rare instances an endogenous (primary) tongue thrust exists. It has been suggested that this is associated with lisping and some proclination of the upper and lower incisors. Any attempt in these cases to close the open bite is doomed to fail as the tongue will return the incisors to their original positions.
2 Speech. By asking Gerald to count from 60 to 70 aloud or to say ‘Mississippi’, the degree of sibilance (lisping) can be detected. The tongue position during speech should also be observed.

Gerald had a tongue to lower lip swallowing pattern and the lisp was deemed to be mild.

image What occlusal anomalies are associated with speech problems? Are the latter likely to resolve if any underlying malocclusion is treated?

Although speech problems are associated with incisor spacing, Class II division 1 malocclusion, Class III malocclusion and anterior open bite, they do not occur in all individuals with these occlusal anomalies. Furthermore, correction of these occlusal problems is no guarantee that the associated speech problem will resolve satisfactorily. Where sibilance is judged to be marked, referral to a speech therapist would be prudent, although treatment may do little to mitigate the defect.

Intraoral

image What other features do you see (Figs 13.1 and 13.3)?

Mild marginal gingival erythema related especially to the incisors and image.
No caries is visible.
Mild spacing of the upper and lower labial segments; mesiolabial rotations of image.
Class I incisor relationship.
Anterior open bite (measured clinically = 6 mm from the mesioincisal aspects of image.
Class III molar relationship bilaterally.
image

Fig. 13.3 (A) Right buccal occlusion.

image

Fig. 1/>

Related posts:

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  2. 39: Gingival bleeding and enlargement
  3. 22: Nursing and early childhood caries
  4. 12: Increased overbite
  5. 30: The fractured permanent incisor root
  6. 38: Dentinogenesis imperfecta

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 13: Anterior open bite

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