“Can Autistic Children Handle Braces?”

Looking at CJ’s handsome face (and adorable smile), I felt blessed to be working with CJ and his loving family, finishing his braces. CJ is one of only 0.07% of children in the world diagnosed with autism.

Parents of autistic children are often perplexed by the multitudes of information they receive regarding how to best care for their child’s health. Dental care in autistic children in particular is a topic few professionals know how to handle. Autism, which occurs in approximately 7 out of every 10,000 children, is a developmental brain disorder usually affects a child’s communication, language and social interaction skills, making it quite difficult for many children suffering from autism to thrive in a medical environment.

The factors associated with autism which make dental care particularly difficult are restrictive and compulsive behaviors, like the inability to stay seated for an extended period of time and limited focus and/or interest. Braces pose a particularly unique challenge: the semi-permanent nature of dental braces must remain on the teeth for at least several months (usually longer). Because autistic children often have a hard time reacting to change, they may become alarmed by the presence of dental braces – some autistic children have even forcefully removed their braces themselves with pliars (extremely dangerous). With risks such as these, is it possible for autistic children to handle braces?

The answer is absolutely, if you do your homework. Finding a dental professional who is attuned to the special needs of autistic patients, who has the patience and level of experience to properly (and gently) care for autistic patients is key. Upon taking your autistic child to a new dentist, let your child know the dentist is his or her friend. The dental professional should give a tour of the practice to you and your child, and the dental professional should spend some time with the child (and the parent): a farmiliar environment will help to sooth an autistic child’s mind. For this reason, the first appointment should be short and positive. By using models, your dentist should be able to easily communicate with your child (showing versus telling). Also, stimming (flailing of limbs, rocking, screaming) is common when the senses are overloaded and the child becomes stressed. By eliminating surrounding sounds, people and general “crowdedness,” your dental professional should create a serene and calm environment for you and your child. Finally, autistic children like to know what is happening, and what will happen next. Your dentist should communicate with you and your child during any procedures what is happening.

Choosing the right dental professional for an autistic patient is vital, but once you do, dental braces should not be a problem! A caring spirit and a gentle touch will make all the difference.

“What is Tongue Thrusting?”

“Dr. Sun, I’ve had braces twice and I still have all of these spaces in my teeth!” Disparaged new patient Lisa was at her wits end for the answer to her dental dilemma.

Lisa did wear her retainer for a year after the braces, bur once stop wearing the retainer, but her condition had relapsed. Two thoughts went through my mind – either bruxism (night grinding) or tongue thrusting. Checking the wear pattern of Lisa’s teeth as well as performing muscle palpitations for clues of bruxism and observing whether Lisa’s tongue could be seen between teeth during swallowing to evaluate her tongue thrust.

Bruxism has gained awareness in recent years, but tongue thrusting is still a mostly unfamiliar word. Let’s have a discussion about this interesting phenomenon!

Although nearly all children experience tongue thrusting, it is usually self-corrected at age six, and some continue tongue thrusting into adulthood. Because we swallow up to 2,000 times a day, pressure exerted on the teeth from a protruding tongue at each swallow can create force on the teeth, leading to mis-aligned dentition or a lisp-orientated speech impediment or reversed orthodontic work.

Generally, there are several contributing factors which can lead to tongue thrusting. Certain types of pacifiers in childhood can set bad oral habits in young children. Allergies or nasal congestion causing the tongue to lie low in the mouth due to breathing obstruction (as opposed to the normal position behind the upper front teeth against the palate), genetics or ankyloglossia (a tongue tie requiring a frenectomy to remedy) can also cause tongue thrusting. A laser frenectomy is the most advanced treatment for alleviating a tongue tie.

Possible treatment includes a training appliance from your dentist. Myofunctional therapy, a proactive strategy which trains  the tongue and swallow properly. With proper myofuntional training and exercise , we can swallow without tongue thrust. To improve airway, check with your ENT doctor, retraining of proper body postures are all important for oralfacial health.

Wow, isn’t this interesting? The tongue is an essential part of our body. It is influenced by and can influence our physiology in many ways! Look at the mirror and swallow – are you tongue thrusting?

” Am I Too Old for Braces? ”

If you’re older than 95, then maybe!

The mechanism of the movement is the result of remodeling of the bone that houses the teeth, the pressure on the side bone will disappear (the tension side), and new bone will deposit so the teeth can be guided to the ideal position. As long as you are healthy, there is no age limit! The most common age to receive braces is 9-12. Braces can be very effective to guide the jaws to reach one’s full potential development during the growth spurt period. If a child is diagnosed with teeth and jaw alignment problems at a younger age, an orthodontic appliance can be worn to correct and aid the development of the jaw. If you missed out on braces as a teenager – or you used to wear braces previously – and you now want to do something to improve your smile or dental health (because you teeth are crooked or gaped), discuss all available options to you with your dentist or orthodontist.

Orthodontic treatment can proceed with fixed braces which can be clear (less noticeable); you can also wear a removable appliance to straighten your teeth – friendly for an adult lifestyle! There are several options depending on your own unique situation and the training background of your dentist. The popular wireless Invisalign system often works well to correct crooked teeth, and most people never notice you are wearing an appliance!

Of all the orthodontic treatment recipients in my office, 95% are adults (average age is 35). The oldest patient I have orthodontically treated was 83! Treatment periods vary from three months to two years, with an average duration of 9 months. 60% of patients choose to receive clear braces for specific bite correction, 30% choose Invisalign for correction of crooked teeth and the convenience of not having to come in and see me very often! The remaining 10% choose alternative treatment methods.

Of course, cosmetic procedures like porcelain veneers or bonding can be the answer to your desire of that million dollar smile, as long as the teeth which are the foundation for your cosmetic restoration are reasonably positioned and in reasonably healthy condition. This type of procedure provides instant gratification. One big caution however to this treatment method worth taking is before the alteration treatment starts, imagine you are an architect. Can you build the design of your tooth without blue prints? Proper diagnosis, treatment planning, and / or wax-up and mock-up modeling are all extremely important things to be taken care of right by a trusted dental physician. If you’d like to know more about these terms, visit my YouTube channel for procedural videos, educational material and more.

Dental braces, a common orthodontic appliance used to straighten and properly align a person’s teeth to a person’s bite,  have been used for nearly a century.Whether your teeth are only slightly off-center or are quite crooked, whether you are age 6 or 106, dramatic transformations in your outward appearance can be achieved at any age through teeth straightening! Dont’ be afraid!