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ORAL HABITS – Case 2

ORAL HABITS – Case 2. Thumb Sucking Habit. The deformation occurring is as a result to 1) The finger or thumb    2) Tongue thrust swallowing as a consequence to the open bite & increased overjet 3) Lower lip activity (lower lip cushions to the lingual of the maxillary incisors)

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ORAL HABITS – Case 2

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  1. ORAL HABITS – Case 2 Thumb Sucking Habit

  2. The deformation occurring is as a result to 1) The finger or thumb    2)Tongue thrust swallowing as a consequence to the open bite & increased overjet 3) Lower lip activity (lower lip cushions to the lingual of the maxillary incisors) 4) Abnormal mentalis muscle function (lower lip & mentalis muscle serve to flatten the mandibular anterior segment) 5)Buccinator muscle activity (unilateral & bilateral crossbite)

  3. Treatment Treatment starts as the time of eruption of permanent incisors approaches. Counseling A straightforward discussion between the child & the dentist that expresses concern & includes an explanation by the dentist.

  4. Reward System • The contract simply states that the child will discontinue the habit within a specified period of time & in return will receive a reward. • Involvement may include placing stick-on stars on a homemade calendar when the child has successfully avoided the habit for an entire day. • At the end of the specified time period, the reward is presented with verbal praise for meeting the conditions of the contract on stopping the habit.

  5. Reminder Therapy This is for the child who wants to quit but needs some help to stop. • An adhesive bandage • Thumb guards • Unpleasant stimuli, such as ill tasting solution • an elastic bandage loosely wrapped around the elbow prevents the arm from flexing

  6. Appliance therapy The palatal crib

  7. Before & After Palatal Crib

  8. W-arch

  9. Quad Helix

  10. RPE

  11. Case 3Management of “e” Space • Mixed Dentition Space Analyses • Tanaka-Johnston • Moyer’s • Radiographic

  12. Tanaka-Johnston The size of the lower incisors correlates better with the size of the upper canines and premolars than does the size of the upper incisors, because upper lateral incisors are extremely variable teeth. Proffit and Fields pages 197-198

  13. Moyers Prediction Tables Mesiodistal width of the lower incisors is measured and this number is used to predict the size of both the lower and upper unerupted canines and premolars

  14. Radiographs Requires an undistorted radiographic image, which is more easily achieved with individual periapical radiographs than with panoramic radiographs.

  15. 1 2 c d e 6 6 e d c 2 1 1 2 c d e 6 6 e d c 2 1 Definition of an Early Mixed Dentition

  16. Primate space: in max: mesial to upper primary canines, in mand: distal to lower primary canines • Leeway space: difference in size between C, D, E & 3, 4, 5 max: 3mm, mand: 5mm • E space: difference in size between 5 & E max: 3mm, mand: 4mm • Early mesial shift: shift of mandibular first molars utilizing the primate spaces • Late mesial shift: shift of first molars due to E spaces and differential growth

  17. Flush Terminal Plane Class II Class I (desirable)  56% FTP ETE

  18. Maintain “e” space with Lower Lingual Holding Arch

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