• Dr. Carmen Briceño Crespi

8-Year Old Sings Songs of Joy with Her New Smile

Updated: Dec 21, 2020

Early orthodontic treatment is critical for some children so they can grow up with a healthy smile. If a parent or guardian waits too long for their child to be seen by a dental specialist, it can lead to many problems. However, finding a solution sooner than later can avoid speech impediments, eating challenges, and dental anxiety from potentially preventable events like having baby teeth extracted too early.

An example of this scenario would be the case of Rebecca, or as she likes to be called, Becky, who is an 8-year-old referred to our office by Nicklaus Children's Hospital. From the moment I met her, I knew this church choir-singing girl was going to be special.

Becky Presented Many Problems

Becky's mother, like most parents, wanted her daughter to smile and be happy. She wanted her daughter to have a better smile for several cosmetic and health-related reasons. Still, the most important one was improving her daughter's self-esteem in daily life and on stage as a performer. Becky came from a family of singers blessed with exceptional vocal abilities; however, her problem was that Becky refused to smile on stage. Mom was a singer and on-stage performer herself. She knew the importance of developing self-assurance and confidence on stage as it would reflect in other aspects of her young daughter's life.

Becky's problems weren't just her stage presence, but she was having significant functional issues. Becky was limited in what she could eat because her teeth didn't touch in the front at all, limiting her food intake significantly. To make matters worse, she had lost some primary teeth earlier on in her life due to cavities. With no back teeth to chew with, Becky had challenges breaking down food.

Occlusal Photo of Maxillary Dentition - Becky

Becky's functional problems are apparent in these pictures. You see a few teeth that touch on one side. However, on the other side, she's missing some of the baby teeth. As part of her interceptive treatment, we would need to deal with the repercussions of space loss. Other teeth moved into that space because of the lack of baby teeth.

Becky's speech was also affected by problems with her teeth. She was in speech therapy at a very early age for a lisp because her front teeth didn't touch. Becky had what we call an "open bite." Her front teeth didn't come together, making it difficult for her to pronounce the 's' sound or making any sounds that required her teeth to touch. Becky would compensate by using her lips or tongue, affecting her ability to make certain sounds. Her difficulties in speaking made her even more self-conscious, further damaging her self-esteem.

Frontal Intraoral Photo - Becky

Becky also had an awkward smile due to skeletal issues - problems with the positioning of her jaw. Becky's Mom once asked her, "I don't understand, why don't you smile?" And Becky replied, "Because I don't like my teeth. They're ugly."

Becky's self-esteem was as low as it could be. Her dental problems caused her to be shy, reserved, and introverted. Becky's teeth were trapping her in her little protective shell.

Although some dental issues are avoidable, others are inherited. Becky had a stronger bottom jaw, which was genetic. She was predisposed based on family history. Becky's Mom also had an open bite and suffered from a milder form of having a strong bottom jaw. We eventually treated Mom, but because she was already an adult, she needed surgery too.

With Becky, we were trying to avoid surgery as an adult - like her Mom had to go through. As an adult, Becky's mouth would stop growing, and there would be no way to guide the growth of the jaws to correct the problem.

Mom didn't want her daughter to go through any more pain than what she had already experienced. She just wanted her daughter to smile and be happy with the way her teeth looked and felt good and see herself as beautiful - something every young girl deserves.

No family should have to go through all of these problems if it can be avoided.

A Mother's Pain, An Orthodontist's Purpose

Panoramic X-Ray

Becky's situation was the perfect example of why early interceptive treatment is essential for children. Becky presented with a few problems, some of which were dental. Other challenges were her skeletal structure and a few bad habits. Since Becky was seeing me early enough, I knew I could come up with a plan to help her achieve a fully developed smile.

I'm an attending faculty member at Doral's Nicklaus Children's, and I run the orthodontic curriculum at Nicklaus Children's Hospital. Because of my expertise in handling severe cases, Becky's case was sent directly to my private office.

I've built a team of dental and medical specialists who handle these types of severe cases at least once a month. Although severe cases like this aren't something we see daily, we are experienced treating kids with problems similar to Becky's.

We knew Becky had already gone into the operating room to get her baby teeth out due to the infections and various cavities. We expected Becky to have severe dental anxiety. However, our experience prepares us for anxious, timid, and potentially reluctant children.

The Treatment Plan

Lateral Ceph X-Ray - Becky

The hardest cases to treat in Orthodontics are "High Angle Open Bite Class III Cases." Class III is the medical term for somebody who has problems with their teeth and their bone that sometimes can't be controlled. Becky had a combination of these problems.

The plan was to address all the things that Becky had going on. Because her bottom jaw was stronger than the top, I had to delay the growth of the lower jaw, and promote the growth of the top jaw.

First, we needed to put an expander on the top so that we could create more space because of those teeth that were lost early. The expander we placed would also help deal with Becky's thumb habit because it doesn't allow for suction between the thumb and the roof of the mouth. With no suction, endorphins don't get released, and children eventually stop sucking their thumbs.

Next, we planned for some braces on the top and a face mask that we'd use to correct Becky's skeletal growth. This plan would create the differential growth needed between the top and the bottom so we could get top teeth to come forward and the bottom teeth to come back. The shift would compensate for the significant size difference between her jaws.

Becky's Mom's main concern was whether her daughter could tolerate the treatment because of her previous dental anxiety. There was also an issue with making it to appointments because Becky's family lived in Homestead, which is about an hour away from our office. The logistics of having to see me every four to six weeks during the treatment could have been an issue. But Becky's Mom had done her research, and everyone recommended me because they know that I dealt with cases like this regularly. Many South Florida pediatric dentists know that I would make sure that the best orthodontic treatment would happen for Becky.

A Scary Start

Becky was petrified when she first walked into our offices. The first appointment is critical because it's when molds (dental impressions) get made for the expanders and braces are put on. It was a lot for Becky, and she cried. Her Mom was extremely concerned - dentally and mentally, Becky had been through a lot.

Her first appointment was the most challenging because we needed to get Becky to trust us and trust me.

In a case like Becky's, I like to maintain the same assistant with me so that that way, the child is not only comfortable with me, but also with the person who's helping me.

Successful Execution

Dr. Carmen Crespi

The beginning step was to get the thumb out of the way. Without the thumb out of the way, no amount of braces or expanders will work because the culprit of the problem would remain. Becky had an expander initially, and then she had a thumb habit appliance after the expander to address the thumb habit.

Becky worked with me and the same assistant throughout her full 13-month treatment. By the second and third visits, Becky realized we weren't going to do anything here that was painful, and we gained her trust.

I also attribute this to the fact that we explain everything before we do it, and we showed her what we're going to do. This is a method called the tell-show-do method - we told her what we were going to do, we showed her what we were going to do, and then we did it. This way, Becky didn't have a fear of not knowing what's coming. As long as we communicated, she was comfortable.

Before and After

Within the first three months, the change that had occurred was drastic. To expand the top required two to three weeks to do because you're moving the bones. Once we put the braces on, within the first three months, we began to see changes in the teeth in the way they move and come into place as planned.

(Left) Before. (Right) After

(Left) Before. (Right) After

What made our job increasingly easier every month was when Becky realized, "Oh my gosh. This didn't really hurt. Look at how good my teeth are looking."

It's gratifying for me as an orthodontist to be able to make an impact like this. When I change a child's smile, I know I've changed their life.

It took us about six months from when she started to be able to get the teeth in the front to come together.

Becky's treatment was supposed to be a one-year. Ultimately, it was 13 months - just one month over the projected treatment.

A Word of Caution to Parents

Becky's Mom, like many parents, would do anything for her child to be healthy. Mom tried many things before coming to see me. She had first gone to the hospital to deal with all of the tooth decay issues and infections. Mom also attempted speech therapy thinking this would solve the problems with her speech issues. However, even the speech therapist told her that the lisp issues were being caused by her teeth.

Mom had tried to take issues into her own hands multiple times, but after years of dental work and therapies, the problems still weren't fixed.

If Becky had not come to see me, a pediatric orthodontist specializing in early interceptive treatment, she would have ended up needing surgery to correct her bite issues. In some cases, you don't have a choice. In Becky's case, she was bound for surgery, additional extractions and potentially more negatively impacting psychological issues. However, my philosophy is not only to avoid surgery and prevent extractions but also to always provide the proper dental function.

In Conclusion

I'm blessed to have an outstanding team. Exposure to many challenging cases with kids makes us a more cohesive unit. I'm proud that we're experienced specialists at dealing with complex dental situations and know how to diagnose problems and find solutions all while focusing to make a child comfortable. When kids aren't fearful, it's easier to have positive outcomes.

Becky's Mom was beyond ecstatic with the results. Becky continued to sing, became a soloist at her church, and still sings to this day. She now performs with her Mom in a Christian trio going around the country.

Becky's teeth ended up coming together perfectly. It not only altered the way she looked but also how she felt. Becky finally felt confident in herself. She's a beautiful young lady now, and big things will come for her.

All children should be seeing an orthodontist by the age of seven because many things are preventable, leading to an improved quality of life. Becky is the perfect example of why we need to see children by second grade - the sooner the checkup, the better preventative care.

In fact, the American Association of Orthodontists recommends all children have their first orthodontic exam by the age of 7 (read here).


I'm so passionate about early interceptive treatment that I'm offering FREE vouchers to parents so we can see your child before problems get worst.

Visit https://lakesortho.checkby7.org/voucher to claim a FREE voucher to bring me your 7-year-old for a checkup.

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