The Real Phase I
by Dr Michel Champagne, ba, dmd, magd, ibo, cde
Our conventional orthodontic education has molded in our mind a concept of Phase I treatment that applies only to primary and mixed dentition. I would like to present you with a paradigm change with a Phase I concept that applies to every age, including the adult age. I will expose one part of the concept for patients 0-5 years in this info-letter and the other parts will follow in the next info letters.
Phase I must be considered as the first part of a health approach to the myofunctional system of the patient or as others may describe as the neuro occlusal rehabilitation (NOR). Phase I starts before birth by the education of the future mother who comes for her appointment and during the update of the health questionnaire tells you that she is pregnant. We should build on this situation and give her a few hints on subjects like breast feeding, how a short lingual frenum can limit normal breast feeding, oral hygiene for her and the future baby and reinforce that the young child should be brought to the office for evaluation when the front teeth have erupted. With her permission, offer to put her on a web info-letter that will give her some advice on the child dental health and development , adapted to the age of the child. We, as dentists, should take our place in the child global health and make parents aware of the negative effects on craniofacial growth of no or not long enough breast feeding, nasal breathing and normal swallowing. Nobody has a better position than the enlarged dental team (dentist, hygienist, speech therapist, osteopath, nutritionist, ENT specialist) to supervise the maximization of the child craniofacial growth.
Later the dental team should see the child when the primary anterior teeth have erupted to re-enforce the basic hygiene notions with the parents, check for nasal breathing and swallowing, lip seal, maxillo-mandibular relationship, proper nutrition, presence of bad habits, etc. Parents have to realize that the child must be able to chew on the gum tissue posterior to the canine to promote proper transverse growth. To do that the food must not be too soft nor too hard. If you see a problem in the choices made by the parents, suggest a consultation with a nutritionist. Everything starts with a normal deglutition to promote transverse growth and nasal breathing, all of which can help to avoid sleep apnea. With the full deciduous dentition, the child becomes a regular patient not only to check for caries but also to supervise his craniofacial growth. Any anomaly will require the care of the entire team. Some will ask ‘’What can happen to such a young child and what can I do about it?’’. Here are a few possibilities : thumb sucking, abnormal swallowing, mouth breathing, no lip seal, allergies, anterior or posterior crossbite, etc., with solutions like parent counseling, ENT consult, myofunctional exercices, osteopathic manipulations, speech therapy, dental intervention with appliances (prefab or individualized), etc.
I already hear some of you murmur ‘’ I do not have time for this, my office is full’’, ‘’I do not want to treat patients that young’’, or ‘’I can always catch these problems later’’. It is possible that this approach is not feasible in your individual practice but it does not mean that in the future you should not try to have this service within your office when a new partner joins the team. As dentists interested in orthodontics, global supervision of craniofacial growth and development must be part of the practice and by the way it is a great practice builder. The future is not created effortlessly.
Do not miss our next info-letter that will discuss ‘’Real Phase I in the mixed dentition’’.