Today, I am deviating from preventive cancer to a children’s problem helpful for dentists and parents. This is related to children and how the development of their bites affect their facial esthetics and occlusion.

Otitis Media Treatment
About 3 – 4 percent of the children in the U.S., ages 3 to 12, have over closed bites, or closed occlusion. Parents and most dentists do not recognize this problem. It can affect hearing, the bite, and facial esthetics.

There is also a problem called “otitis media with effusion.” Otitis media is caused by a child being over closed. It can affect their hearing, bite, and facial esthetics. Today’s BULLETIN will discuss the over closed problems, how they affect young children, and how to detect an over closed bite. Otitis media is not as prevalent in the United States as it is in England, because it is related to barometric pressure and colds. It is an infection of the middle ear and eustachian tube, which can develop an infection, and get plugged up, unable to drain. This can produce an infection and pressure inside the eustachian tube. The eustachian tube infection and pressure produce pressure on the tympanic membrane, causing pressure, severe earaches, and most of the time requiring antibiotics and surgery to put grommets in the eardrum to relieve the pressure on the tympanic membrane.

Dentists usually do not see these young otitis media patients, because parents usually take the child to the pediatrician, where they give them antibiotics and put grommets in the child’s ears. The grommets relieve the pressure on the eardrums but leave the child with a hearing loss of about 3 to 5 percent every time the grommets are placed, because of the scar tissue left in the tympanic membrane. These infections of the eustachian tube can occur many times in the same children. I have seen one mother who has had this done on her child 9 times. That resulted in a hearing loss of about 35 percent.

How does the eustachian tube get obstructed? 90 percent of the time it is because the child is over closed. Yes, it is a dental problem that is very rarely detected by the dentist. That is what I will discuss, how to recognize and correct this problem, without having to put grommets in the eardrums.

Also there are many other ramifications involved with over closed bites of these young children. It affects the development of the bite, creating an otitis media condition, plus a class two over closed occlusion, changing the facial esthetics, and in many cases, changing the way a child swallows. The correction of otitis media and over closed bites can be non-invasive. Also, other changes can be made that will affect the child in several good ways.

What causes an over closed bite? What is the dental treatment that an stop this otitis media infection? How would a dentist detect an over closed bite? These and other questions will be answered in the following discussion.

The cause of an over closed bite in a child
Overclosed bites are related to the resting tongue position of the child. The resting tongue position is where the tongue sits (rests) normally in the mouth 24/7. Different occlusions are guided by the tongue rest and swallowing positions. There are three resting tongue positions that a child can develop. They all produce a small resting force that usually guides the growth and development of the teeth. The three resting positions are.

Position 1. Class one bite. The tongue rests horizontally in the mouth and creates lateral, horizontal, and forward growth. The horizontal force creates an equal force on both, the upper and lower teeth. The child usually breathes through the nose. This creates a normal growth development, usually creating a class one occlusion. The swallowing tongue position is forward on the anterior upper palate and the cingulums of the upper teeth.

Position 2. Class two-bite. The child is usually a nasal breather but their tongue position has been altered by not being on mothers milk for one and one-half years, continuous pacifiers, the Nuk Sagar pacifier, which holds their resting tongue back, and not allowing it to reach the front of the mouth, or breathing through the mouth. This creates a lateral tongue splinting rest position, or the resting tongue position is back from the anterior and overlaps the lower two primary molars and 1st permanent molar when it erupts. The tongue does not put forward resting pressure on the anterior teeth, and not enough resting pressure for a forward force to grow the mandible. Dr. John Mew in England discusses this with photos that show this bisecting tongue position. The lateral position of the tongue is over the lower mandibular primary molars. Even though a small resting pressure, the lateral position over the primary molars retards the bicuspids and the permanent first molar when it erupts, eventually creating the curve of spee. It also prevents the mandible from growing forward because there is not enough tongue bulk to fit over the primary teeth and go forward at the same time. The position is called “lateral tongue splinting.” This creates and over closure and many times a forward head posture when the child gets older. It also creates a class two-bite with an eventual curve of spee. This tongue resting position retrudes the mandible, depending on how much vertical resting tongue pressure and swallowing pressure is exerted.

When the bite gets more and more over closed, the mandibular head of the condyle is restricted further back in the condylar socket. Because of the cartilage and soft bone in that area, the distal pressure will obstruct the eustachian tube in some cases, causing otitis media with effusion. There are two swallowing positions that occur with a class two-bite. One is a tongue thrust swallow, creating a class two civision 1 bite. If the child has a normal class one swallow, they develop a class two-division two-bite. With this normal class one swallow, the lips can exert an abnormal force back, creating a reclining anterior tooth position. With lateral tongue splinting, the free-way space (curve of speed) may sometimes be up to 4 or 5 mm.

POSITION 3. Class three bite. Class three bites have a low resting tongue position usually in the lower vault. The low tongue position is usually caused by obstruction of the nasal airways and mouth breathing. Tonsils, adenoids, deviated septums, polyps, and other nasal constrictions are usually present. The child usually breathes through the mouth. The tongue assumes a low tongue position with the lateral and forward resting position in the lower arch only. There is no force vertically except sometimes downward, which can produce a larger chin area. The maxillary arch has no resting force where the teeth grow with anterior cranium force only. It still can reach a near-normal A-P growth. The resting tongue force on the mandible, however, is usually forward and lateral, which produces the larger vault, depending on the resting force and swallowing force values. There are usually three swallowing positions when a child has a class three bite. The child can have a class one swallow, an anterior tongue thrust swallow, or a low tongue force swallow, with the tongue putting more pressure on the lower anterior teeth.

How can a dentist correct over closed bites and treat otitis media? There is a noninvasive dental procedure that will correct the problem, change the resting tongue position from lateral tongue splinting to normal class one resting position, create a class one growth, and maybe help prevent a temperal mandibular dysfunction problem when the child matures.

In 1985, I discovered a procedure to correct these resting tongue growth problems in an over closed child 3 to 12 years old. The procedure is called “ Vertical dimension, Vertical Crown Buildups.” The correction is done by putting composite overlay crowns on the mandibular primary 1st and 2nd molars, using a Tofflemire matrix. This raises the height of the mandibular molars to a normal class one resting position. It places the tongue into the bisecting tongue class one rest position. Best of all, it enables the permanent 1st molar to erupt to a normal class one position. But the best thing is that it will also correct otitis media in 24 to 48 hours. It not only corrects the resting tongue position but is the start of a normal vertical anterior resting pressure with the tongue, which will change the growth pattern to a class one growth.

How to find if a young child is over closed
There are three ways that a dentist can observe a closed bite on a very young child. First, check the anterior overbite.

1. If a dentist can only see a large amount (half) or full amount of anterior maxillary overlap, and cannot see much or none of the lower anterior teeth the child is over closed.

2 Check the primary maxillary cuspid position and wear. If the cuspid is worn the child is most likely developing a class two-bite. Check to see if they already have a class two-bite, or if the rest of the maxillary teeth are worn.

3. Have them swallow and observe the position of their tongue, or if they are not closing when they are swallowing. Many children who are developing a class-two bite will put pressure on the upper anterior teeth, and it will be noticeable.

There is one caution. Children wear these vertical buildups down over time. A dentist needs to monitor the composite buildups until the permanent 1st mandibular molars erupt fully. Sometimes the dentist needs to add to them to maintain the correct vertical position to maintain a class one resting tongue position, especially if the child is very young.

The dentist also needs to monitor them to make sure the mandibular 1st molars erupt to the vertical buildup height. It is wise to put separators in between the mandibular 2nd primary molars and the permanent first molars when the buildups are placed.

These children who are developing an over closed class two-bite, if not corrected may develop a TM dysfunction as they grow older. Adding the buildups also brings the mandibular condyle down and forward. This may present a temporal mandibular dysfunction later in life.

The dentist can do many things to correct class two and class three bites on these young children. It is a great asset to be able to detect and correct these abnormal bites on developing occlusions.

September 22, 2020

~ the Author ~
Merle E. Loudon, B.S., D.D.S. graduated from the University Of Washington School Of Dentistry in 1957. After two years of service in the Air Force, he started a private practice in East Wenatchee, Washington. For the past 45 years his practice has included Orthodontics and TM Dysfunction treatment specializing in temporomandibular pain treatment, headache, head and neck pain control, functional jaw orthopedics, and straight wire orthodontics. Associated with mercury elimination, oral surgery, crowns and bridges is TMJ treatment, diet control, parasite elimination, intestinal cleansing and healing (wellness).

Merle E. Loudon, B.S., D.D.S. has taught advanced courses for dentists on TM Dysfunction treatment, orthodontics and related pain control for more than 30 years. In 1972 he was the first dentist in Washington to use straight wire orthodontics and the first dentist to correct vertical deficiencies in children by placing vertical dimension-primary molar buildups and/or vertical (erupting) appliances. Merle E. Loudon, B.S., D.D.S. was involved with the first group of dentists to recognize lateral tongue splinting in young infants and integrate functional and fixed techniques to correct vertical dimension deficiencies and condylar placement. He is the originator of vertical dimension-primary molar build ups, which help to correct deep bites and Otitus media in children. He invented the Loudon-Chateau Anterior Repositioning Appliance, the functional muscle malocclusion concept, the twelve commandments of occlusion and the vertical overbite domino rule. Merle E. Loudon, B.S., D.D.S. has written numerous articles in several American and foreign dental journals and has lectured in over 50 cities and 7 foreign countries on functional jaw orthopedics, fixed wire orthodontics, Otitus media treatment and TM Dysfunction treatment. He has been instrumental in setting up criteria for teaching in the International Association For Orthodontics, including the certified instructor program.

Dr. Loudon is a member of The American Dental Association, Diplomat and Senior Instructor in the International Association for Orthodontics, and is a Diplomat of the American Academy of Pain Management. He also is a member of the American Orthodontic Society.