The skeletal system of the facial bones is a structure shaped by the basic physiological activities: breathing, sucking, swallowing, and chewing. Any disturbance in these functions – from incorrect tongue position to mouth breathing – can permanently deform the developing upper and lower jaw.
At our London practice, we offer comprehensive dental and orthodontic care for children, with a strong focus on prevention and early detection of malocclusion. Our team of experienced specialists (orthodontists, ENT doctors, and paediatricians) work together to provide thorough diagnostics and individually tailored treatment.
We offer screening tests to assess bite development, evaluation of breathing and swallowing patterns, and assessment of permanent tooth alignment. Early detection of abnormalities helps prevent complex and costly treatment in the future and supports healthy oral development.
What is malocclusion?
Malocclusion is an abnormal relationship between the upper and lower jaws that causes the upper and lower teeth not to meet properly. In an ideal bite, dental arches should fit together like two pieces of a puzzle – the upper teeth slightly overlap the lower ones, and the cusps of the molars fit into the corresponding grooves of their opposing teeth, providing stable support.
Malocclusions can be divided into two main categories, which often coexist:
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Dental malocclusions. These involve incorrect positioning of the teeth within the dental arch (e.g. crowding, rotations, gaps) while the bone structure remains normal.
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Skeletal malocclusions.These result from abnormal structure or size of the facial bones (e.g. a protruding mandible or a narrow maxilla). They are more serious, as they affect facial features.
It is important to remember that malocclusion is not just an aesthetic issue. It is a dysfunction of the entire chewing system and may lead to difficulties with biting, speech disorders, accelerated tooth wear, and even chronic headaches or temporomandibular joint pain.
Impact of feeding and sucking habits on facial development
Proper bite development begins in the very first days of life, when feeding becomes the most important training for the facial muscles. A newborn is born with a physiologically retracted mandible, and the intense muscle work involved in breastfeeding provides the stimulus necessary for its growth and forward development.
Baby must make a significant effort to extract milk, which stimulates bone growth and allows the tongue to naturally shape a broad palate. When bottle-feeding, it is crucial to replicate this mechanism by choosing teats that require active sucking, preventing milk from flowing passively by gravity and “lazy” jaw muscles.
Equally important is the conscious management of the sucking reflex, which serves a calming function. From an orthodontic perspective, an anatomical pacifier is far safer than thumb sucking. The thumb, being a hard bony structure, acts like a strong lever in the mouth, permanently deforming the palate and pushing the front teeth forward. A pacifier puts much less pressure on tissues, and complete weaning by the age of two gives a high chance that any minor irregularities will resolve spontaneously before being fixed in the skeletal system.
Breastfeeding and bottle selection
A newborn is born with physiological distal bite – the lower jaw is naturally positioned behind the upper jaw. For the teeth to fit together properly in the future, the lower jaw must “catch up” in growth. This occurs mainly in the first months of life thanks to intensive muscle activity.
During breastfeeding, baby has to open their mouth wide and rhythmically move the lower jaw forward to extract milk. This repetitive movement is the strongest stimulus for lengthwise growth of the lower jaw. At the same time, the tongue presses the nipple against the palate, naturally widening it.
Bottle-feeding does not have to lead to malocclusion, provided the feeding mechanism closely resembles the natural one:
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Teat selection. Avoid teats from which milk flows freely by gravity. Choose a firm teat with a slow flow that requires effort and muscle work.
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Position. Do not feed the baby lying flat on their back, as this causes the mandible to fall backwards. The baby should be positioned at an angle (around 45 degrees), which facilitates proper facial muscle activity.
Pacifier vs thumb sucking
The sucking reflex is a fundamental calming mechanism for infants and suppressing it in the first months of life is not recommended. However, parents often face a dilemma: allow thumb sucking or introduce a pacifier. From an orthodontic perspective, a pacifier is definitely the safer option.
The thumb is far more destructive to the bite because, unlike soft silicone, it contains bone. It acts like a hard lever in the mouth, putting strong pressure on the palate, leading to its deformation and pushing the upper incisors forward, creating so-called “buck teeth.”
An additional problem is the difficulty of eliminating this habit – the thumb cannot be “lost” or thrown away, so children may continue sucking it even at school age, permanently deforming the dental arch. An anatomical pacifier puts much less pressure on tissues, but its safety depends on timely weaning. This should be done strictly between 18 and 24 months of age. If the pacifier is eliminated before the second birthday, minor tooth alignment irregularities have a high chance of resolving spontaneously thanks to natural muscle activity. Prolonging this habit beyond the age of three causes defects to become fixed in the bone structure and require specialist treatment.
Food consistency
Another pillar of prevention, often overlooked by parents, is the consistency of child’s diet. The modern model of child nutrition – based on ready-made purées in pouches, blended soups, and soft toast bread – is one of the main contributors to the narrow dental arches. Bones of the maxilla and mandible need strong mechanical stimulation, provided by intensive chewing, to grow properly. A simple biological principle applies here: an unused organ deteriorates or fails to fully develop.
If a child’s diet consists only of foods that can be mashed against the palate with the tongue, the chewing muscles do not work sufficiently, and the bones do not receive the stimulus to grow in width.
The eruption of the first molars should signal the gradual transition from purées to foods that require biting and chewing. Instead of slicing apples thinly or removing crusts from bread, it is better to offer raw vegetables (e.g. carrot sticks, kohlrabi) and bread with a crunchy crust. This daily “training” at the table acts like a natural orthodontic brace, widening dental arches and making space for much larger permanent teeth. Children who have to work harder while eating are less likely to struggle with tooth crowding in the future.
Nasal breathing
A fundamental factor in proper facial development, often underestimated by parents, is the breathing pattern. Physiological breathing route for humans is through the nose – air is warmed, humidified, and filtered. From an orthodontic perspective, however, what matters most is what happens in the mouth when the lips are closed. In this position, the tongue rests flat against the palate, putting constant, gentle pressure. It acts like a natural internal brace that widens the maxilla, giving it a broad, gentle shape and creating enough space for teeth to align properly.
Problems arise when, due to enlarged adenoids, allergies, or frequent infections, a child begins to breathe through the mouth. Lower jaw drops downward, and the tongue rests on the floor of the mouth, losing contact with the palate. Deprived of natural support, the upper jaw begins to narrow under the pressure of the cheeks, taking on a “V” shape (so-called gothic palate), leading to crowding and crossbites. Long-term mouth breathing can even change child’s facial features – face becomes elongated, with a retracted chin and a characteristic “open-mouthed” appearance.
Therefore, if your child sleeps with their mouth open or snores, a visit to an ENT specialist is just as important for straight teeth as a visit to an orthodontist. Restoring nasal patency is crucial for effective prevention and treatment.
Proper care of baby teeth
One of the most harmful myths is the belief that baby teeth do not require care “because they will fall out anyway.” This approach is a direct path to complex malocclusions. Baby teeth play a crucial role in the oral cavity – they are natural “space maintainers” for permanent teeth developing beneath them in the bone. Each baby tooth reserves exactly the amount of space needed for its successor.
If a baby tooth is destroyed by cavity and prematurely extracted (e.g. removing a primary premolar in a five-year-old), the balance of the dental arch is disrupted. Neighbouring teeth begin to drift into the empty space, gradually closing it. When it is time for the permanent tooth to erupt, there is no longer room for it. It may erupt outside the arch (e.g. high in the gum) or remain trapped in the bone as an impacted tooth.
Therefore, treating cavity in children is the best orthodontic prevention. When extraction of a baby tooth is unavoidable, it is essential to consult an orthodontist about placing a special space maintainer, which mechanically prevents neighbouring teeth from shifting until the permanent successor erupts.
First orthodontic visit – the “Seventh-Year rule”
Many parents delay the first orthodontic visit until all permanent teeth have erupted, around the age of 12–13. From a medical perspective, this is a mistake that may result in tooth extractions later. The Polish Orthodontic Society recommends that the first check-up take place no later than the age of seven. This is a pivotal moment – first permanent molars and incisors erupt, allowing the specialist to assess the relationship between the maxilla and mandible.
At this stage, known as mixed dentition, child’s bones are still mouldable. Detecting a defect at the age of 7–8 allows for early (interceptive) treatment. Often, simple removable appliances, trainers, or muscle exercises are sufficient to guide jaw growth in the right direction and prevent serious deformities. If this moment is ignored and treatment is postponed until after the growth spurt, correction may require complex fixed appliances or, in extreme cases, even surgical intervention.
How to prevent malocclusion in children – summary
Prevention of a healthy smile should begin much earlier than the moment of placing braces on permanent teeth – often already in infancy. Although genetics determine predispositions, daily habits play a crucial role in the proper development of the stomatognathic system. Parents play a key role by observing their child’s feeding, breathing, and sleeping patterns. Early recognition of abnormalities, such as mouth breathing or incorrect swallowing, often helps avoid lengthy and costly treatment in the future.
A healthy smile begins with appropriate care from the earliest years. At our practice in London, we combine experience, modern technology, and an individual approach to provide children with the best conditions for proper oral development. Our team of specialists – orthodontists, ENT doctors, and paediatricians – work together to detect abnormalities early and implement effective solutions that help avoid long-term and costly treatment. Thanks to comprehensive care, parents can be confident that their children receive support at every stage of development, in a friendly and safe environment.
