Children Dentistry: Anterior Cross Bite Correction


This is one of the cases that I am really proud of.

I feel proud, not because it is a bombastic treatment.

I feel proud, because a small gesture that I did make a difference for his entire life.

In other word, it is impactful!


Interceptive Orthodontic Treatment

Most parents do not realise the need of an assessment for interceptive treatment at young age;

and will only seek orthodontic treatment (braces)  after all the permanent teeth have erupted.

In most of the cases, it works; but not all.

The trusth is : any problem that involve jaw development is best to be corrected at young age.

Once the jaw has been fully developed, the most likely way to treat it will be surgery in adulthood.

Interceptive orthodontic treatment is treatment that help to remove any obstacle in jaw development and helps the jaw to develop in a natural and correct way.

So the most important take home message from this post is :

Do an orthodontic evaluation at about age 7 and 8.


Case Study

Anterior Cross Bite

This is a little boy at age 7 when his mum brings him for a cleaning of his teeth.

When I see kid at this age, my routine is that I will assess their bite and eruption of the teeth to make sure everything is going the right way.

The two front teeth were trapper by the lower teeth. Take note also that the two lower teeth appears much longer than others.


For him, his upper front teeth were trapped by the lower front teeth.

His mother never realised about this.

To be fair, it wasnt obvious at all as it only involved the two front teeth which just erupted not long ago.

If not because I was checking his bite, I most likely would have missed it as well.

So, parents please check your kid’s bite from time to time to be sure that their bite is correct. The upper teeth should be in front of the lower teeth.

If this condition was left behind, he will become a true class III (reverse bite where the lower jaw become much longer than the upper jaw)

Why is that so?

Jaw Development

At his age, the upper jaw was developing but it can’t continue to grow as the lower teeth were stopping it from growing. It was trapped and limited his upper jaw to grow.

At this point, the lower jaw wasn’t growing as much and hence most people wont notice it.

When he reaches his puberty age, at about 10-13 years old, the lower jaw will start growing.

By then, there is nothing from the top to make sure that the lower jaw grows according to his correct profile. The lower jaw will keep on growing and finally become much longer than the top.

When this happens, depending on the severity of the jaw discrepancy, could be difficult to solve. Worst case scenario is that a major surgery would be required to correct it.

Other problem

On top of the restriction of the upper jaw, another problem happens together with anterior cross bite.

As the upper jaw tries to grow, the upper teeth will push the lower front teeth forward in an abnormal rate.

The lower teeth could be pushed until that not much bone is encircling the lower teeth and hence cause bone lost if the relevant teeth.

In long term, this can become a serious gum problem and cause premature of losing these two lower teeth.

From the picture above, you can tell that the two lower front teeth are much longer than other teeth.

This is because the teeth were pushed to the border of bone and some of the bone that were supposed to encircling the teeth were lost.

In other word, less bone is holding these teeth and hence weaker.


Orthodontic Appliance

After discussion with the mother, I made an removable appliance for him.

The design of the appliance is Z-spring with posterior bite plane.

The Z-spring was used to push the two teeth forward and the posterior bite plane was to make sure that the lower teeth were not in a way when the Z-spring pushed the teeth forward.


This is a photo taken half way through treatment. One of the tooth has successfully cross over, but the other not totally yet.


Six months down the road, finally the bite was corrected.

Bite corrected! Hooray!


I am glad that now his upper jaw is no longer trapped and it can grow naturally.

Would he still need to do braces in the future?

Maybe yes, maybe no depending on his other permanent teeth growth.

At least what I can assure is his jaw development is now normal and any minor correction of his teeth alignment could be solved very easily through simple braces.

Honestly, I am very proud of what I have done for this case.

Like I say, it is a small gesture but it impacts his whole life.


How do I not love being a dentist?

With Love,

Gwen Gan


Baby Teeth: Space Maintainer for Early Tooth Loss

Timeline of Baby Teeth Shedding

Most babies get their full set of baby teeth/primary teeth at around three years old.

At about age 6, they start to have the permanent teeth growing and gradually replace the primary teeth.

This process of replacing baby teeth takes about 6 years to complete.

Early Lost of Baby Tooth

In certain circumstances, a kid could lose a primary tooth before the permanent tooth is ready to grow.

It could be an accident, or it could because of a dental cavity with serious infection.

When such situation occurs, there will be concern if the premature tooth loss will cause misalignment of the remaining teeth and hence cause problem to the eruption of permanent teeth.


Challenge of Premature Baby Tooth Lost

When a baby tooth lost too early, two problems arises:

  1. The permanent tooth lose a guide as of where to come out
  2. The neighbour baby teeth lose the support and move into the space. The jaw is now smaller and the narrower space is insufficient for the permanent tooth to come out properly and hence become crowded.


Space Maintainer

As the name suggested, a space maintainer is a custom made appliance fitting into the space to keep the space.

It makes sure the neighbor teeth keep still and help to keep sufficient space for the permanent tooth to grow properly.

The design of the space maintainer comes in different forms, depending on the number of missing teeth and the location of it.

A most common space maintainer design is called Band and Loop where a metal band circumference the molar tooth and a metal wire keep the space of the missing tooth.


Maintainence of Space Maintainer

There isn’t any additional thing with regards to maintainence, just make sure that the oral hygiene is good (brush and clean the mouth well) to avoid plaque forming around it.

A regular dental check up and follow up is important to make sure that the space maintainer is not in a way when the permanent tooth is coming out.


Must a Space Maintainer be Issued Whenever a Baby Tooth is Lose?

No. it depends on the location and timing of the permanent tooth eruption.

A dental radiograph may be required to help making the decision.


With that, I hope you get some insight about space maintainer.


Gwen Gan


Baby Teeth: Pacifier Teeth


If you are a mother like me, I am sure this topic is not something new to you.

In fact, all of us, at some point of time, wonder if pacifier is the solution for our cranky baby who just cannot be soothed.

However, at the very last moment, you always wonder if it will do more good than harm as you heard stories about pacifier teeth.



Pacifier teeth are misalignment in teeth caused by prolonged usage of pacifier.

The dental problems can be open bite, overbite or crossbite.

Once the problem is developed, it is not going to be solved on its own and intervention is required to solve it.



It depends on how long your baby been using the pacifier.

If the habit is carried on until the grow of the permanent teeth, then the effect is sure.



The use of pacifier should be stopped as early as 6 months and not later than 4 years old, the earlier the better.



Though pacifier has its benefit, the prolong use of it will cause dental problem.

It is recommended to stop using pacifier as early as possible


With Love,

Gwen Gan

Baby Teeth: When Does Baby’s First Tooth Come In?

First, congratulation of your new-born!

By the time you are checking on this topic, your baby is probably about 6 months of age and you just cannot get over with how fast your baby changes and develops.

Out of all the developmental milestones, having the first baby tooth is one of the most exciting achievement that you want to celebrate about.




The appearance of the first tooth means more teeth are coming!

Your baby is now more ready to chew food.

After drinking milk for 6 months or some purees for the past few months, baby is eager to explore the world, taste the food and to join you and the family at dining table.

Other than the abovementioned, there are more reasons of why we should be exciting about baby teething:

  1. With teeth, they are now ready to eat more variety of food and that means nutrients for them to grow.
  2. Chewing solid food means encouraging the jaw to grow.
  3. They are ready to join us at the dining table and start picking up social skills and table etiquette.
  4. Psychologically, they are eager to imitate us to do what we are doing.
  5. Finally, is time to start speaking. (You need teeth to speak and pronounce word properly)


When Does Baby’s First Tooth Come In?

Everyone is different in this. A general rule is 6 months.

At about 6 months old, the two lower central incisors come in.

The location is right at the centre of the lower jaw, and they normally come in pair.

The diagram below shows the timing of when the baby teeth erupt (comes in) and shed (falls out)


However, everyone is different, some babies get their first pearly white as early as from the first day they are born; and some get it much later.

As long as they are coming, there is absolutely nothing to worry about.

Having say that, even if your baby does not get a complete set of 20 teeth, there are nothing to worry about still, as they are just baby teeth.

Just discuss with your dentist if you are worry and the dentist will be able to advice.

With Love,

Gwen Gan

Baby Teeth : Why, When and How To Clean Baby Teeth?

In this topic, we are covering cleaning a baby mouth before the eruption of the first baby tooth which is about 6 months old.

Most of the first time mum are confused with this question. They know by heart that baby needs to be shower everyday, but do they have to clean their baby mouth every day?



Yes, you are right. A new born has no teeth in their mouth. (Only in very rare cases, baby is born with teeth)

There is no teeth to brush, and why should I be bothered to brush then?

The truth is you still need to clean your baby mouth even though you are not brushing their teeth.



The area that you need to clean is the soft tissue of the mouth.

These includes tongue, gum pad, inner side of the cheek, inside of the lip as well as lip.



Two very important reasons to clean baby muth:

First, by cleaning your baby mouth, wiping away the milk residue, you are preventing infection

Second and the most important reason is you are instiling a brushing habit to your baby, which is crucial to the future dental health.

Same as any other routine, the earlier you train them, the easier and less resistance you will face in the future.

The earlier you start the oral hygiene routine, the easier and smoother to transit to a brushing routine.

Seriously, DO NOT wait until your baby has many teeth then only to start the cleaning routine, you will get a lot of resistane and you will need much more effort to do it.



Before the first baby tooth comes in, you can use a wet gauze or softcloth to gently wipe against the soft tissue.

You can also purchase dental wipes for this purpose. I find it very useful whenever I am outside the house so that I do not have to skip cleaning my baby mouth.

Develop a routine of how you will clean the mouth so that you always remember where and do not leave out any area.

Step 1: Wet gauze or softcloth with drinking water

Step 2: Wrap it around your index finger

Step 3: Wipe the lower gum pad, upper gum pad, the inner side of lips and cheeks, then finally the tongue

Step 4: Ta-da, cleaned!

This is one of the prepackaged dental wipes available


There are two wipes in each package


Wrap it around your index finger and you are ready to clean.



If you are hardworking enough, the best is to clean after every single meal.

This is not as simple as said, a newborn needs to be fed almost every two hourly and you are exhausted with the feeding.

Try to do it whenever you feel you can do it in daytime AND NEVER SKIP MORNING AND NIGHT CLEANING.

Make it as part of the morning wake up and night sleeping ritual.

After a while, baby will get it that brushing teeth twice a day is just part of the life.



Brushing teeth is like a battle between you and your baby, and it is a battle that last for years.

You never see the benefit of you doing it until many many years later.

Start earlier and it really help to ease the whole process of oral hygiene routine!

Good luck cleaning and I wish your baby to have healthy teeth in the future.


With Love,

Gwen Gan











Baby Teeth: Natal Teeth

Most babies are born without teeth. They look so adorable, innocent, and harmless without teeth.

When teething comes at about 6 months of age, we are all delighted with the two cute little bunny-like teeth at the lower jaw.

“SOoooooooooo cute!” That is how you feel.


What if…. Your baby is born with teeth?

“What???????? Why?????????? What should I do???????????”


Natal Teeth and Neonatal Teeth

Natal teeth are teeth that are present at birth.

Neonatal teeth are teeth that develops in the first month of life

The incidence varies from 1:2000 to 1:3500.

The most common location is the centre of lower jaw (location of lower central incisor)


How To Find Out

At birth, the paediatricians will examine the oral cavity and it includes checking for natal teeth.

Another common route is if the mother has problem with breastfeeding due to sharp structure in baby mouth, then a thorough examination is required.

In such case, a pediatric dentist will be the right person to examine your baby.

Radiograph will be required to investigate the teeth and decide what treatment is necessary.


Possible Complication of Natal Teeth

The potential complication includes:

  1. Risk of swallowing the tooth if it is very loose
  2. Breastfeeding problem as mother may be injured.
  3. Injury to the baby tongue due to the sharp structure


Management of Natal Teeth

Management is different base on the findings from the radiograph and examination by the pediatric dentist.

  1. No treatment
  2. Grinding or smoothening of the sharp edges of the tooth
  3. Extraction / Removal of the teeth

No matter which is the treatment of choice, the baby should be followed up until at least the eruption of the permanent teeth.


Myth about Natal Teeth

I have heard patients telling me that the baby is born with teeth because the mother has taken too much calcium during pregnancy.

Also, there are superstitious belief that baby born with teeth is bearer of misfortune.

The truth is multiple hypothesis have been established about the condition. These includes hormone disturbance during pregnancy, nutritional deficiency and etc.

The most acceptable theory is the location of the tooth germ that is at a more superficial level.

No matter what the reason for such condition is, the focus should always be at what to do to manage the condition and love your baby unconditionally. The paediatrician and pediatric dentist will help in such a situation and baby will grow healthily just as any other kids. =)


With Love,

Gwen Gan