Preventative orthodontics focuses on the elimination of factors, which if left uncorrected, would result in a worsening of the malocclusion. One example would be space maintenance due to premature loss of deciduous teeth, most commonly the canines and molars. Maintaining space is primarily indicated when permanent tooth eruption will not occur for another six months or more. Depending on the clinical situation, several techniques can be used to maintain space. Early exfoliation of canines or the deciduous molars might be an indication of ectopic eruption patterns or severe crowding and should be carefully evaluated along with the space maintenance. Another example of preventative orthodontics would be habit cessation due to a finger habit or tongue thrust.
Tongue Crib and Tongue Rake
Finger and tongue thrusting habits have the potential to have serious consequences if they continue after the permanent teeth erupt. They can result in open bites and narrowing of the maxillary arch, which left untreated for long periods can result in skeletal changes and require complex orthodontic and possibly surgical intervention. The use of a tongue crib or tongue rake to aid in cessation of the habit early on and correct of the malocclusion can be a simple treatment modality. These appliances consist of bands on the permanent maxillary first molars with soldered wires extending anteriorly. From these wires in the anterior, the crib or rake appliance extends down vertically to the linguo-gingival portion of the lower incisors. The crib serves to keep the tongue out of the interincisal area and as a reminder to the patient to keep their finger out of the mouth. The rake is a sharper appliance that serves as a harsher reminder.