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The Gummy Smile in Children

August 30, 2022

In this brief lecture clip, Dr. Rebecca Bockow points to some telltale signs of problematic dental development, including the presence of mamelons (small bumps on the ridges of the teeth) in older children. In this case, the signs reveal an airway difficulty that the child has had to compensate for through consistent mouth breathing throughout her young life.

Dr. Rebecca Bockow is a dual-trained board-certified orthodontist and periodontist – one of only a handful in the country. She lectures nationally on periodontics, orthodontics, interdisciplinary orthodontics, airway, and skeletal growth and development.

“Well, we have this young woman who's eight years old, and if we look closely here, we start to see mamelons, and we see the beginning of a gummy smile. When we see mamelons on an eight-year-old, we have to stop and think that there's something going on that's preventing this child from bringing her teeth together.

“If we look carefully and critically here, we see the rolled borders of the gingiva. What we will learn as we go through our presentation today is this often is due to mouth breathing, and we see a convergence of both arches as well as an open bite.

“If we look here, we see narrow arches and not a lot of space for the tongue. So why the open bite and why the mouth breathing? Well, this young woman has quite enlarged tonsils, which has led to some compensations over her lifetime. At eight years old. She's always been a mouth breather, and that's changed the way that her jaws, as well as her soft tissue and her teeth, are developing.

“So what is the diagnosis here? Well, it's a lifetime of mouth breathing that's led to the beginnings of a particular skeletal pattern.”

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