Journal of Clinical Pediatric Dentistry,2025,49(6):22-31 DOI:10.22514/jocpd.2025.123
Review

Multidisciplinary management points in early childhood treatment

Qi Su1,2, Zhiying Zhou1,*,

1Department of Stomatology, the First Affiliated Hospital of Jinan University, 510630 Guangzhou, Guangdong, China

2College of Stomatology, Jinan University, 510632 Guangzhou, Guangdong, China

*Corresponding Author(s):zhouzhiying@jnu.edu.cn (Zhiying Zhou)

History Submitted: 23 June 2024 | Accepted: 09 December 2024 | Published: 03 November 2025
Copyright:  ©2025 The Author(s). Published by MRE Press.
This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/).

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Abstract

In recent years, the concept of early intervention in children has gained significant popularity and attention within the healthcare community. The necessity of implementing early intervention strategies and effectively managing malocclusion in children is often a topic of debate among professionals. Furthermore, it is crucial to recognize that various multidisciplinary knowledge areas, including dentistry, pediatrics and psychology, must be taken into account during the treatment process. Currently, there is a lack of a comprehensive action plan that can effectively guide these important considerations. Therefore, this article aims to highlight the key monitoring and management points that are related to the multidisciplinary aspects involved in early intervention. It seeks to summarize the various action plans that should be considered for early intervention, ultimately providing a more thorough and comprehensive guideline for clinical orthodontists to follow in their practice.

Keywords:Early treatment;Dentistry;Skeletal;Decayed tooth;Tongue position;Respiratory;Musculoskeletal;Psychological
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Cite this article

Qi Su, Zhiying Zhou. Multidisciplinary management points in early childhood treatment.Journal of Clinical Pediatric Dentistry,2025,49(6):22-31 DOI:10.22514/jocpd.2025.123

1. Overview of early correction

With the improvement of people’s living standards, national health awareness is gradually growing, and parents’ attention to children’s oral health is also gradually increasing. In recent years, the early treatment of children’s malocclusion has become a hot topic in the oral field, but a consensus on the standardized treatment of early childhood correction has not yet been reached [1]. Children are in the growth and development stage, which requires the relevant practitioners to have strong thinking abilities and the awareness of multidisciplinary monitoring to maintain professionalism and ethical standards of early correction. As orthodontic specialists, it is essential to possess a foundational understanding of early intervention strategies and organize and unify all action plans about early pediatric treatment from a multidisciplinary perspective. When addressing pediatric patients, a comprehensive assessment encompassing oral health, postural alignment, and psychological status is necessary to formulate standardized and reasonable treatment plans. This review focused on the multidisciplinary monitoring and management in early intervention, aiming to consolidate various action plans for consideration in this context. The goal is to provide clinical orthodontic specialists with more comprehensive guidelines.

Early treatment of malocclusion deformities includes addressing tooth alignment, early preventive measures, and orthodontic interventions to achieve functional and aesthetic harmony in patients with craniofacial discrepancies. This approach encompasses the management of oral function, occlusion, maxillofacial growth and overall health development during the critical stages of growth and development [1]. Key considerations in pediatric early intervention include timely correction of adverse tongue, oral, and swallowing habits, dental space management, control of genetic craniofacial anomalies, maintenance of children’s nutrition and health, early treatment of respiratory diseases in children and correction of abnormal body and head postures.

According to reports, if early intervention is not implemented, patients with severe maxillary protrusion are at a higher risk of sustaining anterior dental injuries, which adversely affect their physical and mental well-being [2]. Patients with severe mandibular retrognathia are prone to developing obstructive sleep apnea, attention deficit hyperactivity disorder (ADHD) and neurocognitive issues [3]. If deep overbite and open bite are not corrected promptly, these conditions could have significant adverse effects on the temporomandibular joint of the child over time [4]. In children with excessive protrusion, a lack of prompt monitoring and correction can negatively affect psychological well-being and language expression ability [5]. Variations in the size, shape and number of teeth in a child’s oral cavity can affect occlusion and reduce chewing efficiency [6]. Tooth misalignment also increases the risk of food debris accumulation and dental calculus formation, potentially leading to dental caries and periodontal disease [7]. Failure to intervene in prolonged thumb-sucking habits may alter a child’s tongue position and swallowing pattern, leading to dental arch constriction, anterior protrusion of the upper front teeth or open bite malocclusions [8]. Early intervention is beneficial for preventing and intercepting the severity of malocclusion, addressing both aesthetic and functional issues. Early intervention ensures a child’s growth, development and self-confidence, paving the way for a bright and confident future [9, 10].

2. Common methods of early orthodontic treatment

2.1 Early intervention for Class II malocclusion

Class II malocclusion is characterized by maxillary protrusion and mandibular retrognathia, with a prevalence rate of up to 29% [11]. A recent study indicated that early orthodontic treatment for Class II malocclusion can significantly improve overjet and occlusion, with most patients maintaining long-term stability [12]. For children with a deep overbite, narrow dental arch, maxillary protrusion or mandibular retrusion during the early and middle stages of mixed dentition, it is necessary to block the interfering factors of removing teeth and muscle imbalances, coordinate the width of the dental arch, guide the normal growth and development of the jaw, pay attention to airway problems, break bad oral habits and not advance the jaw prematurely. Early growth control is implemented as children enter late mixed dentition and early permanent dentition stages. This is achieved using inclined planes, expansion devices, twin blocks, and headgear to induce occlusion and control three-dimensional positioning. Early correction of excessive protrusion of children’s anterior teeth can also prevent an increase in trauma incidence. Reports indicate that early treatment of Class II anterior protrusion can reduce the prevalence of anterior tooth trauma from 30% to 19% [13]. The Twin Block appliance can improve the relative position of the mandibular condyle, while headgear reduces overjet and Angle between Points A, N, and B (ANB angle) [14]. Therefore, early intervention and treatment are highly recommended for severe Class II malocclusion. Typically, it is recommended that children with Class II malocclusion begin orthodontic treatment during the peak growth period of cervical vertebrae Cervical Spine Stage3 (CS3 stage) to effectively correct the clinically relevant skeletal impacts associated with Class II malocclusion [15].

2.2 Early intervention for Class III malocclusion

Class III malocclusion is characterized by maxillary retrusion and/or mandibular protrusion, affecting approximately 0% to 26% of the population [16]. However, early treatment of Class III malocclusion often presents challenges, including management difficulties and lower predictability. To optimize the intervention timing during skeletal growth, it is generally recommended that early treatment occurs before the age of 10 [17]. Various orthodontic appliances are used clinically, including facemasks, chin cups and the Frankel-III. The primary advantage of early treatment for Class III malocclusion is the reduction in the need for surgical intervention. Throughout treatment, children should undergo continuous monitoring. For children with simple malocclusion, interventions like tongue springs and the 2 × 4 technique can help to avoid occlusal trauma and promote proper jaw development. Functional appliances, such as the Frankel-III, can correct malocclusion, adjust misaligned positions in patients with functional malocclusion and remedy harmful habits. Children with skeletal issues should undergo an evaluation of genetic factors. Expanding devices in conjunction with facemask therapy is recommended to promote the maxilla’s development.

Furthermore, addressing airway concerns, correcting harmful habits and incorporating myofunctional training are also essential, with regular prognosis assessments. A previous study indicates that the Frankel-III appliance repositions the oral and maxillofacial muscles by tilting the upper front teeth upward with the lips and the lower front teeth downward with the tongue. This adjustment increases the length of the maxillary dental arch and encourages the natural retraction of the mandible, promoting normal development of the dental arch and the chin [18]. Early treatment with facemasks demonstrates positive improvements in both skeletal and dental changes in the short term; however, evidence of long-term benefits remains limited [19]. It is important to note that the combination of maxillary expanders and forward-traction headgear is relatively effective for early treatment of Class III malocclusion in the mixed dentition stage. However, using reverse-pull facemasks may potentially result in an increased steepness of the mandibular plane angle [20]. The early interceptive treatment of Class III malocclusion aims to facilitate potential improvements in growth and development for rapid and significant results. Reports indicate that a shorter and broader maxilla may serve as a triggering factor for relapse and treatment failure in patients with Class III malocclusion [21]. Therefore, ongoing management and monitoring of affected children are necessary, with auxiliary methods such as dental arch analysis to predict relapse and timely intervention for maintaining normal jaw relations.

3. Multidisciplinary monitoring and management in the early correction process

3.1 Caries risk control and caries management

3.1.1 Etiology of dental caries in children

Children have a high incidence of dental caries caused by genetics, environment and diet. The global prevalence of caries among preschoolers is estimated at 65%, with a mean decayed, missing and filled surfaces (dmfs) score of 4.2 [22]. Caries is a disease that requires continuous management throughout the growth and development of children. The American Academy of Pediatrics (AAP) has recently updated several recommendations in a guidance document on “Maintaining and Improving Oral Health in Young Children” [23]. These recommendations emphasize a shift in caries management towards early intervention and preventive strategies, advocating for the collaboration of various healthcare professionals in oral health management. This highlights the necessity for orthodontic specialists to understand and actively participate in early intervention efforts for childhood caries. Children undergoing early orthodontic treatment are generally more prone to dental decay due to the increased difficulty of maintaining oral hygiene with various orthodontic appliances. These appliances can induce changes in the oral environment, including increased plaque accumulation, colonization by Streptococcus mutans and higher levels of lactic acid bacteria, all of which contribute to the risk of dental caries [24, 25]. Some scholars have proposed integrating caries prevention and risk assessment concepts into caries diagnosis and treatment to address this. This includes implementing preventive measures and individualized, comprehensive treatment plans while using the Caries Risk Assessment Tool (CAT) to standardize clinical caries prevention and control [26].

3.1.2 Key aspects of caries monitoring and management

Caries lesions have been associated with malocclusion in children aged 7–10 years [27, 28], underscoring the need for careful monitoring of caries in children undergoing early orthodontic correction. Access to surgery and dental care may be challenging for pre-school children, highlighting the need for personalized and evidence-based care pathways to manage dental caries effectively at the individual level [29]. Some researchers utilize the salivary biomarker Proteinase 3 (PR3) as an effective tool for the early detection of dental caries and assessing caries risk in patients. The severity of caries can be determined through non-invasive and personalized biomarker molecular testing, demonstrating significant clinical value [30].

The application of topical fluoride and oral health education is significant for the early prevention of caries. When necessary, these strategies, in conjunction with regular check-ups and specialized care, constitute essential components of the management plan [31]. In clinical practice, emphasizing oral hygiene education for children is crucial to fostering good dietary habits and reducing plaque formation and accumulation. Regular follow-up visits are necessary to assess the child’s oral hygiene maintenance and caries risk. This enables early caries detection and proactive intervention to promote the remineralization of the teeth. In addition to preventive measures, recent research highlights restorative treatments, such as fillings and extractions, to treat cases of advanced caries [29]. Preventing and early treating childhood cavities can effectively reduce the potential development of malocclusion [32]. For children preparing for early orthodontic treatment, it is essential to close deep fissures and treat active caries before initiating orthodontic therapy. The continuous inclusion of caries management in subsequent monitoring is also indispensable.

3.2 Periodontal health management

3.2.1 Etiology of periodontal disease in early correction

Although the prevalence of destructive periodontal disease is significantly lower in children than in adults, severe periodontitis can occur and may indicate systemic diseases. Early diagnosis is critical to maximizing the chances of successful treatment; therefore, incorporating periodontal examinations as an essential component of routine dental check-ups for children is crucial [33]. Research indicated a close relationship between malocclusion and periodontal disease [34]. Malocclusion contributes to more plaque accumulation, leading to more periodontal destruction. Adverse changes in the subgingival microbial community, including plaque formation, bleeding and increased probing depth (PD), have been found soon after appliance insertion [35]. A recent cross-sectional study showed that 50% of patients developed gingivitis within 6 months after orthodontic treatment [36]. Another study reported that the prevalence of gingival hyperplasia increased from 23.7% at the placement of fixed orthodontic appliances to 73.7% by the end of two years of treatment [37]. Chronic gingivitis is the most common periodontal infection in children and adolescents, and it is considered to be a preexisting stage of periodontitis [7]. The direct stimulation of the gums and potential harm from the effectiveness of oral hygiene practices significantly increase the occurrence of periodontal complications. Furthermore, researchers have proposed that hormonal changes during childhood and the continuous low-dose nickel produced by orthodontic appliances may also contribute to periodontal complications in orthodontic patients [38].

3.2.2 Main points of periodontal disease monitoring and management

The control of periodontal risk in early correction depends on the comprehensive evaluation of periodontal tissue status, appropriate program design, prudent treatment operation and reasonable oral hygiene maintenance. For children, timely removal of dental plaque and maintaining oral hygiene are essential to prevent gum inflammation. In the case of periodontal diseases, orthodontic correction should only proceed when inflammation is under control. The tooth root absorption should be lightly applied and closely monitored for traumatized teeth to eliminate occlusal trauma in time. Careful evaluation of periodontal health management before treatment is conducive to improving children’s oral health level and medical quality [39]. Chairside oral hygiene instruction is the most prevalent method for cultivating motivation for oral hygiene among orthodontic patients. Managing periodontal disease in children undergoing early orthodontic treatment requires orthodontists’ attention to clinical prevention and the comprehensive utilization of information reminders and behavioral corrections [36].

3.3 Eruption management

3.3.1 Abnormal causes occur

Tooth eruption is a key milestone in children’s growth and development. Proper tooth eruption and craniofacial growth to form functional occlusion are essential for children’s growth and development [40]. The emergence of teeth is a complex process closely associated with the differentiation and development of dental tissues, bone formation, resorption in the alveolar bone, and remodeling of the periodontal ligament fibers [41]. Changes at any stage of tooth eruption can potentially lead to abnormalities, such as impacted teeth, delayed eruption of permanent teeth and misaligned eruption, which are common issues in children. Early targeted prevention and intervention are beneficial for ensuring the healthy development of children. Through a cross-sectional retrospective study, German scholars have found a close correlation between delayed eruption of permanent teeth, retention of deciduous teeth and dental caries in children [42]. This further emphasizes the importance of multidisciplinary monitoring. The latest research has found an association between single nucleotide polymorphisms in the gene encoding Cyclooxygenase-2 (COX2) and deciduous tooth retention, which may delay permanent tooth eruption [43]. It is important to note that systemic diseases, such as metabolic bone disorders, can also lead to abnormal tooth eruption in children [44]. This indicates that clinical orthodontists should pay special attention to differential diagnosis.

3.3.2 Main points of monitoring management

During the early correction process, monitoring the replacement situation is essential and timely measures should be implemented, such as gap management, removal of local obstacles and traction to assist eruption. Researchers are exploring using Three-Dimensional Printed (3D-printed) ribbon and ring space maintainers for diagnosis and treatment [45] and digital personalized printing traction devices for traction assistance [46]. Concisely, Xia et al. [47] found that the total effective rate of early intervention in a series of malocclusion malformations caused by abnormal eruption of permanent teeth was as high as 89.29%. Furthermore, Guo et al. [48] also emphasized that in cases involving multiple abnormal teeth, early removal, such as before the eruption of adjacent teeth, can significantly reduce follow-up treatment time. Clinical practitioners have proposed various treatment options for ectopically erupting permanent teeth, including elastic separators, copper wires, prefabricated space maintainers, custom appliances and extraction of primary molars [49]. Among these, custom appliances demonstrate significant advantages in correcting anterior crowding, the anteroposterior skeletal relationship and the positioning of permanent incisors [50]. Therefore, it is essential to pay attention to indications during the early orthodontic process and intervene appropriately, ensuring the correct and complete eruption of permanent teeth in children and improving arch size and dental alignment.

3.4 Respiratory management

3.4.1 Causes of oral respiration

Oral respiration occurs when airflow through the mouth exceeds a certain proportion. Pathological conditions, such as nasal and pharyngeal diseases, and chronic factors, such as bad habits, contribute to this phenomenon. Mouth breathing is classified into three types: anatomical mouth breathing caused by dental and skeletal developmental abnormalities, obstructive mouth breathing resulting from nasopharyngeal diseases and chronic mouth breathing [51]. Airway stenosis caused by hypertrophy of adenoids and tonsils can lead children to exhibit open-mouth breathing, snoring and even apnea. If oral breathing persists due to airway obstruction for an extended period, neuromuscular reflex may develop, making it easier for the habit to persist even after the obstruction is resolved [52]. Chronic mouth breathing can lead to low tongue posture, resulting in narrow upper dental arches, a retruded lower jaw and changes in head posture. In clinical practice, respiratory issues are often identified alongside dental problems. Currently, there is no standard diagnostic method for oral respiration. Pereira CB et al. [53] have summarized several commonly used diagnostic methods, such as mirror test and water test, and explored the use of artificial intelligence pattern recognition and thermal imaging technology for diagnosis. However, these methods require further development. Long-term chronic oral respiration often leads to a low tongue posture, causing narrowing of the upper dental arch, mandibular retraction, changes in head posture and other complications.

The prevalence of malocclusion is high in children who breathe through their mouths. Mild tonsillar hypertrophy is significantly associated with malocclusion, Class II relationships and increased coverage in mouth breathers [54]. Similarly, there is a correlation between skeletal malocclusion and the incidence of mouth breathing [55]. Children who seek orthodontic treatment due to mouth breathing typically exhibit a high palatal vault and lowered tongue posture, often accompanied by a retruded lower jaw. Regarding soft tissue morphology, these children commonly present with more prominent upper lips, which is also gender-related [56]. Recent studies have shown that mouth breathing significantly impacts the anterior part of the mandible (Pog) [57]. Therefore, it is understood that mouth breathing may affect the proportion of lateral and vertical facial development, significantly impacting dental alignment. As a result, parents often seek orthodontic care due to aesthetic concerns or dental issues. This underscores the necessity for orthodontic specialists to monitor further and manage the respiratory problems in these children.

3.4.2 Main points of respiratory monitoring management

The younger the patient, the greater the likelihood of pathological mouth breathing; this condition typically peaks at ages 5 and 10. Clinical attention should be directed towards adenoid and tonsil hypertrophy. It has been reported that the proportion of bony class II in children with adenoid hypertrophy has significantly increased by 16%, and the proportion of bony class III in children with tonsil hypertrophy has increased substantially by 14% [58]. Therefore, paying attention to facial abnormalities in children and monitoring respiratory problems before early treatment is crucial. It is worth noting that oral breathing may also indicate sleep apnea syndrome (OSAHS) in children. Such children have a significantly higher incidence of daytime sleepiness, which is believed to be linked with craniofacial morphology and breathing patterns [59]. Additionally, children exhibiting craniocervical hyperextension and kyphosis should also be closely monitored for mouth-breathing issues [60].

The assessment of the anteroposterior position of the maxilla and mandible, the inclination of the occlusal and mandibular planes, anterior positioning and the measurement of the nasopharyngeal airway gap are crucial for diagnosing mouth breathing and obstructive sleep disturbances. Children with mouth breathing typically exhibit larger Sella-Nasion-A Point Angle (SNA angle), facial height and mandibular plane angles [61, 62]. Children who breathe through their mouths exhibit different airway dimensions than nasal breathers. In adolescents, these variances include facial developmental structures and the position of the tongue bone [63].

In the early treatment process, dental appliances such as maxillary rapid diffuser, Twin Block functional appliance, anterior tractor and muscle function trainer were used to improve functional results by reducing the apnea-hypopnea index [64]. Rapid maxillary expansion is the orthodontic treatment of choice for children with OSAHS cases, but it is not always possible to resolve this problem with orthodontic treatment [65]. Rapid maxillary arch expansion, adenoid tonsillectomy, Twin Block guiding the mandible forward, continuous positive airway pressure ventilation and comprehensive orthodontic therapy are used in clinical practice to manage children’s airway respiratory problems [66]. However, these methods remain controversial. Some scholars argue that routine expansion or growth correction is not an evidence-based means to improve or cure children’s respiratory problems [67]. The assessment and management of early treatment for children with respiratory issues remains inconsistent. Evidence suggests that rapid maxillary expansion may promote the enlargement of the dental arch and the nasomaxillary complex, leading to short-term improvement in mouth breathing. However, the long-term benefits of this approach remain unproven, mainly due to inconsistencies in research methodologies that contribute to limitations in the studies [68]. Nevertheless, these findings highlight the importance of interdisciplinary collaboration among relevant practitioners to diagnose, prevent and treat oral respiration to safeguard children’s physical and mental health [69].

3.5 Tongue position management

3.5.1 Causes of abnormal tongue position

Many factors, primarily environmental and functional, are related to the dental characteristics of growing children from the earliest years of life. For example, altered breathing patterns, specifically mouth breathing, are linked to a downward mandible position, which affects the tongue’s resting position and can make individuals susceptible to malocclusions. Furthermore, Mouth breathing is associated with the downward position of the mandible and subsequently, the lower position of the tongue, which may lead to craniofacial growth changes. Therefore, monitoring and managing tongue position should also be considered when children seek early orthodontic treatment.

Swallowing patterns, tongue position, oral habits and breathing patterns are the most frequently mentioned musculoskeletal and muscle function issues that may influence muscular activity in growing individuals. Muscular activity, in turn, interacts with the underlying facial skeleton and dentition [70]. Limited studies exist on malocclusions independent of tongue position; however, abnormal tongue activity during rest, swallowing and speaking increases the occurrence of malocclusion, especially in children with deciduous teeth. Tongue position and movement abnormalities typically indicate early adverse oral habits in children. Macroglossia or tongue rigidity may be attributed to local or systemic factors. In summary, issues related to the tongue can lead to dental problems, such as anterior open bite and dental crowding, prompting children to seek orthodontic treatment. Therefore, practitioners need to possess the relevant professional expertise.

3.5.2 Key points of tongue position management

Proper tongue hygiene is essential for controlling bacteria responsible for dental caries [71]. Practitioners should prioritize whole mouth hygiene, including tongue hygiene. Furthermore, correct oral posture and proper tongue resting position can contribute to the normal function and morphology of the orofacial muscles. During early growth and development, active appliances are utilized to correct the movements of oral and perioral muscle tissue. Reports indicate that muscle-strengthening exercises conducted with active appliances can help 60% of children achieve a more optimal tongue position in the anterior region of the hard palate [72]. In patients with early oral respiratory development, the rapid expansion of the maxilla promotes correct tongue position, although it does not significantly alter the position of the hyoid bone. Post-treatment assessments reveal that the dorsum of the tongue tends to approach the palatine fornix, yet the hyoid position remains unchanged [73]. This underscores the importance of tongue position as a critical assessment aspect in children undergoing early orthodontic treatment. Therefore, re-education of tongue position and movement during rest and swallowing and orofacial myofunctional therapy to improve swallowing and tongue posture are advocated not only to help children improve their bad habits but also to address malocclusion and establish a balanced orofacial muscle system [74, 75].

3.6 Posture management

3.6.1 Causes of abnormal posture

Children experience rapid growth and development, making this period crucial for establishing proper body posture. Notably, head posture deviations were found in 52.5% of children aged 6–15 years, with over half exhibiting a forward head posture [76]. A cross-sectional survey study demonstrated a high prevalence of postural deviations in schoolchildren, revealing forward head tilt in 53.5% of cases, shoulder elevation was present in 74.3% of instances, iliac crest asymmetry was evident in 51.7% of subjects, knee valgus was identified in 43.1% of subjects. Thoracic and lumbar kyphosis were present in 30.2% and 37.2% of subjects, respectively [77]. Obstructive conditions of the nasopharyngeal airway, caused by factors such as ethnicity, gender, age, temporomandibular joint disorder and various chronic diseases like adenoid hypertrophy, nasal allergies and obstructive sleep apnea, are closely related to head and cervical spine posture [78]. A large number of studies have shown that children with abnormal posture are more likely to have occlusal and facial problems [79, 80, 81]. Poor posture, particularly cranial positioning of the cervical spine, can lead to changes in head and neck alignment and airway dynamics, resulting in muscular dysfunction in the craniofacial region and adversely affecting facial development, tooth calcification, dentition and jaw positioning [80, 82]. Therefore, children seeking early correction in the clinic should also pay special attention to abnormal posture.

3.6.2 Main points of posture monitoring and management

Abnormal posture can lead to changes in craniofacial structure. An interaction may exist between body posture and mandibular position; for instance, cervical curvature is potentially associated with mandibular retrusion [83]. Recent studies also suggest a relationship between head posture and mandibular position [84]. There was a clear association between an overextended head posture and dental crowding in the lower arch [85]. In contrast, spinal lateral bending posture was significantly associated with an underbite and deviated mandibular midline. Children with spinal protrusion tend to have a smaller SNB angle [86].

Moreover, a weak positive correlation exists between head posture and facial profile. Children with a more forward-leaning head posture tend to exhibit a more protrusive facial profile [76]. Standard adverse body postural conditions, such as excessive lumbar curvature, forward pelvis, knee hyperextension and cranial cervical antiarch, should raise clinical suspicion, especially for children with mandibular retraction and abnormal cranio-neck and scapular postural conditions. Effective communication with parents is essential for timely orthopedic and rehabilitation treatment referrals. Photogrammetry can analyze head posture and facial profile by measuring the cranial base and the angle between glabella-subnasale-pogonion [87]. Dentists can prevent or treat malocclusion by correcting poor head and cervical posture. It is reported that the twin block appliance facilitates a more upright craniocervical posture [88]. Modifications to occlusal balance can resonate with postural equilibrium by adjusting subjects’ static morphological patterns and proprioceptive distribution of muscle tonicity [89]. This suggests that clinical corrections by orthodontists can yield significantly improved outcomes.

Additionally, some researchers propose using occlusal splints and intelligent postural correction orthotics to treat children [90, 91]. In early treatment, assessing posture correction and correcting abnormal head, neck and general posture should not be underestimated. Specialists such as dentists, pediatricians, family physicians, otolaryngologists and physical therapists should work as a team to prevent or correct poor posture in children. Posture abnormality should be considered as part of orthodontic clinical evaluation, and more substantial research is expected to support it in the future.

3.7 Psychological monitoring

3.7.1 Causes of psychological problems

The positive growth of children between the ages of 6 and 12 encompasses not only a physical change but also a psychological maturation. Due to their developmental stage, pediatric patients often exhibit anxiety, fear and avoidance or refusal of treatment during dental procedures. Thus, it is essential to consider patients’ physical, psychological and emotional states when selecting optimal treatment plans and predicting their effectiveness.

3.7.2 Key points of psychological monitoring

Studies have shown that utilizing psychological intervention in the treatment process, such as instruction, demonstration, manipulation, behavior modeling and positive reinforcement, can effectively alleviate psychological problems in children [92]. A systematic retrieval and evaluation of basic behavior management techniques (BMTs) is also very effective in pediatric patients [93]. Cognitive behavioral therapy can reduce children’s fear and anxiety, enabling participants to undergo dental treatment [94] willingly. At the same time, during the early treatment period, it is vital to monitor psychological changes and address the emotional needs of children patients to create a suitable environment for their healthy development.

4. Summary

Extensive literature has shown that early correction can improve malocclusion and promote normal bone development in children. However, a standardized process of early treatment has not been wholly unified. Clinicians must focus on monitoring caries, periodontal health, eruption problems, tongue position, breathing and posture, and psychological management in the early treatment to provide more scientific and practical help in children’s growth and development (Fig. 1). This paper’s strength lies in its multidisciplinary perspective, offering comprehensive action plans for orthodontic specialists during early treatment. It seeks to improve clinical practice guidelines by combining and summarizing different early orthodontic therapy techniques. However, this article focuses on typical clinical disorders because of the variety and complexity of the clinical settings. From an orthodontist’s perspective, some of the contents focus on points different from those of specialists. This further demonstrates that early orthodontic treatment requires the cooperation of dentists, pediatricians, otolaryngologists and orthopedists to provide professional and effective management for child growth and development [95].

Early treatment requires multidisciplinary management that focuses on monitoring dental caries, periodontal health, teething issues, tongue position, breathing and posture, as well as psychological management.

Fig. 1.Early treatment requires multidisciplinary management that focuses on monitoring dental caries, periodontal health, teething issues, tongue position, breathing and posture, as well as psychological management.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Author contributions

QS—designed the research study and performed the research; wrote the manuscript. ZYZ—provided help and advice on the research. Both authors contributed to editorial changes in the manuscript. Both authors read and approved the final manuscript.

Ethics approval and consent to participate

Not applicable.

Acknowledgment

Thanks to the Biorender website for providing drawing materials.

Funding

This research received no external funding.

Conflict of interest

The authors declare no conflict of interest.

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