Extra care needs to be taken in preparing a special-needs child for orthodontics.
A ten-year-old girl with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) presented with headaches, every and all day. Her mother said she also experienced brain fog, anxiety, ADHD, obsessive compulsive disorder (OCD), and hallucinations. She was irritable, moody, and had academic regression.
Having worked for a brain-injured center for 16 years, I have found that these children can be very sensitive. Their condition may predispose them to having more difficulty in experiencing dental forces to move teeth than the average child.
She was a happy baby but experienced a concussion two years ago. Orthodontically, she originally had a palatal expander and a set of braces.
She started a second set of braces in February 2024. Her headaches started in September 2024 and have continued for seven months to now.
I found that she had a zero-second brain cycle. She had a thick maxillary arch wire tying her upper teeth and maxillary bones together.
I believe that periodically tightening this wire restricted her maxillary bone motion. This created a cranial domino effect that tightened her entire craniosacral fascial system.
Many of the symptoms of PANDAS are similar to those of a zero-second brain cycle and tight system—tics, anxiety, depression, irritability, and sleep disturbances. This patient needs to become strain-free from the orthodontic effects to see what conditions clear out and what may still remain.
If you, as a provider, find yourself in this predicament, it is a tough presentation to mom. Basically, you are saying that all of her orthodontic care, which have cost the parents a lot of time and a ton of money, have probably created her current headache condition.
There is no way to sugar-coat that conversation. My experience over the years has been to just tell mom what you believe.
If I am to accept this patient, the orthodontist needs to remove the arch wire so the brain has a chance to breathe in therapy. If the headaches go away, she will need to see Dr. Joanna Walska in Newtown, Pennsylvania, who is completely on board with “brain-friendly” orthodontics.
If I do therapy, the headaches go away, and the patient goes back to the original orthodontist to finish the arch wire treatment, all of my work will certainly be undone. If the headaches do not go away, then I was incorrect in my assessment. The orthodontist can easily put the arch wire back on and finish therapy.
My bottom line for orthodontics: a child becomes strain-free and proceeds with orthodontic treatment that is compatible with acceptable craniosacral fascial function. Better yet, do therapy right at birth to mitigate the effects of birth trauma that can sow the seeds for future orthodontic care.
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