It can be said that the orthodontic-orthopaedic problems that we see in the 6-8 year old children, have their genesis at a much earlier age.

In this article I will show instances where problems are present in the early dentition, which require immediate attention. Case 1 (Fig 1) shows a three year old child with a severe Class III malocclusion. Treatment at this early age is relatively simple, the prognosis excellent, and the treatment time less than six months.

Figure 1. Case 1, Pretreatment - CLASS III, 3 year old

At 3 years much activity is taking place in the condylar area, and the posterior fibres of the temporalis muscle are relatively more powerful than the anterior fibres of the temporalis, and the masseter. These facts are very important in facilitating the posterior movement of the mandible, relative to the skull base.

Treatment

Exercise the muscles of the craniofacial system with the Myomunchie (U.S. Patent No. 5163840) for one month. Begin with 2 minutes chewing twice daily for one week.

In the second week increase the time to 10 minutes daily, thereafter - 20 minutes daily until treatment is complete.

After one month (Fig 2) it will be observed that the child has now little difficulty in placing the anterior teeth in an edge to edge position. The posterior fibres of temporalis are horizontally positioned and exert a distal force on the mandible.

Figure 2. Case 1,1 month of Myomunchie 20 minutes per day.

After one month take an impression of the upper arch, and make a simple sagittal appliance with thin posterior cover, with molar band retention on the deciduous second molar.

Use nitrous oxide and tender loving care.

Suggest to the child in whispers how good they are and how good the happy gas is. Ask the child if they like it, and almost everytime the child with nod their head.

Be certain when taking the impression that the water is warm, the mix is thick, such that the setting time is no longer than fifteen seconds. The dentist should supervise the mixing of the alginate, never use a runny mix.

Insert the appliance under nitrous at the next appointment, and adjust the deciduous canines, which most frequently are a major factor in the malocclusion.

The mandible assumes a normal relationship after another six weeks, (Fig 3) however treatment is continued until it can be seen that the child is comfortable in the new position.

Figure 3. Post-treatment after 6 months of sagittal appliance.	Figure 4. finished happy patient

The second series of slides (Fig 5 & 6) shows a four-year-old child in a Class III relationship. In this instance treatment was effected over a six month period after substantial adjustment to the lower deciduous canines. The child was encouraged to exercise with the Myomunchie for 20 minutes daily. This result was achieved without resort to an orthopaedic plate.

Both results remained stable, but correction is expedited by use of an appliance.