Update on Rocky w/updated X-rays

[Elgato5164]

Hi Everyone,
I have posted previously regarding Rocky and the fact that he might have an odontoma. My regular vet has agreed to do an xray ( will be first time doing an xray on a “rodent”). I had to correct him and tell him that Rocky does not identify as a rodent…he identifies as a small dog with a fluffy tail 😂!
Anyway, he only has a large xray machine and not a small dental type machine. Is it possible to get an Xray that is detailed enough for a vet that specializes in squirrels to make a diagnosis from a larger xray machine?
Thank you hope your input!
Lorie

[SamtheSquirrel2018]

Hi Everyone,
I have posted previously regarding Rocky and the fact that he might have an odontoma. My regular vet has agreed to do an xray ( will be first time doing an xray on a “rodent”). I had to correct him and tell him that Rocky does not identify as a rodent…he identifies as a small dog with a fluffy tail 😂!
Anyway, he only has a large xray machine and not a small dental type machine. Is it possible to get an Xray that is detailed enough for a vet that specializes in squirrels to make a diagnosis from a larger xray machine?
Thank you hope your input!
Lorie

Hi Elgato:
I am not a Veterinarian, Dentist, Radiologist or Veterinary surgeon so there's my disclaimer! That being said, I'll give my opinion for what it may be worth and it is based upon some experience viewing radiographic (x-ray) studies obtained to evaluate a Squirrel for the possibility of an odontoma and having viewed other films that were taken with the hope that they would reveal a diagnosis and demonstrated the existence of odontomas. Odontomas are very common in Squirrels! First off, it sure is nice that your Veterinarian has agreed to take the films! Even though he obviously doesn't know me from doodley-squat; please thank him for me anyway!

I cannot make a recommendation to your Vet as to the specifics for the x-ray machine settings but hopefully he has an x-ray tech and this person can help with the settings and positioning if necessary. If your Vet has not performed any x-ray studies on rodents, he could still use similar settings as would be necessary for performing a skull series on a small kitten. Even if you Vet has not performed x-ray studies on rodents, he may still have some guidelines for x-raying Rats as they are a common pet and the x-ray settings for a rat would be essentially the same for Rocky!

My suggestion for the radiographic study itself would be to use an inhaled anesthetic such as isoflurane for sedation enough to have Rocky positioned for the films without significant movement that would likely interfere with the study. Of course, Elgato, your Vet MUST be very familiar with utilizing inhaled sedation on small animals as this has very real and significant risk and the Vet's experience and comfort in utilizing this method is of utmost importance for minimizing risk of complications from the inhaled anesthetic agent.

I would suggest a Skull Series as the study of choice. A specific dental machine is NOT necessary! I would also like to suggest AT LEAST two views; 1) A Dorso-Ventral (DV) view (where Rocky would be positioned belly down facing away from the x-ray tube) OR a Ventro-Dorsal (VD) View (where Rocky would be positioned belly up facing toward the x-ray tube). Rocky's head must NOT be pointed up or down for either of these views! His neck must be straight! Also, it is not necessary to get both a DV and VD view; just one or the other as the x-ray beam passes through the same areas with both views but from opposite directions; and 2) a direct lateral view (either from the left or the right). Oblique views (angled) could be a helpful addition but at least a DV or VD view AND a LATERAL view are essential! With the DV or VD view, we will be able to see an odontoma and be able to differentiate whether it is on the left or right side (or both) and with the LATERAL view, we will be able to determine whether the odontoma involves the upper teeth or the lower teeth or both!

When is the x-ray study gong to be performed? If you are willing, it would be great for you would post the radiographs in this thread for us to view!

Regards,
SamtheSquirrel

[Elgato5164]

Here is an update on my squirrel Rocky. I just got home from my veterinarian’s office with Rocky. Rocky was so calm they did not have to sedate him! I’m so proud of my boy! Because my vet isn’t an expert in squirrels, pointed out the part of the xray that was of concern to him. He was thinking it looks more like an abscess or mass. I’m going to post the x ray below. Would love to know what you guys think and whether or not there is an odontoma/abscess etc.
Thank you!
One pic has the area highlighted and the other does not.

[SamtheSquirrel2018]

Here is an update on my squirrel Rocky. I just got home from my veterinarian’s office with Rocky. Rocky was so calm they did not have to sedate him! I’m so proud of my boy! Because my vet isn’t an expert in squirrels, pointed out the part of the xray that was of concern to him. He was thinking it looks more like an abscess or mass. I’m going to post the x ray below. Would love to know what you guys think and whether or not there is an odontoma/abscess etc.
Thank you!
One pic has the area highlighted and the other does not.

Hello again Elgato:
Ditto on my prior disclaimer!

I suspect that this density seen on the lateral view is an odontoma as it has the appearance of a "popcorn-like" density at the base of one of the upper incisors which is a "hallmark" radiographic sign. This white appearing mass has the same density as the nearby teeth and bone and this is most likely because it contains similar material, mainly calcium. Odontomas are made up of normal but very disorganized dental tissues and this appears quite typical.

A "mass" in "Medical Speak" is not definitive and is simply an abnormal concentration of substance that exists somewhere in the body. A mass can be a solid tumor of some kind which can be benign (not cancer) or malignant (cancer). A mass can also be cystic in character. This is where the mass itself contains a fluid or other substance and often has a thickened surrounding sac of sorts and can be present within skin or an organ. The example your Vet gave of an abscess is actually a cystic mass that contains pus. Some examples of other cystic type masses are hematomas (a sac containing blood) or a seroma
(a collection of cellular and/or interstitial fluid). Most masses do not possess a significant amount of calcium and are relatively radiolucent (the x-ray beam passes through them) and they may either not be seen at all on an x-ray study or there may be some hint of the mass just as you can see a "hint" of Rocky's facial skin in contrast with the high density bones and the calcified mass if issue on the provided lateral radiograph.

An odontoma is a solid mass which is radiopaque (shows up as dense white on an x-ray) but there are other more rare forms of masses that contain at least some calcification as well. Again, however, the densely white mass seen on this radiograph with a classic "popcorn" appearance and located at the base of one of the incisors; strongly suggests to me that this is an odontoma!

Did the Veterinarian obtain any other views such as the DV or VD view or is this the only radiograph obtained? With just a lateral view, it is impossible to determine on which side the calcified mass is located impossible to determine the degree of lateral (outward) extension or medial (inward) extension and to define these critical factors, a DV or VD view is essential!

Assuming that the abnormal density seen on the radiograph is indeed an odontoma; you can easily see why odontomas associated with the upper teeth are often associated with restriction or even obstruction of one or both nasal passages and can involve the sinuses as well! How is Rocky doing? Does he have any signs of problems?

Regards,
SamtheSquirrel

[Elgato5164]

Sam theSquirrel,
Thanks for your response ! Unfortunately Rocky is showing some signs of an odontoma. He is kind of wheezy and congested sounding and one of his eyes is sometimes stuck shut when he wakes up. His appetite is great and doesn’t appear to be in any pain.
I am going to search for a squirrel vet in SC that might be closer than Florida but I’ll just have to see.
I know surgery is risky but do you have any information on what the odds are for a squirrel surviving the surgery?
Thanks for everything!

[SamtheSquirrel2018]

Sam theSquirrel,
Thanks for your response ! Unfortunately Rocky is showing some signs of an odontoma. He is kind of wheezy and congested sounding and one of his eyes is sometimes stuck shut when he wakes up. His appetite is great and doesn’t appear to be in any pain.
I am going to search for a squirrel vet in SC that might be closer than Florida but I’ll just have to see.
I know surgery is risky but do you have any information on what the odds are for a squirrel surviving the surgery?
Thanks for everything!

Thanks for your response, Elgato! I'm sorry that Rocky is having signs suggestive of an odontoma but that, along with the x-ray study certainly makes this seems, IMHO, to lead to this diagnosis! Again, were any other radiographs obtained? Two views are the minimum necessary to adequately identify the the location and the extent of an odontoma and the single study that you posted will NOT be adequate! Please refer to my initial response to your post for definitive suggestions and talk with your Vet about further radiographs if you are so inclined! All potential Veterinary surgeons will need a complete skull series of at least the two main views; the VD or DV view and the lateral which you already have!

I do not know what the true odds are for a good outcome from odontoma surgery as this depends upon a number of factors including the skill and experience of the surgeon (this, along outcome, perioperative and convalescent data must be well documented by prior Squirrel-people whose Squirrels had odontoma surgery performed by any Veterinarian being considered!), the general health of the Squirrel, the number, size and extent of the odontoma(s), and the post-operative care delivered by the Squirrel-parent! Sadly, we lost the world's preeminent Squirrel dental surgeon, Dr Emerson to what appears at least for now to be retirement! She was in Florida and people traveled from all over the Country with their Squirrels to be seen by her! The odds for an optimal outcome from Dr. Emerson's odontoma operations were very good. One of the most significant risks to the surgery has nothing really to do the the actual operation and that is the risk of relatively prolonged inhaled anesthesia and definitive expertise with this induction, maintenance and recovery from anesthesia is an essential requirement for any Veterinary surgeon!

There are other Squirrel surgeons who perform odontoma surgery but I do not know of any specifically! Others here on TSB hopefully can make suggestions for you. Please vet the Vet very thoroughly however! That was one of the great things about Dr. Emerson and that was we all knew that she was highly skilled and had more experience with odontoma surgery than anyone anywhere! What a loss to the Squirrel world!

Regards,
SamtheSquirrel

[island rehabber]

Elgato, please check your PMs.

[Elgato5164]

Hello Everyone
Rocky completed his 21 days of Baytril. On 1/9/25 I took him back to the vet to have another set of X-rays taken for comparison. I will attach those at the bottom of the post. Good news…the area where there was a white popcorn looking “structure” is much smaller! There obviously is an abscess or infection in that area and it is improving. While he was anesthetized the vet examined the incisor on that side and was able to just “pluck” it out. Upon doing so he said the smell was awful. Apparently the incisor wasn’t growing anymore and had broken off at some point. Since the Baytril has been working we are continuing it for another 14 days and then another visit to the vet. The vet is not sure if this is a true odontoma or not. Hopefully the infection will have cleared enough by this next visit so that it can be determined exactly what is going on. The vet said he isn’t sure whether or not teeth will need to be removed or not.
X-RAYS:

[island rehabber]

Wow. I can't say that I have the expertise needed to comment usefully on these x-rays (SamtheSquirrel, where are you? ), but I am very very glad you were able to get them. Hopefully now a course of action can be planned, the infection can be eradicated, and poor Rocky can feel much better.

[Snicker Bar]

I am by no means an expert such as Dr. E….
But from what I have learned from my own Odontoma survivor and her follow up x rays we take (to monitor a new one developing )I would definitely monitor this closely. The lesions to me look mineralized (they have bone density). There very well could be infection too (as evidenced by the odor, and signs of improvement with good meds) But those bright , white areas circled look suspiciously like Odontoma to me. A pus pocket will not be “calcified” in appearance. I would watch and see what the follow up pictures show. If after a reasonable amount of time has passed for antibiotics to do their job, and if the lesion (and if symptoms) persist/come back, I would seek out a second opinion to see if this requires surgery in the future. Just my opinions; not a dental specialist but my girl is sadly teaching me about this miserable disease

[Elgato5164]

Wow. I can't say that I have the expertise needed to comment usefully on these x-rays (SamtheSquirrel, where are you? ), but I am very very glad you were able to get them. Hopefully now a course of action can be planned, the infection can be eradicated, and poor Rocky can feel much better.

That is my hope as well. The vet has definitely not ruled out an odontoma but he is prepared to do the surgery if necessary. But I do think it necessary to get rid of the infection before doing any surgery.

[Elgato5164]

Wow. I can't say that I have the expertise needed to comment usefully on these x-rays (SamtheSquirrel, where are you? ), but I am very very glad you were able to get them. Hopefully now a course of action can be planned, the infection can be eradicated, and poor Rocky can feel much better.

I am by no means an expert such as Dr. E….
But from what I have learned from my own Odontoma survivor and her follow up x rays we take (to monitor a new one developing )I would definitely monitor this closely. The lesions to me look mineralized (they have bone density). There very well could be infection too (as evidenced by the odor, and signs of improvement with good meds) But those bright , white areas circled look suspiciously like Odontoma to me. A pus pocket will not be “calcified” in appearance. I would watch and see what the follow up pictures show. If after a reasonable amount of time has passed for antibiotics to do their job, and if the lesion (and if symptoms) persist/come back, I would seek out a second opinion to see if this requires surgery in the future. Just my opinions; not a dental specialist but my girl is sadly teaching me about this miserable disease

The pics that you referenced that have the area circled in red were from the first set of X-rays. I don’t know if you have seen the second set that was recently done but that area has become smaller, not that it means it isn’t an odontoma but there is improvement.We are absolutely going to monitor this and again he has another visit in 2 weeks to see what needs to be done. The vet does believe that removal of the teeth will be the ultimate end result but on the other hand getting rid of the infection is a good idea before any surgery. I completely trust him as he has done so much with wildlife surgery etc. with a lot of experience in odontoma surgery. He is systematic as he has had situations where people automatically assume their squirrel has an odontoma based on what they read on the internet and it turns out not to be an odontoma. Personally I’m glad he hasn’t automatically jumped to a conclusion and performed surgery. He is ruling out the possibility of it being anything other than an odontoma before doing a dangerous surgery.

[SamtheSquirrel2018]

Hello Everyone
Rocky completed his 21 days of Baytril. On 1/9/25 I took him back to the vet to have another set of X-rays taken for comparison. I will attach those at the bottom of the post. Good news…the area where there was a white popcorn looking “structure” is much smaller! There obviously is an abscess or infection in that area and it is improving. While he was anesthetized the vet examined the incisor on that side and was able to just “pluck” it out. Upon doing so he said the smell was awful. Apparently the incisor wasn’t growing anymore and had broken off at some point. Since the Baytril has been working we are continuing it for another 14 days and then another visit to the vet. The vet is not sure if this is a true odontoma or not. Hopefully the infection will have cleared enough by this next visit so that it can be determined exactly what is going on. The vet said he isn’t sure whether or not teeth will need to be removed or not.

Hello Elgato:
Thanks for your update on Rocky! Again, my disclaimer is that I am not a Veterinarian, a dentist or a radiologist but I will make some comments anyway and you can decide if there is anything that follows that might be useful or beneficial to you, your Vet or Rocky!

1) First off, my suggestion would be for you request that on of the Admin combine all of your threads regarding Rocky's dental issues and x-ray studies that have been performed. When a new thread is started for an update, it makes it very difficult if not impossible to recognize the continuity of events and recognize and interpret trends! For the same Squirrel with the same issues; my suggestion is always the original poster keep only one Thread active so that everyone can see what has transpired and so that new readers who may also be able to offer suggestions and comments will be able to recognize all of the issues and event by reading the entire single Thread rather having to also refer to other Thread that they probably don't even know exist! Okay, moving on in this Thread----->

2) As you know, I reviewed your original series of x-ray films and made some comments. I stand by these same comments now except that your Veterinarian has now performed the further radiographic studies I recommended and these are very beneficial! Here are my comments from 12/11/2024;

Hello again Elgato:
Ditto on my prior disclaimer!

I suspect that this density seen on the lateral view is an odontoma as it has the appearance of a "popcorn-like" density at the base of one of the upper incisors which is a "hallmark" radiographic sign. This white appearing mass has the same density as the nearby teeth and bone and this is most likely because it contains similar material, mainly calcium. Odontomas are made up of normal but very disorganized dental tissues and this appears quite typical.

A "mass" in "Medical Speak" is not definitive and is simply an abnormal concentration of substance that exists somewhere in the body. A mass can be a solid tumor of some kind which can be benign (not cancer) or malignant (cancer). A mass can also be cystic in character. This is where the mass itself contains a fluid or other substance and often has a thickened surrounding sac of sorts and can be present within skin or an organ. The example your Vet gave of an abscess is actually a cystic mass that contains pus. Some examples of other cystic type masses are hematomas (a sac containing blood) or a seroma
(a collection of cellular and/or interstitial fluid). Most masses do not possess a significant amount of calcium and are relatively radiolucent (the x-ray beam passes through them) and they may either not be seen at all on an x-ray study or there may be some hint of the mass just as you can see a "hint" of Rocky's facial skin in contrast with the high density bones and the calcified mass if issue on the provided lateral radiograph.

An odontoma is a solid mass which is radiopaque (shows up as dense white on an x-ray) but there are other more rare forms of masses that contain at least some calcification as well. Again, however, the densely white mass seen on this radiograph with a classic "popcorn" appearance and located at the base of one of the incisors; strongly suggests to me that this is an odontoma!

Did the Veterinarian obtain any other views such as the DV or VD view or is this the only radiograph obtained? With just a lateral view, it is impossible to determine on which side the calcified mass is located impossible to determine the degree of lateral (outward) extension or medial (inward) extension and to define these critical factors, a DV or VD view is essential!

Assuming that the abnormal density seen on the radiograph is indeed an odontoma; you can easily see why odontomas associated with the upper teeth are often associated with restriction or even obstruction of one or both nasal passages and can involve the sinuses as well! How is Rocky doing? Does he have any signs of problems?

Regards,
SamtheSquirrel

3) I am not making the following statement with any disrespect and please forgive me if there is any appearance of this as it is quite unintentional; but IMHNVO (in my humble non-vet opinion); I see little, if any change in size or appearance of the "white popcorn structure" in the new films as opposed to the prior films! The only difference I see is related to the size of the IMAGES themselves and NOT the size of the density. The new films themselves are smaller than the first films and IMO, the apparent decrease in size of the lesion in the new films is essentially an illusion secondary to size difference between the prior images of the new images! I copied the new images and magnified them to the same scale as the original images and the mass appears basically identical to that seen on the initial films!

As I mentioned back in December and as Snicker Bar just now stated; the "popcorn-like" mass that is present in the prior films and now in the new films has the same solid, bright, white denseness as bone and this along with its roundish, popcorn-like morphology (shape) and its location at the root region of one of the incisors is strongly suggestive if not outright diagnostic of an Odontoma!

4) in the new films, assuming that the side markers (these are the "things" you see on the film that show "R" for right) are accurately placed; we can now determine that there is a single mass and it is associated with the right upper incisor!

5) Removing the incisor will most likely aid in drainage from what most likely is a dental abscess associated with the odontoma. Odontomas are common and they often act as focuses for infection and it usually the signs of the infection and not the odontoma itself that suggest the presence of an odontoma!

6) For treating infections associated with the teeth or other oral structure; my preferred antibiotic is Amoxicillin plus Clavulanate! Clavamox is a dental brand and I would humbly like ask that you discuss considering the use of this antibiotic rather than the Baytril. The reason for this suggestion is that Baytril can be effective in treating infections from many bacteria but it is NOT a good choice for infections likely to be caused by anaerobic (those that grow best or only in the absence of oxygen) bacteria.! Dental and oral infections are very often caused by anaerobic bacteria and for these, use of Amoxicillin plus Clavulanate is a usually far better choice than Baytril! The fact that dental infections are frequently caused by anaerobic bacteria; we also have a new sign that anaerobes are playing a part in Rocky's infection because the "awful" smell you noticed when Rocky's diseased incisor was extracted is in itself a sign of the presence of an anaerobic infection! Anaerobic infections commonly cause some of most pronounced and repulsive odors!

7) is your Vet experienced with performing odontoma surgery?

Regards,
SamtheSquirrel

[SamtheSquirrel2018]

6) For treating infections associated with the teeth or other oral structure; my preferred antibiotic is Amoxicillin plus Clavulanate! Clavamox is a dental brand

This was a typo! What I meant to say was that Clavamox is a Veterinary brand of Amoxicillin plus Clavulanate (and Augmentin is a Human brand of Amoxicillin plus Clavulanate). As Rocky is being seen by a Vet; the Vet can write a prescription for Clavamox (or equivalent)! Incidentally, most of us whose Squirrels require antibiotics are not as fortunate as Rocky have a Veterinarian "on the case" and use the human brands that the find at home or from friends or family.
Regards,
SamtheSquirrel

[Snicker Bar]

I totally misunderstood that these were old x rays ; my apologies but by sounds, STS has done a very thorough comparison of these with the previous and I totally trust his opinions I also agree about the Clavamox… And hopefully Rocky is on probiotics as well (while being on Baytril for so long?) Again forgive me if that was also previously stated elsewhere I sometimes read too fast!

I’ll still look for the previous pics for my own curiosity though… Trying to learn as much as I can for my own girl, and others I may need to help some day. And I totally understand, and respect your Dr’s hesitation to dive into a major surgery such as this! It is , for lack of a better description a somewhat brutal operation, no doubt!

Recently, my young adult son (human) was diagnosed with Odontoma; one very large one and a second smaller one next to the first. He texted me the pics of his x rays while I was at work…. And I literally almost cried and passed out lol. After knowing what my “Doodles” went through …. I thought, “Is he going to have to have half his teeth pulled and part of his jawbone removed??” Thankfully not in his case!!

I have only had one Odontoma experience. Here (at TSB) there are many others who can share so much more about the ordeal. It truly was a rough journey for my neuro girl, “Doodlebug”. All four incisors were removed along with one Odontoma. Her aftercare was pretty intense, and she must now forever eat soft foods and be hand fed twice a day (but only because she is neuro).

I don’t get to check in often but I wish the best for your squirrel child! As time allows, I hope to follow his journey and hopefully an eventual success story!

[SamtheSquirrel2018]

I totally misunderstood that these were old x rays ; my apologies but by sounds, STS has done a very thorough comparison of these with the previous and I totally trust his opinions I also agree about the Clavamox… And hopefully Rocky is on probiotics as well (while being on Baytril for so long?) Again forgive me if that was also previously stated elsewhere I sometimes read too fast!

I’ll still look for the previous pics for my own curiosity though… Trying to learn as much as I can for my own girl, and others I may need to help some day. And I totally understand, and respect your Dr’s hesitation to dive into a major surgery such as this! It is , for lack of a better description a somewhat brutal operation, no doubt!

Recently, my young adult son (human) was diagnosed with Odontoma; one very large one and a second smaller one next to the first. He texted me the pics of his x rays while I was at work…. And I literally almost cried and passed out lol. After knowing what my “Doodles” went through …. I thought, “Is he going to have to have half his teeth pulled and part of his jawbone removed??” Thankfully not in his case!!

I have only had one Odontoma experience. Here (at TSB) there are many others who can share so much more about the ordeal. It truly was a rough journey for my neuro girl, “Doodlebug”. All four incisors were removed along with one Odontoma. Her aftercare was pretty intense, and she must now forever eat soft foods and be hand fed twice a day (but only because she is neuro).

I don’t get to check in often but I wish the best for your squirrel child! As time allows, I hope to follow his journey and hopefully an eventual success story!

Thanks for your comments, Snicker Bar! One of the reasons that you did not notice the set of prior films was that there is more than one active Thread about Rocky and I suggested in my recent post for Elgato to stick with this current Thread that we are on and for an ADMIN to combine the other Threads with this one!

Please refer to this Thread for the original films and a subsequent comprehensive discussion of the issues; https://thesquirrelboard.com/forums/...t=#post1374763

Sorry to hear about you son's odontoma. Perhaps surprisingly, odontomas are one of the most common dental associated tumors in humans!

Regards,
SamtheSquirrel

[Snicker Bar]

Thanks will check those out ; always trying to learn

And yes that’s what we were told by the oral surgeon! Thank goodness he doesn’t have to go through what my Doodlebug did !!

[Elgato5164]

Thanks will check those out ; always trying to learn

And yes that’s what we were told by the oral surgeon! Thank goodness he doesn’t have to go through what my Doodlebug did !!

Hi, I’m so sorry to hear about your son’s odontoma! Yes it’s great that the surgery for a human is not as horrific as the surgery for a squirrel. Did they give you any idea what causes an odontoma in a human?
There are actually three sets of x-rays from three different days for Rocky. However, I can’t find the second set on here. Maybe it was user error and I did not actually post them, but I’m getting ready to post all three with dates again.

[SamtheSquirrel2018]

Hi Elgato:
It appears that you may have overlooked the other posts on this thread that preceeded Snicker Bar's most recent post that you recently commented upon!

If so, please go back and read what others, including mysrlf, have written including comments about the x-ray films and a recommendation and rationale for use of Clavamox instead of Baytril!

How is Rocky doing?
Regards,
SamtheSquirrel

[Charley Chuckles]

I've had my share of squirrels with Odontomas, I've asked the question why, what causes this over and over.
DR Emerson during a conversation said to me that she thinks there are many factors but she believed lack of sunlight.
I just looked up odatomas in cats and here is what I read... For what it's worth.


Odontomas in cats are caused by abnormal tissue arrangement during the development of permanent teeth. The exact cause is unknown, but possible causes include:
Trauma to the upper incisors
Vitamin or mineral imbalance
Inadequate wear of the teeth
Lack of sunlight
Infection
Inflammatory processes affecting the jaws during childhood