Some children as early as 5 or 6 years of age may benefit from an
orthodontic evaluation. Although treatment is unusual at this early age,
some preventative treatment may be indicated.
By age 7, most children have a mix of baby (primary) and adult
(permanent) teeth. Some common orthodontic problems seen in children
can be traced to genetics, that is they may be inherited from their parents.
Children may experience dental crowding, too much space between teeth,
protruding teeth, and extra or missing teeth and sometimes jaw growth
problems.
Other malocclusions (literally, “bad bite”) are acquired. In other
words, they develop over time. They can be caused by thumb or
finger-sucking, mouth breathing, dental disease, abnormal swallowing, poor
dental hygiene, the early or late loss of baby teeth, accidents or poor
nutrition. Trauma and other medical conditions such as birth
defects may contribute to orthodontic problems as well. Sometimes an
inherited malocclusion is complicated by an acquired problem. Whatever
the cause, the orthodontist is usually able to treat most conditions
successfully.
Orthodontists are trained to spot subtle problems with jaw growth and
emerging teeth while some baby teeth are still present. The advantage
for patients of early detection of orthodontic problems is that some
problems may be easier to correct if they are found and treated early.
Waiting until all the permanent teeth have come in, or until facial growth
is nearly complete, may make correction of some problems more difficult.
For these reasons, the American Association of Orthodontists (AAO) recommends that all children get a check-up with
an orthodontist no later than age 7. While your child’s teeth may
appear straight to you, there could be a problem that only an orthodontist
can detect. Of course, the check-up may reveal that your child’s bite
is fine, and that is comforting news.
Even if a problem is detected, chances are the orthodontist will take a
“wait-and-see” approach, checking your child from time to time as the
permanent teeth come in and the jaws and face continue to grow. For
each patient who needs treatment, there is an ideal time for it to begin in
order to achieve the best results. The orthodontist has the expertise
to determine when the treatment time is right. The orthodontist’s goal
is to provide each patient with the most appropriate treatment at the most
appropriate time.
In some cases, your orthodontist might find a problem that can benefit
from early treatment. Early treatment may prevent more serious
problems from developing and may make treatment at a later age shorter and
less complicated. For those patients who have clear indications for
early orthodontic intervention, early treatment gives your orthodontist the
chance to:
- Guide jaw growth
- Lower the risk of trauma to protruded front teeth
- Correct harmful oral habits
- Improve appearance and self-esteem
- Guide permanent teeth into a more favorable position
- Improve the way lips meet
It’s not always easy for parents to tell if their child has an
orthodontic problem. Here are some signs or habits that may indicate
the need for an orthodontic examination:
- Early or late loss of baby teeth
- Difficulty in chewing or biting
- Mouth breathing
- Thumb sucking
- Finger sucking
- Crowding, misplaced or blocked out teeth
- Jaws that shift or make sounds
- Biting the cheek or roof of the mouth
- Teeth that meet abnormally or not at all
- Jaws and teeth that are out of proportion to the rest of the face
If any of these problems are noted by parents, regardless of age, it is
advisable to consult an orthodontist. It is not necessary to wait
until age 7 for an orthodontic check-up.
What is preventive orthodontic treatment?
Preventive orthodontic treatment is intended to keep a malocclusion
(“bad bite” or crooked teeth) from developing in an otherwise normal mouth.
The goal is to provide adequate space for permanent teeth to come in.
Treatment may require a space maintainer to hold space for a primary (baby)
tooth lost too early, or removal of primary teeth that do not come out on
their own so to create room for permanent teeth.
What is interceptive orthodontic treatment?
Interceptive orthodontic treatment is performed for problems that, if
left untreated, could lead to the development of more serious dental
problems over time. The goal is to reduce the severity of a developing
problem and eliminate the cause. The length of later comprehensive
orthodontic treatment may be reduced. Examples of this kind of orthodontic
treatment may include correction of thumb- and finger-sucking habits;
guiding permanent teeth into desired positions through tooth removal or
tooth size adjustment; or gaining or holding space for permanent teeth.
Interceptive orthodontic treatment can take place when patients have primary
teeth or mixed dentition (baby and permanent teeth). A patient may require
more than one phase of interceptive orthodontic treatment.
What is comprehensive orthodontic treatment?
Comprehensive orthodontic treatment is undertaken for problems that
involve alignment of the teeth, how the jaws function and how the top and
bottom teeth fit together. The goal of comprehensive orthodontic treatment
is to correct the identified problem and restore the occlusion (the bite) to
its optimum. Treatment can begin while patients have primary teeth, when
they have a mix of primary and permanent teeth, or when all permanent teeth
are in. Treatment may consist of one or more phases, depending on the
nature of the problem being corrected and the goals for treatment.
Orthodontic care may be coordinated with other types of dental treatment
that may include oral surgery (tooth extractions or jaw surgery),
periodontal (gum) care and restorative (fillings, crowns, bridges, tooth
size enhancement, implants) dental care. When finished with comprehensive
treatment, the patient must wear retainers to keep teeth in their new
positions.
What is a space maintainer?
Baby molar teeth, also known as primary molar teeth, hold needed
space for permanent teeth that will come in later. When a baby molar tooth
is lost, an orthodontic device with a fixed wire is usually put between
teeth to hold the space for the permanent tooth.
Why do baby teeth sometimes need to be
removed?
Removing baby teeth may be necessary to allow severely crowded permanent
teeth to come in at a normal time in a reasonably normal location. If the
teeth are severely crowded, it may be that some unerupted permanent teeth
(usually the canine teeth) will either remain impacted (teeth that should
come in, but do not), or come in to a highly undesirable position. To allow
severely crowded teeth to move on their own into much more desirable
positions, sequential removal of baby teeth and permanent teeth (usually
first premolars) can dramatically improve a severe crowding problem. This
sequential extraction of teeth, called serial extraction, is typically
followed by comprehensive orthodontic treatment after eruption of permanent
teeth has brought about as much improvement as it can on its own.
After all the permanent teeth have come in, the extraction of selected
permanent teeth may be necessary to correct crowding or to make space for
necessary tooth movement to correct a bite problem. Proper extraction of
teeth during orthodontic treatment should leave the patient with both
excellent function and a pleasing look.
How can a child's growth affect orthodontic
treatment?
Orthodontic treatment and a child’s growth can complement each other. A
common orthodontic problem to treat is protrusion of the upper front teeth.
Quite often this problem is due in part to the lower jaw being shorter than
the upper jaw. Upper teeth may also be the primary cause of the protrusion
if they stick out too far. While the upper and lower jaws are growing,
orthodontic appliances can be beneficial in reducing these discrepancies. A
severe jaw growth discrepancy may require orthodontics and corrective
surgery after jaw growth has been completed, although this is rare.
The AAO recommends that all children have a check-up with an orthodontist
no later than age 7 so that growth-related problems may be identified and so
that treatment can be commenced at the appropriate time for each patient.
What kinds of orthodontic appliances are
typically used to reduce the severity of jaw-growth problems?
A process of dentofacial orthopedics (guiding the growth of the face and
jaws) with orthodontic appliances may be used to correct jaw-growth
problems. The decision about when and which appliances to use for this type
of correction is based on each individual patient's problem. Some of the
more common orthopedic appliances include:
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A young patient wearing headgear
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Headgear: This appliance applies pressure to the upper teeth and
upper jaw to guide the direction of upper jaw growth and tooth eruption.
The
headgear may be removed by the patient and is usually worn 10 to 12
hours per day.
- Fixed functional appliance: The appliance is usually fixed (glued)
to the upper and lower molar teeth and may not be removed by the
patient. By holding the lower jaw forward, it reduces the protrusion of
the teeth while the patient is growing and helps bring the teeth
together. The appliance can help correct severe protrusion of the upper
teeth.
- Removable functional appliance: This removable appliance holds the
lower jaw forward and guides eruption of the teeth into a more desirable
bite while helping the upper and lower jaws to grow in proportion to
each other. Patient compliance in wearing this appliance is essential
for successful improvement; the appliance cannot work unless the patient
wears it.
- Palatal Expansion Appliance: A child’s upper jaw may be too narrow
for the upper teeth to fit properly with the lower teeth (a crossbite).
When this occurs, a palatal expansion appliance can be fixed to the
upper back teeth. This appliance can markedly expand the width of the
upper jaw. For some patients, a wider jaw may prevent the need for
extraction of permanent teeth.
Can my child play sports while wearing braces?
Yes. But wearing a protective mouth guard is advised while riding a
bike, skating, or playing any contact sports, whether organized sports or a
neighborhood game. Your orthodontist can recommend a specific mouth guard.
Will braces interfere with playing musical
instruments?
Playing wind or brass instruments, such as the trumpet, will clearly
require some adaptation to braces. With practice and a period of adjustment,
braces typically do not interfere with the playing of musical instruments.
Why does orthodontic treatment time sometimes
last longer than anticipated?
Estimates of treatment time can only be that - estimates. Patients grow at
different rates and will respond in their own ways to orthodontic treatment.
The orthodontist has specific treatment goals in mind, and will usually
continue treatment until these goals are achieved. Patient cooperation,
however, is the single best predictor of staying on time with treatment.
Patients who cooperate by wearing rubber bands, headgear or other needed
appliances as directed, while taking care not to damage appliances, will
most often lead to on-time and excellent treatment results.
What is patient cooperation and how important
is it during orthodontic treatment?
Good “patient cooperation” means that the patient not only follows the
orthodontist’s instructions on wearing appliances as prescribed and tending
to oral hygiene and diet, but is also an active partner in orthodontic
treatment.
Successful orthodontic treatment is a “two-way street” that requires a
consistent, cooperative effort by both the orthodontist and patient. To
successfully complete the treatment plan, the patient must carefully clean
his or her teeth, wear rubber bands, headgear or other appliances as
prescribed by the orthodontist, avoid foods that might damage braces and
keep appointments as scheduled. Damaged appliances can lengthen the
treatment time and may undesirably affect the outcome of treatment. The
teeth and jaws can only move toward their desired positions if the patient
consistently wears the forces to the teeth, such as rubber bands, as
prescribed. Patients who do their part consistently make themselves look
good and their orthodontist look smart.
To keep teeth and gums healthy, regular visits to the family dentist must
continue during orthodontic treatment.
I recently took
my child to an orthodontist for an orthodontic check-up. The orthodontist
recommended treatment. Should I seek a second opinion?
You should review the recommended treatment with your family dentist. If you
would like a second opinion, feel comfortable in arranging for one. You may
have already had more than one orthodontist recommended to you by family,
friends or your dentist. Seeking out a member of the AAO assures that your
second opinion is from an educationally qualified orthodontic specialist.
You should feel confident in the orthodontist and his or her staff, and
trust their ability to provide you with the best possible care.
What is two-phase treatment?
Two-phase treatment simply means that the treatment is carried out in
two stages. The first is the interceptive orthodontic phase (see
above) and the second is the comprehensive orthodontic phase (see above).
Some of my children’s friends have already
started treatment, but our orthodontist says my child should wait a while.
Why is there a difference in treatment?
Each treatment plan is specific for that child and his/her specific
problem. In some cases, children mature early (e.g.: get their
permanent teeth early) and in some cases early treatment is indicated to
prevent a more severe problem from occurring. Your orthodontist is the
best person to decide the most optimum treatment plan. If you have
questions, you should discuss them with your orthodontist.
What do the initials mean after an
orthodontist’s name?
The initials after an orthodontist’s name indicate the academic
education of the orthodontist. For instance, DMD and DDS indicate that
the individual is a graduate dentist. M.S. or MSc indicates that the
individual has achieved a Masters in Science degree, usually associated with
orthodontic training. DipOrtho indicates the individual is an orthodontist.
My child has an allergy to nickel. Can
my child still have orthodontic treatment?
Yes, there are appliances available which are nickel-free.
Please tell your orthodontist if your child has any allergies.
How can I fit the orthodontist’s fee into my
family budget?
Orthodontic costs and payment options can be discussed with your treating
orthodontist. Your orthodontist will be able to provide you with information
about insurance and other possible funding options.
