There are some types of orthodontic problems that are best addressed as early as seven years of age. One of the most common types of early treatment is expansion of the upper jaw. This is necessary when the upper jaw, or maxilla, is too narrow to fit well with the lower jaw. At the early childhood ages, this expansion can be accomplished predictably and painlessly. If left unaddressed until adolescence, the maxillary expansion may not be able to be done with a predictable result, or may require surgery to correct.
Other types of early interceptive treatment include correction of crowding, retraction of upper teeth that are too protrusive and may be at increased risk of fracture from trauma, and early correction of disfiguring tooth mal-relationships when they are adversely affecting the patient's developing self-image.
The American Association of Orthodontists recommends an evaluation by age seven. If in doubt as to whether or not your child has an orthodontic problem that may require early treatment, we would be glad to perform a simple examination to determine the nature of the problem. This is a courtesy visit.
The ideal time for most patients to start "braces" is between the ages of 10 and 12. The dental development from patient to patient is extremely variable, and females typically mature dentally about six months ahead of males. This stage of orthodontic treatment may involve not only braces, but also other appliances, such as Pendex appliances to move molars back, Herbst appliances to help correct poor lower jaw relationships, and other adjunctive appliances. Typical treatment times range from 15 to 30 months, depending on the type and severity of the problem.
Facts about Orthodontic Treatment for Growing Children
By age seven, enough permanent teeth have come in and enough jaw growth has occurred that the dentist or orthodontist can identify current problems, anticipate future problems, and alleviate parents' concerns if all seems normal. The first permanent molars and incisors have usually come in by age seven, and crossbites, crowding and developing injury-prone dental protrusions can be evaluated. Any ongoing finger sucking or other oral habits can be assessed at this time also.
Some signs or habits that may indicate the need for an early orthodontic examination are:
early or late loss of baby teeth
difficulty in chewing or biting
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.
An orthodontic screening no later than age seven enables the orthodontist to detect and evaluate problems (if any), advise if treatment will be necessary, and determine the best time for that patient to be treated.
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 early, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth, which will come in later.
Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. Additionally, baby teeth sometimes do not become loose and fall out when they are supposed to. A simple x-ray is used to evaluate if baby teeth are over-retained and may need to be extracted.
Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to the growth of the upper jaw. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective surgery if left untreated until a period of slow or no jaw growth. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys. The AAO recommends that all children have an orthodontic screening no later than age 7 as growth-related problems may be identified at this time.
Correcting jaw-growth problems is done by the process of dentofacial orthopedics. Some of the more common orthopedic appliances used by orthodontists today that help the length of the upper and lower jaws become more compatible include:
Herbst: The Herbst appliance is usually fixed to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward and influencing jaw growth and tooth positions, the Herbst appliance can help correct severe protrusion of the upper teeth.
Bionator: 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 with each other. Patient compliance in wearing this appliance is essential for successful improvement.
Palatal Expansion Appliance: A child's upper jaw may also 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.
The decision about when and which of these or other appliances to use for orthopedic correction is based on each individual patient's problem. Usually one of several appliances can be used effectively to treat a given problem. Patient cooperation and the experience of the treating orthodontist are critical elements in success of dentofacial orthopedic treatment.
For patients who have an underdeveloped lower jaw, it is important to begin orthodontic treatment several years before the lower jaw ceases to grow. One method of correcting an underdeveloped jaw uses an orthodontic appliance that repositions the lower jaw. These appliances influence the jaw muscles to work in a way that may improve forward development of the lower jaw. There are many appliances used by orthodontists today to treat underdeveloped lower jaws – such as the Frankel, Activator, Twin Block, Bionator, MARA and Herbst appliances. Some are fixed (cemented to the teeth) and some are removable. You and your orthodontist can discuss which appliance is best for your child.
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.
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 or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.
After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements will last for a lifetime.
Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout life for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can prevent maturational shifting of the teeth.
In about three out of four cases where teeth have not been removed during orthodontic treatment, there are good reasons to have the wisdom teeth removed, usually when a person reaches his or her mid- to late-teen years. Careful studies have shown, however, that wisdom teeth do not cause or contribute to the progressive crowding of lower incisor teeth that can develop in the late teen years and beyond. Your orthodontist, in consultation with your family dentist, can determine what is right for you.