ORTHODONTICS........for
Children
Orthodontic
treatment for children
Orthodontic treatment for children?
(Through age 12)
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 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 your 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.
Frequently asked questions
about childhood orthodontic treatment:
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:
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.
COSMETIC DENTISTRY - ORTHODONTICS
