Wednesday, May 16, 2012

When Should I Bring My Child In For An Orthodontic Consultation? By trumanorthodontics on 2/20/2012 11:21 AM

One of the most common questions that people ask me is: When should my son or daughter get braces?
One of the most common questions that people ask me is:  When should my son or daughter get braces?  This question has several variations which include:  Why are people getting braces so young now days? or Didn't people used to get braces when they were in middle school?

No matter how it is phrased, what parents really want to know is why some people are getting braces in 2nd or 3rd grade and others are getting their braces in 7th or 8th grade.  Naturally, they also want to know in which of these groups their child belongs.

In order to understand the answer to that question, it is first important to understand something about dental development.  Most children begin losing their front teeth at about 6 years of age.  By 8 or 9 years old, eight permanent front (incisor) teeth have replaced the front baby teeth.  At the same time, four new permanent molars are growing in behind the back baby molars.  So at about 8 or 9 years old, a child usually has twelve permanent teeth and twelve baby teeth in the mouth at the same time.  In dentistry this is called "the mixed dentition" because there is a mix of permanent and baby teeth.

This x-ray shows permanent teeth (which have no tooth buds underneath) as well as baby teeth (which have the buds of permanent teeth underneath them)
At this point, there is typically a window of 2-3 years before the child will lose anymore baby teeth.

It is also at this time that problems of crowding and misalignment of the front teeth become apparent because the size of the permanent teeth is so much larger than the teeth that they replace.  Children who did not have spaces between their baby teeth will develop crowding of the front teeth simply because the permanent teeth are so much bigger.  Because of the development of these and other problems as the new teeth grow in, it is the time when "early intervention" or "phase I treatment"  is usually performed.  Because only half of the permanent teeth have grown in, only partial orthodontic treatment can be rendered at this stage.  It therefore becomes necessary to complete the treatment with a second stage of braces that is worn after the growth of the remaining teeth at approximately the age of 12 or 13. 

While certain children benefit from early intervention as described above, the majority can wait for the eruption of all of the permanent teeth before beginning orthodontic treatment which can be accomplished in a single stage. I recommend two-phase orthodontics for two reasons:

     1.     A better end result can be achieved by intervening early
     2.    Patients and their parents have cosmetic concerns that are affecting the self-esteem of the child. (For example: an 8-year old child is being made fun of at school and does not want to wait 4 more years to begin correcting the problem)

Those children who come to the office in the mixed dentition stage of development who do not meet the criteria above are placed in our observation program. Their parents are re-assured that everything will work out fine and treatment will be more efficient if it is done at a later time. Parents really appreciate the opportunity to discuss their child’s specific situation and understand the course for the future. That is why we like to see children for the first time when the top front teeth start to grow in. Periodic imaging of the developing teeth will be done at follow-up appointments so that treatment can begin at the most efficient time.