Orthodontics – When and why

Written by Dr Etienne Pitout, Orthodontist

When should my child have their first appointment with the braces doctor?

Parents are often concerned that they may have waited too long to visit the orthodontist. Fortunately this is not often the case. We are all very used to teenaged kids going through the mandatory right of passage with “train tracks” braces on their teeth. There are many reasons for this: one being simply that it is socially and culturally acceptable, and our teenagers start asking for braces.

For the orthodontist the teenage years offers a “sweet spot” in terms of treatment timing. The heightened growth and physical change that the human body goes through at this time often makes orthodontic treatment easier. During orthodontic treatment we don’t only want to move teeth. We also want to improve our patients facial growth, leading to more beautiful smiles and faces. Teeth can move at any age, but changing faces simply works better when your patient is growing faster.

That being said: there can also be other stages in life where orthodontic treatment may be a very good idea.

Take a Panoramic radiograph between the ages of six and eight.

I always suggest to parents to ask their dentist to take a panoramic radiograph for their children between the age of six and eight. This is a special kind of x-ray that can help the orthodontist see and evaluate the development of all the permanent teeth. It is possible at this stage to see missing or misshapen adult teeth, extra teeth, and many other abnormalities of tooth development or position. The finding of tooth abnormalities will not necessarily mean orthodontic treatment will start immediately, but it definitely helps to plan the road ahead and get started with treatment at the ideal time.

Early treatment. Between the ages of 6 and 10.

In some situations it is a good idea to start orthodontic treatment as young as 6 years of age. We refer to this as early treatment. This is treatment that is focused on correcting a specific problem. The treatment is usually shorter than full orthodontic treatment, but quite often a second phase of orthodontic treatment may be needed at a later stage as all the adult teeth will not be erupted and cannot yet be straightened. The early treatment should, however make later orthodontic treatment simpler and possibly shorter.

The reason that we will suggest treating a patient early and possibly again later is that there is a specific problem that we can identify that will become progressively worse as the patient grows. Some of the results that we are hoping for when we correct or eliminate this specific problem early are: simpler orthodontic treatment later, more balanced growth of the young patient’s face and less damage to the young patients developing teeth.

Some clear indications for orthodontic treatment at an early age are:

Cross-bite of the front or back teeth.

Because cross-bites lead to abnormal chewing it can cause damage to your child’s teeth. It also can lead to abnormal or asymmetrical growth of the lower jaw. When this occurs it can be really tricky to treat in a teenage or adult patient. Correcting a cross-bite as soon as possible is definitely a good idea.

Habits that can be harmful to the teeth: like lip wedging, tong thrusting or thumb sucking.

The presence of a harmful habit will progressively make the position of the teeth worse. The early treatment in this case will focus on eliminating the harmful habit. Often the position of the teeth will then improve passively and the improvement will remain as long as the harmful habit does not return.

Severely protrusive teeth and increased overjet.

Protrusive teeth are often an aesthetic concern. These are not often the patients that wait too long to consult the orthodontist as the main concern is usually being teased by other kids. Another important factor is tooth damage. The protruded teeth are at a higher risk of being damaged while playing or taking part in sport or just during life in general. Correcting the overjet early and making sure the teeth are not so protrusive is often a good idea.

The “sweet spot” from 10 to 16 years of age.

This is the time when most orthodontic treatment is performed. Our patient is growing quickly and has their full set of adult teeth. Braces has become very fashionable and society almost expects all teenagers to wear braces these days.

But every patient is different. Some need to start treatment at 10 and for others at 16 and knowing into which group your child falls is not always simple to figure out. Your dentist’s advice is vital here. Your family dentist knows you and your kids. He or she sees them grow up and should be able to treat or refer them at the best possible time. A good rule of thumb is to visit the orthodontist as soon as you realise that your child has started their growth spurt. Your friendly orthodontist can do a check-up  and advise you regarding the optimal time to start orthodontics in order to have the most effective and successful treatment.

Adult orthodontics. From 20 to 102.

More and more patients are opting to have orthodontic treatment as adults. There are various reasons for this. Some patients didn’t have the opportunity to have orthodontic treatment as a child or teenager. More often than not the reason for visiting the orthodontist is related to the lower front teeth moving and becoming more crowded. This happens to patients who have had orthodontic treatment as teenagers and also to patients who never had orthodontic treatment and have had perfectly straight teeth for most of their life.

Teeth can move and be moved throughout life and this process only stops when you breathe your last. Teeth don’t move all the time due to the fact that they are in a position of balance between the pressure exerted by the tongue on the inside and the lips and cheeks on the outside. A change in the pressure exerted by either the cheeks or tongue will lead to changes in tooth position, and there are two predictable stages in life when this happens.

During the mid to late twenties there is no more growth of the upper or lower jaws, but our faces mature and change, and part of this change affects what the lips and tongue do, and the teeth react.

After forty the face changes once more, and once more the teeth react. It is no longer strange to meet someone over forty, or even over sixty undergoing orthodontic treatment, and with life expectancy steadily increasing, why not? Those teeth may have more than forty years of service still to perform.

There are many other instances where adult orthodontics may be advisable. Often this will be a suggestion by your family dentist where the position of teeth is leading to excessive tooth wear or damage, or where the position of teeth makes it impossible to place beautiful and lasting restorations.

In short orthodontics is not only appropriate for teenagers and there are many times during the course of a life that orthodontic treatment may be a really good idea. Orthodontics is not only for beautiful straight teeth, but also teeth that last longer because they are positioned better.

Fortunately orthodontics is a very exciting developing field at the moment and orthodontic treatment does not mean “train track” braces for everyone any more. There are more options that may fit your unique situation and life stage. Ask your dentist or orthodontist today.

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