Children
Orthodontics ? (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
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.
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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:
•
A young patient wearing headgear
• 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.
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
and the second is the comprehensive orthodontic phase.
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.
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