by Jeff Serff, DMD
Q: My daughter has friends
with braces, and their permanent
teeth haven’t finished
coming in yet. Is it
better to wait?
A: Even though most people think of pre-teens and teens when they think of orthodontics, there are good reasons your child should get an orthodontic evaluation much sooner.
Because monitoring growth and development is crucial to managing some orthodontic problems, the American Association of Orthodontists recommends a check-up with an orthodontic specialist no later than age 7. Waiting until all the permanent teeth have come in, or until facial growth is nearly complete, may make correction of some problems more difficult.
Two-phase orthodontic treatment consists of two separate times when a child receives orthodontic treatment. A first phase of treatment may be needed while the child still has many of their primary teeth or “baby teeth.” A second phase takes place when the child has most or all of his permanent teeth.
Early treatment may prevent or intercept more serious problems from developing and make treatment at a later age shorter and less complicated. In some cases, the orthodontist will be able to achieve results that may not be possible once the face and jaws have finished growth. A first phase of treatment is commonly utilized to guide jaw growth, correct harmful oral habits, guide the permanent teeth into a more favorable position, treat crossbites of front or back teeth, alleviate crowding and correct excess spacing.
By timing orthodontic treatment to predictable stages of dental development, the orthodontist may be able to take advantage of your child’s growth. Some problems that can be treated quite well in a growing child may require corrective surgery if treated after growth has occurred.
In our office, we see children at age 7 and often place them on a growth and development recall, where they are seen every six months to a year to evaluate the eruption of the permanent teeth. If needed, the first phase of orthodontic care is limited to between 8 to 12 months, and the braces are removed for further development of the dentition.
Orthodontic cases in which an expander is used to widen the upper jaw are often started before the loss of all the primary teeth. This is done early because the ability to expand the upper jaw diminishes as the patient nears maturity. Also, the expander makes additional room in the arch for permanent teeth to erupt. Some cases, such as deep bites, are better treated by waiting until all the permanent teeth are in place—even the lower second molars, which erupt behind the first molars.
Orthodontic care is not a “one size fits all” approach. Each patient has a unique problem that requires a unique treatment plan. The diagnosis of your child’s problem and the treatment plan are the result of study of your child’s mouth and diagnostic records—such as x-rays and tooth models.
Dr. Serff is an orthodontist in private practice in Columbus. He is a 1990 graduate of Brookstone School, a 1994 graduate of the University of Georgia and a 2000 graduate of the Medical College of Georgia, School of Dentistry with residencies in both Hospital Dentistry and Orthodontics.
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