Orthodontics

What is early orthodontic intervention/treatment?

In certain instances, children as young as 5 or 6 years of age, can benefit from an orthodontic evaluation.  Although not very common, some individuals can benefit from early intervention to avoid more severe issues later on.

By 7-8 years of age, most children are in the mixed dentition, with several permanent teeth (1st molars and incisors) and several primary (baby) teeth.  At this stage, they may present with various orthodontic conditions, including dental crowding, excessive spacing, flared teeth, extra or missing teeth, and quite commonly, jaw problems.  Many of these findings are inherited while others are acquired due to a prolonged habit or medical condition, such as thumb or finger-sucking, mouth breathing, dental disease (cavities), abnormal swallowing, poor dental hygiene, the early or late loss of baby teeth, accidents or poor nutrition.  In certain cases, an inherited malocclusion can be complicated by an acquired problem.

For these reasons, the American Association of Orthodontists (AAO) recommends that all children visit an orthodontist no later than age 7 for a thorough evaluation.  While it may seem to you that your child's teeth are straight, there can be an underlying problem requiring an expert (orthodontist) to diagnose.  Fortunately, for most kids, the initial exam reveals a normal developing dentition, requiring only intermittent follow-up by Dr. Y.  If there is a malocclusion, Dr. Y will review the findings with you and your child, present the various treatment options, including the optimal timing for intervention, always trying to address the issue in the most non-invasive and straight-forward manner.  For those patients who present with clear need for early orthodontic intervention, early treatment gives Dr. Y 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
  

Since it is not always easy for parents to ascertain whether their child has an orthodontic problem, the following is a list of possible signs or habits that may indicate a need for an orthodontic evaluation:

• 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 findings are observed by parents, regardless of the child's age, it is recommended to consult Dr. Y.  It is not always necessary to wait until age 7 for an orthodontic evaluation.

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How can the orthodontist reduce the severity of jaw-growth problems?

Dentofacial orthopedics is the treatment of jaw-growth problems by guiding the growth in a more favorable direction.  The decision as to which appliance is necessary for each child is dependent on their age, dental development, cooperation level and severity of the malocclusion.  Some of the more common appliances include:

• Headgear: This appliance applies pressure to the upper teeth and jaw to alter the direction of upper jaw growth and tooth eruption.  The restriction of the vertical and forward growth of the upper jaw also allow the lower jaw the rotate counter-clockwise and come forward.  For an efficient and successful outcome, the headgear is usually worn for 12 hours per day.  The more time it is worn, the faster and greater the effect. 
  
• Fixed functional appliances: This group of appliances address similar problems as does the headgear but with a different approach.  The fixed functional appliance is cemented onto the dentition and cannot be removed by the orthodontist.  It achieves its goal by pushing back on the upper teeth and jaw, while pushing forward on the lower jaw and teeth.  The appliance is traditionally worn for 8-9 months in conjunction with upper and lower braces. 
  
• Removable functional appliances: This group of appliances addresses certain jaw discrepancies in a similar manner to the fixed functional appliances, yet does not require cementation and can be removed by the child.  These appliances are usually used earlier on, prior to the eruption of all the permanent dentition (7-9 years of age).  The removable functional appliances is retained on the teeth much like traditional retainers are, with metal clasps and springs.  They position the lower jaw forward using the upper jaw as the anchor, and therefore present with similar effects seen with the fixed functional appliances.  For ideal results, these appliances should be worn 24/7, except for meals, oral hygiene and physical activity or sports. 
  
• Palatal Expansion Appliances: In many cases, a child's bite or alignment problems arise from a constricted upper or lower arch.  For the upper arch, the most common treatment is expansion.  Palatal or maxillary expanders can also be removable or fixed.  For a greater skeletal effect of the expansion as opposed to dental changes, the fixed appliance is used.  For more mild situations a removable appliance can be used.  Using these appliances in many instances prevents the need for extraction of the permanent teeth.  

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Can my child play sports while in orthodontic treatment?

Absolutely, but wearing a mouth guard is recommended while

biking, skating, skate-boarding or playing any contact sports.  You can consult Dr. Y as to the types of mouth guards available.

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Do braces interfere while playing musical instruments?

With a bit of practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments, even wind and brass instruments. 

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Why does the treatment duration alter?

Estimates of the treatment duration are just that, an estimate.  Treatment length is dependent on various factors, such as patient compliance with appointments and appliances, patient oral hygiene, individual growth patterns.  The single most valuable predictor as to the timing of treatment is patient cooperation, which includes wearing rubber bands, headgear and other necessary appliances as directed.  Adhering to the proper care instructions of your teeth and appliances during treatment ensures a successful and timely end result.

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Why is patient cooperation so important?

Patient cooperation can greatly influence the quality and timing of orthodontic treatment.  It includes cooperation with good oral hygiene practices, proper wear of rubber bands, headgear and other appliances as requested by Dr. Y.  Damage to appliances secondary to poor diet and oral habits results in multiple emergency appointments and prolonged treatment time. 

To maintain an ideal oral environment, regular dental hygiene visits are required throughout the duration of the orthodontic treatment.

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What do they mean by two-phase treatment?

Two-phase treatment simply means that the orthodontic treatment is split into two stages, an early and a late phase.  Generally, early treatment addresses the more severe aspect of the problem and the second phase concentrates on detailing the occlusion and the esthetics.  In certain cases, growth can help and in some hinder the progression of the first phase.  Therefore, Dr. Y is very careful with his approach to two-phase treatment, in an attempt to ensure that children receive the care that is needed at the right time.

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Why do some children start early yet others are told to wait?

Since each child presents with a unique set of problems, it makes perfect sense that the approach to each child cannot be the same.  Certain orthodontic problems greatly benefit from early intervention while others can be treated in a single late phase with the same final result.

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