Timing of Treatment for the Growing Child
Seeing the growing patient at the proper age and dental development can be very important in providing the best orthodontic care. We commonly first see patients by age 8 to anticipate further needs, follow development, and check for the few but important problems that should be treated early.
For almost every child, we would like to do a thorough evaluation before the patient begins their pubertal growth spurt. This means seeing girls by about age 10-10 ½ and boys by age 12. Waiting for eruption of all the permanent teeth before orthodontic evaluation can create significantly greater treatment problems.
Generally, problems involving jaw growth corrections, gaining space for crowded teeth, or guiding impacted teeth should be assessed in the beginning stages of rapid growth (girls by 10 ½, boys by 12). Early evaluation helps determine the best time for each child.
Many orthodontic problems, however, can be treated just as well later in adolescence and into adulthood.
Some children will benefit from limited orthodontic treatment before all permanent teeth grow into the mouth. A few problems can be intercepted and corrected when they first start to develop. Early treatment can prevent some problems from worsening and becoming fully developed. Fully developed problems can (1) be more difficult to treat, (2) require longer treatment time to correct and (3) sometimes limit the treatment results if the problem is allowed to become fully developed before being corrected.
More orthodontic correction is possible in a growing person than in a non-growing person as there is more potential for change in a growing person. Correcting some problems early allows the teeth, jaw structures and surrounding facial structures (lips, cheeks, etc.) to grow in balance and harmony, instead of growing further out of balance.
Treatment started at an early age takes place in two phases. An early phase to intercept and correct a developing problem may take 3 to15 months. Treatment is then stopped, and the patient continues his or her growth and development until finishing treatment is indicated.
A second or finishing phase of treatment is usually necessary in order to complete the correction and finalize the alignment of the teeth and bite relationship (the contact of top and bottom teeth while chewing and biting). The second phase of treatment may take 9-24 months to complete. Overall, the patient may have to undergo treatment for two to two and a half years, but treatment is tailored to the individual’s needs and growth pattern.
Problems that can be corrected at an early age include:
- Aligning front teeth that create significant social problems.
- Realigning crowded teeth and creating space for the remaining permanent teeth to grow into a proper position.
- Correcting jaw growth problems which cause overbite and underbite (due to deviation in the growth pattern of jaw structure).
- Correcting crossbite.
- Eliminating disruptive habits (thumb, finger sucking, etc.).
- Removing extra teeth that may develop early.
- Reducing severe protrusion if upper incisor teeth are prone to injury or creating social problems for the patient.
Early Treatment may:
- Enhance a child’s self-image considerably through improved appearance (child does not have to grow up feeling unattractive).
- Intercept a problem early and prevent a problem from becoming worse.
- Prevent injury or accidental damage (fracture, chipping) to protruded front teeth due to injury or trauma from accidents.
- Prevent impaction of permanent teeth by creating space for these teeth to grow into the mouth. If crowded teeth do not have room to erupt, they can become impacted in the bone structure of the jaw.
- Eliminate oral habits such as finger or thumb sucking.
- Take advantage of the growth of the face and jaw structures to correct a problem.
Disadvantages of Early Treatment
A child may not be ready to take care of braces and help by:
- Brushing and cleaning teeth well.
- Caring for appliances by avoiding hard and sticky foods, which loosen braces.
- Wearing removable appliances if needed to help the teeth move.
If a child is neither ready nor willing to take care of teeth and braces, it is best to delay the start of treatment as treatment will take longer and it may not be possible to gain optimal results. The success of ANY orthodontic treatment depends on reasonable patient cooperation.