Questions and Answers About Orthodontics for Children and Teens

This is the area of Dentistry that deals with helping to guide the development of children as their adult teeth come in and their facial and jaw bones grow. Most commonly, orthodontic treatment is simply known as BRACES. Utilizing various forms of appliances including braces, we have the ability to move individual teeth within the jawbones, and to influence the amount and direction that the facial and jaw bones grow and develop. Some appliances are designed to just move teeth, some are designed to influence growth of the jawbones in certain directions, and some appliances can do both at the same time.

The size and shapes of the teeth and the jawbones are determined by genetics. Because of a difference between size of the adult teeth and the size of the child's jawbones, teeth often do not grow in straight or in the right spots. Just look at the pictures below for typical examples. Evenly arranged and properly positioned teeth are necessary for proper speech development, chewing/digestion/nutrition, oral hygiene, and of course, self-esteem.

The American Association of Orthodontists recommends that children have an orthodontic screening no later than age 7.

There are many benefits to early detection and treatment, including:

• ability to influence jaw growth in a positive manner
• ability to harmonize width of dental arches
• better pattern and sequence of arrival of adult teeth through preservation or increases in space
• correction of harmful oral habits, (i.e. thumb-sucking)
• improvement in esthetics and self-esteem
• improvement of some speech problems
• simplifying or shortening treatments at later ages

By the age of seven, the first permanent (six year) molars and incisors (front teeth) should be in the mouth.
At this time the Dentist may be able to assess the relationship of the teeth in terms of crowding, over bite, cross-bites, rotations, and facial assymetries.

Intervention for and treatment of potential orthodontic problems at younger ages allows for greater flexibility in treatment options and greater control of overall dental and facial development.

For each patient who needs treatment, there is an ideal time for it to begin in order to achieve the best results - hence, the 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.

Below are some photos and descriptions of situations that may warrant early interceptive treatments.

This is difficult to answer, because every case has it's own unique needs. Simple treatments may take only a few months, while more complex ones may take a couple of years. Treatment may be done in phases (with different types of appliances) when starting with children at a younger age. There is always a period of retention after active treatment, so that the teeth may become stabilized and firm in their new positions.

There are many different types of appliances that may be used, the selection of which depends on the type and goal of the treatment (teeth and/or jaw related), and the age and cooperation of the patient. Appliances may be removable or fixed (not movable by the patient) and may be inside the mouth completely or may also involve an external headgear. Comprehensive orthodontic treatment often involves use of much more than just the traditional "braces".

Pressure and tension applied to the teeth by means of the orthodontic wires or elastics are passed on to the thin ligament around the tooth and the surrounding bone. In simple terms, on the side of the tooth where "pushing" is felt , bone is slowly eroded ; on the side of the tooth where "pulling" is felt, new bone is laid down. This process is carried on in all three dimensions so that teeth can be moved up or down, outwards or backwards, or sideways.

Once active treatment has been completed, the teeth can shift out of position if they are not stabilized. Retainers are used to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. There are removable retainers that can be worn part of the time (ie. at night), and there are fixed retainers that permanently hold the teeth in place. Most commonly, a fixed retainer is used on the inside of the lower front teeth because these have the greatest tendency for change (relapse).