Early Treatment??
I have some strong feelings about “early treatment” or “phase 1 treatment”. I have researched the topic extensively, and I have also taken part in a 2-week International Symposium on Early Treatment. And guess what? There are WAY too many young kids running around in braces! Most will have to wear them again as teens (that’s why it’s called “phase 1” … because they will still need to do “phase 2” in a couple years).
And what bothers me about the over-abundance of early treatment is that it isn’t helping anyone. Parents end up paying more money. Kids end up in braces a lot longer (they get to wear them twice instead of just once). And the child’s teeth are at a much higher risk of being permanently damaged, since the oral hygiene of a 9 year old is usually marginal at best. Yet parents are made to feel like they are neglecting their child if they don’t have them in braces by the third grade! It’s crazy!
So what’s a parent to do? How do they know if their child really needs braces early, or if they are just being talked into something unnecessary? Here’s some good rules of thumb that I use:
Problems that DO require early treatment:
1) Anterior crossbites (upper front teeth that bite behind the lower front teeth) = If not corrected, excessive gingival recession will occur on the front surface of the lower teeth, and chipping of the teeth can occur.
2) Unilateral posterior crossbites (the upper back teeth on one side bite inside the lower teeth, but not on the other side) = If left untreated, the mandible (lower jaw) can grow asymmetrically, and asymmetry is bad!
Problems that DO NOT require early treatment:
1) Crowding = Crowding can be corrected just as easily in a single phase of treatment as a teenager. Treating crowding early in the name of “making phase 2 easier” or “to avoid extracting teeth later” isn’t backed up by the research. Unless the child is really bothered by the appearance (social issues relating to the appearance of the teeth), let it go until they get all the permanent teeth in.
2) Bilateral posterior crossbite = Since the lower jaw isnt’ shifting to either side (like the above scenario of a unilateral crossbite), this problem can wait until comprehensive treatment begins as a teen.
3) Overjet (excess “overbite” where the top teeth are out in front of the lower teeth) = Early treatment leads to no improvement in final outcome vs. waiting and correcting the protrusion in a single comprehensive phase of treatment as a teen. The only exception to this is if the upper front teeth are “in harm’s way” and the child is at a high risk of traumatizing the upper front teeth due to an active / injury-prone lifestyle. In that case, we might consider treating early just to minimize the chance of injuring those teeth. Otherwise, the child is much better off waiting.
I hope these rules of thumb help you determine what can and can’t wait when it comes to your child’s teeth. But it’s always best to have a consultation from an orthodontist you trust, who can talk to you about the specifics of your situation.
Let me know if you have any questions about early treatment (you can post in the comments section below) or if I can be of assistance to you in any way! Thanks!
–Dr. Wyatt
10 Responses to “Early Treatment??”
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I had braces as a teenager for 4 years after having 4 teeth pulled to create some room. I fell asleep at the wheel when I was 17 a few months after having my braces removed crashing into a tree and shifting my teeth around from smashing my face on the steering wheel. My question is… I am now 30 years old and would like to get my teeth straightened again. Is it ok as a 30 year old to get braces? Is there a chance of complications with me being older?
Hey Chris! Sorry about the face-smashing incident! OUCH!! It sounds from your description like you didn’t lose any teeth though. Just knocked them around a little? If that’s the case, and if you would like to get braces to realign things, there should be no complications from that. Your bone will be more dense than a teenagers, so the teeth may not move quite as fast, but the biology and physiology is the same, so it works just as well!
Hope that helps!
Thank you Dr. Wyatt! I did not lose any teeth just broke my cheek bone and orbital bone and shifted my teeth around a bit and over time they shifted more. Thanks that really helps!
U might want to consider an endodontic consultation prior to any ortho because with a history of trauma teeth can lose their vitality and thus become infected. Some traumatized teeth have various patterns or resorption or even become fused into tge jaw. All of these variables need to be appropriately addressed before ortho can be successful
Yes, Dr. Kent is right! But most orthodontists worth their salt will catch those problems from a records workup (x-rays, pictures, and models of the teeth) and refer you to an endodontist (root canal specialist) if necessary before attempting to move the teeth.
Dr. Wyatt,
My 11 year old daughter just left our dentist office from a cleaning. We were told that we will need to see an orthodontist to discuss braces. Her canines are coming in crooked. Her top front teeth do jut out quite a bit, but I’m not sure 11 or 12 is old enough for braces. At the same time, I don’t want to wait incase the problems worsen. Based on this information, should we consult with an orothodontist? Thank you for your time.
Hi Adonia! 11 or 12 is probably getting close to the age where braces are ideal (assuming your daughter ends up needing them). If you’d like to come in for a free exam and consultation, just give our office a call at 918-496-1155 and we can visit with you about what (if anything) you daughter needs, and when the timing would be right to start. You don’t want to start if she still has lots of baby teeth, but many 11 and 12 year olds are already done (or almost done) losing baby teeth … which makes them ready for braces!
We were told by the dentist that my six year old is missing his permanent laterals and we will have to eventually get a bridge or partials or implants for him when he is about 12 or 13. Is there any other options?
Hey Cindy, yes there is one other option (besides replacing the missing teeth). That other option would be orthodontically moving the other upper teeth forward into those positions and reshaping them (his canines would be forward in the lateral incisor position, his premolars would be forward in the canine position, and so on). With that solution, there is no need for replacement teeth, but it isn’t always the ideal solution depending on his bite and skeletal structure.