TIMING OF TREATMENT
Many children will benefit from orthodontic treatment at an early age before all permanent teeth grow into the mouth. Treatment at an early age is usually preventive or interceptive orthodontics. Certain types of problems can be intercepted and corrected when they first start to develop. Early treatment will prevent problems from worsening and becoming fully developed. Fully developed problems can (1) be more difficult to treat, (2) can require longer treatment time to correct and (3) sometimes the treatment results can be limited 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 because there is more potential for change in a growing person. Correcting many 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 approximately 12 to 15 months. Treatment is then stopped, and a person is allowed to continue his growth and development to completion.
Once all the permanent teeth have grown into place, a second or late 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 to 15 months to complete. Overall, a person may have to undergo treatment for two to two and a half years, but the treatment is tailored to the individual’s needs and growth pattern, instead of waiting until the problem is fully developed and growth is completed and then attempting to correct the problem.
Two-phase treatment allows correction of a problem to be completed at an earlier age, many times before high school, with optimum results obtained by taking advantage of the growth potential. Another advantage is that the appliances are less complex.
Problems that can be corrected at an early age include:
- Aligning front teeth that are crowded, crooked or spaced apart.
- Relieving crowded teeth and creating space for the remaining permanent teeth to grow into a proper position.
- Correcting jaw malformation – which causes overbite and underbite (due to deviation in the growth pattern of jaw structure).
- Correcting crossbite.
- Eliminating destructive habits (thumb, finger sucking, etc.).
- Removing extra teeth that may develop early.
Advantages of Early Treatment
- Enhances a child’s self-image considerably through improved appearance (child does not have to grow up feeling unattractive)!
- Intercepts a problem early and prevents a problem from becoming worse.
- Returns jaw relationships to normal at an early age and allows future growth of the jaw structures and the facial muscles to occur in balance and harmony.
- Provides better chewing function at an early age.
- Provides better health of the teeth and gum tissue.
- Promotes normal bone development adjacent to the developing teeth.
- Improves long-term stability of the teeth – teeth stay in place better when straightened early.
- Prevents injury or accidental damage (fracture, chipping) to protruded front teeth due to injury or trauma from accidents.
- Prevents the need for extraction of permanent teeth at a later age in order to correct a problem.
- Prevents 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.
- Can eliminate oral habits – such as finger or thumb sucking.
- Partial braces versus full braces are necessary, making it easier for the patient to wear the appliances.
- Can take advantage of the growth of the face and jaw structures to correct a problem.
Disadvantages of Early Treatment
Child may not be ready to take care of braces – this includes:
- Brushing and cleaning of the teeth.
- Care of appliances by avoiding hard and sticky foods, which loosen braces.
- Wearing removable appliances as necessary to help the teeth move.
If a child is not 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 optimum results.
Many times the question is asked, "If corrected early, will teeth shift as a person grows?"
Usually not. The earlier the teeth are aligned, the more stable they will tend to be. There is also less tendency for future shifting or changes to occur. About 90% of all tooth movement is permanent, and there is a 5% to 10% chance of teeth shifting after treatment, regardless of what age they are corrected. The advantage that early treatment offers is that once teeth are aligned and a person continues to grow, the bone adapts to the new position of the teeth and can provide more stability.