Often parents are concerned about the growing dentition of their child. Most feel that their child's teeth should be aligned with braces at the right time so that he/she is in best of the dental health and with nice and confident smile. They also are well aware that straight teeth and an attractive smile can do wonders to their child's career and life goals. Out of their genuine concern comes the question to their dentist - When should we put braces for my child? The child that time could be around 8 years with a developing crossbite.
SCENE 1
Not so well informed dentist could give a well practised answer - wait till all his milk teeth fall off......
The father or mother happily are relaxed and wait till all his milk teeth fall off... The child is 12 - 13 years now... They go back to the dentist and ask - now is it time ? We see that his teeth are more crooked than they were when he was 8 years, his lower jaw is growing more than his U jaw, he has developed face asymmetry. The dentist now calls a Visiting Orthodontist to his clinic who comes in with a small bag with some instruments. He has just finished checking up/ changing wires of 10 other patients with same set of instruments within last 30 min. ( avg. 3 min per patient). He hurriedly looks at the teeth of the child and tells the dentist, "We will extract 4 premolars. I will put brackets today and will give wires next month when I come." So, the child has 4 braces on his incisors and undergoes 4 premolar extraction and waits for a month when the orthodontist is back in his dentist's clinic. The orthodontist puts a wire and starts pulling his teeth back with elastics. This goes on for several months, 2 years are over now... The child is 15 years... tired of having braces... still not happy with the results... The dentist says that now the braces will be removed.... The mother is still concerned about teeth which look too far inside. The crossbite is still there. The child has bite problems which is causing T M joint pain while chewing. The dentist says... now teeth look good and the child is sent off with retainers... He has developed white spots on teeth and few cavities which require urgent attention.... The parents think .... WHY DID WE DO BRACES???
SCENE 2
The parents took the child to an Orthodontic clinic which was well equipped and catered to only braces treatment of children and adults. The orthodontist was well informed. After examining the child, he said that the child has a dental crossbite and a mild functional shift of mandible. He suggested immediate intervention at the age 8 to correct the crossbite and functional jaw shift. To evaluate the case, the orthodontist took study models, few x rays and dental and facial photographs of the child. He studied the plaster records, x rays and photographs and chalked out the right treatment plan for the child. The treatment plan was discussed with the parents at treatment conference appointment. All the queries of the parents were answered. The next appointment the PHASE 1 orthodontic treatment was started with braces to correct crossbites and functional jaw shifts. This continued for few months till all Phase 1 objectives were achieved. Already the child was looking better and had a better teeth alignment and smile. The Phase 1 braces were removed. Then the Orthodontist kept the child under observation till all his milk teeth were shed and permanent teeth erupted. As the permanent teeth were in mouth, few new teeth required some straightening , therefore braces were put again at age 12 to carry out Phase 2 treatment after studying the new set of records. The phase 2 continued for another year or so. Timely flouride applications were done and oral hygiene monitored throughout this period. Then the orthodontist took some prefinishing x rays and carried out few final corrections. And a month or two later, the braces were removed.
The mother could not stop complimenting the child'd healthy and attractive smile. He looked so handsome. The father was excited too with the realization that all the efforts his child put have reaped tremendous benefits with a more attractive face and a confident smile his child had...
Above 2 scenarios are not fictitious, but a very realistic ones which so many of us face in routine life. Getting the right advice about the need for braces from a good orthodontist is most important rather than depending on your dentist's evaluation of your child.
As far as the right age for braces is concerned following points should be considered -
1) All mouth habits such as thumb sucking, lip biting, nail biting, mouth breathing should be corrected as soon as they are detected. Good rule of thumb to follow is - correct habits before first permanent tooth erupts in mouth
2) Certain problems such as adenoids and tonsils can alter a child's facial growth significantly and hence should be rectified conservatively / surgically as soon as these are detected
3) Narrow arches which need palate expansion should be treated as early as 8-9 years of age
4) Skeletal problems such as small lower jaw should be treated early at 9-10 years of age
5) Mild to moderate teeth alignment problems can wait till the age 11 when comprehensive orthodontic treatment should be started
6) Moderate to severe teeth alignment should be started as early as age 9 to give maximum utilization of child's growth potential to expand dental arches
7) Certain cases like cleft lip and palate require multi disciplinary help from Orthodontist, pedodontist, plastic surgeon, speech therapist etc. and involves step wise treatment right from birth to 18 - 20 years of age.
8) Age is not a bar for orthodontic treatment. Your teeth and jaws can be set right at any age. Adult orthodontic treatment even though is possible, has some limitations, is slightly difficult to carry out and may require surgical intervention along with braces.
A good orthodontist knows his worth. He may be more expensive. He puts lot of effort in diagnosing and planning your case in correct way. He has skill sets to execute an ideal treatment plan with right orthodontic appliances and accessories. He uses quality orthodontic appliances which are costly. He is always working towards giving you the best possible and stable orthodontic result which is esthetically and functionally excellent. Orthodontics is a very exacting science. When done in the right way, it gives most satisfying outcomes which many a times are considered dramatic and miraculous.
Find a good orthodontist for yourselves or for your child... After all your smile and your face is your future.... for the right future get the right smile... for the right smile, get the right orthodontist !!!