ORTHODONTIC UPDATE OCTOBER 2009

RICHARD CY SHIN, DDS MS
DIPLOMATE, AMERICAN BOARD OF ORTHODONTICS

One of the most common questions that I get from the parents is “Doctor, when is the best time to start braces for my child?” I am sure that if either of the parents have had orthodontic treatment in the past, he or she would certainly want to make sure that the child is checked to see if they need orthodontic treatment or not.
Many parents are already confused by the mixed messages they received from many sources regarding the best time to start orthodontic treatment.
Is it best to start treatment when just a few of the permanent teeth have erupted (usually between 7 – 10 years)?
Or, when all of the permanent teeth have erupted (usually around 12-13 years)?
Or, is it best to start in primary “baby” teeth (before any of the permanent teeth erupt, i.e. under 6 years)?
The answer is there is not one best time for every child! Each child presents with a unique problem and therefore each child will need a specialized treatment plan beneficial to him or her.
The American Association of Orthodontists recommends that all children have an orthodontic check-up no later than 7 years. Most children, by 7 years, would have reached key landmarks such as: 1) eruption of the front permanent teeth, 2) eruption of the back permanent teeth “six-year-old molars”.
The orthodontists can identify any key problems with the relationship of these permanent teeth and recommend either to start an Early Phase treatment. This is sometimes called Phase 1 treatment or Interceptive treatment. The goal of the treatment is to improve any dental problems that these permanent teeth might pose to the future growth and development of the developing permanent teeth and the jaws. Usually, the magnitude of the problem will be reduced and in some cases eliminated and greatly help in the Comprehensive orthodontic treatment stage when all of the primary teeth have been lost.
Here are some of the common examples of the malocclusions (“bad bites”) that I see in children in this clinic.
ANTERIOR CROSSBITE
Here you can see that one (often more) front tooth is coming out in front its counterpart on the top. This can be particularly damaging to the health of the gums of the teeth in crossbite, as well as to the bite.