Last fall I received many questions in my office regarding early interceptive orthodontic treatment. Two articles about this type of orthodontic treatment prompted these inquiries. The Wall Street Journal published an article titled “The 8-Year-Old With a Perfect Smile” by Nancy Keates, a journalist and mother of an 8-year-old orthodontic patient. It chronicles a parent’s decision for their child to have braces at a young age and before all of their permanent teeth had erupted. “Braces For Young Kids Might Not Always Be Best” by Allison Aubrey was broadcast on NPR. These articles provided some interesting facts and also made me cringe. I have been thinking a long time about starting a blog and this was now the straw that broke the camel’s back.
Let me dispel the mystery around early orthodontic treatment. Early interceptive orthodontic treatment refers to treatment that takes place before all permanent teeth have erupted. The goals of this type of treatment are to make space for all permanent teeth to erupt and modify growth patterns to facilitate harmonious development of the upper and lower jaws. On occasion, early interceptive orthodontic treatment is also helpful to prevent injury of severely protruding front teeth or to intercept potential self-esteem and psychosocial issues associated with severely malaligned teeth at a young age.
Early interceptive orthodontic treatment is also helpful in avoiding more extreme orthodontic treatment when kids are older. For example, using a common appliance to correct an overbite at a young age, such as headgear, could help prevent treatment options that seem much more severe if one were to wait for orthodontic treatment until the child were older – namely extraction of permanent teeth or jaw surgery.
In my opinion, it is not appropriate to put braces on the six front teeth of an 8-year-old for one mildly crooked front tooth, as was chronicled in Nancy Keates’ article discussing her daughter’s early interceptive orthodontic treatment. If you look at a group of 8-year-olds, most of them have mild to moderately crooked front teeth with gaps. This is normal dental development for someone their age and many will likely improve with no treatment at all.
Why limited orthodontic treatment so young? This thought process is driven by the paradigm shift that all people should be able to keep their own teeth a lifetime. This statement might seem a little confusing, however, it was not that long ago when it was very common that teeth with dental problems were simply extracted. When enough teeth are extracted, you end up with false teeth – a denture. Most kids these days have no idea what a denture is and the thought of a denture is horrifying to most parents. This, of course, would be the worst possible outcome, but orthodontic decisions that are being made when your child is 7 or 8 years old are really planning steps for what they will look like when they are 30, 40, or 50 years old.
If the motivating factor for your son or daughter having interceptive or early orthodontic treatment is so that they will avoid orthodontic treatment in the future, I would be very guarded about your decision. The goals for early treatment are distinct and different from comprehensive treatment. The goals of early treatment are to promote favorable growth of the jaw bones and to make enough room for the remaining permanent teeth to come in. The goal of comprehensive treatment is to have all permanent teeth straight teeth and in the best functional biting position. Your teeth are like a puzzle, if one tooth is crooked (esthetic concern), that tooth can adversely affect the bite and function of the teeth because that one tooth does not properly align with the surrounding or opposing teeth. Most patients who need early interceptive orthodontic treatment likely later will need comprehensive treatment because the goals of each type of treatment are different.
An early initial evaluation, at age 7 or 8, is very suitable time to evaluate tooth alignment and bite, but this does not imply that is it is best to treat all individuals in this young age group. The most important bit of wisdom I can provide is that orthodontic treatment decisions should be made on a case-by-case basis. Just because one child in a family would benefit from an expander does not mean that another sibling will need the same treatment. However, the etiology of most orthodontic issues is genetic in nature. Therefore, if a parent was treated for an overbite, there is a very strong likelihood that their son or daughter would also have an overbite. Overbite correction is an appropriate early interceptive orthodontic treatment. Ask your orthodontist, “What would you do if this were your child?” This question usually prompts the most forthcoming answers.
Hope you enjoyed my first blog. When you’re passionate about a topic and live it daily, the words just flow.
Wall Street Journal article:
More about my orthodontic practice in Denver, Colorado:
Posted on 05/21/2011 at 12:00:00 AM