What is the best age to begin treatment?

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Let’s time it right!!

The Question
When is the best time to begin orthodontic treatment? This is a question that is often asked of me by parents, especially as they see other young children in orthodontic appliances. My specialty training in orthodontics placed emphasis both on early treatment (7-10 yrs. old) as well as treatment occurring later, with all of the permanent teeth present.

My Answer
I have been fortunate to have the opportunity to treat numerous patients with both techniques and review them in the following areas: finished results, duration of treatment, number of appointments, loose appliances, cooperation, and patient motivation/enthusiasm. Combining this information with new wire and appliance technology, I have concluded that for the vast majority (appx. 80%) of young patients, it is best to delay treatment until most, if not all, the permanent teeth are in.

The Reasons
The five major advantages and benefits of waiting:

  1. Decreased time in braces and fewer appointments, resulting in:
    • Less chance of enamel decalcification and root shortening
    • Less time absent from school or work
    • Less opportunity for broken braces
  2. Bone growth is occurring more rapidly during the adolescent years, increasing treatment effectiveness.
  3. Understanding and cooperation are better when a child is mature
  4. Completing treatment in one phase is less costly than a prolonged two phase program
  5. More stable results

The most optimal time to realize these benefits will vary somewhat with the individual child, but for most children it is usually between the ages of 11 and 12. Orthodontic treatment initiated during this window of opportunity will usually result in braces being on for 18-24 months instead of 3 to 4 years or more.

Exceptions
There are a few orthodontic conditions that do warrant a brief period of early treatment. These include:

  1. Cross bites causing the lower jaw to shift
  2. Severe jaw imbalances (such as an upper jaw that is too far back)
  3. Space maintenance for early loss of a primary (baby) tooth
  4. Excessive crowding causing damage to teeth, bones and/or gums
  5. Airway problems
  6. Severely protruded front teeth (buck teeth)

Additionally, if a young patient is suffering psychologically or socially from crooked upper front teeth, a brief period of partial braces can improve both the smile and self-image dramatically. Though braces will typically still be needed when all the teeth erupt, I do feel this is a valid treatment indication for some youngsters.

Needless to say, the timing of orthodontic treatment is an important issue that can make orthodontics either a rewarding and enjoyable experience or one that is prolonged and tedious. Our observation/recall program is set up to allow us to evaluate the patient’s dental and overall development on a regular basis in order to begin orthodontic therapy at the appropriate time.