There has been a profound shift in orthodontic practices from decades past. Today, orthodontists are evaluating patients at younger ages – well before eruption of their permanent teeth. By addressing problems in their early stages, more serious issues can be mitigated or potentially avoided. Before this change in emphasis, patients awaited their orthodontic examination until after their permanent teeth came in. For all intents and purposes, orthodontics was limited to teeth straightening; issues with the jaw and facial formation were given short shrift. Braces typically were placed at 13-14 years of age for around two years.

Now, with years of clinical studies behind us, there is substantial evidence that this one-stage approach did not yield optimum results for many patients. The problem was that waiting until the permanent teeth were set and jaw growth complete often resulted in compromised treatment with final results that could have been improved with earlier intervention. Unfortunately, at this late stage, tooth extraction or corrective jaw surgery (orthognathic surgery) was often required. With today’s orthodontic focus on early treatment, these measures can often be avoided.

As such, today’s gold standard in modern orthodontics is a two-phase orthodontic treatment. The whole idea behind this stepped treatment is to apply the appropriate treatment at the appropriate time in order to achieve the optimal outcomes. Early orthodontic intervention prevents problems that become more difficult to resolve as the patient gets older and their bone structure becomes harder to work with.

The lesson learned is that monitoring a child’s tooth and jaw development must begin early. Today’s orthodontics utilizes a patient’s early growth in its favor, tackling problems head-on when interventions are easier and the results are more successful. Why is earlier better? Simply put, the bulk of our facial growth takes place early on. Far earlier than most people think. By age four, 60% of facial growth is complete. By age six, 80% of this growth is complete. By age eleven (or when the second molars have erupted), 90% of facial growth is complete. Guiding and rebalancing jaw growth and tooth development more successful during these tender years when the bones are still malleable in their growth stages.

Right now we are in a transitional time with modern orthodontic practices. Many parents of children ready for orthodontic treatment today grew up and were treated the “old way” with a single-phase orthodontic treatment after eruption of the permanent teeth. Naturally, there are questions and concerns about the two-phase treatment protocol. At our office, the first question we often hear is “Why do this twice?” followed by some commentary to the effect that “The baby teeth fall out anyway so why spend money on straightening baby teeth!”

First, to dispel one of the biggest misconceptions out there, two-phase orthodontics does not involve straightening baby teeth. No one is treating the same “crooked teeth” twice. Second, not every child has orthodontic issues that warrant two-phase orthodontic care. However, for certain children, a phase-one treatment can be indispensable, creating a better environment for the child’s permanent teeth instead of sitting back and hoping for the best.

Phase one treatment is all about laying the foundation so that when the permanent teeth come in there is less work to be done. Taking early corrective action prevents more costly and difficult problems down the road including tooth extractions and major jaw surgery. In short, it is helpful to think of phase one orthodontic treatment as giving nature a gentle nudge, prodding the jaw structure to properly develop so that the permanent teeth erupt under the best possible circumstances. There are a variety of appliances used in phase-one treatment such as palatal expanders and partial bracing for the purpose of front tooth alignment an establishing a correct relationship between the upper and lower jaw. An orthodontist can review the appropriate treatment options, if the child needs any, after an examination.

Of course, there is still more orthodontic work to be done once the permanent teeth erupt. That is the phase-two treatment that parents are familiar with in order to align the teeth with braces. But with phase one treatment, the bone structure is in place to make phase-two go as smoothly as possible. With a two-phase treatment process, your child will not only be left with a healthy, attractive smile as an adult but also a healthy, aligned jaw structure. There is no better gift you can give to your child.

Today’s modern orthodontics is proactive, interceptive, and preventative. We never lose sight of the prize. We want our patients to head down a good path of dental-facial growth and development. Orthodontics goes far beyond aesthetics. A healthy jaw structure and straight, strong healthy teeth are an integral component of one’s long-term overall health.

“When should I first take my child to see an Orthodontist?” It is one of the most frequent questions that we hear from parents calling our office. The answer is earlier than you might think and comes to a surprise to many families. The American Association of Orthodontists (AAO) and the American Dental Association (ADA) recommends that all children see an orthodontist no later than the age of 7.

At first blush, an orthodontic visit at age 7 or earlier seems premature. After all, most 7-year-olds still have many of their 20 baby teeth. We associate braces with tweens and teens that have all of their permanent teeth. The 28 permanent teeth start erupting from the age of 6. For most children, all of the baby teeth have been replaced by the age of 13. For most, four wisdom teeth erupt by the age of 21, taking the total number of permanent teeth to 32.

Why is the age of 7 or less the critical orthodontic milestone for a child’s first visit? The reason is, just like with most everything, early identification of orthodontic issues on the horizon makes the necessary corrections easier for the orthodontist and the child. An early orthodontic visit helps identify problems with a growing jaw and emerging teeth while there is an opportunity to intercept problems that, without intervention, will become more exacerbated. By taking advantages of growth spurts and the partial bone development, early treatment helps prevent more serious problems from developing.

In addition identifying and preventing more serious orthodontic problems, early orthodontic treatment can reap a variety of dental benefits for your child. An early orthodontic visit:

• Helps guide jaw growth
• Lowers the risk of tooth trauma
• Corrects harmful oral habits
• Guides the permanent teeth into favorable positions
• Improves the way the lips come together

Despite the best efforts of the AAO and ADA to disseminate information concerning the benefits reaped from early orthodontic intervention, too many well-intentioned parents remain unaware of the age 7 or less recommendation. The unfortunate reality is that most orthodontic treatment begins between the age of 9 and 14. And while late is better than never, the delay in treatment makes the necessary interventions more intensive and more time-consuming. Parents are often misinformed about the right time to see an orthodontist and are lulled into believing that their are no orthodontic issues because their child appears to have ”straight teeth” or a “normal smile.” However, orthodontic problems can be latent and subtle at their onset. A parent’s superficial assessment of their child’s teeth should not be a substitute for an orthodontic visit to ascertain whether there are orthodontic issues.

However, for parents, there are more obvious signs that indicate the need for orthodontic intervention. They include:

• Early or late loss of baby teeth
• Difficulty chewing or biting
• Breathing through the mouth
• Thumb-sucking past the age of 4
• Crowded or protruding teeth
• Biting the cheek or roof of the mouth
• Upper and lower teeth that don’t meet in the front
• Grinding of teeth

In summary, the ADA and AAO has determined that there is an ideal age for every patient to begin orthodontic treatment. Please have your child examined by an orthodontist before the age of 8. Otherwise, a critical window of opportunity to avoid or mitigate orthodontic issues may be missed.

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