Early Treatment (Phase 1)

Many parents are surprised at how many third and four graders are in orthodontics appliances. They often say: “This is not how it was back in the day.” Well, times have changed, and the knowledge we have about orthodontics, growth, and development is helping us provide better options for our patients.

Rather than getting into all of the early treatment options, let me tell you a story of two patients…

Nina came to me when she was nine years old. She was in “mixed dentition” or a mixture of baby teeth and permanent teeth. Her parents could see she had some crowding of her teeth. Upon my examination I saw that she had a narrow palate (maxilla, upper jaw). When the palate is narrow, there is less circumference to have room for all the teeth. The solution is an expander, which widens the palate and makes room for the teeth. We did this expander for 1 year. After a year, we gave her a break from orthodontics. I checked on her periodically, but no further treatment was needed until she was 13. All her teeth had erupted naturally because we had the space. We did 12 months of braces to get her an ideal bite and alignment.

Tina came to me when she was a teenager. She had no baby teeth left. Her parents could see she had some crowding of her teeth. Upon my examination I saw that all her baby teeth were gone, but not all of her permanent teeth had come in. She was missing her upper right canine tooth. Why? Well, when I measured her palate, I could see it was narrow. So narrow, in fact, that the last permanent tooth to come in (the canine), did not have space to erupt. The other teeth used up all of the space. The treatment plan will include an expander to make space for the teeth. Braces will be added to align the other teeth and to open more space for the canine. Depending on the position of that canine, we may now need to involve an oral surgeon or periodontist to uncover it and attach a brace or chain to it. In Tina’s case it took 12 months to create the space for this tooth. After surgery, it took 12 more months to pull the tooth in and 6 months to gain an ideal bite and alignment.

Every case is different and some kids will benefit from early treatment and others won’t. As your orthodontist, I will only recommend treatment when it is necessary. Many times we put a young patient on a recall schedule to observe growth and development until treatment is needed – if it is needed. Even when a child doesn’t need treatment, the least I can do is let parents know what to anticipate. As for the child, its never a waste of time, getting familiar with an orthodontic office and an orthodontist will help them be more comfortable when/if treatment ever starts.