Many children have orthodontic problems which develop at a young age. So parents want to know how early their children’s orthodontic problems need to be treated. Although some orthodontic problems are best treated with traditional braces after all permanent teeth have come in, many problems can and should be treated as soon as they are noticed, no matter how young a child is. Patients may be treated as early as four years old to correct and help prevent major orthodontic problems. With proper case selection, early orthodontic treatment by a pediatric dentist may be the only orthodontic treatment a child ever requires, or can make later treatment easier, quicker and less expensive later on. Above all, early treatment allows time to design a nice broad beautiful smile for a lifetime.
Some of the problems which are best treated early are:
• Missing or extracted teeth
• A crossbite of the back teeth
• A crossbite of the permanent front tooth or teeth
• An extremely narrow upper dental arch
• Severe crowding preventing normal eruption of permanent teeth
• Tipping of teeth preventing normal eruption of permanent teeth
• A six year molar which cannot erupt because it is caught underneath a baby tooth, called ectopic eruption
• Permanent front teeth which are protruding excessively and are in danger of being hit or traumatized
• A permanent tooth erupting in the wrong direction
• A front tooth having a very receded gum line due to its unfavorable position in the arch.
Missing teeth, especially in the back of the mouth, can allow the teeth around the space to move into the space, causing crowding and poor alignment of the teeth. Proper placement of a space maintainer can prevent these problems and allow the permanent teeth to come into their correct places.
A crossbite occurs when the top teeth don’t align correctly with the bottom teeth. A posterior crossbite involves the back teeth and can lead to uneven growth of the jaw (mandibular asymmetry) as well as chewing problems. Pediatric dentists should treat this condition as soon as the child can tolerate treatment, usually around four years of age. A simple cemented spring appliance using constant gentle force is often used to widen the arch and correct the crossbite in just a few months. Other appliances and longer times are required to treat this condition if the parents wait until the child gets older. Crossbites of the front teeth can be unsightly and create chewing problems and affect the bony support of the teeth. Early treatment can be accomplished with either cemented or removable appliances and can quickly give your child a beautiful smile.
An extremely narrow upper dental arch will often lead to crowding of the teeth an irregular dental alignment when a child is older. The older a person is, the more difficult it can be to correct a very narrow upper dental arch. A palatal expander is often used to improve the shape of the dental arch from a narrow “V” shape to a more normal, wider “U” shape. Early treatment of crowding may prevent the need for extractions of permanent teeth, which used to be necessary for many children.
Improvements in technology have allowed pediatric dentists to more gently and easily than older techniques. Heat-sensitive nickel titanium wires can move teeth rapidly and with less trauma than the older stainless steel wires. While most orthodontic appliances are meant to be worn 24 hours a day or are cemented on the teeth, there is a class of appliances than need only be worn three hours a day during waking hours and at night while sleeping. These occlusal guidance appliances have been shown to be very effective in cases of crowding and biting discrepancies.
This young girl had about a year of active non-surgical early orthodontic treatment from ages 8 to 9. Early treatment made enough space for her adult teeth to grow in. Her smile is much straighter now. In two to three years she may still need or want a year or so of fixed bracket braces to make her smile even more perfect, but she most likely will not need any teeth removed and not need extensive treatment, headgear or surgery.
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Richard A Gindi, DMD, has a specialty in pediatric dentistry with offices in Oakhurst, New Jersey and Brooklyn, New York. He has over 35 years of experience in pediatric dentistry and has been very successful in providing early orthodontic treatment for his patients.
