Early Treatment

Early Treatment

An early orthodontic examination can be a valuable preventive measure in controlling dental and skeletal irregularities in a growing child. This may involve early treatment and management of a patient's skeletal growth before most of the permanent teeth have erupted, or simple interceptive treatment to control harmful habits. In many patients, proper treatment timing can achieve results that are not easily attained once the face and jaws have finished growing.

When should treatment begin?

There is no one answer to this question because each orthodontic problem determines its own best starting time in terms of improvement that can be achieved with the least time and expense. For this reason the American Association of Orthodontists (AAO) recommends that the proper age for a child's first visit to the orthodontist is 7 years or even earlier if a problem is noted by the parents, family dentist, or physician. However, don't assume that treatment will always begin immediately after a first examination. Dr. Sherman and Dr. Balhoff may simply want to check your child periodically while the permanent teeth erupt and the jaws and face continue to grow. In this way, the timing of treatment can be correlated with the best skeletal, dental, and psychological maturation level for each individual.

What causes a malocclusion or "bad bite"?

There are two general causes of malocclusions and facial irregularities: 1) genetic inheritance, and 2) environmental factors. Inherited problems may include such things as the pattern of facial growth, crowding of teeth, too much space between teeth, cleft palate, and a wide variety of other deformities of the jaws and face. Environmental factors include thumb or finger sucking, lip biting, tongue thrusting, mouth breathing (an airway restricted by tonsils or adenoids), and the premature loss of primary or permanent teeth. Many of these factors can affect the entire face as well as the teeth.

Ages 2 through 6

Should treatment begin before the permanent teeth erupt?

This age of development includes the children in the primary dentition "baby teeth", or until the eruption of the permanent incisors (front teeth) and first molars. At this young age, severity of the problem will dictate the necessary treatment.

Preventive treatment, such as space maintenance, in a patient with premature tooth loss (due to trauma or dental diseases) may be required. Controlling harmful habits, such as finger or thumb sucking, is often best done before the eruption of the permanent teeth, depending on the child's willingness to stop. In addition, a child who breathes primarily through the mouth should be evaluated for a restricted nasal air flow.  This is because chronic mouth breathing can possibly lead to future developmental skeletal problems.

As a general rule, the treatment during this age period is kept simple, since the child has a limited understanding of the problem and limited ability to comply with the prescribed treatment.

Ages 6 through 11

What problems can and should be corrected?

This age of development following the eruption of the permanent incisors (front teeth) and first permanent molars (six year molars), is commonly referred to as the "mixed dentition stage". This age represents an excellent time for the correction of dental and skeletal problems because: 1) During this time sixteen permanent teeth will erupt and guidance of this eruption can facilitate the correction of many malocclusions. 2) Several skeletal disharmonies may require Dr. Sherman and Dr. Balhoff to have as much control as possible over the direction and magnitude of the facial growth pattern. 3) Psychological development, understanding of treatment goals, and patient cooperation is most improved.

Problems that are commonly treated during this stage of development include:

1. over-bites- protruding front teeth (lower jaw is behind upper jaw)
2. under-bites- (lower jaw is in front of upper jaw)
3. open-bites (the anterior teeth fail to meet)
4. cross-bites (the upper teeth are inside the lower teeth)

Other problems that can be treated during this time period are prolonged thumb and finger sucking habits, abnormal swallowing habits, mouth breathing, excessive tooth crowding, and jaws that tend to click and pop.

Treatment planning for these individuals usually emphasizes correction of severe skeletal problems (orthopedics), as well as severe dental problems. Custom made appliances, or braces, are prescribed and designed according to the problem being treated. They may be removable or fixed (cemented or bonded) and may require the use of extra-oral orthopedic forces (headgears). All treatment modalities during this stage of development strive to correctly align the teeth and jaws so that the remaining facial growth will be balanced. Following this early treatment phase, the possibility exists that the patient may never need braces once all the permanent teeth erupt.  Normally, though, braces are needed during adolescence, but the length of treatment is usually shortened.

Ages 12- 16

Why is adolescent treatment necessary?

This stage of development constitutes the majority of orthodontic patients treated in the country. There are two primary reasons: 1) The patients in this age group are undergoing pubescent growth, and this represents an excellent time for correction of most mild skeletal and dental problems. 2) The permanent dentition is now present and the orthodontist has control over the development of the final occlusion. Normal pubescent ages for females are between the ages of 10 to 14 and between the ages of 11 and 16 for males.

It should be noted, however, that individuals demonstrate wide variations in their physiological, psychological, and dental development. Delayed or accelerated growth is not unusual and will not necessarily maintain a pattern throughout adolescents, even in the same individual. Consequently, an individual may experience growth spurts varying in both intensity and duration throughout their developmental years.

Braces, or comprehensive fixed appliance therapy, is the most common treatment of choice in this age group. These appliances may be augmented by any number of other removable or fixed appliances.

Why is early orthodontic treatment important?

Every parent wants their child to have a beautiful smile, and everyone should have a healthy one. The orthodontist's goal is to achieve both for the patient.

Untreated malocclusions "bad bites" may contribute to conditions that worsen with age. Crooked and crowded teeth are hard to clean and maintain which may contribute not only to tooth decay but eventual gum disease and tooth loss. Other orthodontic problems can cause abnormal wear of tooth surfaces, excess stress on the supporting bone and gum tissue, or misalignment of the jaw-joints with resulting chronic headaches or pains in the face and neck.

The importance of an attractive smile should not be under estimated. A pleasing appearance is a vital asset to one's self-confidence, and a child's self esteem often improves as treatment brings teeth, lips, and face into harmony. In this way, early orthodontic treatment gives the child a sense of control because it provides an opportunity to participate in the improvement of his or her appearance.

Encouraging good dental health habits and providing professional dental care at an early age produce benefits that will last your child a lifetime. Remember, your child should begin regular visits to the family dentist at age 2. At age 7, or earlier, if a problem is suspected your child should have an orthodontic examination. This allows Dr. Sherman and Dr. Balhoff maximum opportunity to prevent serious problems from developing and to provide corrective treatment at the best age for your child to have the most beautiful and healthy smile possible.