Does My Child Really Need Two Sets of Braces?

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Believe it or not, there was a time braces were not the cool thing they are today. Kids had to wear headgear to school and endure nicknames such as “railroad tracks”, “brace face” and “metal mouth”. Now it is a rite of passage for a youngster to be given the gift of healthy, well-functioning teeth and a beautiful smile. Our society’s expectation is that if we take care of ourselves, we will do better in life. A confident smile means something in our culture and can be a factor in aiding one to become a happy, successful adult. As an orthodontist, I really want all our children to grow up healthy and confident. It just so happens that healthy, straight teeth that function well also look great.

We see children all day, every day. And with each child that we make the decision to defer treatment until the child’s in full adult dentition (all the baby teeth are gone and the adult teeth are erupted, or very close to being so) we will hear the comment “all of my child’s classmates and friends are already in braces. There is a mixed bag of emotions on the parent’s part. They worry that they are not doing everything they can for their children and that they will miss the “opportunity” to get the treatment right. They are afraid that something will go terribly wrong if they don’t do something right now!!

The reality is, there are very few true orthodontic emergencies. And, the statistic still stands true that only 1 in 5 mixed dentition youngsters (those that have a combination of some adult teeth with their baby teeth) are true candidates for early treatment.

Now, with that being said, let’s discuss the reasoning behind Early Treatment or what I prefer to call Interceptive Treatment. Whether you call it Phase I, Early Treatment or Interceptive Treatment, it means intercepting an orthodontic concern that would have the best result if addressed early rather than later. The more common of those concerns would be an excessive overjet (many of you know this as an overbite, this is the back to front relationship of overbite) crossbite (this is where the upper arch of teeth fit to the inside of the lower teeth or completely to the outside of the lower teeth). This may effect one or more teeth and can be particularly alarming if it is in the front. A functional shift of the lower jaw to the left or right when opening or closing can create asymmetrical jaw development and future jaw joint problems. A tongue habit (tongue thrust) can prevent the teeth from staying straight after the braces come off and over time, if not present at the examination, can create an openbite. This is when teeth don’t make contact when biting down and can make eating anywhere from challenging to almost downright impossible. Then, of course, there are unusual growth patterns of the jaws and finger sucking habits that may benefit from early treatment.

Based on the concern and severity of that concern would dictate the type of treatment necessary. In many cases, monitoring the patient’s development over the transition of baby teeth falling out and the eruption of adult teeth is all that is needed with minimal, if any help. This is a no charge program called Growth and Guidance and we see the patient usually about twice a year, until the right time had been determined to begin orthodontic treatment or what I like to call Comprehensive Treatment. Rather than having a patient in full appliances (braces) a young patient’s care might be best managed with early extraction of select baby teeth to allow for better eruption of the adult teeth. A minimally invasive space maintainer may be placed to allow for room to be left available for the adult teeth to erupt properly in a space that might have been made earlier than expected by the necessary removal or accidental loss of a baby tooth. There are many forms of Interceptive Treatment and not all of them are cost prohibitive or inconvenient.

Your orthodontic specialist should discuss with you the benefits of any recommendation for treatment and ultimately the decision is yours. Your decision to proceed with any treatment should be based on the following criteria:

  1. Do I understand the treatment outlined for my child? This does not mean that you understand it completely from a technical standpoint. More simply, can you explain the “whys” of treatment to a family member or relative? Do you agree with the need for treatment and see value in that? If the answer is yes, then you can feel confident that Interceptive Treatment is appropriate for your child.
  1. Do I enjoy the office environment? Is the staff friendly, helpful and knowledgeable? You will be spending a great deal of time there and these things are very important.
  1. Most important, do you trust your orthodontic specialist? If you answer yes, then you will have confidence in his or her work. You will be supportive of the treatment plan and the team effort that is necessary for the orthodontic treatment to be successful.

There are many wonderful and necessary things that can be accomplished during an Interceptive Phase of orthodontic treatment. However, sometimes the best thing for a young patient is to simply leave them alone. You as the parent responsible for your child should never feel pressured or threatened with the thought that deferring treatment will be a irresponsible decision. Listen to your specialist’s recommendations, discuss it with other decision makers in your family and then move forward.

Ultimately, it is your decision.