Early Orthodontic Treatment: Is the new trend for kids to get braces two times?

My wife along with our 3 young girls attended a kids birthday party the other day. Upon arriving, my wife walked into an ongoing conversation amongst a group of moms debating the question “Is the new trend for kids to get braces two times?” The moms were not aware that I was an orthodontist so they carried on the conversation with my wife standing there. Hypothetical questions kept being asked without answers given. “If we do this expander early does that mean we don’t need braces? Is the choice do an expander now or extract adult teeth later? If we do braces now at age 8 and we still have to do braces later when all the adult teeth come in, then what is the point?” 

Yes, early orthodontic treatment has become more common than it was 10 years ago, or 20 years, or 30 years ago whenever today’s generation of parents were in braces. Now, these moms and dads are heading into orthodontic consults with their children and are questioning the need for treatment so early and so young. So these questions of why are important ones to answer. 

Why two phases of orthodontic treatment for some kids?

First, not all kids will benefit from an early phase of orthodontic treatment. In fact, many kids would not benefit. In our practice, the kids who have been recommended for an early phase of treatment are those in which a problem has been identified that is either a) easy to correct now rather than later of b) if not addressed now could become a more difficult problem later resulting in a compromised long term outcome. 

Why is this more common today than when I was growing up?

Through education and research, the orthodontic specialty has learned that early intervention, specifically in the areas of growth and development can have a profound positive impact on treatment outcomes, stability of teeth, and the long-term health of the periodontal supporting tissues (gums and bone). Therefore many current practicing orthodontists have placed special importance on early intervention. Also, kids are being referred to the orthodontist earlier by general dentists. Through education in the dental profession, general dentists are better equipped to identify early orthodontic problems and refer patients at the appropriate earlier times.   

Does early orthodontic treatment always involve early braces?

No, in fact, the majority of early treatment does not include braces. Early intervention often focuses on ‘growth modification’.  What is growth modification? It is an attempt to modify one’s current growth pattern through orthopedic or functional intervention to set a new and more normal growth pattern. This includes undersized or underdevelopment of jaw growth for the given tooth size. Jaw or arch expansion using expanders. It also includes correcting severe overbites or underbites. It is more predictable to address problems associated with improper growth and development earlier when skeletal and jaw growth is occurring rapidly. When kids are older and skeletal growth slows, modifying or altering that pattern is less predictable. 

If an expander is done early does that mean no braces later?

No. Most kids that are treated with an expander will also need braces. An expander is changing the size and shape of the developing jaws. Often to create more space for teeth, tongue, and airway. This should create a much better foundation for the adult teeth to erupt however it does not guarantee the teeth will all erupt into ideal alignment. It should however make braces treatment easier and less time than otherwise would have without the expander treatment. The results should also be more stable long-term because the jaw size is more appropriate for the given adult tooth size. 

Is the choice an expander early or extraction of permanent teeth later?

No. It’s not that black and white. The goal in modern orthodontics is to avoid permanent tooth extractions if possible. Early intervention has proven to reduce the need for extractions over time. In addition, expanders can help with long-term stability of straight teeth, speech, and airway. 

Why do braces early and again when they are older?

In our office, early braces are used to correct a specific problem that presents early with either the front four upper teeth or the front four lower teeth. These teeth commonly erupt between ages 6-9. When a problem is identified at this age, braces for a short period of time (8 to 12 months) can quickly fix the problem. Common early problems include dental cross-bites. A cross-bite is when a top tooth is biting on the inside of the bottom teeth and vise versa for a bottom tooth. These cross-bites can be traumatic to the tooth itself or the surrounding gum tissue. Another common early problem is severe crowding. Some transitional crowding is to be expected when kids start getting their adult front teeth, however severe crowding often requires some early intervention. Early braces can move the adult teeth and create appropriate space for the next incoming adult teeth. If no space (or parking spot) exist for an erupting tooth, sometimes that tooth can become impacted and will require future oral surgery and more complex orthodontic treatment to pull into the mouth. 

If my kid needs braces or orthodontic treatment again when they are older then what is the point of the early treatment?

The goal of early treatment is not necessarily to completely prevent the need for future treatment it is to make future treatment easier, less time, and often to create a more optimal and stable outcome than what otherwise would have been possible. The goal is to correct a specific problem that has been identified early and if left untreated could create a bigger problem down the road. 

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Dr. Justin Wild