Why are kids in braces so early today? Who do you trust when you get two opinions, one to wait and one to treat?

Contemporary Orthodontics & Dentofacial Orthopedics

James R. Waters, DDS, MSD, PA

Board Certified Treatment for Children, Teens and Adults  

Why are kids in braces so early today?

Who do you trust when you get two opinions, one to wait and one to treat?

Choosing an orthodontist for your family can be more daunting than you would expect when your child has a more severe or developmental malocclusion.  All Orthodontists are trained in all aspects of orthodontics including traditional braces, preventative/interceptive treatment, treatment with aligners and also dentofacial orthopedics (the treatment of the developing arches and supporting bones during growth) but not every orthodontic program is as strong in each area and time is limited despite being 2 to 3 years of full school (you can compare this to generals dentist offering braces who may take a 6 months course for 2h per weekend or less).  In truth, there is little time to follow growth and development of individual patients which may need treatment from age 8 through 12 or even 14 year of age.  Most Orthodontists have to build upon their knowledge from school with years of literature study after school and a mentorship with a more experienced practitioner who has treated cases for many years.  Some Orthodontists simply never pursue further knowledge for such cases; they may instead use surgery later to fix a jaw dysplasia or remove permanent teeth to keep the treatment in a single phase v. an early phase (which they know may well still require a second phase of braces).

With all of this, the public is left to discern who is best for them and who to trust.  My advice is to request a review of multiple similar cases already treated by the Orthodontist.  We all keep records for many years and if an Orthodontist cannot produce similar cases with successful results you may want to look around for someone with more experience for your specific needs.

Early treatment has been proven in the literature to prevent removal of teeth in borderline cases, to restore normal growth and to correct skeletal dysplasias from underbites to severe overbites.  Consider the following patient’s retrusive lower jaw:

At age 7, this patient presented with a severe Class II (mandibular hypoplasia) malocclusion.  The literature has shown us that a Class II patient will remain Class II if we do not interrupt the existing growth pattern and alter the equilibrium back to normal growth. IF we treat early enough, there will be time for the lower jaw to “catch up” naturally.  After examination It was determined the upper jaw was narrow which constricted the lower jaw and drove it backward.  Since muscle forces are stronger than the growth potential, the lower jaw could not grow forward. 

Before

18 Months Later

 Now compare the before and after following expansion for 6mo and use of an appliance to de-program the distal closure from the muscles and allow the lower jaw to grow un-impeded for an additional 12mo.

Keeping in mind that much of what we see as crowding later is initially due to the size of the bones v. the size of teeth and also from the pattern of eruption, we can work at each stage to restore the size of the bone back to ideal and remove primary teeth in the ideal sequence.  Sometimes we can even guide the permanent teeth into position without braces at all.  Consider the following patient:

At age 7y 7mo, this young lady presented with such severe overjet that several Orthodontists had already condemned her to surgery later which meant she would live with the overjet until age 17 to 18, then go into full braces and have mandibular advancement surgery at that time.  When I saw the patient on a third opinion, I remember admitting that we probably could not prevent surgery but thinking of my own daughters, I felt we could reduce the amount needed with early intervention and improve the face at least some during the important adolescent years.  At the time, I felt 12mm overjet could not be corrected even with early treatment.

 

Following treatment to restore the arch width in the upper jaw and help restore growth to the lower jaw, I was surprised to see how the growth came back and was able to fully correct the overjet.  Since we were following the patient closely, we also had baby teeth taken out in the proper sequence to help the eruption of the permanent teeth.  As the teeth erupted, I changed to a “positioner” which is not unlike a custom mouthguard fit to the patient’s size of teeth but in ideal occlusion.  The result was a perfect occlusion with ideal overjet and overbite; and no braces (as with all great deeds however, I was surprised when mom was upset her younger sister presented with simple crowding and we recommended braces!).

"The more severe the skeletal malocclusion, 

the more important it is to treat early."

Note that both of these patients were 7 years old which should answer one of the main questions this discussion is meant to address.  The more severe the skeletal malocclusion, the more important it is to treat early.  The sooner the bite is corrected, the sooner growth and development returns to normal.  If nothing is done to correct an early skeletal malocclusion, every other tooth will eventually be stuck trying to erupt into less space; this leads to crowding, impaction of teeth, and eventual loss of permanent teeth in many cases.

So when do you decide just to remove teeth instead of trying to make room early?  Consider the following patient:

This patient presents with only mild crowding but her teeth are forward in the bone making it difficult for the patient close her lips at rest.  Aligning her teeth would actually worsen this profile so instead we removed four bicuspids (ne in each quadrant) and pulled her front teeth back while aligning the rotations.

Following the orthodontic correction, you can see the patient is able to close her lips at rest, improving her profile while still allowing correction of her malocclusion.

"Make sure they are actually Orthodontists and not just offering “orthodontics”. Consider Board Certification and experience..."

So do your research and ask questions when seeking out your family orthodontist.  Make sure they are actually Orthodontists and not just offering “orthodontics”. Consider Board Certification and experience with tougher cases and request to see before and after cases treated at the office with similar problems (more severe if possible).  Interview the staff a little on the phone; they may give you a hint if certain aspects of orthodontics are not really performed at that office.  Make sure you and your family are comfortable then trust them throughout treatment.  There are always different ways to treat and one Orthodontist may just have a different path that fits your needs and provides excellent results.  Try not to listen too much to nay-sayers on the neighborhood blog with poor generic advise.  Remember every child is different; occlusions are no more similar than two kids look alike.  If you hear Headgear or expansion, remember that no Orthodontist wants to be the guy or gal that does these things; if they recommend it, they are doing so based on the needs of your child.  

If you have questions or comments concerning this or any orthodontic question, please feel free to make a complimentary new-patient appointment at either my Steiner Ranch location or my North-central Austin location on West 35^th street and MoPac.

Dr. James R. Waters is a 1996 graduate from UTHSC Dental School in San Antonio, 1997 graduate of Advanced Dentistry from the UNMC in Nebraska and the 2001 Valedictorian graduate from the prestigious Saint Louis University Orthodontic Program receiving the J.P. Marshall award for clinical excellence in 2001.  He holds a Bachelor’s Degree in Science, Doctorate in Dental Surgery, a post-doctorate certificate in Advanced Dentistry, post-doctorate Degree in Orthodontics & Dentofacial Orthopedics and a Master of Science Degree in Orthodontics.  Dr. Waters and his wife of 19 years live in Austin, TX with their 4 children where he has a thriving, multi-faceted Specialist practice with locations in Steiner Ranch and North-Central Austin.  You can learn more about Dr. Waters at BracesAustin.com. 

 Central Austin

1814 W. 35^th Street

Austin, TX 78703

(512) 451-6457

 

Steiner Ranch

4302 N. Quinlan Park

Austin, TX 78732

(512) 266-8585

 

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