Early Treatment

When is the best time to get braces?

Timing of Orthodontic Treatment:

Generally speaking, straightening of teeth can be accomplished at any age. However, modification of jaw growth is only possible while the patient is growing. Optimal treatment of adult patients with severe jaw discrepancies may require surgical alignment of the jawbones.

Since growth modification is at the heart of orthodontic treatment, the younger the patient the more ideal the treatment outcome. Early mixed dentition, which is marked by the emergence of the permanent teeth at the ages of 6 to 7, is considered the optimum age for most types of malocclusion.

Different stages of dental development and the appropriate treatment protocol for each stage are as follows:

  • Primary Dentition (2 to 6 years of age)
  • Early Mixed Dentition (7 to 9 years of age)
  • Late Mixed Dentition (9 to 11 years of age)
  • Early Permanent Dentition (11 to 13 years of age)
  • Adults (After 13 for girls and 16 for boys)

Appropriate Orthodontic Intervention During Primary Dentition:

  • Information about and interception of deleterious effects of habits (sucking, etc.)
  • Correction of posterior crossbite
  • Correction of severe anterior openbite

Appropriate Orthodontic Intervention For Early Mixed Dentition:

Interceptive Orthodontic Treatment (IOT)

Advances in the understanding of facial growth and development in the past 30 years have given orthodontists the ability to modify the growth of the jawbones and dramatically reduce the need for extraction of teeth. Expansion of the maxilla (upper jaw) is the foundation for interceptive orthodontics. The optimal age for this maxillary expansion is between seven to ten years of age, when the first permanent molars develop in the mouth.

Our treatment mechanics is based on the growth studies of Dr. James McNamara at the University of Michigan and Dr. Eugene Roberts at the University of Pacific in San Francisco. Through enhancement of the growth of the jawbones, the space is developed to accommodate the crowded teeth. Therefore, we avoid or minimize the need for extraction of deciduous and permanent teeth.

Advantages of interceptive (early mixed dentition) orthodontics are as follows:

  1. Optimum facial harmony

    Inadequate growth of the jawbone in one direction is frequently compensated by an increase of growth in other directions. For example, narrowing of the upper jaw is usually accompanied by excessive vertical growth of the upper and lower jaws, making the lower portion of the face appear long (long face syndrome). Early interception of this inadequacy in the transverse growth will therefore result in optimization of facial appearance.

  2. Enhanced stability

    The younger age of the patients make them more adaptive to the changes, therefore post-treatment relapses become less likely.

  3. Correction of crowding without extraction

    Expansion of the dental arches creates additional space for the eruption of the permanent teeth, therefore averting the need for removal of the teeth.

  4. Reduced treatment time

    With younger age, tissue adaptation and turnover occurs at a higher rate, hence bones and teeth move faster. Interceptive orthodontic treatment of an 8-year old child usually takes less than 18 months, compared to adolescent orthodontics, which takes two to four years.

  5. Less pain and discomfort

    Children experience minimal discomfort prior to age ten. This is due to a higher pain threshold as well as lower resistance of the bones and teeth to movement.

  6. Improved cooperation

    Prior to the teens, most children are enthusiastic about braces and about following directions. In contrast teenagers are generally skeptical about their treatment and their oral hygiene. Orthodontists are forced in many instances to compromise the results and remove the braces before the proper results are obtained in their adolescent patients.

  7. Minimal side effects

    Moving teeth in younger patients involves more guidance and less pressure. Therefore the possibility for occurrence of such common orthodontic side effects as root resorption, gum recession, or TMJ problems are dramatically reduced.

  8. Lower costs

    The fee for IOT treatment is significantly less than that of a full orthodontic treatment. In those circumstances that a phase II treatment becomes desirable or necessary, the fee paid for IOT treatment will be considered a part of the total treatment fee.

Disadvantages of interceptive orthodontics are as follows:

  1. Possibility of a phase II treatment

    Interceptive treatment is completed prior to the completion of permanent dentition, with the possibility of a phase II treatment being the major disadvantage. However, most of the correction is already accomplished, when a 2nd phase of treatment is needed and is of a short duration (6 to 12 months) and relatively inexpensive.

  2. Inadequate oral hygiene

    Many of the children do not acquire the necessary skills to properly brush and floss their teeth until the age of nine. Parental supervision is needed for the younger age group in order to keep the teeth and braces clean, particularly during the first few months of their treatment.

Who would benefit from early treatment:

  1. Children 7 to 9 years old with severe crowding.
  2. Narrowed upper jaw with or without crossbite.
  3. Openbite cases involving habits such as thumb sucking, forward tongue posture (tongue thrust), or mouth breathing.
  4. Class II cases with large overjet (overbite).
  5. Class III cases involving over growth of the lower jaw or underdevelopment of the upper jaw.