Walnut Creek, Concord, and Lafayette, CA
Many orthodontic, orthotropic, airway or sleep apnea treatments are appropriate for children, even though they may not have any or all of their permanent teeth. Reasons to consider early treatment evaluation for a child are:
- Crowding – not enough room for the permanent teeth. When baby teeth have no gaps between them, they are crowded.
- Bite problems: deep bite, cross bite, overjet, overbite, underbite, or “buck teeth.”
- Mouth-breathing, low tongue posture, thumb-sucking, difficulty breastfeeding.
- Facial growth, recognized or not, that is not optimal: recessed chin, gummy smile, long face, flat cheeks, asymmetries, dark circles under eyes.
- Snoring, teeth grinding, daytime hyperactivity, bed-wetting, ADD-like symptoms – all of which have been associated with airway problems related to facial growth. Early treatment can help!
- Cosmetic issues about which the child is self-conscious.
“Why not just wait and do all orthodontics in one phase in high school?”
Isn’t treatment at a young age a waste?
Sometimes we are asked a very logical question: why spend potentially more time and money on two phases of orthodontics, a first phase now and then a braces phase to align teeth later? Many times we have seen patients who have had “Phase I Orthodontics” in another office, and we have asked the same question. It looked like the patient had wasted time and money because they were left with problems large enough that, in the end, no real time or effort or cost was saved. We do not recommend this!
If orthodontic treatment is undertaken when some or all of the primary (baby) teeth are present, there had better be a good reason. There must be attainable objectives, producing important enough benefits to outweigh the cost, time and hassle of the treatment.
Is Orthodontics just Straightening Teeth?
The reasons for doing any orthodontic treatment can vary. Most of the time, simply straightening teeth becomes the number one goal. We have learned, however, that there are larger issues at stake – some of them even affecting how long a child might live! This is not an exaggeration. When the growth of the jaws, and the formation of the airway are not optimal, serious health consequences can result: irreversible cardiovascular damage, ADD or ADHD, delayed language and phonological skills, altered social development, lower IQ, etc. We take all these seriously.
The Role of Mouth Posture
Ideal rest oral posture is: lips together, teeth lightly together, and tongue to the roof of the mouth. If the rest posture of the mouth is not optimal, then facial and airway growth are a concern – and they will remain a concern throughout life. Correcting muscle function and tone is much easier at younger ages, and when the tongue-space is corrected with expansion or arch development, the muscles adapt to the surrounding structures. They won’t do this as readily with expansion at a later age.
Early Treatment focuses on structural and/or postural correction: the size of the jaws, the direction of jaw growth, etc. It’s like getting a space ship pointed toward the moon soon after it leaves earth; waiting until later will often mean a larger and more difficult correction. Children also cooperate with and tolerate simpler treatment at a younger age – much better than teenagers do. Early treatment can make the teenage treatment, when it is necessary, shorter, simpler, and more comfortable.
When more space is made for the erupting teeth, the likelihood of needing extractions or jaw surgery is decreased. The permanent teeth do better when they can erupt into an arch that has enough room. When teeth do not have enough room, they can end up in positions that are more complicated to correct: they can become impacted, they can erupt through the wrong part of the gum tissue, and they can cause damage to the roots of adjacent teeth. These are all reasons to consider Early Treatment.
If nature has not already done so, it may be the case that the best tooth alignment will result from orthodontics with braces after the permanent teeth are all in. So, yes, sometimes a second phase of treatment to align teeth is desirable. A lot depends on the degree of “perfection” in alignment the patient or parents desire. Usually (if you can believe this coming from an orthodontic office), it is best to skip the full braces phase and accept minor discrepancies in alignment. But, when necessary, expansion, postural, or structural changes at that later age are generally more difficult, and keep the teen in treatment longer. Looked at from a health perspective, the structural changes that are achieved during the growth years are often more important than the final alignment of the teeth later on. We might recommend that the priority be put on the treatment at younger ages to correct the major issues: insufficient space, asymmetries, cross bites, impactions, poor oral posture, improper facial growth, etc.
Evaluate Early – Ages 3-4 are not too young!
Avoiding extractions, surgery, more complicated treatment, tooth impactions, ectopic eruptions (teeth coming in at the wrong place), – and optimizing facial, jaw, and airway growth, – these are all good reasons to put the priority on working toward correction of problems we can address early treatment.