At approximately age 7, a child's first molars will have erupted and will establish their occlusion or bite. It is around this age when we recommend a first visit to the orthodontist. This initial visit is designed to assess whether there are any bite or jaw problems that could best be corrected with an early phase of braces. In general, Dr. Liu believes most cases can be treated best and most efficiently in one phase during the teenage years, however, occasionally two phases will aid in providing the best outcome. Some reasons to start early are:
- A crossbite: Where the upper teeth are behind or inside the lower teeth. A crossbite MUST be corrected before the age of 12-14 to ensure that it can be corrected easily and without surgery.
- An underbite: Where the lower jaw protrudes beyond the upper jaw.
- An openbite: Where the front teeth do not overlap at all. Usually this is caused by a thumb, pacifier or tongue thrust habit.
- A severe overbite: A small overbite (up to 4-6mm) at this age is very normal and in these cases, Dr. Liu will not advocate an early treatment. A large overbite (greater than 6mm) can sometimes be best treated in two phases. The reason overbites are less crucial to treat early than underbites is because the lower jaw tends to outgrow the upper jaw when a person reaches their teenage years and it's this growth spurt that really helps to correct most overbites. However, we are aware that occasionally a large overbite is problematic at an early age because protruding upper teeth can be more prone to trauma and socially the child may feel self conscious. During the exam, Dr. Liu will discuss the option to treat an overbite early and together with the patient and parents decide whether a first phase would be beneficial.
- Severe crowding: A small amount of crowding is very normal between the ages of 7-10. The 4 upper and lower front teeth are almost always bigger than the baby teeth they've replaced and unless there was a significant amount of extra space in between the baby teeth, the permanent front teeth will end up with some crowding. In and of itself, this mild crowding does not need to be treated early, however,if the teeth are overlapped or if the permanent teeth erupt without pushing the baby teeth out (a double row of teeth) sometimes it is best to remove 2 to 4 baby teeth to relieve this crowding.
- An esthetically unpleasing smile: Sometimes the teeth just don't look very good at this age and the patient would benefit from some orthodontic treatment to improve their smile. Typically this encompasses spread out or flared teeth that are rotated or positioned poorly.
Many factors contribute to making the pre-teen and teenage years are the ideal time to treat most orthodontic problems. First and foremost, it is the period of time when a person will hit their growth spurt and harnessing the potential for jaw growth allows a straightforward correction for even severe orthodontic problems.
Secondly, if the child still has their last few baby teeth, simple measures can be taken to preserve the jaw space already present to help correct mild or moderate crowding. This is very important as it allows us to place the teeth in their proper positions without having to extract (pull out) any permanent teeth; something we'd prefer not to do on anyone except the most severe cases.
Another reason the years between 11-13 are the ideal time to perform orthodontic treatment is because it is the LAST time a crossbite can be corrected with a simple orthodontic procedure instead of jaw surgery. As long as a patient is still in early puberty, a narrow upper jaw (maxilla) can be corrected with an expander, a common and simple device that widens the upper jaw.
Finally, it is during this age range that most people will have orthodontic treatment and any social stigma attached to having braces will be lessened. Delaying treatment until 14-16 increases patient apprehension and can complicate treatment because by this time the growth spurt is usually complete and the upper jaw becomes very difficult to expand.
Over recent decades people have been keeping their teeth longer and longer. In our grandparent's generation it wasn't uncommon for a person to lose all of their teeth around age 40. This is no longer the case and more people are entering their later years with a full complement of healthy teeth. Nearly 1/3 of all patients seen in this office are adults.
As long as the teeth and surrounding structures are healthy, orthodontic treatment is possible. There are some differences, however, between orthodontic treatment in children and in adults.
- Treatment tends to take longer. As a person ages, their bone matures and does not react as quickly to orthodontic pressures. An analagous situation would be the difference between the healing time of a broken bone in a child and an adult. The child's bone will heal much faster than an adults. Fortunately, the actual increase in time for adult orthodontics isn't that severe and with simple problems, the treatment time is usually almost the same.
- An adult has no potential for jaw growth. In a child, a discrepancy in jaw size can, in many cases, be corrected with orthopedic appliances to widen or lengthen the affected bones. Not so for adults. If the jaw discrepancy is large, there are few options besides jaw surgery to resize and reshape the jaws. That said, we are well aware that jaw surgery isn't a desired option for the vast majority of people and there are various ways to align crooked teeth so that a greatly improved smile and bite can still be achieved without surgery.
- Gum and bone loss (Periodontal disease). Adults are more likely to have damage to the gums and bones surrounding the teeth. The more severe the damage, the less likely orthodontics can be successfully performed. Adults with a history of periodontal disease will be evaluated carefully and any treatment will be conducted in concert with their general dentist and/or periodontist.
- Esthetic and social concerns. While a 12 year old will most likely be excited to show their friends their new braces, most adult patients are not as enthusiastic and more self-conscious about having braces. We provide a variety of services to help counteract this self-consciousness. Clear braces, Invisalign™ and specialized retainers can all help reduce the visibility of orthodontic appliances.