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Frequently Asked
Questions
Kids Orthodonics
Glossary| Emergencies | Statistics
| Retainer Care
- Why should children have an orthodontic
screening no later than age 7?
By age 7, enough permanent teeth have come in and enough jaw growth
has occurred that the dentist or orthodontist can identify current
problems, anticipate future problems and alleviate parents' concerns
if all seems normal. The first permanent molars and incisors have
usually come in by age 7, and crossbites, crowding and developing
injury-prone dental protrusions can be evaluated. Any ongoing
finger sucking or other oral habits can be assessed at this time
also.
Some signs or habits that may indicate the need for an early
orthodontic examination are:
- early or late loss of baby teeth,
- difficulty in chewing or biting,
- mouth breathing,
- thumb sucking,
- finger sucking,
- crowding, misplaced or blocked out teeth,
- jaws that shift or make sounds,
- biting the cheek or roof of the mouth,
- teeth that meet abnormally or not at all, and
- jaws and teeth that are out of proportion to the rest of
the face.
A check-up with an orthodontic specialist no later than
age 7 enables the orthodontist to detect and evaluate problems
(if any), advise if treatment will be necessary, and determine
the best time for that patient to be treated.
- What are the benefits of early
treatment?
For those patients who have clear indications for early orthodontic
intervention, early treatment presents an opportunity to:
- guide the growth of the jaw,
- regulate the width of the upper and lower dental arches
(the arch-shaped jaw bone that supports the teeth),
- guide incoming permanent teeth into desirable positions,lower
risk of trauma (accidents) to protruded upper incisors (front
teeth),
- correct harmful oral habits such as thumb- or finger-sucking,
- reduce or eliminate abnormal swallowing or speech problems,
- improve personal appearance and self-esteem,
- potentially simplify and/or shorten treatment time for
later corrective orthodontics,
- reduce likelihood of impacted permanent teeth (teeth that
should have come in, but have not), and
- preserve or gain space for permanent teeth that are coming
in.
- What is a space maintainer?
Baby molar teeth, also known as primary molar teeth, hold needed
space for permanent teeth that will come in later. When a baby
molar tooth is lost, an orthodontic device with a fixed wire is
usually put between teeth to hold the space for the permanent
tooth, which will come in later.
- Why do baby teeth sometimes need
to be pulled?
Pulling baby teeth may be necessary to allow severely crowded
permanent teeth to come in at a normal time in a reasonably normal
location. If the teeth are severely crowded, it may be clear that
some unerupted permanent teeth (usually the canine teeth) will
either remain impacted (teeth that should have come in, but have
not), or come in to a highly undesirable position. To allow severely
crowded teeth to move on their own into much more desirable positions,
sequential removal of baby teeth and permanent teeth (usually
first premolars) can dramatically improve a severe crowding problem.
This sequential extraction of teeth, called serial extraction,
is typically followed by comprehensive orthodontic treatment after
tooth eruption has improved as much as it can on its own. After
all the permanent teeth have come in, the pulling of permanent
teeth may be necessary to correct crowding or to make space for
necessary tooth movement to correct a bite problem. Proper extraction
of teeth during orthodontic treatment should leave the patient
with both excellent function and a pleasing look.
- How can a child's growth affect
orthodontic treatment?
Orthodontic treatment and a child's growth can complement each
other. A common orthodontic problem to treat is protrusion of
the upper front teeth ahead of the lower front teeth. Quite often
this problem is due to the lower jaw being shorter than the upper
jaw. While the upper and lower jaws are still growing, orthodontic
appliances can be used to help the growth of the lower jaw catch
up to the growth of the upper jaw. Abnormal swallowing may be
eliminated. A severe jaw length discrepancy, which can be treated
quite well in a growing child, might very well require corrective
surgery if left untreated until a period of slow or no jaw growth.
Children who may have problems with the width or length of their
jaws should be evaluated for treatment no later than age 10 for
girls and age 12 for boys. The AAO recommends that all children
have an orthodontic screening no later than age 7 as growth-related
problems may be identified at this time.
- What kinds of orthodontic appliances
are typically used to correct jaw-growth problems?
Correcting jaw-growth problems is done by the process of dentofacial
orthopedics. Some of the more common orthopedic appliances used
by orthodontists today that help the length of the upper and lower
jaws become more compatible include:
Headgear: This appliance applies
pressure to the upper teeth and upper jaw to guide the rate
and direction of upper jaw growth and upper tooth eruption.
The headgear may be removed by the patient and is usually worn
10 to 12 hours per day.
Herbst: The Herbst appliance is usually
fixed to the upper and lower molar teeth and may not be removed
by the patient. By holding the lower jaw forward and influencing
jaw growth and tooth positions, the Herbst appliance can help
correct severe protrusion of the upper teeth.
Bionator: This removable appliance
holds the lower jaw forward and guides eruption of the teeth
into a more desirable bite while helping the upper and lower
jaws to grow in proportion with each other. Patient compliance
in wearing this appliance is essential for successful improvement.
Palatal Expansion Appliance: A child's
upper jaw may also be too narrow for the upper teeth to fit
properly with the lower teeth (a crossbite). When this occurs,
a palatal expansion appliance can be fixed to the upper back
teeth. This appliance can markedly expand the width of the upper
jaw.
The decision about when and which of these or other appliances
to use for orthopedic correction is based on each individual
patient's problem. Usually one of several appliances can be
used effectively to treat a given problem. Patient cooperation
and the experience of the treating orthodontist are critical
elements in success of dentofacial orthopedic treatment.
- Can I still play sports while
wearing braces?
Yes. Wearing a protective mouthguard is advised while playing
any contact sports. Your orthodontist can recommend a specific
mouthguard.
- Will my braces interfere with
playing musical instruments?
Playing wind or brass instruments, such as the trumpet, will clearly
require some adaptation to braces. With practice and a period
of adjustment, braces typically do not interfere with the playing
of musical instruments.
- Why are retainers needed after
orthodontic treatment?
After braces are removed, the teeth can shift out of position
if they are not stabilized. Retainers provide that stabilization.
They are designed to hold teeth in their corrected, ideal positions
until the bones and gums adapt to the treatment changes. Wearing
retainers exactly as instructed is the best insurance that the
treatment improvements last for a lifetime.
- Will my child's tooth alignment
change later?
Studies have shown that as people age, their teeth may shift.
This variable pattern of gradual shifting, called maturational
change, probably slows down after the early 20s, but still continues
to a degree throughout life for most people. Even children whose
teeth developed into ideal alignment and bite without treatment
may develop orthodontic problems as adults. The most common maturational
change is crowding of the lower incisor (front) teeth. Wearing
retainers as instructed after orthodontic treatment will stabilize
the correction. Beyond the period of full-time retainer wear,
nighttime retainer wear can prevent maturational shifting of the
teeth.
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