| Early Orthodontics May Mean Less Treatment Later
Look at yearbook or prom pictures from the 1950s or '60s and you'll see many smiles framed with heavy metal braces. It's a sight that's less common in high schools today. Why the change? Children today tend to get braces at a much earlier age. Some patients with special problems begin orthodontic treatment at age 7 or younger.
"The American Association of Orthodontics (AAO) recommends that all children receive an orthodontic screening by age 7," says Thomas Cangialosi, D.D.S. "Permanent teeth generally begin to come in at age 6 or 7. It is at this point that orthodontic problems become apparent.
"Because bones are still growing, it's an ideal time to evaluate a child and determine what orthodontic treatment, if any, may be needed either now or in the future," Dr. Cangialosi says.
Dr. Cangialosi is chairman of the Section of Growth and Development and director of the Division of Orthodontics at Columbia University College of Dental Medicine.
To make braces more acceptable to young people, manufacturers have made brightly colored elastics. These are the tiny rubber bands that hold the wires to the braces. Children can choose elastics with their school colors or a holiday color scheme, such as orange and black for Halloween.
Choosing the color of the elastics allows patients "to feel that they are more involved in their treatment," Dr. Cangialosi says.
Braces today tend to be less uncomfortable and less visible than they used to be. But they still take some getting used to. Food can get caught in the wires, and flossing and brushing can take more time. After adjustments sometimes the teeth are a little sore. Tooth discomfort can be controlled by taking a pain reliever, such as ibuprofen (Advil, Tylenol and others) or aspirin if necessary. The use of lighter and more flexible wires has greatly lessened the amount of soreness or discomfort during treatment.
As more and more children get braces, school-yard nicknames such as "tin grin" and "metal mouth" are heard less often. Because treatment has become more socially acceptable, social embarrassment may be less of a concern.
Orthodontic treatment in young children is known as interceptive orthodontics. Intervention may begin as early as age 6 or 7. At this age, teeth are still developing. The jaw is still growing. That means certain conditions, such as crowding, may be easier to address.
Before permanent teeth have come in, it may be possible to help teeth to erupt (emerge through the gums) into better positions. It's common, for example, for the dental arch to be too small to fit all of the teeth. A few decades ago, the solution for crowding was almost always to extract some of the permanent teeth. Then fixed braces were used to position the teeth properly.
Early intervention takes advantage of the fact that a child's jaw is still growing. For example, a device called a palatal expander may be used to expand the child's upper dental arch. Once the arch is the proper size, there's a better chance that the adult teeth will emerge in better position. If all teeth have erupted and there is still a great deal of crowding, some permanent teeth may still have to be extracted to align the teeth properly.
So-called early treatment also may be useful when the dental arches and jaws are not in the correct position. Certain types of appliances may fix or improve these problems. More treatment usually is needed later on, but it may be shorter and less involved.
"It is important to note that children who receive interceptive orthodontics generally still need braces or other orthodontic appliances later," Dr. Cangialosi says. "However, this early treatment may shorten and simplify future treatment in selected cases." This is commonly known as two-phase treatment.
It is important to note that early treatment does not apply to all orthodontic problems. However, it may help in certain selected cases.
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