Racing Toward Braces
When should your child visit the orthodontist?
by Gina Roberts-Grey

PARENTGUIDE NEWS April 2007

Brad Devlin is 9 years old. He plays little league and occasionally fights with his little brother. Brad also has been in braces for almost six months. It seems that more and more children are having braces put on their teeth before they reach double digits. Pallet expanders and spacers are swiftly becoming commonplace childhood accessories among children as young as 9.

When to begin?
The American Association of Orthodontists recommends that children be seen and screened by an orthodontist at age 7. Dr. Theresa Shaver, D.D.S., MS, of Aurora, Colorado has practiced orthodontics for more than ten years, and has treated nearly 5,000 patients. Dr. Shaver explains, “The purpose is just to get an idea of the child’s development and begin to think about the future rather than begin treatment.”

While 7 is the recommended age, the reality is that more children are seen around age 9. “This makes more sense because, truthfully, you can’t do much to a 7 year old in terms of treatment, as their faces, jaws and teeth are still developing so rapidly,” adds Dr. Shaver. Also take into consideration how much a young child can tolerate with orthodontic care. “The two years between ages 7 and 9 makes a big difference.”

The need to see the orthodontist is usually determined by a general dentist because he has been seeing your child since before an orthodontic need arose. If your dentist notices an abnormality that may respond to orthodontia, he can assess your child’s case and suggest referring him to an orthodontic specialist.

Your wallet may be happy to know that the current industry standard in orthodontia is to provide consultations at no charge. Most orthodontists will not suggest or prescribe treatment that is not absolutely necessary, and understand that doing so is not worth it in the long run. In addition, many orthodontists will continue to periodically see a child who will likely need future orthodontic treatment at no charge until that child is ready for treatment.

Should you be recommended?
Many parents wonder whether they should seek orthodontic treatment on their own or if their child’s dentist will refer them to an orthodontist. Orthodontic specialists agree that not all dentists automatically refer children to an orthodontic specialist. “Some dentists have received some orthodontic training and may do initial screenings themselves. They may even perform minor orthodontic procedures, thus they do not refer the simple cases out of the office,” says Dr. Shaver.

Other dentists may not have established a relationship with orthodontists in their area or may not know to refer patients to an orthodontist. “A dentist’s orthodontic knowledge depends on the extent that the dental school they attended kept up with ongoing professional education,” adds Dr. Shaver.

Regardless of whether your family dentist recommends a screening, orthodontists stress the need for parents to seek out a consultation.

Bracing in stages
Patients need to have their teeth and gums in good shape before orthodontic intervention and should have any oral health issues addressed prior to wearing orthodontia. “This is especially important when dealing with tooth decay because if a tooth has decay and braces are placed on it, there are chances the tooth could decay or need a root canal, etc.,” says Dr. Greg Welch, D.D.S., of Henderson, Nevada.

Dr. Welch also says orthodontic intervention can be accomplished in phases. “If a child’s bite is not good, it can be corrected during the ages of 6 and up, when they are still developing. When the bite is corrected, it can decrease or eliminate the need for further treatment,” says Dr. Welch.

Although a great deal of “phase one” is performed before a child loses all of his baby teeth, the next phase of orthodontics is determined when all of the baby teeth are gone.

“Now the industry is returning to the practices of determining if the child’s situation can be treated equally well with one set of braces at a slightly older age, when they are generally more ready to deal with the responsibility of dental care, not losing retainers, etc.,” explains Dr. Max Anderson, D.D.S., a national oral health consultant with Delta Dental Plans Association.

Does age factor into braces?
Dr. Anderson says age definitely plays a pivotal role in bracing a child’s teeth. “Most children will normally lose their primary molars as their adult premolars erupt. This usually occurs around 10 and a half, although it could occur sooner or later. Look to when your child starts to lose his primary molars as an indicator that it might be time for an orthodontic consultation.”

Starting treatment depends on three main factors: when the child’s adult teeth come in, how the child will tolerate treatment and orthodontic care, and the severity of the problem.

Does family history factor into the need for braces?
The answer depends on who you ask. Some dentists and orthodontists say heredity is a definite factor while others caution that just because a parent or sibling needed braces doesn’t always imply a young child will as well.

“People inherit teeth and jaw problems just as they inherit eye color or bone structure. We see many patients with genetic family traits, ranging from a gap between front teeth to jaw structure,” says Dr. Welch.
Yet, the need for braces can be affected by outside influences as well, such as if a child breathes through his mouth, sucked his thumb or has other habits affecting dental health.

Gina Roberts-Grey is a freelance writer.