Early Orthodontic Treatment

What is early or interceptive orthodontic treatment?

This is a form of orthodontic therapy also called phase 1 which attempts to intercept developing problems before they become more severe and harder to correct in the permanent dentition. There are times that children exhibit signs of teeth crowding or jaw problems as they are growing. Children between ages of 6 to 10 years are excellent candidates for early orthodontic care because it takes advantage of the patient’s physical growth potential at a stage when they are growing at a rapid rate. The primary goal of the first phase is to develop a solid foundation for the teeth.  Periodic recall appointments are set in order to check the progression of jaw growth and permanent tooth eruption. For this purpose, appliances can be utilized to direct the growth of the jaws and improve teeth alignment.

In summary, early treatment can reduce the cost, duration and complexity of comprehensive orthodontic treatment.

Which orthodontic problems need early examination and interceptive treatment?

• Injury-prone dental protrusions or commonly known as severe “overbite” or “buck teeth”.
• Prominent or protrusive lower jaw relating in positioning of lower teeth in front of upper teeth or “under-bite”.
• Narrow upper jaw or “cross-bite” (i.e., when the upper teeth bite inside the lower teeth).
• Open-bite which refers to the condition when the front teeth do not touch while biting down on the back teeth.
• Early or late loss of baby teeth.
• Thumb or finger sucking.
• Crowding, misplaced or blocked out teeth.

What are the benefits of early treatment?

Early or interceptive orthodontic treatment offers several potential benefits outlined below:

• When a facial/skeletal imbalance is the cause of the orthodontic problem, early treatment can guide the growth of the jaw.
• Disharmonies of the teeth and the jaws corrected earlier can have a better long-term stability.
• Space gaining and guidance of incoming permanent teeth into proper position at an early age, can shorten the time spent in full braces later and can eliminate the need for removal of permanent teeth and/or corrective jaw surgery.
• When the front teeth stick out abnormally, accidents can cause severe damage to these teeth. Early treatment will lower risk of trauma (accidents) to protruded upper incisors (front teeth).
• Thumb or finger-sucking habits have a pronounced adverse effect on the alignment of the teeth. Early elimination of these habits not only can greatly improve teeth function but can also improve future swallowing and speech problems.
• Severe orthodontic problems such as “buck teeth” can have a negative social and psychological effect in a child’s life. Early correction can help with their confidence and self-esteem among their peers.

What is Phase 2 orthodontic treatment or comprehensive orthodontic treatment?

Often, at the end of the first phase, the teeth are not in their final position. This will be accomplished during the second-phase. The treatment begins when all the permanent teeth have erupted and consists of straight-forward orthodontic therapy (i.e., braces on all teeth) that will accomplish the final alignment of the teeth. Some patients may even not need to go through this second phase if the main problem was resolved in the first phase.

The major advantage of two-phase therapy is to maximize the opportunity to guide jaw growth and tooth eruption. Optimizing the treatment with the correct timing of the child growth and development is of utmost importance in these cases. 

In summary, instead of one comprehensive course of treatment as a teenager, the idea of two phase treatment is to allow the young, growing, child to have some problems solved early and prevent them from suffering with these problems through the years waiting on teeth to erupt and the face to grow. The typical age when full treatment is started is age eleven to thirteen. With phase one treatment, problems are treated between age seven and ten, so the child and the parents do not have to wait until the usual age of orthodontic treatment.

When is the best time to start interceptive orthodontic treatment?

There is no best answer to this question because each orthodontic problem determines its own best starting time in terms of improvement that can be achieved with the least time and expense.

Ages 3 through 6

This age of development includes the children in the primary dentition "baby teeth", or until the eruption of the permanent incisors (front teeth) and first permanent molars. At this young age, severity of the problem will dictate the necessary treatment.

• Preventive treatment, such as space maintenance in a patient with premature tooth loss (i.e., caused by an infected tooth), may be required.
• Controlling harmful habits such as finger or thumb sucking is best done before the eruption of the permanent teeth, in the primary dentition, depending also on the child's willingness to stop.

In general, the treatment during this age period is kept simple, since the child has a limited understanding of the problem and limited ability to comply with treatment.

Ages 6 through 12

This age of development following the eruption of the permanent incisors (front teeth) and first permanent molars (six year molars), is commonly referred to as the "mixed dentition stage". This age represents an excellent time for the correction of dental and skeletal problems because:

• During this time many permanent teeth will erupt and guidance of this eruption can facilitated the correction of many malocclusions.
• The bones and muscles are growing rapidly and the treatment can take advantage of the patient’s physical growth potential
• Psychological development, understanding of treatment goals and patient cooperation is most improved during this time.

Problems that are commonly treated during this stage of development include:

• over-bites: protruding front teeth (lower jaw is behind the upper jaw)
• under-bites (lower jaw is in front of upper jaw)
• open-bites (the anterior teeth fail to meet)
• cross-bites (the upper teeth are inside the lower teeth)

Other problems that can be treated during this time period are prolonged thumb and finger sucking habits, abnormal swallowing habits, mouth breathing, excessive tooth crowding.

Treatment planning for these individuals usually emphasizes correction of either skeletal problems (orthopedics), dental problems or both. Custom made appliances are designed according to the problem being treated. They may be removable or fixed. Treatment modalities during this stage of development strive to correctly align the teeth and jaws so that the remaining facial growth will be balanced. Following this early treatment phase, the possibility exists that the patient may never need braces once all his permanent teeth erupt, or if braces are needed during adolescence, the length of treatment is can be shortened.

Why is interceptive orthodontic treatment important?

Every parent wants their child to have a beautiful smile. Early orthodontic treatment can enhance your child’s smile, but the benefits far surpass appearance.

Untreated malocclusions ("bad bites") may contribute to conditions that worsen with age. Crooked and crowded teeth are hard to clean and maintain, which may contribute not only to tooth decay but eventual gum disease. Other orthodontic problems can cause abnormal wear of tooth surfaces, excess stress on the supporting bone and gum tissue, or even misalignment of the jaw joints with resultant chronic headaches or pains in the face and neck.

The importance of an attractive smile should not be under estimated. A pleasing appearance is a vital asset to one's self-confidence, and a child's self esteem often improves as treatment brings teeth, lips and face into harmony. In this way, early orthodontic treatment gives the child a sense of control because it provides an opportunity to participate in the improvement of his or her appearance.

Often parents think that nothing can be done before all the permanent teeth erupt. This is a common misconception. The answer is an emphatic NO! The maximum growth spurt of the child is generally before all his permanent teeth erupt. In many cases, this growth spurt can be used to greatly reduce the problem of your child. If we wait until the jaws have finished their growth, the complexity of treatment can be increased.

Encouraging good dental health habits and providing professional dental care at an early age produce benefits that will last your child a lifetime. Remember, your child should begin regular visits to the pediatric dentist at age 1. Periodic visits and follow-up, will allow the maximum opportunity to prevent future problems from developing and to provide corrective treatment at the best age for your child to have the most beautiful and healthiest smile possible.

What are the steps before treatment begins?

Diagnostic Records

If treatment is indicated, diagnostic records will need to be taken. At this appointment, impressions for study models, facial and intraoral photographs, and orthodontic x-rays are taken. These records will help to determine what problems are present.

Consultation Appointment

At the consultation, findings from the diagnostic records, specific orthodontic problems, and detailed treatment plan(s) are presented. Anticipated treatment time, financial arrangements, and patient responsibilities will be discussed. The fee for your treatment and convenient payment plan will be discussed. We welcome patients with dental insurance, and we will make every effort to see that you receive your maximum benefits. Also, at this time, appointments will be made to start treatment.