ORTHODONTIC UPDATE OCTOBER 2009
RICHARD CY SHIN, DDS MS
DIPLOMATE, AMERICAN BOARD OF ORTHODONTICS
One of the most common questions that I get from the parents is “Doctor, when is the best time to start braces for my child?” I am sure that if either of the parents have had orthodontic treatment in the past, he or she would certainly want to make sure that the child is checked to see if they need orthodontic treatment or not.
Many parents are already confused by the mixed messages they received from many sources regarding the best time to start orthodontic treatment.
- Is it best to start treatment when just a few of the permanent teeth have erupted (usually between 7 – 10 years)?
- Or, when all of the permanent teeth have erupted (usually around 12-13 years)?
- Or, is it best to start in primary “baby” teeth (before any of the permanent teeth erupt, i.e. under 6 years)?
The answer is there is not one best time for every child! Each child presents with a unique problem and therefore each child will need a specialized treatment plan beneficial to him or her.
The American Association of Orthodontists recommends that all children have an orthodontic check-up no later than 7 years. Most children, by 7 years, would have reached key landmarks such as: 1) eruption of the front permanent teeth, 2) eruption of the back permanent teeth “six-year-old molars”.
The orthodontists can identify any key problems with the relationship of these permanent teeth and recommend either to start an Early Phase treatment. This is sometimes called Phase 1 treatment or Interceptive treatment. The goal of the treatment is to improve any dental problems that these permanent teeth might pose to the future growth and development of the developing permanent teeth and the jaws. Usually, the magnitude of the problem will be reduced and in some cases eliminated and greatly help in the Comprehensive orthodontic treatment stage when all of the primary teeth have been lost.
Here are some of the common examples of the malocclusions (“bad bites”) that I see in children in this clinic.
ANTERIOR CROSSBITE
Here you can see that one (often more) front tooth is coming out in front its counterpart on the top. This can be particularly damaging to the health of the gums of the teeth in crossbite, as well as to the bite.
POSTERIOR CROSSBITE
This time, the crossbite is in the back of the mouth, where the top teeth on one side are biting on the inside of the bottom teeth on that side. Left untreated, a posterior crossbite can cause a permanent asymmetry to the bite and to the face, because the crossbite forces the growing lower jaw to position itself to one side. This results in relatively more lower jaw growth on the side away from the crossbite and relatively less lower jaw growth on the side of the crossbite. Some studies have shown that an untreated crossbite can be a contributing factor in TMJ (temperomandibular joint) problems in an adult.
CROWDING
In this picture, we see severe crowding in the lower arch. Not only does such crowding look unsightly, but it is extremely difficult to clean efficiently and effectively around such crooked teeth. Poor oral hygiene will result in gum bleeding, bone loss and ultimately, tooth loss.
OPEN BITE
An open bite is often associated with habits such as thumb or finger sucking, mouth breathing or with disharmonious growth between the upper and lower jaw. Instead of the forces of eating and chewing being distributed amongst all the teeth, those forces in an open bite patient are only on the back teeth. Such uneven distribution of forces may result in gum and bone loss around the back teeth, tooth fracture, early tooth loss and future TMJ dysfunction. Quite often, open bite patients have associated speech problems.
PROTRUSION OF THE TEETH OR "OVERBITE"
Excessively protruding front teeth are obviously more prone to trauma. What a heartache it is to see that patient in our office with their front teeth broken off because of a fall or a sports injury. Children with upper tooth protrusion are commonly very self-conscious of their appearance.
RETRUSION OF THE TEETH OR "UNDERBITE"
An underbite is a condition where the upper jaw is too small and often too narrow to match with the size of the lower jaw, and consequently, when the upper teeth come in, they fall behind the lower teeth. Here again, we see uneven distribution of forces with resulting premature bone and tooth loss, as well as TMJ dysfunction. If not treated in a growing child, an underbite will usually require corrective jaw surgery in the late teens or early adulthood.
Note: Photos courtesy of the American Association of Orthodontists.
SUMMARY
Growth is critical for an ideal treatment result and it is the best helper available to the orthodontist to position of the upper and lower jaws. When the both jaws are in harmony, the erupting teeth will grow into the best possible position.
About the author:
Dr. Shin practices orthodontics and dentofacial orthopaedics in Los Angeles and in Anaheim, California. Dr. Shin includes early interceptive orthodontic treatment for children ages 7 to 10, adolescent and adult orthodontic treatment, employing growth modification techniques, traditional metal braces, and the self-ligating braces. He is also a certified provider of Invisalign, the invisible way to straighten teeth.
Dr. Shin received his initial dental training at the University of Otago in Dunedin, New Zealand. Since his graduation, he has worked as a dental officer in Palmertson North in New Zealand and in Sydney, Australia. He moved to the U.S. to further his clinical training at the University of Maryland in Baltimore, Maryland, where he completed his Advanced General Dentistry residency and the U.S. dental degree. Upon completing his second dental education at Maryland, he was accepted to the prestigious Vanderbilt University Medical Center in Nashville, Tennessee, to start a three-year orthodontics and dentofacial orthopaedics residency program. He was chosen as the Chief Resident in his third year where he helped to teach fellow residents. As part of the Craniofacial Anomalies Team at Vanderbilt, he also cared for the children with cleft and craniofacial deformities at the Children’s Hospital. After a series of written, clinical and oral examinations, Dr. Shin was recently given the honor of holding the title of the Diplomate of the American Board of Orthodontics.
Dr. Shin welcomes any questions or comments you may have about this article.