Perfect Smiles::Right age for orthodontic treatment

Generally the first orthodontic consultation with a qualified ORTHODONTIST should be done when child’s first permanent incisors , usually lower central incisors, start erupting in the mouth i.e. at the age of about 7 years. At this first visit of the child to the orthodontist, the orthodontist evaluates the following things,

1	Whether the child’s jaws are growing in proportion to each other and with the cranium.
2	Whether the jaws are growing in proper direction without any obstruction.
3	Are the jaws wide enough to accommodate permanent teeth or whether they are growing sufficiently wide.
4	Are the teeth erupting in proper direction and place and whether there is sufficient space for their proper alignment.
5	Does the child have persistant oral habit like thumb sucking etc. and has it caused any abnormality of jaw growth or teeth alignment and arch shape.
6	Does the child has lost milk teeth early due to cavities and if so, then it’s space is maintained or is being lost.
7	General oral hygiene pattern, speech development, facial expressions and tonicity of oral and facial musculature is checked.

INDICATIONS OF EARLY ORTHODONTIC TREATMENT

After complete evaluation of your child , the Orthodontist may suggest to begin with early Orthodontic treatment in following circumstances.

1

PREMATURE OR EARLY LOSS OF MILK TEETH

Milk teeth serve a very important function of preserving the space for the succeedeneous permanent teeth. Hence they should be maintained in good shape and place till the permanent successors are fully formed and start erupting in the mouth. Teeth follow a particular time table and sequence of eruption and shedding.

In the event of early loss of milk tooth due to dental decay, the adjacent and opposing teeth migrate to obliterate or close the space . This decreased the arch length which is available for proper alignment of permanent teeth . This results in occurrence of crowding of permanent teeth or they may be completely locked inside the bone due to lack of space.

herefore, when a milk tooth, particularly milk molar, is lost early, the orthodontist will prescribe an appliance called SPACE MAINTAINER The space maintainer is fabricated and cemented in the space where the milk tooth is lost. It stays there till the permanent successor starts erupting in the mouth and then it is removed. There are different types of space maintainers depending on the site and number of teeth lost.

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2

ANTERIOR OR POSTERIOR CROSSBITE

Normally upper teeth are little outside or labial to the lower teeth which gives normal overjet and overbite seen in ideal dentition. If upper front or back teeth erupt little inside or lingual to the lower teeth, the situation is called crossbite.

Crossbites should be corrected early because they may influence the normal growth and development of the jaws.

Anterior or front tooth crossbites can be usually corrected with a removable plate with a spring. Posterior or back teeth crossbite can be corrected with a removable plate with an expansion screw.

In a child the correction is rapid provided the child wears the appliance as per the instructions. Once the correction is complete the child may be asked to discontinue wearing the plate or wear it for few hours only, for stabilization.More complicated crossbites may require short term treatment with fixed braces.

Before treatment After treatment

3

PROTRUDED UPPER INCISORS OR FRONT TEETH

Protruded upper front teeth need to be corrected early to prevent trauma to them in case of a facial injury and to elevate self esteem of a child who may feel inferior to others due to buck teeth.

The treatment generally is done with short term ( Phase 1 ) fixed braces followed by a removable retainer.

4

PERSISTANT ORAL HABITS

Oral habits like thumb sucking or finger sucking develop in a child as a self assurance or defensive phenomenon. Usually such habits discontinue by the age of 4 years. But in some children they may continue even after the eruption of permanent teeth. These persistant habits may lead to jaw deformity, protruded and crowded teeth and abnormal orofacial muscular development.

When diagnosed, its important to actively discontinue the habit to avoid further damage to orofacial structures.

The habit breaking appliance consists of a removable plate with some wire configurations which will help the child to discontinue the habit. In resistant cases, fixed habit breaking appliance is put to correct the habit. Along with the appliances it’s very important to provide continuous counseling and assurance to the child to help him tackle psychological trauma associated with the habit breaking therapy.

Open bite due to thumb sucking After treatment

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5

ABNORMALITY IN THE GROWTH OF THE JAWS

Growth of the facial skeleton follows a particular gradient. Generally the upper jaw grows ahead of the lower jaw and the growth continues till adult facial proportions are achieved.

Sometimes a child’s upper or lower jaw may show faster or slower growth than the other. This may lead to either undergrowth or overgrowth of one or both the jaws. The cause may be hereditary tendency or certain other factors like persistant habits etc. If undiagnosed in the growing stage of a child this may lead to a full blown jaw deformity in adulthood.

When diagnosed during growing stage, the facial growth of a child can be redirected to give him ideal or near ideal facial proportions as governed by the genetic make of the individual.

The orthodontic appliances which are used for such treatment are called myofunctional appliances. They may be removable or fixed depending on the individual requirement and can treat variety of problems like under / overgrowth of the jaws.

Removable Twin Block Fixed “ Forsus” appliance

After the Phase 1 or early orthodontic treatment the child is kept on a retainer appliance till he is ready for comprehensive treatment with fixed braces. Even after doing phase 1 treatment many children will require phase 2 treatment with fixed braces. But now the treatment becomes much more simplified and the results are more satisfactory.

A comprehensive orthodontic treatment with fixed appliance is ideally started just before the shedding of few last milk teeth and when permanent canines and premolars are just about to erupt. At this stage ( Age 11 – 12 years ), in addition to correcting present crowded or bucked incisors, newly growing teeth can be guided to erupt in ideal locations thereby expanding contracted arches and generating spaces for the alignment of new teeth.

Though age 7 to 12 years may be ideal age to begin orthodontic treatment, the treatment can very well be done in older individuals with equal results. The orthodontic treatment can be done till the age of more than 50 years as long as the condition of the bone surrounding the teeth is healthy.

• After phase 1 or early Orthodontic treatment, the child is kept on a retainer appliance till he is ready for comprehensive treatment with fixed braces. Even after doing phase-1 treatment, many children will require a phase-2 treatment that involves fixed braces. But now the treatment becomes much more simplified and the results are more satisfactory.

• A comprehensive Orthodontic treatment with fixed appliance is ideally started just before the shedding of few last milk teeth and when permanent canines and premolars are just about to erupt. At this stage (age 11–12 years), in addition to correcting present crowded or bucked incisors, newly growing teeth can be guided to erupt in ideal locations thereby expanding contracted arches and generating spaces for the alignment of new teeth.

• Though age 7-12 years may be the ideal age to begin Orthodontic treatment, the treatment can very well be done in older individuals with equal results. The Orthodontic treatment can be done till the age of more than 50 years as long as the condition of the bone surrounding the teeth is healthy.

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