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The American Association of Orthodontists Recommends An Orthodontic Screening By Age 7

Why your child should get an orthodontic checkup no later than age 7.

Orthodontist can spot subtle problems with jaw growth and emerging teeth while some baby teeth are still present.

While your child’s teeth may appear to be straight, there could be a problem that only an orthodontist can detect.

The checkup may reveal that your child’s bite is fine. Or the orthodontist may identify a developing problem but recommend monitoring the child’s growth and development and then, if indicated, begin treatment at the appropriate time for the child. In other cases, the orthodontist might find a problem that can benefit from early treatment.

Early treatment may prevent more serious problems from developing and may make treatment at a later age shorter and less complicated.

In some cases, the orthodontist will be able to achieve results that may not be possible once the face and jaws have finished growing.

Early treatment may give your orthodontist the chance to:
• Guide jaw growth.
• Lower the risk of trauma to protruded front teeth.
• Correct harmful oral habits.
• Improve appearance.
• Guide permanent teeth into a more favorable position.
• Improve the way lips meet.

Through an early orthodontic evaluation, you’ll be giving your child the best opportunity for a healthy, beautiful smile.

Because patients differ in both physiological development and treatment needs, the orthodontist’s goal is to provide each patient with the most appropriate treatment at the most appropriate time.

Some signs or habits that may indicate the need for early orthodontic intervention are:
• Early or late loss of baby teeth.
• Difficulty in chewing or biting.
• Mouth breathing.
• Thumb/finger sucking.
• Crowding, misplaced or blocked out teeth.
• Biting the cheek or roof of the mouth.
• Teeth that meet abnormally or not at all.
• Jaws and teeth that are out of proportion to the rest of the face.

EARLY TREATMENT QUESTIONS
1. What is a space maintainer? Baby molar teeth, also known as primary molars, hold needed space for permanent teeth that will come in later. When a baby molar tooth is lost early, an orthodontic device with a fixed wire is usually put between teeth to hold the space for the permanent tooth, which will come in later.

2. Why do baby teeth sometimes need to be pulled? Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be clear that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called serial extraction, is typically followed by comprehensive orthodontic treatment after tooth eruption has improved as much as it can on its own.

After all the permanent teeth have come in, removal of permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and a pleasing look.

3. How can a child’s growth affect orthodontic treatment? Orthodontic treatment and a child’s growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being shorter than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help the growth of the lower jaw catch up to the growth of the upper jaw. Abnormal swallowing may be eliminated. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective surgery if left untreated until a period of slow or no jaw growth. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys. The American Association of Orthodontists recommends that all children have an orthodontic screening no later than age 7 as growth-related problems may be identified at this time.

4. What orthodontic appliances are typically used to correct jaw-growth problems?

Headgear appliance – This appliance applies pressure to the upper teeth and upper jaw to guide the rate and direction of upper jaw growth and upper tooth eruption. Headgear can be removed by the patient and is usually worn 10-12 hours per day. Patient compliance in wearing this appliance is essential for successful improvement.

Herbst and MARA appliances – The Herbst and MARA appliances are usually fixed to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward and influencing jaw growth and tooth positions, the Herbst and MARA appliances can help correct severe protrusion of the upper teeth.

Bionator, Frankel, Activator and Twin Block appliances – These removable appliances work in similar, but different ways, to hold the lower jaw forward and guide eruption of the teeth into a more desirable bite while helping the upper and lower jaws to grow in proportion with each other. Patient compliance in wearing this appliance is essential for successful improvement.

Palatal expander – A child’s upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth (a crossbite). When this occurs, a palatal expansion appliance can be fixed to the upper back teeth. This appliance can markedly expand the width of the upper jaw.

The decision about when and which of these or other appliances to use for orthopedic correction is based on each individual patient’s problem. Usually one of several appliances can be used effectively to treat a given problem. Patient cooperation and the experience of the treating orthodontist are critical elements in success of dentofacial orthopedic treatment.

5. I’ve just heard about the Herbst appliance. How could it help my son who has an underdeveloped lower jaw? For patients who have an underdeveloped lower jaw, it is important to begin orthodontic treatment several years before the lower jaw ceases to grow. One method of correcting an underdeveloped jaw uses an orthodontic appliance that repositions the lower jaw. These appliances influence the jaw muscles to work in a way that may improve forward development of the lower jaw. There are many appliances used by orthodontists today to treat underdeveloped lower jaws – such as the Frankel, Headgears, Activator, Twin Block, Bionator, MARA and Herbst appliances. Some are fixed (cemented to the teeth) and some are removable. You and your orthodontist can discuss which appliance is best for your child.

6. Can my child play sports while wearing braces? Yes. Wearing a protective mouthguard is strongly recommended while playing any contact sport. We can recommend a specific mouthguard during treatment and after treatment make you a custom mouthguard if you desire.

7. Will my braces interfere with playing musical instruments? Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing of musical instruments.

8. Why does orthodontic treatment sometimes last longer than anticipated? Estimates of treatment time can only be that – estimates. Patients grow at different rates and will respond in their own ways to orthodontic treatment. The orthodontist has specific treatment goals in mind, and will usually continue treatment until these goals are achieved. Patient cooperation, however, is the single best predictor of staying on time with treatment. Patients who cooperate by wearing rubber bands, headgear or other needed appliances as directed, while taking care not to damage appliances, will most often lead to on-time and excellent treatment results.

9. Why are retainers needed after orthodontic treatment? After braces are removed, the teeth can shift out of position if they are not stabilized. Retainers provide that stabilization. They are designed to hold teeth in their corrected, ideal positions until the bones and gums adapt to the treatment changes. Wearing retainers exactly as instructed is the best insurance that the treatment improvements last for a lifetime.

10. Will my tooth alignment change later? Studies have shown that as people age, their teeth may shift. This variable pattern of gradual shifting, called maturational change, probably slows down after the early 20s, but still continues to a degree throughout life for most people. Even children whose teeth developed into ideal alignment and bite without treatment may develop orthodontic problems as adults. The most common maturational change is crowding of the lower incisor (front) teeth. Wearing retainers as instructed after orthodontic treatment will stabilize the correction. Beyond the period of full-time retainer wear, nighttime retainer wear can minimize maturational shifting of the teeth.
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