When is a good age for my child to start braces?

This article answers some commonly asked questions that parents have about when their child should see a dentist or seek orthodontic treatment.

When is a good age for my child to see a dentist?

Age one.

The American Academy of Pediatric Dentistry (AAPD) recommends that a child go to the dentist by age one or within six months after the first tooth erupts. At six months of age, the two lower front teeth begin to erupt. Around age one, your dentist can evaluate the condition of your child's teeth and give recommendations on daily oral hygiene and routine dental care.

When is a good age for my child to see an orthodontist?

Age seven.

The American Association of Orthodontists (AAO) recommends that a child see an orthodontist by age seven. At that age, the orthodontist can evaluate your child's jaw and facial growth patterns, as well as tooth development and bite. Around age seven, your orthodontist can evaluate any dental malocclusion and give recommendations on the best time to start orthodontic treatment. Your orthodontist can help you monitor the eruption of your child's permanent teeth and jaw development.

When is a good age for my child to start orthodontic treatment?

It depends.

Orthodontic treatment varies from child to child. Some children may not need any orthodontic treatment until age 11 or 12. These children may have good jaw and facial growth and only need orthodontic treatment to correct the teeth and occlusion. Other children may need early orthodontic treatment to change the jaw features.

Genetics may dictate a non-favorable jaw relationship, and these children may need interceptive treatment, such as jaw expansion. This jaw modification during growth creates space and reduces the chances of needing jaw surgery later on. Early orthodontic treatment, when required, is usually recommended around age 7 to 10.

A review on development of permanent teeth:

At age six, lower permanent incisors grow in. At age seven, the first back permanent molars grow in. Sequentially other teeth such as canines and premolars erupt in both the lower and upper jaws. When permanent teeth start to grow in, this is a good time to schedule a consultation with an orthodontist.

Why you shouldn't wait to seek orthodontic treatment:

Most parents wait until they think their child needs braces. Then they make an appointment. However, waiting is not a good solution. You can miss out on many available treatment options that are more effective while the jaw is still growing, or before all the permanent teeth are in place. For example, without adequate space, many permanent teeth may fail to come in. The longer you wait, the denser the bone quality and the more slowly teeth erupt.

Waiting can make the face look worse. Since genetic make-up already dictates how the face will grow, you should seek an orthodontic consultation at the first signs of possible problems. Waiting will not reverse growth patterns - they will need orthodontic intervention eventually, and the longer you wait the harder it will be. In addition, older children are less compliant to follow treatment regimens than younger children. Preteens and teens are less willing to wear headgear, expanders, a facemask or rubber bands. They may want braces off quickly before treatment is fully completed.

An early orthodontic evaluation will also allow you more flexibility, not just with treatment planning, but also with financial planning.

At Care Orthodontics, Dr. Nancy Phan provides complimentary consultations and follow-up visits. At these visits, she will check your child's bite and make specific recommendations on when and what needs to be done.

In the follow-up visits, she monitors teeth that are delayed in eruption and verifies any factors that contribute to a bad occlusion. Depending on the diagnosis, she will give you recommendations on whether to pursue orthodontics now or in the future.

Dr. Nancy Phan has been providing orthodontic treatment for children and adults in San Jose and the surrounding Bay areas for over ten years. Schedule a complimentary consultation for your child by calling our office at (408) 971-2885. Check out our website for other beneficial information and educational videos at www.CareOrthodontics.com.

Does my child need a palatal expander?

Some parents are concerned when seeing many crooked teeth in their child’s mouth, and often ask if a palatal expander would be beneficial. The answer is, it depends. A child should be seen by an orthodontist to evaluate the size, shape, and bite of the mouth to determine if an expander is indicated.

What is an expander? It is a custom-fitted dental device that is made by 2 metal halves joined together by a small screw. When turned, the screw opens slowly to widen the width of the upper jaw.

  

When is palatal expander used? A palatal expander can be used on a child or an adult to correct a bad bite, sometimes referred as a "cross-bite." It is also used to widen the maxilla. Anatomically, the upper jaw and roof of mouth are together know as a maxilla. In some individuals the maxilla is narrower than normal and causes the upper teeth to fit abnormally inside the lower teeth when biting down known as a "cross-bite." A cross-bite may restrict the amount of space available for the permanent teeth to erupt. A cross-bite can also cause the lower jaw to shift lopsided when biting down creating facial asymmetry.

In a child, there is a window of opportunity to correct a cross-bite non-surgically. Since the maxilla is made up by 2 pieces of bones connected in the middle by a seam of cartilage, this cartilage is soft and can be stretched by a palatal expander. Once puberty hits, on average round age 12-14; this cartilage hardens into bone. The 2 pieces of maxilla bones fuse together and cease to expand. Any expansion has to be done through surgery.

In adults, jaw expansion works through jaw surgery via a cut through the roof of the jaw, then a palatal expander separates the bones, bone fills in the expansion gap, and finally bone healing occurs 3-4 months later to stabilize the new jaw.

Why is palatal expander used? The expander is used to correct a one-side cross-bite or two-side cross-bites and to widen the roof of the jaw. In a child, the expander fixes the bad bite, prevents unsymmetrical facial growth, prevents uneven wearing of teeth, and gains space to allow ease of eruption of permanent teeth. In adults, using an expander establishes balanced occlusion, prevents uneven enamel wear, and corrects facial asymmetry.

Does it hurt to wear an expander? Insertion of an expander does not hurt except for turning the appliance. One can feel some tight pressure around the base of the nose and the roof of mouth a few minutes after the expander has been turned. An expander does alter speech and swallowing for 1-2 weeks until the tongue adjusts to the new device.

How long is the expander turned? In general the expander is turned for 1 to 2 weeks while being monitored by an orthodontist. After that, the expander is left in the mouth for an average period of 6 months for bones and tissues to adapt.

In summary, a palatal expander is beneficial when indicated. Although it is non-invasive to separate the maxilla bone with an expander, it must be done before puberty. Discovering this type of malocclusion early is one of the many reasons the American Association of Orthodontists recommends a child to see an orthodontist by the age of 7. It is much easier for parents to have a consultation with an orthodontist to survey their child's bite problem, discuss options, and plan the course of treatment early than dealing with complicated options which may require pain and surgical intervention later on.

At Care Orthodontics, we are here to help. Dr. Nancy Phan can provide a complimentary consultation to answer your questions at (408) 971-2885. You can also find other beneficial information on our website at www.CareOrthdontics.com.