A mouth full of train tracks used to be just another rite of passage for teens, but these days, it’s more common to see elementary school kids sporting a tin grin, as some orthodontic treatments are beginning at an earlier age.
With a price tag in the thousands, the need for braces is usually a pronouncement every parent dreads, bringing to mind the geeky metal smiles and headgear of years past.
But better materials and new treatment strategies are making braces work more effectively these days, while giving the patient more options as to how they look while in treatment.
Here are the basics every parent needs to know:
When should a child be screened?
The American Association of Orthodontists recommends screening children be at age 7, around the time when their permanent upper teeth are coming in.
“We are trying to pick up on things that may be way out of line and trying to find things that may affect their growth or smile,” says Dr. Robert Bray, president of the American Association of Orthodontists. “This doesn’t mean every child will need to be treated that young; it depends upon the patient.”
How do braces work?
Orthodontic braces apply gentle pressure to teeth to slowly move them in a way that will improve their appearance and function.
Braces used to be for teens, so why are kids getting braces at an earlier age?
“The trend began about 15 to 20 years ago, when it was determined that early intervention could help in some specific cases,” says Bray. For example, thumb sucking can create a functional problem that affects permanent teeth or the bone structure of permanent teeth. Though some treatments are beginning earlier, the average age of treatment is about 12.
What is a two-phase treatment plan?
A first phase of treatment is sometimes recommended at an early age to correct the position and shape of the upper and lower jaws to help align teeth and give them room to fit better in the mouth. Then the braces come off, and there is a vacation of several months to several years before the next phase begins. The second stage of braces helps refine and align the teeth.
How can a parent know for sure a child needs braces?
If you are seeing a problem in your child’s mouth, such as overcrowding or a severe overbite, see a specialist and listen to what she has to say, Bray advises. Most orthodontists will take photographs and tell you what needs to be improved.
“If you have doubts, or if something doesn’t make sense, you can certainly get a second opinion,” says Bray.
If your child is being made fun of or has low self-esteem because of the appearance of his teeth, that is also a valid reason to consider braces, experts say.
How have braces improved over the years?
Today, instead of the metal bands that wrap each tooth, orthodontists have a number of tools to choose from. The most commonly used and least expensive are metal brackets that attach directly to the teeth. Wires that run through the brackets are held in place by tiny round rubber bands and apply gentle pressure to move the teeth. Colored rubber bands and even metal brackets in the shape of hearts, footballs and flowers can allow the child to personalize his look.
There are several more expensive options that may used, depending on what needs to be corrected. Tooth-colored ceramic brackets lessen the look of braces. Self-ligating braces are metal brackets that do not require rubber bands to hold the wires. Lingual braces fit behind the teeth. Clear aligners like Invisalign are trays worn over the teeth.
How do new braces materials affect treatment plans?
“The change is not so much in shortening treatment plans. You have to be careful with that because if the treatment is too short, there is danger of a relapse,” says Dr. Richard Mariani, a practicing orthordontist since 1983. But new materials have changed treatments in other ways. Mariani says self-ligating braces can spare someone with a severely overcrowded mouth the necessity of having teeth pulled.
Mouths respond differently to these braces, which do not require rubber bands to hold the wires to the brackets, and work without stressing the tissue or bone or hurting teeth, he says. The downside is they cost 50 to 100 percent more than metal brackets.
What is the risk of not getting treated?
If teeth are really crooked, they may be hard to clean around, eventually affecting the strength and durability of the teeth. It may make chewing food difficult or put the child at risk for jaw problems.
What can affect the rate of success?
The patient has to do what he is supposed to do—take care of his teeth, follow instructions and avoid food that can break appliances (wires and brackets).
“What’s hard about orthodontics is that there are facts you can’t control,” Mariani says. “You have to guess how the child is going to grow and guess how compliant he is going to be.”
What is the average length of treatment?
About two years. But if the patient is not compliant, they’re eating the wrong things, appliances are breaking or they’re not taking care of their teeth, it can be longer. “You may have to cut the cord eventually, because there may be a danger of calcifications, gum problems, gingivitis,” Mariani says.
What should a parent ask on a first visit to an orthodontist?
“First listen, and hear the [orthodontist] out, without worrying about the time or cost,” says Bray. “Then ask, ‘What absolutely needs to be done now, and what can be done later?’”
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Julie Landry Laviolette is a freelance writer.