Early treatment in orthodontics is called interventional orthodontics. It is usally completed around 8-10 years old. Although people feel many more kids these days start orthodontics earlier, it is something that has always been around. Most people just don’t notice it until they have kids or family members around the early intervention years. Only about 10-15% of the population would benefit from early intervention. My office is very conservative and we try not to do early intervention unless we truly need to. We recommend early intervention at a rate of about 5-7% of our patients. We frequently put the patients on a growth and development recall. I will frequently, if I can justify it, hold off until the patient is ready for full comprehensive treatment. The reasons early treatment is indicated falls into a couple of specific categories. If the patient has an underbite, psychosocial, overbite, cross-bite, habit, or ectopic eruption
Let me breakdown these categories to understand the benefit of early treatment.
The most common reason for early treatment is a patient is self-conscious about their smile. If a younger patient comes in and they are getting bullied in school or they don’t like to smile because they don’t like the look of their teeth, my team is here to help. We can do limited treatment to address the main concern earlier in order to help boost the patient’s confidence.
If a patient has an underbite, it is sometimes due to the upper jaw growing less than the lower jaw. As a result the lower teeth stick out in front of the upper teeth. The upper jaw grows forward first around the ages of 8-10 years old and then it slows in growth while the lower jaw grows. If a patient younger than 10 has an underbite, then I want to help speed up the growth of the upper jaw to catch up with the lower jaw. I have a few appliances that can help with this. If we wait too long and don’t do early treatment, then the underbite may remain or potentially get worse. After a certain age early treatment won’t help and the patient will have to wait until they are skeletally an adult and may need surgery or extractions to correct the underbite.
If a patient has an overbite or “buck” teeth that stick out, we will also offer early treatment. The main reason is kids that are active playing sports or playing outside, those teeth can take the brunt of a fall or a ball to the face. As a result, they can fracture and require restorative care with a general dentist. I can reduce the risk of this by aligning the front teeth so that the stress is shared by all the front teeth rather than just 1 or 2 teeth.
A cross-bite is when teeth erupt in such a way that they are out of position and the bite doesn’t come together in the same way. A cross-bite in the back, the top teeth should be on the outside of the lower teeth but they are instead on the inside. The reason this is treated early is due to the suture on the upper jaw. The suture is soft until the age of 10-11 for most patients and then it begins to fuse. My team can broaden the upper arch to correct the cross-bite before it fully fuses. If we wait too long, the suture fuses and would have to be re-opened surgically. Many patients with cross-bites in the back have narrow upper jaws. When we widen the jaw, it also helps widen the nasal airway. I will frequently hear parents tell me their son or daughter stopped snoring or they are breathing better. If they have a cross-bite in the front, we want to help the teeth erupt normally so they don’t wear or fracture. You only have one set of adult teeth and we want to protect them as much as possible.
Many infants and toddlers have self-soothing mechanisms such as a blanket, stuffed animal, and/or a pacifier. Many kids will rely on their thumb to provide a similar soothing effect to help with stress or to calm down when sleeping. Sometimes this habit persists throughout the night and despite the best efforts by the parent and their child, they are unable to break the habit. Teeth are pushed around by the forces that act upon them. As a result the habit will cause the teeth to flare, crowd, or create a cross-bite. We use many ways to help kids, teenagers, and adults with such habits so it doesn’t affect the presentation and function of the teeth.
Ectopic eruption is when a tooth is developing and heading off course. As a result it can damage surrounding teeth or result in a smile the patient may not like. I will sometimes intervene early when necessary to help when this occurs.
My office like the first new patient consult to be around the age of 8. 95% of the time the patient is initially put on a growth and development recall. This means we will bring the patient back every 6-12 months to watch them grow and monitor eruption until they are ready for full treatment if it is indicated. I frequently watch kids grow for years and then don’t recommend treatment because the smile and bite look great. I would rather do that than not see then until they are 15 and then I realize that I missed out on doing phase I treatment. We provide free new patient consults because we don’t want people to avoid an evaluation because of money. We don’t charge anything to a family until we are starting active treatment.