Orthodontic treatment is a common procedure for children, aiming to achieve a healthy, functional bite and a well-aligned smile. The process involves systematically moving teeth and sometimes modifying jaw growth to correct alignment issues, known as malocclusions. These problems can affect chewing, speech, and overall oral health. Determining the appropriate age to begin treatment is highly individualized, depending on the specific developmental needs of the child.
Recommended Age for the First Orthodontic Visit
The American Association of Orthodontists recommends that children have their first orthodontic evaluation no later than age seven. At this age, a child typically has a mix of baby and permanent teeth, and the first permanent molars have usually erupted. This developmental stage provides the orthodontist with a clear picture of the developing bite and the relationship between the upper and lower jaws.
This initial visit is for evaluation and monitoring, not necessarily for starting active treatment. The orthodontist examines the child for potential concerns like severe crowding, crossbites, or overbites. Identifying these issues early allows the specialist to track growth patterns and decide on the optimal time to intervene. For most children, the evaluation leads to a recommendation to simply monitor their dental development for several years.
The Difference Between Early and Comprehensive Treatment
The timing of active treatment is often categorized into two phases, known as Phase I and Phase II. Phase I treatment, also called early or interceptive treatment, is reserved for approximately 10 to 15 percent of children who have severe structural or skeletal issues. This phase usually occurs between the ages of six and ten, while the child is still growing rapidly.
The goal of Phase I is to address underlying jaw discrepancies, create space for permanent teeth, or correct severe bite problems like a crossbite. Appliances such as palatal expanders or partial braces are used to modify jaw growth and prevent a minor issue from developing into a more complex problem. Following Phase I, there is typically a resting period where the remaining permanent teeth are allowed to erupt naturally.
Phase II treatment is the comprehensive phase, typically beginning in early adolescence (ages 11 to 14) once nearly all permanent teeth have erupted. The focus is to precisely align all the teeth and ensure the upper and lower arches fit together correctly.
Most children who need orthodontic care only require this single, comprehensive Phase II treatment. For those who completed Phase I, the second phase refines the final alignment, often resulting in a shorter duration. The decision for a single or two-phase approach is determined by the complexity of the alignment and skeletal issues present.
Hardware Options for Teeth Alignment
Teeth alignment relies on applying consistent, gentle pressure over time to move teeth through the bone structure. Traditional metal braces remain a highly effective and durable option, consisting of stainless steel brackets bonded to the teeth and connected by archwires.
Fixed Appliances
Ceramic braces function similarly to metal braces but use tooth-colored or clear brackets for a more discreet appearance. While providing a more discreet appearance, ceramic brackets can sometimes be more prone to staining or fracture than their metal counterparts. Both fixed appliance types use elastics and wires to facilitate tooth movement and bite correction.
Removable Options
Clear aligners, such as custom-made plastic trays, offer a removable and nearly invisible solution for alignment. This option requires significant patient compliance, as the aligners must be worn for most of the day, only being removed for eating and oral hygiene.
Specialized Appliances
Specialized appliances are also used, particularly in Phase I, including palatal expanders, which widen the upper jaw, and headgear or spring devices used to modify jaw growth.
Maintaining Results After Braces
Once the active phase of treatment is complete and the braces are removed, the retention phase begins. This phase is necessary because the bone and soft tissues surrounding the teeth need time to stabilize around the newly aligned roots. Without retention, the teeth have a natural tendency to shift back toward their original positions, a phenomenon known as relapse.
Retainers are custom-made devices designed to hold the teeth in their corrected alignment while stabilization occurs. There are two main categories of retainers:
- Removable options: These include clear plastic trays or the Hawley style (wire and acrylic). The wearing schedule often starts full-time and gradually transitions to nighttime-only use.
- Fixed or permanent retainers: This is a thin wire bonded to the back surface of the front teeth, typically on the lower arch. This type provides continuous support and is often recommended when teeth were significantly crowded or spaced before treatment.
Consistent use of the prescribed retainer is necessary to ensure the structural changes made during treatment are preserved long-term.