I often hear people make comments such as “I had to have braces twice,” or “I’ve noticed that they are doing braces twice these days.” This begs the obvious question, why would you intentionally have to do braces twice? As a parent, it can be confusing if they hear that recommendation, and among orthodontists, it is actually a pretty controversial topic. There are some orthodontists who think that Phase 1 of orthodontic treatment is never indicated, and there are some who recommend it for everyone who walks in their door. Like many things, the best course of action lies somewhere in between those two extremes, and my hope is to provide you with enough of an understanding that if you are presented with Phase 1 Treatment as an option, you will be able to decide whether it is the best choice for your child.
So, what is Phase 1 Orthodontic Treatment? In summary, there are some conditions of the teeth or jaws that can either 1) Adversely affect the growth and development of the jaws, or 2) Cannot be treated as well when the patient is older as it could be at a young age. So, in either of those instances, most people would agree that it is best to address the problem as soon as you see it. In that case, your orthodontist will recommend a short round of treatment (typically 6 to 9 months in our office) to correct the major problem, and then when the child is older and has all of their adult teeth they will get braces on all of the teeth to finish the job (Phase 2). It is a half now, half later kind of approach.
In fact, the American Association of Orthodontists recommends that a child have their first orthodontic evaluation at age 7. It is precisely to allow the orthodontist to screen for those kinds of conditions, and if none are present, to monitor the child’s growth and development to determine the best time to start Comprehensive Treatment.
Here is the million-dollar question: When is it best to do a Phase 1 treatment, and when do you just wait until the child is older? In our office, we are looking for primarily crossbites, impacted permanent teeth, the need for growth modification, and protruding front teeth. Let’s take a little closer look at those.
The first condition and most common reason an orthodontist will recommend Phase 1 is because of a cross bite. A cross bite is the relation of the teeth when one or more of the upper teeth fits on the inside of the lower teeth, instead of the other way around. It can happen with the front teeth or the back teeth, and is a MAJOR PROBLEM! There is nothing good about cross bites, and you generally want to fix them as soon as you see them.
More often than not, when a young person has a cross bite they will have to shift their jaw to the side or forward to find a comfortable position for the teeth to fit together. The problem is that the jaw can be stimulated to grow in an adaptive pattern, and ultimately grow asymmetrically. Jaw asymmetries usually require jaw surgery to correct if it goes too far, so we want to prevent that as much as possible.
If asymmetric growth does not result from the crossbite, at the very least there will be excess stress on the temporomandibular joint (TMJ) and can cause TMJ disorders in the future. Anybody who has ever experienced that knows that other problems may be excessive wear on the teeth, which can be unesthetic when it is on the front teeth, or the lower teeth can even be pushed forward out of the bone causing a bone and gum defect, as seen in the 3rd picture. The bottom line, a crossbite is very bad for the growth and development of a child’s teeth and jaws, but it is also very easy to fix in a young child.
Another major reason for Phase 1 treatment is if there is an impacted permanent tooth. An impaction means that the permanent tooth is beginning to turn sideways before it erupts, or just does not have enough room to erupt, and therefore will not come into the mouth on its own without treatment. Canines are the usual culprits here. Left untreated, they require surgery to expose them, and then they can be moved into the mouth orthodontically. Luckily, if it is caught early enough, an orthodontist can often intercept the impaction and get those teeth to erupt without surgery.
There are two more major reasons that we will recommend Phase 1 orthodontic treatment at Shine Orthodontics. One of those is growth modification. If the jaws are growing improperly, we can orthopedically change the growth pattern, and potentially avoid the need for jaw surgery when they are older. We are talking about the actual jawbones here, not the teeth. Unfortunately, there is a fairly narrow window of opportunity for this and we lose our ability to influence the growth of the jaws as a child gets older.
Finally, we know that children may fall down, or play rough, or any number of other things which may cause them to damage their front teeth. So, it is not hard to believe that the incidence of damage to the front teeth is high in children. Multiple researchers have investigated this and have come up with varying prevalences. Some studies have suggested that as many as 40% of children will have some sort of dental trauma. And here’s the thing, if the upper front teeth are protrusive and sticking too far forward, it is not hard to imagine how they will be damaged much more easily. Researchers have found that children with excess protruding front teeth are 2 to 5 times more likely to have trauma to their front teeth than other kids. The statistics on dental trauma are simply too high for comfort in children with protruding front teeth, and we want to move the front teeth into a safer position before the child has a chance to damage them.
I hope this helps to shed some light on the “why” behind starting orthodontic treatment at a younger age while there are still a lot of baby teeth. Remember, 7 years old is the right age for a child’s first checkup with the orthodontist.