by Gina Roberts-Grey

Before her eighth birthday, Giselle Carmichael of Rancho Cordova had braces put on. And Giselle’s not alone; in fact, it seems that more and more children are getting braces before they reach double digits. Pallet expanders and spacers are swiftly becoming commonplace childhood accessories as kids as young as seven start orthodontic treatment and parents start thinking sooner about their own kids’ teeth.

When to Begin
The American Association of Orthodontists recommends that children be seen and screened by an orthodontist around their 7th birthday. Orthodontist Donna Galante, D.M.D., of Cater Galante Orthodontics in Rocklin and Roseville, explains, “This is so an orthodontist can monitor a child’s growth and evaluate their need for treatment.”

The initial consultation, which Dr. Galante says includes a panoramic x-ray, a head shot of the patient and a discussion with patient and family regarding all aspects of treatment, maps out a treatment plan which, depending on a child’s case, may begin within weeks, or may not start for a few years.

Dr. Max Anderson, D.D.S., a national oral health consultant with Delta Dental Plans Association, says age definitely plays a pivotal role in bracing a child’s teeth. “Most children will normally lose their primary molars as their adult premolars erupt. This usually occurs around age ten-and-a-half, although it could occur sooner or later. Look to when your child starts to lose his primary molars as an indicator that it might be time for an orthodontic consultation.”

The average age to start treatment is eleven or twelve, depending on three main factors: when a child’s adult teeth come in, how the child will tolerate treatment and orthodontic care, and the severity of the problem.

Teeth and gums need to be in good shape before orthodontic intervention, and any oral health issues should be addressed prior to beginning orthodontics. Experts caution this is especially important when dealing with tooth decay because if a tooth has decay and braces are placed on it, the problem could worsen.

Sometimes, orthodontic intervention is best accomplished in phases. “By starting early, you have the ability to prevent possible extractions, possible jaw surgery, and improve the overall health of the teeth,” says Dr. Galante. Although a great deal of ‘phase one’ is performed before a child loses all of his or her baby teeth, the next phase of orthodontics is determined when all of the baby teeth are gone. And many children still won’t need treatment for several more years. Rest assured, most orthodontists will not suggest or prescribe treatment that is not absolutely necessary.

“A few years ago, we saw a trend in “early treatment” in which a child began treatment at age 9 or 10, but doing so often called for longer treatment times and multiple sets of braces,” explains Dr. Anderson. “Now the industry is returning to the practice of determining if the child’s situation can be treated equally well with one set of braces at a slightly older age, when they are generally more ready to deal with the responsibility of dental care (not losing retainers, etc.).”

Where to Turn
The need to see the orthodontist is usually determined by a child’s general dentist. If your dentist notices an abnormality that may respond to orthodontia, he or she may refer your child to an orthodontic specialist. The orthodontist can then determine whether, like Giselle, your child’s case calls for early intervention, or whether it will be better to wait before beginning treatment.

Orthodontic specialists agree that not all dentists automatically refer children to an orthodontic specialist. Some dentists have received some orthodontic training and may do initial screenings themselves. They may even perform minor orthodontic procedures, thus these dentists might not refer the simple cases out of the office. Other dentists may not have established a relationship with orthodontists in their area or may not know to refer patients to an orthodontist. A dentist’s orthodontic knowledge depends on the extent that the dental school they attended kept up with ongoing professional education.

What to Expect
Regardless of whether your family dentist recommends a screening, orthodontists stress the need for parents to seek out a consultation. Parents (and their wallets) will be happy to know that it is standard for orthodontists to provide consultations at no charge. In fact, many orthodontists will also provide periodic follow-up visits for a child who will likely need future orthodontic care at no charge until that child is ready to begin treatment, and it is not unusual for these follow-up consultations to span a few years.
Keep in mind that the need for braces can be affected by outside influences such as a child breathing through his mouth, sucking his thumb or other habits affecting dental health, as well as family history. Some dentists and orthodontists say heredity is a definite factor. Others state that just because you needed braces, that doesn’t always imply your child will too. Along the same lines, neither one of Giselle’s parents had an overbite, yet that’s one of the issues her orthodontist is working to correct.

What’s new in braces?
The American Association of Orthodontists says the look and feel of braces has changed. Talk to your child’s orthodontist about the following options:
• Clear, ceramic brackets match teeth, making them nearly invisible.
• Gold or colorful braces let patients make a fashion statement.
• Comfort brackets dramatically reduce friction, which means your child will be more comfortable and may even get faster results with fewer appointments.
• Invisible aligners are a series of clear plastic appliances that are custom-made, using 3-D computer imaging technology, to gradually straighten teeth without wires or bands. They’re removable too, so patients can eat, drink, brush and floss just as they normally would.
• iBraces have brackets that are custom-fit and placed behind teeth. This means they’re not only invisible, but also much more comfortable for young athletes playing contact sports, singers and musicians who play wind instruments.
• Computerized imaging and treatment planning programs now allow doctors to quickly—and more accurately—predict how kids will grow and what treatment plan will work best for each individual patient.