The traditional image that springs to mind when one hears ‘orthodontics’ is of a teenager with metal 'train tracks' or headgear. Whilst this is still the most common type of brace (without headgear attached!) and the teen years are when treatment is most commonly given, orthodontics have had to change and evolve a lot over the past 10 years.
Nowadays, it is recommended that a child has their first orthodontic check-up at age seven. This can help identify any potential issues early and open up the number of treatment options available. In some cases, early intervention can prevent more complicated treatments later on by taking advantage of a time when your child is growing very fast.
The reasons for early or interceptive orthodontic treatment include:
To help maximise or minimise growth of the jaw
To help realign the jaws relative to each other
To reduce the chance of trauma to misplaced teeth
To reduce the likelihood of having to extract teeth later on
If your child is older than seven and has not been seen by an orthodontist yet, don’t panic: treatment doesn’t usually begin until most of the adult teeth are present, and most dentists will identify any complicating factors that should be addressed early.
While many parents are under the impression that orthodontic treatment is an aesthetic treatment to create a nice smile, orthodontists are more concerned with the functionality of the teeth and jaws, and how the positioning of the teeth impact this. Aesthetics are important, but even children with “straight” teeth are sometimes recommended to have orthodontics for functional reasons. Correcting the positioning of teeth early on can save a lot of trauma and expenses further down the line.
The First Orthodontic Visit
During a child’s first orthodontic visit, the orthodontic practitioner is looking at the teeth in a different way to the dentist. While they will check briefly that the teeth are clean and healthy (poor oral hygiene means no braces!), they will also be looking in your child’s mouth to assess how many teeth are present (we often have one too many, or can be missing a few), whether there is enough space for the remaining teeth to come through, how well the jaws are aligned, and whether the proportions of the face are in harmony with each other.
Orthodontists will look at how the upper and lower teeth meet when the patient is biting together and during chewing movements. Alongside the X-rays, the practitioner or assistant will also more than likely take some photographs (both of the inside and outside of the mouth) and a scan to allow monitoring of your child's growth patterns.
Types of Orthodontic Treatment
Teeth are moved by using 'appliances' that place gentle, controlled forces on the teeth to guide them into the desired position. There are now several different types of orthodontic treatments and appliances available. The most popular ones are outlined below.
1. Removable braces
Removable braces can be provided for the upper or lower teeth, but are not suitable when multiple teeth need to be moved. Although similar in appearance to retainers, removable braces are part of the active stage of treatment. They can be used at the interceptive or early stage to help misaligned jaws to match up with each other, or sometimes they can be used to 'expand' the teeth outwards with the help of screws to make more space in the jaws, as an alternative to extractions. Sometimes a removable brace can have a wire spring to help move just one or two teeth if that is all that is needed. These braces can be removed to eat and clean the teeth, but the constant removal makes them easy to mislay. Speech may also be affected. Treatment with removable braces usually lasts 6-12 months, but they must be worn as instructed, or they won’t work!
2. Fixed braces
The traditional 'train tracks' are still the most common type of brace orthodontists use, although we now often see ceramic or 'clear' brackets, as well as the traditional metal ones. These have two components – a bracket (which is attached to the tooth and holds the wire by means of an elastic tie), and a wire (which moves the teeth). Most fixed brace treatments last 18-24 months, but in some cases it can be as little as 12 months. Although fixed braces are more visible than other treatments and can make teeth cleaning harder, they tend to give the quickest results and are the most economical.
3. Clear aligners/Invisalign
These transparent, plasticlike trays are removable – the patient can take them in and out – and they are made to fit each individual patient’s teeth. They are made in a series of 'sets', each of which is worn for approximately two weeks, for at least 22 hours a day. Each set is designed to gradually move the teeth into the desired position. Tooth coloured bumps or 'attachments' may be placed on some teeth to aid this movement. Invisalign treatments usually last 12-18 months. As this is a less visible option, it is particularly appealing to adults undergoing orthodontic treatment. However, it is a more expensive option and may not be suitable for more extreme orthodontic needs.
After 'active' treatment (when teeth are being moved), patients will need to wear a retainer to help keep the teeth in their new position, especially in the months immediately after treatment. This is to give the bone around the teeth a chance to harden and support teeth in their new position and reduce the chance of relapse. Retainers can be a lingual retainer (wire stuck on behind the front 4-6 teeth), an Essix retainer (clear plastic tray, similar to a clear aligner) or a Hawley retainer (the more traditional type of plastic and wire retainer). These retainers can also be used in combination with other treatments.
It is so important to ensure that your child complies with the retention protocol given to them after their treatment. 70—80% of adult orthodontic treatments are due to relapse after orthodontics earlier in life. Remember: retainers were traditionally advised to be worn for 12 months, but now, they are more likely to be prescribed for lifelong night-time wear, or as long as you want the teeth to stay straight!