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FAQ:  Orthodontics - Children - Teens



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Question:
Orthodontics in Children: I have a 8 1/2 yr old who has top and bottom expanders with arms and 4 top and bottm braces on the front.

She has alot of pain from the arms which attach to bottom and top back teeth and lay between her cheeks and teeth. They dig into the lining of her cheeks. She has a very small mouth and is being treated to expand her mouth to fit all her teeth and also correct here severe overbite.

Can the dentist use rubberbands to fix the overbite or do only some dentists use those? The arms are causing deep sores and bleeding. The child has had to be on Loritab for the extreme pain.

The dentist took out arms after 1 week to heal and have had them in 1 week and nothing can stop the digging into the cheeks since she has no room left. She wears cotton rolls all the time. ...Visitor from MO

Answer:
I am going to be real honest here.

If your child will eventually need to have permanent teeth extracted, there is no amount of expansion that you can do orthodontically to prevent this.

Say for instance that your child had approximately 10mm of crowding in the upper and lower jaws. Expanders may create at most 4mm of space, but you still have a discrepancy of 6mm.

We started doing early treatment in the early 80's because we thought that this would prevent us from removing permanent teeth. We have enough scientific evidence to prove that early expansion is not going to prevent tooth removal in those cases which will require it.

You can expand the lower arch very easily with braces once all the permanent teeth have erupted. The upper arch can be effectively expanded up the age of around 15 years, because the suture in the roof of the mouth does not fuse until about this age.

So you have to ask... why expand now? There is no reason to expand now.

I do very little early treatment in my practice, because 99% of the children I see can be treated effectively with one phase of treatment. This is around 11 to 12 years of age once all the permanent teeth have erupted.

How do you explain the adult that comes to my practice at age 55, who is crowded and I expand to straighten their teeth? Did they have an early phase of treatment? No... making a decision to avoid two phases of treatment accomplishes two things; it prevents your child from having braces twice and financially it is less expensive.

You see, if you have a life time maximum of $1500 this will be utilized entirely for the first phase of treatment. Once the 2nd phase of treatment starts you will have no benefits to apply to that fee.

That I feel is one of the primary reasons two phases of treatment is implemented so many times. Money!

I will tell you how I manage these patients. If the crowding is severe I will extract the upper and lower baby eye teeth. This will allow alignment of the upper and lower front teeth, guaranteed.

Esthetically they will look better and, because of the improved alignment, will be easier clean. The permanent eye teeth will erupt around 11 to 12 years of age and if the crowding is severe you may have to consider extracting teeth and, if not, you can expand orthodontically at this time to fit all the teeth in.

Another point which is not explained to parents is the baby 1st and 2nd molars are much bigger than the adult teeth which will erupt under these teeth. We call this leeway space and can afford us up to 4mm of additional space. But once again this can be used around 11 to 12 years of age.

There is one benefit you will get from early treatment and that is some straighter upper and lower teeth and this is about it. If your child is concerned about the alignment, I can understand addressing those needs for self-esteem, however most kids are not.

I am very passionate about two phases of orthodontic treatment and I try to avoid it at all cost, except in a few select cases. I do not have the records, but I am pretty confident to say I would not be doing this treatment on your child if you were in my practice.

Editorial Staff

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