Until recently, braces on an 8-year-old were almost unheard of. Thirty years ago orthodontists rarely treated youngsters until they were teenagers.

Around 1990, the American Association of Orthodontists began encouraging the screening of 7-year-olds. It was determined that early detection of improper facial growth and tooth eruption could be better treated by earlier, interventional treatment. Insurance companies have also recognized the value of early orthodontic treatment and have made more coverage available.

The earlier a child receives treatment—that is, before all the adult teeth have come in—the less severe the malocclusion, or bad bite, will be later on. In fact, for some of the most common orthodontic problems, early treatment can prevent the need for permanent teeth extraction later on and can prevent some teenagers from needing jaw surgery. Not to mention the self-esteem boost achieved from correcting crooked or buck teeth.

PHASE ONE

Orthodontists recommend early intervention only when they think it will benefit the patient, though roughly 70 percent of 8- to 9-year-olds will need Phase I treatment. Early treatment makes sense for patients with underbites, overbites, narrow upper arches, crossbites, severe crowding or spacing, thumb-sucking or tongue-thrusting. These problems are easier to correct while the jaw is still growing.

Treating patients as young as 7 or 8 years old with a “palatal expander” widens the upper jaw, so the upper teeth line up better with the lower teeth. Once proper balance to the bite and face have been reestablished, facial growth can occur in the normal pattern. This usually makes the second round of treatment, when the patient is a teenager, quicker and easier. Because more jaw space has been created, it’s probable that no permanent teeth will need to be extracted later. The risk of needing jaw surgeries has been reduced.

WHAT IF I PUT OFF PHASE ONE?

A common misconception is that Phase 1/Phase 2 treatment is more expensive than choosing one, comprehensive treatment later. On the contrary, not starting early treatment when recommended can lengthen later orthodontic treatment, making overall costs more expensive. In most instances, Phase 1/Phase 2 costs are about the same as completing a two-year, comprehensive treatment all at once.

Plus, children who have Phase 1/Phase 2 braces actually spend less overall time in braces. If a parent chooses to not begin interceptive Phase I treatment when recommended, then the developing orthodontic problems may become more difficult to correct and lead to more invasive treatment.

THE RESTING PERIOD

The period between Phase 1 and Phase 2 can last one to two years. During this period, the remaining permanent teeth are left alone as they erupt. A successful first phase will have created room for permanent teeth to find an eruption path.

Even during the resting period, periodic appointments for observation are necessary. Selective removal of certain baby teeth may be necessary. And, retainer devices are usually recommended to help save the newly created jaw space and to guide permanent teeth.

PHASE TWO

Phase 2 will begin when ALL permanent teeth have erupted. The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly and be easier to keep clean.

Phase 2 usually involves full upper and lower braces. Perfect aesthetics will be obtained at this point. If a patient has had Phase 1 treatment, then Phase 2 typically will last 12 to 15 months, and can finish before the high school years. Being able to have prom pictures, drivers’ licenses and senior pictures with no braces is definitely a bonus!

COMPREHENSIVE TREATMENT

About 30 percent of children do not need Phase 1/Phase 2 treatment. These children exhibit good skeletal balance and have minor crowding or spacing issues. In these patients, it is a good idea to be seen once every four months by the orthodontist to make sure the baby teeth fall out in a timely manner. When baby teeth don’t want to fall out, it can cause the erupting permanent teeth come in more crooked than they should. When all the teeth have erupted, including the 12-year-old molars, treatment is usually completed in 24-30 months.

WHICH IS BEST FOR MY CHILD?

If your orthodontist determines that the problems are minor, then delaying treatment until all permanent teeth have erupted may be recommended for your child. If it is determined that significant problems are developing, then early Phase 1, and then later Phase 2 braces, may be the answer. Your orthodontist can help recommend the shortest, most conservative treatment that provides the best result and healthiest smile!

Dr. Andy Vondran is a specialist in orthodontics in central Arkansas and has been in private practice for almost 15 years.