DENTAL HEALTH
A time for braces
DR. VINOD ABRAHAM
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Orthodontics is more than just braces and teeth alignment.
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Photo: R.V. Moorthy
FOR that perfect smile: Some common orthodontic problems are preventable.
When is the right/ideal time to start braces? One of the most common questions posed by parents regarding braces is when to start tooth correction for their child. Braces or fixed orthodontics is a dental treatment to correct improper alignment of teeth.
A person can undergo orthodontic treatment at any age with braces. But being a dental science that primarily deals with the overall growth and development of the face; orthodontics is more than just about braces and teeth alignment.
Orthodontic treatment also encompasses corrections of the facial jaw bones and muscles; and these corrections are initiated early, as they are timed to coincide with the various growth milestones. A key factor is that these early corrections, known as “interceptive orthodontics”, are planned to utilise the growth of the child; as during this period the developing facial structures are more responsive and adaptive to change.
Orthodontics also involves the employment of preventive measures in children where procedures are started sometimes as early as 5-6 years to allow the progress of normal facial development. Importantly, these types of early orthodontic procedures usually do not involve the use of fixed braces, but simple appliances that can be removed by the patient; and when instituted at the right time they often help in minimising and sometimes even avoiding the need for fixed braces.
This answer usually evokes a gasp from the parent and is usually followed by the second most common question “…but I was told that 12 years was the ideal age…”
Important period
In general, a majority of facial growth is completed by 11-12 years; although minimal growth-related changes are seen up to early adulthood (18-21years). The most important periods of facial development are from the time the first permanent teeth erupts into the oral cavity (6-7 years); till the eruption of the second permanent molars (12-13 years). During this period, the structures of the facial region — especially the jaw bones — undergo a lot of changes in their size, shape and position.
Additionally, the developing facial structures are influenced by both genetic and environmental factors that have the potential to offset the progress of normal facial development. Early orthodontics aims to identify and eliminate potential factors through periodic dental monitoring of the growing child. Additionally, it allows the re-direction and enhancement of the inherent growth potential with the use of simple dental appliances where necessary.
Although the genes we inherit from our parents provide the blueprint for the development of the facial structures as well as the positions of our teeth; it must be understood that numerous factors are capable of offsetting this genetic blueprint.
The presence of these factors result in a variety of orthodontic problems ranging from the commonly noticed irregularity of the teeth, alterations in soft-tissue and lip posture, to even differences in the size and position of jaws of the face; which either independently or in combination affects the overall balance of our face.
Some causative factors are of simple origin, such as the early loss of a baby tooth or a prolonged thumb-sucking habit. On the other hand the size and position of the jaw bones can be affected even by alterations in our breathing-pattern due to repeated nasal infections or allergies and other obstructions of the nasal airway.
Visits to the general dentist from an early age are essential for the identification and elimination of potential factors. A year before the eruption of the first permanent teeth or when the child is around six years old is the ideal time to start periodic dental check-ups.
Early treatment
Most often early treatment does not involve the use of braces. These check-ups help the prevention of cavities in teeth and guide the eruption of the permanent teeth; an important part of these schedules is also to ensure that dental development is normal for the child’s age. Additionally these check-ups also involve patient and parent counselling regarding the harmful effects of various oral habits.
A common habit like thumb-sucking can be corrected with the use of a simple removable appliance. Most of these procedures are usually carried out by the general dentist under the supervision of the orthodontic specialist.
Another common, important and often overlooked cause that leads to an alteration in normal facial development is due to the mouth-breathing habit in the child. This habit arises usually as a result of nasal obstructions due to infections, allergies that make normal nasal breathing difficult. To cope with this, the child breathes through the mouth. Repeated infections ultimately make it a habit. This changes the muscular balance of the developing face and can lead to a variety of changes in the growth of related facial structures.
Affected individuals often exhibit protrusion of teeth, a “gummy-smile” and a host of other features collectively known as the “Long-Face Syndrome”. In such conditions early interception mostly involves medical management usually by the paediatrician and sometimes even by the ENT specialist. Upon control of the cause, a simple plastic plate is given to the child to be worn during sleep and this helps to correct the mouth-breathing habit. If done early, this not only helps revert the breathing pattern but also normalises facial growth.
As mentioned before, our genes determine the way we look, we resemble our parents. Certain types of orthodontic conditions run in the family. During periodic check-ups; information gained from the parent goes a long way in identifying and predicting the child’s potential dental problems.
This vital information helps the specialist intercept these problems by adopting remedial measures and by employing simple appliances designed to correct the abnormal development of the jaws.
When identified early, some of the commonly seen orthodontic problems are due to causes that are preventable or controllable. Early orthodontic treatment utilises the responsiveness and adaptability of the developing facial structures present during growth; to correct not only irregularities in teeth alignment but also to bring about corrections in the size and position of the jaws.
It must be emphasised that these types of corrections when timed during the growth period of the child, even helps to avoid extractions of teeth in certain individuals; and also helps in minimising the need for surgical jaw corrections undertaken in the adult for severe cases.
So in answering the question regarding “a time for braces”, it would be the orthodontic specialist who replies, “Um…that depends…..”
The writer is a Orthodontist based in Chennai.
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