By the age of 7, most children have a combination of both baby and adult teeth. At that age or even earlier children can benefit from “interceptive orthodontics” to limit or correct a bite that may not be developing optimally. The objective is to reduce the severity of developing problems and to try to eliminate its cause. Straight teeth are not the only criteria by which the bite is evaluated for early treatment. The need for early orthodontic intervention is sometimes indicated by the following:
- Difficulty in chewing or biting
- Aggressive finger habits
- Severe crowding or blocked out teeth
- Teeth not erupting in the right direction
- Jaws that shift
- Biting of cheeks
- Teeth that do not meet properly
- Jaws that are not growing harmoniously
- Lower risk of trauma to protruded upper incisors
- Improve aesthetics and self-esteem
Although a problem is “intercepted,” that does not mean additional orthodontics may not be necessary in a second phase of treatment.
It is not uncommon for an appliance called a “space maintainer” to be made when a baby tooth is lost prematurely. This holds needed space for the permanent teeth that will be coming in later and prevents collapse of other teeth into the space.
There are times when it is necessary to remove baby teeth to allow severely crowded permanent teeth to come in that might otherwise not (impact) or improve their position. The upper permanent canines are teeth that have a tendency to find themselves in positions necessitating removal of the baby canine.
After all permanent teeth come in, the extraction of certain permanent teeth may be necessary to correct crowding. If there is insufficient space available to accommodate all the teeth, then sometimes there is no other choice. The sequential removal of both baby teeth and permanent teeth in order to alleviate a severely crowded mouth is called “serial extraction”. It allows teeth to move on their own into much more desirable positions and is usually followed by comprehensive orthodontic treatment.
There are various appliances that are used to accomplish specific goals:
Headgear: Applies pressure to the upper teeth and jaw to guide the direction of upper jaw growth and tooth eruption.
Palatal Expander: This appliance is fixed to the upper back teeth, markedly expanding the width of the upper jaw. In some patients it may prevent the need for extraction of permanent teeth.
Functional Appliances: Removable and fixed in the mouth, these help to guide teeth and jaws into a more normal bite.
Habit appliances: Are usually attached by bands to the molars and used to control thumb sucking or tongue thrusting.
Braces: The most common appliances. They use bands, wires, and brackets most often bonded to the teeth gradually moving them into a proper position.
Retainers: These can be fixed or removable and are worn to prevent shifting of the teeth into their previous positions.
Aligners: These are alternatives to traditional braces being used in select individuals to move teeth without metal brackets or wires. They are clear, virtually unnoticeable, and are removed for eating and brushing.