Editor’s Note: This article is one person’s experience and is anecdotal. It should not be taken as orthodontic advice. Please consult an orthodontist for treatment needs based on individual circumstances.
As a dental hygienist, we are often the first to see a child and recognize that the patient may have an orthodontic problem. Assessment at a young age can indicate whether a child has the potential for a complicated case. Or, more importantly, the child has an orthodontic condition that would benefit from an early correction in the mixed dentition and prevent more severe problems later on. According to the American Association of Orthodontists (AAO), typically, the types of teeth and bite conditions that may be cause for early interceptive treatment, or also known as Phase 1, are:
- Open bite
- Overbite or deep bite
- Protrusion or overjet
- Diastema or spacing
- Class III underbite
The AAO recommends that children have an evaluation by an Orthodontist by the age of seven or second grade.
The Phase 1 objective goal is to intercede early in order to allow for an efficient Phase 2 treatment. For example, broadening a constricted maxilla may allow room for teeth to drop. However, only specific individual cases require Phase 1 treatment or early intervention.
So, when is early intervention necessary? And, is the outcome any different?
To further understand this more, we have to look at the growth and development of the maxilla and mandible. In a male, the jawbone typically stops growing and begins to harden between the ages of 14-16. In females, the jaw reaches its greatest growth between the ages of 12-15, and oftentimes; this depends on what age the menstrual cycle starts. Because of this, they argue that in most cases, you can achieve the same results in the traditional, one-phase treatment option that begins between the ages of 12-14 years of age or after most permanent teeth have erupted.
In some cases, the malocclusion works itself out without intervention. Malposed teeth that are present at age eight may be better positioned at age 12 because the jaw is still growing and changing in size. Sometimes just waiting and seeing what happens within a few years can work out for the best.
No Thumb Sucking Intervention
I can actually speak from personal experience when we talk about three of the conditions we look for and address in our seven-year-olds, which in my case, were a result of thumb sucking.
By the age of seven, you could see how sucking my thumb daily was affecting my smile. I had an open bite, protrusion, and a diastema. This specific time period in my life, I recall well because this was when I was given the nickname, “The Beaver,” which, to this day, I am still referred to by friends and family. At the age of eight (third grade), I was still struggling with this bedtime habit. I guess you could say this was my first bad habit. I remember how hard it was to quit! Telling myself night after night, this will be the last time. By now, I had developed an open bite with a 12 mm overjet and a 5 mm diastema between 8 and 9. I was extremely self-conscious and rarely smiled.
My mother explained that my thumb sucking started at birth. I was the youngest of seven children and the only thumb sucker. Dental check-ups were not routine for my family. I had the state-required exam through the local health department for kindergarten and then again for second grade. I remember the dentist talking to me about my bad habit of thumb sucking and the effects it had on my teeth and speech.
It wasn’t until the end of third grade that I was finally able to stop sucking my thumb. Unfortunately, it took being humiliated in front of the entire class after a classmate saw me secretly slip my thumb into my mouth, just after the classroom lights were dimmed for movie time. When I encounter a thumb-sucker in my dental chair, my heart goes out to them because I know how difficult it is to stop.
I believe this childhood ordeal is what led me into the dental field. My curiosity about the development of our teeth kept growing as I aged. You see, I didn’t receive any treatment to correct my open bite or 12mm overjet or the diastema so wide between 8 and 9 that my upper lip would get stuck; an orthodontist never evaluated me. I wondered, how did my smile dramatically change from my pre-adolescent years to my teen years, without any orthodontic treatment?
By the seventh grade, the three dental conditions I had, worked themselves out. At this time, while most kids were getting braces on their teeth, I had a normal Class 1 occlusion with minor spacing on the maxillary anterior teeth. When I hit the halls of high school, friends would say I had a movie star smile!
Throughout my life, a countless number of people thought I had to of had braces because my teeth were so perfect. Now, even in my middle forties, my teeth are exactly as they were in my teens.
One Phase Vs. Two Phases
There is no scientific literature that proves that the treatment result is any better with two-phase orthodontics vs. one-phase treatment. But, if you’ve been in an elementary school lately, you would notice that more kids than ever already have brackets and wires on their newly erupted teeth. Some will argue that treating patients at such a young age takes longer, costs more, and leads to more patient burn out. In my specific case, no orthodontic treatment rendered the greatest results.
I will also add that, at the elementary level, I don’t believe that kids have the ability or proficiency to effectively clean around wires and brackets, therefore contributing to an increase in decay and gingivitis.
Most kids starting ortho are given an electric toothbrush by their dentist to combat these diseases. But I will argue that it doesn’t matter what toothbrush you use; how you use it matters. Parents think that using the electric brush is automatic for perfect hygiene. It is usually the opposite.
Most kids are sensitive to the vibration and do not brush the gingival margins. My recommendation has always been for parents to do the nightly brushing until the age of 10, especially if the child is already in ortho.
Let’s talk about the cost of having braces put on at the ages of seven or eight, and then having them on again in the teen years when all the permanent teeth have erupted. Most insurance plans cover 50%, and the average cost is between $5,000 to $6,000. The majority of insurance companies will not cover that necessary second set in the teenage years (or during a lifetime).
After requesting information from ortho offices to better understand their billing protocol and also asking parents who have a child in this one-phase and two-phase treatment, it is my understanding that most offices will offer a “discount” for the second set of braces that are not covered by insurance and offer extended payment plans.
Two-phase treatment plans should not be the routine. While only a few specific cases could gain from two-phase orthodontic plans, most others would benefit from waiting to see what happens without help, as in my case.
Over the past 17 years of treating patients, I’ve learned that wearing retainers after ortho is a must! It’s amazing to hear how many people had braces but did not wear their retainers as instructed. Within a minimal amount of time (sometimes even days), teeth shifted back to how they were before those two to three years of ortho treatment.
This is just fascinating and eye-opening at the same time! The fact that teeth are constantly shifting and moving in the early teenage years makes you wonder that maybe orthodontic treatment shouldn’t be started until the later teenage years for lasting results.
Now Listen to the Today’s RDH Dental Hygiene Podcast Below:
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- Mellion, Z.J., Behrents, R.G., Johnston, L.E. Jr. The Pattern of Facial Skeletal Growth and Its Relationship to Various Common Indexes of Maturation. American Journal Of Orthodontics and Dentofacial Orthopedics. 2013 June; 143 (6):845-54. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23726335
- Ochoa, B.K., Nanda, R.S. Comparison of Maxillary and Mandibular Growth. American Journal of Orthodontics and Dentofacial Orthopedics. Feb 2004; 125(2): 148-159. Retrieved from https://www.sciencedirect.com/science/articlelabs/pii/SO889540603008540