As parents, we all want to do the best for our children. The Internet gives us easy access to information but sometimes this is a double-­edged sword. On one hand it improves awareness, however, it also exposes the reader to misleading information and half-­truths.

Health professionals must stay up-­to-­date with current knowledge and provide evidence-based treatment. We want to provide for our children without subjecting them to unnecessary treatment. This article will discuss the benefits (or otherwise) of early orthodontic intervention.

Early Orthodontic Assessment

It is best for children to have an orthodontic screening consultation around the age of 8. However, this does not mean that your child needs treatment at this age. Only 10% of children under the age of 10 will truly benefit from early orthodontic intervention¹. For this minority, early orthodontic intervention can have significant advantages. In  most cases, the Orthodontist will advise that treatment is not necessary or beneficial at this age. If most children do not need early orthodontic intervention, when might it actually be required? Intervention may be recommended if any of the following are noted²:

• Protruding upper front teeth (especially if the upper front teeth are always visible over the lower lip)
• Protruding upper front teeth (especially if the upper front teeth are always visible over the lower lip)
• Front teeth that do not meet properly when biting
• Protruding or off-­centre lower jaw
• Thumb or finger-­sucking habit (over 5 years of age)

Appropriate orthodontic intervention can prevent damage to the front teeth and gums, prevent teeth wearing down and reduce emotional distress if teasing is occurring at school.

“Preventive” Orthodontic Treatment

Most orthodontic problems are related to genetics. Facial shapes, jaw and teeth size are primarily genetic. Therefore, we generally look like our parents and siblings and this is why true “prevention” of crooked teeth and significant bite problems is generally not possible. Appropriate early orthodontic intervention can reduce the impact of serious problems. Having perfectly straight teeth is generally not possible without customised orthodontic alignment (eg braces or clear aligners) as teenagers or adults. Some suggest that teeth can be “guided” into better positions, through use of pre-­formed (ie non-­customised) “double-­mouthguard” appliances. Some people recommend these “tooth­guidance” or “myo-functional” appliances for young children. Despite the marketing hype, scientific studies 3, 4 clearly show that patients often don’t wear them and even when they do, only small changes result. Such changes are 2mm or less, which for most patients, is not significant. The vast majority of these patients still require braces later to achieve an acceptable outcome3. Straightening the baby teeth will not guarantee that the permanent teeth come through straight. Recent  well-­â€designed  clinical  trials5  show  that  most  orthodontic  treatment  is  best  provided when all of the permanent teeth have come through (eg ages 12-14). Waiting until the permanent teeth are through allows us to do the treatment right the first time. In light of this, we must outline for our patients all of their options, treat at the right time and avoid unnecessary financial expense.

What is an Orthodontist?

An Orthodontist is a registered specialist with both a dental degree and specialist training (8 years of full-­time university). Orthodontists are the most qualified and experienced clinicians available to manage all tooth and jaw alignment problems. Their specialist knowledge base and clinical experience allows them to provide comprehensive  advice and also determine the best time to treat a specific orthodontic problem, whether it be as a child, teenager or adult. To see if your orthodontic practitioner is, in fact, a registered specialist Orthodontist, you can do a quick search on the Australian Health Practitioner Regulation Agency’s online search tool. 

References

1. Gianelly A. Timing of treatment. Pract Rev Orthod 1996;8(3)
2. Australian Society of Orthodontists (AU) [Internet]; 2016 Aug [cited 2016 Aug29] Available from https://www.aso.org.au/benefits-­early-­treatment
3. Janson G, de Souza JE, de Freitas MR, Henriques JF, Cavalcanti CT. Occlusal changes of Class II malocclusion treatment between Fränkel and the eruptionguidance appliances. Angle Orthod. 2004 Aug;74(4):521-­5.
4. ÄŒirgić  E, Kjellberg H, Hansen K. Treatment of large overjet in Angle Class II division 1 malocclusion with Andresen activators versus prefabricated functional appliances-­a multicenter, randomized, controlled trial. Eur J Orthod. 2015 Nov 4.pii: cjv080.
5. Thiruvenkatachari B, Harrison JE, Worthington HV, O'Brien KD. Orthodontic treatment for prominent upper front teeth (Class II malocclusion) in children. Cochrane Database Syst Rev. 2013 Nov 13;(11):CD003452. doi:10.1002/14651858.CD003452.pub3. Review.