Kids and orthodontics

Whilst it might seem unusual for a child to receive orthodontic treatment at a very young age, growth should be viewed as an advantage which can make orthodontic treatment more successful. If treatment is matched to the expected periods of dental development, then the orthodontist can make use of your child's growth to deal with problems which, if left, may eventually require very complex treatment or even corrective surgery.

Because there isn’t a one size fits all approach in orthodontics, a unique treatment plan is drawn up for each and every child. After your orthodontist has diagnosed your child, a bespoke treatment plan will be made which might include one of two approaches:

• Two-phase treatment
• Single-phase treatment

Two-phase treatment is advised depending on which factors are found after a clinical, photographic and x-ray examination of your child. It involves splitting the orthodontic process into two separate time periods, or phases, with the aim of creating a better environment for your child’s permanent teeth. The first phase is performed whilst your child has mostly primary or “baby” teeth, and the second phase will occur when most or all of the permanent or “adult” teeth have grown into the mouth. Typical appliances used during two-phase treatment include removable braces, expansion devices to widen the jaws and fixed braces to manipulate the positions of the teeth.

“The aims of the first phase” says Dr Dirk Schuth of Trinity House Orthodontics, “are to prevent potential problems that may develop, to solve any problems that have already developed and to guide the growth of the jaw bones that support the teeth.” The benefit of this phase will enable your child to bite or chew more efficiently and it will also contribute to long-term stability (meaning that teeth will more readily stay where the orthodontist has moved them).

After the first phase, there will be a period of maintenance or retention (to allow the teeth to settle), during which your orthodontist will review your child frequently during the year.

When your child’s permanent teeth have all appeared, your orthodontist will judge whether they have grown into the correct positions and if not, a second phase of treatment will be recommended. In this case it is likely that your orthodontist will advise the use of another course of orthodontic appliances or braces.

Most patients will require this second phase of treatment once the permanent teeth have established themselves – the objective being to finish the process of aligning the teeth and jaws.

Single-phase treatment is recommended when your orthodontist has determined that there are enough permanent teeth present for your child to have comprehensive orthodontic treatment performed in one single time period. This will usually involve having to wear braces or ancillary appliances, followed by a retention device, which would have to be worn for a long period of time to keep the teeth in the corrected position.

The length of treatment of either two or single-phase treatment will depend on several factors, including the severity of the problem and the age of the patient. No matter which format is followed, treatment success is influenced significantly by cooperation between the parent, child and the orthodontist.

Below is advice on how to ensure your child’s treatment is successful:

• Follow the instructions given to you for the specific appliance being worn
• Keep the appliance, teeth and gums clean, by brushing and flossing as prescribed
• Avoid foods and drinks that may damage the appliance and your teeth
• Maintain a healthy diet
• Keep all your scheduled appointments with the orthodontist
• Visit your dentist at least every six months to maintain your child’s dental health

Orthodontic treatment has become a part of growing up for most children. Treatment during childhood can help to guarantee every young adult a dazzling smile.

Before you come to see the orthodontist you may have some questions you would like answered about this first visit.

Why have I been referred to the orthodontist?

Your dentist would like specialist advice about the position of your teeth. The orthodontist will advise whether you would benefit from orthodontic treatment.

What will happen at my first appointment?

The orthodontist will examine the mouth and teeth. X-rays, photographs and moulds (impressions) may also be taken. These records will help the orthodontist decide which treatment will be best for you.

What will happen next?

There are likely to be four possible outcomes, each of which will be explained to you in plain and simple language by the orthodontist.

These include:

• You are not yet ready for treatment. In this case you may need to see the orthodontist when you are older.
• Your dental health is poor. This may be due to poor tooth brushing or decayed teeth. Your dentist may send you to the orthodontist again when things have improved.
• You do not need treatment because the position of your teeth is perfectly acceptable, or will improve without treatment
• You are ready for treatment and need to decide whether to go ahead

What happens if I am ready to start treatment?

The orthodontist will explain at a follow up appointment:

• The options for treatment, and which is the best for you
• The pros and cons of treatment
• How long the treatment is likely to take
• The commitment needed on your part for the treatment to be successful
• When you can expect the treatment to begin

When will treatment start?

This will depend on:

• How many of your adult teeth have come through. Many treatments are best left until the adult teeth have replaced the first teeth
• Problems with tooth brushing or tooth decay which may need to be dealt with
• The length of any waiting list for the particular type of orthodontic treatment you require
• The degree of urgency for your particular case. For example, certain types of bite are best treated while you are growing fast and would be given priority. Other types of treatment may need to be delayed until growth of the face has almost stopped

Who will carry out the treatment?

The orthodontist often carries out the treatment personally, although in some cases another member of staff may treat you.

What will treatment cost?

You will be offered the choice between private and NHS treatment – private treatment is available on request. If you are privately insured please let the practice know, because often orthodontic treatment is covered by insurances. The practice excludes NHS treatment above the age of 17, when you would have to pay for your treatment.

If you have any further questions you would like to ask, please write them down and bring them to your next appointment – it is important to us that you understand what is involved in orthodontic treatment before you decide to go ahead.

Here is a list of typical braces that might be used in the treatment of children: