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How Can I Prevent Braces for My Child?

Is there any way to prevent braces for my child?  As an orthodontist and mother of three young children, I hear this question daily.  I can understand why people would ask.  Household budgets are tight and the idea of paying for braces can be overwhelming.  Finances aside, orthodontic appointments are another thing on that endless list of extracurriculars that somehow has to be squeezed into the schedule.  In addition, the process of moving teeth can be uncomfortable at times (although much less than ever before) and parents don’t want to cause their child pain.  Even though orthodontics has become almost a rite of passage for many teens today, most parents wouldn’t mind skipping the process altogether.

So can you prevent braces?  The answer isn’t simple.  Some of it is genetic.  A severe overbite or underbite is usually due to an underlying skeletal discrepancy between the jaws.  Crowding or spacing is due to an arch length-tooth size discrepancy.  For example, if you never had braces and your teeth are relatively straight and your spouse never had braces and his teeth are relatively straight, it doesn’t mean your kids won’t need braces.  What???  If you have small arches and small teeth and he has larger arches and larger teeth everything works.  But, your child gets your smaller arches and his larger teeth and there will be crowding.  Large arches and small teeth will cause excessive spacing.  That’s the crapshoot of genetics.  So far, there isn’t anything you can do to prevent these problems from occurring.

All is not lost.  There are some orthodontic conditions that can be prevented.  The best way to decrease your child’s chances of needing orthodontics is taking your child to an orthodontist at age 7 or 8 and continuing to visit regularly.  Let me explain, as I know that sounds counterintuitive.  Most children (approximately 85-90%) do not need orthodontics at such a young age.  So why bring them?  Orthodontists look at teeth and jaws differently than general or pediatric dentists.  It is important for the specialist to get some baseline measurements of the teeth and jaws and to regularly monitor the growth and development of these structures.  Sometimes having baby teeth removed before they are loose will assist in the permanent teeth coming in the arches in a more optimal position.  Other times, keeping a baby tooth longer will help maintain the space for the secondary dentition.  This is where it can get very confusing to parents.  The orthodontist may recommend some baby teeth to be removed and the general dentist thinks they should come out naturally or vice versa.  This can cause the parent to seriously question what is the best treatment for their child.

The best way to explain this is using real life experiences.  I am going to highlight two common situations where the orthodontist could have helped to prevent braces: early loss of a baby tooth and late loss of a baby tooth.

 

Early loss of a baby tooth

Dental caries is the most prevalent childhood disease in the United States.  When it happens in a primary tooth, parents often question whether to fill or extract the tooth.  Other times, the decay is so severe that the dentist has no choice but to extract.  Sometimes extracting a tooth early can have severe orthodontic consequences that will not show up for years.

 

This crowding could have been prevented

This crowding could have been prevented

This patient had upper primary second molars extracted at an early age.  The upper permanent molars drifted forward into the space, giving the second premolars no choice but to erupt into the palate.

 

Four baby teeth were lost when three erupted.  The fourth permanent tooth then had no room

Four baby teeth were lost when three erupted. The fourth permanent tooth then had no room

As you can see from the above example, sometimes a permanent tooth will erupt and cause the loss of two baby teeth instead of one.  Again the teeth will drift and leave no room for a permanent tooth.

 

Both of these situations are going to require extensive orthodontic treatment and could have been less severe or even prevented with the input of an orthodontic professional.

 

Late loss of a baby tooth

Sometimes baby teeth are not lost in a timely manner.  This can cause the permanent teeth to erupt behind or in front of the baby tooth.  This is very common occurrence.  Recently, a friend of mine posted a picture on Facebook of her daughter’s permanent teeth erupting behind the baby teeth.  I recommended immediate extraction of the baby teeth, while her dentist and every other mom said it would be OK and to leave it alone.  In my experience, sometimes it is OK and other times it doesn’t work out.  If it was my child, I wouldn’t roll the dice.  Here are some examples of where over retained baby teeth caused a more urgent need for braces.

The baby tooth remained in the mouth too long and now the permanent tooth is in crossbite creating an esthetic and functional defecit

The baby tooth remained in the mouth too long and now the permanent tooth is in crossbite creating  esthetic and functional issuescanine xbite

 

This patient's parent reported that the lower right incisor (seen on the left) erupted behind a primary tooth and the primary tooth was left in the mouth for a while

This patient’s parent reported that the lower right incisor (seen on the left) erupted behind a primary tooth and the primary tooth was left to come out on its own

 

 

lateral xbite

Another example of an over retained baby tooth causing the permanent tooth to erupt into crossbite.  This new position affects the upper and lower arch  during function and has esthetic consequences

Another example of an over retained baby tooth causing the permanent tooth to erupt into crossbite. This new position affects the upper and lower arch during function and has esthetic consequences

 

All of the above patients were being seen by a general dentist on a regular basis.  The dentists did nothing wrong; they are all excellent clinicians.  It’s just like I said before, we just look at teeth differently.  I think it’s worth adding two appointments a year to see the orthodontist and try to avoid situations like these.

 

I can understand some parent’s hesitation on bringing their child to an orthodontist at age 8.  I know there is a concern about aggressive treatment of children at a young age.  It’s hard to know what is needed and what can wait.  I will explore this issue in my next posting on what conditions really need early orthodontic intervention.   I look forward to your comments.

3 Responses to “How Can I Prevent Braces for My Child?”

  1. Wow Courtney, I had no idea!!! This is so helpful, thanks for posting!

  2. Angela says:

    Great post! I have a feeling in a few years we’re going to see each other A LOT. I’ve started a fund. 😉

  3. Braces says:

    Nice post !! Well, it is very difficult to say how we can prevent braces, dentists can better explain this depending upon the patient’s dental condition. The other topics which you have discussed through this blog is also very informative. People will really be benefited after going through this blog post.

    Hope to see such more posts in future.

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