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The Importance of Obtaining an Orthodontic Consult at the Correct Age

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According to the American Association of Orthodontists (AAO), 3.8 million children received orthodontic treatment in 2008. This number represented a 46% increase over the course of the preceding decade. The rise in the number of these cases (among individuals 17 and younger) may be attributed partly to the initiation of treatment at earlier and earlier ages. Traditionally, braces were loosely associated with middle and high school students. However, their prevalence among elementary school children has been continuing to grow. There is no doubt that parents’ wishes to obtain perfect teeth in their children at a younger age is a contributing factor to earlier initiation of treatment; many parents believe that earlier intervention may reduce treatment later, or prevent the need all together. Other contributing factors include better diagnostic technology and increased insurance coverage. With the number seeming to creep lower and lower, parents with children or general dentists with a wide pediatric population may be uncertain about the correct age at which children should obtain their first orthodontic consult. Furthermore, parents may be left wondering why it is even important. Both of these issues are addressed below.

 

Orthodontists currently appear to agree that an occlusion/orthodontic assessment should be done before a child reaches age 7. This allows specialists to determine whether the child needs no treatment, early treatment, and/or late treatment. The terms “early” and “late” themselves are controversial. Some define “early” treatment as one that is started in the primary or early mixed dentition stage (permanent first molars and incisors present), while others consider it “early” if it is initiated in the late mixed dentition stage (before eruption of second bicuspids and permanent upper canines). This ultimately affects whether children receive a one-phase vs. two-phase treatment.

 

Research has shown that certain conditions are treated more effectively using early treatment. On the other hand, for other conditions, there seems to be no benefit via implementation of early treatment. Orthodontists generally prefer early treatment for most functional habits, which include thumb sucking, mouth breathing, and tongue trusting. Proactive treatment for these conditions are favored since lack of treatment may lead to unfavorable growth of jaws and/or protruded upper anterior teeth capable of trauma or speech problems. Aside from treating functional habits, early treatment is also effective for correcting anterior crossbites, lateral crossbites, and arch constrictions. These problems are best targeted early since it permits orthodontists to take advantage of the still-growing child. Once a child’s main growth period is completed, for example, it becomes very difficult to compensate for narrow maxillary arches. In contrast, one of the most common conditions, class II malocclusions, sees no benefit from early treatment. Patients with class II malocclusions (even if they obtain early treatment) will frequently require a second phase of treatment, so studies have shown that it may just be better and cheaper to wait until the late mixed dentition stage.

 

Indeed the research is controversial, and every case needs to be assessed individually to determine the best treatment protocol, yet it is prudent for children to receive their first orthodontic consult by 7 years of age. Pediatric/general dentists should be aware of this recommendation and instruct parents accordingly. While early treatment is by no means appropriate for every child, it may be extremely beneficial for some.

 

References

 

Aldrees, A., Tashkandi, N., AlWanis, A., AlSanouni, M., & Al-Hamlan, N. (2014, December 8). Orthodontic treatment and referral patterns: A survey of pediatric dentists, general practitioners, and orthodontists. Retrieved January 24, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4273289/

 

Al-Shayea, E. (2014, October 1). A survey of orthodontists’ perspectives on the timing of treatment: A pilot study. Retrieved January 24, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4238079/

 

Keates, N. (2010, November 16). The 8-Year-Old With a Perfect Smile. Retrieved January 24, 2015, from http://www.wsj.com/articles/SB10001424052748703326204575616460332062620

 

Pietilä, I. (2007, October 25). The European Journal of Orthodontics. Retrieved January 24, 2015, from http://ejo.oxfordjournals.org/content/30/1/46.long