Orthodontic treatment has become increasingly common as awareness of the importance of proper dental alignment and bite grows. However, determining the ideal age to start treatment is not a one-size-fits-all decision. It depends on a multitude of factors that interact to influence the effectiveness and long-term outcomes of the treatment.
Dental Development and Growth Spurts
Primary Dentition Stage
During the primary dentition stage, which typically lasts from around six months to six years of age, the focus is mainly on the eruption and development of the baby teeth. At this time, orthodontic treatment is generally not necessary, as the primary teeth are temporary and will be replaced. However, some issues, such as severe thumb-sucking habits that are causing significant dental problems like an open bite, may need to be addressed. For example, if a child has been sucking their thumb aggressively and it is starting to affect the alignment of the front teeth, a dentist might recommend interventions to break the habit, such as using a thumb guard. But this is more about habit correction rather than traditional orthodontic treatment.
It’s important to note that most orthodontic problems during this stage are monitored rather than actively treated, as the natural growth and development of the child may correct some minor irregularities as the permanent teeth start to erupt.
Mixed Dentition Stage
The mixed dentition stage, from about six to twelve years old, is a critical period for orthodontic evaluation. This is when the permanent teeth start to replace the primary teeth. Some children may exhibit early signs of orthodontic issues, such as crowding or crossbites. For instance, if a child’s permanent incisors are erupting and there is not enough space in the dental arch, it could lead to crowding. In such cases, an orthodontist might consider using a palatal expander to create more space.A palatal expander is a device that gradually widens the upper jaw, allowing room for the permanent teeth to erupt in a more proper alignment.
Growth spurts also occur during this stage, and they can have a significant impact on the effectiveness of orthodontic treatment. Girls typically experience a growth spurt earlier than boys, usually around ages 8 – 10, while boys’ growth spurts occur around ages 10 – 12. Orthodontic treatment that takes advantage of these growth spurts, such as using functional appliances to guide the growth of the jaws, can be more successful in correcting skeletal discrepancies. For example, a functional appliance like a Twin Block can be used to correct an overbite or underbite by influencing the growth of the upper and lower jaws.
Permanent Dentition Stage
Once all the permanent teeth have erupted, usually by the age of 12 – 13 for most children, a more comprehensive assessment of orthodontic needs can be made. At this point, traditional braces or clear aligners can be used to correct a wide range of orthodontic problems, including more severe crowding, bite issues, and tooth rotations. For example, if a teenager has crooked front teeth and a mild overbite, braces can be applied to gradually move the teeth into the correct position and improve the bite.
However, even in the permanent dentition stage, the age at which treatment starts can still vary. Some adults may also seek orthodontic treatment, and while the treatment principles are similar, the bone and tissue response may be different due to the completed growth of the jaws. Adult orthodontic treatment may take longer and require more careful monitoring, but it can still achieve excellent results in terms of improving dental alignment and bite function.
Specific Orthodontic Issues and Their Timing
Crowding
Mild crowding in the early mixed dentition stage may be monitored as the remaining permanent teeth erupt, as some self-correction can occur. However, if the crowding is severe and is likely to cause problems such as impacted teeth or abnormal tooth wear, early intervention in the mixed dentition stage is advisable. For example, if a child has a very narrow upper jaw and the permanent incisors are erupting in a crowded and rotated manner, using a palatal expander and braces early can prevent more serious issues later.In the permanent dentition stage, moderate to severe crowding is typically treated with braces or clear aligners. The treatment duration may vary depending on the severity of the crowding but usually ranges from 12 – 36 months.
Bite Problems
Crossbites should be addressed as early as possible, preferably in the mixed dentition stage. A crossbite can affect the growth and development of the jaws and lead to problems with chewing, speech, and facial symmetry. For example, if a child has a crossbite where the upper teeth fit inside the lower teeth on one side, using a removable appliance or a fixed appliance like a lingual arch in the mixed dentition stage can correct the problem and guide the jaws to grow in a more normal pattern.
Overbites and underbites that are due to skeletal discrepancies may benefit from early treatment during the growth spurt in the mixed dentition stage. By using functional appliances, the orthodontist can attempt to modify the growth of the jaws and reduce the severity of the bite problem. However, if the overbite or underbite is mainly due to tooth position rather than skeletal issues, treatment can be initiated in the permanent dentition stage with braces or clear aligners.
Spacing and Diastemas
Excessive spacing between teeth, especially in the front, can be treated at different ages. In the mixed dentition stage, if the spacing is caused by a missing tooth or a growth issue, it may be addressed with a space maintainer or early orthodontic intervention to guide the eruption of the remaining teeth. For example, if a child has a large gap between the front teeth due to a prematurely lost primary tooth, a space maintainer can be used to hold the space until the permanent tooth erupts.
In the permanent dentition stage, braces or clear aligners can be used to close the gaps and align the teeth properly. The treatment approach may depend on the overall dental situation and the patient’s aesthetic preferences.
Benefits and Drawbacks of Early vs. Later Treatment
Benefits of Early Treatment
Guiding Growth: Starting orthodontic treatment in the mixed dentition stage, especially during a growth spurt, allows the orthodontist to take advantage of the child’s natural growth and development. Functional appliances can be used to guide the growth of the jaws, potentially reducing the need for more invasive treatment later. For example, a child with a developing skeletal overbite can have their upper jaw growth restricted and lower jaw growth enhanced with the use of a functional appliance, leading to a more harmonious facial and dental development.
Preventing Complications: Early treatment can prevent more serious dental problems from developing. By addressing issues like crowding or crossbites early, the risk of tooth impaction, gum disease, and abnormal tooth wear can be reduced.For instance, if a child has a crossbite that is left untreated, it can cause the teeth on one side to wear down unevenly and also affect the growth of the jaws in an unfavorable way.
Drawbacks of Early Treatment
Long-Term Commitment: Early orthodontic treatment often means a longer overall treatment period. A child who starts treatment at age 8 may need to wear braces or other appliances for several years, followed by a period of wearing retainers.This long-term commitment can be challenging for both the child and the parents in terms of maintaining the appliances, attending regular appointments, and ensuring compliance with the treatment plan.
Uncertainty of Outcome: There is some uncertainty in the outcome of early orthodontic treatment. While the goal is to guide growth and correct problems, the child’s growth and development can be unpredictable. For example, a child who starts treatment for a mild overbite may experience a growth spurt that changes the relationship of the jaws in an unexpected way, requiring further adjustments or a different treatment approach. Additionally, some problems that seem significant in the early years may self-correct as the child grows, making the early treatment unnecessary.
Benefits of Later Treatment
Definitive Treatment: In the permanent dentition stage, the teeth and jaws are more fully developed, allowing for a more definitive and accurate treatment plan. The orthodontist can have a clearer picture of the final dental and skeletal structure and design a treatment that precisely addresses the existing problems. For example, using braces or clear aligners in the teenage years or adulthood can achieve a more predictable result in terms of tooth alignment and bite correction.
Patient Compliance: Older patients, especially teenagers and adults, may have better compliance with the treatment plan.They are more likely to understand the importance of orthodontic treatment and follow the instructions regarding wearing the appliances, maintaining oral hygiene, and attending appointments. For instance, an adult who has decided to get braces for cosmetic or functional reasons is more likely to take care of the braces properly and keep all their appointments compared to a younger child.
Drawbacks of Later Treatment
Longer Treatment Duration in Some Cases: While definitive, treatment in the permanent dentition stage may take longer in some cases, especially if there are more complex orthodontic issues. For example, if an adult has severe crowding and a bite problem that has been present for many years, it may take longer to correct compared to a child with a similar problem who started treatment earlier.
Limited Growth Modification: Since the growth of the jaws is mostly complete in the permanent dentition stage, the opportunity to modify skeletal growth is limited. If a patient has a significant skeletal discrepancy, treatment may require more invasive procedures like orthognathic surgery in addition to orthodontics, which has its own risks and a longer recovery period.
Conclusion
The age at which orthodontic treatment should begin depends on a complex interplay of factors, including dental and skeletal development, the presence of specific orthodontic issues, and the potential benefits and drawbacks of early or later intervention. Orthodontists carefully evaluate each patient’s case, taking into account tooth eruption patterns, jaw growth, and the nature of any orthodontic problems. While early treatment can offer advantages such as guiding growth and preventing complications, it also comes with challenges like a long-term commitment and uncertainty of outcome. Later treatment, on the other hand, provides a more definitive approach but may have limitations in terms of growth modification and potentially longer treatment times.
