There is a growing skepticism among parents concerning orthodontics, specifically early orthodontic treatment. The most common question that parents ask when they find out that I am an orthodontist is, “Is it me or are kids getting braces earlier and earlier?”. There are several answers to this question. Unfortunately with the competitive nature of the profession of orthodontics and dentistry, as a whole, a very small number of orthodontist/dentists just want to put braces on your child’s teeth because it fits into their business model that drives patients and revenue to their office. Rightfully so, this is where the distrust is generated. I want to stress that this is a very small minority and should not be misconstrued as a norm. Most dentists and orthodontists have your best interests in mind despite your perception of them. The American Association of Orthodontics recommends an initial orthodontic evaluation by age 7. Though it is rare, there are several scenarios where early orthodontic treatment is warranted.
Just like you have noticed that children are getting braces earlier and earlier, you have also probably noticed that there is a child in your kids class that is two heads taller than the rest of the children. You have also noticed the surprisingly young girls that have developed secondary sexual characteristics or have begun their menstrual cycles significantly earlier than their peers. This phenomenon has become increasingly less an anomaly and closer to a norm.
As a parent we stress about our children’s development, whether it be physical or mental, compared to their peers. When considering growth and development of your children, it should give you great comfort to know that there is a very wide range of normal variation. We have all seen the growth chart at the pediatrician’s office. The difference between a child in the 0th percentile compared to a child in the 100th percentile is staggering. Just as the height and weight of our children is variable, the timing of developmental milestones is also variable. On one end of the spectrum, there are babies born with teeth in their mouth. On the other end, my daughter did not have any baby teeth in the first year of her life.
These charts have been developed to monitor and analyze how a child fits into the established norms, but they are also helpful tools to determine if something is not normal. Despite our best wishes for our children, we are not all genetically programmed to develop within the norms. The skeletal features of the cranium do not always develop like we would like them to. The teeth do not always develop the way we would like them to. The relative position of the jaws to each other and the multitude of variation of dental development can lead to conditions that are not favorable for a well-aligned smile without intervention.
As a child there is great potential for growth. Growth centers of the bones are active. Active areas of bone growth allow for orthopedic intervention to stimulate growth of underdeveloped jaws or inhibit growth of overdeveloped jaws. Once a child reaches the end of their growth potential, these areas of the skeleton are no longer active or they fuse creating solid stable unmovable junctions. If it exists, the abnormal skeletal condition becomes permanent. Correction of these conditions, after completion of growth, requires more aggressive interventions such as surgery or tooth extractions. Simple conservative measures are no longer available. The ability to take advantage of a patients growing body no longer exists. The potential for growth modification from age 7 or earlier to the completion of growth compared to that at age 12 or 13, when most parents think that they should be seeking treatment for their children, are extremely different. It is like driving from Denver to Breckenridge with a full tank of gas or trying to get there when your low fuel warning light is on.
Not every child needs orthodontic treatment at age 7. In fact, only a very small minority requires treatment at this early age. Evaluation by age seven allows for early intervention in these specific situations. Due to the degree of variation of growth and development among children of the same age, early evaluation allows the orthodontist to time treatment when it is ideal whether your child falls below 0th percentile of above the 100th percentile.