Reasons why some Early Orthodontic Treatment Fails in Children
Early or interventional orthodontic treatment is recommended by many dentists and orthodontists. While some early treatments are definitely needed, Dr Vaughan is concerned that many early treatments may be a waste of time and money. Additionally, this can be putting patients through unnecessary treatments that have no possibility of success and only serve to lock patients into a practice.
Dr Vaughan was featured on the 60 Minutes program discussing the early treatment of orthodontic patients. Dr Mew, who teaches interventional orthodontic treatment of young children world wide, admitted that there were better options than early orthodontic treatment, for example habit correction was more important.
Early treatment fails because:
- Orthodontic treatment requires high levels of cooperation. Adults would have difficulty cooperating with some of the orthodontic plates I have seen given to children.
- The jaws are too small. Once a tooth erupts it cannot get any bigger, so they are adult teeth trying to fit into a child’s mouth. Mild crowding is natural around the age of 10 to 12 years and will often disappear with growth.
- The last teeth to grow into the mouth, the canines in the upper jaw, require six millimeters of space. Treatment cannnot be completed until these teeth come through.
- Growth enables us to get the best results, and the adolescent growth phase (13 to 16 years) is the most rapid growth stage of a person’s life. This is the best time for orthodontic treatment, unless there are genetic reasons for early intervention.
Remember; children go through “The Ugly Duckling Stage”. This is because growth is not even and some parts of the body grow first and faster. Their legs get too long for their body and their teeth don’t fit into their mouth. They often also lack coordination. It is given the Ugly Duckling name because like the baby swan, when nature is given a chance a thing of beauty can develop. Think back to how many children looked gawky when young, and had crooked teeth, and then blossomed into a beautiful person without treatment.
Warning: There are courses offered to dentists and orthodontists helping them to convince people they need treatment and they need it now, so treat any recommendations of urgent treatment with caution, and always consider getting a second opinion.
Unfortunately many patients, and even dentists, do not understand what quality orthodontics is. Simply:
As orthodontist’s we have three treatment objectives:
- To straighten the teeth
- To correct the bite relationship: making sure the teeth fit into each other or, if there has been atypical growth to improve the bite relationship as much as possible.
- To have the teeth fitting into the face, ie looking natural.
Let us discuss these.
Straightening teeth – there is never an excuse for orthodontists not to leave the patient with straight teeth. However straight teeth also means the teeth must be angled correctly, most teeth have a slight forward tilt, a slight tilt to the midline, and their heights are not flat. If all the teeth were at the same level it makes the patient look older. It is becoming too common now for the orthodontist to use the drill to level the teeth when the braces are removed.
Straightening also means correcting the back teeth. For some reason, some orthodontists do not want to straighten the back teeth, because it takes extra effort and time to straighten the back teeth. By not taking the time to do this orthodontists are able to see more new patients. When patients seek treatment they want and should have all their teeth corrected. You should take the time to find an orthodontist who will do the complete job especially if you are paying for it.
Correcting the bite relationship – there are many orthodontists who will not do their best to correct the bite relationship. Discuss this with your orthodontist before you commence treatment. The last thing you want to hear after treatment is being told that the agreement was to straighten the teeth only.
After treatment the teeth must fit into the face as best as possible. Of course there are a range of factors that come into play here. The goal of the orthodontist should be to make the patient’s smile look natural, as if they had never received treatment. Unfortunately, this is the most commonly disregarded aspect of many orthodontist’s treatments, and can take the most work to satisfactorily achieve. However when this is done right, the teeth look both and natural and pleasing. Because of this, I believe orthodontics is more than a science, it’s an art.