It is best for the orthodontist to see children by age 7 to advise if treatment is required and when the best time to commence treatment would be. The first permanent molars and incisors have usually come in by that time and crossbites, crowding, and other problems can be evaluated. When treatment is begun early, the orthodontist can guide the growth of the jaw and guide incoming permanent teeth. Early treatment can also regulate the width of the upper and lower dental arches, gain space for permanent teeth, avoid the need for permanent tooth extractions, reduce likelihood of impacted permanent teeth, correct thumb-sucking, and eliminate abnormal swallowing or speech problems. In other words, early treatment can simplify later treatment.

Early evaluation provides both timely detection of problems and greater opportunity for more effective treatment. Prudent intervention guides growth and development, preventing serious problems later. When orthodontic intervention is not necessary, an orthodontist can carefully monitor growth and development and begin treatment when it is ideal.

•   Interceptive treatment

  • What are the advantages of interceptive treatment?
    Some of the most direct results of interceptive treatment are:

    Creating room for crowded, erupting teeth
    Creating facial symmetry through influencing jaw growth
    Reducing the risk of trauma to protruding front teeth
    Preserving space for unerupted teeth
    Reducing the need for tooth removal
    Reducing treatment time with braces

•   Appliances

  • Headgear

    

    is typically used in growing patients to correct overbites by holding back the growth of the upper jaw, allowing the lower jaw to catch up. Headgear needs to be worn approximately 10-14 hrs to be effective in correcting the overbite, usually anywhere from 6 -18 months depending on the severity of the overbite and how much a patient is growing.

    Soreness of teeth when chewing, or when the teeth touch, is typical. The soreness/tenderness may persist for several days. Usually, the second and third days are the most severe, with reduction in soreness over the next couple of days. Ibuprofen and soft diet are helpful.The key to the fastest relief of tenderness is to continue the wear headgear/elastics even though the teeth are sore. If you stop wearing the headgear or elastics, your teeth will feel better temporarily, but as soon as you resume wearing your headgear, the symptoms will start all over again.

    Facemask

    

    Children who have an under-bite need special attention, which is why they wear an orthodontic facemask is also known as a reverse pull headgear for up to 18 hours a day.

    Under-bite means the upper front teeth are behind the lower front teeth. This can be caused by either a skeletal discrepancy, growth discrepancy between upper and lower jaws, or a dental discrepancy, where the upper and lower teeth are angled incorrectly, causing the under-bite to form.

    The reverse pull headgear is more often used for growing patients. It is most effective when used between the ages of about six to 10 or 11 years old. It works to bring the pull the upper jaw forward, increasing its size and also restricting the growth of the lower jaw. Essentially, it attempts to normalize the relationship between the upper and lower jaw.

    The reverse pull headgear is usually worn at least 12 hours a day for about six to 18 months, depending on the severity of the discrepancy, and the goal of the treatment

    Patients should keep in mind that the sole purpose of wearing a reverse headgear is to normalize the size of the jaws so they are even. It will not do anything to straighten teeth. Usually we do this first, follow up with a course of braces immediately following, or perhaps when the child gets a bit older. That varies based on what the malocclusion is.

    Expander

    

    The purpose of the orthodontic expander is to widen the upper jaw. That has two goals: The first is to create space for teeth, the second — and the most common — is to correct the crossbite, where the upper teeth are inside the lower teeth.

    In growing children, the palate is made of two bones that are split in the center. As we age and reach puberty, those bones begin to fuse together. Up until that point, using this type of appliance, we can widen the upper jaw and separate those two bones without really any pain at all, and thus create a wider and a broader arch.

    The appliance itself can come in two forms: It can either be a removable one that looks similar to a retainer, or a fixed one.

    The device is typically turned a screw by the patient or his parent one to two times per day for a few weeks. Turing that screw widens the appliance and puts pressure on the teeth to increase or widen the jaw and the palate. Usually there is a small amount of pressure while the run is done but it dissipates quickly, and doesn’t really hurt.

    Once the active expansion is completed, the appliance is generally left in place for four to eight months to allow new bones to develop in the center of the palate and heal and stabilize.

    

    Lip Bumper

    A lip bumper is used to make more space for crowded teeth. Lip bumpers are usually used for lower teeth, but may be used for upper teeth as well.

    A lip bumper slides into metal bands that are glued to the molar teeth. It is worn all of the time except while brushing.

    How does a lip bumper work? It removes lip and cheek pressure from the teeth and allows the tongue to widen the arch. The lip bumper also prevents the permanent molars from sliding forward as primary teeth are lost and permanent teeth come in. For this reason, lip bumpers are most effective if started before all the primary teeth are lost.

    A lip bumper is very easy to wear. It does not affect speech, and patients learn to quickly slide it in and out in a day or two. Most patients will wear a lip bumper for six to twelve months.