Tuesday, September 27, 2005

When is the Best Time to Start Braces?


When we move teeth orthodontically, what happens is that a small pressure exerted over a long period of time stimulates the cells in the bone to resorb in the direction of tooth movement. Once a space is made, the tooth is pushed into the space. Bone fills in behind where the tooth once was located. The process repeats itself again till the tooth is in the final desired position. This process can take place at any age. Yes, you can get braces at 40 years of age! The only caveat is that it usually is easier when the patient is younger. Isn’t most everything? There are however, certain things that can only be done in a growing patient (a preteen or teenager). Once growth ceases, the boney growth of the face halts as well. When a child is growing, certain forces can be applied to guide the growth. That’s usually one of the things a headgear does.

So, when is the best time for my child? Well, it depends on the discrepancy or problem you are trying to correct. If a child has a crossbite, I tend to want to correct it as soon as I see it. I have even corrected a posterior crossbite in a 3 year old! Most of the time braces are not indicated until the patient is between 9.5 and 12 years of age. That’s when a lot of growth takes place. Some children are really ahead of the game in terms of growth. They will get braces sooner. Some patients without severe discrepancies can wait till all their baby teeth fall out around age 12 or so. Different Orthodontists and Pediatric Dentists have different philosophies regarding when to start a particular case. Don’t be surprised if you get a second opinion with a slightly different answer.

I like to see the patient early on so I can guide the eruption of the teeth with early intervention. Placing a lingual arch space maintainer and/or selective removal of certain baby teeth can improve the pattern of tooth eruption. Also, early expansion of a constricted maxillary arch can really help the overall treatment result. One particular case with severe crowding that I remember used timed extractions of baby and then later, permanent teeth. The child ended up not needing any braces at all! So, every child is different. Hey, you know that already.

So, early on, get a Pediatric Dentist or Orthodontist to look examine your child. Most initial crowding problems manifest themselves around 7 years of age when the first permanent teeth are erupting. Good luck, just remember that orthodontics is a long-term proposition. Treatment often takes place over several years. After initial early treatment, you may only be wearing “braces” for 12 to 24 months, but you will wear a retainer once your braces are removed. Oh yes, many of us remember our “retainers”.

More on Braces here: Orthodontic Fashion

85 comments:

Anonymous said...

how much do braces usually cost?

Dr. Dean Brandon said...

The cost of orthodontic treatment varies a lot. Most cases are feed based on how difficult the treatment will be. A good measure is how long the case is estimated to take. In general, more complex cases will be more, simpler cases will be less. Most cases take about 24 months and run about $5000 or so (usually spread out over the 24 months). If you live in a big city or in a high cost area, the fee can be much more. I know of an orthodontist (not in our office) who fees about $10,000 per case.

Anonymous said...

hi,
i had a question about space maintainers. my brother is 8 and he recently got his upper left lateral incisor removed because part of it was broken. the dentist recommended a space maintainer, but according to your chart it should be falling out around his age anyway. okay- but let's say that he goes to an orthodontist and they give him a space maintainer...how long does he have to have it on for? and do you recommend the fixed or the removable type?

thanks so much.

-concerened family member-

Dr. Dean Brandon said...

If it was a baby tooth, check out my post on: "Fake baby teeth -pedo partial".

daqueenb said...

I was trying to determine the difference in terminology of braces and a space maintainer for dental coverage plans. Could you tell me what it is.

Dr. Dean Brandon said...

Insurance plans cover things the way they want, there is no rhyme or reason. Most of the time however, space maintainers is not orthodontic care. You are not moving teeth.

Anonymous said...

My daughter is 6 years old & has lost 5 teeth so far (two top front teeth & three front bottom teeth). 2 of the permanent bottom teeth have come in, but very crooked (they form sort of a V) plus she has a molar (the first molar) on the bottom that is just now coming through - the one opposite has been in for years. I'm really worried that she is going to have some major orthodontic issues. Since she is still losing front teeth, is it too early to take her to an orthodontist?

Dr. Dean Brandon said...

No, it is not too early for an evaluation. The AAO recommends around that time if you see something gong on.

Anonymous said...

I have a 7 year old who has crowding on his lower jaw and my orthodontist said he it can be corrected with hyrax and braces. I have come to learn that hyrax exapnds the jaw and the voice changes as a result and its permanent - no one mentioned this to me. Also, I have a moderate stutter. My son doesnt' stutter (yet) but he does repeat specific words. Although stuttering has been shown to run in families, it is multifactorial. I wonder if we go ahead with this treatment, whether the hyrax - since apparently it does make your speech garbled (not surprising since you have this metallic piece in your mouth) - may contribute to him developing a stutter. Should we wait until he is more developed (teenager)? - Thank you very much for your time.

Dr. Dean Brandon said...

I have read nothing that would indicate stuttering or voice changes from orthodontic treatment.

Anonymous said...

My daughter is 6 and has quite a bit of dental work done already. We are going to see our pediatric dentist this week for a check up and I was wandering if I should ask about starter braces. She has lost tooth #7, #8, #9, #23, #24, #25 & #26. We had #29 & #21 surgically removed and she now has space maintainers. She has a very prominate gap between #8 & 9 which tends to run on the praternal side of the family. This is something that we are definately interested in correcting. Also there is a slight gap between #24 & 25 and 23 is almost sidways the way that it has came in. #26 was a little crooked when it came in but seems to be straightening its self out. Are these issues that you would feel need to begin to be corrected now or would it be better to wait?

Dr. Dean Brandon said...

Ask the pediatric dentist. Sounds like you are doing what is reasonable to be done now--some things have to just wait for growth.

Barb - FL said...

My daughter had to have her canines pulled because her permanent canines were becoming impacted, but it's only been a week and her four front incisors are spreading out quite a bit. She's able to put her tongue between two of the teeth now. Is this normal or is she going to need a space maintainer or something?

Dr. Dean Brandon said...

I can't say, but teeth do move during development, growth and normal eruption.

Anonymous said...

Hi,

I'm 14 years old and I suck my thumb..My bottom teeth have been pushed back and my top teeth pushed forward. When I bite down the distance between my top and botom teeth is about 1cm and a 1/2.
I was wondering how they would push my bottom teeth forward, how long I would have braces for (apprx) and ways to stop sucking my thumb?

Thanks

Dr. Dean Brandon said...

Each case is different, but generally they might approach habits first, then do braces. Still, I see many cases where the orthodontic treatment helps the habit, expecially in older children. Some "overbites, are due to positioning of the teeth like from a habit. Others are from skeletal growth patterns which usually take longer to correct. Most braces are 24 months, but that varies. Moving teeth is easy for the most part with gentile pressure from orthodontic appliances.

MarylandMom said...

My 6.5 year old has bilateral post crossbite. One doc says quad helix combined later with Damen braces on front 4 teeth. Other guy says Damen braces for whole process (crossbite correction alone). What do you say for best efficacy and his comfort?

Dr. Dean Brandon said...

A quad helix is a good appliance when used properly and I use it often on young patients--Each case is different and there is often more than one way to acheive any given goal.

The method or devices used are often less important than the diagnosis and the fact that each dentist uses what they are most comfortable with. Also, orthodontics is often like a long road and you cross each bridge (or problem) as you come to it, or as the age/developmant of the patient allows.

If you are going somewhere, it matters little whether you go in a Honda or a Toyota.

Helen said...

My daughter is 11 now and most teeth grown except for 3 molers and 4 wisdom teeth. One orthodontist stated that we should wait since some of her middle teeth (the two upper and two bottom middle teeth) are not finished yet (the root is not closed yet). Braces might hurt those middle teeth and 'kill' them. Others did not mention anything about those. I am not sure whether we should wait or start braces immediately or wait for another 6 months. I heard it is easier to adjust the teeth when you are young.

Thank you for your help.

Dr. Dean Brandon said...

Some orthodontists are wary about moving teeth drasticlly until most root development is completed or pretty much completed. I did speak to our drthodintists and they often will move teeth at an earlier time, but only when most of the root is formed and the movement ( of the root) is not too much. Each case is different. Some braces are done quite early with a second phase later on. Some kids grow faster, some slower. Usually you don't see braces "kill" teeth. One complication however, is blunting of developing teeth..sort of stops the root growth where it is. Thats not good, but not toooo bad if the roots are pretty well developed already.

As with ay orthodontic treatment (at any age) there can be complications. We almost always go over possible complications with every patient/parent including problems wiht root development, etc.

Anonymous said...

My daughter, who is 9 yrs. old, was recently told she needs braces by this summer, but she has two of her teeth that is growing at the top of the gums....well the dentist is telling me we need to see a oral surgeron because they teeth are growing in the pallet....who knows more? The orthdontic or the dentist? The dentist says that the teeth are not in the pallet...Please help!!!

Dr. Dean Brandon said...

Usually what happens is the the Pediatric Dentist will determine the best time to either begin orthodontic treatment or referral to the orthodontist. If there is some particular anomaly, he might refer to, say an oral surgeon, before an orthodontic evaluation especially if it is going to be a while, then later on tot the orthodontist. Most of the time, if it in amy way relates to tooth position, etc, the orthodontist is making the call on that.

It all depends on the individual circumstances. It is certainly ok to coordinate and communicate any non-orthodontic work with the orthodontist. Sometimes the orthodontist will do a few tooth movements then have an oral surgeon expose and bond brackets to unerupted teeth that might be out of position, etc. This is usually coordinated by the orthodontist in consultation with the oral surgeon. (Just one example).

Again, I recommend a Pediatric Dentist Specialist for any childs regular care needs. In our office most of the orthodontic cases are treatment planned by our orthodontists after referral from us.

Anonymous said...

If the childs still have about eight baby teeth...then..what is the best age to put braces on?

Dr. Dean Brandon said...

Well, as you can see, there is no one best time that can be stated that works for every patient. Each case is different and should be evaluated as to that patient's needs.

Anonymous said...

Hi, I'm a teen and I have an overbite and a gap in between my two front teeth for about 10 years I think.
I noticed it closed a little when my other upper teeth grew.
My parents were told to wait because when my back teeth grow, they will push my front teeth together. That hasn't happened yet, and I'm not sure it will.
How long do you think I will spend with braces?

Thanks!

Dr. Dean Brandon said...

Every person's case is diferent. Braces usually take 24 months, but I have had some done in 6 months for a simple crossbite and some that take much longer especially if we are waiting on growth. If a space between front teeth runs in the family, it will likely not close with age. Most dential development is finished in the teen years. Ask your orthodontist about your case in particular. An initial consultation will give both you and your parents a good idea of what might or might not happen in the future.

Anonymous said...

My son is 4 1/2 years old, and I can see he has a moderate overbite. What should I expect in his first app. with the dentist? Thanks

Dr. Dean Brandon said...

Well, they are not likely to slap on braces the first appointment at 4 years of age. Every dentist usually starts with an exam. Maybe xrays and a cleaning. See my other posts on first visit and behavior in the dental office etc. Although I have done crossbite corrections on young children the vast majority of the time things like overbites will be treated much later on. Usually during the prepubertal growth spurt or later. It all depends on growth crowding etc. Etc. Have fun at your first visit!

Anonymous said...

I have 2 daughters both with quad helix appliances for crossbites. My youngest had difficulty when it was initially placed with the appliance embedding in the roof of her mouth and causing severe sores of which we had to go and get it repositioned by the orthodontist, but it was not removed.
My older daughter has had much difficulty with it. The first night she had her appliance, when she went to eat dinner the band came off and it was hanging in her mouth. I called our orthodontist emergency line and they had us cut the appliance out. She had to have a new one made, wait another 2 weeks, etc. After getting the new one made, we didn't have any issues. When we just went for a follow up, My oldest daughter's band was lose and they had to take it out and reposition it again. Within 2 days her mouth was sore and she couldn't eat, the next morning, it was embedded in the roof of her mouth also with terrible sores. We called the emergency line and after several hours, they met us at the office. The assistant at the office who met us removed the inner part, not the bands and said she couldn't reposition it without putting it back on the roof of her mouth. She did another impression and said it we would have to have another appliance made, even though there was nothing wrong with this one.
Please tell me, is this normal? My daughters are struggling and so am I!
Thanks so much for your input.

Dr. Dean Brandon said...

Sometimes appliances do come loose and need to be recemented. I have seen appliance partially "imbeded" into the Palatal tissue, usually without much problem. If it's just a little, no change is needed. If it's more usually a minor adjustment is needed. Only rarely do you need to remake an appliance. All of them have some benefits and drawbacks. Read more on my post about crossbites. -Particularly posterior crossbites. I will say I use the quad helix often. Sometimes we use the appliance or expander where the parent has to turn it daily with a little key. Parents often have trouble with that one too.

Anonymous said...

How time sensitive is orthodontic treatment? We have been told that my two year old daughter is going to need two courses of treatment with braces as well as jaw surgery one day to correct her deep overbite. Can braces be postponed for up to a year in order to fund a Flexible Spending Account in the amount needed for the treatment?

Dr. Dean Brandon said...

One does not wake up one morning as say, Oh my goodness, we need braces today! There is usually a little flexibility on timing. You just don't want to wait too long after the growth spurt is over. Many folks ask to either postpone things a little while (usually to do with insurance plans at work)or to start a little earlier if possible. Most of the time it's not a big deal. Ask your orthodontist or pediatric dentist about your individual case.

Wendy said...

hi my daughter is turning 7 years old...one of her lower teeth grew cricked in the front. do u think i should be thinking about getting braces for her?

Dr. Dean Brandon said...

Yes, 7 is a good age for an initial evaluation especially if you think something is not quite right. I think the American Association of Orthodontists recommend 7 years of age.

Anonymous said...

hi,
is it better to wait for my wisdom teeth to grow fully or while they are growing to put on braces?

Dr. Dean Brandon said...

Braces are usually not contraindicated of third molars (wisdom teeth) are erupting. If they are bothering or impacted and removal is indicated, the orthodontist may want that done prior to beginning orthodontic treatment.

Anonymous said...

is extracting 4 teeth common?

Dr. Dean Brandon said...

Common, but most orthodontic cases do not need extractions.

Dr. Dean Brandon said...

Wisdom teeth, well, most do need to be removed (usually 4) --but that is another post some day.

Meade Skelton Haufe said...

I think 40 is really young.

Ravi Putcha said...

Hi, is it advisable to go for braces while the kid is still having milk-tooth (barring 8 which aren't)?

Dr. Dean Brandon said...

You can treat young children with "braces". However, age 6 and younger it is not very common--usually limited to simple crossbite corrections. In what we call the "mixed dentition" that is 6 years old to about 12 years old, there are a lot more options--again crossbite corrections, or a limited phase one treatment just to correct some anterior crowding ( that would likely be around age 10 or 11). Most braces are started somewhere between 9 and 12 years of age. A significant number are done a little older (12-15) especially if growth issues are not present. It all depends on the type problem, growth and the child in question.

Anonymous said...

My son fell and broke his incisor midway. What would be a normal proceedure if the incisor is chipped. Is there an alternative to a tooth cap.

Dr. Dean Brandon said...

See my posts on dental trauma, broken teeth etc.

Anonymous said...

I am 12 years old--13 in April--and still have 8 baby teeth to lose (I lost my first tooth when I was 7.5). I know I should probably go to an orthodontist to at least get myself checked out, but do you think now would be a good time to get braces if I need them? Some sources say you should wait until all your permanent teeth come in, which for me could be another year, and some say it's okay if you still have some baby teeth (I need to lose my top canines and all molars except for the ones in the top left). I've also heard that after age 14, braces are more painful, because the head and mouth are pretty much done growing. For that reason, if I need braces, I want to get them ASAP. Do you think I can or should I wait?

Dr. Dean Brandon said...

12 years old is very common to get braces. You do not have to loose all the baby teeth first. Good Luck!

Anonymous said...

My daughter just turned 8 and is missing her laterals (baby and adult) and also has a posterior crossbite. The final recommendation is to start now with reshaping the jaw and later get implants. Initially, the recommendation was to reshape the upper jaw now, pull the top teeth together later with braces and then reshape the actual teeth to look like the ones that are supposed to be there. Is this still possible considering that she may loose her bottom wisdom teeth anyway or could they be pulled to balance her out and avoid getting implants?

Dr. Dean Brandon said...

That is a complex decision depending on many factors. A good discussion about options would be advisable with your orthodontist. Those are the basic two ways to handle missing laterals.

Anonymous said...

My son is 8 yrs old and has a crossbite and an underbite. What is the best treatment option?

Dr. Dean Brandon said...

The best treatment option is one completed and formed after a thorough analysis of your child's particular problem. Each case is different. There is no one size fits all. Your orthodontist or pediatric dentist can give you the best answer. Good luck.

Anonymous said...

i just turned 13, and my bottom 6 in the very front are crooked, and top 4 or 5 are crooked, should i get braces?

Dr. Dean Brandon said...

Ask your orthodontist or pediatric dentist. They can get you started. Sounds like you are ready now.

Anonymous said...

Hey! Im in the 5th grade i know i have to get braces but when is the right time! my mother had braces put on in the 2nd grade and she has lost all her back teeth and every where she goes they say its from braces being pu on so early! Is this true? thanks so much, anonymous

Dr. Dean Brandon said...

Braces do not cause lost teeth.

It is important to brush and clean well during treatment or you possible can get cavities.

kanchana said...

I have a 2 year old with an established skeletal crossbite . When is the best time to start visiting an orthodontist.

Dr. Dean Brandon said...

The first visit to a Pediatric Dentist should be at one year of age. Most Orthodontists say come in at age 7. That's when some of the first permanent teeth begin to erupt. Most crossbites are not corrected till older than that. Every case is different, so having a Pediatric Dentist following the growth and development, they can tell you the best time to begin orthodontic treatment for your child. There are often several things that need to be done, sometimes at different ages.

Dr. Dean Brandon said...

Sometimes there is a growth problem like a Class III case (underbite). Some advocate treating this early, even in the preschool years. I have done this before, but only in a very few cases.

Anonymous said...

my 12 year old son's has 7mm over bite.an orthodontist told to remove 4 permenent teeth and put braces.i am very much worried about the exraction of 4 permenent teeth.what ido?

Dr. Dean Brandon said...

Removal of bicuspids is a very common way of dealing with crowding. A through diagnostic evaluation will tell th orthodontist if that is the best course of action.

Anonymous said...

hi,
my daughter is 12 yearsold and has 2 missing teeth(upper jaw the ones next to the front teeth on both sides).Since she doesnt havethose the nab came directly next.I am taking appiontments with my orthodontist.When do you think she should put braces?


thanks

Dr. Dean Brandon said...

As you can read here, every case is different. It's good to have the orthodontist take a look. I see kids with missing lateral incisors almost ever week. Good luck.

Anonymous said...

Hello Dr:
My son is 11.6 years old. He has all his permanent teeth. He has some crowding in his inferiors. His upper teeth are beautiful. His orthodontist already put braces on him. Now i'm worry it is too early. My family dentist said so. He said he could loose his teeth if too much pressure is inflicted on the teeth, also he could lose bone and roots.I want to have the braces removed. Please help me. I think I should wait to see if his jaw grows and accomodates all his teeth. He also had surgery and had one of his wisdom tooth removed.

Dr. Dean Brandon said...

Orthodontists and pediatric dentists have extensive education on appropriate timing for growth and development. I would discuss your concerns with your orthodontist. As you have presented it, things sound very normal timing wise.

Anonymous said...

Do you need to lose your first molars in order to get braces?

Dr. Dean Brandon said...

There is no hard and fast rule like that. Each case is different. Most kids/teens get braces between 9 and 12 years of age. As you can read, some sooner, some later.

Lela said...

Hi, my son is about to be 15 in a few weeks. He has been seeing the orthodontist since he was 9. He has crowding and crossbite. He has had an upper and lower lingual appliance and 4 permanent teeth extracted (many of his baby teeth had to be pulled by dentist as well, because they would not come out. Now, we are waiting on adolescent growth to level out before braces. The orthodontist explained the jaw grows at about the same rate as femur. Can you help clarify why we have to wait on the braces for that, as I thought the braces would help maniupulate the correct jaw growth?

Dr. Dean Brandon said...

Lela, Kids grow at different rates. Some mature early, some later on. Usually an orthodontist will evaluate this growth using x-rays of head and also things like the sesamoid bone in the wrist. - Also, the eruption of the permanent teeth. Orthodontic appliances like a head gear can modify this growth somewhat if needed. Crowding alone is not usually affected by a head gear though. it's more for overbites and underbites that are skeletal in nature.

Anonymous said...

My son is 8 years old and he has bucked teeth and space between them. He did go to an orthondontic last year at 7 years old but the doctor said to wait until he was older to get braces. His teeth makes it hard for him to close his mouth and his teeth rest on his bottom lip because they protrude. Is there anything that can be done now?

Dr. Dean Brandon said...

Sounds like they determined there was not much to be done at this age. Once more teeth come in, perhaps get them to take another look.

Anonymous said...

Hi
I have a question.. My 7 yr old has an overbite and slight over jet. Will it make a significant difference if we treat it with a bite plate appliance? We have been told she will require braces regardless. The appliances are expensive and the first was lost in a matter of weeks..
Would it be a bad decision to forgo the appliance and just do the braces later or do an appliance in a year or two?
thank-you,
mum

Dr. Dean Brandon said...

No matter what appliance is used, cooperation (how well a child can take care of an appliance is always an important consideration. Some younger children are not quite ready for any treatment even if their teeth are.

Anonymous said...

hi I'm 12 and I really want braces!! but I was wondering do your side teeth (baby side teeth) have to come out before?? and I have an overbite so will I wear rubber bands??

thanks so much :)

Dr. Dean Brandon said...

Your dentist will decide the best time for braces. Some kids get them early because of specific problems they have. Most kids do wait till most if not all their baby teeth are out (about 12 years old). So, talk with your parents about seeing your pediatric dentist or orthodontist. Good Luck!

Anonymous said...

I have an 8 year old daughter who sucks her thumb. She has sucked her thumb since the age of 2. She still sucks it and I've tried to get her to stop. Can you tell me what I can do to get her to stop?? Also due to the thumb sucking she has bucked and spaced teeth,is it the best time to get her braces at 8 years old?? She will definitely need them sooner or later,I would like to get them now.....what do you think?? Thanks for answering;)

Dr. Dean Brandon said...

If I knew a 100% way to get kids to stop sucking their thumb, I'd be famous.

Here is my post on sucking habits:
Pacifiers and Thumbs

Orthodontic treatment is usually necessary after permanent teeth erupt and there seems to be a discrepancy.

Anonymous said...

My 7 years old has a skeletal class iii relationship due to slower growth in the upper jaw. The upper front tooth has chipped a lower tooth due to a cross bite. Ortho #1 recommended a phase 1 approach with an expander, headgear and upper braces. Ortho #2 doesn't believe in phase 1 and says all he needs is a bite block until he is older and can get regular braces. I understand Ortho #1 is addressing his jaw and cross bite but would it be terribly detrimental to start with a retainer to correct the cross bite and address his jaw later (10 yr old) if it worsens? I don't want to pay for braces twice as it is a significant cost difference.

Dr. Dean Brandon said...

There is only so much you can do at a young age. Many Class III cases must wait for final treatment till the child stops growing (around 16-18 years of age). That does not mean you can't or should not do something at earlier ages if indicated. Expansion or early crossbite correction is often utilized. I cannot emphasize more that each case is different. Even two good orthodontists may give slightly different ways to accomplish the gaol. Early treatment modalities do not necessarily mean you will have to have treatment at an older age.

Anonymous said...

Thank you for your blog. It has been informative reading all the posts and your responses. I posted the msg about a 7yr old with 2 varying ortho rec. for a class III. Your response has helped me make a decision. (To go with the retainer and proceed with more treatment later if necessary.)Thank you.

Dr. Dean Brandon said...

Thank you, but I would advise consulting your orthodontist for specific recommendations about your child. What I say here is sort of general in context.

Anonymous said...

Hi, I'm 13, 14 in November and my front four teeth on the top and bottom are crooked, on the top they also have a lot of spacing in the front four. On the bottom they are too close. I still have 5 baby teeth to lose 3 canines and 2 larger molar-ish teeth( the ones next to the canines) and I really want to get braces, can I?

Dr. Dean Brandon said...

Anon.--basically,--yes. Ask your orthodontist or pediatric dentist.

taylor said...

I am 12 years old turning 13,and I still have 5 more baby teeth.should I get my baby teeth removed or just get braces or both??

Anonymous said...

I'm 12 years old and I still have 5 baby teeth. Should I get the 5 baby teeth removed and get braces?

Dr. Dean Brandon said...

I'd get an orthodontist or pediatric dentist to take a look. We start many cases on kids with baby teeth still in place.

Dr. Dean Brandon said...

Well, time to close comments for this post. Youcna find a lot from the comments and responses. You get the basics here. Specifics are best obtained from a thorough dental and orthodontic examination.

Good luck.