Early Orthodontic Treatment
By George V. Dula, DDS
Modern orthodontics involves much more than just straightening teeth. In the past, orthodontists waited for all of a child's permanent teeth to erupt before initiating any treatment. As a result, many people had permanent teeth removed for braces. That is exactly what we want to prevent. Present day orthodontics can be broken into two categories: Phase I and Phase II treatment.
The goal of Phase I treatment is to develop the size of the jaws to accommodate all the permanent teeth and relate upper and lower jaws. Many children's facial bones need help in developing to a normal size. We treat these problems with “orthopedic” appliances, generally not braces. Orthopedic/orthodontic treatment normally begins between the ages of seven and ten for the best growth and stability.
In fact, the American Association of Orthodontists recommends that an orthodontist evaluate all children by the age of seven. A good foundation can be established, thereby providing adequate room for all the permanent teeth; early treatment often eliminates the need to remove permanent teeth for braces. Creating additional space for the teeth also reduces the time that braces are worn. In addition, early treatment also helps correct jaw growth discrepancies, where one jaw is shorter than the other. If these cases are left untreated until jaw growth is complete, treatment either involves the acceptance of a compromised result or surgery. Because a child's jaw growth is 85 to 90 percent complete by the age of eleven to thirteen, timing is very important for these patients. The disadvantage of waiting to see an orthodontist until eruption of the permanent teeth is complete, and subsequently having only one phase of treatment, is having to face the possibility of a compromised result, which may not be functionally healthy, aesthetically pleasing, or stable. Phase I treatment can eliminate the need for removal of permanent teeth, can decrease the time necessary for the second phase of treatment (braces), and can prevent surgical procedures to align the upper and lower jaws.
Phase I treatment is commonly followed by a period of stabilization and observation. During this time, any unerupted permanent teeth are allowed to come into the mouth. In some cases, selective removal of certain primary (baby) teeth during this period will enhance eruption of the permanent teeth. Therefore, periodic recall appointments for observation are necessary.
Each tooth has an exact location in the mouth where it is in harmony with the lips, cheek, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly, stay healthy and look attractive. This is the goal for the second or final phase of treatment. Phase II orthodontics is initiated when the permanent teeth have erupted into the mouth, and usually requires wearing braces on all the teeth for an average of 18 months. Retainers are worn after this phase to help keep the teeth in their final position.
Two-phase orthodontic treatment is a very specialized process that encompasses physical facial changes and straightening the teeth. With emphasis today on living longer, staying healthy, and looking attractive, the scope and demands for excellence requires optimum treatment results. The major advantages of two-phase treatment are to maximize the opportunity to accomplish the ideal, healthy, functional, and aesthetic result that will remain stable throughout a lifetime.
For these reasons, the American Association of Orthodontist's recommends that all children be seen for an orthodontic appointment by age seven.
Dr. George V. Dula received his Bachelor of Science in Physiology from Oklahoma State University and his Doctor of Dental Surgery Degree Magna Cum Laude from Baylor College of Dentistry where he was a member of the prestigious Omicron Kappa Upsilon (OKU) Honor Society. He completed his orthodontic residency at the University of Louisville Dental School and is a Diplomate of the American Board of Orthodontics. Dr. Dula is a member the North Texas Dental Society, the Texas Dental Association, the American Dental Association, the Greater Dallas Association of Orthodontists, the Texas Association of Orthodontists, the Southwest Society of Orthodontists, and the American Association of Orthodontists.