Braces : Early is Better, But It's Never Too Late

by Food and Drug Administration (FDA)

(Page 3 of 3)

Appliances for Children

Other orthodontic appliances besides braces are available to help correct a broad range of tooth and jaw problems in growing children — from closing up a gap to widening the jaw to make room for new teeth to grow in properly. Some of these "functional orthodontics" are fixed in place; others are removable for brushing, eating, and sleeping.

Some children require headgear to guide the development of an improperly growing upper jaw. To move the jaw, wires must connect the upper teeth to another fixed point. Since no other teeth are strong enough to serve as a fixed point, headgear is used to anchor the upper teeth to a point outside the mouth: the head or neck. Elastic is wrapped around the top of the head or the back of the neck and connects an archwire to the upper teeth.

"Make sure the orthodontist demonstrates how to place the device and how to remove it," cautions Fuller. In one case reported to the FDA, a child was blinded in one eye and injured in the other when removing headgear improperly, causing the metal prongs from the mouthpiece to snap back into the child's face in a slingshot-like fashion.

"Never leave the office with headgear — or any other removable appliance — until you have demonstrated to the staff that you know how to remove the device safely and put it back in safely to avoid injury and to optimize treatment," says Fuller.

In some cases, a dental implant can replace the need for headgear. The implant contains a screw or pin that is inserted into the jawbone, allowing a post to protrude. The post serves as a point of stabilization to which a tooth-moving appliance is attached.

Functional orthodontics are ineffective after about age 16 for women and after age 18 for men. At these ages, the permanent teeth are in place and the jaw is set, so only braces or jaw surgery can produce straight teeth or a normal bite.

Early is Better, But It's Never Too Late

Although healthy teeth can be moved at almost any age, the AAO recommends that children get an orthodontic exam by age 7. Many will not need treatment then, but periodic checkups can help the orthodontist detect and evaluate problems early and determine the best time to treat them.

"This is the time you can see permanent teeth erupt and you can determine the size of the teeth, the room available, and the relationship of the teeth to the jaws," says Joondeph.

In some cases, early treatment can guide jaw growth and permanent teeth into better position, avoid the need to extract teeth, and reduce abnormal swallowing or speech problems. Waiting until all the permanent teeth have come in or until facial growth is complete may make correction of some problems more difficult, as Wendy Kelly of Issaquah, Wash., will tell you.

Kelly, who didn't get braces as a child, had crowded teeth and an overbite. At 31, she was getting headaches and having problems chewing, she says. "I was only able to chew in the front of my mouth because my back teeth didn't meet when I bit down."

Joondeph, Kelly's orthodontist, informed her that braces alone wouldn't fix the problem. She also needed oral surgery to reposition the jaws so that her teeth would fit together properly. After wearing braces for 10 months, Kelly had surgery under general anesthesia, spent a night in the hospital, and continued wearing braces for several more months.

"In the old days, it was a hopeless situation," says Pracht. But today, this type of surgery, called orthognathic surgery, can improve both function and appearance for people with severe skeletal problems such as a "Dick Tracy" jaw that juts out. "It's done from inside the mouth," he says. "Nobody cuts on the face." In the early days of this surgery, the jaw was wired together for months. "Now we use little titanium screws," says Pracht, one on either side of the jaw.

"The end result is so fantastic," says Kelly, adding that her headaches are gone, she can chew without pain, and she can eat foods, such as steak, that she avoided before. But she admits that the recovery was rough. "I had a ton of pain," she says. "I was very swollen, and my jaw movement was so limited I couldn't really eat for awhile." She lost 15 pounds while recovering.

Kelly wanted to save her two girls from a similar painful experience, she says. The girls accompanied her to orthodontic appointments and got to know the staff so "they didn't have any fear" when they got their own braces at ages 7 and 9. The staff "had a very gentle way," she says, advising other parents to choose an orthodontist who talks to the child directly and explains the treatment thoroughly.

Joondeph, who treats all ages, says he has put braces on people in their 70s and 80s, as long as their gums and bones supporting the teeth are healthy. "They're the kind of people who are very vital and active," he says. "Typically, they've always wanted to have it done and for some reason they did not."

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.