Why Do I See So Many 7-to-9-Year-Olds In Braces These Days?

By Dr. Jeff Beyer

This is a question I get asked almost daily in my practice, and quite honestly, it is a perfectly valid question to ask from a generation of parents who were never told to see the orthodontist (when they were kids) until middle school or even high school.

A little history here… during the ‘70s, ‘80s and early ‘90s, both pediatric and general dentists recognized orthodontic problems in their younger patients (age 6-10), but there was nothing they could do about it. So in the ‘90s, the orthodontic community decided it would be good to evaluate these young folks and offer them some options. Hence, the era of interceptive, Phase I orthodontics or Early Orthodontics (there are more labels than I can write here) treatment was born.

As you can imagine, this created some confusion on the part of the parents who did not understand why they were taking their child in to see the orthodontist before they had all of their permanent teeth. Quite frankly, we as orthodontists did a very poor job of explaining this, and some parents saw this as nothing more than a ploy to fund the orthodontist’s 401K account by charging parents “twice” for braces.

The reality is that there are some children who can benefit greatly from having early treatment. The truth is, however, that there is no UNIVERSALLY accepted standard for who should get treatment and who should not. A more aggressive orthodontist may treat 80-90% of patients with Phase I, while a more conservative orthodontist may only treat 20-30%.

Over my 20 years of practice, I have settled in on three major reasons for recommending Phase I treatment. It’s when I observe at least one of the following…

1. A severe crowding problem in one or both jaws, that if not corrected, would result in the need for multiple oral surgical procedures to have multiple baby and permanent teeth extracted
2. A severe growth problem (overbite, underbite, crossbite) that could greatly benefit from orthopedic (skeletal or bone) correction that may prevent the need for future jaw surgery
3. A traumatic bite of the permanent teeth that are present, that if left uncorrected while waiting for the remaining permanent teeth to erupt, may cause irreversible damage to the existing permanent teeth
   
   

A more gray area is for cosmetics applications, which is open to a high degree of subjectivity. In cases like this, I will typically point out what can be done, but does not necessarily NEED to be done to improve the overall short-term (and possibly long-term) orthodontic situation.

The bottom line is this: If your orthodontist proposes Phase I treatment for your child, be sure to ask why, and what benefits it will have on your child’s orthodontic and dental health now. Ask what the potential ramifications are if you do not elect to proceed with treatment, as well as the financial implications (insurances have a lifetime maximum). In other words, be sure are comfortable with the treatment that is presented. If you are not, it is probably best to seek a second opinion. After all, if you proceed with Phase I treatment you are establishing what will become a long-term relationship with that particular orthodontist.

There are two final points I would like to make. First, over 95% of patients who undergo Phase I treatment will need full orthodontic care when they are teenagers.  I cannot emphasize this enough. We tell patients’ parents this and have it in or consent forms and literature, but I am still surprised at the number of parents who seem surprised when we tell them their child is ready for full braces 2-4 years after we have completed Phase I.
Finally, the American Association of Orthodontists recommends ALL children have an orthodontic screening at age 7 to 8. We wholeheartedly support and agree with this. Your initial exam is always complimentary at Commonwealth Orthodontics, and you do NOT need a referral from your general or pediatric dentist to schedule with us. Many times your child will not need anything but an annual checkup until they are ready for full treatment as a teenager. However, if your child can benefit from Phase I Orthodontics (or Early Orthodontics) and avoid potential future orthodontic complications, having the screening and your options presented to you is one of the best things you can do for your children.

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