Pre-Orthodontics

Most children are ready to begin comprehensive orthodontics care once most of the primary teeth are lost and replaced by permanent teeth, normally around ages 10-12 years old.  However, this treatment is optimized by obtaining pre-orthodontic care from a pediatric dentist that is trained in this practice.  Pre-orthodontic care can be thought of as “setting the stage” for the eventual orthodontic treatment.  Individuals that receive pre-orthodontic treatment tend to (1.) be in braces a shorter period of time, (2.) have cheaper orthodontic expenses, and (3.) avoid the need for braces altogether in some instances, and (4.)obtain more esthetic results at an earlier age.  Very often orthodontists, themselves, provide this care, but normally at increased costs and requiring visits to multiple offices.  At West Valley Pediatric Dentistry, we have streamlined this care to allow for treatment to be completed in one office and during your child’s already scheduled semi-annual visits.  By working closely with select orthodontists, we have developed a specific protocol for various problems. 
Pre-orthodontic care typically includes:

• Correction of anterior and posterior crossbites.
• Correction of single tooth crossbites.
• Space maintenance.
• Extracting primary teeth to alleviate moderate to severe crowding.
• Slendering primary teeth to alleviate minor crowding.
• Fabricating appliances to guide the eruption of permanent teeth.

The primary goal of pre-orthodontics is to precipitate the eruption of the permanent dentition by alleviating primary crowding and minor complications causing this lack of space.  This early care also allows us to document a child’s facial growth pattern to establish a blueprint for future orthodontic care.  The orthodontist considers this information vital to their future treatment, as the established growth pattern allows them to formulate their recommendations.  Without such information, the orthodontist is often relying on their instinct to determine exactly how a child is growing.
Using this multidisciplinary approach to orthodontic care has proven to be an extremely cost-effective and time saving approach for our patients over the past few years.  This care is actually incorporated into your child’s regular dental check-ups and you have probably been benefitting from it without even knowing it!  You can anticipate that an attending dentist will begin discussing your child’s spacing around the time the permanent teeth begin to erupt and at every visit thereafter until we recommend visiting the orthodontist.

Orthodontic Overview

Orthodontics is the specialty of dentistry that deals with properly aligning teeth and jaws to improve esthetics, establish an ideal bite and function and to created optimal oral health.
West Valley Pediatric Dentistry prides itself on providing a wide range of dental treatments.  Almost 85% of children require some sort of pre-orthodontic or orthodontic care from a function standpoint, without even including those who benefit esthetically.  Without this needed care, children are at an increased risk for jaw dysfunction, TMJ pain, wearing of the teeth, and eventually the need to repair worn or damaged teeth.  Braces help children to feel more confident from a psycho-social standpoint, as researchers have shown these individuals actually become higher achiever. 
In the past, parents routinely complained that when we referred them to several orthodontists, selecting the most qualified doctor became an arduous and extremely confusing process.  They regularly contacted us to ask questions and for our professional opinion on various proposed treatment modalities.  Because this treatment is a huge investment in your child’s appearance and overall dental function, we wanted to make seeking care as easy as possible for our family of patients.  In turn, we have helped with this process by completing some of this research for you.  Though pediatric dentists obtain formal education in orthodontics during their advanced post-graduate training, our primary focus is providing dentistry and not orthodontics.  But, this training is extremely helpful in evaluating different orthodontist’s theories, protocol and quality of care.  Our interview process allows you to narrow the search for the most qualified orthodontist.  This is a huge advantage, as nobody gets to evaluate ongoing orthodontic care more frequently than a pediatric dental office.  We see care from every orthodontist in the area and are will accustomed to everyone’s treatment protocols.  So, we decided to take this knowledge and convey the benefits to our patients! 
First, we spent an extensive amount of time evaluating each orthodontist’s quality of care, cost, and patient perception.  We conducted interviewed of each to determine treatment theories, ethics and to discuss how certain complications would be managed.  From this, we established a short list of providers that we feel provide an elevated quality of care to their patients, and therefore highly recommend these individuals only.  Second, we have met with these doctors to discuss what we and our patients expect from their offices.  Together we create a routine protocol for the management of orthodontic treatment and establish an open line of communication with these highly qualified individuals.  They are fully aware of our high expectations and understand that we will be evaluating the quality of their care throughout the extent of your child’s treatment.  Furthermore, they understand that their quality is of utmost importance to us, as their future referrals from our office depend on them providing our mutual patients with an increased level of care; above what is commonly found in most orthodontic offices.  Third, this open line of communication allows us to work closely with the orthodontist to motivate patients and to help keep the patient’s care on track.  Because orthodontic charges are typically based upon length of a child’s treatment, it is imperative that patients wear appliances, rubber bands and head gear.  This ultimately gets patients out of their braces quicker, saves parents money and results in enhanced outcomes.  We work with the orthodontist ensuring your child’s success.  Lastly, these select orthodontists have allotted our referrals specialized pricing.  This obviously is extremely helpful in making this important care affordable for almost every financial situation.

Orthodontic treatment will help your child by:

• Guiding permanent teeth into the proper positions.
• Improving lip closure.
• Reserving or gaining space for erupting permanent teeth.
• Reducing the potential for to jaw joint damage.
• Reducing the likelihood of impacted permanent teeth.
• Influencing proper jaw growth.
• Ensuring the proper width of dental arches.
• Improving eruption patterns.
• Lowering the risk of damage to protruded upper teeth.
• Shortening treatment time for later corrective orthodontics.
• Improving some speech problems.

An orthodontic problem is called a malocclusion, or "bad bite." Some examples of causes of malocclusion include crowded teeth, extra teeth, missing teeth or misaligned jaws. Most malocclusions are inherited, although some can be acquired. Acquired malocclusions can be caused by accidents, early or late loss of baby teeth, or oral habits that are continued over a long period of time.

Patients of almost any age, but mostly children, can benefit from treatment for orthodontic problems. Typically, braces are worn between the ages of 10 and 14; this is the period of development in which the head and mouth are still growing and teeth are more accessible to straightening. Earlier orthodontic intervention can sometimes prevent the need for full orthodontic treatment. (If you have been advised that your child needs braces, it is very important to discuss the matter carefully with your child. It can be traumatic because of your child's sensitivity to his or her looks.) More and more adults are also wearing braces to correct minor problems and to improve their smiles.

Space Maintenance

Sometimes a primary tooth is lost before the permanent tooth beneath it is ready to erupt.  If a primary tooth is lost too early because of cavities or injury, adjacent teeth can tip or shit into the vacant space.  When the permanent tooth is ready to emerge into this space, there may not be enough room for it.  The new tooth may be unable to erupt, or may emerge in an abnormal position.  If loses a primary tooth prematurely, the pediatric dentist may recommend a space maintainer, a plastic or metal appliance that holds open the space left by the missing tooth.  Eventually the space maintainer will be removed once the permanent tooth is close to or begins to erupt.

Common Types of Space Maintainers Include

• Band & Loop.
• Crown & Loop.
• Lower Lingual Holding Arch.
• Nance Holding Appliance.
• Distal Shoe.
• Transpalatal.
• Pedi-Partial.

Pediatric space maintenance is the key to preventing a serious malocclusion in the permanent dentition.  The early loss of primary teeth often results in a reduction of arch length or space.  This change can directly effect the normal eruption of the adult teeth.  If the permanent teeth are not going to erupt within six months of the loss, a primary tooth appliance therapy is indicated.

Premature loss of the front teeth in young children can be due to tooth decay or trauma.  If space loss has already occurred, rapid intervention with a space maintaining appliance is of utmost importance.  If space loss has already occurred, a space regaining device should be considered.

Common Orthodontic Conditions

Here's a look at some of the conditions your child may have that can be alleviated or reversed via orthodontic treatment.

• Crowded Teeth - Teeth may be aligned poorly because the dental arch is small and/or the teeth are large. The bone and gums over the roots of extremely crowded teeth may become thin and recede as a result of severe crowding.

• Impacted Teeth - In many cases, wisdom teeth do not grow in properly, have a proper bite relationship, or have healthy gum tissue around them. Often, wisdom teeth improperly erupt and become impacted, requiring them to be extracted, or pulled. Impacted teeth may also be caused by improper biting relationships.

• Protruding Upper Teeth - Thumb and finger sucking habits in young children is often the culprit for protruding upper teeth. The clinical term for this is "overjet," which happens when your child's upper front teeth protrude outward. Because they don't have normal contact with the lower front teeth, protruding front teeth are especially prone to being broken, chipped, or even knocked out. In some cases, overjet may indicate a poor bite of the back teeth, or molars, and more seriously, uneven jaw growth. Children with protruded upper teeth often have a lower jaw that is short in proportion to the upper jaw.

• Deep Overbite - A deep overbite or "deep bite" is caused by the lower incisor (front) teeth biting too close or into the gum tissue behind the upper teeth. When the lower front teeth bite into the palate or gum tissue behind the upper front teeth, significant bone damage and discomfort can occur. A deep bite can also contribute to excessive wear of the incisor teeth.

• Underbite - Underbite, or lower jaw protrusion, usually occurs in a small percentage of children. Underbite is a condition in which the lower jaw is longer than the upper jaw. The lower front teeth protrude, creating a "crossbite." Orthodontic treatment involves monitoring jaw and tooth growth.

• Openbite - Open bite is usually the result of the upper and lower incisor teeth failing to make contact when biting down. This causes all the chewing pressure to be placed on the back teeth, making chewing less efficient and may contribute to significant tooth wear.

• Spacing - If teeth are missing or small, or the dental arch is very wide, space between the teeth can occur. The most common complaint from those with excessive space is poor appearance.

• Crossbite - Crossbite typically occurs when the upper teeth bite inside the lower teeth. This condition can be easily alleviated if caught early.

All About Braces

Orthodontics, best known by its tools of the trade - braces - is a special discipline of dentistry concerned with aligning the teeth and jaws to improve your child's smile and oral health.

Braces today are smaller and less conspicuous - and a bit more sophisticated than the conventional gun-metal wire straps. While they still utilize wire straps, newer appliances are much more comfortable. In fact, traditional metal braces can be replaced by clear braces and braces from behind.

Braces generally come in three varieties:

• Brackets, usually made from metal, plastic or ceramic, are bonded to teeth.
• Lingual braces are brackets that attach to the back of teeth, hidden from view.
• Bands are the traditional type that covers most of your teeth with metal strips that wrap around the teeth.
• Clear retainer-like appliances

If required, orthodontic evaluations are appropriate for most children beginning around seven years old.

Orthodontia is a multi-stage process. First, pretreatment records are made to make an accurate diagnosis. They include medical/dental history, clinical examination, plaster study models of teeth, photos of your face and teeth, and X-rays of your mouth and head. This information will be used to decide on the best treatment.

A custom treatment plan includes recommendations for a specific treatment appliance, such as braces or space maintainers, which are best suited to correct your child's orthodontic problem.

During the "active treatment" phase, orthodontic appliances are in place. Appliances are adjusted periodically so that the teeth are moved correctly and efficiently. The time required for orthodontic treatment varies from person to person. Two phases of active treatment are somtimes needed for early orthodontic intervention. An important factor in how long your child wears braces is how well he or she cooperates during treatment.

During the post treatment, or "retention" phase, the child typically wears a retainer so that the teeth stay in their new positions. For severe orthodontic problems, surgery may be necessary.
 

Cosmetic Issues

Today's braces are generally less noticeable than their predecessors. Brackets, the part of the braces that hold the wires, are bonded to the front of the teeth. These brackets can be metal, clear, or tooth-colored. Wires that are used for braces today are also less noticeable. Today's wires are made of "space age" materials that exert a steady, gentle pressure on the teeth, making the tooth-moving process faster and more comfortable for patients. In some cases, brackets may be put on the back of the teeth.

Patients typically wear braces for about 24 months, although this varies based on the severity of the problem, the health of the teeth, gums and supporting bone and how closely the patient follows instructions. Usually, adult treatment takes a little longer.

Comfort Issues

During the treatment phase of orthodontia, it is necessary to periodically re-tighten the interconnecting wires. This causes mild pressure on the brackets or bands to shift teeth or jaws gradually into a desired position. Your child's teeth and jaws may feel slightly sore after such a visit, but the discomfort is short-lived.

Hygiene Issues

If your child wears braces, avoid some kinds of foods, such as sweets, chips and pop. Sugary and starchy foods generate acids and plaque that can cause tooth decay and promote gum disease. Cut healthy hard foods like carrots or apples into smaller pieces. And by all means, avoid sticky chewy sweets, such as caramel, which can cause wire damage and loosen brackets. Avoid hard and crunchy snacks such as popcorn, nuts, and hard candy, because these can break braces.

Oral hygiene is extremely important during the treatment phase of orthodontia. Insufficient cleaning while wearing braces can cause enamel staining around brackets or bands. Braces have tiny spaces where food particles and plaque get trapped. Brush carefully after every meal with fluoride toothpaste and a soft-bristled toothbrush. Rinse thoroughly and check your teeth in the mirror to make sure they're clean. Floss between braces and under wires with the help of a floss threader. Have your teeth cleaned every six months to keep your gums and teeth healthy.

Space Maintainers

Space maintainers can be very important to your child's long-term oral health. If your child loses a baby tooth early through guidance eruption, decay or injury, his or her other teeth could shift and begin to fill the vacant space. When your child's permanent teeth emerge, there's not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking.

Space maintainers are used to hold the spot left by the lost tooth until the permanent tooth emerges. The space maintainer might be a band or a temporary crown attached to one side of the vacant space. Later, as the permanent tooth emerges, the device is removed.