Frequently Asked Questions: Parents Of Orthodontic Patients (tm) Part 2

Contents - General Information About Orthodontic Treatment

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  1. How Can I tell if my child needs orthodontic treatment?

    It is usually difficult to know if your child will need orthodontic treatment until your child is 8-12 and their permenant teeth start to come in. We reccomend that you bring your child in to the orthodontist when your child is 8 to evaluate whether treatment will be needed. Generally, the orthodontist will evaluate your child, and if your child needs treatment, the orthodontist will take corrective action to avoid costly and painful treatment later on.

  2. What are the early symptoms of orthodontic problems and how can I look for them?

    Proper occlusion

    Well, it is always better to consult a professional. Still, there are some warning signs that you can look for to help evaluate whether your child needs orthodontic treatment. The figure above shows what proper occlusion is like. Notice how the top teeth exactly line up with the bottom teeth, and there are no spaces or gaps. If your child teeth look perfect, your child probably will not need orthodontic treatment. On the other hand if your child's teeth look as shown in one of the figures below, your child will need orthodontic treatment.


  3. Class I
    Malocclusion

    Class II
    Malocclusion

    Class III
    Malocclusion
    First ask your child to open their mouth, and let you look at their teeth. Are all of their teeth straight? Do any of the teeth slant to the side? Are there any gaps between your childs teeth? Do any of your child's teeth overlap? If you see any signs of crooked teeth, gaps between your childs teeth or overlapping teeth, your child will need orthodontic treatment.

    Next ask your child to bite down. Does the center of the front top teeth line up with the center of the front bottom teeth? Do your child's top teeth protrude out the front of their mouth? Does your child have bucked teeth? Do the top front teeth cover more than 25% of the bottom teeth? Are any of the top teeth behind the bottom teeth? Do the teeth come together smoothly, or are there any gaps? If your childs teeth do not come together smoothly, or if any of your childs teeth do not lining up properly your child will need orthodontic treatment.

    Now look at the alignment of your childs jaw. Do all of the teeth come together smoothly, or does your childs jaw shift off center when your child clenches their teeth together? If you see any misalignment or shifting of your child's jaw, your child will need orthodontic treatment.

    If you see any of the above symptoms, or if you are not sure, bring your child in for orthodontic treatment. Do not wait hoping that the problems will go away.

  4. If I wait, isn't there a chance that my child's bite will get better on its' own;

    NO! We have never heard about a childs bite improving as the child ages. Just the opposite, if you wait orthodontic problems will almost always get worse. If a few teeth are crooked or crowded, the orthodontist can realign the crowded teeth them easily. However, if you do not treat the crowding right away, the crooked teeth will encroach onto your child's other teeth and push the other teeth out of alignment too. As a result if you wait, your childs' orthodontic problems will usually get worse.

    Further, as your child gets older, orthodontic treatment becomes more painful. As you child ages, fibers grow in to anchor your child's teeth to your childs jaw. It takes more force to move the fibers as your child ages so treatment is more painful. Also the bones in the roof of their mouth harden as your child ages, which makes treatment more difficult.

    If you avoid needed treatment when your children are teens, the children will usually need more painful treatment later in life. Isn't it better to take care of the problem when it is first discovered rather than waiting until the problem gets worse?

  5. What are the consequences of my child not getting needed orthodontic treatment.

    It is hard to see into the future, to tell how the lack of orthodontic treatment will affect your child. Certainly, a child who needs orthodontic treatment but does not get it will have problems with the teeth for years to come; so much so that many adult patients are now going back for orthodontic treatment. The difficulties with not getting needed orthodontic treatment include:

    • Teeth that wear unevenly leading to weak enamel and tooth loss.
    • Teeth that are difficult to clean, leading to gum problems and evential tooth loss
    • Difficulty chewing
    • Periodontal (Gum) problems as you child gets older

    The health issues, go well beyond good oral hygiene. One of our employees did not undergo an orthodontic procedure called palatal expansion when he was young. Now it is too late. The roof of his mouth has moved up to partially block the air passages in his nose. The result is a breathing problem which cannot be corrected without major surgery.

    Another employee has painful sores on their tongue. Again, that is because they did not get orthodontic treatment when they were young, and now their teeth do not come together straight, and they bite their tongue.

    Also, chewing is the first step in digestion. If your children cannot chew their food properly, their digestive system will not work as well. Stomach problems are very common in people who skip needed orthodontic treatment since if your child cannot chew their food right, it irritates their stomach, and produces a lifetime problem.

    Now we cannot predict which of these problems your child will have if he or she does not get orthodontic treatment. Still, orthodontic treatment is so easy that it is not worth taking a chance. Besides, your child will look wonderful after they get orthodontic treatment.

    Besides, orthodontic treatment can make your child's smile look wonderful and improve their self esteem. Wouldn't you like your child to have great self esteem?


  6. Before

    After

    After
    Figure 1 An example of how much orthodontic treatment can improve your face. These pictures were published, by Dr David Sarver, DDS, MS in the American Journal Of Orthodontics, 110(1996) 128. © 1996, the American Association of Orthodontists, with permission

  7. If poor orthodontia causes so many health problems, why didn't evolution/natural selection eliminate orthodontic problems?

    According to Alex Duncan of the Anthropology Department at the University of Texas, "with very few exceptions, fossil hominids (cave men) had nearly perfect bites."

    Malocclusion (overbites and underbites) developed mainly over the last 10,000 years. As peoples diets improved, people got bigger. The average height of an adult male increased from 4 ft (1.3M) 10,000 years ago to about 5 1/2 feet (1.9M) today. Human mouths and human teeth did not grow at the same rate. In many cases your childs teeth will be larger than your childs mouth. If so, your child will need orthodontic treatment.

    It has been estimated that in modern man, about 70% of the general population needs orthodontic treatment.

  8. If orthodontic problems are caused by my childs teeth being too big for their mouth, will my child grow out of it?

    Unfortunately no. Remember that your child's permenant teeth do not grow in all at once. As your child's mouth grows, more permenant teeth grow in too. The additional teeth take up all of the extra space created when your child grows.

    If you wait orthodontic problems will almost always get worse and your child will have to endure more painful treatment to correct the problem.

  9. At what age should my children start orthodontic treatment?

    There are two parts to orthodontic treatment, interceptive orthodontic treatment and Class I (i.e regular) orthodontic treatment. Interceptive orthodontic treatment should be done at around age 8. Class I orthodontic treatment should start at age 12.

  10. What is interceptive orthodontic treatment and is it necessary?

    The objective of interceptive orthodontic treatment is to make room in your child's mouth for your child's permanent teeth. Your orthodontist may expand your child's palate, and try to start to correct overbites and underbites. As noted above orthodontic problems arise because human teeth do not grow at the same rate as human mouths. Your children's mouth will be growing a lot between ages 8 and 12. It is important to make sure that there is room for your children's permanent teeth.

  11. How long does interceptive orthodontic treatment take.

    It varies a lot according to the complexity of the case. Interceptive orthodontic treatment can take anywhere from 3 to 14 months.

  12. Can't I wait on interceptive orthodontic treatment until my child is older than 8?

    We do not recommend waiting. If your child gets interceptive orthodontic treatment when they are 8, and their palates are growing rapidly, the treatment will be uncomfortable, but not tremendously painful. By time the child is 12, the bones in the top of the child's mouth will have hardened, so palatial expansion will be more painful. If you wait until your child is 20 to do palatal expansion, your child will need major surgery to correct a palatal problem.

    I do not want to imply that the pain will be unbearable if you wait until your child is 12, but it is better to do the interceptive treatment when your child is 8.

  13. What steps are involved in full orthodontic treatment?

    The objective of full orthodontic treatment is to correct your child's bite, and to make sure that their teeth are in proper alignment

    .

    First there are a series of appointments where the orthodontist examines your child's mouth and figures out what is needed.

    Next the orthodontist installs braces in your child's mouth.

    Your child will usually keep their braces in for two to two and a half years. During that time, the orthodontist's assistant will "tighten" your child braces every three to five weeks.

    The orthodontist may tell your child to wear a facebow during that time.

    Then your orthodontist will remove your child's braces and give him or her a retainer.

    Your child will need to wear the retainer 24 hours a day for a year, then a few nights a week until they stop growing (when they are 24).

    A more detailed description of all of the steps in orthodontic treatment is given in the FAQ for teenage orthodontic patients.

  14. How long does full orthodontic treatment take?

    Generally, full orthodontic treatment takes about two or two and a half years for a typical case. It will take longer with a complicated case or if your child does not follow the orthodontist's instructions.

  15. How can I find an orthodontist?

    We usually suggest that you talk to your regular general dentist first. He can recommend quality orthodontists in your area for you to consider. Also ask your children's friend's parents. They can recommend quality orthodontists in your area. The American Association Of Orthodontists(AAO) maintains a lists of board certified orthodontists. You can call the AAO at 1-800-787-2444. Finally, if all of those leads fail, we maintain an online list of orthodontists. for your convenience.

  16. How should I go about making the first appointment

    We suggest that you make an initial phone call to the orthodontist before you make an appointment to make sure that the orthodontist's treatment philosophy agrees with your desires.

  17. What are some of the questions that I should ask on the phone?

    First ask the orthodontist's assistant about the techniques the orthodontist uses and the orthodontist's general treatment philosophy. Some orthodontists try to make the treatment as short and painless as possible. Others try to make the treatment as inexpensive as possible. The orthodontist's assistant may not be able to tell you about the orthodontist's treatment philosophy but you should ask.

    You will need to decide whether the orthodontist's treatment philosophy is right for your children.

    Ask the orthodontist's assistant about the materials they use in their office. Some orthodontists take materials out of one patients mouth and "recycle" them into another patients mouth! The safety and reliability of this procedure is still unclear. Therefore we recommend that you make sure that your orthodontist does not attach any materials to your child's mouth that has been in another person's mouth first.

    Ask the orthodontist's assistant about the sterilization procedures used in the orthodontist's office. Make sure that the orthodontist uses an autoclave or dry heat sterilizer on all of his instruments. The orthodontist's assistant may tell you about how they use a "gluteraldehyde" solution instead. If so try another orthodontist. Also make sure that everyone in the office who works on your child wears gloves and changes the gloves (and not just wash them) before each patient. If they do not use fresh gloves, find another orthodontic office.

    Ask the assistant about x-rays. A quality orthodontist will do three sets of x-rays: cephalometric x-rays, panographic x-rays and bitewing x-rays. Those x-rays are needed to make sure that the treatment proceeds smoothly, and there are no complications. Be sure that the orthodontist takes the approproiate x-rays to make sure there are no unexpected complications with your child's treatment.

    Ask the orthodontist's assistant whether the orthodontist offers treatment options. Generally, the best orthodontists will offer braces in a variety of colors to suit your child's taste. Ligatures and wax are available in a variety of colors, flavors, and styles. All of these options will make the orthodontic treatment much less stressful for your children and much easier on you.

  18. Don't all dentists sterilize everything?

    Unfortunately no. There are still a few dentists will put on a pair of gloves in the morning and never change the gloves no matter how many mouths touch the gloves. We recomend that you avoid dentists who do not take precautions to make sure that they do not spread infections to your child.

  19. Do all orthodontists offer stylish braces(tm)?

    No! Some orthodontists only offer clunky, old fashioned braces, because that is what they learned how to use 20 years ago when the orthodontist was in school.

  20. What can I expect on the initial visits to the orthodontist?

    Generally, it takes four visits to the orthodontist for your child to start their treatment. On your first visit orthodontist's assistant will take a medical history. The orthodontist will then examine your child, and start to explain the orthodontic process.

    Next your child will come in for what is called a RECORDS APPOINTMENT. The orthodontist's staff will take xrays and photographs of your child, and make impressions (castings) of his mouth. Further details of the procedure can be found in the patient's FAQ. However, the idea of the records appointment is to gather as much information about your child's bite as possible.

    Once the records appointment is done, the orthodontist will be able to design a treatment plan. The orthodontist will build a model of your child's mouth and study the case. He will then draw on his knowledge and training to design a treatment plan.

    Once the orthodontist determines what is needed, the orthodontist will then do a "consultation" with you to discuss his/her treatment approach and his/her fees.

    The initial exam and consultation are usually FREE. The records appointment typically costs $200-$400

  21. Is there anything I should do before the consultation?

    Most parents find the consultation visit rather overwhelming. Here is the orthodontist using all of these complicated words, such as Class II Malocclusion, Mandibular Protraction ..., and he is asking for $3,000-$7,000 for your child's treatment. You want to do the best for your child, but how can you tell?

    We recommend that you do some reading about orthodontics before you come to the consultation appointment. This FAQ is a good start, and the dictionary of orthodontic terms would also be helpful. I have looked for a good book to help parents through orthodontic treatment, but have not found one yet.

    You should also talk to your friends to see what their experiences have been. Also, ask your friends how much they paid. It will help the shock when the orthodontist tells you that your child's treatment will cost $3,000 to $7,000.

    The one thing to recognize is that most adolescents really do need orthodontic treatment. Human growth patterns were designed back in the days of the cave men, when nutrition was terrible. Today, most children's teeth are too big for their mouth, and so orthodontics is needed in 70%-90% of all teenagers.

    Also reread the section above about the costs of orthodontic treatment. Remember, $3,000 to $7,000 is still less than the lifetime maintenance on your car. Aren't your children more important than your car?

  22. What questions should I ask the orthodontist at the consultation?

    First ask the orthodontist about the techniques he uses and his general treatment philosophy. Some orthodontists try to make the treatment as short and painless as possible. Others try to make the treatment as inexpensive as possible. Ask the orthodontist about his treatment philosophy. You will need to decide whether the orthodontist's treatment philosophy is right for your children.

    Ask the orthodontist about his materials. Some orthodontists take materials out of one patients mouth and "recycle" them into another patients mouth. The safety and reliability of this procedure is still unclear. Therefore we recommend that you make sure that your orthodontist does not attach any materials to your child's mouth that has been in another person's mouth first.

    Ask the orthodontist about his sterilization procedures. Make sure that he uses an autoclave or dry heat sterilizer on all of his instruments. The orthodontist may tell you about how they use a "gluteraldehyde" solution instead. If so try another orthodontist. Also make sure that everyone in the office changes their gloves (and not just wash them) before they work on your child.

    Ask the orthodontist about his treatment options. Generally, the best orthodontists will offer braces in a variety of colors to suit your child's taste. Ligatures and wax are available in a variety of colors, flavors, and styles. All of these options will make the orthodontic treatment much less stressful for your children and much easier on you.

    Ask the orthodontist about the brackets he plans to use. The orthodontists choice of bracket will determine how long your child's treatment will take, and how comfortable your child will be during treatment.

    Some orthodontists' particularly the old fashioned ones, will not want talk to you about the brackets the orthodontist plans to use. Sometimes, the orthodontist will need to use a special bracket because of something special about your child's case. However, other times the orthodontist will have some latitude to choose one of several different brackets designs. If so, you may be able to have some input into which bracket your orthodontist chooses.

    One key choice is whether to use a low profile or a high profile bracket. Generally, low profile brackets are less irritating to your children's lips than high profile brackets but they are newer, and some orthodontists never learned how to use them. The orthodontist also has a choice whether to use cast brackets, machined brackets, or MIM brackets. Generally, cast brackets are more comfortable than MIM or machined brackets, but they cost slightly more.

    No one cannot tell you what is right for your child, without looking at your case. However, as a parent, you need to be comfortable with the orthodontist's choice of brackets and whether the choice is right for your child.

  23. What are the other treatment options that I should consider?

    This is a difficult question to answer because only your orthodontist has examined your child's mouth and knows what is required. We generally recommend that you trust your orthodontist and discuss all treatment options with him or her.

    Still, there are things that you should consider when your children get braces. Braces have changed considerably since when you and I were young. There are Designer Braces (tm) in gold and sapphire to add a touch of class. Even Outrageous Braces (tm) in bright purple,pink, green and black for a decidedly outrageous look. Your child can add sparkles in their school colors.

    As a parent you will have to decide whether you want your children to have plain old fashioned braces or something modern and stylish. We make both kinds, but recommend the stylish braces whenever possible.

  24. How do I get Stylish Braces(tm)?

    Talk to your orthodontist. He can get them.

  25. Should I pay extra for designer braces, colored ligatures and brackets, flavored rubber bands, etc

    Sure those things cost a little more. However, think about how much less stressful it will be for you if your child has something to look forward to when he or she visits the orthodontist.

    Just as a general guideline, modern, low profile braces cost the orthodontist about the same as old fashioned braces. Composite Orthocosmetic(tm) braces, Outrageous Braces (tm) and Gold Designer Braces(tm) cost your orthodontist $50 to $100 more than old clunky braces. Sapphire Designer braces(tm) cost $100-$200 more than the clunky ones. Most orthodontist mark up the prices slightly, since designer braces sometimes take slightly longer to put on. Still, the cost is a minor fraction of the cost of orthodontic treatment.

  26. Should I seek a second opinion?

    Many parents want to seek a second opinion as reassurance that they are doing the best for their child. Many orthodontists do encourage their patients to seek a second opinion. However, it is often difficult to find a quality orthodontist to do the second opinion. Further, if you do find someone, it is often very expensive to get the second opinion.

    One resource that is often overlooked is the child's general dentist. Most general dentists have not been trained to do orthodontia. However, they can look over the case, and see if the orthodontist's recommendations are reasonable.

    Dental Schools also offer second opinions at nominal rates if you can provide x-rays and impressions. Contacting a dental school is also a way to confirm your orthodontist's treatment plan.

    We recommend that if a parent wants a second opinion, they discuss their concerns with their child's orthodontist. If the orthodontist cannot allay the parents concerns, the parents should ask the orthodontist to allow the parent to borrow their child's study models and x-rays, so they can show them to another dentist for confirmation of the treatment plan.

  27. What are extraction and non-extraction therapy, and what are the advantages and disagvantages of each?
    Extraction therapy is an technique where some teeth are removed to make room for the other teeth in your child's mouth. This is in contrast to non-extraction therapy where one expands a patients' jaw and shave down some teeth to make everything fit.

    Years ago, everyone got extraction therapy. Now, most orthodontists use non-extraction therapy with most adolescent patients. Instead, a gadget called a palatal expander is used to expand the adolescent's jaw. Adult patients are still treated via extraction therapy, however, because once someone stops growing, it takes major surgery to expand someone's jaw.

  28. What are lingual braces, and what are their advantages and disadvantages?

    Lingual braces are a technique where braces are mounted behind a patients teeth. They were used years ago, before the advent of stylish or orthocosmetic(tm) braces. Now lingual braces are rarely used.

    Occasionally an orthodontist can be convinced to use lingual braces when the patient insists that the braces absolutely cannot show. Generally, lingual braces are much more uncomfortable than standard braces. The orthodontic treatment is much more painful, and the treatment takes almost twice as long as with standard braces. Many people have trouble talking with lingual braces.

    Today, most orthodontists refuse to put on lingual braces except in special cases where the lingual braces are needed clinically. However, occasionally, the orthodontist must use lingual braces because of some special aspects of the treatment. If so, we reccomend that the patient follows the orthodontists advice.

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