Braces For Young Kids Might Not Always Be Best

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    Quinique Jones, 15, will soon be free of braces. Her mother, Pamika Lee, says they have perfected her smile.
    Mike Ruocco/NPR
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    Dalia Shlash, an orthodontist-in-training, didn't wear a retainer after first having braces when she was 14. She later had Invisalign treatment to correct the relapse. "Teeth always want to go back to the way they were initially," she says.
    Mike Ruocco/NPR
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    Orthodontist Robert Williams never had braces, and has no plans to improve his teeth. Invisalign, a clear orthodontic device, might straighten his front teeth, he says, but it's not worth the problems it would cause for his back teeth.
    Mike Ruocco/NPR
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    Ricardo Carter, 16, had braces in his early teens. Now he's wearing a clear, acrylic retainer to correct some shifting. Teeth are most prone to moving back to their original locations within the first five years after braces come off.
    Mike Ruocco/NPR
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    A crossbite led Rachel Bateman, 9, to a mouth full of braces. Williams, her orthodontist, decided not to give her an expander, a popular device that can sometimes lead to relapse.
    Mike Ruocco/NPR

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If you walk the halls of an elementary school, you're likely to see a lot of "metal mouths." Many parents are now opting for early orthodontic treatment, and the American Association of Orthodontists recommends that children see an orthodontist for an evaluation no later than age 7. But research shows there are often advantages to deferring treatment, though decisions are made on a case-by-case basis.

"There's been a number of studies that have shown for some very common problems that you're better off waiting until all the permanent teeth have come in first before treatment is started," says Robert Williams, a board certified orthodontist who teaches at the University of Maryland.

Common problems that fall into the "better-to-defer" category include conditions such as overjets — that's when teeth protrude or stick out — or crooked teeth that just need simple straightening.

"Many years ago, you wouldn't do anything until the permanent teeth were all in," says Antonino Secchi, a professor of orthodontics at the University of Pennsylvania. Now he says if parents opt to treat an overjet early — say at age 9 — the child may end up needing another phase of intervention a few years down the road.

"And at the end, instead of having two years of orthodontics, you end up having four years of orthodontics," Secchi says. And he says this can be much more expensive. "Instead of paying one bill, you pay two bills."

Evaluating Treatment Options

Orthodontists have varying payment structures. Sometimes families are given a break or a discount on a second phase of treatment. "You want to get the most bang for the least number of bucks," Williams says. So, when parents are trying to decide on the best treatment plan, he says, they should ask questions until they understand the pros and cons of each option.

"I definitely asked a lot of questions," says Mary Bateman, whose 9-year-old daughter Rachel is being treated for a crossbite. That's when upper teeth bite down on the inside of the lower teeth. If left untreated, it could lead to problems like damaging the gum tissue.

"This is the kind of problem that we pretty much always treat early," Williams says. Other conditions that warrant early intervention include overbites or severe crowding.

In Rachel's case, the ideal time to intervene is between the ages of 6 and 9.

"When the baby teeth are still in, we have more treatment options because we have more flexibility in moving the teeth," Williams says.

The Batemans ended up at the University of Maryland orthodontic clinic after an evaluation by another orthodontist recommended an expander to correct the overbite. "I didn't just jump into it," says Mary Bateman. Over the course of getting orthodontic treatment for her three older children, she learned that expanders aren't the best option for every case, though many orthodontists recommend them in certain circumstances.

"In some cases expansion of the upper arch [using an expander] is not a stable position," Williams says. He opted to treat Rachel Bateman's overbite by extracting a few baby teeth and putting on braces to move a problem tooth. Williams says some people don't realize that expansion may relapse and not hold, so some patients may need to wear retainers indefinitely to maintain the extra space in their mouths.

Form Vs. Function

Orthodontists have varying approaches, and there isn't one right way or wrong way to treat a problem. Patients, likewise, have different expectations. Many parents put a strong emphasis on a beautiful smile over fixing functional dental problems. This is the case with Pamika Lee, the mother of 15-year-old Quinique Jones.

"I looked at her teeth today, and they are beautiful," Lee says. "Perfect."  Jones is about to get her braces off, and Lee says her daughter's self-confidence is already improved.

As orthodontists blend aesthetic, or cosmetic, interventions with the business of fixing dental problems, people who have just marginal cases of crooked or crowded teeth are increasingly opting for treatment. Lee says she's considering it herself — when she can afford it.

"I may get braces soon," Lee says. And she'll be in good company — the American Association of Orthodontists now says 1 in 5 new patients is an adult.

"Some of my patients are in their 60s and 70s," Williams says. "It's never too late."



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