Orthodontics

Look at yearbook or prom pictures from the 1950s or '60s and you'll see many smiles framed with heavy metal braces, a sight that's increasingly rare on today's high school campuses. Why the change? Children today tend to get braces at a much earlier age. It's not uncommon for a patient as young as 7 or earlier to begin orthodontic treatment.

"The American Association of Orthodontics (AAO) recommends that all children receive an orthodontic screening by age 7," says Thomas Cangialosi, D.D.S., chairman of the Section of Growth and Development and director of the Division of Orthodontics at Columbia University College of Dental Medicine. "Permanent teeth generally begin to com in at age 6 or 7, and it is at this point in a child's oral development that orthodontic problems become apparent.

"Because bones are still growing, it's an ideal time to evaluate a child and determine what orthodontic treatment, if any, may be needed either now or in the future," Dr. Cangialosi says.

Making Braces Hip
To make braces more acceptable to young people, manufacturers have made brightly colored elastics, the tiny rubber bands that hold the wires to the braces. Children can choose elastics with their school colors or a holiday color scheme, such as orange and black for Halloween.

"When patients are given the opportunity to choose the color of the elastics at every orthodontic visit, they tend to feel that they are more involved in their treatment," Dr. Cangialosi says.

Still Take Getting Used to
Braces today tend to be less uncomfortable and less visible than they used to be, but they still take some getting used to. Food can get caught in the wires, flossing and brushing can take more time, and after the monthly adjustments sometimes the teeth are a little sore. Tooth discomfort can be controlled by taking an analgesic, such as ibuprofen (Advil, Motrin and others) or aspirin if necessary. The use of lighter and more flexible wires has greatly lessened the amount of soreness or discomfort during treatment.

"I got braces when I was in fifth grade and I beyond hated them," recalls Jessica Claflin, 18, a freshman at the University of North Carolina at Wilmington. "I looked ridiculous."

As more and more children get braces, school-yard nicknames such as "tin grin" and "metal mouth" are heard less often. Because treatment has become more socially acceptable, social embarrassment may be less of a concern.

Beyond Braces
Orthodontic treatment in young children is known as interceptive orthodontics, in which intervention begins before the child starts first grade. At this age, tooth development and jaw growth have not been completed, so certain conditions, like crowding, are easier to address.

Before permanent teeth have come in, it may be possible to help teeth to erupt (emerge through the gums) into the proper positions. It's common, for example, for the dental arch to be too small to accommodate all of the teeth. A few decades ago, the solution for crowding was to extract some of the adult teeth, then use fixed braces to position the teeth properly. Early intervention takes advantage of the fact that a child's jaw is still growing. For example, a device called a palatal expander may be used to expand the child's upper arch. Once the arch is the proper size, there's a better chance that the adult teeth will emerge naturally where they should. If all teeth have erupted and there is still a great deal of crowding, some permanent teeth may have to be extracted to align the teeth properly.

"It is important to note that children who receive interceptive orthodontics may still need braces or other orthodontic appliances later," Dr. Cangialosi says. "However, this early treatment may shorten and simplify future treatment and may eliminate the need for more drastic measures such as the need to extract permanent teeth in the future."

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