WHEN SHOULD KIDS SEE AN ORTHODONTIST?
After 23 years in practice, I think seeing kids at age 7 is an ideal time. This is also the age recommended by the American Association of Orthodontists, AAO. At this age the permanent first molars should be erupted and some of the anterior teeth. This starts to give doctors an idea about the future bite of the patient. This is a good time to start looking for tooth eruption problems, especially the maxillary permanent canines.
These are the two teeth that most frequently cause problems by erupting toward the palate. If they erupt toward the palate it is possible that they can dissolve the roots of the front teeth, either partially or totally. Retrieving palatally impacted canines is a routine part of orthodontic practice, but it is not a fun experience for the patients. It is typically a long and painful treatment starting with the oral surgeon bonding a gold chain onto the crown of the impacted canine.
Permanent damage (excessive wear) of the teeth is also something to watch for. Typically this is due to excessive overlapping of the upper and lower front teeth causing wearing of the incisal edges of the mandibular incisors.
Narrow palates causing unilateral or bilateral posterior crossbites start showing up at this time. Skeletal deformities such as narrow palates can cause a host of problems such as: TMJ disorder, restricted airway leading to UARS (upper airway resistance syndrome), excessive occlusal wear and tooth fracture, crowding and unpleasant look of the maxillary teeth.
So, as dentists we all see these developing problems. The big question is what should be done about them. The opinions vary widely amongst orthodontists. In my practice I like to do the least amount of treatment for patients as possible before all of the permanent teeth are erupted. Instead, I prefer to wait until all of the permanent teeth have erupted, or are almost erupted. The rare exception is in the case where permanent damage is occurring. These cases are tooth wear from deep overbites and/or crossbites, skeletal posterior crossbites and severe tooth eruption problems.
Most tooth eruption problems can be simply corrected by the careful extraction of some primary teeth. Permanent teeth erupt through the path of least resistance. Removing the appropriate primary tooth easily creates the needed path of least resistance.
Posterior crossbites are very predictably corrected with a palatal expander. Deep overbites are painlessly corrected with a specially designed removable retainer.
What I almost never do is expansion treatment to create space for permanent teeth. In my experience this is usually unnecessary due to normal growth of kids and space that is always gained when the back baby molars are lost, called leeway space. It is very rare that I extract premolars in my practice and I do not do phase I treatment to make space or "develop the arches".
If you ever have any questions regarding your treatment, please be sure to ask me.