Teeth: when to put braces and why

Fonte: Di Nina Buday / shutterstock

His teeth are crooked, he'll have to wear braces. But she is still small: we are waiting for her to go to middle school.

These are some considerations that parents often find themselves making in the mistaken belief that the appliance serves (only) to correct aesthetic problems and that orthodontic therapy is contraindicated in early childhood.

“Actually - he explains Angela Galeotti, head of Odontostomatology atChild Jesus Children's Hospital of the city - there are cases in which it makes sense to recommend the use of the appliance also to 4-year-old children, because the sooner you intervene the better, in terms of (greater) effectiveness and (reduced) duration of the intervention ".

Periodic check-ups at the dentist are important

Regular check-ups by the pediatric dentist are important precisely to promptly intercept any problems and intervene accordingly. As stated in the Clinical recommendations in odonstomatology, it is advisable that the first dental visit is made around the age of two, regardless of the presence or absence of dental problems, precisely to intercept any malocclusions, caries, ... and bad habits that endanger the health of the oral cavity.

"If necessary, the dentist can suggest a view to the orthodontist specialist, because some treatments require early intervention."

When the malocclusion is skeletal, it must be corrected early

"When the problem concerns the skeletal and non-dental component, that is the skeletal growth of the jaws, it is important to intervene early". Dr. Galeotti refers to cases of class III malocclusion, to the open bite from a vitiated habit such as thumb sucking, or to the cross bite (asymmetrical): to be treated as soon as possible, "even at an early age, for example at 4 years old, to prevent the development of anomalies that could determine, with growth, the establishment of more complex problems. In these cases we speak of interceptive orthodontic therapy, performed at an early age, in growing patients with skeletal alterations ".

Some orthodontic problems are easier to correct if they are detected early. Additionally, interceptive orthodontic treatment helps prevent more serious problems later on.

For other cases of malocclusion (for example if classified as class II), however, it is advisable to intervene at the pubertal growth peak: not before the age of 9-11: "first on girls, then on boys who reach later the skeletal maturity ".

If the teeth are crooked

"When the maloccusion is of a dental nature - to be clear, in the case of the famous crooked teeth - in most cases the complete exchange of the teeth is expected, that is, the replacement of milk teeth with permanent ones, before intervening with orthodontic therapy ".

However, it is not necessary to wait for the eruption of all permanent teeth when, for example, a permanent upper incisor, following a delay in the exchange of the corresponding milk tooth, is positioned abnormally within the dentition. "When the problem is circumscribed and limited to a specific sector of the dentition, if intercepted promptly it can be solved even within 3-6 months" explains Galeotti, therefore recommending that his sons and daughters do periodic checks, in especially in the most important phases of growth (3, 6, 9, 12 years).

Read also: fear of the dentist? Here's how to avoid it

Fixed or mobile device? It depends!

“Can you put the fixed and non-mobile braces? Many parents ask for it to overcome the child's low level of cooperation. But orthodontic therapy, which may require the use of fixed or removable appliances, or the combination of both, must be prescribed taking into consideration various factors and not only the cooperation of the young patient: for example, they play a decisive role in the choice of the medical device. the type and severity of the malocclusion ... ".

For example, explains Dr. Galeotti, in the so-called functional treatment to correct a skeletal type problem, children of 9-11 years of age are typically offered a mobile device, advising them to put it on in the afternoon and during the night (it is necessary to use at least 16 hours a day).

Also read: teenagers and appliance, instructions for use

To align crooked teeth, after a complete exchange, we generally recommend the classic fixed appliance with brackets that clip onto the teeth.

"However, it depends from case to case, even more so today that, thanks to technology, we have many medical devices available".

Doctor Angela Galeotti helps us to dispel 3 clichés

1 - It is still small to put the appliance
In reality, it is never too early to put it on: previously 12-13 years old were expected and the exchange, i.e. the replacement of milk teeth with permanent ones, was to be completed, but it has been seen that in the case of skeletal alterations if managed early it is possible first re-establish (with a therapy of 6-9 months) the correct functioning of the mouth system - then chewing, swallowing, breathing - and avoiding major problems in the future.

2 - The appliance is used to correct aesthetic problems
Also, but not only. It makes the smile more beautiful, but also improves the alignment of the bite. The use of the appliance during childhood and before adolescence can be decisive for solving functional problems and restoring correct chewing.

3 - If there is space between the teeth, immediately the appliance
Between the ages of 7 and 9 it is physiological that spaces are created between the upper incisors: for this reason, teeth are spaced out from each other. It is the so-called ugly duckling stage.
In most cases there is no need to intervene. Yet it is a situation that prompts many parents to consult the dentist and request the use of the appliance. Parents must be reassured.
Just as they should also be reassured when the incisors begin to appear, lower before and upper after (age range 5-7 years), but the corresponding milk teeth have not yet fallen out. This situation also usually resolves spontaneously.

  • children's teeth
  • 3-5 children years
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