Orthodontics, Braces, & Invisalign - Manhattan and Riverdale, NY (New York), Orthodontist, Adam Goodman and Orthodontist Margareth Mintzberg

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When to Start Orthodontics
The American Association of Orthodontists recommends an orthodontic evaluation at age 7, in order for the orthodontist to get a baseline assessment of a child's jaw growth, tooth size, and dental development. At this early age, the first permanent teeth are just starting to erupt, so it generally too early to start any type of treatment. However, between age 7 and 9, more severe problems can be addressed with an interceptive phase of orthodontic treatment. Unlike comprehensive orthodontic treatment seen in adolescents, teens, and adults, where braces are seen on all the teeth, Interceptive treatment is limited to braces on only the front teeth, and various appliances that can improve tooth and jaw positions.

Problems which require early interceptive intervention vary. When the size of a patients permanent teeth are wider than th boy with tooth

e dental arch, crowding of teeth will result. In the age range of 7-9, children with severe crowding will often not have sufficient space for the full eruption of the four front Incisors. The solution for this may include removal of adjacent baby teeth, or appliances which widen the dental arch. A popular appliance for the purpose of gaining additional dental arch space is the Palatal Expander, which orthopedically widens the upper jaw, creating additional space to alleviate the crowding.

The other common reason to start an interceptive treatment would be to correct a bite problem. Left uncorrected, bite problems will worsen or become more difficult to correct. A crossbite refers to a bite where the upper teeth, either in the front or the side, are biting inside of the lower teeth, the reverse of normal. If a crossbite is left uncorrected, the patient will often grow into this asymmetric position. Another common bite problem is an overbite, which can either refer to the upper front teeth being flared out ("buck teeth"), or in a vertical dimension where the lower teeth are biting up against the roof of the mouth. Flared, spaced teeth are often vulnerable to injury, and teeth which are impinging the palate will often interfere with normal lower jaw growth potential. Treatment for overbites is often carried out with removable appliances.

Interceptive treatment will generally not eliminate the need for future comprehensive treatment with full braces, but it may avoid the need for permanent tooth extractions, and make the treatment less complicated or of less duration. Current research and opinion holds that while the interceptive treatment philosophy has been a great advance in orthodontic treatment philosophy, it may be an overused modality. The majority of children that need orthodontic treatment can be started upon the loss of many primary teeth, usually around age 11. From age 7-9, as the first permanent teeth start erupting, a patient often goes through a normal awkward period where there teeth are not aligned like a Hollywood star. Many kids and parents and kids are anxious to start treatment, either to be the first in the class with braces, or to have the most perfect looking teeth at the earliest opportunity. Some orthodontists are too aggressive, perhaps wanting to lock a patient into treatment. Often times, children with only minor to moderate problems are treated with interceptive treatment, and this trend makes some parents anxious to start, and others cynical when there may in fact be a true need for treatment. Only a reputable orthodontist, and a little self education, can help you evaluate all the options.

Dr. Goodman is a Certified Invisalign® Provider