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What is the best age for your child to see an orthodontist and how often should they see one?
The answer to this question might surprise you. Twenty or 30 years ago, kids typically got braces at age 12 or 13. However, today the American Association of Orthodontics (AAO) recommends that all children have an initial exam with an orthodontic specialist no later than age seven. The recommendation that children be seen earlier is to help them get treatment, if needed, for perceived problems down the road. The advantage of seeing kids younger is that they can be treated while their jaws are still growing.

Treating kids at a younger age is referred to as interceptive or two-phase treatment. Orthodontists are uniquely trained to evaluate the facial jaw bones and teeth, and based on training determine if the bones are the proper size.  The first phase is most often orthopedic in nature (changing the size, shape, and width of the jaw bones). It’s not really about bracing the teeth and gaining the proper alignment; that typically takes place in Phase II.  Kids who undergo two-phase treatment don’t usually need to have any adult teeth extracted. And when it’s time for a full set of braces later on, they tend to have better results and prettier smiles.

Sometimes parents are aware their children need orthodontics. It’s obvious. Other times, the child’s teeth may look fine, but in reality, their jaws may be too small to accommodate all their teeth—and that may not be as obvious. So, in all instances, it’s best to be safe and have an initial orthodontic exam when your child is younger. Why is the timing important? Because the back teeth, the adult molars, usually erupt by age seven.  Basically, the back molars and the front adult teeth are the boundaries for everything else to come in the mouth.  At that point, the size of the jaws can be evaluated to determine if they are big enough to accommodate all of the adult teeth.

In my initial exams, 30 percent of kids I see at age seven need interceptive (two-phase) treatment. For the other 70 percent, the main benefit of the exam is just peace of mind.  For those that don’t need early treatment, the orthodontist will most likely place them on a yearly recall to evaluate the patient’s growth and development.

What are the orthodontic options available to children and teens? 

Interceptive orthodontics or early orthodontic treatment. Diagnosing and treating a problem early can keep an individual from going through a more serious procedure later. Being more proactive is especially powerful in children and teens since problems that are diagnosed at an early age can be dealt with very easily.

One example to illustrate my point is extracting a baby tooth early to make room for an adult tooth that’s having a difficult time coming in otherwise. In this instance, the orthodontist can place an appliance called a space maintainer to save room for an adult tooth to come in.  Another great example of interceptive treatment is to help stop bad habits, such as thumb-sucking. Having X-rays at the age of seven along with initial examination by an orthodontist is essential when it comes to preventing problems in the mouth. Even if the teeth are only slightly crooked, it’s still worth making an appointment with an orthodontist. That way a problem you may not even be aware of doesn’t develop into something that’s more serious.

Early interceptive treatment is the first phase of two-phase treatment. The first phase is usually orthopedic in nature, meaning that the jaw bones are treated to help them develop to the proper size to accommodate all the teeth. The most popular appliance of Phase I treatment or early treatment is an expander, which makes the jaws wider.

Braces are the most popular procedure offered by orthodontists. Braces are used to align the teeth and fix the bite.

With this treatment, braces are glued to each tooth. A flexible wire that has shape memory is threaded through the braces and applies force to the teeth to gradually move the teeth into the correct position.  The length of the treatment depends on the severity of the crowding and how much bite correction is needed. These days, treatment is much faster than it used to be. The average treatment time is about 18 months.  For a more aesthetic option, there are white braces that blend in with the color of teeth so they’re less noticeable.  Braces have earned a reputation for being a painful procedure. With modern, state-of-the-art orthodontics, that is simply not the case. The techniques to place and remove braces has been dramatically improved, meaning your teeth can be straightened with a minimum level of discomfort.

Invisalign. If the thought of braces, even if they are tooth colored, sounds a little bit intimidating, then you’ll be happy to hear about Invisalign. Invisalign is a series of clear, nearly invisible aligners. Each aligner moves your teeth in the direction of a desired result.  Each aligner is worn 22 hours a day. They are only taken out to eat and when brushing.

Retainers are an issue all orthodontists have to deal with. Teeth are stubborn and have an inherent memory to them. So, even if treatment results in the ideal alignment, without a retainer to help maintain that position, teeth will gradually move back toward the position they were in before treatment.  There are many different types of retainers, and the choice of which to use should be customized to the individual.

Lingual braces attach to the inner side of the teeth, next to the tongue. The main advantage of lingual braces is they are difficult to see and are usually only noticeable when the mouth is open very wide.  Lingual braces tend to be very uncomfortable. They can irritate the patient’s tongue and make it somewhat difficult to speak and eat. Lingual braces also cost considerably more, sometimes more than double the cost of traditional braces.  With Invisalign offering so many advantages, including better aesthetics, the market for lingual braces has really declined.

What should parents know about retainers?
Retainers are typically used at the end of an orthodontic treatment to keep your teeth straight and to prevent them from shifting back to where they were before treatment.

There are three common types of retainers: the Hawley, the Essix, and bonded retainers. The Hawley and Essix each have advantages and disadvantages. One advantage of both of these is that they are removable.

Hawley retainer . I consider the Hawley retainer a little old-fashioned. It consists of a thin layer of plastic that fits to the roof of the mouth or inside the gums near the tongue, depending on whether it is worn on the upper or lower teeth. The plastic has a small, metal wire attached. The wire is visible on the outside of the front six teeth and helps hold the retainer in place.

One of the advantages of this type of retainer is that the plastic comes in different colors and designs. Kids have fun with them even though the plastic is invisible when the retainer is inside the mouth. Another advantage is that the retainer does not cover the biting surface of the teeth. As a result, Hawleys last a little longer in patients that grind their teeth.

There are several disadvantages of the Hawley retainer. The biggest is that it’s uncomfortable to wear due to how large the plastic is on the inside of the mouth. If a patient has upper and lower Hawleys, they really feel like they have a mouthful of plastic. Another big disadvantage is that the metal wire that keeps the front six teeth straight doesn’t always do its job. And some people don’t like the look of the metal wire running across the front of their six teeth. It’s really not aesthetic.

Essix retainer. A better type of retainer, one that’s more modern, is the Essix retainer. The Essix retainer is a clear plastic retainer that snaps onto the teeth and fits over the entire surface of each tooth.

A big advantage of the Essix retainer is that it’s virtually invisible when worn. Some people call it the Invisalign retainer because it looks like Invisalign. It’s much more comfortable than the Hawley retainer, so compliance is much better. In fact, the advent of the Essix retainer has made compliance with retainers much easier.  Another advantage of the Essix retainer is that it does a much better job of keeping the teeth straight after the orthodontic treatment. Your teeth simply cannot move if you wear an Essix retainer.

A disadvantage of the Essix retainer is that it may crack or may wear through if you grind your teeth. In the latter of these instances, it serves double duty by protecting your teeth. However, instead of using the Essix retainer as a night guard, it may be best to talk with your dentist about creating an appliance to help protect your teeth from grinding.

Wearing retainers really is a simple insurance plan protecting that investment. You only need to wear them when you’re sleeping. I like to think of retainers as pajamas for your teeth. Never go to sleep without them!

What is a palate expander and how does it work?
A palatal eExpander is used to expand or widen the upper jaw.

The upper jaw is actually made up of two bones that are loosely connected in the middle by what’s called a suture. This connection begins to fuse at puberty, which is usually a little earlier for females than males, usually around age 12. As a general guideline, expansion is best done as soon as the need is discovered because the response to an expander will become less and less until ultimately it will not work.  Expanders work better on younger patients, and work less on teenagers.

There are serious consequences for not undergoing expansion when it’s needed, such as asymmetric facial growth and the possibility that adult teeth will become impacted, which means they won’t be able to erupt into the mouth because there’s not enough space.  Sometimes if a child snores or needs speech therapy, that could be a symptom of the upper jaw not being wide enough and in need of an expander.

The palatal expander for the upper jaw usually has one band on each side with a screw in the middle. It is glued in place and cannot be removed for the duration of treatment. The screw is turned (usually by the child’s parents) twice daily—once in the morning and once at night—for two to four weeks. At that point, the expansion phase of treatment is complete. It’s a very fast treatment. However, the expander is left in place for six to twelve months to maintain the expansion until new bone can fill in and strengthen the suture.

CaggianoDr. David Caggiano is a nationally well-known orthodontist who is proud to practice in the Parsippany area and serve the community close to where he grew up.  Raised in Fairfield, and son of an engineer, he attended NJIT, where he graduated top of his class with a Master’s of Science degree in biomedical engineering.

A 2001 graduate of the University of Medicine and Dentistry of New Jersey (now Rutgers University), Dr. Caggiano practiced as a general dentist for seven years before becoming an orthodontist.  Combining his background in biomedical engineering with his extensive training and experience in general dentistry, Dr. Caggiano can create innovative and exciting approaches to solve even the toughest orthodontic situation, in a manner that is as efficient as possible.

Because of this unique training, passion, and experience, other dentists voted him as a top Orthodontist every year since 2009 (as published in NJ Monthly).  Moms appreciate his comforting chairside manner and acknowledge his dedication to customer service by perennially voting him a top doc in New Jersey Family Magazine.  Other prestigious awards include Orthodontic Products Best of 2011 & 2012 (a national recognition), Best of Morris County, NJ Top Docs, and Consumer Research Council’s America’s Top Orthodontists.

Dr. Caggiano is the author of “A Parent’s Guide to Understanding Orthodontics: How to Confidently Choose the Best Orthodontist for Your Family,” “Perfectly Clear: Everything You Need to Know About Invisalign” and is currently working on his third book, “The Art of Orthodontics: A Consumers Handbook to the Most Common Orthodontic Questions.”