Early orthodontic treatment can be started while some of the primary teeth (baby teeth) are still present in the mouth. An evaluation can be done as early as 6 years old to determine if the jaws are growing properly to develop enough room for all the permanent teeth. Normally you should see spaces between the primary upper and lower front teeth. The permanent front teeth will be larger in size than the primary teeth and the spaces allow room for the permanent teeth to erupt correctly into the mouth. If there are not any spaces between primary teeth then the jaws are too small and the permanent front teeth will not have enough room. This may result in delayed eruption of the permanent teeth or they will come in crowded and misaligned.
When the four permanent front teeth do not have enough room to erupt into the mouth they may push out six of the primary teeth to gain room to erupt. The jaws will not develop correctly and there will not be enough space for the remaining permanent teeth to erupt later. If left untreated at this time, extraction of permanent teeth may be needed in the future to straighten the teeth.
Underdeveloped jaws may cause many other problems other than just crowded teeth. Headaches, jaw joint pain (TMJ), ear and neck pain can result from a misalignment of the bite resulting from crowded teeth. The palate of the upper jaw is the floor of the nasal cavity. A narrow underdeveloped palate can contribute to poor nasal breathing causing the child to become a mouth breather. In order to swallow properly the tongue must rest against the palate and if the palate is narrow and underdeveloped swallowing will be affected. The tongue may then push forward and prevent the upper and lower front teeth from touching. This is called an open bite and can affect speech. The tongue could drop backwards into the throat compromising the airway. This can result in snoring and sleep apnea. Sleep apnea occurs when a person stops breathing for short periods of time during sleep. This can be a serious medical condition causing daytime sleepiness, accidents, poor concentration and it can contribute to ADHD and poor performance in school.
Correction of all these problems should begin as soon as possible, ideally between 6-8 years old. At the age of nine, the roots of the primary molars may be too short to support the appliances needed to correct the problems. Small wire appliances (shown in the picture) are fit over the primary molars. These are left in 24/7 and removed at each appointment and activated to expand the size of the jaws. These appliances are comfortable, hygienic and do not interfere with the loss of primary teeth or the eruption of the permanent teeth. Treatment time is usually 12-18 months. This treatment is orthopedic and develops the jaws to their normal dimensions in width, height and forward growth.
A second phase of orthodontic treatment is usually needed between 11-13 years old, when all the primary teeth are lost and the permanent teeth have erupted into the mouth. Treatment time is approximately 12-20 months and utilizes fixed braces or other appliances to finish aligning the teeth and the bite.
The goals of early orthodontic treatment are to:
1) Develop the jaws to make room for all the permanent teeth.
2) Improve tongue function to correct swallowing, breathing and speech.
3) Eliminate headaches, TMJ pain, ear and neck pain that is caused by the bite.
4) Correct sleep apnea.