| Look
at yearbook or prom pictures from the 1950s or '60s and you'll see many
smiles framed with heavy metal braces, a sight that's increasingly rare
on today's high school campuses. Why the change? Children today tend
to get braces at a much earlier age. It's not uncommon for a patient
as young as 7 or earlier to begin orthodontic
treatment.
"The American Association of Orthodontics (AAO) recommends that
all children receive an orthodontic screening by age 7," says Thomas
Cangialosi, D.D.S., chairman of the Section of Growth and Development
and director of the Division of Orthodontics at Columbia University College
of Dental Medicine. "Permanent teeth generally begin to com in at
age 6 or 7, and it is at this point in a child's oral development that
orthodontic problems become apparent.
"Because bones are still growing, it's an ideal time to evaluate
a child and determine what orthodontic treatment, if any, may be needed
either now or in the future," Dr. Cangialosi says.
Making Braces Hip
To make braces more acceptable to young people, manufacturers have made
brightly colored elastics, the tiny rubber bands that hold the wires
to the braces. Children can choose elastics with their school colors
or a holiday color scheme, such as orange and black for Halloween.
"When patients are given the opportunity to choose the color of
the elastics at every orthodontic visit, they tend to feel that they
are more involved in their treatment," Dr. Cangialosi says.
Still Take Getting Used to
Braces today tend to be less uncomfortable and less visible than they
used to be, but they still take some getting used to. Food can get caught
in the wires, flossing and brushing can take more time, and after the
monthly adjustments sometimes the teeth are a little sore. Tooth discomfort
can be controlled by taking an analgesic, such as ibuprofen (Advil, Motrin
and others) or aspirin if necessary. The use of lighter and more flexible
wires has greatly lessened the amount of soreness or discomfort during
treatment.
"I got braces when I was in fifth grade and I beyond hated
them," recalls Jessica Claflin, 18, a freshman at the University
of North Carolina at Wilmington. "I looked ridiculous."
As more and more children get braces, school-yard nicknames such as "tin
grin" and "metal mouth" are heard less often. Because
treatment has become more socially acceptable, social embarrassment may
be less of a concern.
Beyond Braces
Orthodontic treatment in young children is known as interceptive orthodontics,
in which intervention begins before the child starts first grade. At
this age, tooth development and jaw growth have not been completed, so
certain conditions, like crowding, are easier to address.
Before permanent teeth have come in, it may be possible to help teeth
to erupt (emerge through the gums) into the proper positions. It's common,
for example, for the dental arch to be too small to accommodate all of
the teeth. A few decades ago, the solution for crowding was to extract
some of the adult teeth, then use fixed braces to position the teeth
properly. Early intervention takes advantage of the fact that a child's
jaw is still growing. For example, a device called a palatal expander
may be used to expand the child's upper arch. Once the arch is the proper
size, there's a better chance that the adult teeth will emerge naturally
where they should. If all teeth have erupted and there is still a great
deal of crowding, some permanent teeth may have to be extracted to align
the teeth properly.
"It is important to note that children who receive interceptive
orthodontics may still need braces or other orthodontic appliances later," Dr.
Cangialosi says. "However, this early treatment may shorten and
simplify future treatment and may eliminate the need for more drastic
measures such as the need to extract permanent teeth in the future."
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