Two Sets of Braces?!

One of the most common questions I get asked by patients and parents is, "Why do so many kids nowadays get braces twice?". Well, the answer to that question is one of the most debated topics among orthodontists.

Well - it isn't straightforward. Predicting how and when kids will grow is... well, unpredictable.

Let me start by saying that almost all orthodontists would agree that for most children, it is fine to wait until all the permanent teeth have erupted to begin braces. This usually happens around age 11-13, depending on the child. Any treatment that is done before that time is considered early orthodontic treatment.

Also, you need to understand that orthodontists are always looking for ways to give our patients the best possible result in the shortest length of time in braces. Nobody wants their child to wear their braces for eight years! For our more complicated patients, this can sometimes happen.

People who have complicated bites, growth patterns, or tooth eruption problems are almost always the ones who end up wearing their braces longer than they (or their orthodontist) would prefer. So, orthodontists decided to break this process up into two stages to give their patients a break. Oftentimes, this two-phase treatment can help patients avoid complicated procedures later, like jaw surgery or extraction of permanent teeth.

Almost every orthodontist would agree that there is a time to intervene with early orthodontic treatment. The disagreements that we have are over exactly which problems warrant us intervening and which problems can wait until all permanent teeth have erupted. Every orthodontist has a list of problems that they feel are worth putting braces on twice to correct. Some are more liberal, and others more conservative in their approaches.

Personally, I tend to be more conservative in my approach to early treatment. I want the whole process to be an enjoyable one for the kids, if at all possible. And, this usually means less time in braces. Almost every child is excited the day their braces are placed - but the first question I get asked as they come back for follow-up appointments is, "Now, when are these coming off?". Also, the risk for complications, like cavities or white spot lesions on the teeth, goes up the longer a child is in braces.

So, here is my general list of problems that I think are worth addressing early: severe crowding, severe overbites, underbites, crossbites, and teeth erupting in the wrong place. Of course, this list is not exhaustive, but it is close.

There are also some problems that some people want to fix early that I do not recommend fixing early. The obvious exception to this would be a child who is self-conscious or is being teased at school. If that is the case, I will fix just about anything for one of my kids if it were possible. I do not think it is necessary to correct crooked teeth or spaced-out teeth early. These problems can almost always be corrected later. Also, overbites that are not severe can usually wait to be treated later. This one is probably the most debated. I'll address this one in a later post.

Hopefully, that helps your understanding of the timing of orthodontic treatment. It is a complicated issue, for sure.