Orthodontic Treatments for Children

At what age can the child go under orthodontic treatment ?

Generally the first orthodontic check up for children should be the age of 6-7 which is when the permanent teeth eruption starts. If the child has skeletal malfunctions treatment is needed at an earlier age such as 4-5 years old. In general the ideal orthodontic treatment age for children is after all permanent teeth eruption is complete. Skeletal jaw problems might be genetical, and in case the parents or any close relatives have skeletal jaw malfunctions, children should definitely go to an orthodontist at an earlier age and undergo regular check-ups. The cleft lip and palate patients go through a series of treatments and operations from the time they are born.

Which cases show skeletal malfunctions?

An excessive prominent mandible
A very small mandible
When maxillary teeth are not in contact with the mandibular teeth.
Extremely narrow and small jaws
Asymmetric jaw formations in relation to the midline of the face
Excessive Open bite
Cleft lip and palate.

Is it possible to treat skeletal malfunctions only with orthodontic treatment?

Sometimes it is not possible. Some of these patients undergo regular check-ups until the end of their growth period and a combination of jaw surgery and orthodontic treatment.

At what age should children stop sucking dummies?

Babies’ sucking need is normal and natural, and stimulates the development of the mandible. Bad habits like nail-biting, thumb thrusting and chewing on pencils are considered as malfunction cause and increases developmental problems for the patient. Also longterm use of dummies cause open bite and deep palatal curve on the maxilla. Use of pacifiers should be stopped around the age of 3.

How many types of orthodontic treatments are there?

Fixed treatment: Brackets are bonded onto the teeth and, each bracket is ligated to the wires to control the movement of the teeth into the desired directions. The orthodontist places braces, they are fixed and stay until the end of the treatment.

Removable aligner treatment: Patients can take off the aligner by themselves. These plastic aligners should be used between 16-22 hours per day for successful treatment results. The most popular removable treatment method is invisalign for adults and removable expansion and functional devices for the young children.

During orthodontic treatment how frequently are the appointments scheduled?

Orthodontic treatment control appointments are scheduled in 4-8 week intervals depending on the bracket system and treatment protocols. At the finishing phase the appointments may be scheduled weekly. Regular control appointments are very important. If the patients cannot come to the fixed appointment he/ she should cancel it 4 hours in advance and make a new appointment for as soon as possible. If the braces or archwires pop off, please contact and schedule an appointment for the fixing procedure. Also, please keep popped-off pieces as they will be sterilized and reused in the same session for you. Otherwise you might be charged for the new material.

How many types of brackets are there? How do I choose the correct type for my child?

There are two types of brackets according to the bonding tooth surface; Buccally placed and lingually placed brackets.

Buccal Brackets are classical metal / porcelain / plastic braces placed on the outer surfaces of the teeth. The other alternative to the classical buccal brackets is the buccal self ligating brackets that can be metal, porcelain or a combination of both. This type has less friction forces between the bracket slot and the wire that helps shortening the treatment period. Also chair time is shorter compared to classical buccal ones while changing the wires.

Lingual brackets are placed on the inner tongue surfaces of the teeth (STB Ormco, Incognito 3M Unitek, Win Lingual Orthodontics Dr Wiechmann). Lingual brackets can be used for all age groups of patients with permanent dentition. There might be slight phonation problems during speaking due to the tongue and the lingual bracket contact. In time the patient will get used to the feeling of the brackets. Also in the first stages of the treatment; irritation and light wounds of the tongue are possible.

You should discuss the advantage and disadvantages of each bracket and treatment method with your orthodontist, and freely choose the most suitable one for your child.

How much does the treatment cost for each type of bracket?

The price of every bracket type varies. The most expensive ones are lingual brackets followed by self-ligating and porcelain brackets. The orthodontist usually decides on the price according to treatment time, difficulty of the case and the material type. The most important factor in orthodontic treatment is correct indication and diagnosis. Material eases the process and comforts the patient.

Which bracket type do you recommend?

The quality of material shortens the treatment time and comforts the patient. However, the most important factor in orthodontic treatment is correct indication , diagnosis and treatment planning. If the patient can afford it, of course the best quality materials should be chosen, but classic and standard materials with good results can be used, too. The details in the bracket and treatment system choice should be explained to patients/parents, and the patient should have the freedom of choice.

I generally suggest metal buccal and lingual brackets for children. They are easy to remove at the end of the treatment with less damage to the enamel compared to porcelain ones.

Do braces and brackets cause allergy?

Some brackets and wires contain nickel. Nickel can cause allergic reactions. If the patient has a nickel allergy, or does not know but has an allergic body type, the parents must inform the orthodontist. The orthodontist will choose alternative material without nickel.

Will there be any discomfort such as pain, mobility of the teeth, cavity formation and soft tissue irritation/inflammation during orthodontic treatment?

During orthodontic treatments light forces are applied to the teeth to achieve a bodily movement through the bone into the desired direction. At the beginning stage of a treatment or after every wire changing visits, slight teeth pain, teeth numbness and teeth mobility may occur. These effects are temporary, and during the first 2-4 hours the pain is at a maximum rate. Within 1-7 days the discomfort fades away. The patient can use pain killers to ease the temporary pain felt during these stages if he/she does not have any systemic health problems. Until the patient gets used to the feeling of the brackets, dental waxes are placed on the brackets. Within time the tongue, cheeks and lips will get used to the brackets with it pain and phonation problems will also lessen. Soft nutrients must be consumed during this time period. Biting should never be done by the anterior teeth. Food should be cut into small pieces and then chewed. Oral hygiene is very important. Every three months the patient should make a dentist visit for the professional cleaning, and must brush his/her teeth very well. Dental care should be supported with high fluoride toothpastes and mouthwash. Additional cleaning instruments such as water peek, dental floss and interdental brush should be used at least before going to bed after brushing the teeth.
Before orthodontic treatment patient should go under general dentistry check up, and have healthy gingiva, periodontal tissues, and healthy teeth. Also the hygiene level must be perfect during orthodontic treatment otherwise staining, cavities, tooth pain, gum tissue swelling, bleeding and inflammation followed by dental supportive tissue loss will occur.

Tooth Extraction for the Orthodontic treatment. Is it necessary? Will this do any harm?

In some cases tooth extraction is needed for treatment success. If there is a size ratio problem between jaw bones and the teeth, not allowing the total eruption of 28 permanent teeth, tooth extraction may need to take place for longterm success of treatment. Each orthodontic treatment is planned individually for each patient. Unnecessary extractions will not be done by the orthodontist. Always the orthodontist do calculations in order avoid the extraction of teeth, but if needed symmetrical extractions are suggested.

Which medicines are used to heal wounds created by braces?

Placing dental wax above the brackets facing the irritated region and using gels on the irritated tissue such as Kenacort-A Orabase or Protefix wound healer can be recommended.

During orthodontic treatment process can children harm themselves?

During treatment process, fixed braces, wires and elastic bands, or removable orthodontic appliances should be used as recommended. Rarely, there is a slight chance of swallowing of the broken or detached pieces. In this case, for the necessary intervention, please go to a fully equipped hospital. Intra and extraoral removable orthodontic appliances should not be used while practicing sports and eating. Patient should take care of their oral hygiene. Braces create areas that retain food rest, if patients do not brush their teeth and caries lesions and gum inflammation will be occur.

Where can I buy additional dental wax for my child?

These waxes are not sold in pharmacies, or at the grocery stores. Patients should get dental wax from their orthodontist. At the beginning of the treatment we suggest our patients to use the wax especially at the posterior regions above the brackets and wires, even if there is no discomfort or irritation of the soft tissues. It is better to use before going to bed for a comfortable sleep until you get use to the brackets.

Can relapse occur after orthodontic treatments? What is orthodontic retention treatment? Why is it done?

After placing the teeth to the new positions in the jaw bones and finishing active orthodontic treatment, this new position needs to be retained. To stabilize the new positions of the teeth fixed and removable retainers are used. Fixed retention wires are bonded with composite filling material to the tongue facing sides of the 4 incisors and the canines in both upper and lower arches. It is advised that the fixed retainers attached to the lower incisors should be permanent for a lifetime, and be present at least for 5 years. Removable invisible plastic retainers should be used day and night time both for the first month, following the first month retainers should be used while sleeping for a year or when needed as bruxism appliance forever. Patients are responsible for relapse and should be very well informed about the consequences. That is why besides 6 monthly dentist check-up and cleaning, at least an orthodontic control appointment once year is suggested.

What does a successful orthodontic treatment depend on?

Orthodontic treatment is a longterm treatment. Cooperation of the patient and the doctor is essential for a good result. Patient should go through the treatment with good hygiene and cooperation until the end. The worst and harmful decision is to quit the treatment before the treatment goals are achieved. Better not to start at all than giving up after a while.

Orthodontic treatment is a smart investment for your child’s longterm oral health and a nice smile!