Dr. Robert Bard, an orthodontist with offices in Gurnee and Carol Stream, remembers the only child who ever cried in his office. “She was a new patient about 10 or 11 years old who had come in for an evaluation. I told her she had a few minor problems that could be addressed later and to come back in six months.
“She immediately started crying, `All my girlfriends are getting braces, and I want them, too.’ Braces have become a status symbol,” Bard said, “and children and parents often want orthodontia started early, whether it’s appropriate or not.”
“Twenty years ago, if you walked into an orthodontist’s office, all of the patients would be between 12 and 15. Now we’re treating patients from age 3 to 73,” said Dr. Lee Graber, president of the Midwest Society of Orthodontists who sees patients in Vernon Hills and Kenilworth.
The move to early orthodontia is not without controversy. While some area orthodontists advocate using such orthodontic appliances as head gear that expand the jaw, retainers and even braces on grade school youngsters, others maintain that an early introduction to braces provides no lasting benefit and may cause “orthodontic burnout.”
Parents, too, are divided on the subject. By the time he was 7, Dennis Keizer Jr., of west suburban Westchester, for example, had a severe underbite. “My bottom teeth stuck out farther than my top teeth,” he recalled. “Then in 3rd grade my dentist, who is also an orthodontist, put me into a chin brace, which I had to wear every day after school until the next morning. The thing really bothered me, but after a year my top teeth fit over my bottom teeth, just like normal. Now I’m 17, my teeth are perfect, and I never even had to wear braces.” His mother, Loretta, said, “It was like a miracle.”
But for the Miller family of Glenview, a trip to the orthodontist with their 6-year-old son turned into a nightmare. “Our son Kevin (now 12) had an overbite, which our first orthodontist said could be corrected if he wore a retainer and a band for a year. When they came out, his mouth looked no different. So when Kevin was 8, we went to a second orthodontist, who put braces on Kevin’s top teeth. By the time he turned 11, Kevin still had an overbite and we’d spent $1,500. Kevin will still have to wear full braces, and we’ll have to spend another $3,500,” said his mother, Judy.
Dr. Ralph Robbins, who lives in Deerfield, said he is concerned about some children who start orthodontia too early. “You know,” Robbins said from the middle of his high-tech treatment room on the top floor of the Golf Mill Professional Building in Niles, “we like to see children when they’re 7 or 8, so we have some idea of what problems they may have. Some children have functional problems with the way their jaws or teeth are growing. But spacing between the teeth is normal at that age, and there’s no need to do anything about it. Yet I have young children who want braces and parents who want me to close up spaces that will disappear on their own later on.”
In California, some orthodontists are putting full braces on children so young they still have their baby teeth, and a northwest suburban orthodontist recently held a workshop on treatment for 3- and 4-year-olds.
“I find all this appalling,” said Elgin orthodontist Dr. H.T. Perry, former chairman of the Orthodontic Department at Northwestern University’s School of Dentistry, who feels that almost all early orthodontia is unwarranted. “Orthodontic treatment should begin during the adolescent growth spurt, no sooner than age 11 for girls and age 12 for boys. Starting treatment at an extremely young age is ludicrous and is related to the orthodontist’s need for busy-ness, not the child’s need. In 40 years of practice, I’ve seen very few cases in which early intervention kept a problem from recurring 5 or 10 years later,” he said.
Yet others, such as Graber, said that in the last decade orthodontists have learned to treat younger patients “to make a situation better or to keep one from getting worse. Beginning treatment when a child is young can reduce the complexity of orthodontia during the patient’s teen years,” he said.
Early othodontia takes two forms: prevention or intervention. Most orthodontists practice intervention-that is, using functional appliances such as the chin strap Dennis Keizer wore to guide the jaw growth of their young patients.
The nation’s leading expert on early orthodontic treatment, Dr. William Proffit, chairman of the Department of Orthodontics at the University of North Carolina and author of “Contemporary Orthodontics” (Mosby-Year Book, $63.95), explained, “If a child has a problem with the growth of his or her jaws, if the upper front teeth are protruding or if the lower jaw is not growing at the same rate, then we should intervene. In fact, if we wait until a child has finished growing, it may be too late,” he said.
A commonly used intervention device is the Frankel appliance, a removable mouthpiece that guides and influences the growth of the jaw.
According to Proffit, there are a number of studies showing that most children with jaw-growth problems also get good results from early intervention. “But there are two schools of thought on whether early treatment is beneficial for children who just have crooked teeth,” he acknowledged.
While some orthodontists, such as Perry, are on one side and prefer to postpone treatment until an adolescent has all permanent teeth, others have begun preventive orthodontia by treating malocclusion (crooked teeth) in two steps.
Bard explained, “We begin Phase 1 treatment when children are in that ugly ducking stage, at ages 6 through 8, when they have some of their large permanent teeth and some of their baby teeth. If we can see that there won’t be room for the other permanent teeth, if we have Cadillac teeth growing into Volkswagen parking spaces, then we can begin a little tooth guidance early.”
That guidance usually involves a retainer and may include partial braces on the permanent teeth that have come in.
While Phase 1 treatment usually does not eliminate Phase 2-installation of braces on all permanent teeth-it can reduce the length of time a teen must wear those braces.
But even so, braces no longer carry the negative feelings for wearers they once did. “There used to be a stigma attached to wearing braces,” Graber said. “Now the kids think wearing some kind of a gizmo in your mouth is cool, and there’s social pressure to start treatment early.”
Graber said early orthodontia is appropriate when used to correct jaw formation problems; to treat specific problems, such as protruding “buck” teeth, which are prone to injury; to help young children who are not able to chew; or when a problem, like a snaggle tooth, is so obvious that the child is teased by other children.
But Graber also worries about orthodontic “burnout” among children whose treatment started too soon.
Orthodontia requires a high degree of cooperation from the patient, who must brush his teeth more often, replace rubber bands, keep appointments and consistently wear a removable retainer. A 7- or 8-year-old child who cooperates during Phase 1 may lose enthusiasm for the process and sabotage Phase 2 later.
“Early treatment usually runs into long treatment,” Robbins added, “and should only be used to decrease the severity of a problem.”
How can parents know whether early treatment is appropriate? “Seek a second opinion,” advised Susan Weiss of Deerfield, who took her 9-year-old son, Adam, to one orthodontist last summer. “This man walked into the examining room and said that awful things would befall my son if he didn’t start wearing braces and other appliances right away. If we waited, he said, my son would need to have his jaw broken later.” Weiss added.
“Instead of going along with that, we went to see Dr. Robbins, who said Adam could wait for braces until he’s 13 or 14. These people are not gods. If someone tells you one thing, go somewhere else.”
Perry suggested that parents wondering about early treatment seek a second opinion from “neutral territory, the orthodontic departments of local dental schools.” Northwestern and the University of Illinois Medical School in Chicago have such departments.
Finally, Bard said, be suspicious of any doctor who agrees to do something right away. There is so much pressure from parents and children to start orthodontia early, he warned, “that some orthodontists will agree to start treatment, just to keep such families in their care.”
