It used to be that wearing braces was an annoying part of being a teen.
The resulting “wire mouth” was right up there with acne and overactive sweat glands. Now braces and other orthodontic appliances are being worn by children still young enough to believe in the tooth fairy.
The trend reflects the belief of many orthodontists that some problems can be fixed better if tackled early, when the jaws and face are still growing.
A new advertising campaign by the American Association of Orthodontists urges parents to have their children screened no later than age 7 to detect potential problems.
But does it really make a difference when a child begins orthodontic treatment? Two studies funded by the National Institutes of Health found that, at least in the case of buck teeth, the answer probably is no.
“Whether you treat early or whether you treat later, you get the same results,” said Orhan Tuncay, chairman of orthodontics at Temple University School of Dentistry in Philadelphia. “The only difference is that, if you begin treatment early, you end up in treatment longer.”
One study done at the University of Florida found that children who started treatment early–either by wearing a headgear or a retainer-like appliance–spent an average of three years going to the orthodontist, as opposed to two years for the children who waited to get braces, according to researcher Timothy Wheeler.
University of North Carolina researchers found that those children who first wore an appliance spent several months less in permanent braces later on, but in the end there was no difference between early or later treatment.
“The quality of outcome was identical,” said Camilla Tulloch, professor of orthodontics at North Carolina’s School of Dentistry.
Tulloch said the findings give parents “a little bit of room for choice” when it comes to treatment timing. “They don’t have to feel guilty if they decide not to do it right now.”
In the last few decades, braces have gone from being a luxury that only the well-off could afford to a more routine part of many families’ dental care. About 4.4 million people in the U.S., most of them children and teens, are now in orthodontic treatment, according to the orthodontists’ group.
One study that analyzed the government’s latest health data found that the number of teens in orthodontic treatment tripled from the mid-1960s to the early 1990s, and the number of children in treatment increased fourfold.
“It’s quite clear that teeth matter. And straight teeth really matter,” Tulloch said. “There certainly is a public perception that people who have crooked teeth are socially or economically inferior.”
Dental insurance often covers only a fraction of the cost, typically about $3,000 to $6,000, depending on the complexity of the case.
Many orthodontists like to see children around the age of 7 or 8 because the permanent adult teeth are starting to come in, giving some indication of how things will shape up.
It is estimated that half of U.S. children need braces.
Because orthodontics, like many branches of medicine, is as much an art as a science, a practitioner’s own style, habits and training can influence decisions on the timing of treatment. The studies, funded by the NIH’s National Institute on Dental Research, were designed to provide some more scientific answers.
Orthodontic problems can be clumped into three broad categories–the alignment of the jaws is correct but the teeth are crooked and crowded; the upper jaw protrudes, creating buck teeth; the lower jaw juts in front of the upper jaw.
Researchers focused on buck teeth because it is the most common reason to get braces, said Wheeler, chairman of orthodontics at the University of Florida’s College of Dentistry. The 300 children in his study were divided into three groups: Two wore either a headgear or an appliance, starting, on average, at age 10 and later moved into braces; the last group didn’t get treated until their teens.
“All three groups ended up at the same place at the end of treatment,” Wheeler said.
He also looked at self-esteem because many parents worry their children will develop a poor self-image as a result of crooked teeth. The surprising answer: “The kids didn’t care about their teeth,” Wheeler said. “The parents did.”
North Carolina’s Tulloch said that, while it often is assumed that early treatment will lessen the need for extractions and surgery, her study found there is no difference in either of those measures, whether treatment is early or late.
“Is it worth it? Some parents truly feel they want to start treatment early because they think the kids will go through grade school looking odd and being teased,” Tulloch said. “What I would say to a mom: `If that’s your reason to do treatment, that’s a good reason.’ “
