I am wondering when the best time will be for my son to see someone who can straighten out his crooked teeth. Do I need to see a specialist or can an ordinary dentist help us out?
The improper positioning of teeth such as crooked teeth, crowded teeth or protruding teeth is referred to as malocclusion. It also refers to an abnormal development of the jaw, potentially resulting in teeth which do not properly fit together.
The most common cause of malocclusion is genetics. Protracted mouth breathing may also affect the development of the palate and subsequently the teeth. Can thumb sucking and pacifiers also play a role? Thumb sucking is a concern for some families; they worry that a child who sucks his or her thumb will definitely need to see an orthodontist. The same may be true for children who use pacifiers.
However, most children stop sucking their thumbs or using pacifiers between two and four years of age. A dentist should, however, keep an eye on your child's teeth. Information on the American Academy of Pediatric Dentistry web site (www.aapd.org) tells parents that for most children, there is no reason to worry about a sucking habit until the permanent front teeth are ready to come in.
According to the Canadian Association of Orthodontists, the best time for orthodontic screening is no later than age 7. This age coincides with the complete eruption of the first permanent molars, also known as the six-year molars. At this age, the permanent incisors have also initiated their eruption.
This is also a good time for an orthodontist to evaluate jaw dimensions and the position of any teeth still developing within the jaws. A special X-ray, known as a panoramic X-ray, can show the dimensions of the teeth and jaws to the face and skull.
It is a major challenge for both parents and pediatricians to time the treatment of malocclusion. In the past, most pediatricians received very little general training in pediatric dentistry. As a result, many felt uncomfortable giving any dental advice, especially in an area as controversial as malocclusion management.
The best clinicians to help children who suffer from malocclusion are orthodontists, who are dentists that choose to specialize and train for an additional 2 to 3 years. Orthodontists gain advanced training in areas such as genetics, embryology, human growth, development and biophysics. These specialists are accredited by the Canadian Dental Association (For further information on how to find out more about orthodontists in your area, look at www.cao-aco.org).
The treatment of malocclusion by general dentists who do not have formal training remains controversial. Some orthodontists object that these generalists even treat children. The orthodontists argue that without proper training, some general dentists can make misleading claims. One such claim is that of success after only six months of treatment. Another claim may be that having an orthodontic device behind the teeth - that is, not visible when patients open their mouths - works just as well (Some patients do not want others to know they are using orthodontic devices).
Generally, orthodontic appliances come in two basic forms: removable and fixed. Fixed appliances are what we commonly know as "braces". Braces are attached directly to the teeth, thus controlling tooth movement. It requires disciplined, consistent oral hygiene. Patients also have to refrain from chewing hard or sticky substances such as gum, caramels, peanuts, ice chips and pop corn, which may either cause the braces to snap or complicates oral hygiene.
The diagnosis and treatment of crooked, crowded and protruding teeth has improved over the years, thanks to modern computerized technology. One expert in Calgary, Dr. Mehra, relies almost exclusively on technology which enables him to diagnose, treat, and teach families in a dynamic way via computerized models and images. More and more orthodontists are relying on this technology instead of using more traditional tools.
Many pediatric patients are receiving two phases of orthodontic care. The first phase of treatment - mixed dentition - often concentrates on skeletal issues rather than dental corrections. It may focus on rapid expansion of the palate and head gear.
The second phase involves biomechanical appliances which affect the positioning of teeth. In some cases, an orthodontist will arrange for the extraction of teeth to minimize crowding and to allow space for future guidance of the teeth.
The cost of treatment varies from orthodontist to orthodontist. Many offer a convenient payment plan extended over time. It may also be prudent to time the payments in such a way that a family's accountant can maximize tax deduction allowances.
If improper jaw development is left untreated, the child may grow up with either a very prominent chin which juts too far forward or a chin which is underdeveloped. Two former prime ministers of Canada, one with a prominent chin and one with an underdeveloped chin, exhibited these two extremes. Cartoonists had plenty of "fun" exaggerating these features.
Some individuals may end up with poor self-esteem due to having jaw abnormalities or crooked teeth. However, an attractive smile and a boost to a person's self-image are just some of the benefits of seeking help from a skilled orthodontist. Other benefits include:
- Reduction in tooth decay
- Decrease in gum disease
- Reduced risk of bone destruction
- Less likelihood of chewing problems, digestive troubles, chipped teeth or other dental injuries
Not all children are fortunate enough to get early treatment. This raises the question: Is it ever too late for a patient to get treatment? According to Dr. Mehra, it is never too late. In fact, on their web site, the Canadian Association of Orthodontists tell interested adults - as old as 50-60 years - that older people make up quite a bit of their patient population.
In the end, it may be best to meet face to face with an orthodontist, and even to consider a second opinion if you are not fully comfortable. Another way to arrive at a suitable plan is to talk to present and former patients to get an idea of their experiences with a particular orthodontist.
Two web sites which are particularly useful are: www.cao-aco.org and www.aapd.org. The latter site links patients to an excellent, general pediatric dentistry resource provided by the University of Manitoba School of Dentistry.
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