Click on the following questions to be directed to the answers

  1. What is a "malocclusion"?

  2. What age should my child see an orthodontist?

  3. Why should children have an orthodontic screening no later than age 7?

  4. What are some of the signs and symptoms that may indicate the need for an early orthodontic evaluation?

  5. How do I know if my child is in need of orthodontic treatment?

  6. What are the benefits of early treatment?

  7. What are the benefits of braces?

  8. How can a child's growth affect orthodontic treatment?

  9. What is Phase I (Interceptive Treatment) and Phase II Treatment?

  10. Does everyone need a Phase I treatment?

  11. Can I wait on Phase I/Interceptive Orthodontic Treatment until my child is older?

  12. Will growth allow "self correction" of crowded teeth or bite problems?

  13. What is Full or Comprehensive Orthodontic Treatment?

  14. Why do baby teeth sometimes need to be pulled?

  15. What is extraction and non-extraction therapy?

  16. Can I still have braces if I have missing teeth?

  17. What kinds of orthodontic appliances are typically used to correct jaw-growth problems?

  18. Can my child play sports while wearing braces?

  19. Will my braces interfere with playing musical instruments?

  20. Will it hurt?

  21. What is the length or duration of orthodontic treatment?



1) What is a "malocclusion"?

Malocclusion literally means "bad bite"

2) What age should my child see an orthodontist?

The American Association of Orthodontists recommends that your child be evaluated by age 7. Dr. Patel may see a child earlier, if a problem is detected by parents, the child’s family dentist, or the child’s physician. An early evaluation allows Dr. Patel, to determine when a child’s particular problem should be treated. In many patients, early treatment provides results that are unattainable once the face and jaws have finished growing!

3) Why should children have an orthodontic screening no later than age 7?

By age 7, enough permanent teeth have come in and enough jaw growth has occurred that Dr. Patel can identify current problems, anticipate future problems and alleviate parents' concerns, if all seems normal. The first permanent molars and incisors have usually come in by age 7 and if the patient has a crossbite, crowding and developing injury-prone dental protrusions, Dr. Patel can evaluate these problems. Any other habits such as finger sucking or other oral habits can be assessed at this time.

4) What are some of the signs and symptoms that may indicate the need for an early orthodontic evaluation?

Determining, if treatment is necessary may be difficult for you to assess, the following signs and symptoms may help in prompting you to seek our orthodontic advice. Although the following are only some of the more obvious signs there may be other signs that are more subtle and require an orthodontic professional to detect such problems.

First, look at your child’s teeth for some obvious conditions such as crooked teeth, gaps between the teeth or overlapped teeth. Then, ask child to bite all the way down, keeping their lips open and check the following:

  1. Do the front top teeth line up with the bottom?
  2. Do the top teeth protrude out away from the bottom teeth?
  3. Do the top front teeth cover more than 50% of the bottom teeth?
  4. Are the top teeth behind the bottom teeth?

If you see any of the above conditions, your child should be seen by an Orthodontist.

Now, look at the alignment of your child’s jaw to see if the jaw shifts off center when your child bites down. If you see any mal-alignment or shifting of the jaw, your child may have an underlying skeletal problem or imbalance. Your child should be seen by an Orthodontist.

Some other signs or habits that may indicate the need for an early orthodontic examination are:

  • early or late loss of baby teeth,
  • difficulty in chewing or biting,
  • mouth breathing,
  • speech difficulty
  • thumb sucking,
  • finger sucking,
  • crowding, misplaced or blocked out teeth,
  • jaws that shift or make sounds,
  • biting the cheek or roof of the mouth,
  • teeth “sticking out” to much
  • teeth that meet abnormally or not at all, and
  • jaws and teeth that are out of proportion to the rest of the face.

5) How do I know if my child is in need of orthodontic treatment?

It is usually difficult for you to determine if treatment is necessary because there are many problems that can occur even though the front teeth look straight. Also, there are some problems that look intimidating and complex which will resolve on their own. Asking your family dentist is good reference, but we are still your best resource since orthodontics is all we do. Our initial exam is complimentary and we would be more than happy to see your child and make any recommendations necessary.

6) What are the benefits of early treatment?

For those patients who have clear indications for early orthodontic intervention, early treatment presents an opportunity to:

  • guide the growth of the jaw,
  • regulate the width of the upper and lower dental arches (the arch-shaped jaw bone that supports the teeth),
  • guide incoming permanent teeth into desirable positions,
  • lower risk of trauma (accidents) to protruded upper incisors (front teeth),
  • correct harmful oral habits such as thumb- or finger-sucking,
  • reduce or eliminate abnormal swallowing or speech problems,
  • improve personal appearance and self-esteem,
  • potentially simplify and/or shorten treatment time for later corrective orthodontics,
  • reduce likelihood of impacted permanent teeth (teeth that should have come in, but have not), and
  • preserve or gain space for permanent teeth that are coming in.

7) What are the benefits of braces?

  • Having straight teeth that fit together properly improves function. Your teeth and jaw joints can work more efficiently.

  • Straight teeth are easier to clean.

  • properly aligned.

  • The appearance of the smile and face are improved. Having a pleasing smile can improve self-esteem, confidence, and a feeling of acceptance in daily life.

8) How can a child's growth affect orthodontic treatment?

Orthodontic treatment and a child's growth can complement each other. A common orthodontic problem to treat is protrusion of the upper front teeth ahead of the lower front teeth. Quite often this problem is due to the lower jaw being smaller than the upper jaw. While the upper and lower jaws are still growing, orthodontic appliances can be used to help restrict the growth of the upper jaw thus allowing the lower jaw catch up to the growth of the upper jaw. Abnormal swallowing may be eliminated. A severe jaw length discrepancy, which can be treated quite well in a growing child, might very well require corrective jaw surgery if left untreated until a period of slow or no jaw growth. Children who may have problems with the width or length of their jaws should be evaluated for treatment no later than age 10 for girls and age 12 for boys. The AAO recommends that all children have an orthodontic screening no later than age 7 as growth-related problems may be identified at this time and proper treatment recommendations can be made.

9) What is Phase I (Interceptive Treatment) and Phase II Treatment?

Phase I or Interceptive Treatment usually starts while the child has most of their baby teeth and a few of their permanent front incisors and molars. This stage in development is usually about the age of 7. The goal of Phase I treatment is to intercept a moderate or severe orthodontic problem early in order to reduce or attempt eliminate it. These problems include skeletal dysplasia, cross bite and crowding and many other problems. Phase I treatment takes advantage of the early growth spurt and turns a difficult orthodontic problem into a more manageable one. This helps reduce the need for extractions sometimes or jaw surgery and delivers better long term results and future treatment options. Most Phase I patients require a Phase II treatment in order to achieve an ideal bite. Some patients may need additional phases based on jaw growth, initial patient response to treatment procedures and the desired end results.

Phase II treatment usually occurs a number of years later when more permanent teeth have erupted. This most commonly occurs at the age of 11 to 13 years of age. The goal of Phase II treatment is to achieve an ideal occlusion with all of the permanent teeth.

10) Does everyone need a Phase I treatment?

Not necessarily! Only certain orthodontic conditions require early intervention. All others can wait until most if not all their permanent teeth erupt. Usually it is recommended to begin orthodontic treatment, if indicated, prior to the loss of baby second molar teeth!

11) Can I wait on Phase I/Interceptive Orthodontic Treatment until my child is older?

If treatment was recommended by the orthodontist, then waiting on Phase I treatment when the child is older is not recommended. If your child needs Phase I treatment this usually means that they have a difficult problem that requires attention now. If no orthodontic action is taken, treatment options become limited, more difficult, and the long-term stability may be compromised in future. In addition, it may lead to extractions, oral surgery and increased costs and other problems later!

12) Will growth allow "self correction" of crowded teeth or bite problems?

Generally not, the jaws grow in the back to allow for eruption of the 12-year molars and wisdom teeth. In most children the amount of available space DECREASES as the permanent teeth erupt.

Either in children or adults, untreated orthodontic problems may become worse. Orthodontic treatment is often less expensive than the additional dental care needed to treat serious problems that often develop later in life.

13) What is Full or Comprehensive Orthodontic Treatment?

This is another name for orthodontic treatment in the permanent dentition at any age. It is more commonly used when a Phase I treatment was not performed.

14) Why do baby teeth sometimes need to be pulled?

Pulling baby teeth may be necessary to allow severely crowded permanent teeth to come in at a normal time in a reasonably normal location. If the teeth are severely crowded, it may be clear that some unerupted permanent teeth (usually the canine teeth) will either remain impacted (teeth that should have come in, but have not), or come in to a highly undesirable position. To allow severely crowded teeth to move on their own into much more desirable positions, sequential removal of baby teeth and permanent teeth (usually first premolars) can dramatically improve a severe crowding problem. This sequential extraction of teeth, called “serial extraction”, is typically followed by comprehensive orthodontic treatment after tooth eruption has improved as much as it can on its own.

After all the permanent teeth have come in, the pulling of permanent teeth may be necessary to correct crowding or to make space for necessary tooth movement to correct a bite problem. Proper extraction of teeth during orthodontic treatment should leave the patient with both excellent function and acceptable esthetics!

15) What is extraction and non-extraction therapy?

Selected permanent teeth are removed in extraction therapy to make room for crowded teeth, to correct bite relationships, or to change the facial profile.

Non-extraction therapy does not require the removal of permanent teeth.

The doctors will discuss the "pro’s and con’s" of different treatment options at your New Patient Examination, and again at the Consultation Appointment.

16) Can I still have braces if I have missing teeth?

Yes. When teeth are missing adjacent teeth will drift into the empty space. This often causes functional, esthetic or periodontal problems. Orthodontic treatment can close the space or provide proper alignment for your dentist to replace the missing teeth.

17) What kinds of orthodontic appliances are typically used to correct jaw-growth problems?

Correcting jaw-growth problems is done by the process of dentofacial orthopedics. Some of the more common orthopedic appliances used by orthodontists today that help reduce the upper and lower jaw discrepancy include but not limited to:

Headgear: This appliance applies pressure to the upper teeth and upper jaw to guide the rate and direction of upper jaw growth and upper tooth eruption allowing the lower jaw to catch up! The headgear may be removed by the patient and is usually worn 12 to 18 hours per day.

Palatal Expansion Appliance: A child's upper jaw may be too narrow for the upper teeth to fit properly with the lower teeth. When this occurs, a palatal expansion appliance can be used to widen the upper jaw to fit better with the lower jaw!

Herbst: The Herbst appliance is usually fixed to the upper and lower molar teeth and may not be removed by the patient. By holding the lower jaw forward and influencing jaw growth and tooth positions, the Herbst appliance can help correct severe protrusion of the upper teeth and/or reduce the jaw discrepancies.

The decision about when and which of these or other appliances to use for orthopedic correction is based on each individual patient's problem. Usually one of several appliances can be used effectively to treat a given problem. Patient cooperation and the experience of the treating orthodontist are critical elements in success of dentofacial orthopedic treatment.

18) Can my child play sports while wearing braces?

Yes. Wearing a protective mouthguard is advised while playing any contact sports. Your orthodontist can recommend a specific mouthguard. These mouth guards are usually dispensed by your orthodontist.

19) Will my braces interfere with playing musical instruments?

Playing wind or brass instruments, such as the trumpet, will clearly require some adaptation to braces. With practice and a period of adjustment, braces typically do not interfere with the playing certain types of musical instruments.

20) Will it hurt?

Orthodontic treatment has improved dramatically. As a rule, braces make your teeth sore for a few days, but it is not painful. This annoyance can be relieved with an over-the-counter pain reliever. Today's braces are smaller, more comfortable and the use of high-tech wires further reduces the discomfort. We use the latest in miniature braces and the highest quality of orthodontic materials in order to reduce both, discomfort and treatment time.

21)What is the length or duration of orthodontic treatment?

Braces are usually worn for about six to thirty months, or longer depending on the age of the patient, the severity of the problem, the patient's cooperation, the degree of movement possible and the desired end result. Extraction therapy is a technique where some teeth are removed to make room for the other teeth in your child's mouth. This is in contrast to non-extraction therapy wherein all permanent teeth are aligned, if possible without removal of teeth.












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