Orthodontic Treatment for Children

While there is no exact age to begin orthodontic treatment, The American Association of Orthodontists recommends a first assessment around age 7 or 8 years in order to detect early developmental problems.

Treatment is often classified into different stages based on the dental and skeletal development of your child.

Early Treatment is also known as Phase 1 treatment or Interceptive Orthodontics. This is treatment carried out when your child has a mixture of baby and adult teeth and the top jaw has not completed its natural growth (approximately ages 7-12). Early orthodontic treatment can be indicated to intercept a developing problem or diagnose an imbalance in the growth of the teeth and facial bones.  These can include crossbites (narrow upper jaw), underbites, open bite (front teeth don’t touch), protruding teeth, sucking habits, mouth breathing and space problems where adult teeth cannot erupt.

Comprehensive Treatment is also known as Phase 2 treatment. This is the orthodontic treatment provided when most of the adult teeth have erupted and the face is undergoing active growth during puberty (12-18 years of age depending on each child’s individual growth). The goal of the second phase is to make sure each tooth has an exact location in the mouth where it is in harmony with the lips, cheeks, tongue, and other teeth. When this equilibrium is established, the teeth will function together properly. Phase Two usually involves full upper and lower braces and retainers are worn after this phase to ensure the patient retains a beautiful smile.

Early treatment is performed while your child still has many of their ‘baby’ teeth with the goals of:

Preventing a problem from developing

  • Create space and guide adult teeth into better positions
  • Reduce the likelihood of extractions of permanent teeth
  • Make full braces treatment quicker and easier and more stable

Intercepting a developing problem

  • Reduce or eliminate the need for corrective jaw surgery (underbites)
  • Reduce the risk of injury to protruding teeth
  • Correct the size and shape of small, ill- fitting jaws (cross bites)

This treatment aims to create a better environment for your child’s permanent teeth to erupt into. Expander plates and mini-braces are two of the common appliances used during the first treatment phase. At the initial assessment appointment Dr Fermanis will listen to your concerns and thoroughly assess your child and their individual pattern of growth and development. You will then discuss their current and future orthodontic needs (if any) and arrange for further diagnostic records such as radiographs, facial and dental photographs and impressions of the teeth if indicated.

Rapid Palatal Expansion (RPE)

The maxilla (top jaw) is formed by 2 separate bones which fuse together after puberty. Up until this time the maxilla can be made wider to correct a size deficiency (crossbite) in the top jaw or to make extra space to accommodate the larger adult teeth. As specialists we are comfortable using expanders called Rapid Palatal Expander (RPE). This appliance (pictured) is cemented temporarily to your child’s top adult molar teeth which means that 1) expansion is achieved quickly- within 6 weeks 2) children become adapted very easily to the fitted plate and 3) they do not have to remove it for eating/sports and so cannot lose it!

The parent/guardian is instructed on how to turn the expander using the key. Each turn very gently widens the maxilla by 0.25mm  and so does not cause pain. Occasionally some children report a tingle or tickle under their nose after the first few turns. It is normal to notice a large gap appear between the front teeth towards the end of the turning phase and this indicates the space created. This gap slowly closes/reduces once turning has stopped.

Resting Period

In this phase, the remaining permanent teeth are left alone as they erupt. Retaining devices may not be recommended if they would interfere with eruption. It is best to allow the existing permanent teeth some freedom of movement. A successful first phase will have created room for permanent teeth to find an eruption path. Otherwise, they may become impacted or severely displaced.
The parent/guardian is instructed on how to turn the expander using the key. Each turn very gently widens the maxilla by 0.25mm  and so does not cause pain. Occasionally some children report a tingle or tickle under their nose after the first few turns. It is normal to notice a large gap appear between the front teeth towards the end of the turning phase and this indicates the space created. This gap slowly closes/reduces once turning has stopped.