2-PHASE ORTHODONTIC

TREATMENT by David M. Muench, DDS

This is a companion article to another titled “The Benefits of Early Orthodont ic Treatment ,” which explains why your child should have their first orthodontic examination at age 7. The goal of this report is to help you understand how children with serious orthodontic problems can benefit from early intervention. Hopefully, this information will assist you in making the best choice for your child. This report will explain what early orthodontic treatment is all about, how it can help your child, and what you need to know about their future treatment needs, like when they reach their teens.

F i r s t a n d f o r e m o s t , congratulations for bringing your child for their first orthodontic evaluation. You have taken an important first step in helping your child achieve a health bite and beautiful smile. Age seven is when your child’s upper and lower permanent front teeth are developing. These teeth set the stage for future jaw position and serious problems can develop if they come into the wrong position. T h a t ’ s w h y t h e A m e r i c a n Associat ion of Orthodontists

recommends an initial orthodontic evaluation by age 7. From an orthodontic standpoint, this is the best time to diagnose problems with the alignment of the jaws and teeth which could potentially result in harmful bite problems later.

In our office, only 1 in 10 children need early treatment. The other 90% can safely wait until all of their permanent teeth have erupted prior to initiating orthodontic treatment. But, for the 10% with the type of severe problems listed below, a period of early orthodontic intervention is followed by full braces treatment during their teens. That means your child’s problem will involve two separate phases of treatment with braces or appliances. Each phase is usually separated by a “res t per iod ,” dur ing which additional growth and development are monitored. If you are reading this report, your child may benefit f r o m 2 - P h a s e O r t h o d o n t i c Treatment. Allow me to explain this

in greater detail.

PROBLEMS THAT BENEFIT F R O M 2 - P H A S E ORTHODONTIC TREATMENT

1.Large overbites - deep bite 2.Underbites 3.Protruding front teeth 4.Crossbites 5.Thumb/finger sucking habits 6.Severe crowding

7.Severe spacing

PHASE I - EARLY TREATMENT Phase I, or early treatment,

typically happens between ages 8 and 9. The goal of Phase I is to lessen the severity of the types of problems listed. Note the emphasis on lessen. Phase I treatment does not completely cure all conditions your child may have, but it will definitely lessen the severity of certain problems, which in turn will make fu ture t reatment le s s complicated, less painful, faster, and less expensive.

A common example would be a child with severe crowding. Photo #1 shows a teenaged girl with severe crowding. Sadly, she will need to have several permanent teeth r e m ove d t o e n a b l e p ro p e r alignment and correction of her bite. Early treatment could have prevented this.

C h i l d re n w i t h fl a re d o r protruding upper front teeth (photo #2) often suffer low self-esteem as they are mercilessly teased at school. They are also at high risk for tooth trauma since the teeth stick out too far. Early intervention can dramatically improve their social development and self-confidence, not to mention, protecting their protruding teeth from irreversible damage.

Children sometimes exhibit early signs of jaw growth problems, like large overbites or underbites (#3). Overbite problems are usually due to underdevelopment of the lower jaw, while underbites are usually due to overgrowth of the lower jaw. Orthodontic appliances can be used to correct problems with jaw shape and size and direct growth toward a healthier bite.

#1 Severe Crowding

#2 Protrusion

#3 Underbite

Thumb suckers usually develop an open bite where the front teeth can’t touch. Not only is chewing difficult, but tongue thrusting and s p e e c h p r o b l e m s t y p i c a l l y accompany this problem. A crossbite is when the top teeth fit inside the bottom teeth. Since the teeth don’t fit together properly, the child shifts their jaw to the side, as seen in Photo #4. The resulting jaw asymmetry can become permanent if not corrected when the child is still growing.

Phase I Treatment can: 1. prevent the need to remove

healthy permanent teeth to correct crowding.

2. reduce protruding upper front teeth and avoid possible damage.

3. prevent jaw surgery to align the upper and lower jaws.

Leaving a serious problem untreated until all of the permanent teeth erupt is risky and could result in far more painful and costly treatment later.

BETWEEN PHASES REST PERIOD Once all treatment objectives

have been accomplished in Phase I, braces or appliances are removed, and the child is given retainers. This marks the beginning of the Between Phases rest period, during which the remaining baby teeth shed, and the adult teeth erupt. Retainers are designed to allow eruption of the

p e r m a n e n t t e e t h . A successful first p h a s e w i l l h a v e e l i m i n a t e d any serious threat to a healthy smile and proper bite and will have set the s t a g e f o r m o r e n o r m a l

development.

It is important to understand that at the end of the first phase of treatment, the permanent teeth are not in their final positions, and the final adult bite has not been established. This will be accomplished in the second phase of treatment.

P e r i o d i c o b s e r v a t i o n appointments will continue to be necessary throughout the Between Phases Period, usually about once every four to six months.

PHASE II - TEEN TREATMENT Since each tooth has an exact

location in the mouth where it is in harmony with the cheeks, tongue, jaw joints and other teeth, Phase II is not initiated until after all the permanent teeth have erupted. Stated another way, the goal in Phase II is to finish what was started in Phase I, and to establish your child’s final adult bite and beautiful smile that will last a lifetime. This is the only way to ensure a stable lifelong result. Once the teeth are perfectly aligned, and the bite has been completely corrected, retainers are worn to hold the teeth in their final corrected positions. With good home care and faithful retainer wear, an attractive smile can be preserved for many years. This is the goal of the second and final phase of treatment.

ADVANTAGES OF TWO-PHASE ORTHODONTIC TREATMENT

Two-phase treatment is a very s p e c i a l i z e d p r o c e s s t h a t encompasses jaw and facial changes ( o r t h o p e d i c s ) a n d t o o t h straightening (orthodontics). The emphasis today on living longer, staying healthy, and looking at tract ive requires opt imum treatment results. The major advantage of two-phase treatment is to maximize the opportunity to accomplish the ideal healthy, f u n c t i o n a l , a e s t h e t i c , a n d comfortable result that will remain stable for life.

The disadvantage of avoiding early treatment is the possibility of a compromised result that may not be functionally healthy or stable and may require preventable adult tooth extraction or jaw surgery later.

I hope this report has helped you better understand the benefits of early orthodontic treatment for your child. There may be other things you are wondering about. If so, don’t hesitate to ask me.

ABOUT THE AUTHOR

Dr. Muench is Secretary-Treasurer of the New York State Society of Orthodontists, and Treasurer of the Broome County Dental Society. He is a former Assistant Professor in the Departments of Orthodontics and Pediatric Dentistry at the University of Rochester Eastman Institute of Oral Health. A published author and lecturer, Dr. Muench maintains a private practice in Vestal, NY.

#4 Crossbite