Am I too old for orthodontic treatment?

June 26th, 2011 by drnicole No comments »

Let me tell you a story. About a year ago a white-haired adult woman came to our office for an orthodontic consultation. She was referred by a local dentist who happened to ask her, “Is there anything you would like to see different about your smile?” When I walked in the consultation room to meet her, I could barely introduce myself before she immediately said, “I know what you’re thinking.” I thought to myself, “You do?” She continued, “I could live until I’m 105 or I could die tomorrow, but I put my two adult children through orthodontic treatment as teenagers and I’ve had this overbite my whole life and I don’t want to look like this any more.” “Okay,” I thought. “Let’s chat.”

Adults comprise 40% of the new patients we see. Their orthodontic treatment ranges from very mild single tooth alignment issues to very complex orthodontic treatment in preparation for future implants and crowns. There are numerous benefits to teeth that are aligned and in a healthy biting position, including easier cleaning, less adverse wear, increased longevity, and of course better looking teeth.

As adults are living longer and desire a better quality of life they are looking toward orthodontic treatment to enhance what mother nature has provided. The best timing for orthodontic treatment is not time or chronological age related – it is when that individual is ready to help plan their treatment with the goal of obtaining the best result. This could be at age 13 or age 80. Often adults are our best patients because they are serious about their goals and do what’s necessary to obtain them.

Goals for adult orthodontic treatment may be different than for children. When you are young and growing, orthodontists have the ability to intercept deviant jaw growth to normalize their teeth and bite. As an adult your genetically predetermined growth has already expressed itself. A more realistic goal for adult orthodontic treatment is to straighten the teeth and improve the bite discrepancy rather than attempt to make the bite perfect.

There are many treatment options available today for adults. In addition to traditional metal braces, there are clear braces, Invisalign (a series of clear aligners to move the teeth), and braces glued on the inside of the teeth. You may be a candidate for one or more of these orthodontic treatment options depending upon the severity of your alignment, bite discrepancy, and your treatment goals.

The challenges of holding the teeth in the new aligned position with an improved bite relationship are the same for adolescents and adults. All age groups need retainers to hold the teeth in the new position for life. Wow – that sounds daunting! However, most adults who are motivated about their brushing and flossing are great candidates for permanent retainers – wires glued on the back side of the front teeth that are the most likely to move back toward the original position. Removable retainers are typically just worn at night while sleeping.

If you have ever thought about improving your smile, the health of your teeth, and perhaps your self-confidence, consult your local orthodontist. I have never spoken to an adult patient who has regretted having orthodontic treatment. Most adult patients wish they had done it a lot sooner and are highly motivated to get the best result possible.

About the woman at the beginning of my article – her orthodontic treatment is progressing fabulously and her diligent work with brushing and flossing during orthodontic treatment along with her great attitude will ensure she gets a great result. We’re already planning a big party when she gets her braces off. Many adult patients are concerned that they will be the only one “their age” in our office. I smile under my mask when she’s in the office as she quizzes the kids and checks in on the treatment of other adults. At a youthful 73, she still wears the crown of the oldest patient in our office.

 

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Is early interceptive orthodontic treatment appropriate for my child?

March 21st, 2011 by drnicole No comments »

Last fall I received many questions in my office regarding early interceptive orthodontic treatment. Two articles about this type of orthodontic treatment prompted these inquiries. The Wall Street Journal published an article titled “The 8-Year-Old With a Perfect Smile” by Nancy Keates, a journalist and mother of an 8-year-old orthodontic patient. It chronicles a parent’s decision for their child to have braces at a young age and before all of their permanent teeth had erupted. “Braces For Young Kids Might Not Always Be Best” by Allison Aubrey was broadcast on NPR. These articles provided some interesting facts and also made me cringe. I have been thinking a long time about starting a blog and this was now the straw that broke the camel’s back.

Let me dispel the mystery around early orthodontic treatment. Early interceptive orthodontic treatment refers to treatment that takes place before all permanent teeth have erupted. The goals of this type of treatment are to make space for all permanent teeth to erupt and modify growth patterns to facilitate harmonious development of the upper and lower jaws. On occasion, early interceptive orthodontic treatment is also helpful to prevent injury of severely protruding front teeth or to intercept potential self-esteem and psychosocial issues associated with severely malaligned teeth at a young age.

Early interceptive orthodontic treatment is also helpful in avoiding more extreme orthodontic treatment when kids are older. For example, using a common appliance to correct an overbite at a young age, such as headgear, could help prevent treatment options that seem much more severe if one were to wait for orthodontic treatment until the child were older – namely extraction of permanent teeth or jaw surgery.

In my opinion, it is not appropriate to put braces on the six front teeth of an 8-year-old for one mildly crooked front tooth, as was chronicled in Nancy Keates’ article discussing her daughter’s early interceptive orthodontic treatment. If you look at a group of 8-year-olds, most of them have mild to moderately crooked front teeth with gaps. This is normal dental development for someone their age and many will likely improve with no treatment at all.

Why limited orthodontic treatment so young? This thought process is driven by the paradigm shift that all people should be able to keep their own teeth a lifetime. This statement might seem a little confusing, however, it was not that long ago when it was very common that teeth with dental problems were simply extracted. When enough teeth are extracted, you end up with false teeth – a denture. Most kids these days have no idea what a denture is and the thought of a denture is horrifying to most parents. This, of course, would be the worst possible outcome, but orthodontic decisions that are being made when your child is 7 or 8 years old are really planning steps for what they will look like when they are 30, 40, or 50 years old.

If the motivating factor for your son or daughter having interceptive or early orthodontic treatment is so that they will avoid orthodontic treatment in the future, I would be very guarded about your decision. The goals for early treatment are distinct and different from comprehensive treatment. The goals of early treatment are to promote favorable growth of the jaw bones and to make enough room for the remaining permanent teeth to come in. The goal of comprehensive treatment is to have all permanent teeth straight teeth and in the best functional biting position. Your teeth are like a puzzle, if one tooth is crooked (esthetic concern), that tooth can adversely affect the bite and function of the teeth because that one tooth does not properly align with the surrounding or opposing teeth. Most patients who need early interceptive orthodontic treatment likely later will need comprehensive treatment because the goals of each type of treatment are different.

An early initial evaluation, at age 7 or 8, is very suitable time to evaluate tooth alignment and bite, but this does not imply that is it is best to treat all individuals in this young age group. The most important bit of wisdom I can provide is that orthodontic treatment decisions should be made on a case-by-case basis. Just because one child in a family would benefit from an expander does not mean that another sibling will need the same treatment. However, the etiology of most orthodontic issues is genetic in nature. Therefore, if a parent was treated for an overbite, there is a very strong likelihood that their son or daughter would also have an overbite. Overbite correction is an appropriate early interceptive orthodontic treatment. Ask your orthodontist, “What would you do if this were your child?” This question usually prompts the most forthcoming answers.

Hope you enjoyed my first blog. When you’re passionate about a topic and live it daily, the words just flow.

Wall Street Journal article:

http://online.wsj.com/article/SB10001424052748703326204575616460332062620.html

NPR article:

http://www.npr.org/templates/story/story.php?storyId=130073442

More about my orthodontic practice in Denver, Colorado:
www.smilesbyeberle.com

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