Orthodontic treatment for children

Many orthodontic interventions in children begin as early as 9 years old, with the prospect of affecting jaw development and ensuring better and faster overall results than the results that would be achieved with a delayed onset of treatment. The above hypothesis has been scientifically proven to be completely wrong, beyond any doubt.

A systematic and randomized literature review of all scientific papers carried out by a team of British researchers, compared treatments starting before the age of 11 with those starting at the age of 11-12. Among the parameters studied were the correction of the existing horizontal overjet, crossbite occlusion, opened bite, crowding, etc. It turned out that in no case did the early onset of the intervention lead to better treatment results, and it was the same in both groups (treatment starting before and after 11 years of age), with no difference whatsoever. On the contrary, it turned out that the early onset of orthodontic treatment led to an increased duration of the intervention, an increased burden on young patients in terms of the need for their cooperation during treatment, as well as to increased financial costs. The benefit of getting an orthodontic treatment in the mixed dentition and before 11 years of age, not only lacks scientific documentation, but in most cases, it should be considered as an unsubstantiated medical act. It should also be noted that even more so, the use of mobile devices (mobile braces) or an extraoral arch for the performance of early orthodontic treatment is deemed as an outdated and obsolete method, from a scientific aspect. It is fully scientifically proven that mobile functional devices have no effect on the development of the jaw, while, at the same time, they lack the ability to cause dental movement at all levels. Although they are mostly made in any kind of joyful colours, preferably with built-in logos of a favourite football club or hero, this does not change the fact that they are not a suitable means of intervention in modern orthodontic treatment.

Early orthodontic treatment before 11 years of age is only indicated in the following cases:

1. Existence of anterior cross bite (“reverse bite”), usually in a background of mandibular prognathism (underbite).

2. Existence of unilateral cross bite with clear (more than 2.5 mm) functional deviation of the mandible.

3. Particularly increased horizontal protrusion of the upper teeth (“buck teeth”), to such an extent that it is possible to fully place the lower lip behind the upper central incisors during occlusion (horizontal protrusion of more than one centimetre). In this case the treatment is indicated not so much for aesthetic, but mainly for psychological (i.e., to avoid bullying) and dentistry reasons related to the protection of the upper incisors from a possible accident (risk mitigation, i.e., a reduction of the possibility of injury by about 30%, not complete elimination of the risk).

4. Impacted upper incisors.

It should be emphasized that all the above possibilities overall do not exceed 10% of the cases that come for examination at an orthodontic practice. This immediately means that 90% of the cases do not need orthodontic treatment until the completion of the permanent dentition, which happens at around 12 years of age. Therefore, crowding, mild and moderate horizontal projections, relative or even complete lack of space for permanent canines, should not be treated before 12 years of age, and even more so using “mobile braces” or extraoral arches.

In 10% of cases where there is an indication for the first phase of orthodontic treatment, it is best to perform it with fixed appliances. This ensures its effectiveness and eliminates the risk of a long-term and tiring orthodontic treatment for all parties involved (especially for the child, of course). So what is the reason that we constantly see so many times the onset of orthodontic “treatments” in patients with mixed dentition, before 11 years of age? The reason has already been mentioned above and it is the increased financial cost for the child’s parents or guardians, which of course is very positive for the “treating” physician. This is the big secret behind the reason why the conclusions of research like the one mentioned above are carefully concealed by the majority of the scientific community, in order to avoid the parents from being informed.

Important advice for parents and guardians: do not accept to have any orthodontic intervention started while there are still deciduous teeth in your child’s mouth if your child is under 11 years old, unless the orthodontist has medical and contemporary scientifically substantiated data about its necessity.

References:

Sunnak R, Johal A, Fleming PS. Is orthodontics prior to 11 years of age evidence-based? A systematic review and meta-analysis. J Dent. 2015 May; 43 (5): 477-86. doi: 10.1016 / j.jdent.2015.02.003.  Review. PubMed PMID: 25684602.

Koretsi V, Zymperdikas VF, Papageorgiou SN, Papadopoulos MA. Treatment effects of removable functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis. Eur J Orthod. 2015 Aug; 37 (4): 418-34. doi: 10.1093 / ejo / cju071. Review. PubMed PMID: 25398303